The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis

Asghar, Adil; Naaz, Shagufta; Ansari, S; Kumar, Ashutosh; Singh, Vishwajeet

doi:10.1016/j.morpho.2022.05.005

Cited by 8 publications

(8 citation statements)

References 89 publications

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“…An increase in the cross-sectional area of the median nerve has been correlated with the diagnosis of CTS. In their systematic review and meta-analysis of 97 observational studies published between 1992-2021 involving 6,679 wrists of healthy subjects, Asghar et al revealed that the pooled estimate of the cross-section area of the median nerve at carpal tunnel inlet was 8.54mm2 (95% CI: 8.34-8.74mm2) [ 71 ]. The same pooled estimate at the carpal tunnel outlet was 8.03mm 2 (95% CI: 7.46-8.60mm 2 ).…”

Section: Reviewmentioning

confidence: 99%

“…The same pooled estimate at the carpal tunnel outlet was 8.03mm 2 (95% CI: 7.46-8.60mm 2 ). They suggested a reference value for median nerve disorders, including carpal tunnel syndrome: cross-section area of the median nerve at any place in carpal tunnel more than 10mm2 [ 71 ]. Ting et al revealed a positive association between ultrasound measurement and electrodiagnostic studies in CTS patients [ 72 ].…”

Section: Reviewmentioning

confidence: 99%

“…6,679 wrists of healthy subjects, Asghar et al revealed that the pooled estimate of the cross-section area of the median nerve at carpal tunnel inlet was 8.54mm2 (95% CI: 8.34-8.74mm2)[71]. The same pooled estimate at the carpal tunnel outlet was 8.03mm 2 (95% CI: 7.46-8.60mm 2 ).…”

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confidence: 98%

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An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem

Omole¹,

Awosika²,

Khan³

et al. 2023

Cureus

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Carpal tunnel syndrome (CTS) is a common entrapment neuropathy characterized by pain, numbness, and impaired function of the hand due to compression of the median nerve at the level of the wrist. Although CTS can develop from repetitive strain, injury, or medical conditions, there are also congenital and genetic risk factors that can predispose individuals to the condition. With respect to anatomical factors, some individuals are born with a smaller carpal tunnel, which increases their susceptibility to median nerve compression. Variations in specific genes, such as those encoding proteins involved in extracellular matrix remodeling, inflammation, and nerve function, have also been linked to an increased risk for CTS. CTS is associated with a high cost of health care maintenance and loss of work productivity. Therefore, it is vital that primary care physicians fully understand the anatomy, epidemiology, pathophysiology, etiology, and risk factors of CTS, so they can be proactive in prevention, diagnosing, and guiding proper treatment. This integrated review also provides insights into how biological, genetic, environmental, and occupational factors interact with structural elements to determine who is most likely to acquire and suffer from CTS. Keeping health practitioners abreast of all the factors that could impact CTS should go a long way in decreasing the health care and socioeconomic burden of CTS.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem

Omole¹,

Awosika²,

Khan³

et al. 2023

Cureus

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“…Kantarci et al 11 also demonstrated significantly increased MN stiffness measured by shear wave elastography (SWE) in CTS patients compared to healthy controls, even in mild CTS. A recent systematic review and meta-analysis by Asghar et al 16 reported a mean normative value of 9.1 ± 1.8 mm² for CSA at the carpal tunnel inlet. Our study demonstrated a progressive increase in CSA from the negative/mild CTS group to the moderate/severe CTS groups, with the severe CTS group exhibiting a mean CSA of 15.8 ± 4.5 mm² at the carpal tunnel inlet, which aligns with the normative CSA data from the meta-analysis and supports the utility of this parameter in differentiating CTS severity stages.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study

El-Maghraby,

Almalki,

Basha

et al. 2024

ORR

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Purpose Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). Materials and Methods This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28–57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. Results CSAu and CSAu–CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). Conclusion The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.

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“…In comparison to the healthy controls from this study, the median nerve of cyclists at rest had a significantly higher CSA and significantly greater stiffness. Recent meta-analyses reported that the pooled estimate of the CSA at carpal tunnel inlet is 8.54 mm 2 [ 11 ] or 8.3 mm 2 [ 12 ]. The values observed in the current study are consistent with these reports, as the normal young volunteers mean CSA was estimated at 7.17 mm 2 and the values of resting cyclist at 9.10 mm 2 ( Table 2 , Figure 4 ).…”

Section: Discussionmentioning

confidence: 99%

Elastography of nerves in the wrists of cyclists

Dąbrowska,

Paluch,

Walecka

et al. 2024

Pol J Radiol

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PurposeThis study aimed to investigate changes in the elasticity of the median and ulnar nerves in cyclists.Material and methodsThe study included 30 cyclists and 2 non-biking reference groups that included 32 healthy volunteers and 32 individuals with ulnar nerve entrapment neuropathies. All participants underwent physical, ultrasonographic, and elastographic examinations including assessment of nerve cross-sectional area (CSA) and stiffness (SWE). The cyclists’ group was tested before and after a 2-hour workout.ResultsThe values of ulnar nerve CSA and stiffness in Guyon’s canal in resting cyclists were 5.30 ± 1.51 mm2 and 49.05 ± 11.18 kPa, respectively. These values were significantly higher than in the healthy volunteers, but not higher than in the nerve entrapment group. Median nerve CSA and stiffness at rest were 9.10 ± 2.61 mm2 and 38.54 ± 14.87 kPa, respectively. Both values were higher than respective values in the healthy group. Cycling induced an increase in all these parameters, although the increase in nerve stiffness was more noticeable than in CSA.ConclusionsThe elasticity of the median and ulnar nerve in cyclists remains within normal limits, questioning the belief that cyclists are at risk of nerve palsy in Guyon’s canal. However, cycling workout does exert compression, resulting in transient oedema of both nerves. The dynamics of changes was more noticeable in SWE examination than in conventional ultrasound, which may depend on SWE sensitivity.

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The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis

Cited by 8 publications

References 89 publications

An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem

An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem

Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study

Elastography of nerves in the wrists of cyclists

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