Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor?

Mondelli, Mauro; Filippou, Georgios; Aretini, Alessandro; Frediani, Bruno; Reale, F.

doi:10.1080/03009740801914850

Cited by 70 publications

(76 citation statements)

References 21 publications

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“…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

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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.

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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

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“…Our data based on the CSA measurements show additional facts. If there was exclusive constriction only to the axonal flow, the corresponding nerve should be swollen in a pseudoneuroma-like manner mainly proximal to the point of relevant constriction and show distal to that rather "normal" caliber as known from carpal tunnel syndrome [16,17]. This is (astonishingly!)…”

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confidence: 99%

“…Ergebnisse: Textur-Veränderungen konnten in 4,6 (76,7 %) ± 1,2 nachgewiesen werden, Verän-derungen der äußeren Nervenscheide in 4,1 (68,3 %) ± 1,1 der Segmente. Kaliber-Veränderun-gen basierend auf die 6 Segmente konnten nachgewiesen werden: eine CSA von 7,45 mm² ± 2,24 wurde proximal des oberen Faszien-Durchtritts (PUF) gefunden, am oberen Faszien-Durchtritt (UF) eine mittlere CSA von 11,96 mm² ± 3,61, distal des oberen Faszien-Durchtritts (DUF) eine mittlere CSA von 11,49 mm² ± 8, 16, proximal des unteren Faszien-Durchtritts (PLF) eine mittlere CSA von 10,84 mm² ± 4,73, am unteren Faszien-Durchtritt (LF) eine mittlere CSA von 12,12 mm² ± 5 und distal des unteren Faszien-Durchtritts (DLF) eine mittlere CSA von 7,89 mm² ± 3,42. Alle verlagerten Nerven zeigten relevanten Knickstellen an der UF, 6 Nerven präsentierten relevanten Knickstellen an der LF.…”

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The Ulnar Nerve After Surgical Transposition: Can Sonography Define the Reason of Persisting Neuropathy?

Gruber

Baur

Plaikner

et al. 2015

Fortschr Röntgenstr

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Purpose: Ulnar nerve neuropathy is mainly caused by compression at the level of the cubital tunnel. Two main approaches are currently known for the surgical treatment of this condition: decompression of the nerve in its usual position or transposition to the ulnar flexor side. This study was performed to define the usefulness of ultrasound in patients with persisting symptoms after ulnar nerve transposition. Materials and Methods: We present the data of 8 subjects with persisting symptoms after nerve transposition due to compressive neuropathy. The cross-section areas (CSA) and texture changes were recorded. Each ulnar nerve was divided into 6 segments ? 3 segments at the proximal pass and 3 segments at the distal pass through the subcutaneous fascia. Results: Texture changes were recorded in 4.6 (76.7?%)???1.2 and outer nerve sheath blurring in mean 4.1 (68.3?%)???1.1 of the segments. Caliber changes were found in the course of the nerve based on the 6 segments: A mean CSA of 7.45?mm????2.24 was found proximal to the upper fascial passage?(PUF), a mean CSA of 11.96?mm????3.61?at the?upper?fascial passage (UF), a mean CSA of 11.49?mm????8.16 distal to the upper fascial passage (DUF), a mean CSA of 10.84?mm????4.73 proximal to the lower fascial passage (PLF), a mean CSA of 12.12?mm????5?at the lower fascial passage (LF), and a mean CSA of 7.89?mm????3.42 distal to the lower fascial passage (DLF). All transposed nerves presented relevant kinks at the UF, 6 nerves presented relevant kinks at the LF. Conclusion: In cases of secondary ulnar neuropathy after nerve transposition, ultrasound can reliably assess the actual ?situation? of the nerve and thus at least ease the decision for secondary surgery. Key points ??Sonography can reliably define pathology of the ulnar nerve. ??Blood flow restriction after nerve transposition can be the cause of secondary neuropathy. ??Secondary neuropathy after ulnar nerve transposition can be assessed by sonography. Citation Format: ??Gruber H., Baur E. M., Plaikner M. et?al. The Ulnar Nerve After Surgical Transposition: Can Sonography Define the Reason of Persisting Neuropathy?. Fortschr R?ntgenstr 2015; 187: 998???1002

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“…Mondelli et al14 reported post-operative changes in CTS patients. They found that ultrasonography was useful for the diagnosis of CTS, providing anatomical images of the median nerve, carpal tunnel, and neighboring structures, as well as for demonstrating improvement following surgical release.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography in CTS is variable and controversial, and some studies have evaluated the median nerve CSA at the carpal tunnel inlet, outlet, and mid-portion 14,16,17,19. The present study only used the maximal CSA 15.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Ultrasonography to Predict Response to Injection Therapy in Carpal Tunnel Syndrome

et al. 2011

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ObjectiveTo verify the feasibility of initial parameters of ultrasonography or electromyography for the prediction of effect after steroid injection therapy in a carpal tunnel syndrome (CTS) patient.MethodWe recruited individuals with clinical and electrodiagnostic evidence of CTS. Results from the Boston self-assessment questionnaire, median motor and sensory nerve conduction studies, and median nerve ultrasonography were evaluated at baseline, 1 month, and 6 months after injection. Evaluation of median nerve ultrasonography parameters included measurements taken at the maximal swelling point (MS), 2 cm proximal from MS (2MS), and 12 cm proximal from MS (12MS), and its ratio (MS/12MS, 2MS/12MS) was calculated. The correlation between improvement of the symptom score after treatment and baseline parameters was estimated.ResultsFourteen individuals (14 women, mean age 53.8 years) with 22 affected wrists were enrolled. After steroid injection therapy, clinical and electromyographic parameters showed significant improvements at 1 month or 6 months after injection, and ultrasonographic parameters showed significant changes in maximal area and area ratio (MS/12MS) of the median nerve. Symptom score improvement showed a positive correlation in the initial 2MS and ratio of 2MS/12MS after 6 months (p<0.05).ConclusionMost of the improvements occurred during the first month after injection and lasted up to 6 months. The initial median nerve swelling and its ratio may be a useful predictor of response after steroid injection.

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Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor?

Abstract: CSA-I is the most sensitive US measurement before surgery. The presurgical value of CSA-I is a predictor of postsurgical normalization of clinical parameters and of its own value.

Cited by 70 publications

References 21 publications

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

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

The Ulnar Nerve After Surgical Transposition: Can Sonography Define the Reason of Persisting Neuropathy?

Usefulness of Ultrasonography to Predict Response to Injection Therapy in Carpal Tunnel Syndrome

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