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Tezcan EA, Levendoglu F, Durmaz MS, Batur EB, Gezer IA, Erol K. Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis. Ir J Med Sci 2024; 193:977-985. [PMID: 37670102 DOI: 10.1007/s11845-023-03512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. AIMS The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. METHODS To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. RESULTS Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). CONCLUSIONS We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.
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Affiliation(s)
- Ezgi Akyildiz Tezcan
- Department of Physical Medicine and Rehabilitation, Cumra State Hospital, Konya, 42500, Turkey.
| | - Funda Levendoglu
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Elif Balevi Batur
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | - Ilknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
| | - Kemal Erol
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Selcuk University Medical Faculty, Konya, Turkey
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Kim SW, Kim S, Shin D, Choi JH, Sim JS, Baek S, Yoon JS. Feasibility of artificial intelligence assisted quantitative muscle ultrasound in carpal tunnel syndrome. BMC Musculoskelet Disord 2023; 24:524. [PMID: 37370076 DOI: 10.1186/s12891-023-06623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND In case of focal neuropathy, the muscle fibers innervated by the corresponding nerves are replaced with fat or fibrous tissue due to denervation, which results in increased echo intensity (EI) on ultrasonography. EI analysis can be conducted quantitatively using gray scale analysis. Mean value of pixel brightness of muscle image defined as EI. However, the accuracy achieved by using this parameter alone to differentiate between normal and abnormal muscles is limited. Recently, attempts have been made to increase the accuracy using artificial intelligence (AI) in the analysis of muscle ultrasound images. CTS is the most common disease among focal neuropathy. In this study, we aimed to verify the utility of AI assisted quantitative analysis of muscle ultrasound in CTS. METHODS This is retrospective study that used data from adult who underwent ultrasonographic examination of hand muscles. The patient with CTS confirmed by electromyography and subjects without CTS were included. Ultrasound images of the unaffected hands of patients or subjects without CTS were used as controls. Ultrasonography was performed by one physician in same sonographic settings. Both conventional quantitative grayscale analysis and machine learning (ML) analysis were performed for comparison. RESULTS A total of 47 hands with CTS and 27 control hands were analyzed. On conventional quantitative analysis, mean EI ratio (i.e. mean thenar EI/mean hypothenar EI ratio) were significantly higher in the patient group than in the control group, and the AUC was 0.76 in ROC analysis. In the analysis using machine learning, the AUC was the highest for the linear support vector classifier (AUC = 0.86). When recursive feature elimination was applied to the classifier, the AUC value improved to 0.89. CONCLUSION This study showed a significant increase in diagnostic accuracy when AI was used for quantitative analysis of muscle ultrasonography. If an analysis protocol using machine learning can be established and mounted on an ultrasound machine, a noninvasive and non-time-consuming muscle ultrasound examination can be conducted as an ancillary tool for diagnosis.
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Affiliation(s)
- Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sunwoo Kim
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea
| | - Dongik Shin
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea
| | - Jae Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung Sub Sim
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea
| | - Seungjun Baek
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea.
| | - Joon Shik Yoon
- Department of Physical and Rehabilitation Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Ohno K, Fujino K, Fujiwara K, Yokota A, Neo M. Sonographic evaluation of the abductor pollicis brevis muscle reflects muscle strength recovery after carpal tunnel release. J Med Ultrason (2001) 2022; 49:279-287. [PMID: 35239087 DOI: 10.1007/s10396-022-01195-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/14/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE This study aimed to examine the associations between sonographic measurements of the abductor pollicis brevis (APB), grip and pinch strength, and distal motor latency (DML) in patients with carpal tunnel syndrome (CTS) before and after surgery. METHODS We prospectively studied patients (46 hands) who underwent 1 year of postoperative follow-up after endoscopic carpal tunnel release. The patients underwent ultrasound (US) scans, grip and pinch strength assessment, a nerve conduction study, and patient-reported outcome measures (Carpal Tunnel Syndrome Instrument and Michigan Hand Outcomes Questionnaire) before and 1 year after surgery. The standardized response mean was calculated to compare the sensitivity of clinical changes in these measurements. RESULTS US measurements (thickness of the APB and the cross-sectional area of the APB) and muscle strength (grip strength, key pinch, and tip pinch) were greater, and DML was reduced after surgery compared with those before surgery (all P < 0.05). Patient-reported outcome measures also showed clinical improvement 1 year after surgery (P < 0.05). US measurements of the APB were significantly correlated with grip and pinch strength (all P < 0.05), but not with DML, before surgery and 1 year after surgery. The standardized response mean showed a large responsiveness for US measurements of the APB and patient-reported outcome measures. CONCLUSION US evaluation of the APB after CTS can complement the evaluation of grip and pinch strength in the clinical setting. Postoperative recovery of the APB leads to improved motor dysfunction in CTS. Therefore, US measurement of the APB could be a useful tool for evaluating motor function.
