Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgery

Naranjo, Antonio; Ojeda, Soledad; Rúa-Figueroa, Íñigo; García-Duque, Orlando; Fernández-Palacios, Javier; Carmona, Loreto

doi:10.3109/03009741003685632

Cited by 44 publications

(50 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This might be explained by the larger amount of soft tissue and structures surrounding the tibial nerve, leading to more diffusely spread pressure. In patients with idiopathic carpal tunnel syndrome and without diabetes, release of the flexor retinaculum results in a decrease of CSA (27)(28)(29). One study showed an increase of CSA and T/W ratio (30).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Findings After Surgical Decompression of the Tarsal Tunnel in Patients With Painful Diabetic Polyneuropathy: A Prospective Randomized Study

et al. 2014

View full text Add to dashboard Cite

OBJECTIVEIt has been hypothesized that the development of diabetic polyneuropathy (DPN) is due to swelling of the nerve, as well as thickening and stiffening of the surrounding ligaments, causing chronic compression of nerves. We aimed to examine the effect of surgical decompression of the tibial nerve on the mean cross-sectional area (CSA). RESEARCH DESIGN AND METHODSWe performed a randomized controlled trial of 42 subjects with painful DPN diagnosed using the Diabetic Neuropathy Score. A computer randomized for the surgery arm of the study. A control group consisting of 38 healthy subjects was included. An experienced sonographer measured the CSA and thickness-to-width (T/W) ratio of the tibial nerve, as well as the thickness of the flexor retinaculum. RESULTSCSA is significantly larger in patients with painful DPN (8.4 6 3.9 mm 2 ) than in control subjects (6.4 6 1.3 mm 2 ), P = 0.007. The T/W ratio in patients with painful DPN is 0.64 and in control subjects 0.59, P = 0.03. Patients with DPN have a significantly thicker retinaculum (1.07 mm) than control subjects (0.84 mm), P < 0.001. Mean follow-up was 28.2 weeks (range 23-45). Difference between baseline and follow-up in the operated leg was 1.49 mm 2 and in the control leg 1.81 mm 2 , P = 0.674. CONCLUSIONSDecompression of the tibial nerve does not result in a significant difference between baseline and follow-up in CSA using ultrasound between the operated and control leg. Ultrasound measurements show a significantly increased CSA, a significantly thicker retinaculum, and a significantly increased T/W ratio in patients with painful DPN compared with healthy control subjects.

show abstract

Section: Discussionmentioning

confidence: 99%

Ultrasound Findings After Surgical Decompression of the Tarsal Tunnel in Patients With Painful Diabetic Polyneuropathy: A Prospective Randomized Study

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Significant decreases in cross-sectional area have been noted, and decreased cross-sectional area has been correlated with improvement in symptom scores and electrodiagnostic parameters [53–56]. However, another study found no significant difference in cross-sectional area between patients with favorable and unfavorable outcomes, although cross-sectional area was decreased in both groups [57]. Additional investigations into the reliability of sonographic parameters for predicting outcomes are needed.…”

Section: Compressive Neuropathymentioning

confidence: 99%

Ultrasonography of Peripheral Nerves

Suk

Walker

Cartwright

2013

Curr Neurol Neurosci Rep

108

View full text Add to dashboard Cite

Over the last decade, neuromuscular ultrasound has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent papers outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasound is well suited for use in electrodiagnostic laboratories where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient’s history, physical examination, electrophysiological studies, and imaging for diagnosis and management.

show abstract

“…For example, is a reduced cross‐sectional area a result of atrophy or reduced edema and improvement? Although these findings seem to be a part of the pathologic process, are these a result or an etiologic factor in CTS [3]? Using these findings as an outcome measure, therefore, is problematic, and furthermore, because we are treating a clinical syndrome composed of symptoms and signs, it is much easier and more logical to evaluate clinical improvement as an outcome measure. 2In a modality that is reliant on the operator, can we quantify these changes in a meaningful way?…”

Section: Resultsmentioning

confidence: 99%