|
1
|
Braham S, Moussa A, Bouhoula M, Ben Meriem N, Annen I, Sakly G, Chouchane A, Ben Abdelkader M, Aloui A, Kacem I, Maoua M, Kalboussi H, Elmaalel O, Mhabrech H, Chatti S, Brahem A. Exploring ultrasound and electromyography for carpal tunnel syndrome diagnosis: a comprehensive comparative study and implications for occupational medicine. Front Neurol 2024; 15:1490873. [PMID: 39722697 PMCID: PMC11668638 DOI: 10.3389/fneur.2024.1490873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 11/28/2024] [Indexed: 12/28/2024] Open
Abstract
Background To assess the contribution of ultrasound in diagnosing occupational carpal tunnel syndrome (CTS), compare it with electromyography (EMG) results, and evaluate the ultrasound characteristics of CTS patients. Methods A nine-month cross-sectional study (January-September 2021) involved CTS patients and a control group, utilizing a structured form for data collection. EMG was performed on the patient group ('cases') and ultrasound examinations were conducted on both groups. Statistical analysis was performed using SPSS software. Results Among 44 cases and 30 controls, CTS patients (mean age 44.9 years) exhibited predominantly bilateral symptoms (90.9%). The optimal cross-sectional area (CSA) threshold for diagnosis was 10.3 mm2 (89% sensitivity, 84% specificity). Significant differences in ultrasound criteria were observed between patient and control groups, including the "notch sign" (p = 0.012), hypoechoic appearance (p = 0.016), and reduced median nerve mobility (p = 0.021). Quantitatively, CSA (13.7 mm2 vs. 7.4 mm2), flattening ratio (3.3 vs. 2.1), and retinaculum bulging (3.2 mm vs. 1.9 mm) significantly differed between cases and controls (p = 0.0019, 0.025, and 0.01, respectively). Positive Phalen tests correlated with higher CSA (p = 0.005) and retinacular bulging (p = 0.02). CSA correlated with EMG parameters, indicating slower conduction velocities, lower amplitudes, and longer latencies (p < 10^(-3), r = -0.56, -0.62, -0.36, and -0.68, respectively). Conclusion This study highlights ultrasound's diagnostic potential for CTS, particularly in occupational settings. Its non-invasiveness and reliability advocate for its integration into routine diagnostic protocols, supporting evidence-based management strategies. Further research is needed to explore long-term efficacy and broader applicability.
Collapse
Affiliation(s)
- Salem Braham
- Department of Radiology, Farhat Hached University Hospital, Sousse, Tunisia
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
| | - Amen Moussa
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Marwa Bouhoula
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Nihel Ben Meriem
- Department of Radiology, Farhat Hached University Hospital, Sousse, Tunisia
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
| | - Ichraf Annen
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- Department of Neurophysiology, Sahloul University Hospital, Sousse, Tunisia
| | - Ghazi Sakly
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- Department of Neurophysiology, Sahloul University Hospital, Sousse, Tunisia
| | - Asma Chouchane
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Malek Ben Abdelkader
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Asma Aloui
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imène Kacem
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Maher Maoua
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Houda Kalboussi
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Olfa Elmaalel
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Houda Mhabrech
- Department of Radiology, Farhat Hached University Hospital, Sousse, Tunisia
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
| | - Souheil Chatti
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Aicha Brahem
- Medical Faculty Ibn Jazzar, University of Sousse, Sousse, Tunisia
- LR19SP03, Occupational Medicine Department, Farhat Hached University Hospital, Sousse, Tunisia
| |
Collapse
|
|
2
|
Tomažin T, Pušnik L, Albano D, Jengojan SA, Snoj Ž. Multiparametric Ultrasound Assessment of Carpal Tunnel Syndrome: Beyond Nerve Cross-sectional Area. Semin Musculoskelet Radiol 2024; 28:661-671. [PMID: 39561748 DOI: 10.1055/s-0044-1790561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
Carpal tunnel syndrome (CTS), the most common mononeuropathy, results from compression of the median nerve within the fibro-osseous carpal tunnel. Diagnosis is typically based on clinical evaluation and confirmed by nerve conduction studies. However, ultrasound (US) has emerged as a valuable noninvasive adjunct for CTS confirmation, offering potential advantages over electrodiagnostic testing in terms of patient comfort and diagnostic accuracy. This review begins with a concise summary of carpal tunnel anatomy and CTS pathophysiology as a foundation for exploring the diverse applications of US in CTS evaluation. B-mode US assessment is presented with a focus on cross-sectional imaging and dynamic evaluations, including the transverse translocation and longitudinal gliding of the median nerve. We also review current methods for assessing vascularization in CTS and explore the usefulness of elastography in CTS evaluation. The advantages and limitations of each US method are elucidated, highlighting their practical utility in clinical practice.
Collapse
Affiliation(s)
- Tjaša Tomažin
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Suren Armeni Jengojan
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Žiga Snoj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
|
3
|
Murciano Casas MDLP, Rodríguez-Piñero M, Jiménez Sarmiento AS, Álvarez López M, Jiménez Jurado G. Evaluation of ultrasound as diagnostic tool in patients with clinical features suggestive of carpal tunnel syndrome in comparison to nerve conduction studies: Study protocol for a diagnostic testing study. PLoS One 2023; 18:e0281221. [PMID: 37948425 PMCID: PMC10637656 DOI: 10.1371/journal.pone.0281221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy, accounting for 90% of all neuropathies. Its prevalence ranges from 3.8%-7.8% in the population. The gold standard for its diagnosis is the neurophysiological study (85% sensitivity and 95% specificity), with the disadvantage of being invasive, complex and expensive, which means an increase in cost and time for the diagnosis of the disease. The main objective of this diagnostic test evaluation study is to investigate the value of ultrasound in the diagnosis of CTS, and among the secondary objectives, to establish the ultrasound parameters that are predictors of CTS in comparison with neurophysiological studies, attempting to standardize a protocol and reference values that determine the presence or absence of CTS. METHODS Prospective, cross-sectional study. The reference test with which we compared the ultrasound is the neurophysiological test (NPT). Patients will come consecutively from the Neurophysiology Department of the Virgen Macarena Hospital, with clinical suspicion of CTS and fulfilling the inclusion/exclusion criteria. To calculate the sample size (EPIDAT program) we proposed a sensitivity of 78% and specificity of 87% with a confidence level of 95%, requiring 438 patients (264 NPT positive, 174 NPT negative). We followed an ultrasound study protocol that included the ultrasound variables: cross-sectional area at the entrance and exit of the tunnel, range of nerve thinning, wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and the existence of adjacent wrists or masses. We propose a timeline for the study to be performed between 2020 and 2023. Finally, we propose a cost-effectiveness analysis. DISCUSSION Ultrasound not only allows to objectify the alterations of the median nerve but also the underlying pathological mechanisms in CTS. A multitude of ultrasound parameters have been described that should be regarded in syndrome's study, among which we included the cross-sectional area, the range of nerve thinning, the wrist-forearm index, flexor retinaculum bulging, power Doppler uptake and assessment of anatomical alterations. The use of ultrasound as a diagnostic tool in CTS has many advantages for both doctors and the patients, as it is a non-invasive, convenient, and fast tool increasingly accessible to professionals. TRIAL REGISTRATION Trials registry number: NCT05556278.
