Ultrasound examination of the median nerve in the diagnosis of carpal tunnel syndrome

Authors

  • Liudmyla Klymchuk SI «Institute of traumatology and orthopedics of National Academy of Medical Sciences of Ukraine», Kyiv, Ukraine
  • Oksana Haiko SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv , Ukraine
  • Roman Luchko SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv , Ukraine
  • Yulianna Halii SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv , Ukraine
  • Tymochenko Sergey SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv , Ukraine

DOI:

https://doi.org/10.15674/0030-59872020336-43

Keywords:

carpal tunnel syndrome, tunnel neuropathy, median nerve, ultrasound diagnostics, orthopedics, neurology

Abstract

Median nerve (MN) compression neuropathy (CN) at the carpal tunnel (CT) level goes up to 90 % of all tunnel neuropathies. Instrumental methods of examination that are used to diagnose this pathology are electromyography (EMG) and ultrasound (US). Objective: to systematize diagnostic possibilities and to determine the value of US for the patients with carpal tunnel syndrome (CTS). Methods: 99 patients (160 MN) of the main group with CTS (38 — unilateral, 61 — bilateral) clinical signs were analyzed. Control group included 35 patients (70 MN) without symptoms of CTS. Patients were examined clinically and with US on «Esaote MyLab 20 Plus» and PHILIPS HD 11 XE with a 5–12 MHz multi-frequency sensor. Cross-sectional nerve area (CSNA), flattening coefficient (FC), nerve deformation index (NDI), thickness of transverse carpal ligament, its shape, contours, nerve structure, median nerve and carpal ligament echogenicity were studied. EMG was performed in 64 (64.7 %) patients. Thresholds of sonographic parameters for the diagnosis of CTS were determined with ROC analysis with sensitivity and specificity calculation. Results: main qualitative ultrasound parameters of CTS were: change of nerve shape and decreased echogenicity with loss of structural pattern. CSNA in main group was (14.1 ± 4.59) mm², and control — (8.32 ± 1.92) mm², FC — 3.02 ± 0.63 and 2.48 ± 0.60, NDI — 1.21 ± 0.09 and 1.03 ± 0.06, respectively. Optimal threshold level for CSNA was value ˃ 10 mm², FC — ˃ 2.73; NDI — ≤ 1.09 (sensitivity 84.3; 68.0; 81.7 %, respectively). Total frequency of concomitant pathology in main group was 54 (33.8 %) cases, in control group — 13 (18.6 %) (p < 0.02). Conclusions: ultrasound is objective and valuable method to diagnose MN compression neuropathy at the CT level and allow to assess the adjacent structures.

Author Biographies

Oksana Haiko, SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv 

MD, DSci in Traumatology and Orthopaedics

Roman Luchko, SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv 

MD

Yulianna Halii, SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv 

MD

Tymochenko Sergey, SI «Institute of Traumatology and Orthopaedics of the National Academy of Medical Sciences of Ukraine», Kyiv 

