Axonal degeneration in association with carpal tunnel syndrome

Caetano, Marcelo Ribeiro

doi:10.1590/s0004-282x2003000100008

Cited by 12 publications

(5 citation statements)

References 9 publications

(10 reference statements)

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“…Regarding the evaluation and functional prognosis of axonal degeneration during an NCS, Caetano et al [ 19 ] examined the severity of axonal degeneration by comparing the amplitude of the SNAP induced by wrist and palm stimulation. In this study, only the extent of axonal degeneration and functional prognosis of the SNAP were discussed.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

Sasaki

Terao

Saito

et al. 2020

BMC Musculoskelet Disord

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Background Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients. Methods In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland’s classification of grade 5 or 6, and assessed for the changes in Bland’s classification grade before and after surgery. Those who showed improvement from preoperative grades 5–6 to postoperative grades 1–4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups. Results Among the 60 hands of 46 patients who had a preoperative Bland’s classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland’s classification grade was correlated with the degree of clinical symptom improvement. Conclusions Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

Sasaki

Terao

Saito

et al. 2020

BMC Musculoskelet Disord

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“…In a study of 100 hands by Caetano the CTS patients were separated as mild, moderate and severe, and were compared with 50 control hands in terms of median palmar sensory amplitudes and those with normal median sensory amplitude were evaluated as cases seen to have no axonal degeneration (25). In the mild CTS group and in 40.3% of the moderate CTS group, the sensory nerve action potential (SNAP) amplitude value was normal and no axonal degeneration was seen, whereas in the severe CTS group and in more than half of the moderate cases (59.7%), the SNAP amplitude was low or absent and axonal degeneration was seen.…”

Section: Discussionmentioning

confidence: 99%

The relationship between median nerve axon count and clinical findings and electrophysiological parameters in patients with carpal tunnel syndrome

Berk¹,

Nacitarhan²

2019

Ann Med Res

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To determine the association of clinical and electrophysiological findings in cases of carpal tunnel syndrome (CTS) using motor unit (axon) number estimation (MUNE) of the median nerve and to evaluate how these findings can contribute to treatment planning. Material and Methods: Evaluation was made of 43 hands of 25 patients (22 females, 3 males, mean age 45.63±9.89 years) with clinical and electrophysiological diagnosis proven CTS and a healthy control group of 50 hands of 25 subjects (21 females, 4 males, mean age 44.72±8.89 years). Electrophysiological nerve transmission measurements and CTS grading were applied. MUNE measurement was made from the abductor pollicis brevis (APB) muscle with the incremental method. Results: According to the electrophysiological grading, the mean MUNE values were at Grade-0: 134.66±41.00, Grade-1: 78.83±33.51, Grade-2: 71.72±32.15 and Grade-3: 50.25±27.45. A positive correlation was determined between electrophysiological grading and APB muscle atrophy, and median nerve latency. A negative correlation was determined with MUNE, muscle strength, median nerve amplitude and conduction velocity. Between MUNE and muscle strength, median nerve amplitude and conduction velocity there was a positive correlation, between MUNE and median nerve latency, a negative correlation was found. According to regresion analysis, median nerve wrist segment sensory velocity and median nerve distal motor action potential amplitude were predictive parameters for MUNE. Conclusion: Together with the clinical evaluation, patients with grade 3 and/or MUNE value below 2 standard deviations of normal according to the electrophysiological evaluation, should be considered for surgery, while in milder cases, it can be recommended that clinical and electrophysiological follow-up is added to conservative treatment.

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“…3 As the disease progresses, axonal loss begins to occur. 4 5 6 Patients may present anywhere along the spectrum of early demyelination to chronic axonal loss. Axonal loss is generally considered irreversible, and its presence has implications for outcomes after carpal tunnel release.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Cross-Sectional Area in Median Nerve Axonal Loss and Demyelination in Carpal Tunnel Syndrome

2023

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Introduction Ultrasound is an effective diagnostic tool for carpal tunnel syndrome (CTS). However, it is unclear how ultrasound correlates with axonal loss and/or demyelination on electrodiagnostic studies (EDS). The objective of this study is to determine whether ultrasound cross-sectional area (CSA) of the median nerve varies between patients with axonal loss or demyelination. Methods A retrospective review was completed of patients who presented to an orthopaedic hand clinic with numbness/paresthesias over a 6-year period. Demographics, CTS symptoms scale 6 (CTS-6) scores, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, EDS results, and ultrasound results were collected. Median neuropathies were graded as normal, demyelination, or axonal loss using EDS reports. The data were analyzed with chi-square and t-tests. Results In all, 383 hands were included (92 axonal loss, 182 demyelination only, and 108 neither). The average patient age was 52.2 and the average body mass index (BMI) was 31.7. The group consisted of 70.7% females, and 23.2% had diabetes. Patients with either axonal loss or demyelination had larger CSA and higher CTS-6 and BCTQ scores than patients with negative EDS. Patients with axonal loss also had larger CSA and higher CTS-6 and BCTQ scores than patients with demyelination only. The rates of positive ultrasound results between axonal loss and demyelination groups did not differ until the ultrasound cutoff was increased from 10 to 12 mm2. Conclusion Rates of positive ultrasound results (CSA ≥ 10 mm2) do not differ between wrists with axonal loss or demyelination alone. Therefore, the character of carpal tunnel neuropathy does not affect ultrasound's diagnostic ability. Additionally, CSA increases as wrists develop axonal loss, and an increased ultrasound cutoff of 12 mm2 is correlated with this pathology.

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Axonal degeneration in association with carpal tunnel syndrome

Cited by 12 publications

References 9 publications

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study

The relationship between median nerve axon count and clinical findings and electrophysiological parameters in patients with carpal tunnel syndrome

Ultrasound Cross-Sectional Area in Median Nerve Axonal Loss and Demyelination in Carpal Tunnel Syndrome

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