Collapse
|
|
4
|
Yao B, Evans KD, Roll SC. Assessing the Potential for Error in Investigating Intraneural Vascularity: A Need for a Standardized Imaging Protocol. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2023; 39:549-559. [PMID: 38074490 PMCID: PMC10701715 DOI: 10.1177/87564793231193396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Objective This study examined the implementation of a Doppler sonography imaging protocol to assess intraneural blood flow, within the median nerve, in healthy individuals. Materials and Methods A total of 176 participants were examined, and this involved 717 retrospective observations of the images collected. The implemented imaging protocol was assessed, and the data that were collected were cleaned and checked for fidelity and validity. Results A large percentage of missing evidence (11%-35%) across proximal, mid, and distal carpal tunnel locations. Only a quarter of cases with evidence of intraneural blood flow had the strongest evidence of a power Doppler video clip, of which only three-quarters were valid. The study identified potential areas for improving the imaging protocol to reduce missing data and improve data quality. Conclusion This study demonstrates the significance of a standardized imaging protocol to guide the sonographic acquisition of Doppler images and provides important insights into potential issues with data quality. The recommendations have the potential to help future studies assess intraneural blood flow in healthy populations in a more rigorous and reliable way. Incorporating the study's recommendations into a standardized protocol, there is potential to enhance the diagnostic accuracy of carpal tunnel syndrome and improve diagnosis and treatment.
Collapse
Affiliation(s)
- Buwen Yao
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Kevin D. Evans
- Radiologic Sciences and Respiratory Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
|
5
|
Mandeville R, Deshmukh S, Tan ET, Kumar V, Sanchez B, Dowlatshahi AS, Luk J, See RHB, Leochico CFD, Thum JA, Bazarek S, Johnston B, Brown J, Wu J, Sneag D, Rutkove S. A scoping review of current and emerging techniques for evaluation of peripheral nerve health, degeneration and regeneration: part 2, non-invasive imaging. J Neural Eng 2023; 20:041002. [PMID: 37369193 DOI: 10.1088/1741-2552/ace217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/27/2023] [Indexed: 06/29/2023]
Abstract
Peripheral neuroregenerative research and therapeutic options are expanding exponentially. With this expansion comes an increasing need to reliably evaluate and quantify nerve health. Valid and responsive measures of the nerve status are essential for both clinical and research purposes for diagnosis, longitudinal follow-up, and monitoring the impact of any intervention. Furthermore, novel biomarkers can elucidate regenerative mechanisms and open new avenues for research. Without such measures, clinical decision-making is impaired, and research becomes more costly, time-consuming, and sometimes infeasible. Part 1 of this two-part scoping review focused on neurophysiology. In part 2, we identify and critically examine many current and emerging non-invasive imaging techniques that have the potential to evaluate peripheral nerve health, particularly from the perspective of regenerative therapies and research.
Collapse
Affiliation(s)
- Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Swati Deshmukh
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Ek Tsoon Tan
- Department of Radiology, Hospital for Special Surgery, New York, NY 10021, United States of America
| | - Viksit Kumar
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Benjamin Sanchez
- Department Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Arriyan S Dowlatshahi
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Justin Luk
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Reiner Henson B See
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Carl Froilan D Leochico
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Global City, Taguig, The Philippines
- Department of Rehabilitation Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, The Philippines
| | - Jasmine A Thum
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Stanley Bazarek
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Benjamin Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States of America
| | - Justin Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Jim Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Darryl Sneag
- Department of Radiology, Hospital for Special Surgery, New York, NY 10021, United States of America
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| |
Collapse
|
|
6
|
Song JM, Kim J, Chae DJ, Park JB, Lee YJ, Hwang CM, Shin J, Hong MJ. Correlation between Electrodiagnostic Study and Imaging Features in Patients with Suspected Carpal Tunnel Syndrome. J Clin Med 2022; 11:jcm11102808. [PMID: 35628932 PMCID: PMC9146520 DOI: 10.3390/jcm11102808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 01/25/2023] Open
Abstract
Electrodiagnostic studies (EDXs) are the confirmative diagnostic tool for carpal tunnel syndrome (CTS). Previous studies have evaluated the relationship between EDXs and ultrasonography (US) but not with X-rays. Recently, many studies on the diagnostic value of X-rays in various diseases have been reported, but data on CTS are lacking. We evaluated the relationship between electrodiagnostic parameters and roentgenographic and ultrasonographic features in CTS and investigated the usefulness of X-rays and US for CTS. This retrospective study included 97 wrists of 62 patients. All patients with suspected CTS underwent EDXs, wrist US, and wrist X-rays. The CTS patients were classified into mild, moderate, and severe groups. The roentgenographic features included the ulnar variance (UV) and the anteroposterior diameter of the wrist (APDW), and the ultrasonographic features included the flattening ratio (FR) and the thickest anteroposterior diameter of the median nerve (TAPDM). Most EDX parameters showed significant correlations with roentgenographic and US features. The electrodiagnostic severity was also correlated with all imaging features. Therefore, both wrist X-rays and wrist US can be useful for the diagnosis of CTS as supplements to EDXs.
Collapse
Affiliation(s)
- Jae Min Song
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Korea; (J.M.S.); (J.K.); (D.-J.C.); (J.B.P.); (Y.J.L.)
| | - Jungyun Kim
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Korea; (J.M.S.); (J.K.); (D.-J.C.); (J.B.P.); (Y.J.L.)
| | - Dong-Jin Chae
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Korea; (J.M.S.); (J.K.); (D.-J.C.); (J.B.P.); (Y.J.L.)
| | - Jong Bum Park
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Korea; (J.M.S.); (J.K.); (D.-J.C.); (J.B.P.); (Y.J.L.)
| | - Yung Jin Lee
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Korea; (J.M.S.); (J.K.); (D.-J.C.); (J.B.P.); (Y.J.L.)
| | - Cheol Mog Hwang
- Department of Radiology, Konyang University College of Medicine, Daejeon 35365, Korea;
| | - Jieun Shin
- Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon 35365, Korea;
| | - Mi Jin Hong
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon 35365, Korea; (J.M.S.); (J.K.); (D.-J.C.); (J.B.P.); (Y.J.L.)
- Correspondence: ; Tel.: +82-42-612-2187
| |
Collapse
|
|
7
|
Bayat M, Bagheri Z, Raeissadat SA, Rayegani SM, Ahmadzadeh A, Shirani F. Diagnostic Value of Ultrasound for Detecting Carpal Tunnel Syndrome in Patients With Rheumatoid Arthritis: A Three-Arm Cross-Sectional Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221092982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study was conducted to assess the diagnostic value of sonography in detecting carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and to compare the results with a normal control group. Materials and Methods: In this three-arm cross-sectional study, the sonographically measured median nerve cross-sectional area (MNCSA) was compared in three groups: RA patients with CTS, RA patients without CTS, and normal subjects (no RA, no CTS). A nerve conduction study (NCS) was performed for all enrolled participants, across the three study arms. Results: In this study, 38 RA patients (17 in CTS group and 21 in no CTS group) and 19 healthy subjects were recruited. The MNCSAs were 11.86 (±1.87) mm2 in RA patients with CTS, 10.16 (±1.71) mm2 in RA patients without CTS, and 9.42 (±1.46) mm² in healthy control patients. The accuracy of sonography in detecting CTS was 0.79 (95% confidence interval, 0.67–0.91), with a sensitivity and specificity of 88% and 57%, respectively. The MNCSA in CTS group was significantly higher than the control group ( P = .02). Conclusion: In this cohort, the sonographic measurement of MNCSA was an accurate and sensitive method for the diagnosis of CTS, especially in its early stages. In addition, in this cohort, RA without CTS did not increase the MNCSA.
