Ultrasonography for the diagnosis of carpal tunnel syndrome: an umbrella review

The Median Nerve Displays Adaptive Characteristics When Exposed to Repeated Pinch Grip Efforts of Varying Rates of Force Development: An Ultrasonic Investigation

OBJECTIVES

Repeated gripping with high grip forces and high rates of grip force development are risk factors for carpal tunnel syndrome. As the nerve's adaptive ability is crucial to prevent disease progression, we investigated how these risk factors influence median nerve deformation and displacement over the time course of a repeated pinch grip task.

METHODS

Seventeen healthy participants performed a repeated grip task against a load cell while their carpal tunnel was scanned with ultrasound. The grip task involved pulp-pinching three consecutive times from 0 to 40% maximal voluntary exertion (MVE), performed at three different rates of force development (RFD): 40% MVE/1 second; 2 seconds; and 5 seconds. Ultrasound images were analyzed at 10% MVE intervals. Nerve circularity, width, height, and cross-sectional area were measured to assess deformation. Median nerve displacement was assessed by its change in position relative to the flexor digitorum superficialis tendon of the third digit (FD) in both radioulnar and palmodorsal axes.

RESULTS

Linear mixed modeling indicated that median nerve deformation increased, becoming more circular, with each repeated pulp-pinch (P < .01) and with grip force magnitude (P < .01). However, a faster RFD decreased nerve deformation (P < .01). Furthermore, the nerve displaced ulnarly during pulp-pinching, with greater displacement during the fastest (ie, 40% MVE/1 second) RFD (P < .01).

CONCLUSIONS

The median nerve deformed and displaced in response to pulp-pinching; however, faster rates of force development hindered this adaptive response. This likely reflects the viscoelastic properties of the healthy nerve and subsynovial connective tissue, highlighting the importance of tissue compliance in preventing nerve compression.

Grip Force Modulation on Median Nerve Morphology Changes

Compression on the median nerve can lead to carpal tunnel syndrome (CTS), and median nerve indicators measured from ultrasound images can be used for CTS diagnosis. The aim of this study was to investigate the relationship between grip force modulation and dynamic morphological changes of the median nerve. We used a digital grip dynamometer to measure grip force while simultaneously conducting ultrasound examinations. Ultrasound images were sampled for both the dominant and nondominant hands of all participants (n = 20) during a baseline condition at approximately 0% maximum voluntary force (MVF), during sustained grip force conditions at 25%, 50%, 75%, and 100% MVF, and during the return to a relaxed state (≈0% MVF) directly following each grip force condition. Regardless of hand dominance, grip force level, and grip force modulation, median nerve cross-sectional area (MNCSA) during the grip tasks was smaller relative to the initial baseline condition without grip force. With respect to shape change, the median nerve became more flattened, including increased longitudinal diameter (D1) and decreased vertical diameter (D2), when grip force was relaxed compared to the preceding sustained grip force condition for the dominant hand; however, there were no significant shape changes for the nondominant hand. As morphological changes to tissue result in strain, our results indicate that median nerve injury development may be associated with more hand usage (dominant hand, grip exertion, and grip force modulation), and further suggests the evaluative potential for median nerve dynamics within the carpal tunnel.

Effectiveness of Comprehensive Video Datasets: Toward the Development of an Artificial Intelligence Model for Ultrasonography-Based Severity Diagnosis of Carpal Tunnel Syndrome

OBJECTIVES

Advances in diagnosing carpal tunnel syndrome (CTS) using ultrasonography (US) and artificial intelligence (AI) aim to replace nerve conduction studies. However, a method for accurate severity diagnosis remains unachieved. We explored the potential of comprehensive video data formats for constructing an effective model for diagnosing CTS severity.

METHODS

We studied 75 individuals (52 with CTS) from 2019 to 2022, categorizing them into 3 groups based on disease severity. We recorded 132 US videos of carpal tunnel during finger movement. Features of the median nerve (MN) were extracted from automatically segmented US video frames, from which 3 datasets were created: a comprehensive video dataset with full information, a key metrics dataset, and an initial frame dataset with the least information. We compared the accuracy of machine learning algorithms for classifying CTS severity into 3 groups across these datasets using 63-fold cross-validation.

RESULTS

The cross-sectional area of the MN correlated with severity (P < .05) but MN displacement did not. The algorithm using the comprehensive video dataset exhibited the highest sensitivity (1.00) and accuracy (0.75).

CONCLUSIONS

Our study demonstrated that utilizing comprehensive video data enables a more accurate US-based diagnosis of CTS severity. This underscores the value of capturing the patterns of MN deformation and movement, which cannot be captured by representative metrics such as medians or maximums. By further developing an AI model based on our findings, a simpler and painless method for assessing CTS severity can be achieved.

Elasticity Characteristics of Thenar Muscles in Carpal Tunnel Syndrome

OBJECTIVE

Measurement of thenar muscle elasticity by ultrasound shear wave elastography (SWE) may be useful for the diagnosis and evaluation of carpal tunnel syndrome (CTS), but there is a paucity of information on SWE of the thenar muscles in patients with CTS. The purpose of this study was to investigate the elasticity of the thenar muscles in patients with CTS.

METHODS

Twenty-two adult patients with a referral diagnosis of CTS (27 hands) and 20 healthy volunteers as a control (20 dominant hands) participated in this study. The elastic modulus of the thenar muscles was measured with SWE in two conditions, rest and pinch. The elastic modulus and percent change between the two conditions for each muscle were compared between groups.

RESULTS

The elastic modulus of the abductor pollicis brevis (APB) in the patient group was lower than that in the control group at rest (20.6 ± 5.6 kPa vs. 25.0 ± 8.5 kPa; p = 0.034). However, the elastic modulus (87.9 ± 49.0 kPa vs. 62.5 ± 28.5 kPa; p = 0.044) and percent change (373.3 ± 336.4% vs. 169.2 ± 116.0%; p = 0.006) of the APB in the patient group were higher than those in the control group with pinch. For the opponens pollicis and adductor pollicis, there was no significant difference in the elastic modulus between groups.

