Median Nerve’s Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging

Yıldıran, Gökçe; Seher, Nusret; Sütçü, Mustafa; Nayman, Alaaddin; Akdağ, Osman; Tosun, Zekeriya

doi:10.1097/prs.0000000000007940

Cited by 14 publications

(20 citation statements)

References 22 publications

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“…Compared with CDUS and PDUS, SMI was more accurate in the detection of intraneural blood flow in patients with CTS, yet even in SMI 13 of the 25 healthy subjects showed no visible intraneural vascularisation. Similar results regarding vessel sensitivity in CTS were reported by Karahan et al 9 and Yildiran et al 18 who also reported a correlation between SMI grading and electrophysiology results.…”

Section: Introductionsupporting

confidence: 87%

Intraneural vascularity of the median, ulnar and common peroneal nerve: Microvascular ultrasound and pathophysiological implications

Deeg

Mündel

Loizides

et al. 2023

Australas J Ultrason Med

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ObjectivesChanges in the microvascular environment are considered crucial in the pathogenesis of compression neuropathies. Several studies have demonstrated elevated intraneural vascularity in severe neuropathy compared with healthy subjects, where intraneural vascularity is considered predominantly undetectable. The aim of this study was to assess and quantify intraneural vasculature by superb microvascular imaging (SMI) in healthy volunteers in the median, ulnar and common peroneal nerve.MethodsIntraneural vascularity was quantified in 26 healthy volunteers (312 segments overall) by SMI sonography using a 22‐MHz linear transducer. Individual nerve segment vascularity was compared with the mean vascularity using one‐way ANOVA and Kruskal–Wallis tests, respectively. Vendor‐provided quantification and manual vessel count were compared by linear regression analysis.ResultsIntraneural vascularity was detectable in all nerve segments (100.0%). Vessel density was highest in the median nerve at the wrist (1.54 ± 0.44/mm2, P < 0.0001) and lowest in the sulcal ulnar nerve (0.90 ± 0.34/mm2, P < 0.0001). Vendor‐provided automated quantification severely overestimated vascular content compared with manual quantification.ConclusionSuperb microvascular imaging can facilitate the visualisation of nerve vascularity and even detect local variations in vessel density. The pathophysiological implications for peripheral neuropathies, especially compression neuropathies, warrant further investigation, but the absence of visible intraneural vasculature as a negative finding in the diagnostic of compression neuropathies should be interpreted with caution, as the intraneural vascularity may lie beyond the 18 MHz resolution power of a transducer.

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Section: Introductionsupporting

confidence: 87%

Intraneural vascularity of the median, ulnar and common peroneal nerve: Microvascular ultrasound and pathophysiological implications

Deeg

Mündel

Loizides

et al. 2023

Australas J Ultrason Med

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“…We used also SMI in our study to overcome these technical defects. In a literature review, we found four (4) studies investigating intraneural vascularity of median nerve in CTS by SMI [26][27][28][29]. However, the main research focus in Karahan et al [26] and Chen et al [27] was the comparison of SMI and Doppler US.…”

Section: Discussionmentioning

confidence: 99%

“…Similar results were observed in our study as well. In a research output of Yildiran et al [29], the vascular indexes were compared before and after open carpal tunnel release in CTS patients. A healthy control group was not considered in this paper.…”

Section: Discussionmentioning

confidence: 99%

“…However, superb microvascular imaging (SMI) is a new ultrasound technology so that it can capable of differentiate blood flow signals from artefacts by using a newly developed algorithm [25]. In CTS, hypervascularization of the median nerve has been shown by SMI [26][27][28][29]. To the best our knowledge, there is not any study assessing median nerve hypervascularity by using SMI in PsA.…”

Section: Introductionmentioning

confidence: 99%

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Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis; Superb Microvascular Imaging Findings

