Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Nkrumah, Gideon; Blackburn, Alan R; Goitz, Robert J.; Fowler, John R.

doi:10.1177/1558944718788642

Cited by 17 publications

(16 citation statements)

References 16 publications

(19 reference statements)

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“…This finding could potentially be a result of natural differential distribution of fat resulting from higher BMI. 6 Additional studies examining this trend could guide pretest probability in physician decision making in the analysis of CTS and severity of future symptoms. Advanced imaging techniques can be useful in guiding the assessment of the carpal tunnel anatomy and median nerve impingement and may aid in the confirmation of a CTS diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 , 9 , 10 The factors predictive of the median nerve CSA have prognostic value as the median nerve CSA is a reliable predictor of CTS severity. 6 Although obesity is a known risk factor for CTS, the exact mechanism of how this contributes to increased risk for CTS is unclear. 2 , 11 , 12 Additionally, to our knowledge, how obesity may predispose individuals to median nerve changes and where within the carpus this may occur were previously unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have found a significant positive correlation between the median nerve CSA and CTS-6 results, making it an acceptable alternative to electrodiagnostic testing. 5 , 6 , 7 The magnetic resonance images of median nerves can also be used to measure the average median nerve CSA, although they are not typically obtained in the management of CTS. Nevertheless, magnetic resonance images obtained for reasons other than the evaluation of CTS can be used to determine baseline CSA values for a large cohort of patients.…”

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confidence: 99%

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Magnetic Resonance Imaging–Measured Cross-Sectional Area of the Median Nerve

Como¹,

Dooley²,

Bowers³

et al. 2022

Journal of Hand Surgery Global Online

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The size of the median nerve may serve as a useful parameter to predict carpal tunnel syndrome (CTS) in a subset of patients. The purpose of this study was to evaluate magnetic resonance imagingebased measurements of median nerve cross-sectional area (CSA) to examine trends between patient subgroups and CSA that may assist in predicting the individuals who are most likely to develop CTS symptoms. Methods: A retrospective chart review of 1,273 wrist magnetic resonance images was performed, and the images were analyzed to evaluate the median nerve CSA at the level of the pisiform and the hook of hamate. The age, sex, height, weight, and body mass index (BMI) of the patients were collected from their medical records. Results: The median nerve size correlated with patient BMI. Additionally, patients with CTS had larger median nerves at the hook of hamate and pisiform than those without CTS. When subdividing patients on the basis of BMI, obese patients with CTS had larger median nerve CSA at the pisiform than those without CTS. Conclusions: This study demonstrated that increased BMI is associated with increased median nerve CSA at the hook of hamate and pisiform in patients with or without CTS. Additionally, patients with CTS had larger median nerve CSA than those without CTS. Measurements at these locations may help predict individuals who are likely to experience median nerve impingement. Type of study/level of evidence: Prognostic III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Magnetic Resonance Imaging–Measured Cross-Sectional Area of the Median Nerve

Como¹,

Dooley²,

Bowers³

et al. 2022

Journal of Hand Surgery Global Online

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“…Karadağ et al reported that US can give additional information about the severity of median nerve involvement and introduced US as a cost-effective modality in patients with suspected CTS, which reduced the number of NCV [30]. Nkrumah et al showed CSA findings in US were able to predict the severity of CTS in certain patients and influenced the decision to proceed with surgery [31].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Sonographic Evaluation of the Median Nerve and Fourth Flexor Tendon Between Asymptomatic Subjects With and Without Diabetes

et al. 2019

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Diabetes mellitus (DM) is a common metabolic disease associated with carpal tunnel syndrome (CTS) and tendinopathy. This study aimed to assess the ultrasonographic (US) parameters of the flexor tendon and median nerve in asymptomatic subjects with diabetes in comparison with controls without diabetes. In this study, 22 DM and 22 non-DM subjects with no symptoms or manipulations in non-dominant hands and wrists were assessed. Ultrasound evaluations of the length, width, cross-sectional area, and circumference of the fourth flexor tendon and the median nerve were performed in the two groups. There was no statistically significant difference in age (P value= 0.473), gender (P value= 0.364), or wrist circumference (P value= 0.1921) between the groups. This study showed no significant difference between the two groups in median nerve length (P value= 0.35), width (P value= 0.17), cross-sectional circumference (P value= 0.23), or cross-sectional area (P value= 0.16). Also, a comparison of the sonographic data of the fourth flexor tendon between the two groups presented no significant difference in length (P value = 0.68), width (P value= 0.80), cross-sectional circumference (P value= 0.70), or cross-sectional area (P value= 0.80). In conclusion, data from the present study showed that sonographic values of the median nerve and fourth flexor tendon in asymptomatic subjects with DM did not differ significantly with those of non-diabetics. These findings demonstrate that still more case studies and more evaluations are required to validate the applicability of ultrasonography in the prediction of carpal tunnel syndrome and tendinopathy in diabetic patients.

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Sonographic Measurement of Median Nerve Cross‐Sectional Area to Determine Severity of Carpal Tunnel Syndrome: A Cautionary Tale

Savage,

McKell

2024

J of Ultrasound Medicine

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ObjectivesEvaluate the diagnostic accuracy of median nerve cross‐sectional area (CSA) to determine the severity of carpal tunnel syndrome (CTS) vs the presence of CTS across existing electrodiagnostic‐based (EDX) classification systems.MethodsRetrospective analysis of cross‐sectional patient data. Receiver operating characteristic (ROC) analysis was used to determine CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX‐based classifications of CTS severity. Identification of CSA cutoff values associated with likelihood ratios capable of achieving conclusive (but at least moderate) shifts in diagnostic probability.ResultsBinary categorizations of CTS (ie, “Normal” vs “Absent”) were statistically superior to consolidated categorizations of CTS severity (ie, “Normal,” “Mild,” “Moderate,” or “Severe”). Binary categorizations established consistent CSA cutoff values across all EDX‐based classifications examined and achieved conclusive shifts in diagnostic probability based on the following values of distal CSA or delta CSA: <7 or <1 mm2 to rule out and >13 or >7 mm2 to rule in CTS, respectively. Additionally, the following values of distal CSA and delta CSA may be used in certain circumstances because they produce only small shifts in diagnostic probability: ≤10 or ≤3 mm2 to rule out and ≥11 or ≥4 mm2 to rule in CTS, respectively.ConclusionsUsing median nerve CSA to categorize the severity of CTS is not recommended based on lack of consistent and meaningful shifts in diagnostic probability. Rather, binary categorizations to rule out or rule in CTS based on the proposed CSA cutoff values consistently provided conclusive shifts in diagnostic probability across all EDX‐based classifications examined.

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Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Abstract: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.

Cited by 17 publications

References 16 publications

Magnetic Resonance Imaging–Measured Cross-Sectional Area of the Median Nerve

Magnetic Resonance Imaging–Measured Cross-Sectional Area of the Median Nerve

Comparison of Sonographic Evaluation of the Median Nerve and Fourth Flexor Tendon Between Asymptomatic Subjects With and Without Diabetes

Sonographic Measurement of Median Nerve Cross‐Sectional Area to Determine Severity of Carpal Tunnel Syndrome: A Cautionary Tale

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