Ultrasonographic measurement of median nerve and wrist skin thickness in patients with carpal tunnel syndrome: relationship with clinical, electrophysiologic and functionality

Abstract

The study aimed to investigate the relationship between the proximal and distal cross-sectional area (CSA) of the median nerve and wrist skin thickness measured by ultrasound in patients with carpal tunnel syndrome (CTS), demographics, disease characteristics, electrophysiological measurements, symptom severity, functionality, and symptom severity. 98 patients with electrophysiological diagnoses of CTS in the dominant hand were included in the study. Proximal and distal CSAs of the median nerve and wrist skin thickness were measured ultrasonographically. Demographic and disease characteristics of the patients were recorded. Patients were evaluated with the Historical-Objective scale (Hi- Ob) for clinical staging, the Functional status scale (FSS) for functional status, and the Boston symptom severity scale (BSSS) for symptom severity. Ultrasonographic findings were correlated with demographic and disease characteristics, electrophysiological findings, Hi-Ob scala, Functional status scale (FSS), and Boston symptom severity scale (BSSS). Proximal median nerve CSA median was 11.0 (7.0-14.0) mm2, distal median nerve CSA median was 10.5 (5.0-18.0) mm2, and wrist skin thickness was measured 1.10 (0.6-1.40) mm. Median nerve CSAs were positively correlated with the CTS stage and FSS, negatively correlated with the sensory nerve action potential of the median nerve (SNAP) and the compound muscle action potential of the median nerve (CMAP) ( p<0.05). Wrist skin thickness was positively correlated with disease characteristics, including the presence of paresthesia and loss of dexterity and FSS and BSSS levels. Ultrasonographic measurements in CTS are associated with functionality rather than demographics. Especially the increase in wrist skin thickness leads to an increase in symptom severity.

A transmuscular path of the medial branch of the high division of the median nerve: an anatomical variation of clinical and surgical importance

“…Ultrasonography (US) has been shown to be a reliable tool for detecting the morphology of the bifid MN, which is generally not an infrequent variation, particularly in hands with CTS [30][31][32]. It is also important in the diagnosis of CTS, based on the enlargement of the MN with an area greater than 9 mm² or 10 mm² at the level of the pisiform bone [33][34][35][36]. Monagle et al, [37] demonstrated with magnetic resonance imaging that the MN in CTS was enlarged both proximally and within the carpal tunnel.…”