Collapse
Affiliation(s)
- Masume Bayat
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Physical Medicine and Rehabilitation Research Center, Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Bagheri
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Ahmadzadeh
- Department of Rheumatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shirani
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
8
|
Abstract
Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.
Collapse
Affiliation(s)
- Sebastian Kluge
- Handchirurgie Seefeld, Seefeldstrasse 27, Zurich 8008, Switzerland; Department of Hand Surgery, Klinik Impuls, Bahnhofstraße 137, Wetzikon 8620, Switzerland.
| | - Martin Langer
- Department of Trauma, Hand and Reconstructive Surgery, University of Munster, Waldeyerstraße 1, Munster 48149, Germany
| | - Thomas Schelle
- Department of Neurology, Klinikum Dessau-Rosslau, Auenweg 38, Dessau-Rosslau 06847, Germany
| |
Collapse
|
|
9
|
Systematic Review of the Use of Power Doppler Ultrasound in the Imaging of Peripheral Nerve Compression Neuropathy. Plast Reconstr Surg 2022; 149:48e-56e. [PMID: 34936616 DOI: 10.1097/prs.0000000000008627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Power Doppler ultrasonography has been used as an adjunct in the diagnosis of peripheral nerve compression neuropathy. To better characterize its sensitivity and specificity, the authors performed a systematic review of its use in carpal and cubital tunnel syndrome diagnosis. METHODS The authors systematically reviewed published literature on the use of power Doppler ultrasound to diagnose peripheral compression neuropathy using Ovid MEDLINE, Embase.com, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, World Health Organization International Clinical Trial Repository Platform, and Clinicaltrials.gov. No filters for language, date, or publication type were used. RESULTS After reviewing 1538 identified studies, 27 publications were included involving 1751 participants with compression neuropathy (2048 median and 172 ulnar). All but three studies examined patients with carpal tunnel syndrome. Heterogeneity between study design and methodology was a noted limitation. Sensitivity and specificity of power Doppler ultrasound in the diagnosis of carpal tunnel syndrome ranged from 2.2 to 93.4 percent, and 89 to 100 percent, respectively, whereas sensitivity for cubital tunnel syndrome was 15.3 to 78.9 percent. There was variability in power Doppler signal detection based on location, with higher sensitivities at the carpal tunnel inlet and in areas of increased nerve swelling. CONCLUSIONS Power Doppler ultrasound is unreliable as a screening test but appears to increase diagnostic accuracy of ultrasonography in compression neuropathies. It is most beneficial in moderate to severe disease and may be valuable in detecting early cases and in disease surveillance.
Collapse
|
|
10
|
Machine learning-based approach for disease severity classification of carpal tunnel syndrome. Sci Rep 2021; 11:17464. [PMID: 34465860 PMCID: PMC8408248 DOI: 10.1038/s41598-021-97043-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/12/2021] [Indexed: 12/23/2022] Open
Abstract
Identifying the severity of carpal tunnel syndrome (CTS) is essential to providing appropriate therapeutic interventions. We developed and validated machine-learning (ML) models for classifying CTS severity. Here, 1037 CTS hands with 11 variables each were retrospectively analyzed. CTS was confirmed using electrodiagnosis, and its severity was classified into three grades: mild, moderate, and severe. The dataset was randomly split into a training (70%) and test (30%) set. A total of 507 mild, 276 moderate, and 254 severe CTS hands were included. Extreme gradient boosting (XGB) showed the highest external validation accuracy in the multi-class classification at 76.6% (95% confidence interval [CI] 71.2–81.5). XGB also had an optimal model training accuracy of 76.1%. Random forest (RF) and k-nearest neighbors had the second-highest external validation accuracy of 75.6% (95% CI 70.0–80.5). For the RF and XGB models, the numeric rating scale of pain was the most important variable, and body mass index was the second most important. The one-versus-rest classification yielded improved external validation accuracies for each severity grade compared with the multi-class classification (mild, 83.6%; moderate, 78.8%; severe, 90.9%). The CTS severity classification based on the ML model was validated and is readily applicable to aiding clinical evaluations.
Collapse
|
|
11
|
Yildiran G, Seher N, Sutcu M, Nayman A, Akdag O, Tosun Z. Median Nerve's Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging. Plast Reconstr Surg 2021; 147:1355-1360. [PMID: 33974590 DOI: 10.1097/prs.0000000000007940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging. METHODS Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared. RESULTS The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p < 0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p > 0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression. CONCLUSIONS Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
Collapse
Affiliation(s)
- Gokce Yildiran
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Nusret Seher
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Mustafa Sutcu
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Alaaddin Nayman
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Osman Akdag
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Zekeriya Tosun
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| |
Collapse
|
|
12
|
Ng AWH, Griffith JF, Tsoi C, Fong RCW, Mak MCK, Tse WL, Ho PC. Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome. Korean J Radiol 2021; 22:1132-1141. [PMID: 33987990 PMCID: PMC8236373 DOI: 10.3348/kjr.2020.1039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.
Collapse
Affiliation(s)
- Alex Wing Hung Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carita Tsoi
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Raymond Chun Wing Fong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Michael Chu Kay Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Lim Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
|
13
|
Ehmke S, Farias Zuniga A, Keir PJ. Effect of Force, Posture, and Repetitive Wrist Motion on Intraneural Blood Flow in the Median Nerve. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:939-950. [PMID: 32896908 DOI: 10.1002/jum.15467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Pinching, deviated wrist postures, and repetitive motion are risk factors for carpal tunnel syndrome. Hypervascularization of the median nerve and increased intraneural blood flow proximal to the carpal tunnel result in finger force and deviated wrist postures. The purpose of this study was to determine the effects of pinching with and without force, wrist posture, and repetitive wrist motion on intraneural blood flow in the median nerve. METHODS Eleven healthy and 11 carpal tunnel syndrome-symptomatic individuals completed 3 sections of this study: 15 pinch posture force trials, 3 repetitive wrist motion trials, and 3 static wrist posture trials. Intraneural blood flow (centimeters per second) was measured with pulsed wave Doppler ultrasound during each trial. Transverse B-mode images obtained from static trials were used to calculate the median nerve cross-sectional area and circumference. RESULTS An analysis of variance statistical analysis revealed significant main effects of pinch posture force (F4,80 = 21.397; P < .001) and wrist posture (F2,40 = 14.545; P < .001). Intraneural blood flow velocities were significantly greater when 6 N of force was applied by the thumb, finger, or pinch compared to no applied force in the same postures. Intraneural blood flow velocities were higher at 30° wrist flexion (mean ± SD, 2.24 ± 0.42 cm/s) than neutral (2.06 ± 0.45 cm/s) and 30° wrist extension (1.97 ± 0.46 cm/s). No changes were found in response to repetitive wrist motion. CONCLUSIONS Flexed wrists as well as applied finger and thumb forces increase median nerve blood flow at the entry to the carpal tunnel, which may negatively affect the median nerve.
Collapse
Affiliation(s)
- Samantha Ehmke
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Farias Zuniga
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Keir
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
|
14
|
Abstract
OBJECTIVE. The purpose of this article is to cover technical advances in musculo-skeletal ultrasound from the viewpoint of the radiologist. CONCLUSION. Among the advances in musculoskeletal ultrasound that we highlight the use of ultrahigh-frequency transducers to visualize ever-finer anatomic detail, the expanding practical clinical applications for microvascular imaging, and the use of elastography to predict function and, possibly, healing potential.
