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Can we define severity of carpal tunnel syndrome by ultrasound?

Ghasemi M, Abrishamchi F, Basiri K, Meamar R, Rezvani M - Adv Biomed Res (2015)

Bottom Line: A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria.The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS.We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study (EDS). Ultrasonography (US) also has been shown to be a useful diagnostic tool in CTS and is based on an increase in the median nerve cross-sectional area (CSA) at the level of the pisiform bone. In this study we assessed findings in US in correlation with severity of CTS.

Materials and method: This was a cross-sectional case-control study, which was carried out on November 2012 to July 2013. Subjects were chosen from patients who referred to the Alzahra Hospital (Isfahan, Iran). Patients were classified as having mild, moderate, and severe CTS according to EDS and high-resolution US was performed for CSA measurement at the tunnel inlet.

Results: A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria. The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS. We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).

Conclusion: In conclusion it is expected that sonography may serve as an additional or complementary method which is useful and reliable in assessing the severity of CTS.

No MeSH data available.


Related in: MedlinePlus

(a) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a healthy subject. The outer margin of the median nerve is surrounded by a dotted line. (b) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a subject with carpal tunnel syndrome. The nerve is relatively hypoechogenic
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Figure 1: (a) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a healthy subject. The outer margin of the median nerve is surrounded by a dotted line. (b) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a subject with carpal tunnel syndrome. The nerve is relatively hypoechogenic

Mentions: High-resolution US were performed using a scanner with a 13-MHz linear array transducer for the carpal tunnel study and measuring of CSA (Sonosite machine). During the examination, the patient sat in a comfortable position facing the examiner, with the measured forearm resting on the table, the palm supine, and fingers semi-extended in the neutral position.[19] Since previous reports demonstrated that the CSA of the MN at the carpal tunnel inlet is the best discriminatory criterion with which to identify patients with CTS, so in the present study, the CSA measurement was obtained at the tunnel inlet (just before the proximal margin of the flexor retinaculum)[20] [Figure 1]. The MN was imaged in a longitudinal scan first, placing the US probe at the midline between the radius and ulna with the center of the probe at the distal wrist crease, to obtain an initial general overview of the MN which was then used to assist the examiner in order to obtain optimal axial (cross-sectional) images. Then a transverse scan, keeping the probe directly perpendicular to the long axis of the MN in order to ensure that the area measured indeed reflected a CSA, was performed to record the CSA (calculated by continual tracing of the nerve circumference, excluding the hyperechoic epineurial rim) and elliptical (the transverse and the anteroposterior) diameters (DMN).[21]


Can we define severity of carpal tunnel syndrome by ultrasound?

Ghasemi M, Abrishamchi F, Basiri K, Meamar R, Rezvani M - Adv Biomed Res (2015)

(a) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a healthy subject. The outer margin of the median nerve is surrounded by a dotted line. (b) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a subject with carpal tunnel syndrome. The nerve is relatively hypoechogenic
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4544117&req=5

Figure 1: (a) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a healthy subject. The outer margin of the median nerve is surrounded by a dotted line. (b) Transverse view of sonogram of the median nerve at the carpal tunnel inlet in a subject with carpal tunnel syndrome. The nerve is relatively hypoechogenic
Mentions: High-resolution US were performed using a scanner with a 13-MHz linear array transducer for the carpal tunnel study and measuring of CSA (Sonosite machine). During the examination, the patient sat in a comfortable position facing the examiner, with the measured forearm resting on the table, the palm supine, and fingers semi-extended in the neutral position.[19] Since previous reports demonstrated that the CSA of the MN at the carpal tunnel inlet is the best discriminatory criterion with which to identify patients with CTS, so in the present study, the CSA measurement was obtained at the tunnel inlet (just before the proximal margin of the flexor retinaculum)[20] [Figure 1]. The MN was imaged in a longitudinal scan first, placing the US probe at the midline between the radius and ulna with the center of the probe at the distal wrist crease, to obtain an initial general overview of the MN which was then used to assist the examiner in order to obtain optimal axial (cross-sectional) images. Then a transverse scan, keeping the probe directly perpendicular to the long axis of the MN in order to ensure that the area measured indeed reflected a CSA, was performed to record the CSA (calculated by continual tracing of the nerve circumference, excluding the hyperechoic epineurial rim) and elliptical (the transverse and the anteroposterior) diameters (DMN).[21]

Bottom Line: A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria.The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS.We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

ABSTRACT

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study (EDS). Ultrasonography (US) also has been shown to be a useful diagnostic tool in CTS and is based on an increase in the median nerve cross-sectional area (CSA) at the level of the pisiform bone. In this study we assessed findings in US in correlation with severity of CTS.

Materials and method: This was a cross-sectional case-control study, which was carried out on November 2012 to July 2013. Subjects were chosen from patients who referred to the Alzahra Hospital (Isfahan, Iran). Patients were classified as having mild, moderate, and severe CTS according to EDS and high-resolution US was performed for CSA measurement at the tunnel inlet.

Results: A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria. The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS. We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).

Conclusion: In conclusion it is expected that sonography may serve as an additional or complementary method which is useful and reliable in assessing the severity of CTS.

No MeSH data available.


Related in: MedlinePlus