超声引导下针刀松解腕横韧带联合神经阻滞治疗腕管综合征疗效观察

目的 探讨超声引导下针刀松解腕横韧带联合正中神经阻滞治疗腕管综合征(GTS)的临床疗效.方法 28例患者36个腕关节在超声引导下行针刀松解腕横韧带联合腕管内正中神经阻滞治疗.于术后1 w、4 w、12w时对患者的临床疗效进行评价.结果 36个腕关节术后均未见肌腱、血管及神经损伤等并发症.SNCV、SNAP、DML、CM...     

腕管MR影像:腕管综合征

腕管综合征(CTS)是一种比较常见的慢性疾患,以夜间手部不适和正中神经分布区的手指感觉异常为特征,进而肌肉无力和萎缩。该疾患一般是由于正中神经在腕管内受压的结果。作者研究了CTS 患者的14个腕关节的 MR 影像,不论其病因如何一般均可见到四种表现:1.正中神经在腕豆骨平面的水肿。其腕豆骨平面对桡骨平面肿胀率为2.4     

超声在腕管综合征中的诊断价值

目的:探讨超声诊断腕管综合征(CTS)的准确性。方法:对37例腕管综合征患者的44只手腕和40例无CTS志愿者的80只手腕行动态超声检查,在腕管桡尺关节、豌豆骨及钩骨水平测量正中神经的截面积及其扁平率(长径与短径之比),两组结果进行相关性的对比研究,由ROC曲线评价超声诊断腕管综合征标准值的准确性。结果:CTS患者的正中神经在腕豆骨的截面积明显大于正常对照组,两组比较差异有统计学意义,正中神经的截面积增大对于诊断腕管综合征最有预测价值。以正中神经在豌豆骨水平的截面积9.5cm2为阈值,其诊断准确性为87%,诊断敏感度为88%,诊断特异度为87.5%。结论:超声测量正中神经的截面积是诊断腕管综合征的可靠方法。     

桡骨远端骨折致腕管综合征临床治疗分析

腕管综合征（Carpal tunnel syndrome）是正中神经在腕管内受压于腕横韧带近侧缘而表现出的症状及体征,桡骨远端骨折是其诱发因素之一[1]。作者自1995年2月～2008年3月期间收治486例桡骨远端骨折患者中8例出现腕管综合征。结合相关文献资料,现报道如下。     

高分辨MRI预测腕管综合征病人激素注射后的反应

正摘要目的研究腕管综合征(CTS)病人激素注射(SI)反应与腕管内正中神经T2信号和形状的相关性。方法连续92例准备行SI的病人共163个CTS腕行3 T MR成像和神经     

高频超声对老龄腕管综合征的诊断价值

目的:探讨高频超声对老龄腕管综合征(CTS)的诊断价值.方法:选择125例(140只腕)老龄CTS患者(CTS组)按肌电图检测的感觉/运动传导参数分为轻、中、重度3组,另选择匹配的45例健康志愿者为对照组,行高频超声检测正中神经横截面积(CSA),以及腕管入口和出口正中神经面积比(R-CSA)和面积差(△CSA),比较...     

计算机辅助定量分析灰阶超声在腕管综合征诊断中的应用

【摘要】目的：采用计算机辅助定量分析腕管综合征（CTS）的灰阶超声图像,探讨其在定量分析CTS中的应用价值。方法：搜集60例CTS患者（77个异常手腕）和30例正常志愿者（60个正常手腕）,其中17例为双侧卡压,在豌豆骨水平保留正中神经图像,共得到137组图像,并且在二维图像上对正中神经进行勾勒,提取正中神经卡压的客观数据,为CTS的诊断提供依据。结果：CTS患者病灶区域像素的均值、标准差、变异系数、偏度、峰度均比正常组大;CTS患者直方图熵较正常组大;正常组亮度熵较CTS组大;而CTS患者整个灰阶区域像素中的均值、中值较正常组低;CTS患者所有表示对比度的参数均高于正常组;CTS患者病灶的厚度、长度、面积、长轴、短轴、周长等参数均较正常组大。表明在CTS患者中,图像分布较正常对照组欠均匀,且CTS患者正中神经较正常肿胀,横截面积增大。结论：计算机辅助定量分析在CTS中表现良好,可定量分析正中神经卡压时图像的均匀性和对比度。     

MRI在腕管综合征中的应用

腕管综合症（carpaltunnelsyndrome,CTS）,俗称鼠标手,是最常见的上肢神经卡压综合征之一。任何造成腕管内压力增加的因素,都可导致正中神经受压而引起CTS,主要与手腕部反复动作的慢性损伤有关。随着电脑的普及,CTS患者日益增多,人们对CTS也越来越重视。CTS最常见的症状为桡侧3个半指麻木、疼痛,严重者大鱼际肌萎缩。典型者通过症状、体征（Phalen试验阳性、Tinel征阳性等）及神经电生理检查做出诊断,但却不能显示腕管内部结构。这有赖于影像学检查,MRI对软组织显影最为清楚,目前成为公认的最佳腕管影像学方法。     