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Affiliation(s)
- Katsunori Ohno
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Keitaro Fujino
- Department of Orthopedic Surgery, Hokusetsu General Hospital, 6-24 Kitayanagawa-cho, Takatsuki, Osaka, 569-8686, Japan
| | - Kenta Fujiwara
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Atsushi Yokota
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Sung JH, Kwon YJ, Baek SH, Son MH, Lee JH, Kim BJ. Utility of shear wave elastography and high-definition color for diagnosing carpal tunnel syndrome. Clin Neurophysiol 2021; 135:179-187. [PMID: 34963555 DOI: 10.1016/j.clinph.2021.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The diagnostic values of measuring median nerve (MN) stiffness and vascularity with shear wave elastography (SWE) and high-definition (HD) color were investigated in carpal tunnel syndrome (CTS). METHODS Seventy patients (123 wrists) with CTS and thirty-five healthy volunteers (70 wrists) were enrolled. Based on nerve conduction studies (NCS), the patients were subdivided into NCS-negative, mild-to-moderate, and severe CTS groups. MN and abductor pollicis brevis (APB) SWE and MN HD color were performed on a longitudinal plane. RESULTS The mild-to-moderate and severe CTS groups showed increased MN stiffness at the wrist and MN stiffness ratio (wrist-to forearm) compared with the control (p < 0.001). The NCS-negative CTS group showed increased MN stiffness at the wrist (p = 0.022) and MN stiffness ratio (p = 0.032) compared with the control. The severe CTS group showed increased MN stiffness at the wrist compared with the mild-to-moderate CTS group (p = 0.034). The cutoff-values in diagnosing NCS-confirmed CTS were 50.12 kPa for MN stiffness at the wrist, 1.91 for MN stiffness ratio, and grade 1 for HD color. CONCLUSIONS SWE and HD color are good supportive tools in diagnosing and assessing severity in CTS. SIGNIFICANCE SWE and HD color demonstrated that MN in CTS was associated with increased stiffness and hypervascularity.
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Affiliation(s)
- Joo Hye Sung
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ye Ji Kwon
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Myeong Hun Son
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, Republic of Korea.
| | - Jung Hun Lee
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, Korea.
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Fan C, Fede C, Pirri C, Guidolin D, Biz C, Macchi V, De Caro R, Stecco C. Quantitative Evaluation of the Echo Intensity of Paraneural Area and Myofascial Structure around Median Nerve in Carpal Tunnel Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10110914. [PMID: 33171617 PMCID: PMC7695137 DOI: 10.3390/diagnostics10110914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to investigate whether the echo intensity (EI) of the paraneural area (PA), the median nerve (MN) at the carpal tunnel, the EI of the myofascial structure (MS) around MN, the ‘PA and MN’ at the mid-forearm, and the MN transversal displacement at both sites differs between persons with carpal tunnel syndrome (CTS) and control subjects. Methods: In total, 16 CTS patients and 16 controls, age- and gender-matched, were recruited. Cross-sectional ultrasound images of MN were obtained to evaluate the EI of the PA, the MN at carpal tunnel, the EI of MS, and the ‘PA and MN’ at the mid-forearm in a natural position, then images were taken after a whole-hand grasp movement, to evaluate MN transversal displacement. Inter-rater and intra-rater reliability in control, and differences in the EI and MN displacement between CTS and control, were analyzed. In addition, the correlations between ultrasound parameters and MN displacement were evaluated. Results: The quantitative EI of PA, MN, EI of MS, ‘PA and MN’ had high inter-rater and intra-rater reliability in the control. The EI of PA, MS and ‘PA and MN’ were significantly higher in CTS subjects (p < 0.01), whilst there was no significant difference in the EI of MN at the carpal tunnel. MN displacement was significantly decreased both at the carpal tunnel and the mid-forearm in CTS subjects (p < 0.01). In addition, there were negative correlations among the EI of PA (rs = −0.484, p = 0.004), EI of MS (rs = −0.479, p = 0.002), EI of ‘PA and MN’ (rs = −0.605, p < 0.001) and MN transversal displacement. Conclusions: The higher EI of PA and MS around MN in CTS may indicate greater fibrosis along the course of MN, reducing fascial adaptability, influencing the synergy and coordination of the MS, and increasing the shear stress between MS and MN, and it may further increase the abnormal pressure on the MN not only at the carpal tunnel, but also at the mid-forearm. These results may partly explain the role of PA and MS in CTS pathogenesis.
