Role of High Resolution Ultrasound in Assessment of Abnormalities of Median  Nerve in Carpal Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. The diagnosis of CTS is based on a combination of characteristic symptoms and electrophysiologic abnormalities. Electrodiagnostic testing (EDT) is uncomfortable for patients, time consuming and expensive. Objective To evaluate the role of greyscale and strain elastography ultrasound imaging in diagnosing patients with CTS and controls in comparison with nerve conductive studies. Patients and Methods Type of Study: Descriptive, prospective study. Study Setting: The study will be conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months. Study Population: Patients with carpal tunnel syndrome diagnosed clinically and underwent nerve conduction velocity study. Results In this study 7 wrists were diagnosed with mild CTS, 5 wrists demonstrated moderate CT, whereas only 3 wrists revealed severe CTS. The mean CSA would have increased if the number of cases with severe CTS had been higher. CSA of the median nerve has been reported to increase with the severity of entrapment. The cut off point of the average CSA to differentiate between cases and controls was found > 8 with sensitivity of 93.33%, specificity of 80% and area under curve (AUC) of 91.3% while the best cut off point for Elasto score was found > 1 with sensitivity of 86.6%, specificity of 80% and area under curve (AUC) of 93.3%. Conclusion We concluded that sonoelastography is a sensitive tool for prediction of CTS and it’s severity in correlation to NCV.

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The Effect Of Tenosynovectomy On Patient Outcome In Carpal Tunnel Syndrome Surgery

İstanbul Kanuni Sultan Süleyman Tıp Dergisi ◽

10.5222/iksstd.2021.78055 ◽

2021 ◽

Author(s):

Ahmet Levent Aydın ◽

Melih Üçer

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Large Scale ◽

Long Term Results ◽

Vascular Elements ◽

Tunnel Syndrome ◽

Subsynovial Connective Tissue

INTRODUCTION: Carpal tunnel syndrome (CTS) is estimated to be the most frequently seen mononeuropathy, needing surgical intervention. Its prevalence is known to range between 1, and 3 percent. The components contained in this tunnel are the median nerve, four deep digital flexor tendons, as well as four superficial flexors and the tendon of flexor pollicis longus. Between the tendons and bursae an anatomical structure is present called subsynovial connective tissue (SSCT). SSCT absorbs and transmits stress between tendons and the median nerve and it functions as a scaffold for vascular elements. To find out the role of compression or pathologic proliferation of SSCT in the pathogenesis of CTS, we aimed to conduct a study about the surgical technique of this pathology and compared the long- term results of patients operated with or without SSCT excision in our neurosurgery clinic. METHODS: Between 2003 and 2019 we operated 1279 patients at our neurosurgery clinic. Among them 250 patients who had SSCT excision (syn+) were chosen and they were compared with other 250 patients operated without SSCT excision (Syn-). RESULTS: All patients were evaluated preoperatively and 12 months postoperatively based on the results of Boston Carpal Tunnel Syndrome Questionnaire. When pre-, and post-operative results were compared, we didn’t observe a statistically significant intergroup difference. DISCUSSION AND CONCLUSION: Although our primary goal in patients in whom we performed excision of tenosynovium is to relieve the median nerve by increasing decompression, we observed that there was no difference between the two groups in this large-scale study. We think that only liberation of the transverse carpal ligament during surgery will be sufficient.

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High-Resolution MR Neurography of the Thenar Motor Branch of the Median Nerve in Carpal Tunnel Syndrome

10.1055/s-0038-1672710 ◽

2018 ◽

Author(s):

Larissa de Barros ◽

Jonadab Silva ◽

Renan Souza

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Mr Neurography ◽

Motor Branch ◽

Tunnel Syndrome

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Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3010-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Basant Elnady ◽

Elsayed M. Rageh ◽

Tohamy Ekhouly ◽

Sabry M. Fathy ◽

Mohamed Alshaar ◽

...

