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Chen SY, Wang YW, Chen WS, Hsiao MY. Update of Contrast-enhanced Ultrasound in Musculoskeletal Medicine: Clinical Perspectives - A Review. J Med Ultrasound 2023; 31:92-100. [PMID: 37576422 PMCID: PMC10413398 DOI: 10.4103/jmu.jmu_94_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 08/15/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) uses an intravascular contrast agent to enhance blood flow signals and assess microcirculation in different parts of the human body. Over the past decade, CEUS has become more widely applied in musculoskeletal (MSK) medicine, and the current review aims to systematically summarize current research on the application of CEUS in the MSK field, focusing on 67 articles published between January 2001 and June 2021 in online databases including PubMed, Scopus, and Embase. CEUS has been widely used for the clinical assessment of muscle microcirculation, tendinopathy, fracture nonunions, sports-related injuries, arthritis, peripheral nerves, and tumors, and can serve as an objective and quantitative evaluation tool for prognosis and outcome prediction. Optimal CEUS parameters and diagnostic cut off values for each disease category remain to be confirmed.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wei Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
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Dong D, Liu H. Prevalence of carpal tunnel syndrome in patients with long-term type 2 diabetes mellitus. Heliyon 2022; 8:e12615. [PMID: 36593820 PMCID: PMC9803777 DOI: 10.1016/j.heliyon.2022.e12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/11/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Generally, Carpal tunnel syndrome (CTS) is more common in diabetes mellitus (DM), especially in subjects with coexisting diabetic polyneuropathy (DPN) and/or long-term DM. Based on the analysis of nerve conduction velocity (NCV), the prevalence of CTS and the features of nerve injury were retrospectively explored in type 2 diabetes mellitus (T2DM) patients. In this cohort, there were 353 T2DM patients who were hospitalized in Taiyuan Central Hospitalbetween January 2018 and January 2019. The pathological rates of NCVs between the left and right median nerves were compared, including the gender effect. The examinations were mainly directed to analyze the median nerve injury features. Among 353 patients, 139 patients (39.3%) presented with CTS. These 139 T2DM patients with CTS were then divided into groups based on the nerve injury location and injured nerve type. The prevalence of sensory nerve injury (SNI) was higher than that of motor nerve injury (MNI). The CTS patients had a significantly higher occurrence rate of SNI than MNI (P < 0.05). The abnormal rate of sensory nerve conduction velocity (SCV, P = 0.01) and motor nerve conduction velocity (MCV, P < 0.05) were higher in the right median nerve. No significant differences were detected for other nerves on either side. Significant differences in abnormal rates of SCV of the left (P = 0.04) and the right (P = 0.03) median nerves between the two genders were found. There were no significant abnormalities for other nerves on either side and either gender. Early screening of NCV is needed for T2DM patients to detect CTS with a high prevalence rate. This study suggests that early detection of NCV can identify CTS in the absence of clinical conditions and SNI may occur earlier in long-term T2DM patients with CTS.
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Affiliation(s)
- Defu Dong
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030000, China
| | - Hongwei Liu
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030000, China,Department of Neurology, Tai yuan Central Hospital, Shanxi Medical University, Taiyuan, China,Corresponding author.
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Dynamic Evaluation of Intraneural Microvascularity of the Ulnar Nerve Using Contrast-Enhanced Ultrasonography in Patients With Cubital Tunnel Syndrome. J Hand Surg Am 2022; 47:687.e1-687.e8. [PMID: 34462166 DOI: 10.1016/j.jhsa.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 04/24/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the intraneural microvascular patterns of the ulnar nerve at 2 elbow flexion angles in asymptomatic volunteers and patients with cubital tunnel syndrome (CuTS) and to evaluate the effects of surgery on the microvascular pattern in patients with CuTS by using contrast-enhanced ultrasonography (CEUS). METHODS This study included 10 elbows in 10 asymptomatic volunteers (control group) and 10 elbows in 10 patients with CuTS who underwent anterior subcutaneous transposition of the ulnar nerve (CuTS group). The CuTS group underwent clinical and electrophysiologic examinations and CEUS before surgery and at 1, 2, and 3 months after surgery. The intraneural enhancement pattern was calculated as an area under the curve (AUC) value in the entrapment site of the ulnar nerve within the cubital tunnel and in the area 1 cm proximal to the site (proximal site) at elbow flexion angles of 20° and 110°. RESULTS Serial electrophysiologic examinations showed improvements at 1, 2, and 3 months after surgery compared with before surgery. In the control group, the AUC values of the central part of the cubital tunnel and proximal sites showed no substantial changes with the increase in elbow flexion. In the CuTS group, the AUC in the proximal site at 110° of elbow flexion was decreased compared with that at 20° of flexion before surgery. The AUC values for both the entrapment and proximal sites at 20° and 110° of elbow flexion were the most increased at 2 months after surgery compared with before surgery. CONCLUSIONS Increased elbow flexion in patients with CuTS influences the intraneural blood flow of the ulnar nerve. Surgery for CuTS alters the intraneural blood flow. CLINICAL RELEVANCE Quantitative evaluation of the intraneural blood flow of the ulnar nerve using CEUS may be a new supplementary diagnostic tool for CuTS and an indicator for the evaluation of postoperative recovery from nerve damage.
