Value of Power Doppler and Gray-Scale US in the Diagnosis of Carpal Tunnel Syndrome: Contribution of Cross-Sectional Area just before the Tunnel Inlet as Compared with the Cross-Sectional Area at the Tunnel

Akcar, Nevbahar; Özkan, Serhat; Mehmetoglu, Ozlem; Çalışır, Cüneyt; Adapınar, Baki

doi:10.3348/kjr.2010.11.6.632

Cited by 63 publications

(95 citation statements)

References 25 publications

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“…In this study, a logical occasion that CTS present in mean age of (41.5 ± 6.5) years agrees with other researchers as Phalen [25] who reported that the peak age range of patients with CTS was 40–60 years [26] and Akcar et al [4] who studied a sample with ages ranging between 33 and 58 years.…”

Section: Discussionsupporting

confidence: 91%

“…It accounts for 90% of all entrapment neuropathies [3] and it is particularly prevalent in middle-aged women [4] and is recognized as one of the most important causes of the workplace morbidity [5]. The prevalence of CTS in the United Kingdom was 7–16% in 2010, while in the United States was only 5% [6].…”

Section: Introductionmentioning

confidence: 99%

“…High resolution ultrasound (HRUS) has emerged as a feasible, simple, relatively low-cost, rapid, accurate, and noninvasive imaging method for evaluating the MN in the carpal tunnel [1, 2, 4, 5, 8–21]. Despite that, some authors consider that the role of ultrasound scanning (US) in diagnosis of CTS is yet to be proven [22] and other stated that US appears to be of little use in the diagnosis of CTS [9].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

et al. 2013

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Introduction. Carpal tunnel syndrome (CTS) is the most commonly diagnosed entrapment neuropathy of the upper extremity. The objective of this study was to diagnose CTS and to assess its severity using high resolution ultrasound (HRUS) depending on the results of nerve conduction study (NCS). Methods. A prospective cross-sectional study, in which HRUS was performed at 63 wrists of 35 female patients with different severity of CTS (as proved by NCS). Furthermore, 40 healthy volunteers (80 wrists) underwent the same tests as the patients and have been chosen to match the patients in gender, age, and body mass index (BMI). The cross section area (CSA) of the median nerve (MN) was obtained using HRUS at the carpal tunnel inlet by direct tracing method. Results. There was a significant difference in the CSA of the MN at the tunnel inlet in CTS patients when compared with the control group. In fact, the CSA of the control group showed a significant difference from each of patients subgroups. Furthermore, a significant difference in the CSA was seen in between these subgroups. In conclusion, the US examination of the MN seems to be a promising method in diagnosing and grading of carpal tunnel syndrome.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

et al. 2013

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“…However, no protocol for obtaining these waveforms was provided, and no criterion was reported to ensure that blood flow measurements using Doppler were taken within the median nerve instead of in the surrounding tissues. Mallouhi et al 9 and Akcar et al 16 successfully collected Doppler tracings within the carpal tunnel; however, these study reports lacked the detail necessary to replicate their results. The present study provides a detailed methodology for recording blood flow using Doppler, as well as a rigorous process for evaluating the validity of the waveforms for statistical analysis.…”

Section: Discussionmentioning

confidence: 99%

Morphologic Characterization of Intraneural Flow Associated With Median Nerve Pathology

Evans

Volz

Hutmire

et al. 2011

Journal of Diagnostic Medical Sonography

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A prospective cohort of 47 symptomatic patients who reported for nerve conduction studies and 44 asymptomatic controls was examined with sonography to evaluate the median nerve. Doppler studies of the median nerve were collected with handheld sonography equipment and a 12-MHz linear broadband transducer. Strict inclusion criteria were established for assessing 435 waveforms from 166 wrists. Two sonographers agreed that 245 waveforms met the a priori criteria and analyzed the corresponding data. Spectral Doppler waveforms provided direct quantitative and qualitative data for comparison with indirect provocative testing results. These Doppler data were compared between the recruitment groups. No statistical difference existed in waveforms between the groups (P < .05). Trending of the overall data indicated that as the number of positive provocative tests increased, the mean peak systolic velocity within the carpal tunnel (mid) also increased, whereas the proximal mean peak systolic velocity decreased. However, by using multiple provocative tests as an indirect comparative measure, researchers may find mean peak spectral velocity at the carpal tunnel inlet a helpful direct measure in identifying patients with carpal tunnel syndrome.