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Control Group ◽

Saudi Population ◽

Pronator Quadratus ◽

Severity Grade ◽

Significant Difference ◽

Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population. Methods Sixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitus or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group. High resolution ultrasound (US) was performed to assess median nerve cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd). Results There was a significant difference between both groups regarding mean ± SD of CSAd, CSAp, ∆CSA, and CSApd (p = 0.0001). A positive significant correlation was also found between the CSAd, ∆ CSA and the CSApd measurements with neurophysiologic severity grade of CTS (P = 0.001). A ∆CSA threshold of 2.5 mm2 showed the highest sensitivity and specificity to diagnose CTS in Saudis. Conclusion High resolution ultrasound is a valid and accurate diagnostic modality in carpal tunnel syndrome and correlated to CTS severity. A ∆CSA greater than 2.5 mm2 is considered a valid diagnostic value for CTS in our Saudi population. CTS in our patients with diabetes tend to have greater median nerve US measurement values.

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Ultrasound of the Median Nerve in the Surgical Treatment of Severe Carpal Tunnel Syndrome

Hand ◽

10.1177/1558944720988075 ◽

2021 ◽

pp. 155894472098807

Author(s):

William Melton ◽

Maximillian Soong ◽

Gabrielle Paci ◽

Brian Clair ◽

Dayana Blanchet ◽

...

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Statistical Significance ◽

Objective Assessment ◽

Boston Carpal Tunnel Questionnaire ◽

Tunnel Syndrome ◽

Carpal Tunnel Questionnaire

Background High-resolution ultrasound (HRU) has demonstrated utility in the diagnosis and treatment of carpal tunnel syndrome (CTS) by measuring the cross-sectional area (CSA) of the median nerve. We investigated whether HRU could be helpful in evaluating outcomes of carpal tunnel release in patients with severe CTS. Methods Patients greater than 18 years of age with severe CTS on electrodiagnostic (EDX) studies and scheduled to have carpal tunnel release were enrolled. At baseline visit within 6 weeks preoperatively, HRU was used to measure median nerve CSA at the carpal tunnel inlet and forearm, and the wrist/forearm ratio (WFR) was calculated. Patients also completed the Boston Carpal Tunnel Questionnaire (BCTQ). Ultrasound and BCTQ were repeated at 6 weeks and 6 months postoperatively. Results Twelve patients completed the study (average age, 69 years; range, 52-80 years). The WFR improved significantly at 6 weeks and reached normal levels at 6 months. The CSA at the wrist also improved at 6 months, although this did not reach statistical significance ( P = .059). Boston Carpal Tunnel Questionnaire symptoms and function scores improved significantly at 6 weeks and 6 months. Conclusions High-resolution ultrasound provides an objective assessment of surgical outcomes in cases of severe CTS, demonstrating normalization of WFR in our series of successful cases. Future study of poor outcomes may help determine whether improvement in WFR and CSA can provide reassurance and support for observation rather than reoperation. Ultrasound also provides anatomical evaluation and may be helpful in cases with medicolegal or psychosocial issues while potentially being less costly and better tolerated than EDX or magnetic resonance imaging.

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Understanding central sensitization for advances in management of carpal tunnel syndrome

F1000Research ◽

10.12688/f1000research.22570.1 ◽

2020 ◽

Vol 9 ◽

pp. 605

Author(s):

César Fernández-de-las-peñas ◽

José L Arias-Buría ◽

Ricardo Ortega-Santiago ◽

Ana I De-la-Llave-Rincón

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Central Sensitization ◽

Current Data ◽

Carpal Tunnel Surgery ◽

The Central Nervous System ◽

Tunnel Syndrome ◽

Pain Symptoms

Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).

