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Ultrasound assessment of the median nerve: a biomarker that can help in setting a treat to target approach tailored for carpal tunnel syndrome patients.

El Miedany Y, El Gaafary M, Youssef S, Ahmed I, Nasr A - Springerplus (2015)

Bottom Line: The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio.This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1).The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection.

View Article: PubMed Central - PubMed

Affiliation: Rheumatology, Darent Valley Hospital, Dartford, Kent UK ; Rheumatology and Rehab, Department, Ain Shams University, Cairo, Egypt.

ABSTRACT
Ultrasonography (US) is a valuable tool for confirming the diagnosis of carpal tunnel syndrome (CTS) as it enables the detection of changes in the median nerve shape and rule out anatomic variants as well as space-occupying lesions such as ganglion cysts or tenosynovitis. This work was carried out aiming at: 1. Ultrasonography assessment of the median nerve and its neurovascular blood-flow in CTS patients before and after management. 2. Verify the possibility of using baseline US parameters as a biomarker to predict likely outcomes and frame a treatment plan for CTS patients. 233 CTS subjects diagnosed based on clinical and electrophysiological (NCS) testing were included in this work. US measures at the tunnel inlet included: cross sectional area, flattening ratio and neural Power Doppler (PD) signals. Patients who had severe NCS outcomes or neurological deficit were referred for open surgical decompression; the remaining patients were given the choice of either conservative or surgical management. The main outcome variable was improvement >70% in CTS symptoms. Assessments were carried out at baseline, 1-week, 1-month and 6-months post treatment. Results revealed an inverse relation between the neural vasculature and CTS severity defined by NCS (r‚ÄČ=‚ÄČ- 0.648). In CTS cases treated conservatively, the US measures started to improve within 1-week, whereas in the surgically treated cohort there was an initial phase of post-operative nerve measures increase, before settling at 1-month time of follow-up. The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio. This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1). The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection.

No MeSH data available.


Related in: MedlinePlus

Scatterplot displaying Actual Percent Improvement at 6 months FUP and Unstandardized Predicted Values of the Model.
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Fig1: Scatterplot displaying Actual Percent Improvement at 6 months FUP and Unstandardized Predicted Values of the Model.

Mentions: In multivariate regression analyses involving the entire cohort, greater pre-management CSA (>14.0¬†mm2) and Flattening ratio (>2.8) were the most important predictors of poorer outcome and presence of symptoms at 6-months follow-up. Table¬†4 displays predictors of percent improvement at 6¬†months follow up. Baseline CSA (<14.0¬†mm2) and PD score (>2) at baseline were associated with better response at 6¬†months. Figure¬†1 is a scatterplot displaying actual percent improvement at 6¬†months follow-up. Figure¬†2 is an ROC assessing the potential use of PD as a predictor of good outcome (>70% improvement of the patient global score). Independent of the disease duration, AUC was 0.755 with sensitivity of 92.8% and specificity of 51.4% and positive likelihood ratio of 1.91, whereas in the patient cohort with disease duration‚ÄČ<‚ÄČ6¬†months, AUC was 0.844 with sensitivity of 89.3% and specificity 79.5% and positive likelihood ratio of 4.353.Table 4


Ultrasound assessment of the median nerve: a biomarker that can help in setting a treat to target approach tailored for carpal tunnel syndrome patients.

El Miedany Y, El Gaafary M, Youssef S, Ahmed I, Nasr A - Springerplus (2015)

Scatterplot displaying Actual Percent Improvement at 6 months FUP and Unstandardized Predicted Values of the Model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300309&req=5

Fig1: Scatterplot displaying Actual Percent Improvement at 6 months FUP and Unstandardized Predicted Values of the Model.
Mentions: In multivariate regression analyses involving the entire cohort, greater pre-management CSA (>14.0¬†mm2) and Flattening ratio (>2.8) were the most important predictors of poorer outcome and presence of symptoms at 6-months follow-up. Table¬†4 displays predictors of percent improvement at 6¬†months follow up. Baseline CSA (<14.0¬†mm2) and PD score (>2) at baseline were associated with better response at 6¬†months. Figure¬†1 is a scatterplot displaying actual percent improvement at 6¬†months follow-up. Figure¬†2 is an ROC assessing the potential use of PD as a predictor of good outcome (>70% improvement of the patient global score). Independent of the disease duration, AUC was 0.755 with sensitivity of 92.8% and specificity of 51.4% and positive likelihood ratio of 1.91, whereas in the patient cohort with disease duration‚ÄČ<‚ÄČ6¬†months, AUC was 0.844 with sensitivity of 89.3% and specificity 79.5% and positive likelihood ratio of 4.353.Table 4

Bottom Line: The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio.This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1).The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection.

View Article: PubMed Central - PubMed

Affiliation: Rheumatology, Darent Valley Hospital, Dartford, Kent UK ; Rheumatology and Rehab, Department, Ain Shams University, Cairo, Egypt.

ABSTRACT
Ultrasonography (US) is a valuable tool for confirming the diagnosis of carpal tunnel syndrome (CTS) as it enables the detection of changes in the median nerve shape and rule out anatomic variants as well as space-occupying lesions such as ganglion cysts or tenosynovitis. This work was carried out aiming at: 1. Ultrasonography assessment of the median nerve and its neurovascular blood-flow in CTS patients before and after management. 2. Verify the possibility of using baseline US parameters as a biomarker to predict likely outcomes and frame a treatment plan for CTS patients. 233 CTS subjects diagnosed based on clinical and electrophysiological (NCS) testing were included in this work. US measures at the tunnel inlet included: cross sectional area, flattening ratio and neural Power Doppler (PD) signals. Patients who had severe NCS outcomes or neurological deficit were referred for open surgical decompression; the remaining patients were given the choice of either conservative or surgical management. The main outcome variable was improvement >70% in CTS symptoms. Assessments were carried out at baseline, 1-week, 1-month and 6-months post treatment. Results revealed an inverse relation between the neural vasculature and CTS severity defined by NCS (r‚ÄČ=‚ÄČ- 0.648). In CTS cases treated conservatively, the US measures started to improve within 1-week, whereas in the surgically treated cohort there was an initial phase of post-operative nerve measures increase, before settling at 1-month time of follow-up. The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio. This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1). The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection.

No MeSH data available.


Related in: MedlinePlus