Akyildiz Tezcan,

Levendoglu,

Durmaz

et al. 2023

Aktuelle Rheumatologie

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Background It is well known that the carpal tunnel syndrome (CTS) is the most widespread peripheral nerve entrapment syndrome throughout the world. CTS can also be seen more often in rheumatic disease, especially in psoriatic arthritis (PsA). Usage of ultrasonography to diagnose CTS has been the subject of investigations for many years. Superb microvascular imaging (SMI) is a newly developed ultrasonographic technique to visualise vascularity. More recently, there have been some studies on the diagnosis of CTS with SMI. However, a review of the literature reveals that there there has been no study on the diagnosis of CTS in PsA. This is the subject of the present report, where we evaluate the diagnostic value of SMI in CTS in patients with PsA. Materials and methods 30 PsA patients (56 wrists) and 26 healthy volunteers (52 wrists) were examined in the study. Demographic and clinical features were recorded carefully. All participants underwent a standard electrodiagnostic study (EDS) and ultrasonographic examination within a maximum of one week. CTS was diagnosed using EDS. The vascularity of the median nerve was examined using a new ultrasonographic technique. SMI signals were graded from 0 to 3. Results There were no significant differences between groups, with respect to their age, gender, body mass index, smoking status, and hand dominance. Although CTS was diagnosed in 9 patients (14 wrists) in the PsA group, CTS was not diagnosed for any patient in the control group (p=0.002). The blood flow display ratio of SMI in the median nerve was markedly higher in CTS patients than with controls (median (25th, 75th percentile): 2(0.75, 2), 1(0, 2); p=0.014; respectively) or compared with CTS-free PsA patients (2(0.75, 2), 1(0, 2); p=0.030; respectively). There was no remarkable difference between PsA patients and healthy controls with respect to the median nerve’s blood flow display ratio (median (25th, 75th percentile): 1(0, 2), 1(0, 2); p=0.164; respectively). Conclusion To the best our knowledge, this is the first study assessing SMI in the diagnosis of CTS in PsA patients. We concluded that SMI has important diagnostic value in PsA patients for diagnosing CTS.

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“…SMI may be used to improve the diagnostic accuracy of low-grade digital collateral ligament injuries where there may not be a clear disruption in the ligament substance. Early research on grading of vascularity using SMI in the musculoskeletal system 12,13 has already seen promising results, and with improvements in the technology and conducting similar studies in the hand, it may be possible to stratify and grade injuries to smaller ligaments such as DCL injuries. There are two important limitations to the usage of this technology.…”

Section: Discussionmentioning

confidence: 99%

Entrapment of the index finger radial collateral ligament in the metacarpophalangeal joint: A case report

et al. 2021

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Introduction Digital collateral ligament injuries are common hand injuries that can cause significant pain and functional impairment. Ultrasonography can be useful in the evaluation of these ligamentous injuries, as it is both cost-effective and allows for easy, dynamic evaluation during imaging. Case report We report a rare sonographic finding of an index finger radial collateral ligament injury that was found to have a flap of the ligament entrapped within the metacarpophalangeal joint, which to our knowledge has not been described previously. We correlate this finding with an intraoperative image of the entrapment of the collateral ligament. We also report on the novel application of superb microvascular imaging to aid in the diagnosis of digital collateral ligament injury. Discussion This particular injury pattern has not been reported in the literature previously and likely explains the patient’s lack of improvement with nonoperative management. Our finding is similar to a Stener lesion seen in a thumb ulnar collateral ligament injury in which the ligament is unable to heal due to entrapment. In addition, using superb microvascular imaging (SMI), we were able to visualize hyperemia to surrounding structures and the ligament itself which suggested an acute injury. Conclusion We anticipate that this case report will provide sonographers with knowledge and images of this specific injury pattern to the digital collateral ligaments.

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Median Nerve’s Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging

Cited by 14 publications

References 22 publications

Intraneural vascularity of the median, ulnar and common peroneal nerve: Microvascular ultrasound and pathophysiological implications

Intraneural vascularity of the median, ulnar and common peroneal nerve: Microvascular ultrasound and pathophysiological implications

Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis; Superb Microvascular Imaging Findings

Entrapment of the index finger radial collateral ligament in the metacarpophalangeal joint: A case report

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