Application of shear wave elastography and median nerve cross-section area in the diagnosis and staging of carpal tunnel syndrome: a case-control study

Mohammadi, Afshin; Afshar, Ahmadreza; Mirza-Aghazadeh-Attari, Mohammad; Mokhtari, Seyed Arman Seyed

doi:10.5114/pjr.2021.111437

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Therefore, the influence of training confirms that cycling exerts compression causing oedema in both nerves as their CSA increases. However, the rise in stiffness that depends of fibrosis [ 23 ] is pronounced more than CSA that depends on oedema. This phenomenon deserves clarification.…”

Section: Discussionmentioning

confidence: 99%

Elastography of nerves in the wrists of cyclists

Dąbrowska,

Paluch,

Walecka

et al. 2024

Pol J Radiol

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PurposeThis study aimed to investigate changes in the elasticity of the median and ulnar nerves in cyclists.Material and methodsThe study included 30 cyclists and 2 non-biking reference groups that included 32 healthy volunteers and 32 individuals with ulnar nerve entrapment neuropathies. All participants underwent physical, ultrasonographic, and elastographic examinations including assessment of nerve cross-sectional area (CSA) and stiffness (SWE). The cyclists’ group was tested before and after a 2-hour workout.ResultsThe values of ulnar nerve CSA and stiffness in Guyon’s canal in resting cyclists were 5.30 ± 1.51 mm2 and 49.05 ± 11.18 kPa, respectively. These values were significantly higher than in the healthy volunteers, but not higher than in the nerve entrapment group. Median nerve CSA and stiffness at rest were 9.10 ± 2.61 mm2 and 38.54 ± 14.87 kPa, respectively. Both values were higher than respective values in the healthy group. Cycling induced an increase in all these parameters, although the increase in nerve stiffness was more noticeable than in CSA.ConclusionsThe elasticity of the median and ulnar nerve in cyclists remains within normal limits, questioning the belief that cyclists are at risk of nerve palsy in Guyon’s canal. However, cycling workout does exert compression, resulting in transient oedema of both nerves. The dynamics of changes was more noticeable in SWE examination than in conventional ultrasound, which may depend on SWE sensitivity.

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Section: Discussionmentioning

confidence: 99%

Elastography of nerves in the wrists of cyclists

Dąbrowska,

Paluch,

Walecka

et al. 2024

Pol J Radiol

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“…SWE allows quantitative measurement of tissue stiffness or elasticity by tracking the propagation of shear waves generated by the US transducer. [8][9][10] Studies have reported increased MN stiffness or elasticity correlating with CTS severity, as the nerve undergoes biomechanical changes due to compression. [10][11][12][13] While both US and SWE have shown promise individually in CTS diagnosis, there is a paucity of research investigating their combined diagnostic performance in comprehensively evaluating CTS.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study

El-Maghraby,

Almalki,

Basha

et al. 2024

ORR

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Purpose Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). Materials and Methods This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28–57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. Results CSAu and CSAu–CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). Conclusion The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.

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“…With different targeting CTS cases and using either static strain elastography (tissue compression produces strain)[ 5 ] or share wave elastography (focused acoustic radiation force from a linear ultrasound array),[ 6 ] MN stiffness was reported, and its elastoscan determined the early pathophysiological changes that are caused by CTS. [ 7 - 10 ]…”

Section: Introductionmentioning

confidence: 99%

“…With different targeting CTS cases and using either static strain elastography (tissue compression produces strain) 5 or share wave elastography (focused acoustic radiation force from a linear ultrasound array), 6 MN stiffness was reported, and its elastoscan determined the early pathophysiological changes that are caused by CTS. [7][8][9][10] This study is an extension of the study by Lasheen et al, 11 which aimed to compare CTS patients and healthy volunteers regarding the ultrasound and sonoelastography (SE) of the MN at the wrist and the later correlation to nerve conduction study (NCS) results and included increased stiffness of MN affected by CTS with positive correlations with NCSs. In this paper, we focused on the symptomatic and the functional evaluation in correlation to MN elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary CTS patients.…”

mentioning

confidence: 99%

Elastosonography and electrodiagnosis in relation to symptomatic and functional grading of carpal tunnel syndrome

Yahia,

El Shambaky,

Lasheen

2023

Arch Rheumatol

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Objectives: This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. Patients and methods: In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7±10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. Results: CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Conclusion: Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS.

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Application of shear wave elastography and median nerve cross-section area in the diagnosis and staging of carpal tunnel syndrome: a case-control study

Cited by 7 publications

References 16 publications

Elastography of nerves in the wrists of cyclists

Elastography of nerves in the wrists of cyclists

Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study

Elastosonography and electrodiagnosis in relation to symptomatic and functional grading of carpal tunnel syndrome

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