Carpal Tunnel Syndrome Carpal Tunnel Syndrome Ghada Almeshali AlBandri AlZahid.
Update on the Use of Ultrasound in the Diagnosis of Carpal Tunnel Syndrome Renato A. Sernik, MD,...
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Transcript of Update on the Use of Ultrasound in the Diagnosis of Carpal Tunnel Syndrome Renato A. Sernik, MD,...
![Page 1: Update on the Use of Ultrasound in the Diagnosis of Carpal Tunnel Syndrome Renato A. Sernik, MD, PhD.](https://reader036.fdocuments.net/reader036/viewer/2022062519/5697bffc1a28abf838cc19d7/html5/thumbnails/1.jpg)
Update on the Use of Ultrasound in the Diagnosis of Carpal Tunnel
Syndrome
Renato A. Sernik, MD, PhD
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t
Flexor retinaculum
median nerve
median nerve
carpal tunnel
• Common compressive neuropathy.• Initially, pain and sensitivity changes in the median nerve territory.• Advanced stages – weakness and atrophy of the thenar muscles.
Carpal Tunnel Syndrome
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Carpal Tunnel Syndrome
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- useful as a screening test, reducing the cost of diagnosis of carpal tunnel syndrome.
Fowler JR, Maltenfort MG, Ilyas AM. Ultrasound as a first-line test in the diagnosis of carpal tunnel syndrome: a cost-effectiveness analysis. Clin Orthop Relat Res. 2013 Mar;471(3):932-7.
Ultrasonography
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Linear transducers:-12 –18 MHz.-High resolution.
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PERIPHERAL NERVE ANATOMY
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fiber
fasciclenerve
perineurium
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scaphoid pisiform
trapeziumhamate
flexor retinaculum
Carpal Tunnel
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PIS
CARPAL TUNNEL
* a
n
scaphoidpisiform
a u fu
* PIS
scaphoid pisiform
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trapezium
hamatetrapezium
hamate
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ULTRASONOGRAPHY
Median Nerve Evaluation
• Qualitative• Quantitative
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Qualitative Evaluation
- shape-echogenicity-structure
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Echogenicity / structures
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Shape
• COMPRESSION• EDEMA HOURGLASS SHAPE
carpal tunnel
median nerve
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proximal distal
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Quantitative Evaluation
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In 1991, Buchberger et al. proposed 3 criteria for sonographic diagnosis of the carpal tunnel syndrome:
- increase in cross-sectional area of the median nerve, proximal to the compression.- thinning of the median nerve at the site of the compression, measured by the ratio of two diameters of the nerve.- bulging of the flexor retinaculum.
Carpal Tunnel Syndrome
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In 1991, Buchberger et al. proposed 3 criteria for sonographic diagnosis of the carpal tunnel syndrome:
- increase in cross-sectional area of the median nerve, proximal to the compression.- thinning of the median nerve at the site of the compression, measured by the ratio of two diameters of the nerve.- bulging of the flexor retinaculum.
Carpal Tunnel Syndrome
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Quantitative Evaluation
The measurement of the area must be made where it is greater
At the entrance carpal tunnel or in the proximal carpal tunnel
Median Nerve Área
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Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94.
Tai TW, Wu CY, Su FC, Chern TC, Jou IM. Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy. Ultrasound Med Biol. 2012 Jul;38(7):1121-8.
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Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94.
- increase the area of the median nerve used as diagnostic criteria. - Cutoff 9 -11mm².- sensitivity 77.6% and specificity 86.8%.
Tai TW, Wu CY, Su FC, Chern TC, Jou IM. Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy. Ultrasound Med Biol. 2012 Jul;38(7):1121-8.
Mhoon JT, Juel VC, Hobson-Webb LD. Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality. Muscle Nerve. 2012 Dec;46(6):871-8.
Ultrasonography in Carpal Tunnel Syndrome
Fowler JR, Maltenfort MG, Ilyas AM. Ultrasound as a first-line test in the diagnosis of carpal tunnel syndrome: a cost-effectiveness analysis. Clin Orthop Relat Res. 2013 Mar;471(3):932-7.
![Page 24: Update on the Use of Ultrasound in the Diagnosis of Carpal Tunnel Syndrome Renato A. Sernik, MD, PhD.](https://reader036.fdocuments.net/reader036/viewer/2022062519/5697bffc1a28abf838cc19d7/html5/thumbnails/24.jpg)
Cutoff- 10 mm2 sensitivity – 85.0%
specificity – 92.1%
accuracy – 89.3%
Tai TW, Wu CY, Su FC, Chern TC, Jou IM. Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy. Ultrasound Med Biol. 2012 Jul;38(7):1121-8.
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pronador quadratus
Comparative Evaluation
carpal tunnel
A1
A2
Normal Nerve:A1- A2 ≤ 2mm²
Thickened Nerve:A1- A2 ≥ 2mm²
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pronador quadratus
A1
A2
carpal tunnel
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Palmar Cutaneus Branch(PCB) of the Median Nerve
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antebrachial fascia
flexor retinaculum
median nerve median nerve
FCRT
palmaris longus t
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Palmar Cutaneus Branch of the Median Nerve
• Compression in the tunnel.• Stretching as a consequence to reduced mobility of the
median nerve.
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FCRT
median nerve
PCB
median nerve FCRT
palmaris longus t
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Median nerve
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median nerve
median nerve
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Post-Operative - Carpal Tunnel Syndrome
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Post-Operative - Carpal Tunnel Syndrome
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median nerve
median nerve
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CONCLUSION
Ultrasound in Carpal Tunnel Syndrome
• The method doesn’t predict severity.• useful as a screening test, reducing the cost of diagnosis
of carpal tunnel syndrome.• post-operative evaluation.