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“…19 Power Doppler ultrasound is considered superior to colour Doppler in demonstration of vascular flow due to high sensitivity to slow flow, no angle dependency, and no aliasing. 20 Malhoui et al used colour Doppler for evaluation of hypervascularity of non-bifid median nerve and found that it has a good sensitivity and specificity for diagnosing CTS.…”

Section: -11mentioning

confidence: 99%

Ultrasound evaluation of carpal tunnel syndrome in patients with bifid median nerve

2016

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INTRODUCTIONThe sensory and motor innervation of the upper limb is via three nerves originating from the brachial plexus -the ulnar, radial and median nerves. Ultrasound (US) of the forearm can effectively reveal structural abnormalities and variants of the median nerve. Bifid median nerve, defined as high division of the median nerve proximal to the carpal tunnel, is a variation of nerve anatomy first described by Lanz in 1977 and has an incidence of 2.8%. 1,2The forearm and hand are supplied by radial and ulnar arteries, however the median artery (accompanying the median nerve) normally regresses in the early embryonic period.3 Persistence of the median artery, demonstrated effectively by colour doppler, is commonly associated with bifid median nerve. 4 The median nerve is supplied by epineural, interfascicular, and intrafascicular vascular plexuses that link to one another and form a free vascular network. Vascular compromise involving the median nerve in ABSTRACT Background: Patients with high division of the median nerve proximal to carpal tunnel, or bifid median nerve, may present with carpal tunnel syndrome (CTS). Ultrasound (US) measurements indicative of CTS in this subset of patients differ from those in patients with non-bifid median nerve. The objectives were to evaluate the parameter ∆CSA [difference between the maximum cross-sectional area of bifid median nerve within carpal tunnel (CSAc) and outside tunnel (CSAp)] in the diagnosis of CTS, to compare sensitivity and specificity of ∆CSA with nerve conduction velocity studies (NCS), and to compare the cross-sectional area (CSAc, CSAp & ∆CSA) of bifid median nerve in CTS patients with that in asymptomatic controls. Methods: 20 wrists with bifid median nerves and symptoms suggestive of CTS were included in the study group. Nerve conduction velocity studies (NCS) were performed in all cases. 4 wrists of asymptomatic age-matched subjects had bifid median nerves and normal NCS and were included in the control group. High resolution ultrasonography was performed for all wrists and findings documented. Statistical Analysis: Receiver Operating Characteristics curves were used to obtain the level of significance (p-value) and assessment of correlation between ∆CSA and NCS findings. Results: There was significant correlation between ∆CSA and NCS. A cut-off value of 2.3mm 2 gave the best calculated sensitivity (76.9 %) and specificity (100%). Conclusions: CSA criteria for diagnosing CTS in patients with bifid median nerves are different from those in patients with non-bifid median nerve. ∆CSA is a sensitive and specific parameter for confirming the diagnosis of CTS in patients with bifid median nerve with sensitivity approaching that of NCS.

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Value of Power Doppler and Gray-Scale US in the Diagnosis of Carpal Tunnel Syndrome: Contribution of Cross-Sectional Area just before the Tunnel Inlet as Compared with the Cross-Sectional Area at the Tunnel

Cited by 63 publications

References 25 publications

Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

Morphologic Characterization of Intraneural Flow Associated With Median Nerve Pathology

Ultrasound evaluation of carpal tunnel syndrome in patients with bifid median nerve

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