Evaluation of bifid median nerve with sonography and MR imaging.

Iannicelli, Elsa; Chianta, G A; Salvini, Vittorio; Almberger, Maria; Monacelli, G; Passariello, Roberto

doi:10.7863/jum.2000.19.7.481

Cited by 56 publications

(37 citation statements)

References 16 publications

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“…23 Naturally, it is mandatory to perform a preoperative ultrasound evaluation (to exclude anatomical variations of the median nerve and the surrounding structures, flexors tenosynovitis, and space-occupying lesions 16 ) as well as to use cutaneous landmarks (to avoid damage to either the palmar cutaneous branch of the median nerve or the vascular branches of the superficial palmar arch).…”

Section: Discussionmentioning

confidence: 99%

“…The exclusion criteria were anatomical variations of the median nerve and the surrounding structures, flexor tenosynovitis, and incidental space-occupying lesions 16 identified by an ultrasound wrist scan; a history of or current associated upper-limb injuries due to orthopedic, neurological, rheumatological, or metabolic disorders (e.g., diabetes mellitus, thyroid diseases); pregnancy; or Body Mass Index greater than 30.…”

Section: General Exclusion Criteriamentioning

confidence: 99%

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The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

Vanni

Sirabella

Galzio

et al. 2015

JNS

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OBJECT The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). METHODS This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. RESULTS The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤ 0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6 ± 0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. CONCLUSIONS The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

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Section: Discussionmentioning

confidence: 99%

Section: General Exclusion Criteriamentioning

confidence: 99%

The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

Vanni

Sirabella

Galzio

et al. 2015

JNS

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“…9) These anatomical variations are important to recognize, especially in the preoperative setting, because they may influence the way of treatment. 15) Sonography is also valuable for evaluating pathological changes in rheumatic arthritis (most frequently tenosynovitis of the flexor tendons), traumatic neuromas, neurogenic tumors such as schwannoma and neurofibroma, soft tissue masses of the ganglia, deposits of amyloid, and accessory muscles. 7,8,11,22,35) CTS may also develop in patients with dialysis-related amyloidosis, as amyloid infiltration may thicken the flexor tendons.…”

Section: Discussionmentioning

confidence: 99%

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Çolak

Kutlay

Pekkafalı

et al. 2007

Neurol. Med. Chir.(Tokyo)

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The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.

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“…[3][4][5][6] Detection of median nerve anomalies with ultrasonography and MRI, showing 2 nerve trunks in the carpal tunnel, has been reported recently. 23,24 The increasing spatial resolution with the use of a 7-to 15-MHz broadband linear array transducer and the newly developed SonoCT technology leads to better delineation of the perineurium, fascicles, and septal structures within the nerve. This enables the examiner to differentiate high division proximally to the carpal ligament, with complete separation of fascicles and the perineurium, from a mere fascicle regrouping separated by septal structures but enveloped by a common perineurium.…”

Section: Discussionmentioning

confidence: 99%

Persistent Median Artery in the Carpal Tunnel

Gassner

Schocke

Peer

et al. 2002

J of Ultrasound Medicine

111

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Objective. To describe the ultrasonographic and color Doppler ultrasonographic findings in 2 patients with carpal tunnel syndrome associated with a persistent median artery and to report the frequency of this anatomic variation in healthy volunteers. Methods. Two patients with the clinical appearance of carpal tunnel syndrome and 100 wrists and distal forearms of 50 asymptomatic volunteers were examined with ultrasonography and color Doppler ultrasonography. The frequency and size of a persistent median artery and its relationship to median nerve anatomy in the carpal tunnel were evaluated. Results. A large persistent median artery of 3 mm in diameter was found in the affected hands in both patients with carpal tunnel syndrome. Findings were confirmed at surgery. Among the asymptomatic volunteers, a persistent median artery could be found in 13 (26%, 10 [20%] unilateral and 3 [6%] bilateral), with a mean diameter of 1.1 mm (range, 0.5-1.7 mm). In 10 (63%) of 16 hands, the persistent median artery was associated with high division of the median nerve or a bifid nerve configuration in the carpal tunnel. Conclusions. A persistent median artery is a common condition in healthy individuals and in most cases is related to median nerve variations such as high division or a bifid nerve. Because a persistent median artery has a superficial course close to the transverse carpal ligament, preoperative diagnosis of this anatomic variation may be of clinical importance.

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Evaluation of bifid median nerve with sonography and MR imaging.

Cited by 56 publications

References 16 publications

The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Persistent Median Artery in the Carpal Tunnel

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