CONCLUSION

Patients with CTS showed differences in SWE of the APB. Future studies need to investigate the accuracy of SWE in diagnosing CTS and assessing prognosis.

Ultrasound of the Median Nerve: A Pictorial Review. Normal Ultrasound Findings and Variations

This is the first of a two-part article in which we focus on the Ultrasound (US) appearance of the normal median nerve (MN) and its main branches. The detailed anatomy and US anatomy of the MN course are presented with high-resolution images obtained with the latest-generation US machines and transducers. Variations are discussed to avoid misinterpretation of normal findings.

Diagnostic Value of Measurements of Median Nerve Diameter at the Site of the Maximal Stenosis in Carpal Tunnel Syndrome

Introduction

Ultrasonography is increasingly used to diagnose the carpal tunnel syndrome (CTS). Most frequently, the enlargement of the nerve cross-sectional area (CSA) at the tunnel inlet serves to confirm the diagnosis. Recent research has shown that the nerve diameter is decreased within the tunnel, when measured at the level of pisiforme or capitatum. The stenosis index (SI), which uses the ratio of the diameter of median nerve at the tunnel inlet to the diameter within the tunnel (SI diameter), was proposed as the diagnostic marker of CTS. In this study, we compared the diameter of the median nerve measured at the site of maximal stenosis (DMS) between patients with CTS and controls. Additionally, we investigated the diagnostic utility of the modified SI, which uses the ratio of CSA at the inlet to the diameter within the tunnel (SI CSA).

Methods

Forty-eight patients (72 hands) with CTS and 18 asymptomatic controls (28 hands) underwent electrodiagnostic testing and ultrasonography.

Results

CSA at the inlet was larger in patients, whereas DMS showed only trend towards being smaller in CTS. CTS was also associated with more distal localization of maximal stenosis. Both SI diameter and SI CSA were higher in patients, however the discriminative effect of SI CSA was stronger. SI diameter, SI CSA, CSA at the inlet and DMS correlated with the electrodiagnostic severity grade of CTS. The post-hoc analysis revealed that patients with moderate and severe electrodiagnostic grade of CTS have smaller DMS, whereas patients with mild CTS did not differ from controls.

Conclusion

DMS seems to have only limited diagnostic potential in mild CTS, but it may be a marker of more advanced cases. CTS may be associated with the distal shift of DMS. SI CSA may have significant diagnostic potential in CTS.

Diagnostic Dilemmas in Carpal Tunnel Syndrome and Cervical Spine Disorders: A Comprehensive Review

Carpal tunnel syndrome (CTS) and cervical spondylosis (CS) are both common diseases, yet differentiation between the two is sometimes necessary. However, there are few evidence-based reviews on the differentiation of these conditions. This review examined the literature on the diagnosis of CTS and CS, focusing on how to distinguish between them. The analysis is divided into four categories: clinical symptoms, physical examination, diagnostic imaging, and electrodiagnosis. A total of 281 studies are reviewed, revealing a major issue: the inclusion criteria for defining each disease varies widely across studies. Understanding this limitation, the conclusion drawn is that no single clinical symptom, test, or imaging evaluation can be deemed uniquely reliable for diagnosing CTS or CS. Therefore, it is essential to apply the most up-to-date knowledge, conduct thorough examinations, and perform necessary tests for each patient to achieve a confident and accurate diagnosis.

Ultrasound imaging: Enhancing the diagnosis of carpal tunnel syndrome

Broader adoption of ultrasound (US) imaging in carpal tunnel syndrome management enhances patient care and outcome. This case underscores the importance in diagnosing carpal tunnel syndrome, highlighting its capability to uncover hidden anomalies and assist in surgical planning.

Study of ultrasound and nerve electromyogram in diagnosis of carpal tunnel syndrome and its severity in the elderly

OBJECTIVE

To explore the diagnostic value of ultrasound and nerve electromyography (EMG) in the diagnosis of carpal tunnel syndrome (CTS) and its severity in the elderly.

METHODS

The data of 140 elderly CTS patients were retrospectively analyzed. The data of 80 patients with other diseases with similar symptoms and high suspicion of CTS during the same period were retrospectively analyzed. Pearson method was used to analyze the correlation between cross-sectional area (CSA) and motor nerve conduction velocity (MCV), distal motor latency (DML), compound muscle action potential (CMAP), sensory conduction velocity (SCV), middle-latency (ML) and sensory nerve action potential (SNAP) levels. The value of CSA, MCV, DML, CMAP, SCV, ML and SNAP in the diagnosis of CTS and its severity was analyzed by receiver operating characteristic (ROC) curve.

RESULTS

CSA in mild, moderate and severe groups was positively correlated with DML (P < 0.001) and negatively correlated with CMAP (P < 0.001). The area under the curve (AUC) values of CSA, MCV, DML, CMAP, SCV, ML and SNAP in the diagnosis of normal people and mild CTS were 0.877, 0.787, 0.921, 0.730, 0.860, 0.688 and 0.904. The AUC values of CSA, DML, CMAP, SCV, ML and SNAP in the diagnosis of mild and moderate CTS were 0.863, 0.890, 0.760, 0.848, 0.850 and 0.739, respectively. The AUC values of CSA, MCV, DML and CMAP in the diagnosis of mild and moderate CTS were 0.683, 0.660, 0.870 and 0.693.

CONCLUSION

Ultrasound and nerve EMG are effective in the diagnosis of CTS.

