Evidence‐based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome

French, Catherine E; Cartwright, Michael S.; Hobson‐Webb, Lisa D.; Boon, Andrea J.; Alter, Katharine E.; Hunt, Christopher H.; Flores, Víctor Hugo Portilla; Werner, Robert A.; Shook, Steven J.; Thomas, Tayler; Primack, Scott J.; Walker, Francis O.

doi:10.1002/mus.23389

Cited by 290 publications

(289 citation statements)

References 63 publications

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“…In CTS, the swelling of the nerve at the tunnel inlet has been very early recognized as a consistent sign of compression within the tunnel (Buchberger et al, 1991) and has become the mainstay for the ultrasonographic diagnosis of CTS (Cartwright et al, 2012;Tai et al, 2012). It has been postulated that the swelling resulting from compression is translated to the site of least resistance, which explains why it is seen at the proximal edge of the retinaculum, at the tunnel inlet, where the nerve is relieved from pressure, rather than within the confined space of the tunnel (Therimadasamy et al, 2012;Paliwal et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…The meta-analyses of the large body of literature that has accumulated in the past two decades (Cartwright et al, 2012;Tai et al, 2012) showed that level A evidence support the ultrasonographic measurement of median nerve crosssectional area at the tunnel inlet (CSA-I) as an accurate diagnostic test for CTS (Cartwright et al, 2012). The cut-off value of CSA-I showed a wide range of variation between 8 and 14 mm 2 , possibly due to issues of resolution, machine settings and individual examination technique, but most of the articles set the cut-off value of CSA-I at 9-11 mm 2 (Tai et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Csillik

Bereczki

Bora³

et al. 2016

Clinical Neurophysiology

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). The sponsor had no direct involvement in the collection, analysis and interpretation of data and in the preparation of the manuscript. 2 HIGHLIGHTS Median nerve enlargement in CTS is significantly greater at the tunnel outlet than at the inlet  It is postulated that pressure progressively increases from proximal to distal within the tunnel  The addition of outlet measurements increases diagnostic sensitivity and accuracy of CTS 3 ABSTRACT Objective: A retrospective study to investigate the utility of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome (CTS).Methods: 118 hands of 87 patients with electrophysiologically confirmed CTS and 44 control hands of 23 subjects were assessed. Cross-sectional areas (CSA) of the median nerve were measured at the tunnel inlet, outlet, and forearm. Longitudinal diameters (LAPD) were measured at the inlet, proximal tunnel, distal tunnel, and outlet.Results: CSA at the outlet (median: 18 mm 2 ) and its palm-to-forearm-ratio (median: 2.7) were significantly larger than CSA at the inlet (median: 15 mm 2 ) and its wrist-to-forearm-ratio (median: 2.2) (p <0.001). 27% of the hands showed enlargement only at the outlet versus 13% only at the inlet.LAPD jump was significantly greater, suggesting relief of higher pressure, at the outlet / distal tunnel versus inlet / proximal tunnel (p <0.001). Conclusion:Median nerve enlargement in CTS is greater at the tunnel outlet than at the inlet. We postulate that this is explained by the progressive increase of pressure within the tunnel from proximal to distal.Significance: The addition of outlet measurements to inlet measurements increased sensitivity and accuracy of the ultrasonographic diagnosis of CTS by 15% and 10%, respectively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

Csillik

Bereczki

Bora³

et al. 2016

Clinical Neurophysiology

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“…Ultrasonography is widely used to investigate compression of the median nerve in the carpal tunnel (FIG. 1), and these studies have provided standard criteria for the diagnosis of all nerve entrapments with ultrasonography 36,37 . One meta-analysis of papers that reported the sensitivity and specificity of ultra sonography from clinical or nerve conduction studies showed that ultrasonography has a sensitivity of 77.6% and a specificity of 86.8% for diagnosis of carpal tunnel syndrome (CTS) 38 .…”

Section: Entrapment Neuropathiesmentioning

confidence: 99%

“…Interestingly, abnormalities in ultrasonographic images have a linear correlation with hand function (for example, fine finger movement) -the larger the nerve cross-sectional area, the greater the impairment -but not with the severity of the symptoms (such as paraesthesias and dysaesthesias) 39 . Nevertheless, evidence-based guidelines state that the median nerve cross-sectional area at the wrist is of value in combination with nerve conduction studies, and can be used as a diagnostic test 36 . Intraneural Doppler sonography might have a role in the diagnosis of CTS, but what this role is remains unclear owing to technical limitations and a lack of standardization in depicting the vasa nervorum as a sign of inflammation 37 .…”