PhD

References

  1. Assmus, H., Antoniadis, G., & Bischoff, C. (2015). Carpal and cubital tunnel and other, rarer nerve compression syndromes. Deutsches Arzteblatt International, 112(1–2), 14–25. doi: 10.3238/arztebl.2015.0014
  2. Tang, D. T., Barbour, J. R., Davidge, K.. M., Yee, A., & Mackinnon, S. E. (2015). Nerve en trapment: update. Plastic and Reconstructive Surgery, 135(1), 199e–215e. DOI: 10.1097/PRS.0000000000000828
  3. El Miedany, Y. M. (2004). Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: Substantive or complementary tests? Rheumatology, 43(7), 887-895. doi: 10.1093/rheumatology/keh190
  4. Aroori, S., & Spence, R. A. (2008). Carpal tunnel syndrome. The Ulster Medical Journal, 77(1), 6–17
  5. Mohammadi, A., Afshar, A., Etemadi, A., Masoudi, S., & Baghizadeh, A. (2010). Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Archives of Iranian Medicine, 13(16), 516–521
  6. Keith, M. W., Masear, V., Chung, K. C., Amadio, P. C., Andary, M., Barth, R. W., ... & McGowan, R. (2010). American Academy of orthopaedic surgeons clinical practice guideline on the treatment of carpal tunnel syndrome. The Journal of Bone and Joint Surgery-American Volume, 92(1), 217-219. doi: 10.2106/jbjs.i.00642
  7. Wong, S. M., Griffith, J. F., Hui, A. C., Lo, S. K., Fu, M., & Wong, K. S. (2004). Carpal tunnel syndrome: diagnostic useful ness of sonography. Radiology, 232(1), 93–99. doi: 10.1148/radiol.2321030071
  8. Duncan, I., Sullivan, P., & Lomas, F. (1999). Sonography in the diagnosis of carpal tunnel synd­rome. American Journal of Roentgenology, 173(3), 681–684
  9. Trung, D. T., Ngoc, T. M., Gia, D. H., Ngoc, S. D., Manh, S. L., Dinh, T. D., ... & Hoang, L. N. (2019). Endoscopic carpal tunnel release surgery: a case study in Vietnam. Journal of Orthopaedic Surgery and Research, 14(1), 149. doi: 10.1186/s13018-019-1192-z
  10. Billakota, S., & Hobson-Webb, L. D. (2017). Standard median nerve ultrasound in carpal tunnel syndrome: A retrospective review of 1,021 cases. Clinical Neurophysiology Practice, 2, 188–191. doi: 10.1016/j.cnp.2017.07.004.
  11. Vahed, L. K., Arianpur, A., Gharedaghi, M., & Rezaei, H. (2018). Ultrasoundas a diagnostic toolintheinvestigation of patient swith carpal tunnel syndrome. European Journal of Translational Myology, 28(2), 7380. doi: 10.4081/ejtm.2018.7406
  12. Sucher, B. M. (2009). Carpal tunnel syndrome: ultrasonographici maging and pathologic mechanisms of median nerve compression. The Journal of the American Osteopathic Association, 109(12), 641–647. doi: 10.7556/jaoa.2009.109.12.641
  13. van Doesburg, M. H., Henderson, J., Yoshii Y., van der Molen, A. B. M., Cha, S. S., An, K.-N., & Amadio, P. C. (2012). Median nerve deformation in differential fingermotions: ultrasonographic comparison of carpal tunnel syndrome patients and heal thy controls. Journal of Orthopaedic Research, 30(4), 643–648. doi: 10.1002/jor.21562
  14. Saltykova, V. G. (2011). The role of ultrasound in the diagnosis of tunnel neuropathies. Ultrasound and Functional Diagnostics, 4, 43–56.[in Russian]
  15. Maletskiy, E. Yu., Alexandrov, N. Yu., Itskovich, I. E., Lobzin, S. V., & Villar Flores, F. R. (2014). Cross sectional area change of the median nerve at different stages of carpal tunnel syndrome. Medical Imaging, 1, 102–109. [in Russian]
  16. Alves, M. P. T., Fonseca, C. O. P., Granjeiro, J. M., Gonçalves de Souza, P. R., & Tzirulnik, M. (2013). Carpal tunnel syndrome: comparative study between sonographic and surgical measurements of the median nerve in moderate and severe cases of disease. Radiologia Brasileira, 46(1), 23–29. doi: 10.1590/ S0100-39842013000100009