Diagnostic Accuracy of Neuromuscular Ultrasound vs. Electrodiagnostic Studies for Carpal Tunnel Syndrome: Systematic Review and Meta-analysis of Paired Accuracy Studies

This systematic review with meta-analysis compared the diagnostic accuracy of neuromuscular ultrasound (NMUS) and electrodiagnostic studies (EDX) as confirmatory tests for carpal tunnel syndrome (CTS) diagnosis. We used bivariate random-effects models to estimate pooled sensitivity and specificity and generate hierarchical summary receiver-operating characteristic curves to assess diagnostic test accuracy. Nine paired accuracy studies were included, representing 1751 hands (743 clinically diagnosed CTS; 1008 without CTS) that underwent NMUS and EDX. Compared to the clinical diagnosis reference standard, the pooled sensitivity was 86.4% for NMUS and 91.6% for EDX. Pooled specificity was 79.3% for NMUS and 81.9% for EDX. The positive likelihood ratios were 4.2 and 5.1 for NMUS and EDX, respectively, and the negative likelihood ratios were 0.17 and 0.10, respectively. The diagnostic odds ratio was 24 for NMUS and 49 for EDX. No statistically significant differences were identified between NMUS and EDX for sensitivity, specificity, or overall diagnostic accuracy. Overall, the diagnostic accuracy of NMUS is similar to that of EDX for CTS diagnosis, with high sensitivity and moderate specificity for each. The choice between these confirmatory diagnostic tests should incorporate shared decision-making between patients and providers that weighs diagnostic accuracy as well as factors such as patient preferences, test availability, cost, and tolerability.

Ultrasound Diagnosis of Upper Extremity Peripheral Entrapment Neuropathies: A Narrative Review

» Diagnostic ultrasound evaluation has become an important adjunct to electrodiagnostic studies in the diagnosis of upper extremity entrapment neuropathy. » For the common median and ulnar entrapment neuropathies, published normative values for nerve cross-sectional area at the wrist and elbow have demonstrated a high degree of diagnostic validity of diagnostic ultrasound. » Expert consensus on best practice for the clinical use of these reference is lacking and should be a logical next step in the deployment of ultrasound for upper extremity neuropathy evaluation.

Successful evaluation of a new image-based parameter for the diagnosis of carpal tunnel syndrome: ultrasound assessment of longitudinal median nerve gliding in patients, healthy volunteers, and cadavers

BACKGROUND

Reduced longitudinal median nerve gliding is a new promising diagnostic feature in carpal tunnel syndrome (CTS). However, the complexity of existing ultrasound analysis protocols undermines the application in routine clinical practice.

AIM

To provide a simple method for assessing longitudinal gliding with ultrasound, without the need for post-hoc image analysis.

DESIGN

1) Retrospective cohort study, validation by external blinded reviewers; 2) proof of concept in body donors.

SETTING

1) Outpatient clinic; 2) anatomy department.

POPULATION

The population included 48 patients with idiopathic CTS diagnosed by electrodiagnostic testing and ultrasound, as well as 15 healthy controls. Twelve, non-frozen, non-embalmed body donors were enrolled.

METHODS

Longitudinal gliding of the median nerve in the carpal tunnel was visualized in all patients with idiopathic CTS and healthy controls. All ultrasound videos were pseudonymized, equipped with a scale, and randomized. Videos were analyzed by four independent radiologists, all blinded to clinical characteristics. The endpoint was gliding rated as millimeters. Validity of the technique was tested by using speckle tracking software, and in body donors, directly measuring nerve excursion in situ, simultaneously to ultrasound.

RESULTS

Gliding differed significantly between controls and patients with CTS, decreasing with incremental CTS severity. A cut-off value of 3.5 mm to identify patients with CTS, yielded 93.8% sensitivity and 93.3% specificity. Intraclass correlation coefficient among senior author and raters was 0.798 (95% CI 0.513 to 0.900, P<0.001), indicating good reliability. Speckle tracking and especially direct validation in body donors correlated well with ultrasound findings.

CONCLUSIONS

First, longitudinal median nerve gliding can reliably be assessed using this simple technique without the need for complicated procedures. Second, a decrease in gliding was found with progressive severity of CTS. Reproducibility for measured distances is good among raters.

CLINICAL REHABILITATION IMPACT

An easy to apply sonography parameter would bolster the diagnostic ability of specialists in physical medicine and rehabilitation in daily routine.

Diagnostic meta-analysis of the efficacy of ultrasonography for diagnosing carpal tunnel syndrome: A comparison between Asian and non-Asian populations

BACKGROUND

Ultrasonography is used to diagnose carpal tunnel syndrome (CTS) according to various criteria. This diagnostic meta-analysis aimed to evaluate the efficacy of ultrasonography for diagnosing CTS, focusing on the cross-sectional area (CSA) of the median nerve (MN) at the inlet of the carpal tunnel and regional variations in diagnostic thresholds between Asian and non-Asian populations.

METHODS

A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Patient demographic data, diagnostic "gold standards", CSA cutoff values, and diagnostic results were extracted. Meta-analysis was performed to determine the sensitivity, specificity, and optimal CSA cutoff values.

RESULTS

For the 25 included studies, a combined sensitivity of 88% and specificity of 84% for CSA measurements at the carpal tunnel inlet were obtained. The Asian group had a sensitivity of 84% and specificity of 86%, while the non-Asian group had a sensitivity of 91% and specificity of 82%. The mean CSA in the Asian group was significantly lower than that in the non-Asian group (12.93 mm2 and 14.77 mm2, respectively; p = 0.042). For the Asian group, the summary receiver operating characteristic curve had an area under the curve (AUC) of 0.92 with an optimal cutoff of 10.5 mm2; for the non-Asian group, an AUC of 0.94 was obtained with a cutoff of 11.5 mm2.

CONCLUSION

Ultrasonography is a reliable diagnostic method for CTS, with distinct optimal cutoff values observed between Asian and non-Asian populations. Therefore, population-specific diagnostic criteria for CTS are recommended.

Diabetes Increases Median Nerve Cross-Sectional Area but Not Disease Severity in Patients with Carpal Tunnel Syndrome

Background

Ultrasonography (US) is a useful diagnostic modality for diagnosis of carpal tunnel syndrome (CTS). Diabetes mellitus is increasingly prevalent and is a risk factor for CTS. Given the increasing use of US in the diagnosis of CTS, our goal was to evaluate the influence of diabetes on CTS severity and the cross-sectional area (CSA) of the median nerve in patients with CTS.

Methods

Patients with clinically diagnosed CTS were seen in the outpatient setting from October 2014 to February 2021. Median nerve CSA and patient reported severity measures were obtained: Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6. For patients with diabetes, additional parameters were collected including most recent A1c, insulin pharmacotherapy, and polypharmacy.

