Sonography of the Median Nerve in Carpal Tunnel Syndrome with Diabetic Neuropathy

Kim, Li Na; Kwon, Hee Kyu; Moon, Hyun Im; Pyun, Sung Bum; Lee, Hang Jae

doi:10.1097/phm.0000000000000084

Cited by 20 publications

(26 citation statements)

References 21 publications

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“…We point out that CSA enlargement in compression sites correlates with a reported susceptibility of diabetic patients for entrapment syndromes . However, it is of interest that our patients lacked relevant symptoms.…”

Section: Discussioncontrasting

confidence: 88%

“…The findings reveal a pronounced increase in CSA of most peripheral nerves in patients with DPN and not only of individual nerves as reported before (for example median nerve in the carpal tunnel and posterior tibial nerve. These morphological abnormalities can be further classified as CSA enlargement in compression sites (carpal tunnel, Guyon canal, ulnar nerve at the elbow, fibular nerve at the fibular head, tibial nerve at the tarsal tunnel) and noncompression sites (median nerve in forearm and fibular nerve in the popliteal fossa).…”

Section: Discussionmentioning

confidence: 64%

“…We point out that CSA enlargement in compression sites correlates with a reported susceptibility of diabetic patients for entrapment syndromes. 9,10 However, it is of interest that our patients lacked relevant symptoms. This observation probably represents subclinical presentation of morphological nerve pathology in these sites and may have 2 important implications.…”

Section: Discussionmentioning

confidence: 99%

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Facing the diagnostic challenge: Nerve ultrasound in diabetic patients with neuropathic symptoms

et al. 2016

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Nerve ultrasound revealed crucial morphological alterations in diabetic patients. CSA enlargement at compression sites indicates subclinical nerve affection and may indicate susceptibility to entrapment syndromes. CSA increase at noncompression sites despite normal electrophysiology suggests early morphological abnormalities. Further longitudinal studies are required to confirm our results. Muscle Nerve, 2015 Muscle Nerve 54: 18-24, 2016 Muscle Nerve 54: 18-24, 2016.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Facing the diagnostic challenge: Nerve ultrasound in diabetic patients with neuropathic symptoms

et al. 2016

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“…These results showing that electrophysiological CTS can be a part of the polyneuropathy in diabetic patients should be interpreted carefully. Kim et al22 ) also found increased CSAs of the median nerve in DPN-only patients compared with those of healthy controls at the wrist. Therefore, ultrasonographic CTS diagnoses are inconsistent with electrophysiological results in patients with DPN.…”

Section: Discussionmentioning

confidence: 85%

Is ultrasonography useful in the diagnosis of the polyneuropathy in diabetic patients?

et al. 2016

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[Purpose] The aim of this study was to investigate the usefulness of ultrasonography for the diagnosis of polyneuropathy in diabetic patients by examination of the median and ulnar nerves. [Subjects and Methods] Sixty-three diabetic patients and fourteen controls were enrolled in the study. Nerve conduction studies were performed on both upper and lower limbs. Median and ulnar nerve cross-sectional areas were measured at the wrist and forearm levels in 140 hands by ultrasound. [Results] The median nerve cross-sectional area was increased at the hook of hamatum, pisiform bone, and radioulnar joint levels in patients with carpal tunnel syndrome. The ulnar nerve area at the medial epicondyle was significantly increased in the diabetic polyneuropathy (9.2 ± 1.6), diabetic polyneuropathy plus carpal tunnel syndrome (9.3 ± 1.4), and carpal tunnel syndrome (9.2 ± 1.9) groups compared with the control group (7.7 ± 1.1). In receiver operating characteristics analysis, the cutoff value of the ulnar nerve was 8.5 mm2 at ulnar epicondyle with 71.4% specificity and 70.4% sensitivity, corresponding to the highest diagnostic accuracy for diabetic polyneuropathy. [Conclusion] Ultrasonographic examination of the median and ulnar nerves can be an alternative or additional diagnostic modality for the evaluation of neuropathies in diabetic patients.

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“…Kim et al found that all the crosssectional areas (CSA) of the median nerve were larger in DSP patients compared with healthy controls, and the CSA of the median nerve at the wrist revealed no significant differences among DSP patients with and without CTS; however, patients with CTS (with and without DM) had larger CSAs at the wrist and a higher wrist/forearm ratio compared with DSP patients. The cutoff value for the CSA at the wrist that yielded the highest sensitivity and specificity was 11.6 mm [22]. A smaller study found no ultrasound measurement (distal median CSA, wrist-forearm ratio, wrist-forearm difference) reached significance to detect CTS in patients with DSP [17].…”

Section: Electrophysiologic and Ultrasonographic Diagnostic Techniquementioning

confidence: 89%

Focal Upper Limb Mononeuropathies in Patients with Diabetes Mellitus

Alon¹,

Bril²

2020

Peripheral Nerve Disorders and Treatment

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In this chapter, we describe the prevalence, diagnostic methods, and treatment efficacy of compressive neuropathies of the median and the ulnar nerves in patients with diabetes mellitus (DM). Median neuropathy at the wrist is found in up to onethird of patients with DM, when demonstrated electrophysiologically, but is symptomatic as carpal tunnel syndrome (CTS) in a smaller proportion of these patients. It is clear that diabetes increases the risk of having clinical CTS. Diagnosis of CTS using nerve conduction studies is difficult in patients with DM and diabetic sensorimotor polyneuropathy (DSP) as median nerve conduction studies are affected predominantly by the diabetes state. We will discuss different electrodiagnostic and ultrasonography techniques for diagnosis and the outcomes of carpal tunnel release decompressive surgery in this special patient population. It is controversial whether DM is a risk factor for cubital tunnel syndrome or ulnar neuropathy at the elbow (UNE) or at the wrist (UNW). In this chapter, we will review the ultrasonographic and electrophysiological diagnostic techniques used in UNE and UNW and the efficacy of cubital tunnel release in DM patients.

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Sonography of the Median Nerve in Carpal Tunnel Syndrome with Diabetic Neuropathy

Abstract: The CSA of the median nerve at the wrist and the wrist/forearm ratio could be useful for diagnosing the comorbidity of CTS with DPN.

Cited by 20 publications

References 21 publications

Facing the diagnostic challenge: Nerve ultrasound in diabetic patients with neuropathic symptoms

Facing the diagnostic challenge: Nerve ultrasound in diabetic patients with neuropathic symptoms

Is ultrasonography useful in the diagnosis of the polyneuropathy in diabetic patients?

Focal Upper Limb Mononeuropathies in Patients with Diabetes Mellitus

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