Predictors of Carpal Tunnel Syndrome: Accuracy of Gray-Scale and Color Doppler Sonography

Mallouhi, Ammar; Pültzl, Petra; Trieb, Thomas; H, Piza; Bodner, Gerd

doi:10.2214/ajr.04.1715

Cited by 172 publications

(181 citation statements)

References 38 publications

Supporting

Mentioning

162

Contrasting

Unclassified

Order By: Relevance

“…We monitored adverse events related to electroacupuncture and splinting using a previously published approach. 40 Details of outcomes and measurement methods for adverse events can be found in Appendix 1.…”

Section: Discussionmentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

View full text Add to dashboard Cite

Background:The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods:We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results:Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06).Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting.

show abstract

Section: Discussionmentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

View full text Add to dashboard Cite

show abstract

“…2,3 When the pressure on a peripheral nerve is experimentally increased, a reduction of intraneural microcirculation occurs with subsequent breakdown of the blood nerve barrier and the formation of intraneural and extraneural edema. 4 In CTS, swelling of the median nerve has been identified intra-operatively, 5,6 with ultrasound imaging 7 and with conventional magnetic resonance imaging (MRI). 8,9 If present for prolonged periods, intraneural edema may lead to potentially irreversible fibrotic changes.…”

mentioning

confidence: 99%

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms

Schmid

Elliott

Strudwick

et al. 2012

Journal Orthopaedic Research

View full text Add to dashboard Cite

Splinting and nerve and tendon gliding exercises are commonly used to treat carpal tunnel syndrome (CTS). It has been postulated that both modalities reduce intraneural edema. To test this hypothesis, 20 patients with mild to moderate CTS were randomly allocated to either night splinting or a home program of nerve and tendon gliding exercises. Magnetic resonance images of the wrist were taken at baseline, immediately after 10 min of splinting or exercise, and following 1 week of intervention. Primary outcome measures were signal intensity of the median nerve at the wrist as a measure of intraneural edema and palmar bowing of the carpal ligament. Secondary outcome measures were changes in symptom severity and function. Following 1 week of intervention, but not immediately after 10 min, signal intensity of the median nerve was reduced by $11% at the radioulnar level for both interventions (p ¼ 0.03). This was accompanied by a mild improvement in symptoms and function (p < 0.004). A similar reduction in signal intensity is not observed in patients who only receive advice to remain active. No changes in signal intensity were identified further distally (p > 0.28). Ligament bowing remained unchanged (p > 0.08). Intraneural edema reduction is a likely therapeutic mechanism of splinting and exercise. Keywords: MRI; nerve and tendon gliding exercises; splinting; carpal tunnel syndrome; neurodynamics Carpal tunnel syndrome (CTS) is a peripheral neuropathy at the level of the wrist. Despite considerable efforts, the pathophysiology of CTS is not yet fully understood. 1 There is however a well-established link between an elevated pressure in the carpal tunnel and the development of CTS. 2,3 When the pressure on a peripheral nerve is experimentally increased, a reduction of intraneural microcirculation occurs with subsequent breakdown of the blood nerve barrier and the formation of intraneural and extraneural edema. 4 In CTS, swelling of the median nerve has been identified intra-operatively, 5,6 with ultrasound imaging 7 and with conventional magnetic resonance imaging (MRI). 8,9 If present for prolonged periods, intraneural edema may lead to potentially irreversible fibrotic changes. 4 These fibrotic changes are present in patients with severe CTS. 9 Edema reduction to prevent progression to a fibrotic stage is therefore a plausible target in the management of patients with mild to moderate CTS.Besides advice, splinting and nerve and tendon gliding exercises are the most frequently performed noninvasive treatment modalities for CTS. 10 The beneficial effect of night splinting in a neutral wrist position is commonly attributed to the avoidance of end-range positions associated with high carpal tunnel pressures. 11,12 Maintenance of a neutral wrist position is believed to promote adequate blood circulation with a subsequent reduction of edema. 13 Although further research is required, recent systematic reviews indicate that conservative management with nerve and tendon gliding exercises may be beneficial for patie...

show abstract

“…Intraneural vascularity has been proposed as an additional parameter in the diagnosis of CTS, sometimes being the only detectable finding [34,35]. Recent studies have shown that endoneural hypervascularity is correlating with the severity of the median nerve lesions evaluated through electrophysiologic studies [36,37].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic evaluation of the median nerve at the level of the carpal tunnel outlet and mid forearm in patients with type II Mucopolysaccharidosis

Bocşa¹,

Asăvoaie

Bucerzan

et al. 2016

Med Ultrason

View full text Add to dashboard Cite

Aims: The ultrasonographic (US) evaluation of the median nerve at the level of the carpal tunnel outlet (CTO) and mid forearm in pediatric patients with mucopolysaccharidosis type II (MPS II) and comparison with healthy subjects. Material and method: Fifteen children with MPS II and 44 healthy children were included in the study and they were divided into three age groups. The cross-sectional area, the appearance of the nerve, and the ratio of the cross-sectional areas were evaluated by US. Results: At the level of the CTO the mean area of the nerve was increased in all MPS II groups compared with the correspondent healthy age groups and the differences were statistically significant (p<0.01). At the level of the mid forearm the differences were statistically significant only for the first age group. Other US findings at the level of the CTO in the MPS II groups were represented by hypoechogenicity (86.67 % on the right and 93.33% on the left), thickened fascicles (80% bilaterally), irregular contour (53.33% bilaterally) and the presence of the Doppler signal including the nerve (26.67 % on the right and 33.33 % on the left). The CTO/mid forearm cross-sectional area ratio was higher in all MPS II age groups and the differences were statistically significant (p<0.001). Conclusion: In patients with MPS II there are significant US changes in the size and aspect of the median nerve.

show abstract

Predictors of Carpal Tunnel Syndrome: Accuracy of Gray-Scale and Color Doppler Sonography

Abstract: Color Doppler sonography is more accurate than gray-scale sonography for characterizing median nerve involvement in patients with suspected carpal tunnel syndrome.

Cited by 172 publications

References 38 publications

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms

Ultrasonographic evaluation of the median nerve at the level of the carpal tunnel outlet and mid forearm in patients with type II Mucopolysaccharidosis

Contact Info

Product

Resources

About