  17. Roll, S., Case-Smith, C. J., & Evans, K. D. (2011). Diagnostic accuracy of ultrasonography vs. electromyography in carpal tunnel syndrome: a systematic review of literature. Ultrasound in Medicine and Biology, 37(10), 1539–1553. doi: 10.1016/j.ultrasmedbio.2011.06.011
  18. Lee, D., van Holsbeeck, M. T., Janevski, P. K., Ganos, D. L., Ditmars, D. M., & Darian, V. B. (1999). Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiologic Clinics of North America, 37(4), 859–872. doi: 10.1016/s0033-8389(05)70132-9
  19. Roll, S. C., Volz, K. R., Fahy, C. M., & Evans, K. D. (2015). Carpal tunnel syndrome severity staging using sonographic and clinical measures. Muscle Nerve, 51(6), 838–845. doi: 10.1002/mus.24478
  20. Graham, B., Regehr, G., Naglie, G., & Wright, J. G. (2006). Development and validation of diagnostic criteria for carpal tunnel syndrome. The Journal of Hand Surgery, 31(6), 919–924. doi: 10.1016/j.jhsa.2006.03.005
  21. Katz, J. N., & Stirrat, C. R. (1990). A self-administered hand diagram for the diagnosis of carpal tunnel syndrome. The Journal of Hand Surgery, 15-A(2), 360–363. doi: 10.1016/0363-5023(90)90124-a
  22. CTH-6. Diagnostic Aide for Carpal Tunnel Syndrome. http://www.orthoguidelines.org/ctsdiagnosis
  23. Giannini, F., Cioni, R., Mondelli M., Padua, R., Gregori, B., D'Amico, P., & Padua, L. (2002). A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clinical Neurophysiology, 113(1), 71–77. doi: 10.1016/S1388-2457(01)00704-0
  24. (2002). AAEM practice topic in electro diagnostic medicine. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. Muscle Nerve, 25, 918–922
  25. Bland, J. D. (2000). A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve, 23(8), 1280–1283
  26. van Doesburg, M. H., Henderson, J., Yoshii, Y., van der Molen, A. B. M., Cha, S. S., An, K.-N., & Amadio, P. C. (2012). Median nerve deformation in differential finger motions: ultrasonographic comparison of carpal tunnel syndrome patients and heal thy controls. Journal of Orthopaedic Research, 30(4), 643–648. doi: 10.1002/jor.21562
  27. Sucher, B. M. (2009). Carpal tunnel syndrome: ultrasonographici maging and pathologic mechanisms of median nerve compression. The Journal of the American Osteopathic Association, 109(12), 641–647. doi: 10.7556/jaoa.2009.109.12.641
  28. Kumar, R., & Indrayan, A. (2011). Receiver operating characteristic (ROC) curve for medical researches. Indian Pediatrics, 48(4), 277–288. doi: 10.1007/ s13312-011-0055-4
  29. Al-Hashel, J. Y., Rashad, H. M., Nouh, M. R., Amro, H. A., Khuraibet, A. J., Shamov, T., Tzvetanov, P., & Rousseff, R. T. (2015). Sonography in carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve, 51(4), 592–597. doi: 10.1002/mus.24425
  30. Gassner, E. M., Schocke, M., Peer, S., Schwabegger, A., Jaschke, W., & Bodner, G. (2003). Persistent median artery in the carpal tunnel – color Doppler ultrasonographic findings. Ultrasound in Medicine & Biology, 29(5 Suppl.), S170. doi: 10.1016/ S0301-5629(03)00677-X
  31. Vanderschueren, G. A., Meys, V. E., & Beekman, R. (2014). Doppler sonography for the diagnosis of carpal tunnel syndrome: a critical review. Muscle Nerve, 50(2), 159–163. doi: 10.1002/mus.24241

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How to Cite

Klymchuk, L., Haiko, O., Luchko, R., Halii, Y., & Sergey, T. (2023). Ultrasound examination of the median nerve in the diagnosis of carpal tunnel syndrome. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (3), 36–43. https://doi.org/10.15674/0030-59872020336-43

Issue

No. 3 (2020)

Section

ORIGINAL ARTICLES

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Copyright (c) 2020 Liudmyla Klymchuk, Oksana Haiko, Roman Luchko, Yulianna Halii, Tymochenko Sergey

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