Results

Ninety-nine patients (122 nerves) without diabetes and 55 patients (82 nerves) with diabetes were recruited for the study. Patients in the diabetes group were more obese and older and had a significantly increased median nerve CSA compared with patients without diabetes. Obesity was associated with higher median nerve CSA in all patients but not in patients with diabetes. There was no difference in disease severity in patients with and without diabetes as reported by BCTSQ or CTS-6 scores. In patients with diabetes, there was significantly decreased median nerve CSA with A1c of 6.5 or higher and a trend to decreased CSA with polypharmacy. There was no influence of insulin therapy on median nerve CSA.

Conclusion

Diabetes is associated with higher median nerve CSA in patients with CTS of similar disease severity. The increased median nerve CSA in patients with diabetes may be reflective of diabetes-related microvascular changes. Interestingly, the trend to decreased median nerve CSA in patients with suboptimal diabetic control (A1c ≥ 6.5) may suggest eventual degenerative changes to the median nerve. In summary, clinicians should be cautious with interpreting a larger median nerve CSA as more severe CTS in patients with diabetes.

Level of Evidence

Level 3 Diagnostic.

Reliability of Ultrasound Measurements of the Median Nerve in Asymptomatic Subjects Using a Handheld Device

This study investigated the reliability of measuring the median nerve cross-sectional area (CSA) at the carpal tunnel inlet using a handheld ultrasound device (HUD) compared to a standard ultrasound system, focusing on intra- and inter-operator reproducibility among novice and expert operators. Employing a prospective cross-sectional design, 37 asymptomatic adults were assessed using both devices, with measurements taken by an expert with over five years of experience and a novice with less than six months. The CSA was determined using manual tracing and ellipse methods, with reproducibility evaluated through intraclass correlation coefficients (ICCs) and agreement assessed via Bland-Altman plots. Results showed a high degree of agreement between the devices, with excellent intra-operator reproducibility (ICC > 0.80) for the expert, and moderate reproducibility for the novice (ICCs ranging from 0.539 to 0.841). Inter-operator reliability was generally moderate, indicating acceptable consistency across different experience levels. The study concludes that HUDs are comparable to standard ultrasound systems for assessing median nerve CSA in asymptomatic subjects, with both devices providing reliable measurements. This supports the use of HUDs in diverse clinical environments, particularly where access to traditional ultrasound is limited. Further research with a larger sample and symptomatic patients is recommended to validate these findings.

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. Although surgery is often performed for CTS, clear international guidelines to indicate when to perform non-surgical or surgical treatment, based on stage and severity of CTS, remain to be elucidated. Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS. History and clinical examination are particularly relevant globally owing to lack of other equipment. Various instruments are used to assess CTS and treatment outcomes as well as the effect of the disorder on quality of life. The surgical treatment options of CTS - open or endoscopic - offer an effective solution to mitigate functional impairments and pain. However, there are risks of post-operative persistent or recurrent symptoms, requiring meticulous diagnostic re-evaluation before any additional surgery. Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being.

Occupational Carpal Tunnel Syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies

Carpal Tunnel Syndrome (CTS) has traditionally been viewed as a specialized medical condition. However, its escalating prevalence among professionals across a multitude of industries has sparked substantial interest in recent years. This review aims to delve into CTS as an occupational disease, focusing on its epidemiological patterns, risk factors, symptoms, and management options, particularly emphasizing its relevance in professional environments. The complex interaction of anatomical, biomechanical, and pathophysiological factors that contribute to the development of CTS in different work settings underlines the critical role of ergonomic measures, prompt clinical identification, and tailored treatment plans in reducing its effects. Nevertheless, the challenges presented by existing research, including diverse methodologies and definitions, highlight the need for more unified protocols to thoroughly understand and tackle this issue. There's a pressing demand for more in-depth research into the epidemiology of CTS, its injury mechanisms, and the potential role of targeted medicine. Moreover, recognizing CTS's wider ramifications beyond personal health is essential. The economic burden associated with CTS-related healthcare costs, productivity losses, and compensation claims can significantly impact both businesses and the broader society. Therefore, initiatives aimed at preventing CTS through workplace interventions, education, and early intervention programs not only benefit the affected individuals but also contribute to the overall well-being of the workforce and economic productivity. By fostering a collaborative approach among healthcare professionals, employers, policymakers, and other stakeholders, we can strive towards creating safer and healthier work environments while effectively managing the challenges posed by CTS in occupational settings.

Characteristics of Patients with Clinical Signs and Symptoms of Carpal Tunnel Syndrome but Negative Diagnostic Testing

Background

Carpal tunnel syndrome (CTS) is a clinical diagnosis involving numerous confirmatory diagnostic tools, including patient questionnaires, ultrasound (US), and electrodiagnostic studies (EDX.) Patients may experience clinical symptoms of CTS with false negative diagnostic testing. The purpose of this study was to identify characteristics of patients with clinical symptoms of CTS with negative diagnostic testing.

Methods

An existing database of 295 hands containing the six-item CTS-6, US of the median nerve, and EDX was queried. Patients with symptoms of carpal tunnel scoring 12.5 or higher on CTS-6 were sorted into those with all positive testing or negative testing.

Results

In 60 patients, 103 hands had both positive US and EDX and a CTS-6 of 12.5 or higher. Twenty-nine hands in 25 patients had a CTS-6 of 12.5 or higher and both negative ultrasound and EDX. There was a significantly younger average age of 43 (P = 0.007) and lower average BMI of 28 (P < 0.0001) of patients in the negative diagnostic study group, compared with the average age of 53, and a body mass index (BMI) of 34 in the positive diagnostic study.

Conclusions

In this series, patients with symptoms of carpal tunnel syndrome and negative diagnostic studies were on average younger and had a lower BMI. These patients may warrant more careful consideration of CTS clinical diagnosis and counseling regarding a higher risk of false-negative confirmatory testing. Further studies are needed to determine possible effects of age and BMI on electrodiagnostic studies and ultrasound testing in CTS.

