DIAGNOSTIC VALUES OF ULTRASOUND MEASUREMENTS OF THE MEDIAN NERVE IN PATIENTS WITH CARPAL TUNNEL SYNDROME

  • Dushanka Grujoska-Veta PHI University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Clinical Center „Mother Theresa”, Skopje, RNM, University Clinic for Orthopedic Diseases -Skopje
  • Roze Dzoleva Toleska PHI University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Clinical Center „Mother Theresa”, Skopje, RNM, University Clinic for Orthopedic Diseases -Skopje
  • Vilijam Velkovski PHI University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Clinical Center „Mother Theresa”, Skopje, RNM, University Clinic for Orthopedic Diseases -Skopje
  • Bashkim Osmani University clinic of rheumatology- Skopje, Clinical Center “Mother Theresa”, Skopje, RNM
  • Filip Gucev University clinic of rheumatology- Skopje, Clinical Center “Mother Theresa”, Skopje, RNM
  • Jasna Bogdanska Institute of Medical and Experimental Biochemistry, Faculty of Medicine in Skopje, University „Ss. Cyril and Methodius” Skopje, RN Macedonia

Abstract

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper extremity, caused by chronic compression of the median nerve in the area of the carpal tunnel with prevalence in females. The diagnosis is based on characteristic symptoms and signs, clinical findings, electroneuromyographic examination (ENMG) and diagnostic imaging.The aim of our study is to determine the role of ultrasound examination (US) of the median nerve in patients with CTS .A prospective clinical study included 116 patients with clinical diagnosis of CTS and positive findings of ENMG examination who were admitted for surgical procedure of open carpal tunnel release. US examination of carpal tunnel and the median nerve were done in all patients on transverse and longitudinal axis of wrists. Measurements of the cross-sectional area (CSA) of the median nerve at inlet level revealed various grades of severity: mild, moderate and severe with CSA values of 10,9 -12,1 mm2; 12,2 -15,3 mm2 ;15,9-20,3mm2 respectively. Correlation of severity grading of US measurements and ENMG findings was positive and statistically significant (p=0.000003, p=0.00006, and p<0.0001). Neuromuscular ultrasound examination provides valuable information on morphology of carpal tunnel content and possible etiology of CTS. Although dynamic imaging is used during US examination, measurements are done only on static scanning. It is used as additional tool in clinical practice of orthopedic surgeons and is very useful in early diagnosis, treatment planning and outcome follow-up.