高频超声对糖尿病并发腕管综合征的临床诊断研究

目的探讨高频超声诊断糖尿病(DM)并发腕管综合征(CTS)的临床应用价值。方法选取2014年1月～2017年12月在我院就诊的CTS患者共72例,其中非DM(non-DM)CTS患者40例,DM合并CTS患者32例。所有病例均经临床查体及电生理检查证实。DM者64只手腕中患有CTS手腕的为36只,non-DM中患有CTS手腕的为46只。将同期来我院进行健康体检的人共20例(40只手腕)设为A组,B组为non-DM合并CTS的手腕(共46只)、C组为DM无CTS的手腕(共28只)、D组为DM合并CTS的手腕(共36只)。高频超声测量每位受试者腕管入口(腕豆骨水平)与腕管出口(钩骨钩水平)正中神经(MN)的CSA值,并计算两者的比值,即肿胀率(SR)。单因素方差分析比较4组间各测值是否存在统计学差异。结果 1)各组腕管入口正中神经的CSA值分别为(8.78±0.76)mm~2(A组)、(13.36±0.18)mm~2(B组)、(10.37±0.30)mm~2(C组)以及(13.96±0.75)mm~2(D组)。各组腕管入口处正中神经CSA统计学差异显著(F=87.79,P0.001,多重比较结果显示B组与D组无差异,但是与A、C两组差异显著,而A、C两组测值差异亦显著。腕管入口正中神经的CSA值为B组=D组C组A组;2)各组腕管出口处正中神经的CSA值分别为(7.82±0.66)mm~2(A组)、(11.52±0.86)mm~2(B组)、(9.43±0.40)mm~2(C组)以及(13.12±0.74)mm~2(D组)。各组腕管出口处正中神经CSA统计学差异显著(F=90.429,P0.001),多重比较结果显示该处各CSA值均存在差异,其中以D组最大,其次为B组,然后为C组,最小者为A组;3)各组腕管SR值分别为1.12±0.07(A组)、1.17±0.11(B组)、1.10±0.06(C组)及1.07±0.07(D组)。各组SR值差异显著(F=9.850,P0.001),多重比较结果显示B组SR值A组=C组D组。结论高频超声诊断CTS和DM合并CTS具有一定的临床价值,值得推广应用。     

针极肌电图与神经传导速度检查对腕管综合征患者的诊断价值

目的:提高对腕管综合征(CTS)的诊断水平。方法:应用针极肌电图与神经传导速度(NCV)对30例46侧腕管综合征(CTS)患者进行了检测和分析。结果:正中神经腕管以下支配肌针极肌电图见失神经支配电位而不累及其他神经支配肌;腕管以下正中神经运动传导速度(MCV)、MCV潜伏期及感觉传导速度(SCV)均有不同程度的减慢,MCV潜伏期与针极肌电图的异常率比值极其相近,之间存在显著相关性。不经过腕管的尺神经与腕管以上的正中神经传导速度(NCV)均正常。结论:针极肌电图对观察CTS的损害范围与程度有重要意义,NCV不同部位和分节段的检查可以排除其他周围神经病变而确诊CTS。     

High resolution ultrasonography in the diagnosis of the carpal tunnel syndrome

PURPOSE: Carpal tunnel syndrome (CTS) is a neuropathy caused by compression of the median nerve in the carpal tunnel. Our purpose was to evaluate the role of high-resolution ultrasonography (US), performed with a 10-13 MHz probe, in the detection of morphovolumetric changes of the median nerve to confirm the clinical diagnosis. MATERIALS AND METHODS: Fifty healthy volunteers were examined first by US; subsequently we studied 294 wrists in 186 symptomatic patients, calculating the cross-sectional area of the median nerve at three levels: before the median nerve enters the carpal tunnel, at the carpal tunnel inlet and at the outlet. US was considered diagnostic for CTS when the median nerve area increased at the inlet or flattening was present along the carpal tunnel. RESULTS: Ultrasonography showed pathologic findings in 267 wrists: in 261 cases morphovolumetric changes of the median nerve were found; in six cases anatomic variant of the median nerve was detected. Surgery was performed in 277 cases and all patients became symptom-free. The sensitivity of US was 96.3 % . CONCLUSIONS: Our study confirms that quantitative ultrasonographic assessment is a useful support in confirming the clinical diagnosis of CTS.     