The prevalence of carpal tunnel syndrome in patients with epilepsy

Objective

Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy caused by compression of the median nerve in the carpal tunnel. Epilepsy is characterised by recurrent seizures caused by abnormal neuronal discharges in the brain.This study aimed to investigate whether there is a link between epilepsy and carpal tunnel and, if so, the underlying factors.

Materials and methods

Two hundred patients with epilepsy were included in this study. The patients' history of epilepsy, seizure type, and seizure frequency were assessed. The Tinel, Phalen, and Flick physical examination tests were performed on patients with complaints that matched those of median nerve neuropathy. Patients with epilepsy and clinically diagnosed carpal tunnel syndrome completed the Boston Carpal Tunnel Syndrome Questionnaire, and nerve conduction studies were performed. The relationship between seizure type and frequency in patients with carpal tunnel syndrome was compared.

Results

Compared to focal-aware motor-onset seizures, the risk of detecting carpal tunnel syndrome was 88.7 times higher in focal-onset bilateral tonic-clonic seizures. Patients with a seizure frequency of one per month or more had a 0.704 times lower risk of CTS than those with a frequency of one per week or more (p = 0.026).

Discussion

Patients with epilepsy, especially those experiencing frequent seizures or specific seizure types, may be more susceptible to repetitive wrist flexion-extension postures. Therefore, during clinical follow-up, it is important to inquire about the presence of carpal tunnel syndrome in patients with epilepsy.

One-Stop Automated Diagnostic System for Carpal Tunnel Syndrome in Ultrasound Images Using Deep Learning

OBJECTIVE

Ultrasound (US) examination has unique advantages in diagnosing carpal tunnel syndrome (CTS), although identification of the median nerve (MN) and diagnosis of CTS depend heavily on the expertise of examiners. In the aim of alleviating this problem, we developed a one-stop automated CTS diagnosis system (OSA-CTSD) and evaluated its effectiveness as a computer-aided diagnostic tool.

METHODS

We combined real-time MN delineation, accurate biometric measurements and explainable CTS diagnosis into a unified framework, called OSA-CTSD. We then collected a total of 32,301 static images from US videos of 90 normal wrists and 40 CTS wrists for evaluation using a simplified scanning protocol.

RESULTS

The proposed model exhibited better segmentation and measurement performance than competing methods, with a Hausdorff distance (95th percentile) score of 7.21 px, average symmetric surface distance score of 2.64 px, Dice score of 85.78% and intersection over union score of 76.00%. In the reader study, it exhibited performance comparable to the average performance of experienced radiologists in classifying CTS and outperformed inexperienced radiologists in terms of classification metrics (e.g., accuracy score 3.59% higher and F1 score 5.85% higher).

CONCLUSION

Diagnostic performance of the OSA-CTSD was promising, with the advantages of real-time delineation, automation and clinical interpretability. The application of such a tool not only reduces reliance on the expertise of examiners but also can help to promote future standardization of the CTS diagnostic process, benefiting both patients and radiologists.

Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment

BACKGROUND

Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand.

OBJECTIVES

The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage.

METHODS

Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome.

RESULTS

The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments.

CONCLUSION

We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.

Assessment of the carpal tunnel and associated neural structures with superb microvascular imaging: a scoping review

INTRODUCTION

Superb microvascular imaging (SMI) is an advanced ultrasound technique that portrays microcirculation. Its clinical applications have been studied in various diseases, including carpal tunnel syndrome (CTS) i.e. the most common entrapment neuropathy. This scoping review explores the role of SMI in diagnosing CTS or the assessment of relevant neural structures.

METHODS

We conducted a comprehensive search of electronic databases (PubMed, Embase and Web of Science) up to 26 September 2023. Two independent authors conducted the literature search, quality assessment, and data extraction.

RESULTS

This review includes seven studies comprising 385 wrists. SMI consistently revealed increased intraneural vascularity in the median nerves of patients with CTS compared to healthy individuals. While SMI demonstrated higher sensitivity than traditional Doppler methods for detecting CTS, its specificity was somewhat lower. Combining SMI with B-mode ultrasound appears to enhance the diagnostic accuracy for CTS. However, the relationship between SMI findings and CTS severity remains unclear.

CONCLUSIONS

This review highlighted the ability of SMI to provide detailed vascular structures in both healthy wrists and those with CTS. Additional research is crucial to determine the typical SMI findings of the carpal tunnel and within that context, tailor more precise diagnostic/therapeutic applications for the CTS population.

Assessing the Potential for Error in Investigating Intraneural Vascularity: A Need for a Standardized Imaging Protocol

Objective

This study examined the implementation of a Doppler sonography imaging protocol to assess intraneural blood flow, within the median nerve, in healthy individuals.

Materials and Methods

A total of 176 participants were examined, and this involved 717 retrospective observations of the images collected. The implemented imaging protocol was assessed, and the data that were collected were cleaned and checked for fidelity and validity.

Results

A large percentage of missing evidence (11%-35%) across proximal, mid, and distal carpal tunnel locations. Only a quarter of cases with evidence of intraneural blood flow had the strongest evidence of a power Doppler video clip, of which only three-quarters were valid. The study identified potential areas for improving the imaging protocol to reduce missing data and improve data quality.

Conclusion

This study demonstrates the significance of a standardized imaging protocol to guide the sonographic acquisition of Doppler images and provides important insights into potential issues with data quality. The recommendations have the potential to help future studies assess intraneural blood flow in healthy populations in a more rigorous and reliable way. Incorporating the study's recommendations into a standardized protocol, there is potential to enhance the diagnostic accuracy of carpal tunnel syndrome and improve diagnosis and treatment.

