Quantitative MR imaging of carpal tunnel syndrome.

Monagle, K.; Dai, Guangping; Chu, Anita; Burnham, Robert; Snyder, R. E.

doi:10.2214/ajr.172.6.10350293

Cited by 108 publications

(87 citation statements)

References 26 publications

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“…The mean cross-section area of the patient group was found to be 15.58 ± 0.84 sq mm while the mean cross-section area of the nerve As their measurements were the absolute values obtained from the wrist MRI's, the values had a big variance because of the personal anatomical differences and each author commented that there are big variations in each group. They also did not discuss Phalen's theory of increased synovial and tendon volumes and instead commented on the congenital susceptibility to carpal tunnel syndrome and reported that more work has to be done for this purpose (4,13,21).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Quantitative MRI analysis of idiopathic carpal tunnel syndrome

Oge¹,

Acu²,

Gucer³

et al. 2012

Turkish Neurosurgery

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ABSTRACTaIM: The aim of this study was to try to find parametric ratios for the diagnosis and pathophysiology of carpal tunnel syndrome using MR. MaterIaL and MetHOds:Dominant side wrist MRI examinations of 27 female carpal tunnel patients and 21 normal females were compared. The carpal tunnel contents area / carpal tunnel cross section area ratio was defined, analysed and discussed with the literature. resuLts: Carpal tunnel contents / wrist area ratios of the carpal tunnel patients were measured and compared with the control group. This comparison revealed that the proportion of the contents of the carpal tunnel is increased in the carpal tunnel syndrome patients. Palmar bowing was found to be increased and median nerve cross section area was found to be increased at the proximal entrance of the carpal tunnel.cOncLusIOn: As Phalen has postulated, the volume of the contents of the carpal tunnel were found to be increased in the carpal tunnel syndrome patients. Carpal tunnel cross section areas remained the same with the control group. This increase can be demonstrated by MRI imaging which can provide an evidence for the pathophysiology of carpal tunnel syndrome.keywOrds: Carpal tunnel syndrome, Area measurement, Ratio ÖZ aMaÇ: Bu çalışmanın amacı, el bileği MR incelemesiyle tespit edilen karpal tünel kapsamı/karpal tunel alanı oranları ile karpal tunel sendromuna diagnostik ve patofizyolojik bir yaklaşımda bulunmaktır. yÖnteM ve gereÇLer: 27 karpal tunel hastası kadın ile dominant el bileği MR incelemesi yapılan 21 kadından oluşan kontrol grubunun el bilek MR ları karşılaştırılmıştır. Karpal tunel kapsamı / karpal tunel alanı oranı tanımlanarak bu oran, median sinir alanı ve transverse karpal ligamentteki palmar yaylanma ölçülerek analiz edilmiştir.BuLguLar: Seride karpal tunel kapsamı/karpal tunel alanı oranında karpal tunel sendromlu hastalarda karpal tunel kapsamı lehinde istatistiksel olarak anlamlı bir artış tespit edilmiştir. Hastalarda karpal tunel proksimal girişinde ölçülen median sinir kesit alanlarında ve transvers karpal ligament palmar yaylanmasında da istatistiksel olarak anlamlı bir artış bulunmuştur. sOnuÇ: Karpal tunel sendromlu hastalarda Phalen'in öne sürdüğü gibi karpal tunel kapsamında kronik travmaya bağlı bir artış tespit edilmiştir. Bu kapsam artışına karşılık karpal tunel yüzey alanlarında anlamlı bir artış tespit edilmemiştir. Bu bulgu MR ile gösterilebilmektedir ve karpal tunel sendromunun fizyopatolojisinin anlaşılması konusunda bir kanıt olabilmektedir.anaHtar sÖZcÜkLer: Karpal tunel sendromu, Alan ölçümü, Oran

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Section: Resultsmentioning

confidence: 99%

“…In the proximal sections, the tendon courses superficial to the scaphoid bone as an ovoid dark bundle. When traced distally, it can be observed in the vertical groove of the trapezium and then inserts to the bases of second and third metacarpal bones (12,13,24).…”

Section: Introductionmentioning

confidence: 99%

Quantitative MRI analysis of idiopathic carpal tunnel syndrome

Oge¹,

Acu²,

Gucer³

et al. 2012

Turkish Neurosurgery

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“…We used a Likert scale to measure symptom severity in this study because several researchers have found that patients find this type of scale easier to understand and use than a VAS (visual analog scale), and because Likert scale and VAS responses are highly correlated even in children or the elderly (19,20). In the present study, only women were investigated because previous studies have found differences in the incidence of CTS and in carpal tunnel area between genders (21,22). In addition, an Italian CTS research group demonstrated significant gender differences in CTS symptom duration (23), which we used to stratify CTS patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Palmar bowing of the flexor retinaculum on wrist MRI correlates with subjective reports of pain in carpal tunnel syndrome

Tsujii

Hirata

Morita

et al. 2009

Magnetic Resonance Imaging

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Purpose:To investigate the utility of palmar bowing of the flexor retinaculum (PBFR) on magnetic resonance imaging (MRI) as an adjunct to presurgical evaluation of carpal tunnel syndrome (CTS). Materials and Methods:The CTS group comprised 48 women with CTS diagnosed from clinical history, physical examination, and electrophysiological findings. Another 21 healthy women with no symptoms of CTS served as controls. The CTS group was divided into four subgroups based on symptom duration. CTS patients were preoperatively assessed for symptom severity using a Likert scale. In both groups, palmar bowing of the flexor retinaculum (PBFR) was measured on MRI. Furthermore, relationships with disease duration, subjective symptom severity, and electrophysiological findings were assessed in the CTS group.Results: Although PBFR increased significantly in all CTS groups when compared to the control group, PBFR in patients who complained of severe pain tended to exceed that in patients with mild to moderate pain. Statistical analysis showed a positive correlation between PBFR and pain severity. In contrast, PBFR did not reflect median nerve function.Conclusion: PBFR as seen on MRI seems to correlate significantly with patients' subjective reports of pain severity.Key Words: carpal tunnel syndrome; magnetic resonance imaging; palmar flexor bowing of flexor retinaculum; pain severity.

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“…29 Since ligament bowing at the pisiform level has previously been shown to be normal in CTS, ligament bowing was only established at the level of the hook of hamate. 31 All MRI scans were coded and an investigator blinded to the group allocation took all measurements (AS). To verify the inter-tester reliability of the measures, a second investigator blinded to group allocation independently evaluated all MRI scans (JE).…”

Section: Interventionmentioning

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

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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...

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Quantitative MR imaging of carpal tunnel syndrome.

Cited by 108 publications

References 26 publications

Quantitative MRI analysis of idiopathic carpal tunnel syndrome

Quantitative MRI analysis of idiopathic carpal tunnel syndrome

Palmar bowing of the flexor retinaculum on wrist MRI correlates with subjective reports of pain in carpal tunnel syndrome

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

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