TITLE:
Role of High Resolution Ultrasound in Assessment of Abnormalities of Median Nerve in Carpal Tunnel Syndrome
AUTHORS:
Mohamed Farouk Agag, Moutaz M. Kamal Elsharkawy, Ahmed Khedewy Ahmed
KEYWORDS:
Carpel Tunnel Syndrome, Median Nerve, Ultrasound, Electrodiagnostic Studies
JOURNAL NAME:
Open Journal of Medical Imaging,
Vol.10 No.2,
April
20,
2020
ABSTRACT: Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy
and consists of the compression of the median nerve as it courses through the
carpal tunnel. Carpal tunnel syndrome was diagnosed by history and physical
examination, electrodiagnostic studies (EDX) were used to confirm the
diagnosis. However, these studies are painful for most of the patients with high incidence of false positive or false negative results. Ultrasound is a low
cost, short time and non-invasiveness technique that could be used to assess a
number of parameters of the median nerve (MN) in cases of CTS. Objective: To assess the utility of high resolution ultrasound (HRUS) in assessment of median nerve in carpal tunnel syndrome through
different ultrasound diagnostic criteria in patients with clinical and electrodiagnostic evidence of CTS. Patients
and Methods: This study included a total of 60 participants divided into 2 groups; group
A, the patients group included 30 patients with a clinical diagnosis of carpal tunnel syndrome (CTS) and
group B, the control group who included 30 sex and age-matched healthy individuals. All the included cases were
subjected to full history taking, full general and general examination. Nerve
conduction studies were performed using a Caldwell Sierra Wave and the NCS
consisted of sensory median nerve conduction tests using standard techniques. High resolution US was
performed by using an Aplio 400 Ultrasound
System. The following measurement was recorded in each of the included subjects including cross sectional area (CSA) of the median nerve, flattening
ratio (FR) of median nerve and palmar
bowing (PB) of the flexor retinaculum. Results: There was high statistically significant difference in
the mean CSA and mean PB between the cases with CTS and healthy control. No
statistically significant difference in the mean FR between the cases with CTS
and healthy control. Optimal CSA cut-off value to differentiate between cases
with CTS and control was (10.2 mm2) and the optimal PB cut-off value
to differentiate between cases with CTS and control was (3.3 mm). Positive correlation was detected between the
CSA and PB with increasing the severity of CTS. Conclusion: Electrophysiological
studies are the most utilized diagnostic methods for diagnosing nerve
entrapment including median nerve in CTS. Hugh resolution ultrasound (HRUS) is non- invasive sensitive diagnostic tool in diagnosing CTS.