Dynamic Doppler Evaluation of the Radial and Ulnar Arteries in Patients With Carpal Tunnel Syndrome

Özcan, Hatice Nursun; Kara, Murat; Özcan, Fırat; Bostanoğlu, Settar; Karademir, Mehmet Alp; Erkin, Gülten; Özçakar, Levent

doi:10.2214/ajr.11.6559

Cited by 11 publications

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References 29 publications

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“…In a study comparing the arterial flow parameters of CTS patients with those of healthy controls, a significant increase was seen in the radial and ulnar artery flows of the CTS patients [9]. It was suggested in that study that the increased arterial flow could be associated with substance P or local inflammatory response to sympathoparalytic vasodilation in CTS patients [9].…”

Section: Discussionmentioning

confidence: 94%

“…It was suggested in that study that the increased arterial flow could be associated with substance P or local inflammatory response to sympathoparalytic vasodilation in CTS patients [9]. Another reason for increased arterial blood flow in CTS may be impairment in the autonomic control of local blood perfusion in the distal area innervated by the median nerve associated with median nerve compression [22].…”

Section: Discussionmentioning

confidence: 99%

“…There are published studies showing a relationship between diagnosis confirmation by ultrasonography and electrodiagnostic results in CTS patients with or without DM [3,4]. Changes in flow volumes in hand arteries [9] and impairments in vasomotor activity have also been shown in idiopathic CTS patients [10]. However, to the best of our knowledge there are no studies in literature which have evaluated the characteristics of wrist artery blood flow and ultrasonography and electrodiagnostic findings in DM patients with and without CTS.…”

Section: Introductionmentioning

confidence: 99%

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An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Boyacı

Tutoğlu²,

Boyacı³

et al. 2014

J Clin Exp Invest

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ÖZETAmaç: Diabetes mellituslu (DM) hastalarda karpal tünel sendromu (KTS) teşhisinde ultrasonografinin değerini ve diabetik KTS'li hastalarda radial ve ulnar arterlerin akım karakteristiklerini araştırmak amaçlanmıştır. Bulgular: DM-KTS grubunda, CSA-p ve CSA-d değerle-ri DM ve C gruplarına göre anlamlı olarak daha büyüktü (p<0.01). FR-p, DM-KTS grubunda C grubuna göre anlamlı olarak daha büyüktü (p<0.01). ROC eğrisi analizinde, CSA-p ≥ 9.5 mm 2 (AUC 0.84; duyarlılık 78.3% and özgüllük 88%) ve CSA-d ≥ 9.5 mm 2 (AUC 0.78; duyarlılık 73.9% and özgüllük 84%), DM-KTS elin çok güçlü bir prediktörüdür. Doppler incelemesinde her iki radial ve ulnar arter akım volumü, pik sistolik hız, end-diyastolik hız ve rezistif indeks ölçümlerinde gruplar arası farklılık yoktu (p>0.05). Radial arter damar çapı, DM-KTS grubunda C grubuna göre anlamlı olarak daha büyüktü (p<0.05). Sonuçlar: Diabetik KTS'li hastalarda diabetli ve sağlıklı kişilere göre median sinir CSA anlamlı olarak büyüktür. Diabetik hastalarda KTS değerlendirilmesinde, ultrasonografiyle ölçülen CSA diagnostik bir araç olabilir. YöntemlerAnahtar kelimeler: Karpal tünel sendromu, kesit alanı, median sinir, ultrasonografi ABSTRACTObjective: This study aimed to research the value of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS) in patients with diabetes mellitus (DM) and to examine the flow characteristics of the radial and ulnar arteries in diabetic patients with CTS. Methods:A total of 23 diabetic hands diagnosed with CTS from electrophysiological evaluation (DM-CTS), 47 asymptomatic diabetic hands (DM) and 50 healthy hands (C) as the control group were evaluated with high resolution ultrasonography. The median nerve was measured in the crosssectional area (CSA), flattening ratio (FR) and at the level of the carpal tunnel inlet [proximal (p)] and the wrist crease [distal (d)]. The radial and ulnar arteries were evaluated with both hands in a neutral position. Results:In the DM-CTS group, the CSA-p and CSA-d values were statistically signficantly greater compared to the DM and C groups (p<0.01). The FR-p in the DM-CTS group was statistically significantly greater than that of the C groups (p<0.01). In the ROC curve analysis, CSA-p ≥ 9.5 mm 2 (AUC 0.84; sensitivity 78.3% and specificity 88%) and CSA-d ≥ 9.5 mm 2 (AUC 0.78; sensitivity 73.9% and specificity 84%) were very strong predictors of the DM-CTS hand. In the Doppler examination, no difference was determined between the groups in terms of flow volume, peak systolic velocity, enddiastolic velocity and resistive index measurements of both radial and ulnar arteries (p>0.05). The radial artery diameter was determined to be statistically significantly greater in the DM-CTS group than the C group (p<0.05). Conclusion:The median nerve CSA is significantly greater in diabetic CTS patients compared to patients with diabetes only and healthy controls. In the evaluation of CTS in diabetic patients, CSA measured with ultrasonography may be a diagnostic tool. J Clin Exp Invest 2014; 5 (2): 179-185