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Affiliation(s)
- Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
| | - Carlo Biz
- Department of Surgery, Oncology and Gastroenterology, Orthopedic Clinic, University of Padua, 35128 Padua, Italy;
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (C.F.); (C.P.); (D.G.); (V.M.); (R.D.C.)
- Correspondence: ; Tel.: +39-049-8272315
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Ozsoy-Unubol T, Bahar-Ozdemir Y, Yagci I. Diagnosis and grading of carpal tunnel syndrome with quantitative ultrasound: Is it possible? J Clin Neurosci 2020; 75:25-29. [PMID: 32234336 DOI: 10.1016/j.jocn.2020.03.044] [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: 01/12/2020] [Accepted: 03/21/2020] [Indexed: 12/22/2022]
Abstract
The recent diagnostic tools for carpal tunnel syndrome (CTS) include nerve conduction studies (NCS) and ultrasound (US). Quantitative US (QUS) can be used for demonstrating muscle changes according to denervation. The aim of this study was to evaluate if QUS can diagnose and grade the severity of CTS. In this single blinded cross-sectional study, female patients diagnosed with CTS and age-matched healthy female subjects were included in the study. Median and ulnar nerve conduction studies (NCS) were performed for CTS diagnosis. Median and ulnar nerve cross-sectional area (CSA) was measured, and the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles were longitudinally and transversally visualised. Axial images were analysed for echo intensity (EI) via computer-assisted, grayscale analysis. Intra-rater and inter-rater reliability analysis was performed. The Boston questionnaire was used for the evaluation of symptom severity and functional status. Forty-two patients (42 hands) and 32 controls were included. In the CTS group, 17 patients had mild, 13 patients had moderate, and 12 patients had severe CTS. CSA of the median nerve and APB echo intensity was significantly higher in patients with CTS. However, according to the CTS grade, no significant difference was detected for APB EI. The intraclass correlation coefficient (ICC) was calculated as 0.928 for intra-rater reliability and 0.768 for inter-rater reliability. QUS evaluation is helpful for the diagnosis of CTS, but not for grading. Further studies are needed with a larger population including both genders.
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Affiliation(s)
- Tugba Ozsoy-Unubol
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey.
| | - Yeliz Bahar-Ozdemir
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey
| | - Ilker Yagci
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey
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Choi H, Choi JH, Kang S, Yoon JS, Son SH. Pilot study: Differences in echo intensity ratios between ulnar and median innervated muscles in ulnar neuropathy. Muscle Nerve 2019; 60:387-391. [PMID: 31294856 DOI: 10.1002/mus.26631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study evaluated muscle echo intensity (EI) ratio in patients with ulnar neuropathy at the elbow (UNE) and healthy controls. METHODS In this prospective study, 28 patients with electrodiagnostically confirmed unilateral UNE and 12 healthy controls were ultrasonographically assessed for EI ratios of the hypothenar and thenar muscles. The affected and unaffected hands between the UNE patients and controls and patient subgroups (subdivided according to electrodiagnostic severity) were compared to determine any significant differences. RESULTS In patients with UNE, the EI ratio of the hypothenar to thenar muscles was significantly higher for the affected side than for the unaffected side (1.08 ± 0.11 and 0.97 ± 0.18, respectively) or the control group (0.95 ± 0.05). A significant difference in the EI ratio was observed among the subgroups (mild vs. severe subgroup, P < 0.01). CONCLUSIONS Ultrasonographic EI measurement may be a useful parameter in the evaluation and screening of UNE.