Effects of high-intensity laser therapy on pain, functional status, hand grip strength, and median nerve cross-sectional area by ultrasonography in patients with carpal tunnel syndrome

The aim of this study was to evaluate the effects of high intensity laser therapy (HILT) on pain, functional status, hand grip strength, and median nerve cross-sectional area by ultrasonography in patients with carpal tunnel syndrome. Sixty patients who were diagnosed with carpal tunnel syndrome were included in the study. The patients observed during the research were randomly divided into two groups with 30 patients in each group. Splint+ exercise and HILT (pulsed mode with a power of 8.0 W and energy density of 8 J/cm2 for 1.40 minutes for every 25 cm2, continuous mode with a power of 3.0 W and energy density of 80 J/cm2 for 11 minutes for each 25 cm2; total 10 sessions 5 days a week) were applied for 2 weeks for the first group, and splint+exercise and sham laser treatment were applied for 2 weeks for the second group. Randomization was undertaken with the assistance of a computer-generated random number table before beginning the treatment processes. The patients were evaluated with the determined scales before the treatment, at the end of the treatment, and at the 3rd month. Hydraulic hand dynamometer was used to measure hand grip strength, visual analog scale (VAS) for pain, Boston CTS Questionnaire to assess function, and ultrasonography to measure median nerve cross-sectional area. The impact of time on the change in VAS levels was found to be of statistical significance within each group of patients (p<0.001), but between-group comparisons did not yield significant results (p<0.454). The effects of time on variations in Boston CTS Questionnaire scores were found to have been of statistical significance for both groups (p<0.001), but significance was not subsequently observed when the results of the two groups were compared on a between-group basis (p=0.226 and p=0.973 for the FSS and SSS, respectively). While time had a statistically significant effect on the change in hand grip strength for both groups (p=0.000), between-group comparisons statistical significance finding in favor of HILT was found in the early period (p=0.012). The time-group association patterns of the groups showed significant difference (p=0.025). While time had a statistically significant effect on the changes in the median cross-sectional areas of the nerve for the patients of both treatment groups (p<0.001), between-group comparisons yielded no findings of statistical significance (p=0.438). The time-group relationship patterns of the groups were found to reflect statistical significance (p=0.001). In conclusion, the results of the research presented here have confirmed that hand grip strength may increase and the median nerve's cross-sectional area may decrease upon the application of high-intensity laser for individuals experiencing CTS. However, this effect was demonstrated here only in the short-term and the evidence was not maintained through the course of follow-up of a longer duration.

The Potential of Ultrasound Radiomics in Carpal Tunnel Syndrome Diagnosis: A Systematic Review and Meta-Analysis

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy for which ultrasound imaging has recently emerged as a valuable diagnostic tool. This meta-analysis aims to investigate the role of ultrasound radiomics in the diagnosis of CTS and compare it with other diagnostic approaches. Methods: We conducted a comprehensive search of electronic databases from inception to September 2023. The included studies were assessed for quality using the Quality Assessment Tool for Diagnostic Accuracy Studies. The primary outcome was the diagnostic performance of ultrasound radiomics compared to radiologist evaluation for diagnosing CTS. Results: Our meta-analysis included five observational studies comprising 840 participants. In the context of radiologist evaluation, the combined statistics for sensitivity, specificity, and diagnostic odds ratio were 0.78 (95% confidence interval (CI), 0.71 to 0.83), 0.72 (95% CI, 0.59 to 0.81), and 9 (95% CI, 5 to 15), respectively. In contrast, the ultrasound radiomics training mode yielded a combined sensitivity of 0.88 (95% CI, 0.85 to 0.91), a specificity of 0.88 (95% CI, 0.84 to 0.92), and a diagnostic odds ratio of 58 (95% CI, 38 to 87). Similarly, the ultrasound radiomics testing mode demonstrated an aggregated sensitivity of 0.85 (95% CI, 0.78 to 0.89), a specificity of 0.80 (95% CI, 0.73 to 0.85), and a diagnostic odds ratio of 22 (95% CI, 12 to 41). Conclusions: In contrast to assessments by radiologists, ultrasound radiomics exhibited superior diagnostic performance in detecting CTS. Furthermore, there was minimal variability in the diagnostic accuracy between the training and testing sets of ultrasound radiomics, highlighting its potential as a robust diagnostic tool in CTS.

Efficiency of Direct Transcutaneous Electroneurostimulation of the Median Nerve in the Regression of Residual Neurological Symptoms after Carpal Tunnel Decompression Surgery

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy. CTS therapy includes wrist immobilization, kinesiotherapy, non-steroidal anti-inflammatory drugs, carpal tunnel steroid injection, acupuncture, and physical therapy. Carpal tunnel decompression surgery (CTDS) is recommended after failure of conservative therapy. In many cases, neurological disorders continue despite CTDS. The aim of this study was to investigate the efficiency of direct transcutaneous electroneurostimulation (TENS) of the median nerve in the regression of residual neurological symptoms after CTDS. Material and Methods: 60 patients aged 28-62 years with persisting sensory and motor disorders after CTDS were studied; 15 patients received sham stimulation with a duration 30 min.; 15 patients received high-frequency low-amplitude TENS (HF TENS) with a duration 30 min; 15 patients received low-frequency high-amplitude TENS (LF TENS) with a duration 30 min; and 15 patients received a co-administration of HF TENS (with a duration of15 min) and LF TENS (with a duration of 15 min). Results: Our research showed that TENS significantly decreased the pain syndrome, sensory disorders, and motor deficits in the patients after CTDS. Predominantly, negative and positive sensory symptoms and the pain syndrome improved after the HF TENS course. Motor deficits, reduction of fine motor skill performance, electromyography changes, and affective responses to chronic pain syndrome regressed significantly after the LF TENS course. Co-administration of HF TENS and LF TENS was significantly more effective than use of sham stimulation, HF TENS, or LF TENS in patients with residual neurological symptoms after CTDS.