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Boyacı

Tutoğlu²,

Boyacı³

et al. 2014

J Clin Exp Invest

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“…The methods used for estimating the flow rate in these studies estimates the flow rate simply through the product of maximum velocity and blood vessel area (Ozcan et al 2011;Toprak et al 2011;Tiftik et al 2014). Further, no consideration in the literature has been given to evaluate the accuracy or reliability of these measurements.…”

Section: Introductionmentioning

confidence: 99%

Investigation of Ultrasound-Measured Flow Rate and Wall Shear Rate in Wrist Arteries Using Flow Phantoms

Zhou

Xia

Khan

et al. 2016

Ultrasound in Medicine & Biology

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“…Furthermore, neither article defined how the authors arrived at the determination that the nerve was hypervascular versus vascularity in the surrounding tissues. Ozcan et al 5 analyzed the radial and ulnar arteries in patients with carpal tunnel syndrome, and Ghasemi‐Esfe et al 6 analyzed the arteries in the little finger in patients with carpal tunnel syndrome, neither study focusing on vascularity within the median nerve itself.…”

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Evans

Roll

Volz

et al. 2013

Journal of Ultrasound in Medicine

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The results are surprising in showing reduced blood flow at the level of the pisiform bone in symptomatic patients compared to asymptomatic controls. This finding is in contrast to 4 studies in the literature documenting consistently increased blood flow at the carpal tunnel inlet. [2][3][4][5] Unfortunately, the authors do not discuss the relevant literature or interpret the differing results. In view of increased vascularity already having been proposed as a biomarker for carpal tunnel syndrome, this factor seems a particularly important point to appropriately discuss. 6 The first study to document and quantitate intraneural blood flow in carpal tunnel syndrome showed significantly increased blood flow (mean, 13.3 cm/s) in hands with highly likely carpal tunnel syndrome. 4 Furthermore, with the increasing clinical likelihood of carpal tunnel syndrome, there was increasing intraneural blood flow velocity, and a significant positive linear correlation was observed between nerve conduction parameters and intraneural blood flow velocity. In 2 studies, increased blood flow was the single most sensitive measure of carpal tunnel syndrome. 4,7 Our own laboratory data in controls show a receiver operating characteristic curve cutoff for intraneural blood flow at less than 7 cm/s. Comparing this value to the average of 3.75 cm/s measured by Evans et al, 1 one does wonder whether there are not factors in play that affected this low reading. In a study by Joy et al, 4 all cases with highly likely carpal tunnel syndrome had recordable blood flow; only 2 were less than 7 cm/s. More than 50% of asymptomatic hands had unrecordable blood flow. 4 In the study by Evans et al, 1 it would be important to know how many patients with and without carpal tunnel syndrome symptoms had unrecordable blood flow? Why did the authors average the peak systolic values, which lowers values as the hand undergoes considerable vasomotion dependent on sympathetic activation? 8 Because pain is a strong sympathetic activator, it would be important to consider the effect of the directly preceding electromyography of the abductor pollices brevis (a painful procedure!) on median nerve blood flow. In a recently published article, we were able to show a significant effect of varying sympathetic activation on median nerve blood flow. 9 We also wonder why the authors included electromyography in the evaluation of carpal tunnel syndrome, which is not sensitive in its diagnosis or quantification. 10 In our analysis of 60 hands, it was evident that increased blood flow occurs maximally in the carpal tunnel inlet, where it is also easiest to characterize, which makes it difficult to understand why in the study of Evans et al, 1 of the 123 analyzed systolic peaks, most were analyzed in the distal region of the carpal tunnel.The authors are ambiguous about the site of measurement for the proximal carpal tunnel, which once is described at the level of the pisiform and later as the region immediately proximal to the distal edge of the radius. These areas are...

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Dynamic Doppler Evaluation of the Radial and Ulnar Arteries in Patients With Carpal Tunnel Syndrome

Cited by 11 publications

References 29 publications

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Investigation of Ultrasound-Measured Flow Rate and Wall Shear Rate in Wrist Arteries Using Flow Phantoms

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