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Affiliation(s)
- Hanboram Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Ho Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Ho Son
- Department of Mechanical Engineering, Soonchunhyang University, Asan, 31538, Korea
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Karvelas KR, Walker FO. Clinical and Ultrasonographic Features of Distal Ulnar Neuropathy: A Review. Front Neurol 2019; 10:632. [PMID: 31293494 PMCID: PMC6601364 DOI: 10.3389/fneur.2019.00632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023] Open
Abstract
Focal ulnar neuropathy at the wrist is a rare but problematic disorder often associated with the unique anatomy of this nerve as it courses through Guyon's canal, a superficial fibro-osseous tunnel in the proximal ulnar palm. The electrophysiologic features of this disorder have been well-characterized, but the sonographic anatomy of the nerve across the wrist and palm has yet to be systematically described in normal and abnormal states. In this review, we describe the basic anatomy and the sonographic appearance of the nerve in the wrist and palm in normals and individuals with pathology. The value of using US in conjunction with electrodiagnostic testing is emphasized as the two tests together provide critical information regarding etiology, predisposing factors, and functional significance. Furthermore, ultrasound is useful as a patient educational tool to promote behavioral changes that assist in nerve recovery when pathology is related to repetitive stress.
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Affiliation(s)
- Kristopher R Karvelas
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Fujino K, Ohno K, Fujiwara K, Yokota A, Neo M. Sonographic morphometry of abductor pollicis brevis: can direct contact yield images comparable with those obtained by the water bath technique? J Med Ultrason (2001) 2019; 46:489-495. [PMID: 30989442 DOI: 10.1007/s10396-019-00945-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study sought to compare ultrasound-guided measurements of the abductor pollicis brevis (APB) using the water bath technique (WBT) and the direct contact method (DM) and investigate whether the DM can reproduce the measurements that would be obtained with a non-contact method, such as the WBT. METHODS The APB muscles of 80 hands (40 healthy adults) were measured. The WBT was performed in a plastic container filled with water. The probe was placed adjacent to the skin surface without contact. In the DM, sonographic images were obtained with the probe and skin separated by sufficient transmission gel. The muscle thickness and cross-sectional area (CSA) were calculated with both methods. All subjects were examined three times by two examiners to estimate the inter- and intra-observer reliability. Bland-Altman analysis was performed to examine the agreement between the methods. RESULTS No significant differences in the thickness or CSA of the APB were found. The interclass correlation coefficients for the WBT and DM showed almost perfect intra- and inter-observer reliability (range 0.87-0.94). There was no systematic bias between the techniques in the Bland-Altman analysis. CONCLUSION Similar to the WBT, the DM provides measurements of the APB thickness and CSA without causing morphometric changes.
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Affiliation(s)
- Keitaro Fujino
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, 569-8686, Osaka, Japan
| | - Katsunori Ohno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, 569-8686, Osaka, Japan.
| | - Kenta Fujiwara
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, 569-8686, Osaka, Japan
| | - Atsushi Yokota
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, 569-8686, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, 569-8686, Osaka, Japan
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Seok HY, Kim JW, Kim YH, Park MH, Kwon DY. Quantitative evaluation of hand motor function using a gyrosensor in mild and moderate carpal tunnel syndrome. Muscle Nerve 2019; 59:465-469. [PMID: 30677150 DOI: 10.1002/mus.26424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The objective of this study was to determine whether patients with carpal tunnel syndrome (CTS) manifest changes in early-stage motor function and to investigate the utility of a gyrosensor for quantitative evaluation of motor function. METHODS Angular velocity signal was measured during finger tapping in 52 patients with mild-to-moderate CTS and 45 controls. Four finger-tapping performance (FTP) values-root-mean-squared (RMS) velocity, RMS angle, peak power, and total power-were derived from the signal. RESULTS All FTP values were significantly lower in patients with CTS than in controls (P = 0.001 or P < 0.001). There were no significant differences between the mild and moderate CTS subgroups. DISCUSSION FTP measurement with a gyrosensor represents a valuable tool for the evaluation of median nerve motor function in patients with CTS. It facilitates the detection of subclinical motor dysfunction in patients with early stage CTS. Muscle Nerve 59:465-469, 2019.
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Affiliation(s)
- Hung Youl Seok
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Ji-Won Kim
- Department School of Biomedical Engineering, Konkuk University, Chungju, South Korea
| | - Yool-Hee Kim
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Ansan-City, South Korea
| | - Moon-Ho Park
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Ansan-City, South Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Ansan-City, South Korea
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Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol 2018; 129:2658-2679. [PMID: 30309740 DOI: 10.1016/j.clinph.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Over the last two decades, dozens of applications have emerged for ultrasonography in neuromuscular disorders. We wanted to measure its impact on practice in laboratories where the technique is in frequent use. After identifying experts in neuromuscular ultrasound and electrodiagnosis, we assessed their use of ultrasonography for different indications and their expectations for its future evolution. We then identified the earliest papers to provide convincing evidence of the utility of ultrasound for particular indications and analyzed the relationship of their date of publication with expert usage. We found that experts use ultrasonography often for inflammatory, hereditary, traumatic, compressive and neoplastic neuropathies, and somewhat less often for neuronopathies and myopathies. Usage significantly correlated with the timing of key publications in the field. We review these findings and the extensive evidence supporting the value of neuromuscular ultrasound. Advancement of the field of clinical neurophysiology depends on widespread translation of these findings.
