The usefulness of ultrasonography to diagnose the early stage of carpal tunnel syndrome in proximal to the carpal tunnel inlet: A prospective study

Sonographic Diagnosis of Carpal Tunnel Syndrome

Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.

Effect of Force, Posture, and Repetitive Wrist Motion on Intraneural Blood Flow in the Median Nerve

OBJECTIVES

Pinching, deviated wrist postures, and repetitive motion are risk factors for carpal tunnel syndrome. Hypervascularization of the median nerve and increased intraneural blood flow proximal to the carpal tunnel result in finger force and deviated wrist postures. The purpose of this study was to determine the effects of pinching with and without force, wrist posture, and repetitive wrist motion on intraneural blood flow in the median nerve.

METHODS

Eleven healthy and 11 carpal tunnel syndrome-symptomatic individuals completed 3 sections of this study: 15 pinch posture force trials, 3 repetitive wrist motion trials, and 3 static wrist posture trials. Intraneural blood flow (centimeters per second) was measured with pulsed wave Doppler ultrasound during each trial. Transverse B-mode images obtained from static trials were used to calculate the median nerve cross-sectional area and circumference.

RESULTS

An analysis of variance statistical analysis revealed significant main effects of pinch posture force (F_4,80 = 21.397; P < .001) and wrist posture (F_2,40 = 14.545; P < .001). Intraneural blood flow velocities were significantly greater when 6 N of force was applied by the thumb, finger, or pinch compared to no applied force in the same postures. Intraneural blood flow velocities were higher at 30° wrist flexion (mean ± SD, 2.24 ± 0.42 cm/s) than neutral (2.06 ± 0.45 cm/s) and 30° wrist extension (1.97 ± 0.46 cm/s). No changes were found in response to repetitive wrist motion.

CONCLUSIONS

Flexed wrists as well as applied finger and thumb forces increase median nerve blood flow at the entry to the carpal tunnel, which may negatively affect the median nerve.