Objectives The purpose of this study was to document and analyze intraneural vascular flow within the median nerve using power and spectral Doppler sonography and to determine the relationship of this vascular flow with diagnosis of carpal tunnel syndrome based on electrodiagnostic testing. Methods Power and spectral Doppler sonograms in the median nerve were prospectively collected in 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted with a 12-MHz linear transducer. Strict inclusion criteria were established for postexamination assessment of waveforms; routine quality assurance was completed; electrodiagnostic tests were conducted on the same day as sonographic measurements; and the skin temperature was controlled. Included waveforms were categorized by location and averaged by individual for comparative analysis to electrodiagnostic testing. Results A total of 416 waveforms were collected, and 245 were retained for statistical analysis based on strict inclusion criteria. The mean spectral peak velocity among all waveforms was 4.42 (SD, 2.15) cm/s. At the level of the pisiform, the most consistent data point, mean peak systole, was 3.75 cm/s in symptomatic patients versus 4.26 cm/s in asymptomatic controls. Statistical trending showed an initial increase in the mean spectral peak velocity in symptomatic but diagnostically negative cases, with decreasing velocity as diagnostic categories progressed from mild to severe. Conclusions An inverse relationship may exist between intraneural vascular flow in the median nerve and an increasing severity of carpal tunnel syndrome based on nerve conduction results. Randomized controlled trials are needed to determine whether spectral Doppler sonography can provide an additive benefit for diagnosing the severity of carpal tunnel syndrome.

A prospective cohort of 47 symptomatic patients who reported for nerve conduction studies and 44 asymptomatic controls was examined with sonography to evaluate the median nerve. Doppler studies of the median nerve were collected with handheld sonography equipment and a 12-MHz linear broadband transducer. Strict inclusion criteria were established for assessing 435 waveforms from 166 wrists. Two sonographers agreed that 245 waveforms met the a priori criteria and analyzed the corresponding data. Spectral Doppler waveforms provided direct quantitative and qualitative data for comparison with indirect provocative testing results. These Doppler data were compared between the recruitment groups. No statistical difference existed in waveforms between the groups (P < .05). Trending of the overall data indicated that as the number of positive provocative tests increased, the mean peak systolic velocity within the carpal tunnel (mid) also increased, whereas the proximal mean peak systolic velocity decreased. However, by using multiple provocative tests as an indirect comparative measure, researchers may find mean peak spectral velocity at the carpal tunnel inlet a helpful direct measure in identifying patients with carpal tunnel syndrome.

This mixed-method blinded research study used high-frequency diagnostic medical sonography (DMS) to document myofascial trigger points (MTrPs) associated with ankle/foot pain. A total of 17 symptomatic and 8 asymptomatic participants provided 500 MTrP areas for palpation. Forty-nine of these MTrP areas (including 16 tender points, 15 palpable MTrPs, and 18 palpated and imaged MTrPs) were compared with the patient’s ankle/foot pain, collected with the SF-12 Health Survey, Victorian Institute of Sports Assessment–Achilles questionnaire, and a visual analog scale. Qualitative analyses of the participants’ histories were used to understand the context of the data collected. The mean area of the 18 imaged MTrPs was 0.09 cm2, and they appeared inhomogeneous and hypoechoic. Those with right-sided MTrPs were statistically significant for those with reported pain. Participants with left-sided MTrPs did not demonstrate a significant correlation to reported pain. The results demonstrated a promising possible diagnostic approach using sonography to evaluate MTrPs in the ankle/foot for documenting myofascial pain. In addition, elastography and transducer frequencies >12 MHz are proposed as a DMS technique to increase overall diagnostic yield.

Introduction Ultrasonography may be valuable in staging carpal tunnel syndrome severity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinical measures. Methods Measures were obtained in 104 participants. Multiple categorization structures for each variable were correlated to diagnostic severity based on nerve conduction. Goodness-of-fit was evaluated for models using iterative combinations of highly correlated variables. Using the best-fit model, a preliminary scoring system was developed, and frequency of misclassification was calculated. Results The severity staging model with best fit (Rho 0.90) included patient-reported symptoms, functional deficits, provocative testing, nerve cross-sectional area, and nerve longitudinal appearance. An 8-point scoring scale classified severity accurately for 79.8% of participants. Discussion This severity staging model is a novel approach to carpal tunnel syndrome evaluation. Including more sensitive measures of nerve vascularity, nerve excursion, or other emerging techniques may refine this preliminary model.

This study examined the feasibility of a longitudinal design to sonographically measure swelling of the median nerve due to controlled exposure to a work task and to evaluate the relationship of changes in morphology to diagnostic standards. Fifteen macaca fascicularis pinched a lever in various wrist positions at a self-regulated pace (8 hours/day, 5 days/week, 18–20 weeks). Nerve conduction velocity (NCV) and cross-sectional area (CSA) were obtained every two weeks from baseline through working and a 6-week recovery. Trending across all subjects showed that NCV slowed and CSA at the carpal tunnel increased in the working arm, while no changes were observed in CSA either at the forearm or for any measure in the non-working arm. There was a small negative correlation between NCV and CSA in the working arm. This study provides validation that swelling can be observed using a longitudinal design. Longitudinal human studies are needed to describe the trajectory of nerve swelling for early identification of median nerve pathology.