Technical advances in ultrasound and MR imaging of carpal tunnel syndrome

The aim of this study was to compare the latest ultrasound-array technology to a conventional “high-resolution” transducer, modified MRI technique, and nerve conduction studies (NCS), in the diagnosis of carpal tunnel syndrome (CTS). In 19 normal wrists and 15 wrists with CTS, US with two different transducers was performed: a conventional linear-array transducer (LA) and a newly developed Multi-D linear-array transducer (MDA) were used. The US images were evaluated determining the swelling and the flattening ratios of the median nerve and correlated to respective findings in MRI (1.5 T) and to NCS. The NCS confirmed CTS in all 15 wrists. Measures of median nerve compression (swelling and flattening ratios) were significantly different in patients with CTS and controls (p < 0.01) with both types of US transducers and MRI. The MDA yielded higher correlation to MRI than the LA. Using critical values of 1.3 for the swelling and 3.4 for the flattening ratio, MRI, and US with the MDA yielded a sensitivity of 100 % each. Modern imaging modalities allow for an exact diagnosis of CTS even in cases with only slight median nerve pathology. Received: 24 June 1999; Revised: 8 October 1999; Accepted: 25 February 2000     

High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients

Objectives

To correlate median nerve T2 signal and shape at the carpal tunnel with steroid injection (SI) response in carpal tunnel syndrome (CTS) patients.

Methods

One hundred and sixty-three CTS wrists of 92 consecutive patients who were scheduled to undergo SI were prospectively evaluated with 3-T magnetic resonance imaging (MRI) and a nerve conduction study. All patients underwent axial high-resolution T2-weighted MRI (in-plane resolution of 0.25?×?0.25 mm). The CTS wrists were classified into three groups according to the nerve T2 signal and the flattening ratio at the hook of hamate level: group 1, high and oval; group 2, high and flat; group 3, low and flat. Clinical response to SI was evaluated at 6 months after injection.

Results

One hundred and thirteen of the 163 wrists (69.3 %) responded well to SI. The percentage of improvement was 81.7 % (49/60) in group 1, 69.9 % (51/73) in group 2, and 43.3 % (13/30) in group 3 (P?<?0.01). On stepwise logistic regression analysis high-resolution MRI was the only significant independent factor for SI response in CTS patients (P?<?0.01).

Conclusions

High-resolution MRI correlates well with SI response in CTS patients and seems useful for predicting SI response.

Key Points

? MRI may help determine appropriate care in carpal tunnel syndrome. ? MRI helps in therapeutic decision-making whenever steroid injection is considered. ? T2 signal decrease of the median nerve correlates with poor outcome. ? T2 signal decrease of median nerve may reflect fibrosis and amyloid deposition.     

Clinical, electrophysiological and MRI correlations in carpal tunnel syndrome]

Even though diagnosis of carpal tunnel syndrome is mainly based on clinical findings, other examinations are often useful for confirmation and management. The most useful of these examinations is EMG. However, EMG may be inconclusive and MRI may then be helpful. The indications for MRI in patients with carpal tunnel syndrome will be reviewed. METHOD: 20 patients with a total of 33 clinically suspected cases of carpal tunnel syndrome (CTS) underwent EMG and MRI evaluation. Clinical and EMG findings identified three groups of patients based on degree of deficit: mild, moderate, and severe. The following structures were evaluated at MRI: median nerve, retinaculum, retrotendinous fat, flexor tendons, thenar space, and muscles and bones of the wrist. Surgery was performed for 19 wrists. RESULTS: Only retinacular bowing and increased T2W signal intensity within the median nerve were significantly related to the diagnosis of CTS (sensitivity of 70% and 57% respectively). Retinacular bowing indicates increased "pressure" within the compartment (mechanical compression of the nerve) and increased T2W signal of the median nerve indicates nerve suffering. These findings correlated well with more severe cases based on clinical and EMG findings. CONCLUSION: In cases where there is discordance between clinical and EMG findings, MRI is helpful to identify patients who would benefit from surgical intervention.     

Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome

The magnetic resonance (MR) images of 14 wrists of patients with carpal tunnel syndrome (CTS) were studied. Four general findings visible regardless of the cause of CTS included swelling of the median nerve, best evaluated at the level of the pisiform bone; flattening of the median nerve, most reliably judged at the hamate level; palmar bowing of the flexor retinaculum, best visualized at the level of the hamate bone; and increased signal intensity of the median nerve on T2-weighted images. Findings related to cause were tendon sheath edema in traumatic tenosynovitis, synovial hypertrophy in rheumatoid tenosynovitis, a ganglion cyst, and excessive amount of fat within the carpal tunnel, a persistent median artery, and a large adductor pollicis muscle. Knowledge of these findings may permit more rational choice of treatment. In four cases in which symptoms persisted after surgery, findings valuable in explaining or predicting the failure included incomplete incision of the flexor retinaculum, excessive fat within the carpal tunnel, persistent neuritis of the median nerve, and development of neuromas.     

