Median nerve ultrasound as a screening tool in carpal tunnel syndrome: Correlation of cross‐sectional area measures with electrodiagnostic abnormality

Mhoon, Justin T.; Juel, Vern C.; Hobson‐Webb, Lisa D.

doi:10.1002/mus.23426

Cited by 132 publications

(183 citation statements)

References 44 publications

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“…Some have found that CSA increased from mild to moderate severity (Chen et al, 2011), others have reported that ultrasonography can be complementary but not conclusive in the classification of CTS severities (Abrishamchi et al, 2015). On the other hand, in the study of Mhoon et al (2012), no significant correlation was demonstrated between ultrasound parameters and electrophysiological severity and concluded that ultrasound cannot determine severity.…”

Section: Discussionmentioning

confidence: 92%

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: 92%

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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“…Furthermore, whereas the ERK/Elk-1, JAK/STAT, and AKT/ CREB pathways have all been correlated to neuroprotection, it is today widely admitted that IGF-1-mediated neuroprotection occurs through activation of the AKT/CREB pathway (D'Mello et al, 1997;Párrizas et al, 1997;Yadav et al, 2005). Furthermore, in the specific case of cerebellar granule neurons, IGF-1-induced neuroprotection results from both the activation of AKT and the inhibition of MEK-ERK1/2 through the AKT pathway (Subramaniam et al, 2005). Similarly, the neuroprotection induced by IGF-1R reduction in SMA spinal cords, as evidenced by the relative persistence of the motor neuron population and the reduced activation of caspase-3, might result from both an increased SMN protein expression and the presence of the two powerful antiapoptotic molecules, AKT and CREB, at the activated state.…”

Section: Discussionmentioning

confidence: 99%

“…MN-1 (Motoneuron-1) cells have been derived from the spinal cords of E18 control mice and immortalized (Salazar-Grueso et al, 1991). These cells only harbor the two alleles of the murine Smn genes.…”

Section: Methodsmentioning

confidence: 99%

IGF-1R Reduction Triggers Neuroprotective Signaling Pathways in Spinal Muscular Atrophy Mice

Biondi

Branchu

Salah

et al. 2015

Journal of Neuroscience

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Spinal muscular atrophy (SMA) is a neuromuscular disease characterized by the selective loss of spinal motor neurons due to the depletion of the survival of motor neuron (SMN) protein. No therapy is currently available for SMA, which represents the leading genetic cause of death in childhood. In the present study, we report that insulin-like growth factor-1 receptor (Igf-1r) gene expression is enhanced in the spinal cords of SMA-like mice. The reduction of expression, either at the physiological (through physical exercise) or genetic level, resulted in the following: (1) a significant improvement in lifespan and motor behavior, (2) a significant motor neuron protection, and (3) an increase in SMN expression in spinal cord and skeletal muscles through both transcriptional and posttranscriptional mechanisms. Furthermore, we have found that reducing IGF-1R expression is sufficient to restore intracellular signaling pathway activation profile lying downstream of IGF-1R, resulting in both the powerful activation of the neuroprotective AKT/CREB pathway and the inhibition of the ERK and JAK pathways. Therefore, reducing rather than enhancing the IGF-1 pathway could constitute a useful strategy to limit neurodegeneration in SMA.

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“…In a hand with carpal tunnel syndrome (CTS), Ultrasonography can show the enlarged median nerve just proximal to the carpal tunnel [1]. In open carpal tunnel release surgery, the enlarged median nerve is recognized as a pseudoneuroma.…”

Section: Introductionmentioning

confidence: 99%

Ultasonographic indicators of carpal tunnel syndrome demonstrate reversibility following carpal tunnel release

Osada¹,

Zukawa²,

Kimura³

2018

Radiol Diagn Imaging

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Median nerve ultrasound as a screening tool in carpal tunnel syndrome: Correlation of cross‐sectional area measures with electrodiagnostic abnormality

Abstract: Median nerve ultrasound is a highly sensitive screening tool for EDx abnormality, but it cannot determine severity. This may lead to changes in the current standards for evaluating CTS.

Cited by 132 publications

References 44 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

IGF-1R Reduction Triggers Neuroprotective Signaling Pathways in Spinal Muscular Atrophy Mice

Ultasonographic indicators of carpal tunnel syndrome demonstrate reversibility following carpal tunnel release

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