Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas.

BMC Medical Imaging (Impact Factor: 0.98). 07/2012; 12(1):15. DOI: 10.1186/1471-2342-12-15
Source: PubMed

ABSTRACT BACKGROUND: Using high-resolution ultrasonography (US) to measure the median nerve cross-sectional areas (CSAs) such as in the "inching test" conducted in nerve conduction studies is a valuable tool to assess carpal tunnel syndrome (CTS). However, using this US measurement method to assess the median nerve CSA in diabetic patients with CTS has rarely been reported. Therefore, we used this US measurement method in this study to measure median nerve CSAs and to compare the CSAs of idiopathic, diabetic and diabetic polyneuropathy (DPN) patients with CTS. METHODS: 124 hands belonging to 89 participants were included and assigned into four groups: control (32), idiopathic (38), diabetic (38) and DPN (16) CTS. In the latter two groups, only patients with mild and moderately severity CTS were included. The median nerve CSAs were measured at 8 points marked as i4, i3, i2, i1, w, o1, o2, and 03 in the inching test. The measured CSAs in each group of participants were compared. RESULTS: Compared with the CSAs of the control group, enlarged CSAs were found in the idiopathic, diabetic and DPN CTS groups. The CSAs were larger at i4, i3 and i2 in the diabetic CTS group compared to the idiopathic CTS group. The CSAs measured at the i1 and w levels of the DPN CTS group were smaller than those of the diabetic CTS group. In the diabetic CTS group, the cut-off values of CSAs measured at the inlet, wrist crease, and outlet were 15.3 mm2, 13.4 mm2 and 10.0 mm2, respectively, and 14.0 mm2, 12.5 mm2 and 10.5 mm2, respectively, in the DPN CTS group. CONCLUSIONS: Compared with the median nerve CSAs of the control and idiopathic CTS groups, the median nerve CSAs of the diabetic patients with CTS were significantly enlarged. However, compared with the diabetic CTS group, the CSAs were significantly smaller in the DPN CTS group. This US 8-point measurement method can be of value as an important complementary tool for CTS studies and diagnosis among diabetic patients.

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    ABSTRACT: OBJECTIVE: To investigate the possible association of external and ultrasonographic measurements of the hand and wrist with median nerve conduction studies. DESIGN: Two group comparison study SETTINGS: Out- patient neurophysiology laboratory and radiology department in the University hospital, Patras, Greece PARTICIPANTS: Patient group: Fifty patients (40 female) with clinically overt and electrophysiologicaly proven idiopathic carpal tunnel syndrome (ICTS) and control group: 50 age and sex-matched healthy volunteers participated in this study. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: The following measurements were taken: i. motor and sensory conduction studies of median nerve; ii. external hand and wrist dimensions (hand ratio (HR) and wrist ratio (WR)); iii. ultrasonographic dimensions of the carpal tunnel (carpal tunnel ratio (CTR)) and cross sectional area of the median nerve (CSA) at the inlet (in) and outlet (out) of the tunnel. The results showed significant differences of HR, WR, CTRin, CTRout, CSAin and CSAout between patients and controls. RESULTS: Differences between patients and controls were significant for HR,WR, CTRin, CTRout, CSAin and CSAout. Sensory conduction velocity and distal motor latency of the median nerve in all 100 subjects were well correlated with HR, WR, CTRin and CTRout estimates. WR was significantly correlated with CTRin and CTRout. CONCLUSIONS: It was concluded that a particular hand and wrist configuration, i.e. short and wide handwith square wrist matching to narrow and deep tunnel entrance demonstrated increased liability for idiopathic CTS. For screening purposes, it was suggested that simple external hand or wrist measurements could be used to predict the tendency for CTS.
    Archives of physical medicine and rehabilitation 11/2012; · 2.18 Impact Factor

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