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Tullie S, Wiberg A, Furniss D, Schmid A. T2-weighted MRI defines critical compression in the distal carpal tunnel that is relieved after decompressive surgery. J Plast Reconstr Aesthet Surg 2022; 75:2251-2258. [PMID: 35341704 PMCID: PMC7613040 DOI: 10.1016/j.bjps.2022.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
Introduction Despite Carpal Tunnel Syndrome (CTS) being the most common entrapment neuropathy, its pathophysiology remains debated. Sub-synovial connective tissues (SSCT) within the carpal tunnel are thought to play a role but are poorly characterised. MRI analysis offers potentially novel insights into SSCT characteristics. Methods A pilot study of T2-weighted MRI was performed in healthy controls (n=7), and in CTS patients (n=16) pre- and 6 months post-surgical decompression. Image analysis was performed to quantify SSCT cross-sectional area, SSCT signal intensity ratio, and wrist index (depth/width) at distal, middle and proximal wrist landmarks. Results Median SSCT signal intensity was lower in the distal carpal tunnel of CTS patients pre-operatively (0.96) compared to controls (1.13; P = 0.008) and normalised post-operatively (1.13, P = 0.001). Median wrist index was also lower in CTS patients pre-operatively (0.60) compared to controls (0.67, P = 0.022), and again normalised post-operatively (0.74, P =0.001). This was attributed to changes in carpal depth in the antero-posterior axis with decompression surgery. Conclusion This pilot study successfully demonstrated MRI assessment of SSCT in patients with CTS. The decreased SSCT signal intensities suggest predominant changes at the distal tunnel, potentially indicating reduced SSCT perfusion pre-surgery which normalised post-surgery. Our preliminary findings merit further investigation in a larger cohort.
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Affiliation(s)
- S Tullie
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom
| | - A Wiberg
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom; Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - D Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom; Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - A Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, West Wing Level 6, Headley Way, Oxford OX3 9DU, United Kingdom.
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Inoue A, Funakoshi T, Koga R, Kusano H, Takahashi T, Miyamoto A, Murayama T, Kainuma Y, Koda S, Kawanabe K, Yamamoto Y. Evaluation of hypervascularity in synovitis of the shoulder using ultrasound: Comparison of preoperative ultrasound findings and intraoperative arthroscopic findings. JSES Int 2022; 6:473-478. [PMID: 35572442 PMCID: PMC9091746 DOI: 10.1016/j.jseint.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Akira Inoue
- Department of Rehabilitation Keiyu Orthopaedic Hospital, Tatebayashi, Japan
- Corresponding author: Akira Inoue, PT, Keiyu Orthopaedic Hospital, 2267 Akoda, Tatebayashi, Gunma 374-0013, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Ryuji Koga
- Department of Orthopaedic Surgery Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Hiroshi Kusano
- Department of Orthopaedic Surgery Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Toru Takahashi
- Department of Orthopaedic Surgery Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Azusa Miyamoto
- Department of Rehabilitation Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Toshiki Murayama
- Department of Rehabilitation Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Yuta Kainuma
- Department of Rehabilitation Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Saki Koda
- Department of Rehabilitation Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Keito Kawanabe
- Department of Rehabilitation Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Yuzuru Yamamoto
- Department of Orthopaedic Surgery Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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Yildiran G, Seher N, Sutcu M, Nayman A, Akdag O, Tosun Z. Median Nerve's Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging. Plast Reconstr Surg 2021; 147:1355-1360. [PMID: 33974590 DOI: 10.1097/prs.0000000000007940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging. METHODS Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared. RESULTS The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p < 0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p > 0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression. CONCLUSIONS Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Affiliation(s)