Collapse
|
|
15
|
Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
Collapse
Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
|
16
|
Ardakani AA, Afshar A, Bhatt S, Bureau NJ, Tahmasebi A, Acharya UR, Mohammadi A. Diagnosis of carpal tunnel syndrome: A comparative study of shear wave elastography, morphometry and artificial intelligence techniques. Pattern Recognit Lett 2020. [DOI: 10.1016/j.patrec.2020.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
|
17
|
Kamel SR, Sadek HA, Hamed A, Sayed OA, Mahmud MH, Mohamed FA, El Sagher GM, Aly LH. Ultrasound-guided insulin injection for carpal tunnel syndrome in type 2 diabetes mellitus patients. Clin Rheumatol 2019; 38:2933-2940. [PMID: 31209710 DOI: 10.1007/s10067-019-04638-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM). METHOD Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. All injections were performed with ultrasonographic guidance. All patients were assessed by modified Boston Carpal Tunnel Questionnaire (FD score), CTS severity score (SS score), and neurophysiological and ultrasonographic assessments at baseline and 10 weeks after treatment. RESULTS A significant improvement in mean FD score, SS score, DML (distal motor latency), SNCV (sensory nerve conduction velocity), PSL (peak sensory latency), Samp (sensory amplitude), and CSA (cross-sectional area of median nerve) observed in all groups (with exception of mean DML and Samp in the second group and mean Samp in the third group). Group III showed significant improvement in CSA especially when compared to group II by post hoc analysis (P = 0.005). CONCLUSIONS Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 DM and is a safer alternative. Adding insulin injections after steroid shows more sonographic improvement than steroid alone. Key Points • Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 diabetic patients. • Measuring CSA of median nerve at CT inlet by US is a better tool for monitoring median nerve changes after treatment. • Adding insulin injections after steroid has more sonographic improvement than steroid alone.
Collapse
Affiliation(s)
- Shereen Refaat Kamel
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt.
| | - Hanaa A Sadek
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Hamed
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Omima A Sayed
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mona H Mahmud
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Fatma A Mohamed
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ghada M El Sagher
- Internal Medicine Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Lamia H Aly
- Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt
| |
Collapse
|
|
18
|
Bagga B, Sinha A, Khandelwal N, Modi M, Ahuja CK, Sharma R. Comparison of Magnetic Resonance Imaging and Ultrasonography in Diagnosing and Grading Carpal Tunnel Syndrome: A Prospective Study. Curr Probl Diagn Radiol 2019; 49:102-115. [PMID: 31126663 DOI: 10.1067/j.cpradiol.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To use anatomic measurements on magnetic resonance imaging (MRI) and ultrasonography (USG) in diagnosing and grading carpal tunnel syndrome (CTS) using nerve conduction studies (NCS) as the gold standard. MATERIAL AND METHODS In this prospective study, 26 patients with CTS (45 wrists; 22 female and 4 male patients; mean ± SD age of 49.42 + 14.47 years) and 19 age and sex matched healthy volunteers (32 wrists; 15 female and 4 male volunteers, mean ± SD age of 42.52 + 10.85 years) underwent MRI and USG. Cross-sectional area (CA) of median nerve was measured using free hand ROI at four levels: hamate hook (H0), pisiform bone (PI0), 1 cm proximal (PI1) and 2 cm proximal to PI0 (PI2). Relative median nerve signal intensity (MNSI) was calculated as ratio of median nerve signal intensity with hypothenar muscle signal intensity. Flexor retinacular bowing was calculated at hamate hook level. Echogenicity and Power Doppler vascularity of median nerve were assessed on USG. Independent t-test, chi square test and receiver operating characteristic curve analysis were used as appropriate. RESULTS On USG, CA measured at PI0 (95% confidence interval of 0.872-0.987) and retinacular bowing (0.816-0.912), while, on MRI, CA at PI1 (0.874-0.997) were most useful in diagnosing CTS based on the ROC and Zombie plot analysis. Area under curves for CA measurements on USG and MRI were not significantly different. CA at PI1 on MRI (0.752-0.965) was significantly different between minimal to moderate CTS and severe to extreme CTS groups (on NCS). CONCLUSION CA of median nerve is the most useful parameter to diagnose and grade CTS and USG and MRI are comparable for measurements. Increased retinacular bowing on USG and hypoechogenicity of median nerve increase the diagnostic confidence while MRI helps in picking up important associated conditions.
Collapse
Affiliation(s)
- Barun Bagga
- Department of Radio diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anindita Sinha
- Department of Radio diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Niranjan Khandelwal
- Department of Radio diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Chirag K Ahuja
- Department of Radio diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ramesh Sharma
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
|
19
|
Wessel LE, Marshall DC, Stepan JGH, Sacks HA, Nwawka OK, Miller TT, Fufa DT. Sonographic Findings Associated With Carpal Tunnel Syndrome. J Hand Surg Am 2019; 44:374-381. [PMID: 30241975 DOI: 10.1016/j.jhsa.2018.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to identify associations between the clinical manifestations of carpal tunnel syndrome (CTS) and the sonographic measurements of the median nerve in the carpal tunnel. We hypothesized that sonographic changes in the median nerve from proximal to distal along the carpal tunnel would be associated with symptom severity scores. METHODS We report on 38 patients with clinical signs and symptoms of CTS in a prospective investigation. Subjects underwent sonographic evaluation with measurement of median nerve cross-sectional area (CSA) at 3 locations: the level of the pronator quadratus, pisiform, and hamate. In addition, we measured dimensions of the carpal tunnel at the levels of the pisiform (inlet) and hamate (outlet). Finally, we recorded maximal thickness of the transverse carpal ligament (TCL). Patients underwent routine clinical evaluation and 31 patients had electrodiagnostic examination. Patients completed the Levine Katz Questionnaire (LKQ) to characterize severity of clinical symptoms. Each clinician was blinded to symptom severity scores. Pearson correlation coefficients were calculated to measure the relationship between LKQ score and sonographic measures. RESULTS Median nerve CSA decreased over the course of the carpal tunnel from proximal to distal in 30 of 38 wrists. A greater absolute change in CSA of the median nerve over the course of the carpal tunnel between the pisiform and the hamate as well as between the pronator quadratus and the hamate correlated with increased severity of clinical symptoms. Increased thickening of the TCL also correlated with greater symptom severity scores. CONCLUSIONS Changes in CSA of the median nerve as well as thickening of the TCL correlate with CTS severity. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
Collapse
Affiliation(s)
| | | | | | - Hayley Anne Sacks
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York
| | | | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York
| | | |
Collapse
|
|
20
|
|
|
21
|
Karahan AY, Arslan S, Ordahan B, Bakdik S, Ekiz T. Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2855-2861. [PMID: 29663478 DOI: 10.1002/jum.14645] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate intraneural blood flow of the median nerve using superb microvascular imaging (SMI) and power Doppler ultrasonography (PDUS), and to examine their correlation with electroneuromyography in patients with carpal tunnel syndrome (CTS). METHODS A cross-sectional survey was used, and the study was conducted in the research unit of a training and research hospital. Patients diagnosed with CTS according to electroneuromyography studies were included in the study. Ultrasound measurements were taken using an Aplio-500 (Toshiba Medical System Corporation, Tokyo, Japan) device and a linear multifrequency 14-MHz probe. The cross-sectional area of the median nerve at the carpal tunnel level was measured by the direct tracing method using electronic calipers. The power Doppler ultrasonography and superb microvascular imaging scores were recorded by grading the vascularity between 0 and 3. RESULTS Evaluation was made of a total of 113 hands of 80 patients (18 men, 62 women) with a mean age of 34.67 ± 12.82 years. The mean duration of symptoms was 12.34 ± 6.66 months. When the patients were grouped as mild, moderate, and severe CTS, there was a statistically significant difference between the SMI and PDUS grades (P < .05). As the severity of CTS increased, an increase in SMI and PDUS scores was observed. There was a strong correlation between SMI scores and motor distal latency (r = .71/P = .026), amplitude of sensory action potential (r = -.77/P = .029), and sensory neurotransmission rate (r = .77/P = .029). CONCLUSION SMI seems to be more sensitive than PDUS for evaluating the vascularity of the median nerve in patients with CTS, and SMI grading is correlated with the ENMG results.