Body mass index and carpal tunnel syndrome: A case-control study

To investigate the electrophysiological characteristics of carpal tunnel syndrome (CTS) and to evaluate the relationship between electrophysiological indexes and body mass index (BMI). In the analysis of 153 hospitalized patients with CTS, the median motor conduction velocity, motor conduction amplitude, motor conduction latency, sensor conduction velocity, sensor conduction amplitude and median sensory latency were analyzed. BMI was calculated. Total 171 healthy individuals were selected as control group. According to Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults, patients were divided into groups A, B and C. Patients with BMI (kg/m2) <24 were classified into group A; those with 24 ≤ BMI < 28 were regarded as overweight and classified into group B; and those with BMI ≥ 28 were regarded as obese and classified into group C. The BMI of CTS patients was significantly higher than that of healthy individuals (P < .05). For the sensory nerve, with the increase of BMI, the incubation period was gradually prolonged and the conduction velocity gradually decreases (P < .05). In terms of motor latency, with an increase in BMI, the latency showed a trend of first decreasing and then increasing, while the conduction velocity showed a trend of first increasing and then decreasing (P < .05). Electrophysiological examination plays an important supporting role in the diagnosis of CTS. BMI is positively correlated with the degree of CTS injury to a certain extent. Weight loss can effectively prevent the occurrence of CTS and slow the progression of nerve damage in CTS patients.

The role of ultrasound in determining the presence and severity of carpal tunnel syndrome in diabetic patients

Carpal tunnel syndrome (CTS) is seen in 5% of the population and 14%-30% in diabetics. Although electrophysiological tests are used as the gold standard method in the diagnosis, alternative methods are being studying. We aimed to investigate whether the measurement of median nerve cross-sectional area (CSA) by ultrasound is associated with the presence and severity of CTS. This prospective, cross-sectional observational study includes 128 randomly selected T2DM patients. Electrodiagnostic study was performed for all patients to diagnose CTS. Median nerve CSA were measured with ultrasound examination. The severity of the CTS was determined by Padua method. Among 128 diabetes mellitus (DM) patients, 54 (28%) had CTS and 53 (41%) had diabetic peripheral polyneuropathy. The mean duration of DM was 11.55 years. Median nerve CSAs of the patients were significantly higher in patients with CTS (CTS (-): 10.47 ± 2.67 vs CTS: (+) 12.37 ± 3.17; p < 0.001). Median nerve CSA cutoff value of >10 mm2 predicts the diagnosis of CTS. However, minimal, mild, and moderate CTS groups had similar CSA according to Padua classification (p > 0.05 for all). CSA measurement with ultrasonography can be used as an effective method in diagnosing severe CTS disease. However, median nerve CSA values should not be used to reveal the severity of CTS, in order not to miss the demonstration of minimal, mild, and moderate groups, as well as being an indicator of only the severe CTS group.

Enhancing diagnosis and treatment of superior cluneal nerve entrapment: cadaveric, clinical, and ultrasonographic insights

OBJECTIVES

Low back pain is a prevalent public health issue caused by superior cluneal nerve (SCN) entrapment. This study aimed to explore the course of SCN branches, cross-sectional area (CSA) of the nerves, and effects of ultrasound-guided SCN hydrodissection.

METHODS

SCN distance relative to the posterior superior iliac spines was measured and compared with ultrasound findings in asymptomatic volunteers. The CSA of the SCN, pressure-pain threshold, and pain measurements were obtained from asymptomatic controls and patients with SCN entrapment at various time points after hydrodissection (with 1 mL of 50% dextrose, 4 mL of 1% lidocaine, and 5 mL of 1% normal saline) in the short-axis view.

RESULTS

Twenty sides of 10 formalin-fixed cadavers were dissected. The SCN locations on the iliac crest did not differ from the ultrasound findings in 30 asymptomatic volunteers. The average CSA of the SCN across different branches and sites ranged between 4.69-5.67 mm² and did not vary across different segments/branches or pain statuses. Initial treatment success was observed in 77.7% (n = 28) of 36 patients receiving hydrodissection due to SCN entrapment. A group with initial treatment success experienced symptom recurrence in 25% (n = 7) of cases, and those with recurrent pain had a higher prevalence of scoliosis than those without symptom recurrence.

CONCLUSIONS

Ultrasonography effectively localizes SCN branches on the iliac crest, whereby increased nerve CSA is not useful for diagnosis. Most patients benefit from ultrasound-guided dextrose hydrodissection; however, those with scoliosis may experience symptom recurrence and whether structured rehabilitation can reduce recurrence post-injection should be considered as one perspective in future research. Trial registration ClinicalTrials.gov (NCT04478344). Registered on 20 July 2020, https://clinicaltrials.gov/ct2/show/NCT04478344?cond=Superior+Cluneal+Nerve&cntry=TW&draw=2&rank=1 . Critical relevance statement Ultrasound imaging accurately locates SCN branches on the iliac crest, while enlargement of the CSA is not useful in diagnosing SCN entrapment; however, approximately 80% of SCN entrapment cases respond positively to ultrasound-guided dextrose hydrodissection.

Ultrasound Diagnosis and Guided Intervention of Musculoskeletal/Neuromuscular Pathology 2022

The field of musculoskeletal medicine has been revolutionized by the introduction of ultrasound imaging [...].

Factors Associated with Change in Diagnosis of Carpal Tunnel Syndrome after Electrodiagnostic Studies

Background: Hand surgeons sometimes place more weight on clinical findings and may not always consider the results of electrodiagnostic studies (EDX) in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to determine factors associated with a change in diagnosis of CTS after EDX. Methods: This is a retrospective study of all patients with an initial clinical diagnosis of CTS who underwent EDX at our hospital. We identified patients whose diagnosis changed from CTS to non-CTS after EDX and used univariate and multivariate analysis to determine if age, sex, hand dominance, unilateral symptoms, history of diabetes mellitus, rheumatoid arthritis, haemodialysis, cerebral lesion, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items in CTS-6 and a CTS-negative EDX result were associated with a change in diagnosis after EDX. Results: A total of 479 hands with a clinical diagnosis of CTS underwent EDX. The diagnosis was changed to non-CTS in 61 hands (13%) after EDX. Univariate analysis demonstrated that unilateral symptoms, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items and a CTS-negative EDX result were significantly associated with a change in diagnosis. In the multivariate analysis, only the number of examined items was significantly associated with a change in diagnosis. Conclusions: EDX results were particularly valued in hands where the initial diagnosis was uncertain for CTS. In hands with an initial diagnosis of CTS, the performance of sufficient history-taking and physical examination was more valued at the final diagnosis than EDX results or other aspects of the patient's background. The process of confirming a clear initial clinical diagnosis of CTS using EDX may be of little value for decision-making at the final diagnosis. Level of Evidence: Level III (Therapeutic).

