Influence of Disease Activity and Body Composition Parameters on Cross-Sectional Area of the Median Nerve in Acromegalic Patients

Carpal tunnel syndrome (CTS) is neuropathy that occurs due to compression of the median nerve in the carpal tunnel. Acromegaly is one of the important causes of CTS. The aim of this study was to examine median nerve with ultrasound in acromegalic patients and to assess the relationship with activity, duration of disease and body composition parameters. We prospectively examined the cross-sectional area (CSA) of the median nerve with high-resolution ultrasound in 107 acromegalic patients – control group (70 females and 37 males) and 107 healthy controls (70 females and 37 males) matched for age, gender, and BMI. Body composition parameters were assessed by dual-energy X-ray absorptiometry (DXA). The Student t-tests and Pearson correlation were used for data analysis. The cross sectional area of the median nerve was increased in acromegalic patients compared to controls (11.9±4.8 mm2 vs. 7.7±2.4 mm2, P<0.001). Positive correlation was found between IGF-1 levels and CSA in the acromegalic group (R = 0.400, P<0.001). Relationship between CSA and duration of acromegaly was not confirmed. In acromegalic patients, BMI correlated with the CSA (R=0.294, P=0.002). There was no significant difference in BMI, fat mass between the acromegalic and control group, but lean mass was higher in acromegalic patients compared with controls (54.8±13.3 vs. 51±11.6, P=0.047). Lean mass and LMI (total body lean mass/height) positively correlated with CSA in acromegalic patients (R=0.340, P<0.001; R=0.424, P<0.001). No correlation was observed between fat mass and CSA of median nerve in all groups. We confirmed the enlargement of the median nerve in acromegalic patients. This enlargement is proportional to the degree of IGF-1 levels and is not dependent on the duration of the disease. The enlargement of the median nerve in acromegalic patients also depends on lean body mass and is not dependent on fat body mass.

Download Full-text

Musicians Have Thicker Median Nerve Cross Sectional Area and More Symptoms of Carpal Tunnel Than Non-Musicians

Medical Problems of Performing Artists ◽

10.21091/mppa.2020.3023 ◽

2020 ◽

Vol 35 (3) ◽

pp. 138-144

Author(s):

Emily Pratt ◽

Henning Vauth ◽

Gary McIlvain ◽

Mark K Timmons

Keyword(s):

Median Nerve ◽

Carpal Tunnel ◽

Hand Function ◽

Cross Sectional Area ◽

Mean Difference ◽

Control Group ◽

Ultrasound Images ◽

Sectional Area ◽

Cross Sectional ◽

Patient Reported

AIMS: Musicians spend numerous hours perfecting their skills and art, often leading to overuse injuries of the hand; of specific concern to musicians is carpal tunnel syndrome (CTS). This study evaluated the median nerve cross-sectional area and hand function of musicians and made comparisons to non-musicians. METHODS: Seventy-six participants took part in the study, 38 music students and professors in the musician group and 38 participants in the control group. Participants completed patient-reported questionnaires to assess the level of pain and hand function. Ultrasound images were collected at the carpal tunnel inlet and outlet. The median nerve cross-sectional area and the depth of the carpal tunnel were measured on ultrasound images using software imbedded in the ultrasound unit. RESULTS: Musicians showed higher levels of hand dysfunction and CTS symptoms than the non-musicians. The median nerve cross-sectional area was greater in musicians than in the non-musician group on both the right (mean difference 1.5 mm2, p=0.002) and left sides (mean difference 0.9 mm2, p=0.036). The depth of the carpal tunnel at the carpal tunnel inlet and outlet did not differ between the groups (p>0.05). CONCLUSION: The current research identified between-group differences in median nerve cross-sectional area and the level of hand dysfunction. Understanding the interaction between the anatomy of the wrist and wrist and hand dysfunction will benefit clinicians when evaluating and treating musicians.

Download Full-text

Efficacy of Diagnosing Carpal Tunnel Syndrome Using the Median Nerve Stenosis Rate Measured on Ultrasonographic Sagittal Imagery: Clinical Case-Control Study

Hand ◽

10.1177/15589447211017225 ◽

2021 ◽

pp. 155894472110172

Author(s):

Toshiyuki Okura ◽

Tomohisa Sekimoto ◽

Tomomi Matsuoka ◽

Hajime Fukuda ◽

Hiroaki Hamada ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Control Group ◽

Sectional Area ◽

Cross Sectional ◽

Ultrasonographic Examination ◽

Stenosis Rate ◽

Tunnel Syndrome

Background The purpose of the present study was to evaluate the usefulness of the median nerve stenosis rate (MNSR) measured on sagittal sonographic images of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). Methods The study population consisted of 45 hands from 37 patients with idiopathic CTS (CTS group), and 60 hands from 35 asymptomatic healthy subjects (control group). Carpal tunnel syndrome was diagnosed by clinical findings and positive electrophysiological study results. All patients and control subjects underwent ultrasonographic examination. At the carpal tunnel level, the transducer was placed longitudinally to the median nerve, and an image of the longitudinal median nerve was obtained. The minimum median nerve diameter (MND) was measured at the middle part of the capitate level, while the maximum MND was measured at the distal radioulnar joint level. The MNSR was calculated as (1 – minimum MND/maximum MND) × 100 (%). The cross-sectional area of the median nerve was also measured at the level of the pisiform. Results On longitudinal sonographic images, the MNSR was significantly larger in the CTS group than the control group. When the cut-off value of the MNSR was 26.73%, the sensitivity and specificity were 91.1% and 80%, respectively. The area under the receiver operating characteristic curve was larger for the MNSR than for the cross-sectional area. Conclusion The results suggest that the MNSR proposed in the present study may be useful as an auxiliary method for CTS diagnosis on ultrasonographic examination.

