Sonographic Diagnosis of Carpal Tunnel Syndrome

Kluge, Sebastian; Langer, Martin; Schelle, Thomas

doi:10.1016/j.hcl.2021.08.003

Cited by 9 publications

(7 citation statements)

References 107 publications

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“…Likewise, peripheral nerve blocks via ultrasound guidance are commonplace for perioperative analgesia. Similarly, others have previously shown that nerves in the cadavers can be accurately identified by ultrasound [17, 20, 23, 26]. That said, nerves and tendons in cadaveric specimens may be easier to identify than during in vivo clinical procedures.…”

Section: Discussionmentioning

confidence: 86%

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

Rothrauff

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the distances using ultrasound between the supericial peroneal nerve (SPN) and sural nerve along the peroneus longus tendon (PLT) autograft harvest path at diferent ankle or knee positions in order to minimize risk of iatrogenic nerve injury during PLT autograft harvest. Methods Twenty-four fresh-frozen human cadaveric lower extremities were used to harvest a full-thickness PLT autograft with a tendon stripper. Four specimens were utilized to validate correct identiication of nerves under ultrasound. Sonographically guided perineural injections were performed at the start point and end point of the PLT harvest path using coloured latex, followed by dissection with gross inspection. Using ultrasound, the distance from the peroneus brevis muscle to the sural nerve at diferent ankle positions (20° dorsilexion, neutral, and 20° plantarlexion) was measured, and the distance from the end of the tendon stripper to the SPN at diferent knee positions (full extension and 90° lexion) was also measured. Measurements were performed by two separate observers using ImageJ software. Results Cadaveric dissection showed the presence of latex around nerves in all four specimens. The average distance from the brevis muscle to the sural nerve increased signiicantly from dorsilexion to plantarlexion. The shortest distance from the tenodesis site to the sural nerve was 5.8 ± 1.7 mm. There was no signiicant diference from the end of the tendon stripper to the SPN between full extension or 90° lexion of the knee. Conclusion When harvesting the PLT, it is recommended to place the ankle at plantarlexion. The knee at full extension or 90° lexion had no efect. Joint positions at the time of graft harvest should be monitored to reduce risks of iatrogenic nerve injury.

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Section: Discussionmentioning

confidence: 86%

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

Rothrauff

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…To accommodate individual anthropometric variability, the wrist:forearm ratio (WFR), wrist–forearm difference (WFD), median-to-ulnar nerve ratio (MUR) and median-to-ulnar nerve difference (MUD) were also suggested as diagnostic criteria for CTS [ 11 , 12 , 13 , 14 , 15 ]. In addition, increased intraneural vascularity of the MN was also reported in patients with CTS [ 16 , 17 ]. Gonzalez-Suarez et al [ 11 ] revealed that combining the WFD obtained by grayscale sonography and intraneural hypervascularity obtained by color Doppler could provide better sensitivity of up to 98.1%.…”

Section: Introductionmentioning

confidence: 95%

“…Some researchers [ 18 , 19 ] further utilized elastography to observe the changes in the nerve environment and tissue elasticity. Kluge et al [ 16 ] also described the changes in echogenicity as another sonographic criterion for CTS. In healthy wrists, the hypoechoic nerve fascicles were enclosed by hyperechoic perineurium, forming a honeycomb-like structure.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, many researchers have tried to use dynamic ultrasonographic studies to evaluate gliding of the MN and flexor tendons [ 16 , 21 , 22 ]. Since the MN, flexor tendons and SSCT are exposed to repetitive biomechanical compressive and shear stress force during motion of the upper extremities, the gliding of the MN might be reduced when it is sandwiched between tensed tendons and fibrotic SSCT [ 23 , 24 , 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonographical Evaluation of the Median Nerve Mobility in Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

et al. 2022

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Diagnostic ultrasound is widely used for evaluating carpal tunnel syndrome (CTS), an entrapment neuropathy of the median nerve (MN). Decreased mobility of the MN inside the carpal tunnel has been reported in CTS, and various methods have been used to evaluate MN mobility; however, there is still no conclusive understanding of its connection with CTS. The purpose of this study is to conduct a systematic review and meta-analysis of the current published literature on ultrasonographic evaluations of transverse and longitudinal MN displacement and to identify the relationship between MN mobility and CTS. This study was conducted in accordance with the 2020 PRISMA statement and the Cochrane Collaboration Handbook. Comparative studies that investigated differences in MN displacement between CTS patients and healthy controls were retrieved by searching the Cochrane Library, Embase and PubMed. A total of 15 case–control studies were included. Nine of 12 studies evaluating transverse MN displacement and 4 of 5 studies evaluating longitudinal MN gliding showed that the MN was less mobile in CTS patients than in healthy subjects. Despite the large heterogeneity among the 15 included studies, this systematic review and meta-analysis provide evidence that the mobility of the MN is significantly reduced in both transverse and longitudinal planes in CTS patients compared to healthy controls. Five of the 15 included studies reported that a decrease in transverse or longitudinal MN displacement in CTS was correlated with clinical symptoms or with severity as measured by a nerve conduction study (NCS).

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“…It is important to note that in patients with moderate-severe CTS, EDX findings will not return to normal even with complete relief of symptoms. High-resolution ultrasound can be used to identify potential structural causes of recurrence [ 60 , 61 , 62 ]. Carita et al imaged 35 median nerves with recurrent symptoms and found persistent compression in 30 out of the 35 with incomplete release in 20, perineural fibrosis in four, both of these findings in five, and tenosynovitis in one patient.…”

Section: Approach and Assessmentmentioning

confidence: 99%

Revision of Carpal Tunnel Surgery

Pripotnev

Mackinnon

2022

JCM

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Carpal tunnel release is one of the most commonly performed upper extremity procedures. The majority of patients experience significant improvement or resolution of their symptoms. However, a small but important subset of patients will experience the failure of their initial surgery. These patients can be grouped into persistent, recurrent, and new symptom categories. The approach to these patients starts with a thorough clinical examination and is supplemented with electrodiagnostic studies. The step-wise surgical management of revision carpal tunnel surgery consists of the proximal exploration of the median nerve, Guyon’s release with neurolysis, the rerelease of the transverse retinaculum, evaluation of the nerve injury, treatment of secondary sites of compression, and potential ancillary procedures. The approach and management of failed carpal tunnel release are reviewed in this article.

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Sonographic Diagnosis of Carpal Tunnel Syndrome

Cited by 9 publications

References 107 publications

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions

Ultrasonographical Evaluation of the Median Nerve Mobility in Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Revision of Carpal Tunnel Surgery

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