Collapse
Affiliation(s)
- Ali Yavuz Karahan
- Department of Physical and Rehabilitation Medicine, Medical Faculty of Usak University, Usak, Turkey
| | - Serdar Arslan
- Department of Radiology, Konya Training and Research Hospital, Konya, Turkey
| | - Banu Ordahan
- Department of Physical and Rehabilitation Medicine, Konya Training and Research Hospital, Konya, Turkey
| | - Suleyman Bakdik
- Department of Radiology, Konya Training and Research Hospital, Konya, Turkey
| | - Timur Ekiz
- Department of Physical and Rehabilitation Medicine, Dermancan Medical Center, Adana, Turkey
| |
Collapse
|
|
22
|
Motomiya M, Funakoshi T, Ishizaka K, Nishida M, Matsui Y, Iwasaki N. Blood Flow Changes in Subsynovial Connective Tissue on Contrast-Enhanced Ultrasonography in Patients With Carpal Tunnel Syndrome Before and After Surgical Decompression. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1597-1604. [PMID: 29171083 DOI: 10.1002/jum.14500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/20/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Although qualitative alteration of the subsynovial connective tissue in the carpal tunnel is considered to be one of the most important factors in the pathophysiologic mechanisms of carpal tunnel syndrome (CTS), little information is available about the microcirculation in the subsynovial connective tissue in patients with CTS. The aims of this study were to use contrast-enhanced ultrasonography (US) to evaluate blood flow in the subsynovial connective tissue proximal to the carpal tunnel in patients with CTS before and after carpal tunnel release. METHODS The study included 15 volunteers and 12 patients with CTS. The blood flow in the subsynovial connective tissue and the median nerve was evaluated preoperatively and at 1, 2, and 3 months postoperatively using contrast-enhanced US. RESULTS The blood flow in the subsynovial connective tissue was higher in the patients with CTS than in the volunteers. In the patients with CTS, there was a significant correlation between the blood flow in the subsynovial connective tissue and the median nerve (P = .01). The blood flow in both the subsynovial connective tissue and the median nerve increased markedly after carpal tunnel release. CONCLUSIONS Our results suggest that increased blood flow in the subsynovial connective tissue may play a role in the alteration of the microcirculation within the median nerve related to the pathophysiologic mechanisms of CTS. The increase in the blood flow in the subsynovial connective tissue during the early postoperative period may contribute to the changes in intraneural circulation, and these changes may lead to neural recovery.
Collapse
Affiliation(s)
- Makoto Motomiya
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Orthopedic Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Tadanao Funakoshi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiologic Technology, Hokkaido University Hospital, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine , Hokkaido University Hospital, Sapporo, Japan
| | - Yuichiro Matsui
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
|
23
|
Mohamed FI, Kamel SR, Hafez AE. Usefulness of neuromuscular ultrasound in the diagnosis of idiopathic carpal tunnel syndrome. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_22_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
|
|
24
|
Gonzalez-Suarez CB, Buenavente LD, Cua RCA, Fidel MBC, Cabrera JTC, Regala CFG. Inter-Rater and Intra-Rater Reliability of Sonographic Median Nerve and Wrist Measurements. J Med Ultrasound 2018; 26:14-23. [PMID: 30065508 PMCID: PMC6029182 DOI: 10.4103/jmu.jmu_2_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/14/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Electrophysiologic studies have been considered the “gold standard” in diagnosing carpal tunnel syndrome (CTS); however, reports of false-negative results, as well as discomfort for the patient during the procedure has paved the use of ultrasound, being a painless and cost-efficient tool, as an alternative means for its diagnosis. Various ultrasound parameters assessing the median nerve and wrist dimensions have been described, but description of landmarks to assess these in a reliable manner has been lacking. Methodology: A systematic search of different databases yielded data regarding ultrasound parameters for CTS diagnosis, the landmarks used, and presence of reliability testing. Based on this, three sonologists discussed the external and sonographic landmarks that will be used in measuring the median nerve measurements, bowing of the flexor retinaculum and the carpal tunnel dimensions. A pilot test with two consecutive healthy participants using the discussed ultrasound parameters was carried out, and results were subjected to inter- and intra-rater reliability testing. Modifications were accordingly made on the acquisition of ultrasound image using external landmarks. The reliability testing proper was done with ten consecutive healthy participants. Results: Based on the systematic review and the pilot study, external landmarks were used to locate the median nerve in the forearm, carpal tunnel inlet and outlet. For the forearm measurement, it was taken 10 cm proximal from the distal palmar crease. The distal palmar crease was the external landmark used for the carpal tunnel inlet, while for the carpal tunnel outlet; it was measured 1 cm distal to the distal palmar crease. Instead of using the inner edge of the hook of hamate and trapezium, the apices of these bones were used as the landmarks in measuring the carpal tunnel outlet dimensions. There was excellent intra-rater reliability (mid-forearm, carpal tunnel inlet and outlet) except for the following: cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet and outlet; and bowing of the flexor retinaculum. All the parameters had an excellent inter-rater reliability measured at the three levels (intraclass correlation [ICC]: Of 0.77–0.99) except for CSA of the median nerve at the levels of the forearm (fair-to-good with ICC of 0.71) and the carpal tunnel inlet (fair-to-good reliability of ICC: 0.43). Conclusion: There was an improved inter- and intra-rater reliability when external landmarks were used instead of sonographic landmarks.
Collapse
Affiliation(s)
- Consuelo B Gonzalez-Suarez
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Surgery, University of Santo Tomas, San Pablo, Laguna, Philippines.,Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines.,SPC Medical Center, San Pablo, Laguna, Philippines
| | - Lorraine D Buenavente
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| | - Ronald Christopher A Cua
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| | - Maria Belinda C Fidel
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines.,Center for Health Research and Movement Science, University of Santo Tomas, Manila, Philippines
| | - Jan-Tyrone C Cabrera
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| | - Carina Fatima G Regala
- Department of Physical Medicine and Rehabilitation, University of Santo Tomas Hospital, Manila, Philippines
| |
Collapse
|
|
25
|
Rbia N, Nijhuis THJ, Roukema GR, Selles RW, van der Vlies CH, Hovius SER. Ultrasound assessment of the sural nerve in patients with neuropathic pain after ankle surgery. Muscle Nerve 2017; 57:407-413. [PMID: 28710794 DOI: 10.1002/mus.25744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The sural nerve may be damaged after ankle injury. The aim of our study was to determine the diagnostic utility of high-resolution sonography in patients with ankle fractures treated by open reduction and internal fixation in whom there was a clinical suspicion of sural neuropathy. METHODS We examined the ultrasound (US) characteristics of patients with and without postsurgical sural neuropathic pain and healthy volunteers. Cross-sectional area (CSA), echogenicity, and vascularization of the sural nerves were recorded. RESULTS Fourteen participants and all sural nerves were identified. CSA (P < 0.001) and vascularization (P = 0.002) were increased in symptomatic patients when compared with asymptomatic patients and healthy volunteers. There were no significant differences in nerve echogenicity (P = 0.983). DISCUSSION US may be a valuable tool for evaluating clinically suspected sural nerve damage after ankle stabilization surgery. Sural nerve abnormalities are seen in patients with postsurgical neuropathic pain. Muscle Nerve 57: 407-413, 2018.