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Affiliation(s)
- Francis O Walker
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Katharine E Alter
- Department of Rehabilitation Medicine, National INeurolnstitutes of Health, Bethesda, MD 20892, USA.
| | - Leo H Visser
- Departments of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA.
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Piazzale Rodolfo Morandi, 6, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Universita Cattolica del Sacro Cuore, Rome, Italy.
| | - Jeffery A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; OhioHealth McConnell Spine, Sport and Joint Center, Columbus, OH, USA.
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Einar Wilder-Smith
- Department of Neurology, Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, Kantonsspital Lucerne, Switzerland; Department of Neurology, Inselspital Berne, Switzerland.
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Canada.
| | - Jeremy D P Bland
- Deparment of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Craig M Zaidman
- Division of Neuromuscular Medicine, Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Box 8111, St. Louis, MO 63110, USA.
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12
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Seok HY, Park J, Kim YH, Oh KW, Kim SH, Kim BJ. Split hand muscle echo intensity index as a reliable imaging marker for differential diagnosis of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:943-948. [PMID: 29666207 DOI: 10.1136/jnnp-2017-317917] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the usefulness of muscle ultrasound in evaluating dissociated small hand muscle atrophy, termed 'split hand', and its feasibility in the diagnosis of amyotrophic lateral sclerosis (ALS). METHODS Forty-four patients with ALS, 18 normal subjects and 9 patients with other neuromuscular disorders were included in this study. The hand muscles were divided into three regions, the median-innervated lateral hand muscle group (ML), the ulnar-innervated lateral hand muscle (UL) and the ulnar-innervated medial hand muscle (UM), and the muscle echo intensity (EI) and compound muscle action potential (CMAP) were measured. We calculated the split hand index (SHI) using muscle EI (SHImEI) and CMAP (SHICMAP) for comparison among groups. The SHI was derived by dividing muscle EI (or CMAP) measured at the ML and UL by that measured at the UM. RESULTS The SHImEI was significantly higher in patients with ALS (51.7±28.3) than in normal controls (29.7±9.9) and disease controls with other neuromuscular disorders (36.5±7.3; P<0.001), particularly in upper limb-onset ALS (66.5±34.0; P<0.001). Receiver operating characteristic curve analysis indicated that the SHImEI had significantly better diagnostic accuracy than the SHICMAP. CONCLUSIONS The SHImEI was more sensitive in evaluating dissociated small hand muscle atrophy compared with the SHICMAP and may be a reliable diagnostic marker for differentiating ALS from other neuromuscular disorders and healthy controls.
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Affiliation(s)
- Hung Youl Seok
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yoo Hwan Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Neurology, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University, Seoul, Republic of Korea
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13
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Park DY, Kang S, Jeong JS, Yoon JS. Muscle echogenicity ratio can indicate severity of carpal tunnel syndrome. Muscle Nerve 2018; 58:304-306. [PMID: 29510442 DOI: 10.1002/mus.26116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/21/2018] [Accepted: 03/04/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the usefulness of the echogenicity (EI) ratio of the thenar to hypothenar muscle measured using ultrasonography in assessing the severity of carpal tunnel syndrome (CTS). METHODS Fifty-nine hands of 30 patients electrodiagnostically confirmed as having CTS were classified into 3 subgroups (mild, moderate, and severe). The EI of the thenar and hypothenar muscles was measured with ultrasonography, and the EI ratio was calculated in the patients and 13 normal participants (26 hands). RESULTS The average EI ratio was higher in the CTS group than in the control group. We also found a positive correlation between the severity of CTS and a high EI ratio measured with ultrasonography. DISCUSSION The EI ratio of the thenar to hypothenar muscle is a useful parameter that can indicate the severity of CTS. Muscle Nerve 58: 304-306, 2018.