Kew words:carpal tunnel syndrome, ultrasound measurements, severity grading

References

1.Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med 2002; 346(23):1807-12.
2.Kazamel M, Warren PP. History of electromyography and nerve conduction studies: A tribute to the founding fathers. J Clin Neurosci. 2017;43 (9):54-60.
3.Spindler HA, Dellon AL. Nerve conduction studies and sensibility testing in carpal tunnel syndrome. J Hand Surg Am. 1982;7(3):260-3.
4.Jablecki CK, Andary MT, So YT, Wilkins DE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee. Muscle Nerve. 1993;16(12):1392-414.
5.Buchberger W, Schon G, Strasser K, Jungwirth W. High-resolution ultrasonography of the carpal tunnel. J Ultrasound Med. 1991;10:531–537.
6.Bagatur A E, Yalcinkaya M, Ali Onder Atca A O. Bifid Median Nerve Causing Carpal Tunnel Syndrome: MRI and Surgical Correlation. Orthopedics April 2013 - Volume 36 • Issue 4: e451-e456 DOI: 10.3928/01477447-20130327-21
7.BuchbergerW, JudmaierW, BirbamerG, LenerM, SchmidauerC. Carpal Tunnel Syndrome: Diagnosis with High-Resolution Sonography. AJR.1992;159:793-798.
8.Wong D C M, Wansaicheong G K L, Tsou I Y Y. Ultrasonography of the hand and wrist. Singapore Med J. 2009; 50: 219-225.
9.Billakota S, Hobson-Webb LD. Standard median nerve ultrasound in carpal tunnel syndrome: A retrospective review of 1,021 cases. Clinical Neurophysiol Practice 2017;2:188–191
10.Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. Diagnosis of carpal tunnel syndrome: ultrasound versus electromyography. Radiol Clin North Am 1999;37(4):859 – 872.
11.Meyer P et al. The Median Nerve at the Carpal Tunnel … and Elsewhere. Journal of the Belgian Society of Radiology. 2018; 102(1):17 1–11.
12.Hobson-Webb LD, Massey JM, Juel VC, Sanders DB. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol. 2008; 119:1353–1357. [PubMed: 18387336]
13.Roll SC, Evans K. Feasibility of using a hand-carried sonographic unit for investigating median nerve pathology. J Diagn Med Sonography. 2009; 25:241–249.
14.Bland JD. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 2000;23(8):1280‐1283.doi:10.1002/1097-4598(200008)23:8<1280::aid-mus20>3.0.co;2-y
15.Kaplan Y, Kurt SG, Karaer H. Carpal tunnel syndrome in postmenopausal women. J Neurol Sci. 2008; 270:77–81.
16.Apostoli P, Sala E, Curti S, et al. Loads of housework? Biomechanical assessments of the upper limbs in women performing common household tasks. Int Arch Occup Environ Health. 2012; 85:421–5.
17.Hegmann KT, Thiese MS, Kapellusch J, et al. Association between cardiovascular risk factors and carpal tunnel syndrome in pooled occupational cohorts. J Occup Environ Med. 2016;58(1):87–93. doi: 10.1097/JOM.0000000000000573.
18.Chang YC, Chiang JH, Lay IS, Lee YC. Increased Risk of Coronary Artery Disease in People witha Previous Diagnosis of Carpal Tunnel Syndrome: A NationwideRetrospective Population-Based Case-Control Study. Biomed Res Int. 2019:3171925. doi.org/10.1155/2019/3171925
19.Mondelli M, Aprile I, Ballerini M, et al. Sex differences in carpal tunnel syndrome: comparison of surgical and nonsurgical populations. Eur J Neurol; 2005;12:976–83.
20.Farioli A, Curti S, Bonfiglioli R, Baldasseroni A, Spatari G, Mattioli S, Violante FS.
21.Observed Differences between Males and Femalesin Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysisof Findings from a Large Population Study. Ann Work Expo Health. 2018; 62(4):505–515.
doi: 10.1093/annweh/wxy015
22.Phalen, G. S. The carpal-tunnel syndrome: seventeen years' experience in diagnosis and treatment of six hundred and fifty-four hands. J Bone Joint Surg.1966; 48A: 211-228.
23.Kuhlman K A, Hennessey W J. Sensitivity and Specificity of Carpal Tunnel Syndrome Signs. Am J Phys Med Rehabil. Nov-Dec 1997;76(6):451-7.doi: 10.1097/00002060-199711000-00004
24.Bathala L, Kumar P, Kumar K, Shaik A, Visser LH. Normal values of median nerve cross-sectional area obtained by ultrasound along its course in the arm with electrophysiological correlations, in 100 Asian subjects. Muscle Nerve 2014;49:284–286. PMID
25.Mani B, Sarawagi R, Cherian RA. Review of the dimensions of the median nerve and carpal tunnel using sonography in asymptomatic adults. J Med Imaging Radiat Oncol. 2011;55:126–131.
26.Fu T, Cao M, Liu F, Zhu J, Ye D, et al. (2015) Carpal Tunnel Syndrome Assessment with Ultrasonography: Value of Inlet-to-Outlet Median Nerve Area Ratio in Patients versus Healthy Volunteers. PLOS ONE 10 (1): e0116777.
https://doi.org/10.1371/journal.pone.0116777
27.Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurol Sci. 2010; 31(3):243–252.
28.El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?. Rheumatology 2004;43:887–895. Doi:10.1093/rheumatology/keh190
29.Fujimoto K, Kanchiku T, Kido K, Imajo Y, Funaba M, Taguchi T. Diagnosis of severe carpal tunnel syndrome using nerve conduction study and ultrasonography. Ultrasound Med Biol. 2015;41:2575–80.
30.Ooi CC, Wong SK, Tan AB, Chin AY, Abu Bakar R, Goh SY, Mohan PC, Yap RT, Png MA. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skelet Radiol. 2014;43:1387–94.
31.Ziswiler HR, Reichenbach S, Vöö¨gelin E, Bachmann LM, Peter M. Villiger PM and Juni P. Diagnostic Value of Sonography in Patients With Suspected Carpal Tunnel Syndrome ARTHRITIS & RHEUMATISM, Vol. 52, No. 1, 2005;304–311 DOI 10.1002/art.20723
32.Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol. 2013 Feb;17(1):28-33. doi: 10.1055/s-0033-1333911
33.Moran L, Perez M, Esteban A, Bellon J, Arranz B, del Cerro M. Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound. 2009;37(3):125-31. 40.
34.Mhoon JT, Juel VC, Hobson-Webb LD. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality. Muscle Nerve. 2012;46(6):871-8
35.Koyuncuoglu HR, Kutluhan S, Yesildag A, Oyar O, Guler K, Ozden A. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol. 2005;56(3):365-9.
Published
2020-12-25
How to Cite
GRUJOSKA-VETA, Dushanka et al. DIAGNOSTIC VALUES OF ULTRASOUND MEASUREMENTS OF THE MEDIAN NERVE IN PATIENTS WITH CARPAL TUNNEL SYNDROME. Journal of Morphological Sciences, [S.l.], v. 3, n. 3, p. 56-69, dec. 2020. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/165>. Date accessed: 28 jan. 2021.
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Articles