Section: Entrapment Neuropathiesmentioning

confidence: 99%

New technologies for the assessment of neuropathies

et al. 2017

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Peripheral neuropathies are among the most common neurological disorders 1 . In routine clinical practice, diagnosis of peripheral neuropathies is typically based on clinical assessment, nerve conduction studies and needle electromyography, which can determine whether symptoms are caused by primary axonal damage or demyelinating damage. This distinction is often relevant to therapeutic choices and to prognosis, as axonal damage typically reflects an inflammatory (for example, vasculitic) or degenerative (for example, hereditary or idiopathic) process that correlates with disability, whereas demyelinating damage can reflect a hereditary neuro pathy, but more often reflects an acquired immunemediated neuropathy. Besides metabolic, inflammatory or primary degenerative neuropathies, peripheral nerves can also be damaged by compression from adjacent tissue structures, such as tendons, cysts or haematomas. In this case, proper identification of the site, nature and degree of the lesion might be challenging, but is relevant to treatment and prognosis. Moreover, some patients present with symptoms that suggest damage to small nerve fibres, which nerve conduction studies cannot be used to detect.In the past 15 years, several techniques have become available to investigate focal and diffuse peripheral neuropathies, and their reliability has widened the spectrum of diagnostic tools for clinicians and improved assessment of neuropathies. In this Review, we provide an overview of these new and emerging technologies. We first discuss peripheral nerve imaging with MRI and ultrasonography, which can provide information about the precise localization of neuro pathies and the pathological processes involved in large-fibre neuropathies, and can complement clinical and electrophysiological evaluation. We then consider techniques that can provide diagnostic information when the pathological process is restricted to small nerve fibres and is consequently not detectable with nerve conduction studies or neuroimaging. These include skin biopsy, which is established in clinical practice, and the emerging techniques of corneal confocal microscopy, laser-evoked potentials and heat-related and pain-related evoked potentials, and microneurography.Nerve imaging technology Advances in imaging techniques have made it possible to gain great insight into nerve pathology with magnetic resonance and ultrasound. Each approach offers distinct advantages, and can provide different information about damage to large myelinated fibres. Abstract | Technical advances are rapidly changing the clinical and instrumental approach to peripheral nerve diseases. Magnetic resonance neurography, diffusion tensor imaging and nerve ultrasonography are increasingly entering the diagnostic workup of peripheral neuropathies as tools that complement neurophysiology and enable investigation of proximal structures, such as plexuses and roots. Progress in the design of magnetic resonance scanners and sequences, and the development of high-frequency ultrasound probes mean th...

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“…[14] For wrist, US has been used for diagnosis of anatomical anomalies like bifid median nerve and for therapeutic interventions. [15] US has been found quite useful in trochanteric pain during interventions in hip joint, in interventions related to knee joint and plantar fascia. [16] For interventions in knee joint, US has limited use due to limited visualization of cruciate ligament, meniscopathy and fractures.…”

Section: Musculoskeletal Interventions In Chronic Painmentioning

confidence: 99%

Ultrasound guided chronic pain interventions (Part I)

Akkaya

Alptekin

Özkan

2015

Agri

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SummaryRecently, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy or computed tomography. Latest publications in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expand its applications in algology practice. This review highlights different applications of US in chronic pain conditions. Keywords: Chronic pain; nerve blocks; ultrasound. ÖzetSon zamanlarda rejyonal anestezi pratiğinde ultrasonografi (US) vazgeçilmez görüntüleme tekniği olarak yerini almıştır. Ultrasonografi ile kas/iskelet, periferik ve nöraksial bölgelerin kronik ağrılı patolojilerde çeşitli invaziv girişimler yapmak olasıdır. Bu girişimler diagnostik bloklar, radyofrekans uygulamaları ve nörolitik ajanların uygulamaları olarak özetlenebilirler. Algolojik girişimler esnasında US; hedef dokuların görüntülenmesinde, uygulanan ilacın yayılımında, çevredeki vasküler yapıların görün-tülenmesinde büyük kolaylıklar sağlar. Ayrıca US ile floroskopi veya bilgisayarlı tomografi uygulamaları esnasındaki radyasyon yayılımı söz konusu değildir. Kronik ağrı girişimlerinde US ile yayınlanan klinik çalışmalar umut vericidir. Ayrıca son yıllarda bu alandaki gelişmeler (ekojen iğneler, üç boyutlu US cihazları vd.) US'nin algoloji pratiğindeki kullanımının daha da yaygınlaşaca-ğını düşündürmektedir. Bu derlemenin amacı, US eşliğinde yapılan çeşitli kronik ağrı girişimlerini gözden geçirmektir.

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Evidence‐based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome

Cited by 290 publications

References 63 publications

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

The significance of ultrasonographic carpal tunnel outlet measurements in the diagnosis of carpal tunnel syndrome

New technologies for the assessment of neuropathies

Ultrasound guided chronic pain interventions (Part I)

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