Ultrasound measurement of median nerve cross-sectional area at the inlet and outlet of carpal tunnel after carpal tunnel release compared to electrodiagnostic findings

Inui, Atsuyuki; Nishimoto, Hanako; Mifune, Yutaka; Kokubu, Tatsuo; Sakata, Ryosuke; Kurosaka, Masahiro

doi:10.1007/s00402-016-2514-9

Cited by 22 publications

(31 citation statements)

References 24 publications

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“…Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, affecting 2.7% to 3.8% of the general population . Carpal tunnel syndrome results from compression of the median nerve within the carpal tunnel region, resulting in intraneural edema, demyelination, and, in severe cases, axonal loss and fibrosis . Depending on the extent of median nerve dysfunction, clinical symptoms and signs may include thenar atrophy, numbness, paresthesia, pain, and weakness in the median nerve distribution .…”

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confidence: 99%

“…For example, the US‐measured proximal median nerve CSA has similar sensitivity and specificity as electrodiagnostic testing in the diagnosis of CTS when clinical findings are used as a reference standard, and a CSA of greater than 15 mm 2 correlates with electrodiagnostically severe CTS . The observed increases in the proximal median nerve CSA are often accompanied by hypoechogenicity and a reduction in the normal fascicular architecture . These changes are presumed to represent the US manifestations of intraneural edema and therefore may be at least partially reversible after successful treatment …”

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confidence: 99%

“…The observed increases in the proximal median nerve CSA are often accompanied by hypoechogenicity and a reduction in the normal fascicular architecture . These changes are presumed to represent the US manifestations of intraneural edema and therefore may be at least partially reversible after successful treatment …”

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confidence: 99%

“…Multiple studies have used US to document changes in the proximal median nerve CSA within the proximal carpal tunnel region after open or endoscopic CTR. Despite potentially significant methodological differences, most of these studies reported reductions in the proximal median nerve CSA during follow‐up periods of 1 to 12 months after CTR . Postoperative median nerve CSA reductions appear to be similar among patients treated with open and endoscopic CTR, and in both cases, the reduction in the median nerve CSA has been interpreted to represent a reduction in intraneural edema as a result of successful TCL transection .…”

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confidence: 99%

“…Despite potentially significant methodological differences, most of these studies reported reductions in the proximal median nerve CSA during follow‐up periods of 1 to 12 months after CTR . Postoperative median nerve CSA reductions appear to be similar among patients treated with open and endoscopic CTR, and in both cases, the reduction in the median nerve CSA has been interpreted to represent a reduction in intraneural edema as a result of successful TCL transection . Despite the improvement in median nerve CSA after open and endoscopic CTR, the CSA does not necessarily return to normal even at long‐term follow‐up in clinically improved patients .…”

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confidence: 99%

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Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Chappell¹,

Beckman²,

Baird

et al. 2019

J of Ultrasound Medicine

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Objective To document changes in the median nerve cross‐sectional area (CSA) in the proximal carpal tunnel region after ultrasound (US)‐guided carpal tunnel release (CTR). Methods Prospective data were collected on 23 consecutive patients (37 wrists) treated with US‐guided CTR by the primary author using the same office‐based microinvasive technique. Ultrasound was used to measure the largest CSA of the median nerve in the proximal carpal tunnel region both preoperatively and postoperatively. The primary outcome measure was the change in the preoperative versus 6‐ to 10‐week postoperative median nerve CSA. Results The mean CSA of the median nerve decreased from 16.08 to 12.75 mm2 at 6 to 10 weeks after US‐guided CTR (P < .001). During the same period, the mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom score decreased from 3.23 to 1.67 (P < .001), and mean BCTQ functional score decreased from 2.49 to 1.47 (P < .001), both exceeding minimal clinically important differences. Although the primary end point was the median nerve CSA at 6 to 10 weeks, statistically significant reductions in the median nerve CSA, as well as BCTQ scores, were also observed as early as 2 to 4 weeks after US‐guided CTR (median nerve CSA, 12.40 mm2; BCTQ symptom score, 2.00; BCTQ functional score, 1.75; all P ≤ .03). Conclusions To our knowledge, this investigation was the largest to date examining changes in the proximal median nerve CSA after US‐guided CTR. Statistically significant reductions in the proximal median nerve CSA were observed within 6 to 10 weeks after ultrasound‐guided CTR. These reductions were similar to those previously reported for open and endoscopic CTR and validate the ability of US‐guided CTR to relieve median nerve compression.

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Chappell¹,

Beckman²,

Baird

et al. 2019

J of Ultrasound Medicine

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Application of ultrasound images‐based radiomics in carpal tunnel syndrome: Without measuring the median nerve cross‐sectional area

Lyu¹,

Zhang²,

Zhang³

et al. 2023

J of Clinical Ultrasound

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PurposeBy constructing a prediction model of carpal tunnel syndrome (CTS) based on ultrasound images, it can automatically and accurately diagnose CTS without measuring the median nerve cross‐sectional area (CSA).MethodsA total of 268 wrists ultrasound images of 101 patients diagnosed with CTS and 76 controls in Ningbo NO.2 Hospital from December 2021 to August 2022 were retrospectively analyzed. The radiomics method was used to construct the Logistic model through the steps of feature extraction, feature screening, reduction, and modeling. The area under the receiver operating characteristic curve was calculated to evaluate the performance of the model, and the diagnostic efficiency of the radiomics model was compared with two radiologists with different experience.ResultsThe 134 wrists in the CTS group included 65 mild CTS, 42 moderate CTS, and 17 severe CTS. In the CTS group, 28 wrists median nerve CSA were less than the cut‐off value, 17 wrists were missed by Dr. A, 26 wrists by Dr. B, and only 6 wrists were missed by radiomics model. A total of 335 radiomics features were extracted from each MN, of which 10 features were significantly different between compressed and normal nerves, and were used to construct the model. The area under curve (AUC) value, sensitivity, specificity, and accuracy of the radiomics model in the training set and testing set were 0.939, 86.17%, 87.10%, 86.63%, and 0.891, 87.50%, 80.49%, and 83.95%, respectively. The AUC value, sensitivity, specificity, and accuracy of the two doctors in the diagnosis of CTS were 0.746, 75.37%, 73.88%, 74.63% and 0.679, 68.66%, 67.16%, and 67.91%, respectively. The radiomics model was superior to the two‐radiologist diagnosis, especially when there was no significant change in CSA.ConclusionRadiomics based on ultrasound images can quantitatively analyze the subtle changes in the median nerve, and can automatically and accurately diagnose CTS without measuring CSA, especially when there was no significant change in CSA, which was better than radiologists.

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Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study

Karahan

Arslan

Ordahan

et al. 2018

J of Ultrasound Medicine

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Ultrasound measurement of median nerve cross-sectional area at the inlet and outlet of carpal tunnel after carpal tunnel release compared to electrodiagnostic findings

Abstract: The proximal CSA of the median nerve decreased continuously over the time after CTR while the distal CSA increased up to 3 months before it decreased continuously, too.

Cited by 22 publications

References 24 publications

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Application of ultrasound images‐based radiomics in carpal tunnel syndrome: Without measuring the median nerve cross‐sectional area

Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study

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