Collapse
Affiliation(s)
- Nadia Rbia
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center, Postal Box 2040, 300 CA, Rotterdam, The Netherlands
| | - Tim H J Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center, Postal Box 2040, 300 CA, Rotterdam, The Netherlands.,Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Gert R Roukema
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center, Postal Box 2040, 300 CA, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Steven E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center, Postal Box 2040, 300 CA, Rotterdam, The Netherlands
| |
Collapse
|
|
26
|
Chen J, Chen L, Wu L, Wang R, Liu JB, Hu B, Jiang LX. Value of superb microvascular imaging ultrasonography in the diagnosis of carpal tunnel syndrome: Compared with color Doppler and power Doppler. Medicine (Baltimore) 2017; 96:e6862. [PMID: 28538376 PMCID: PMC5457856 DOI: 10.1097/md.0000000000006862] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to compare the value of superb microvascular imaging (SMI) in carpal tunnel syndrome (CTS) with that of color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS).Fifty patients with symptomatic CTS and 25 healthy volunteers were enrolled. The cross-sectional area (CSA), CDUS score, PDUS score, and SMI score of the median nerve (MN) at the carpal tunnel were recorded. The value of different ultrasonography (US) diagnostic strategies was calculated.The blood flow display ratio in the MN of the healthy volunteers had no statistical difference between CDUS, PDUS, and SMI (20%, 32%, and 48%, respectively, P >.05). The blood flow display ratio for SMI in patients was significantly higher than that of CDUS and PDUS (90%, 52%, and 60%, respectively, P <.005). The accuracy of SMI score ≥2 (79%) was much higher than that of CDUS and PDUS (61% and 63%, respectively, P <.05). Comprehensive consideration of SMI and CSA, CSA≥10.5 mm, and/or SMI score ≥2 has the highest accuracy (83%), significantly higher than that of CSA combination with CDUS or PDUS (68% and 69%, respectively, P <.05).SMI is more sensitive to display the blood flow in the MN with CTS than CDUS and PDUS. It might significantly improve the diagnosis value for CTS.
Collapse
Affiliation(s)
- Jie Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, People's Republic of China
| | - Li Chen
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, People's Republic of China
| | - Lei Wu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, People's Republic of China
| | - Rui Wang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, People's Republic of China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, People's Republic of China
| | - Li-Xin Jiang
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, People's Republic of China
| |
Collapse
|
|
27
|
Witteveen E, Sommers J, Wieske L, Doorduin J, van Alfen N, Schultz MJ, van Schaik IN, Horn J, Verhamme C. Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unit-acquired weakness: a cross-sectional observational study. Ann Intensive Care 2017; 7:40. [PMID: 28382599 PMCID: PMC5382120 DOI: 10.1186/s13613-017-0263-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/27/2017] [Indexed: 02/07/2023] Open
Abstract
Background Neuromuscular ultrasound is a noninvasive investigation, which can be easily performed at the bedside on the ICU. A reduction in muscle thickness and increase in echo intensity over time have been described in ICU patients, but the relation to ICU-acquired weakness (ICU-AW) is unknown. We hypothesized that quantitative assessment of muscle and nerve parameters with ultrasound can differentiate between patients with and without ICU-AW. The aim of this cross-sectional study was to investigate the diagnostic accuracy of neuromuscular ultrasound for diagnosing ICU-AW. Methods Newly admitted ICU patients, mechanically ventilated for at least 48 h, were included. As soon as patients were awake and attentive, an ultrasound was made of four muscles and two nerves (index test) and ICU-AW was evaluated using muscle strength testing (reference standard; ICU-AW defined as mean Medical Research Council score <4). Diagnostic accuracy of muscle thickness, echo intensity and homogeneity (echo intensity standard deviation) as well as nerve cross-sectional area, thickness and vascularization were evaluated with the area under the curve of the receiver operating characteristic curve (ROC–AUC). We also evaluated diagnostic accuracy of z-scores of muscle thickness, echo intensity and echo intensity standard deviation. Results Seventy-one patients were evaluated of whom 41 had ICU-AW. Ultrasound was done at a median of 7 days after admission in patients without ICU-AW and 9 days in patients with ICU-AW. Diagnostic accuracy of all muscle and nerve parameters was low. ROC–AUC ranged from 51.3 to 68.0% for muscle parameters and from 51.0 to 66.7% for nerve parameters. Conclusion Neuromuscular ultrasound does not discriminate between patients with and without ICU-AW at the time the patient awakens and is therefore not able to reliably diagnose ICU-AW in ICU patients relatively early in the disease course. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0263-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Esther Witteveen
- Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Laboratory of Experimental Anesthesiology and Intensive Care (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands. .,Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Juultje Sommers
- Department of Rehabilitative Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Anesthesiology and Intensive Care (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands.,Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jonne Doorduin
- Department of Neurology and Clinical Neurophysiology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Anesthesiology and Intensive Care (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Janneke Horn
- Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Anesthesiology and Intensive Care (L·E·I·C·A), Academic Medical Center, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
|
28
|
Kutlar N, Bayrak AO, Bayrak İK, Canbaz S, Türker H. Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity. Neurol Res 2017; 39:126-132. [PMID: 28050946 DOI: 10.1080/01616412.2016.1275455] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography. PATIENTS AND METHODS The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization. RESULTS A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages. CONCLUSION Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.
Collapse
Affiliation(s)
- Nihal Kutlar
- a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey
| | - Ayse Oytun Bayrak
- a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey
| | - İlkay Koray Bayrak
- b Faculty of Medicine, Department of Radiology , Ondokuz Mayis University , Samsun , Turkey
| | - Sevgi Canbaz
- c Faculty of Medicine, Department of Public Health , Ondokuz Mayis University , Samsun , Turkey
| | - Hande Türker
- a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey
| |
Collapse
|
|
29
|
Chen YT, Williams L, Zak MJ, Fredericson M. Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2311-2324. [PMID: 27629754 DOI: 10.7863/ultra.15.12014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/21/2016] [Indexed: 06/06/2023]
Abstract
Carpal tunnel syndrome is the most common peripheral compressive neuropathy. Ultrasonography (US) is an emerging technology that can be used in the diagnosis of carpal tunnel syndrome. Although the cross-sectional area is the most studied and validated measurement for carpal tunnel syndrome, there is no standardized neuromuscular US scanning protocol. We review the most studied neuromuscular US characteristics and protocols in the evaluation of carpal tunnel syndrome and propose a standardized protocol for evaluating carpal tunnel syndrome with neuromuscular US based on current literature.
Collapse
Affiliation(s)
- Yin-Ting Chen
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland USA
| | - Lisa Williams
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, California USA
| | - Matthew J Zak
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland USA
| | - Michael Fredericson
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, California USA
| |
Collapse
|
|
30
|
Cheng Y, Xu X, Chen W, Wang Y. Doppler sonography for ulnar neuropathy at the elbow. Muscle Nerve 2016; 54:258-63. [PMID: 26718909 DOI: 10.1002/mus.25022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The aim of this study was to determine the value of Doppler sonography for evaluation of ulnar neuropathy at the elbow (UNE). METHODS A total of 102 patients with a clinical suspicion of UNE and 50 healthy controls were examined by Doppler and gray-scale sonography. RESULTS Intraneural vascularization was found in 31 (46.3%) of 67 patients with confirmed UNE and in 3 (6.0%) of 50 healthy controls. Combining gray-scale sonography measurement of nerve size and the presence of intraneural vascularization increased sensitivity by 3%, but decreased the specificity. Patients with intraneural vascularization had more severe disease than those without intraneural vascularization (P < 0.05). The variables obtained by Doppler sonography were associated with the severity of UNE (P < 0.05). CONCLUSIONS Doppler sonography is not helpful for diagnosing UNE but can be used to assess the severity of UNE. Muscle Nerve 54: 258-263, 2016.