Carpal tunnel syndrome: usefulness of sonography

The aim of this study was to evaluate sonographic signs described for carpal tunnel syndrome (CTS). Sixty-four wrists from 40 patients with CTS confirmed by electromyography, and 42 wrists from 24 healthy individuals, were examined using sonography. Cross-sectional area, flattening ratio in proximal, middle and distal segments of the carpal median nerve and bowing of the flexor retinaculum were measured. The accuracies of the sonographic diagnostic criteria for CTS were assessed using receiver-operating-characteristic (ROC) analytical techniques. A significant swelling of the median nerve was observed at the proximal (p < 0.001), middle (p < 0.0001) and distal (p < 0.0001) segments and a significant bowing of the flexor retinaculum in CTS patients with respect to healthy subjects. No significant differences were found in the mean value of flattening ratio between the groups. The sensitivity, specificity, positive predictive value, and the negative predictive value were 73.4, 57.1, 72.3 and 58.5 %, respectively, in the proximal and middle segments; 75, 57.1, 72.7 and 60 % in the distal segment for areas greater than 11 mm²; and 81.3, 64.3, 77.6 and 69.2 % for the bowing of the flexor retinaculum greater than 2.5 mm. All sonographic criteria were found in 34 CTS patients (53.1 %) and none in 3 patients. Sonography may be useful in the diagnosis of CTS. The most reliable sign was increased bowing of the flexor retinaculum and cross-sectional area of median nerve with specificity close to 60 %. Received: 29 September 1999; Revised: 11 February 2000; Accepted: 2 May 2000     

Ultrasound features of carpal tunnel syndrome: a prospective case-control study

Purpose The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). Material and methods Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29–78) in the symptomatic and 45.1 years (range 24–82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. Results In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm² (DT) and 9 mm² (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. Conclusion Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm² (DT) and 9 mm² (IT) and several additional findings.     

Diffusion tensor imaging of the median nerve in healthy and carpal tunnel syndrome subjects

Purpose

To determine if diffusion tensor imaging (DTI) of the median nerve could allow identification of patients with carpal tunnel syndrome (CTS).

Materials and Methods

A total of 13 healthy subjects and 9 CTS patients were scanned on a 3T magnetic resonance imaging (MRI) scanner. The MRI protocol included a DTI sequence from which the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and the parallel and radial diffusivities could be extracted. Those parameters were quantified at different locations along the median nerve (proximal to the carpal tunnel, within the carpal tunnel, and distal to the carpal tunnel).

Results

At the carpal tunnel, the FA, radial diffusivity, and ADC differed significantly between healthy subjects and CTS patients (P < 0.0002). This highly significant difference between the two groups was due to an opposite trend of changes in the DTI indices between the proximal to the carpal tunnel and within the carpal tunnel locations. In healthy subjects the FA increased (+20%, P < 0.001) and the radial diffusivity and ADC decreased (by ?15% and ?8%, respectively, P < 0.05) between the proximal to the carpal tunnel and within the carpal tunnel locations. In CTS subjects the FA decreased (by ?21%, P < 0.05) and the radial diffusivity increased (by +23%, P < 0.01) between the proximal to the carpal tunnel and within the carpal tunnel locations.

Conclusion

DTI enables visualization and characterization of the median nerve in healthy subjects and CTS patients. DTI indices show clear‐cut discrimination between the two groups and in fact enables the of use DTI in the diagnosis of CTS. J. Magn. Reson. Imaging 2009;29:657–662. © 2009 Wiley‐Liss, Inc.

     

The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome

AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.     

Contribution of power Doppler and gray-scale ultrasound of the median nerve in evaluation of carpal tunnel syndrome

Aim of the work

To assess the role of gray-scale and power Doppler ultrasound (US) of the median nerve at the wrist in evaluating carpal tunnel syndrome (CTS).

Materials and methods

Seventy-one wrists in 51 patients with CTS in addition to 50 healthy volunteers that served as the control group were enrolled in this study. The following sonographic parameters were evaluated in both patients and controls: cross sectional area of the median nerve just proximal to the tunnel inlet (CSA1), at the pisiform bone level (CSA2), the CSA difference (ΔCSA), flattening ratio of the median nerve and bowing of the flexor retinaculum. The power Doppler US was used to assess the number of nerve vessels with estimation of the vascularity score.

Results

The ΔCSA revealed an excellent discriminative ability (AUC = 0.988) in differentiating patients with CTS at an optimal cut-off value of 3.9 mm². Intraneural hypervascularization was significantly correlated with the ΔCSA of the median nerve (P < 0.001), while not significantly correlated with the age of patients, median nerve flattening ratio and bowing of flexor retinaculum.

Conclusion

The ΔCSA and vascularity score of the median nerve are important and useful sonographic parameters in evaluation of CTS.