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Diagnostic value of median nerve shear wave ultrasound elastography in diagnosis and differentiation of carpal tunnel syndrome severity

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00573-3 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Heba Refaat Ibrahim

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Diagnostic Accuracy ◽

Median Nerve ◽

Shear Wave ◽

Carpal Tunnel ◽

Diagnostic Value ◽

Ultrasound Elastography ◽

Control Group ◽

Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is the commonest type of peripheral nerve entrapment syndromes. The study aimed at evaluation of diagnostic value of median nerve stiffness measured by shear wave ultrasound elastography for diagnosis and differentiation of CTS severity, correlated to electrophysiological studies. This case–control study involved 40 patients (56 wrists) with CTS of different severity and 40 controls (40 wrists). All participants underwent electrophysiological study to assess the CTS severity, high-resolution conventional B-mode ultrasound to assess cross-sectional area “CSA” of median nerve at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm, and shear wave ultrasound elastography with measurement of median nerve mean stiffness and correlation to electrophysiological results as the reference standard. Results Mean median nerve stiffness by shear wave US elastography was increased in patients with CTS compared to controls and across the different CTS severity groups (P value < 0.001 & 0.001, respectively). The cutoff value by ROC curve analysis for median nerve stiffness to differentiate between patients with CTS and control group was 65.4 kPa (P value < 0.001, 94.6% sensitivity, 97.3% specificity). Higher diagnostic accuracy was noted with the combination of shear wave elastography and conventional B-mode US with improved AUC (B-mode + shear wave; 0.962, P value < 0.001). Conclusions Shear wave ultrasound elastography of median nerve was able to discriminate different severity subgroups of CTS with high sensitivity, while conventional US couldn’t. The diagnostic accuracy of CTS was improved when combined high-resolution conventional B-mode US and complementary shear wave ultrasound elastography.

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The Role of Multifactorial Contribution in Carpal Tunnel Syndrome Occurrence

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210447 ◽

2021 ◽

Vol 6 (2) ◽

pp. 266-272

Author(s):

Putu Feryawan Meregawa ◽

John Nolan

Keyword(s):

Risk Factor ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Strength Loss ◽

Peripheral Neuropathies ◽

Functional Disturbance ◽

Tunnel Syndrome ◽

The Common

As one of the common peripheral neuropathies, carpal tunnel syndrome (CTS) is accountable for the majority of typical hand pain and functional disturbance in median nerve innervation. The median nerve compression may cause some uncomfortable sensations including pain, numbness, tingling, and strength loss which also depends on the severity of the condition. Many factors could contribute to CTS occurrence. Several risk factors are thought to be in charge in CTS progressions, such as body mass index (BMI), gender, pregnancy, and biomechanical exposures combination is significantly explained as the major component in suffering CTS. Clinicians need to know the contributing risk factor to benefit the information within the implication for the treatment and reducing symptoms severity. Keywords: carpal tunnel syndrome, risk factor, multifactor.

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Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity.

10.21203/rs.2.16396/v2 ◽

2019 ◽

Author(s):

Basant Elnady ◽

Elsayed M Rageh ◽

Tohamy H. Ekhouly ◽

Sabry M. Fathy ◽

Mohamed Alshaar ◽

...

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Control Group ◽

Pronator Quadratus ◽

Severity Grade ◽

Diagnostic Potential ◽

Significant Difference ◽

Tunnel Syndrome

Abstract BackgroundCarpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population.MethodsSixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitis or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group. High resolution ultrasound (US) was performed to assess median nerve cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd).ResultsThere was a significant difference between both groups regarding mean±SD of CSAd, CSAp, ∆CSA, and CSApd (p = 0.0001). A positive significant correlation was also found between the CSAd, ∆ CSA and the CSApd measurements with neurophysiologic severity grade of CTS (P=0.001). A ∆CSA threshold of 2.5 mm2 showed the highest sensitivity and specificity to diagnose CTS in Saudis. Conclusion High resolution ultrasound is a valid and accurate diagnostic modality in carpal tunnel syndrome and correlated to CTS severity. A ∆CSA greater than 2.5 mm2 is considered a valid diagnostic value for CTS in our Saudi population. CTS in our patients with diabetes tend to have greater median nerve US measurement values.

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