- Gokce Yildiran
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Nusret Seher
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Mustafa Sutcu
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Alaaddin Nayman
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Osman Akdag
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
| | - Zekeriya Tosun
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, and the Radiology Department, Selcuk University Medical Faculty
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Ultrasound-guided platelet-rich plasma injection and multimodality ultrasound examination of peripheral nerve crush injury. NPJ Regen Med 2020; 5:21. [PMID: 33298932 PMCID: PMC7680141 DOI: 10.1038/s41536-020-00101-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/28/2020] [Indexed: 02/06/2023] Open
Abstract
Ultrasound-guided platelet-rich plasma (PRP) injection is able to make up for the limitations of applying a single growth factor. The goal of this study was to investigate the effects of serial ultrasound-guided PRP injections of the appropriate concentration on the treatment of sciatic nerve crush injury, and explore the value of multimodality ultrasound techniques in evaluating the prognosis of crushed peripheral nerve. In vitro, optimal concentration of PRP (from 150%, 250%, 450%, and 650%) was screened due for its maximal effect on proliferation and neurotrophic function of Schwann cells (SCs). In vivo, ninety rabbits were equally and randomly divided into normal control, model, PRP-2.5×, PRP-4.5×, and PRP-6.5× groups. The neurological function and electrophysiological recovery evaluation, and the comparison of the multimodality ultrasound evaluation with the histological results of sciatic nerve crush injury were performed to investigate the regenerative effects of PRP at different concentrations on the sciatic nerve crush injury. Our results showed that the PRP with a 4.5-fold concentration of whole blood platelets could significantly stimulate the proliferation and secretion of SCs and nerve repair. The changes in stiffness and blood perfusion were positively correlated with the collagen area percentage and VEGF expression in the injured nerve, respectively. Thus, serial ultrasound-guided PRP injections at an appropriate concentration accelerates the recovery of axonal function. Multimodality ultrasound techniques provide a clinical reference for prognosis by allowing the stiffness and microcirculation perfusion of crush-injured peripheral nerves to be quantitatively evaluated.
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Blood flow velocity but not tendon mechanics relates to nerve function in carpal tunnel syndrome patients. J Neurol Sci 2020; 411:116694. [PMID: 32001379 DOI: 10.1016/j.jns.2020.116694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 12/22/2022]
Abstract
Carpal tunnel syndrome (CTS) develops from chronic compression of the median nerve. Chronic compression results in a number of vascular, structural and functional changes to the carpal tunnel tissues which ultimately manifest in the characteristic symptoms of CTS. The purpose of this study was to investigate the interplay of median nerve function, median nerve hemodynamics, and finger flexor tendon and subsynovial connective tissue (SSCT) mechanics in CTS patients. Thirty-five patients were recruited following nerve conduction study for this double-blinded imaging study. Ultrasound B-mode, pulse-wave Doppler, and colour Doppler images and videos were collected at the proximal carpal tunnel to quantify: (1) median nerve cross-sectional area, (2) intraneural blood flow velocity in 3 wrist postures (neutral (0°), flexion (15°), extension (30°)), and (3) flexor digitorum superficialis and SSCT displacement. Results demonstrate that intraneural blood flow velocity is dependent on median nerve function and wrist posture such that patients with mild CTS are more susceptible to the effects of non-neutral wrist postures. Tendon-SSCT mechanics do not appear to differ based on severity. This study stresses the importance of limiting exposure to non-neutral wrist postures in patients with early signs of the condition.