Ultrasound Imaging and Guidance for Distal Peripheral Nerve Pathologies at the Wrist/Hand

Ultrasound has emerged as a highly valuable tool in imaging peripheral nerve lesions in the wrist region, particularly for common pathologies such as carpal tunnel and Guyon's canal syndromes. Extensive research has demonstrated nerve swelling proximal to the entrapment site, an unclear border, and flattening as features of nerve entrapments. However, there is a dearth of information regarding small or terminal nerves in the wrist and hand. This article aims to bridge this knowledge gap by providing a comprehensive overview concerning scanning techniques, pathology, and guided-injection methods for those nerve entrapments. The median nerve (main trunk, palmar cutaneous branch, and recurrent motor branch), ulnar nerve (main trunk, superficial branch, deep branch, palmar ulnar cutaneous branch, and dorsal ulnar cutaneous branch), superficial radial nerve, posterior interosseous nerve, palmar common/proper digital nerves, and dorsal common/proper digital nerves are elaborated in this review. A series of ultrasound images are used to illustrate these techniques in detail. Finally, sonographic findings complement electrodiagnostic studies, providing better insight into understanding the whole clinical scenario, while ultrasound-guided interventions are safe and effective for treating relevant nerve pathologies.

The Impact of Rheumatoid Arthritis (RA) in Median Nerve Area in the Wrist Joint: A Case-Control Study

Background Rheumatoid arthritis (RA) is one cause of carpal tunnel syndromes (CTS); due to increased intracarpal pressure in the rheumatoid wrist, synovial enlargement, joint erosions, and ligamentous laxity cause the compression of the median nerve (MN). Materials and methods A case-control study was conducted to assess the measurement of median nerve areas in RA using high-frequency ultrasound (US) and to correlate the measurement with the disease duration. Forty patients with rheumatoid arthritis (RA) and 40 with non-rheumatoid arthritis (RA) as a control group were referred to the radiology department of Yastabshiron Hospital, Khartoum, Sudan, from June to August 2022. After assessing the wrist joint by ultrasound scans, median nerve (MN) cross-sectional area (CSA) measurements were performed using a Fukuda Denshi ultrasound machine (Tokyo, Japan) with a linear-array high-frequency transducer (10 MHz), after receiving ethical approval from the research committee of the faculty of radiological science at University of Medical Sciences and Technology (UMST) and the study participants. Results The study demonstrated that the mean measurement of MN cross-sectional area (CSA) in RA patients was 13.60 mm2 for the right and 13.25 mm2 for the left MN. The study found that the MN CSA decreased by increasing the disease duration, with significant differences in the median nerve cross-sectional areas in RA and healthy control (p-value of <0.01). Conclusion The study concluded that rheumatoid arthritis (RA) had a greater influence on the median nerve cross-sectional areas. MN areas significantly decreased with increasing duration of diseases; the MN cross-sectional areas were more in RA than in the healthy control group.

Measuring pain and nociception: Through the glasses of a computational scientist. Transdisciplinary overview of methods

In a healthy state, pain plays an important role in natural biofeedback loops and helps to detect and prevent potentially harmful stimuli and situations. However, pain can become chronic and as such a pathological condition, losing its informative and adaptive function. Efficient pain treatment remains a largely unmet clinical need. One promising route to improve the characterization of pain, and with that the potential for more effective pain therapies, is the integration of different data modalities through cutting edge computational methods. Using these methods, multiscale, complex, and network models of pain signaling can be created and utilized for the benefit of patients. Such models require collaborative work of experts from different research domains such as medicine, biology, physiology, psychology as well as mathematics and data science. Efficient work of collaborative teams requires developing of a common language and common level of understanding as a prerequisite. One of ways to meet this need is to provide easy to comprehend overviews of certain topics within the pain research domain. Here, we propose such an overview on the topic of pain assessment in humans for computational researchers. Quantifications related to pain are necessary for building computational models. However, as defined by the International Association of the Study of Pain (IASP), pain is a sensory and emotional experience and thus, it cannot be measured and quantified objectively. This results in a need for clear distinctions between nociception, pain and correlates of pain. Therefore, here we review methods to assess pain as a percept and nociception as a biological basis for this percept in humans, with the goal of creating a roadmap of modelling options.

Dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release: technical innovation and case study

Background

Minimally invasive carpal tunnel release has recently emerged as the primary surgical approach for recalcitrant carpal tunnel syndrome. A major concern related to surgical failure with this technique is the incomplete release of the flexor retinaculum.

Case presentation

We developed a technique using dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release. This novel imaging method was applied to two patients who showed significant symptom relief after the intervention. This case study also provides details of the dynamic ultrasound protocol and highlights the advantages of this technique.

Conclusion

Dynamic ultrasound imaging can be used to confirm the completeness of carpal tunnel decompression. A large-scale prospective trial should be conducted to validate whether additional dynamic ultrasound examination can improve the outcome of minimally invasive carpal tunnel release.

An overview of common peroneal nerve dysfunction and systematic assessment of its relation to falls

PURPOSE

Compression of the peroneal nerve is recognized as a common cause of falls. The superficial course of the peroneal nerve exposes it to trauma and pressure from common activities such as crossing of legs. The nerve can be exposed also to distress due to metabolic problems such as diabetes. The purpose of our manuscript is to review common peroneal nerve dysfunction symptoms and treatment as well as provide a systematic assessment of its relation to falls.

METHODS

We pooled the existing literature from PubMed and included studies (n = 342) assessing peroneal nerve damage that is related in any way to falls. We excluded any studies reporting non-original data, case reports and non-English studies.

RESULTS

The final systematic assessment included 4 articles. Each population studied had a non-negligible incidence of peroneal neuropathy. Peroneal pathology was found to be consistently associated with falls.

CONCLUSION

The peroneal nerve is an important nerve whose dysfunction can result in falls. This article reviews the anatomy and care of the peroneal nerve. The literature review highlights the strong association of this nerve's pathology with falls.