The Use of Ultrasound Imaging to Demonstrate Reduced Movement of the Median Nerve during Wrist Flexion in Patients with Non-Specific Arm Pain

Abstract

Following clinical screening, we examined movement of the median nerve at the wrist using high-resolution (10-22 MHz) ultrasound in 16 controls and 12 patients with non-specific arm pain (also referred to as repetitive strain injury). Imaging was performed just proximal to the carpal tunnel with the wrist in neutral, 30 degrees of extension and 30 degrees of flexion. In control subjects the position of the median nerve was 4.8 (SE=0.4) mm more radial with the wrist flexed than with the wrist extended. In the twelve arm pain patients the average change was only 1.2 (SE=0.5) mm. It appears that ultrasound imaging may be helpful in diagnosing non-specific arm pain, a condition for which there are no well-defined diagnostic tests at present. The reduced nerve movement seen with ultrasound imaging confirms previous work with magnetic resonance imaging.

The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study

“…In vivo studies using diagnostic ultrasound (DUS) demonstrate that this type of imaging is a valid tool for use in measuring longitudinal and transverse movement of nerve tissue during neural mobilization. 7,9,32,62,70 In addition, DUS has the ability to detect pathological changes in nerve morphology 52,71,72 and can be useful in visualizing the structures within an osteofibrous tunnel. 51,73 The ability of DUS to detect morphological changes as well as nerve movement makes this an excellent tool for further exploring the direct effects of neurodynamic mobilization on nerve tissue mechanics.…”

“…These disorders include compression syndromes or other neuromuscular conditions that may be accompanied by neuropathic pain. [1][2][3][4][5] Damaged nerves exhibit predictable pathophysiological responses including impaired nerve mobility, [6][7][8][9] increased mechanosensitivity, 8,10 impaired nerve conduction, [11][12][13] nerve tissue ischemia, 14,15 axonal transport inhibition, [16][17][18][19][20][21][22] and intraneural edema. 15,[23][24][25][26][27][28] Impaired nerve mobility and increased mechanosensitivity provide the basis for existing studies of neurodynamic techniques.…”

Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial

“…Entrapment of the median nerve in the carpal tunnel has been suggested as an associated component to the chronic pain of the upper limb in patients with cervical whiplash [11]. Furthermore, reduced movement of the median nerve has been reported proximal to the carpal tunnel in subjects with non-specific arm pain [12]. To the best of the authors' knowledge, this is the first study to report the effect of manual therapy on grip strength in patients with cervical whiplash.…”

High‐resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel

“…As the tunnel size and shape is uncommonly altered, increased pressure is assumed to result from a change in volume or material properties of the contents of the tunnel, 8,9 of which the most likely is the SSCT, which is known to be fibrotic in patients with CTS. 8,[10][11][12] Ultrasound imaging has been described to detect pathologies such as thickening of the flexor tendons 13 and transverse carpal ligament, 14 shape and echogenicity alterations, restricted median nerve sliding in the carpal tunnel, 15,16 synovial proliferation, soft-tissue infection and joint effusion, tissue calcification and tumors, 17 persistent median artery, 18 tendinous and ligamentous injuries and swelling of the median nerve in the proximal part of the carpal tunnel, and flattening of the median nerve in the distal part of the carpal tunnel. 6,14,[19][20][21] High-resolution ultrasonography with approximately 7 MHz transducers is suitable for assessment of dynamic changes in the tunnel.…”