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Zhu Y, Jin Z, Luo Y, Wang Y, Peng N, Peng J, Wang Y, Yu B, Lu C, Zhang S. Evaluation of the Crushed Sciatic Nerve and Denervated Muscle with Multimodality Ultrasound Techniques: An Animal Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:377-392. [PMID: 31699548 DOI: 10.1016/j.ultrasmedbio.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 06/10/2023]
Abstract
This study was aimed at evaluating the value of multimodality ultrasound techniques in the detection of crushed sciatic nerve and denervated muscle in rabbits. Fifty healthy male New Zealand white rabbits were randomly divided into five groups (n = 10 in each group): four crushed injury groups at 1, 2, 4 and 8 wk post-sciatic nerve crushed injury, and a control group without crush injury. The crushed sciatic nerve and denervated muscle were measured with conventional ultrasound, shear wave elastography and contrast-enhanced ultrasonography, and the results were compared with the histopathological parameters. The inter- and intra-reader reliability of multimodality ultrasound was assessed with intra-class correlation coefficients. Our results revealed that the sciatic nerve thickened at 2 wk post-crushed injury (p < 0.01), but recovered to almost normal thickness at 8 wk post-injury. Stiffness of the crushed nerve gradually increased (p < 0.01), and intraneural blood volume decreased (area under the curve, peak intensity, time to peak, p < 0.01 each) over time. Histopathological evaluation revealed obvious collagen hyperplasia and poor regenerated microvascular and sparse axonal regeneration and remyelination. Compared with that of the control group, the elastic modulus of the denervated muscle significantly increased (p < 0.05), which may be related to the increased intramuscular collagen (p < 0.01) and decreased muscle fiber cross-sectional area (p < 0.01). There were no significant differences in contrast-enhanced ultrasonography parameters (area under the curve, peak intensity, time to peak) of the denervated muscle between the crush injury groups and the control group (p >0.05). All ultrasound results had excellent inter- and intra-reader consistency (intraclass correlation coefficient >0.80). In conclusion, multimodality ultrasound techniques could provide quantitative information on the morphologic changes, mechanical properties and blood perfusion of crushed nerve and denervated muscle, which may be of great importance in clinical practice.
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Affiliation(s)
- Yaqiong Zhu
- Medical College of Nankai University, Tianjin, China; Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China; Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhuang Jin
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China; General hospital of Northern Theater Command, Shenyang, Liaoning province, China
| | - Yukun Luo
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Yuexiang Wang
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Nan Peng
- Department of Geriatric Rehabilitation, Chinese PLA General Hospital, Beijing, China
| | - Jiang Peng
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China; Key Lab of Musculoskeletal Trauma & War Injuries, Chinese PLA General Hospital, Beijing, China
| | - Yu Wang
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China; Key Lab of Musculoskeletal Trauma & War Injuries, Chinese PLA General Hospital, Beijing, China
| | - Bo Yu
- Departments of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Changfeng Lu
- Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China; Key Lab of Musculoskeletal Trauma & War Injuries, Chinese PLA General Hospital, Beijing, China
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Chakkalakkoombil SV, Nair PP, Govindarajalou R, Barathi D, Marusani R, Kumar Kottyen Thazhath H. Role of Ultrasound to Monitor Patients With Carpal Tunnel Syndrome Treated With a Local Corticosteroid. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2373-2378. [PMID: 30653694 DOI: 10.1002/jum.14932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/10/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Carpal tunnel syndrome (CTS) is an entrapment neuropathy resulting from compression of the median nerve at the carpal tunnel (CT). We assessed the role of high-resolution ultrasound (US) in monitoring patients with CTS treated with corticosteroid injection. METHODS We performed high-resolution US evaluations of the wrists of patients with CTS before and after treatment with local corticosteroid. Thirty-nine and 17 wrists were included for analysis at the end of 1 and 3 months, respectively. The cross-sectional area (CSA) and anteroposterior diameter (APD) of the median nerve at the CT and clinical and electrophysiologic data were recorded. We assessed whether changes in US measurements before and after the treatment correlated with clinical and electrophysiologic parameters. RESULTS The Boston symptom severity scale (p < .01), Boston functional status scale (p < .01), median nerve motor latency (p = .017), median nerve sensory velocity (p = .003), and difference in motor latencies (p = 0.03) and difference in sensory latencies (p = .03) between median and ulnar nerves showed significant changes over 1 or/and 3 months compared to baseline values. Changes in the CSA and APD correlated with changes in some clinical and electrophysiologic parameters. However, measurements of the CSA and APD at 1 or 3 months were not significantly different from baseline values. CONCLUSIONS High-resolution US parameters such as the APD and CSA of the median nerve at the CT inlet were not useful to monitor patients with CTS treated with corticosteroid injections.
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Affiliation(s)
| | - Pradeep Pankajakshan Nair
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ramkumar Govindarajalou
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Deepak Barathi
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Revanth Marusani
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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