Intracarpal Tunnel Contents: Evaluation of the Effects of Corticosteroid Injection with Sonoelastography

Abstract

The stiffness of the intracarpal tunnel contents in untreated CTS patients is higher than that of healthy volunteers but decreases 6 weeks after corticosteroid injection.

Thickness and Stiffness Adaptations of the Transverse Carpal Ligament Associated With Carpal Tunnel Syndrome

“…Most commonly, B-mode imaging has been used to examine the size and shape of the median nerve in CTS patients according to established cut-off criteria [2, 15, 27, 29, 46, 49]. More recently, sonoelastography techniques have also been applied to the assess CTS-associated changes in the elasticity of the median nerve [25, 27, 33] and additional carpal tunnel contents [28]. The current study provides insight into the structural and mechanical maladaptations of the TCL using ultrasound imaging, which may provide valuable, complimentary assessment in addition to current clinical strategies for diagnosing or of evaluating CTS.…”

Carpal Tunnel Syndrome: Evaluation of the Effects of Low‐Level Laser Therapy With Ultrasound Strain Imaging

“…In recent years, the application of median nerve elastography has become widespread for diagnosis of CTS in combination with grayscale US, with regard to evaluation of the elasticity of the tissues. Most of the studies performed up to date analyzed the efficacy of elastography in the diagnosis of CTS by comparing the elasticity of the median nerve in healthy volunteers and patients with CTS . However, few studies compared the stiffness of the median nerve in pretreatment and posttreatment periods for CTS .…”

“…Compression of the median nerve causes hyperemia and edematous changes in the nerve in the early period, and after the initial changes, fibrosis, axonal loss, or demyelination becomes prominent over the next month . Fibrosis or demyelination, which may be caused by ischemic injury due to the chronic compression, leads to an increase in the stiffness of the median nerve, which may recover after treatment options, including conservative management, splinting, local steroid injection, US, surgery, and low‐level laser therapy . In recent years, low‐level laser therapy has become a widely used option for mild and moderate CTS, owing to the benefits on clinical and electrophysiologic tests.…”

“…Determination of the median nerve stiffness in pretreatment and posttreatment procedures may provide information about the efficacy of treatment and recovery of the median nerve in CTS. Several studies on median nerve applications of strain elastography have revealed that it has been valuable in detecting nerve stiffness in patients with CTS compared to healthy control groups . To the best of our knowledge, the use of strain elastography for evaluation of the median nerve after low‐level laser therapy has not yet been studied.…”

The Median Nerve at the Carpal Tunnel … and Elsewhere

“…The difference in cross-sectional area between the nerve in the carpal tunnel (scaphoid-pisiform) and proximally at the level of the pronator quadratus muscle has better sensitivity (99%) and specificity (100%) than measurements obtained only at the level of the carpal tunnel, with an optimal cut off value of 2 mm². In patients with bifid median nerve, the optimal threshold for the difference is 4 mm² (specificity > 90%) [303140]. …”