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Affiliation(s)
- Dong Yoon Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, Korea
| | - Jin Seok Jeong
- Cheonan Chungmu Hospital, 8 Dagamal 3-gil, Seobuk-gu, Cheonan, Chungcheongnam-do, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, Korea
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14
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Hokkoku K, Matsukura K, Uchida Y, Kuwabara M, Furukawa Y, Tsukamoto H, Hatanaka Y, Sonoo M. Quantitative muscle ultrasound is useful for evaluating secondary axonal degeneration in chronic inflammatory demyelinating polyneuropathy. Brain Behav 2017; 7:e00812. [PMID: 29075571 PMCID: PMC5651395 DOI: 10.1002/brb3.812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/11/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In chronic inflammatory demyelinating polyneuropathy (CIDP), exclusion of secondary axonal degeneration is challenging with conventional methods such as nerve conduction study (NCS), needle electromyography, and nerve biopsy. Increased echo intensity (EI) and decreased muscle thickness (MT) identified on muscle ultrasound (MUS) examination represent muscle denervation due to axonal degeneration in neurogenic disorders, suggesting MUS as a new tool to detect secondary axonal degeneration in patients with CIDP. METHODS EI and MT of abductor pollicis brevis, abductor digiti minimi, and first dorsal interosseous muscles were measured in 16 CIDP patients. Raw values were converted into z-scores using data from 60 normal controls (NCs). RESULTS Six of 45 muscles showed abnormally high EI and low MT, suggesting denervation following secondary axonal degeneration. These six muscles belonged to two patients with long disease history, unresponsiveness to treatment, and long interval from onset to initial therapy. There were no significant differences in EI and MT (p = .23 and .67, respectively) between the CIDP and NC groups, although NCS results revealed obvious demyelinating abnormalities in all CIDP patients, suggesting the fact that muscle structures will be preserved, and EI and MT will not change unless secondary axonal degeneration occurs in CIDP. CONCLUSION MUS is a promising tool for evaluating secondary axonal degeneration in patients with CIDP.
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Affiliation(s)
- Keiichi Hokkoku
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Kiyoshi Matsukura
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Yudai Uchida
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Midori Kuwabara
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Yuichi Furukawa
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Hiroshi Tsukamoto
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Yuki Hatanaka
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
| | - Masahiro Sonoo
- Department of Neurology Teikyo University School of Medicine Itabashi-ku Tokyo Japan
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15
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Kim YH, Yang KS, Kim H, Seok HY, Lee JH, Son MH, Kim BJ. Does Diabetes Mellitus Influence Carpal Tunnel Syndrome? J Clin Neurol 2017; 13:243-249. [PMID: 28748675 PMCID: PMC5532320 DOI: 10.3988/jcn.2017.13.3.243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/28/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Diabetes mellitus (DM) has been proposed as a risk factor for carpal tunnel syndrome (CTS), but this remains controversial. We investigated the association between DM and CTS using both ultrasonography (US) and nerve conduction study (NCS) data. Methods We analyzed a prospectively recruited database of neuromuscular US and medical records of subjects who had undergone NCSs and electromyography for symptoms suggestive of CTS. Subjects were assigned to the follow groups: Group I, CTS with DM; Group II, CTS without DM; Group III, no CTS with DM; and Group IV, no CTS without DM. US cross-sectional area (CSA) and NCS measurements at the median nerve (MN) were compared among groups. We used a general linear mixed model to adjust for statistically significant covariates. Results The 230 participants comprised 22, 83, 19, and 106 in Groups I–IV, respectively. In multivariate analyses, the MN action potential amplitude in females was the only variable that was significantly associated with DM (p<0.001). Groups with DM tended to have a longer latency, smaller amplitude, and lower conduction velocity in the NCSs compared to groups without DM. The measured US CSA values did not differ significantly among the groups. Conclusions NCS measurements of the MN tended to differ between DM and non-DM patients regardless of the presence or absence of CTS. However, US did not reveal any statistically significant relationship between CTS and DM.
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Affiliation(s)
- Yoo Hwan Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Neurology, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hanjun Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hung Youl Seok
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Hun Lee
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, Korea
| | - Myeong Hun Son
- Neurophysiology Laboratory, Korea University Anam Hospital, Seoul, Korea
| | - Byung Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.,Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Korea.
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16
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Lee H, Jee S, Park SH, Ahn SC, Im J, Sohn MK. Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome. Ann Rehabil Med 2016; 40:1048-1056. [PMID: 28119835 PMCID: PMC5256332 DOI: 10.5535/arm.2016.40.6.1048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. Methods Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. Results Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). Conclusion These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.
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Affiliation(s)
- Hyewon Lee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Soo Ho Park
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Chan Ahn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Juneho Im
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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