Collapse
Affiliation(s)
- Yi Cheng
- Department of Ultrasound in Medicine, Fudan University affiliated Huashan Hospital, 12 Urumqi Middle Road, Shanghai, 200012, China
| | - Xiuyue Xu
- Department of Hand Surgery, Fudan University affiliated Huashan Hospital, Shanghai, China
| | - Weimin Chen
- Department of Ultrasound in Medicine, Fudan University affiliated Huashan Hospital, 12 Urumqi Middle Road, Shanghai, 200012, China
| | - Yi Wang
- Department of Ultrasound in Medicine, Fudan University affiliated Huashan Hospital, 12 Urumqi Middle Road, Shanghai, 200012, China
| |
Collapse
|
|
31
|
|
|
32
|
Junck AD, Escobedo EM, Lipa BM, Cronan M, Anthonisen C, Poltavskiy E, Bang H, Han JJ. Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2077-2088. [PMID: 26453123 PMCID: PMC4905730 DOI: 10.7863/ultra.15.01069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/02/2015] [Indexed: 06/05/2023]
Abstract
Objectives-The aim of this study was to determine the intra- and inter-rater reliability of sonographic measurements of the median nerve cross-sectional area in individuals with carpal tunnel syndrome and healthy control participants.Methods-The median nerve cross-sectional area was evaluated by sonography in 18 participants with carpal tunnel syndrome (18 upper extremities) and 9 control participants (18 upper extremities) at 2 visits 1 week apart. Two examiners, both blinded to the presence or absence of carpal tunnel syndrome, captured independent sonograms of the median nerve at the levels of the carpal tunnel inlet, pronator quadratus, and mid-forearm. The cross-sectional area was later measured by each examiner independently. Each also traced images that were captured by the other examiner.Results-Both the intra- and inter-rater reliability rates were highest for images taken at the carpal tunnel inlet (radiologist, r = 0.86; sonographer, r = 0.87; inter-rater, r = 0.95; all P < .0001), whereas they was lowest for the pronator quadratus (r = 0.49, 0.29, and 0.72, respectively; all P < .0001). At the mid-forearm, the intra-rater reliability was lower for both the radiologist and sonographer, whereas the inter-rater reliability was relatively high (r = 0.54, 0.55, and 0.81; all P < .0001). Tracing of captured images by different examiners showed high concordance for the median cross-sectional area at the carpal tunnel inlet (r = 0.96-0.98; P < .0001).Conclusions-The highest intra- and inter-rater reliability was found at the carpal tunnel inlet. The results also demonstrate that tracing of the median nerve cross-sectional area from captured images by different examiners does not contribute significantly to measurement variability.
Collapse
Affiliation(s)
- Anthony D Junck
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Eva M Escobedo
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Bethany M Lipa
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Michael Cronan
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Colleen Anthonisen
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Eduard Poltavskiy
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Heejung Bang
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.)
| | - Jay J Han
- Departments of Radiology (A.D.J., E.M.E., M.C.) and Physical Medicine and Rehabilitation (B.M.L., C.A., J.J.H.), University of California Davis School of Medicine, Sacramento, California USA; and Department of Public Health Sciences, University of California at Davis, Davis, California USA (E.P., H.B.).
| |
Collapse
|
|
33
|
Zhang L, Rehemutula A, Peng F, Yu C, Wang TB, Chen L. Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity? Neural Regen Res 2015; 10:1172-6. [PMID: 26330845 PMCID: PMC4541253 DOI: 10.4103/1673-5374.160117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/04/2022] Open
Abstract
Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5-17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.
Collapse
Affiliation(s)
- Li Zhang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Aierken Rehemutula
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Feng Peng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Cong Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Tian-Bin Wang
- Department of Orthopedics, Beijing University People's Hospital, Beijing, China
| | - Lin Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| |
Collapse
|
|
34
|
Ooi CC, Wong SK, Tan ABH, Chin AYH, Abu Bakar R, Goh SY, Mohan PC, Yap RTJ, Png MA. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skeletal Radiol 2014; 43:1387-94. [PMID: 24915739 DOI: 10.1007/s00256-014-1929-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/29/2014] [Accepted: 05/28/2014] [Indexed: 02/07/2023]
Abstract
The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79%; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm(2)). There was a good correlation between the severity of NCS and CSA (r = 0.78, p < 0.001). The sensitivity and specificity of color-Doppler and dynamic US in detecting CTS was 69, 95, 58, and 86%, respectively. Combination of these subjective criteria with CSA increases the sensitivity to 98.3%. US measurement of CSA provides additional information about the severity of MN involvement. Color-Doppler and dynamic US are useful supporting criteria that may expand the utility of US as a screening tool for CTS.
Collapse
Affiliation(s)
- Chin Chin Ooi
- Department of Diagnostic Radiology, Singapore General Hospital, Block 2, level 1, Outram Road, 169608, Singapore, Singapore,
| | | | | | | | | | | | | | | | | |
Collapse
|
|
35
|
Vanderschueren GAKB, Meys VEWH, Beekman R. Doppler sonography for the diagnosis of carpal tunnel syndrome: a critical review. Muscle Nerve 2014; 50:159-63. [PMID: 24633597 DOI: 10.1002/mus.24241] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Doppler sonography may detect increased intraneural blood flow of the median nerve in carpal tunnel syndrome (CTS). The purpose of this review is to critically evaluate the literature about the diagnostic value of increased intraneural flow detected by sonography in CTS Methods: Systematic review of studies published between 1985 and 2013. RESULTS The 7 studies we found had considerable differences in study design and had methodological shortcomings. Doppler sonography had a median sensitivity of 72% (range, 41-95%) and a median specificity of 88% (range, 71-100%). Most studies could not compare the diagnostic value of sonography to that of electrophysiological studies, because the latter were often used as a reference test. CONCLUSIONS Increased intraneural flow detected by Doppler sonography may be a promising diagnostic test for CTS, but further studies are needed before it can be implemented in clinical practice.
Collapse
|
|
36
|
Nakashima Y, Sunagawa T, Shinomiya R, Ochi M. High-resolution ultrasonographic evaluation of "hourglass-like fascicular constriction" in peripheral nerves: a preliminary report. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1718-1721. [PMID: 24613638 DOI: 10.1016/j.ultrasmedbio.2013.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/29/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
An hourglass-like constriction is a focal fascicular lesion observed in one or a few places in one or a few fascicles of a peripheral nerve trunk, and usually affects the anterior interosseous (AIN) or posterior interosseous (PIN) nerve. Constrictions have previously been discovered only by surgical exploration, and have been unable to be recognized on pre-operative imaging. We encountered some cases in which the lesion was able to be diagnosed pre-operatively by high-resolution ultrasonography; these findings were then confirmed intra-operatively. Five consecutive cases were included in this study. In three cases with constrictions revealed on pre-operative ultrasound, the findings were confirmed intra-operatively. In the remaining two cases in which no constrictions were detected pre-operatively, no constriction was revealed intra-operatively. High-resolution ultrasonography may play a significant role in the diagnosis of hourglass-like constrictions, and may thus lead to significant changes in treatment strategies for AIN and PIN palsy.
