Donghwi Park1. 1. Department of Rehabilitation Medicine, Daegu Fatima Hospital, Ayangro 99, Dong gu, Daegu 41199, Republic of Korea; Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, Republic of Korea(∗). Electronic address: bdome@hanmail.net.
Abstract
BACKGROUND: To date, there have been conflicting suggestions regarding the initial pathogenesis of carpal tunnel syndrome (CTS). It has been characterized as either inflammation of the median nerve caused by compression or noninflammatory fibrosis of the subsynovial connective tissue (SSCT). OBJECTIVE: To investigate the initial pathogenesis of CTS, we compared the deformation and displacement of the median nerve in accordance with the electrophysiological severity between patients with CTS (via the Bland scale) and healthy controls. DESIGN: Cross-sectional, case-control study. SETTING: General teaching hospital, rehabilitation unit. PATIENTS: Thirteen hands of 10 healthy participants and 39 hands of 27 patients with CTS were recruited and classified into 4 groups (stage 0-3) according to the severity of the electrodiagnostic test results. METHODS: Ultrasound images of the median nerve in response to the wrist and finger motions were analyzed. MAIN OUTCOME MEASURE: We measured the deformation of the median nerve (the maximal change values of the median nerve area, and aspect ratio of the minimum-enclosing rectangle [MER]) and movement of the median nerve (the maximal change value of the median nerve displacement) in response to the motions of wrists and finger. The maximal change value of the median nerve displacement was normalized with respect to the width of the wrist. Moreover, the maximal change values of the median nerve area, and the aspect ratio of the MER, were also normalized to the median nerve area and the aspect ratio of the MER in wrist-neutral position with finger extension. RESULT: CTS patients in stage 3 showed a significantly lower normalized maximal change of the median nerve movement compared with CTS patients in stages 0, 1, and 2 (P <.001). Regarding the deformation of the median nerve, however, there were statistically significant differences among all groups (area, P < .001; MER, P <.001). According to multivariate logistic regression analysis, the normalized maximal change of the aspect ratio of the MER is a meaningful parameter in diagnosing the initial stage of CTS (P < .01). CONCLUSION: These results showed that the deformation of the median nerve may be associated with the initial pathogenesis; however, further studies are necessary to validate the findings of this study. LEVEL OF EVIDENCE: III.
BACKGROUND: To date, there have been conflicting suggestions regarding the initial pathogenesis of carpal tunnel syndrome (CTS). It has been characterized as either inflammation of the median nerve caused by compression or noninflammatory fibrosis of the subsynovial connective tissue (SSCT). OBJECTIVE: To investigate the initial pathogenesis of CTS, we compared the deformation and displacement of the median nerve in accordance with the electrophysiological severity between patients with CTS (via the Bland scale) and healthy controls. DESIGN: Cross-sectional, case-control study. SETTING: General teaching hospital, rehabilitation unit. PATIENTS: Thirteen hands of 10 healthy participants and 39 hands of 27 patients with CTS were recruited and classified into 4 groups (stage 0-3) according to the severity of the electrodiagnostic test results. METHODS: Ultrasound images of the median nerve in response to the wrist and finger motions were analyzed. MAIN OUTCOME MEASURE: We measured the deformation of the median nerve (the maximal change values of the median nerve area, and aspect ratio of the minimum-enclosing rectangle [MER]) and movement of the median nerve (the maximal change value of the median nerve displacement) in response to the motions of wrists and finger. The maximal change value of the median nerve displacement was normalized with respect to the width of the wrist. Moreover, the maximal change values of the median nerve area, and the aspect ratio of the MER, were also normalized to the median nerve area and the aspect ratio of the MER in wrist-neutral position with finger extension. RESULT: CTS patients in stage 3 showed a significantly lower normalized maximal change of the median nerve movement compared with CTS patients in stages 0, 1, and 2 (P <.001). Regarding the deformation of the median nerve, however, there were statistically significant differences among all groups (area, P < .001; MER, P <.001). According to multivariate logistic regression analysis, the normalized maximal change of the aspect ratio of the MER is a meaningful parameter in diagnosing the initial stage of CTS (P < .01). CONCLUSION: These results showed that the deformation of the median nerve may be associated with the initial pathogenesis; however, further studies are necessary to validate the findings of this study. LEVEL OF EVIDENCE: III.
Authors: Verena J M M Schrier; Stefanie Evers; Jennifer R Geske; Walter K Kremers; Hector R Villarraga; Sanjeev Kakar; Ruud W Selles; Steven E R Hovius; Russell Gelfman; Peter C Amadio Journal: Ultrasound Med Biol Date: 2019-09-02 Impact factor: 2.998
Authors: Fauzia Javed Sheereen; Bibhuti Sarkar; Pallavi Sahay; Mohammad Abu Shaphe; Ahmad H Alghadir; Amir Iqbal; Taimul Ali; Fuzail Ahmad Journal: Pain Res Manag Date: 2022-06-08 Impact factor: 2.667