Download Full-text

Sonographic Findings of Median Nerve and Prevalence of Carpal Tunnel Syndrome in Computer Mouse Users

Rivista di Neuroradiologia ◽

10.1177/197140090501800213 ◽

2005 ◽

Vol 18 (2) ◽

pp. 212-220 ◽

Cited By ~ 4

Author(s):

A. Yucel ◽

M. Yaman ◽

M. Acar ◽

A. Haktanir ◽

R. Albayrak ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Control Group ◽

Sectional Area ◽

Cross Sectional ◽

Computer Mouse ◽

Tunnel Syndrome ◽

Flattening Ratio

The purpose of this study was to evaluate the median nerve sonographically and estimate the prevalence of carpal tunnel syndrome (CTS) in computer mouse users. Forty-nine right wrists of 49 employees who had used a computer mouse were included in the study. Thirty-three right wrists of 33 non-mouse user employees were studied as a control group. Both the mouse user and non-mouse user employees underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained proximally, in the middle and distally in the carpal tunnel. At each level, flattening ratio and the cross-sectional area of the median nerve were calculated. We found no significant difference in any parameters between mouse users and control group ( p>0.05). However, when we compared mouse users according to the presence of pain, there was a significant increase in the cross-sectional area of the median nerve proximally in the mouse users having pain ( p<0.05). Of all mouse users, eight (16.3%) were diagnosed as sensory CTS, four (8.2%) as motor CTS by EMG. We also found that four (50%) CTS patients had a proximal cross-sectional area of median nerve exceeding 10 mm2 and five (62.5%) had a distal flattening ratio over three. Prolonged use of a mouse may pose an occupational risk for employees. Sonography can serve as an initial step in symptomatic patients for diagnosis of CTS.

Download Full-text

Reduction in median nerve cross-sectional area at the forearm correlates with axon loss in carpal tunnel syndrome

Clinical Neurophysiology Practice ◽

10.1016/j.cnp.2021.06.001 ◽

2021 ◽

Author(s):

Lauri Martikkala ◽

Katri Mäkelä ◽

Sari-Leena Himanen

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Axon Loss ◽

Tunnel Syndrome

Download Full-text

Cross-Sectional Area of the Median Nerve Characterized by Ultrasound in Patients With Carpal Tunnel Syndrome Before and After the Release of the Transverse Carpal Ligament

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479313477731 ◽

2013 ◽

Vol 29 (3) ◽

pp. 116-121 ◽

Cited By ~ 2

Author(s):

Benedito F. Pimentel ◽

Claudia A. Abicalaf ◽

Larissa Braga ◽

Walter M. Albertoni ◽

Carlos H. Fernandes ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Sectional Area ◽

Transverse Carpal Ligament ◽

Cross Sectional ◽

Before And After ◽

Tunnel Syndrome

Download Full-text

Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2013.48.4.290 ◽

2013 ◽

Vol 48 (4) ◽

pp. 290 ◽

Cited By ~ 2

Author(s):

Seung-Joo Lee ◽

Ji-Sup Kim ◽

Yun-Rak Choi ◽

Sung-Jun Kim ◽

Ho-Jung Kang

Keyword(s):

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional

Download Full-text

Ultrasound Assessment of the Median Nerve Does Not Adequately Discriminate the Carpal Tunnel Syndrome among Patients Diagnosed with Diabetes

Diabetology ◽

10.3390/diabetology2040020 ◽

2021 ◽

Vol 2 (4) ◽

pp. 226-231

Author(s):

Carlos Antonio Guillen-Astete ◽

Monica Luque-Alarcon ◽

Nuria Garcia-Montes

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Cross Sectional Area ◽

Diabetic Patients ◽

Sectional Area ◽

Cross Sectional ◽

Patients With Diabetes ◽

Ultrasound Assessment ◽

Tunnel Syndrome

Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11.7 years old, 57.89% female, mean of time of evolution 13.6 ± 8.3 months) from 2012 to 2020. The cross-sectional area of the median nerve was 10.46 ± 1.44 mm2 in non-diabetic patients and 8.92 ± 0.9 mm2 in diabetic patients (p < 0.001). Additionally, diabetic patients had a shorter time of evolution (7.91 ± 8.28 months vs. 14.36 ± 0.526 months, p < 0.001). In the multivariate analysis, the resultant model (fixed R-square = 0.659, p = 0.003) included a constant of the following four variables: the evolution time (Beta coeff. = 0.108, p < 0.001 95% CI 0.091 to 0.126, standardized coeff. = 0.611), the condition of diabetes (Beta coeff. = −0.623, p < 0.001 95% CI −0.907 to −0.339, standardized coeff. = −0.152), the severity (Beta coeff. = 0.359, p = 0.001 95% CI 0.147 to 0.571, standardized coeff. = 0.169), and the masculine sex (Beta coeff. = 0.309, p = 0.003, 95% CI 0.109 to 0.509, standardized coeff. = 0.103). Conclusions: Ultrasound assessment of the median nerve in patients with diabetes is not a useful tool to confirm whether carpal tunnel syndrome should be diagnosed or not diagnosed.

Download Full-text