Ultrasound Assessment of the Median Nerve: a Biomarker That Can Help in Setting a Treat to Target Approach Tailored for Carpal Tunnel Syndrome Patients

Overview

Journal Springerplus

Date 2015 Jan 28

PMID 25625037

Citations 15

Authors

Yasser El Miedany

Maha El Gaafary

Sally Youssef

Ihab Ahmed

Annie Nasr

Affiliations

Soon will be listed here.

Abstract

Ultrasonography (US) is a valuable tool for confirming the diagnosis of carpal tunnel syndrome (CTS) as it enables the detection of changes in the median nerve shape and rule out anatomic variants as well as space-occupying lesions such as ganglion cysts or tenosynovitis. This work was carried out aiming at: 1. Ultrasonography assessment of the median nerve and its neurovascular blood-flow in CTS patients before and after management. 2. Verify the possibility of using baseline US parameters as a biomarker to predict likely outcomes and frame a treatment plan for CTS patients. 233 CTS subjects diagnosed based on clinical and electrophysiological (NCS) testing were included in this work. US measures at the tunnel inlet included: cross sectional area, flattening ratio and neural Power Doppler (PD) signals. Patients who had severe NCS outcomes or neurological deficit were referred for open surgical decompression; the remaining patients were given the choice of either conservative or surgical management. The main outcome variable was improvement >70% in CTS symptoms. Assessments were carried out at baseline, 1-week, 1-month and 6-months post treatment. Results revealed an inverse relation between the neural vasculature and CTS severity defined by NCS (r = - 0.648). In CTS cases treated conservatively, the US measures started to improve within 1-week, whereas in the surgically treated cohort there was an initial phase of post-operative nerve measures increase, before settling at 1-month time of follow-up. The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio. This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1). The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection.

Citing Articles

Fluorescein Angiography for Monitoring Neural Blood Flow in Chronic Nerve Compression Neuropathy: Experimental Animal Models and Preliminary Clinical Observations.

Saito K, Okada M, Yokoi T, Hama S, Nakamura H Neurol Int. 2024; 16(5):976-991.

PMID: 39311347 PMC: 11417749. DOI: 10.3390/neurolint16050074.

Gray-Scale and Power Doppler Ultrasound Findings Predictive of Cubital Tunnel Syndrome Severity.

Lee T, Dy C, Ray W, Colorado B, Brogan D Hand (N Y). 2022; 19(3):392-399.

PMID: 36218028 PMC: 11067851. DOI: 10.1177/15589447221127334.

Ultrasonographic and electrophysiological outcomes of carpal tunnel syndrome treated with low-level laser therapy: A double-blind, prospective, randomized, sham-controlled study.

Nalbant M, Yemisci O, Ozen S, Tezcan S Arch Rheumatol. 2022; 37(1):19-30.

PMID: 35949869 PMC: 9326377. DOI: 10.46497/ArchRheumatol.2022.8605.

Ultrasonography for the diagnosis of carpal tunnel syndrome: an umbrella review.

Lin T, Chang K, Wu W, Ozcakar L J Neurol. 2022; 269(9):4663-4675.

PMID: 35639198 DOI: 10.1007/s00415-022-11201-z.

The value of sonographic quantitative parameters in the diagnosis of carpal tunnel syndrome in the Vietnamese population.

Vo N, Nguyen T, Nguyen D, Le T, Le N, Nguyen T J Int Med Res. 2021; 49(12):3000605211064408.

PMID: 34939464 PMC: 8721721. DOI: 10.1177/03000605211064408.