Collapse
Affiliation(s)
- Yuko Nakashima
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Toru Sunagawa
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan.
| | - Rikuo Shinomiya
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Mitsu Ochi
- Department of Orthopedic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
|
37
|
Ghasemi-rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E, Mohammadi MH, Sayed D, Davarian A, Maleki-Miyandoab T, Hasan A. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol 2014; 6:284-300. [PMID: 24976931 PMCID: PMC4072815 DOI: 10.4329/wjr.v6.i6.284] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/28/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anatomy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.
Collapse
|
|
38
|
Ishizaka K, Nishida M, Motomiya M, Satoh M, Inoue M, Kudoh Y, Omotehara S, Horie T, Funakoshi T, Iwasaki N. Reliability of peripheral intraneural microhemodynamics evaluation by using contrast-enhanced ultrasonography. J Med Ultrason (2001) 2014; 41:481-6. [PMID: 27278029 DOI: 10.1007/s10396-014-0533-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/17/2014] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of the study was to validate the reliability of quantitative intraneural enhancement patterns by using contrast-enhanced ultrasonography (CEUS). METHODS Nine asymptomatic wrists underwent a total of three CEUS examinations each conducted at 1-month intervals. The CEUS enhancement pattern of median nerves was quantitatively evaluated. The area under the time-intensity curve was calculated by placing the regions of interest at the proximal, center, and distal regions of the median nerve. An intra-class correlation coefficient for intra-observer, inter-observer, and inter-examination reproducibility was calculated. RESULTS The intra- and inter-observer reproducibility was almost perfect. Inter-examination reproducibility of the proximal, center, and distal regions was 0.891, 0.614, and 0.535, respectively. In this study, we found that the reproducibility of the distal and center regions of the median nerve in the carpal tunnel was lower than that of the proximal region. CONCLUSION High intra-observer, inter-observer, and inter-examination reproducibility of CEUS was obtained in the evaluation of the intraneural enhancement pattern when the region of interest was placed in the proximal region of the median nerve.
Collapse
Affiliation(s)
- Kinya Ishizaka
- Department of Radiological Technology, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Megumi Satoh
- Department of Radiological Technology, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Mamiko Inoue
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Yusuke Kudoh
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Tatsunori Horie
- Department of Radiological Technology, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
|
39
|
Mohamed RE, Amin MA, Aboelsafa AA, Elsayed SE. Contribution of power Doppler and gray-scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
|
40
|
Aoki T, Oshige T, Matsuyama A, Oki H, Kinoshita S, Yamashita Y, Takahashi H, Hayashida Y, Sakai A, Hisaoka M, Korogi Y. High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients. Eur Radiol 2013; 24:559-65. [DOI: 10.1007/s00330-013-3064-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 10/14/2013] [Accepted: 10/19/2013] [Indexed: 12/13/2022]
|
|
41
|
Park GY, Kwon DR. Platelet-rich plasma limits the nerve injury caused by 10% dextrose in the rabbit median nerve. Muscle Nerve 2013; 49:56-60. [DOI: 10.1002/mus.23863] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Gi-Young Park
- Department of Rehabilitation Medicine; Catholic University of Daegu School of Medicine; 33 Duryugongwon-ro 17-gil Nam-Gu Daegu 705-718 Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine; Catholic University of Daegu School of Medicine; 33 Duryugongwon-ro 17-gil Nam-Gu Daegu 705-718 Korea
| |
Collapse
|
|
42
|
Zidan S, Tantawy H, Fouda N, Ali M. The value of power and pulsed Doppler in the diagnosis of CTS: Is a solution in sight. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
|
43
|
Abstract
Over the last decade, neuromuscular ultrasonography has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves, including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent articles outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasonography is well suited for use in electrodiagnostic laboratories, where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient's history, physical examination, electrophysiological studies, and imaging for diagnosis and management.
Collapse
Affiliation(s)
- Jung Im Suk
- Department of Neurology, School of Medicine, Catholic University of Daegu, 3056-6, Daemyeong-4-dong, Nam-gu, Daegu, South Korea.
| | | | | |
Collapse
|
|
44
|
Kerasnoudis A. Which ultrasound method has the upper hand in the follow-up of the patients with recurrent carpal tunnel syndrome? Ann Rheum Dis 2013; 72:e11. [PMID: 23505232 DOI: 10.1136/annrheumdis-2013-203206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
|
45
|
Goedee HS, Brekelmans GJF, van Asseldonk JTH, Beekman R, Mess WH, Visser LH. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy - a review of the literature. Eur J Neurol 2013; 20:1342-51. [DOI: 10.1111/ene.12182] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/25/2013] [Indexed: 12/20/2022]
Affiliation(s)
- H. S. Goedee
- Department of Neurology and Clinical Neurophysiology; St Elisabeth Hospital; Tilburg; The Netherlands
| | - G. J. F. Brekelmans
- Department of Neurology and Clinical Neurophysiology; St Elisabeth Hospital; Tilburg; The Netherlands
| | | | - R. Beekman
- Department of Neurology; Atrium Medical Centre; Heerlen; The Netherlands
| | - W. H. Mess
- Department of Clinical Neurophysiology; Maastricht University Medical Centre; Maastricht; The Netherlands
| | - L. H. Visser
- Department of Neurology and Clinical Neurophysiology; St Elisabeth Hospital; Tilburg; The Netherlands
| |
Collapse
|
|
46
|
The international society of peripheral neurophysiological imaging: Pioneering innovation in a multidisciplinary context. Clin Neurophysiol 2013; 124:631-3. [DOI: 10.1016/j.clinph.2012.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/17/2022]
|
|
47
|
Evans KD, Roll SC, Volz KR, Freimer M. Reply: To PMID 22535720. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:188-189. [PMID: 23269726 DOI: 10.7863/jum.2013.32.1.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
|
48
|
Wilder-Smith EP, Therimadasamy A. Nerve blood flow. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:187-188. [PMID: 23269725 DOI: 10.7863/jum.2013.32.1.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
|
49
|
Frijlink DW, Brekelmans GJF, Visser LH. Increased nerve vascularization detected by color Doppler sonography in patients with ulnar neuropathy at the elbow indicates axonal damage. Muscle Nerve 2012; 47:188-93. [PMID: 23168608 DOI: 10.1002/mus.23505] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2012] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The aim of this study was to establish the prevalence of increased intraneural vascularization detected by ultrasonography (IVUS) in patients with ulnar neuropathy at the elbow (UNE) and to determine its relationship to clinical, ultrasonographic, and electrodiagnostic findings. METHODS High-resolution ultrasonography and color Doppler imaging were performed in 137 patients with confirmed UNE, 24 patient controls, and 70 healthy controls (HCs). RESULTS IVUS was found in 21 (15%) of 137 patients with UNE, in 1 (4%) of 24 patient controls, and in 0 of 70 HCs (P = 0.001). Patients with IVUS were more likely to have severe weakness (P = 0.01), severe atrophy of ulnar-innervated muscles (P = 0.008), axonal damage (P = 0.001), and more pronounced nerve enlargement (P = 0.03) than those without IVUS. CONCLUSIONS IVUS in the ulnar nerve can be detected in patients with UNE and is associated with nerve enlargement and clinical and electrodiagnostic severity. In addition, IVUS is associated with axonal damage.
Collapse
Affiliation(s)
- Daphne W Frijlink
- Department of Neurology, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC Tilburg, The Netherlands
| | | | | |
Collapse
|