Ultrasound and elastography role in pre- and post-operative evaluation of median neuropathy in patients with carpal tunnel syndrome

Abstract

IntroductionCarpal tunnel syndrome (CTS) is a common compression neuropathy of the median nerve in the wrist. Early diagnosis of CTS is essential for selecting treatment options and assessing prognosis. The current diagnosis of CTS is based on the patient's clinical symptoms, signs, and an electromyography (EMG) test. However, they have some limitations. Recently, ultrasound has been adopted as an adjunct diagnostic tool for electromyography (EMG). Ultrasound is a non-invasive and cost-effective technique. It provides a dynamic display of morphological changes in the median nerve and an assessment of CTS etiology such as tenosynovitis, mass compression, and tendon disease. This study aimed to investigate the value of conventional ultrasound and real-time shear wave elastography (SWE) in evaluation of median neuropathy in patients with carpal tunnel syndrome (CTS) before and after surgery.MethodsFirst, the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients with CTS. All subjects were measured at three levels: the distal 1/3 of the forearm, the carpal tunnel inlet, and the distal carpal tunnel using conventional ultrasound and SWE. Median nerve parameters were examined in patients with CTS 1 week after surgery.ResultsThe cross-sectional area (CSA) and stiffness of the median nerve at the carpal tunnel inlet and distal carpal tunnel were significantly higher in patients with CTS than in healthy controls (p < 0.001). The CSA and stiffness of the median nerve at the carpal tunnel inlet were statistically significantly significantly between pre- and postoperative patients with CTS (p < 0.001). The CSA and stiffness of the nerve in patients with CTS had a positive correlation with electrophysiology severity.Conclusions and discussionConventional ultrasound and elastography are valuable in the diagnosis of CTS and are useful in the clinical assessment of patient's nerve recovery after operation.

Comparison efficacy of ultrasound-guided needle release plus corticosteroid injection and mini-open surgery in patients with carpal tunnel syndrome

“…Several studies have reported the meaning of elastography in diagnosing CTS. Wu et al investigated the value of both ultrasound and real-time shear wave elastography (SWE) in evaluating the median nerve with CTS and demonstrated that SWE was useful in assessing the median nerve both before and after the operation ( 41 ). Recently, some research studies indicated that in CTS patients, blood flow changes of the median nerve can help to confirm.…”

Elastography of nerves in the wrists of cyclists

“…Conduction blockade in both nerves is probably rare, but reports of the use of electrodiagnostic examination (EDX) have been sparse [ 8 ]. Recently, shear wave elastography (SWE) has been shown to have valuable diagnostic charac-teristics in carpal tunnel syndrome (CTS) [ 9 ]. It enables quick and objective assessment of changes in the nerve, allowing for conclusions about their nature [ 8 ].…”