References

Miedany Y, El Gaafary M, Youssef S, Ahmed I, Nasr A . Ultrasound assessment of the median nerve: a biomarker that can help in setting a treat to target approach tailored for carpal tunnel syndrome patients. Springerplus. 2015; 4:13. PMC: 4300309. DOI: 10.1186/s40064-014-0779-4. View

Jordan R, Carter T, Cummins C . A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome. Br J Gen Pract. 2002; 52(481):670-3. PMC: 1314389. View

Klauser A, Halpern E, De Zordo T, Feuchtner G, Arora R, Gruber J . Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2008; 250(1):171-7. DOI: 10.1148/radiol.2501080397. View

Yu G, Firrell J, Tsai T . Pre-operative factors and treatment outcome following carpal tunnel release. J Hand Surg Br. 1992; 17(6):646-50. DOI: 10.1016/0266-7681(92)90192-5. View

Mondelli M, Passero S, Giannini F . Provocative tests in different stages of carpal tunnel syndrome. Clin Neurol Neurosurg. 2001; 103(3):178-83. DOI: 10.1016/s0303-8467(01)00140-8. View

Mackinnon S, Dellon A, Hudson A, Hunter D . Chronic nerve compression--an experimental model in the rat. Ann Plast Surg. 1984; 13(2):112-20. DOI: 10.1097/00000637-198408000-00004. View

Bessette L, KELLER R, Liang M, Simmons B, Fossel A, Katz J . Patients' preferences and their relationship with satisfaction following carpal tunnel release. J Hand Surg Am. 1997; 22(4):613-20. DOI: 10.1016/S0363-5023(97)80117-7. View

Muhlau G, Both R, Kunath H . Carpal tunnel syndrome--course and prognosis. J Neurol. 1984; 231(2):83-6. DOI: 10.1007/BF00313722. View

PHALEN G . The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966; 48(2):211-28. View

10.

Mondelli M, Filippou G, Aretini A, Frediani B, Reale F . Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor?. Scand J Rheumatol. 2008; 37(3):219-24. DOI: 10.1080/03009740801914850. View

11.

Abicalaf C, de Barros N, Sernik R, Pimentel B, Braga-Baiak A, Braga L . Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament. Clin Radiol. 2007; 62(9):891-4. DOI: 10.1016/j.crad.2007.01.029. View

12.

Lundborg G, Dahlin L . Anatomy, function, and pathophysiology of peripheral nerves and nerve compression. Hand Clin. 1996; 12(2):185-93. View

13.

Strickland J, Gozani S . Accuracy of in-office nerve conduction studies for median neuropathy: a meta-analysis. J Hand Surg Am. 2010; 36(1):52-60. DOI: 10.1016/j.jhsa.2010.09.012. View

14.

Mallouhi A, Pulzl P, Pultzl P, Trieb T, Piza H, Bodner G . Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol. 2006; 186(5):1240-5. DOI: 10.2214/AJR.04.1715. View

15.

Torp-Pedersen S, Terslev L . Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis. 2007; 67(2):143-9. DOI: 10.1136/ard.2007.078451. View

16.

Smidt M, Visser L . Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve. 2008; 38(2):987-91. DOI: 10.1002/mus.20982. View

17.

Rahmani M, Ghasemi Esfe A, Vaziri-Bozorg S, Bozorg S, Mazloumi M, Khalilzadeh O . The ultrasonographic correlates of carpal tunnel syndrome in patients with normal electrodiagnostic tests. Radiol Med. 2011; 116(3):489-96. DOI: 10.1007/s11547-011-0632-6. View

18.

Mohammadi A, Afshar A, Etemadi A, Masoudi S, Baghizadeh A . Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med. 2010; 13(6):516-21. DOI: 010136/AIM.0012. View

19.

Ferraccioli G, Alivernini S, Gremese E . Biomarkers of joint damage in rheumatoid arthritis: where are we in 2013?. J Rheumatol. 2013; 40(8):1244-6. DOI: 10.3899/jrheum.130566. View

20.

Roll S, Case-Smith J, Evans K . Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature. Ultrasound Med Biol. 2011; 37(10):1539-53. DOI: 10.1016/j.ultrasmedbio.2011.06.011. View