正常人腕管内正中神经的超声解剖学研究及其意义

目的：探讨腕管内正中神经的超声解剖测量方法及各项指标,为临床提供正常解剖参数。方法应用高频超声检查60侧正常人腕管段正中神经,分别测量其腕管入口、中点和出口平面的横截面积,腕管中点平面正中神经的扁平率和屈肌支持带的厚度。应用超声剪切波弹性成像技术测量30侧腕管内正中神经近1/3段、中1/3段、远1/3段的硬度值。结果腕管入口、中点、出口平面正中神经截面积分别为（0.09±0.02）、（0.08±0.02）、（0.10±0.03）cm2,不同部位截面积均值无统计学差异(P<0.01);腕管中点平面正中神经的扁平率3.12±0.29;屈肌支持带厚度为（0.33±0.07）cm。正中神经腕管近段、中段、远段最高硬度的分别为（41.3±10.3）、（35.4±5.8）、（38.1±4.3）kPa,不同部位硬度均值无统计学差异(P>0.05)。结论高频超声检查为临床提供了腕管内正中神经形态学解剖参数,剪切波弹性成像提供了神经硬度参数。两者结合应用为腕管综合征的临床诊断提供超声解剖学依据。     

以上肢麻木不适为主要表现患者的周围神经高频超声和电生理研究

目的：探讨用高频超声和神经电生理方法来评估以上肢的麻木不适伴疼痛、肌无力、肌萎缩等为主要症状的患者周围神经病变的价值。方法：对具有上肢不适的患者37例（共74只上肢）（病例组）和健康志愿者26例（共52只上肢）（对照组）进行高频高分辨力超声和神经电生理的检查,超声重点测量正中神经、桡神经、尺神经上臂以及正中神经在腕管内的横截面积,电生理主要测定这三条神经的传导速度（NCV）。结果：病例组正中神经在上臂及腕管内的横截面积分别为上臂11．66（7．1～19．3）mm^2,桡尺关节平面处为11．94（5．3～18．2）mm^2,豌豆骨平面处为10．75（4．4～14．1）mm^2,钩骨钩平面处为12．51（6．2～18．9）mm^2,均大于对照组,（P〈0．01）;尺神经在肘管上缘的横截面积为7．85（3．3～22．8）mm^2,桡神经在上臂的横截面积为5．71（4．0～10．2）mm^2,与对照组比较差异不显著（P〉0．05）。超声和电生理检测得单纯正中神经损害率分别为62％和50％;正中神经、尺神经联合损害率分别为24％和19％;单纯尺神经的损害率分别为5．4％和8％,桡神经损害最少。正中神经损害最常见部位在腕管,但有35％的患者合并正中神经在上臂的增粗。尺神经最常损害部位在肘管。结论：高频超声和电生理检测都有助于明确上肢周围神经病变。出现上肢症状者正中神经损害最为常见,其次为正中神经尺神经联合病变,单独的尺神经异常不是太多,涉及桡神经的病变发生率最低。正中神经腕管内损害合并上臂的增粗应予以关注。     

高频超声对国人四肢周围神经及颈部神经根正常值的研究

目的　确定在固定测量位点的四肢周围神经、颈部神经根的神经横截面积 (cross sectional area,CSA) 的参考值范围,并探索与之相关的影响因素。 方法　探查100例健康志愿者正中神经、尺神经、胫神经、腓总神经、C5、C6神经根的超声图像,在预定的22个测量位点获取超声声像图及测量各点神经的横截面积,每个测量点重复测量3次,取其平均值,并将神经CSA与年龄、身高、体重及体重指数进行相关性分析。 结果　双侧神经CSA趋向于对称,男性神经CSA比女性大。正常人四肢周围神经与身高、体重、体重指数呈正相关,其中与体重的相关性最为显著。前臂中部尺神经、胫神经、C5、C6神经根与年龄呈正相关。双侧测量部位的差值与上述人口学特征均无相关性。 结论　本研究确定了正常人四肢周围神经、颈部神经根CSA的参考值,这些值可用于周围神经系统疾病诊断的参考。     

正常青年人群腕管正中神经MRI成像的断层解剖学测量

目的通过我国青年人群正中神经的断层解剖测量,为正中神经形态学研究和腕管综合征(CTS)的诊治提供参考。方法共采集28例志愿者56侧腕部MRI数据,测量计算正中神经横截面积(CSA)、扁平率(MNFR)和膨胀率(MNSR)并进行性别之间、双侧肢体间比较,再将上述指标分别与年龄、身高、体重进行相关分析。结果正中神经CSA、MNFR和MNSR在双侧肢体之间无统计学差异;CSA和MNSR在性别之间无统计学差异;而女性MNFR显著大于男性,差异具有统计学意义,而MNFR与身高存在着统计学负相关性。结论基于MRI(1.5T)正中神经的解剖测量具有可靠和精度高的特点;国人正中神经CSA存在着性别间差异,和西方人CSA相比差异较大,CSA和身高存在负相关性;CTS的MRI诊断标准应与国人解剖参数相结合。     

正中神经与肌皮神经、尺神经的吻合

<正> 国人正中神经与肌皮神经在臂部的吻合及正中神经与尺神经在前臂的吻合已有报导,但各作者报导的出现率有差异。为了进一步积累国人体质资料,我们作了观察和测量。观察用的尸体共100侧上肢(30具男尸和20具女尸)。为了便于描述和记录神经的吻合部位,我们将臂部和前臂全长等分为四段,自上而下分别称之为臂1/4,2/4,3/4,4/4和前臂1/4,2/4,3/4和4/4段。现将结果报导于下。     

“三线定位法”体表定位诊断旋前圆肌综合征的研究

目的 探寻旋前圆肌综合征的神经易卡压点的体表投影,应用三线定位法快速诊断。方法 观察正中神经与旋前圆肌和指浅屈肌的解剖关系,测量正中神经在穿出旋前圆肌处的直径。以肱骨外上髁为A点,肱骨内上髁为B点,桡骨茎突为C点,三点均选择最高点定位;正中神经穿入旋前圆肌点(D)、正中神经与旋前圆肌下缘交汇点(E)、正中神经穿入指浅屈肌腱弓点(F)点及正中神经穿出指浅屈肌点(G),ABC点连线成三角形,分别测量各点到AB连线、AC连线、BC连线的垂直距离。并以C点至AB的垂直距离为前臂的相应长度,以D、E、F、G点至AB连线的垂直距离数值除以前臂长度,测量各点在前臂相应的自身位置比。结果 10具标本的正中神经均在旋前圆肌肱骨头与尺骨头之间穿行,走行斜向下穿出,与指浅屈肌交汇,7具标本可见指浅屈肌联合腱弓,3具标本可见指浅屈肌纤维弓,未发现无外侧头的指浅屈肌。旋前圆肌腱膜或腱束等结构异常,指浅屈肌腱弓处筋膜异常增厚或纤维化以及腱性结构异常时,可产生对邻近正中神经的卡压。正中神经穿出旋前圆肌处直径,成年男性左、右两侧平均(3.12±0.12) mm,成年女性左、右两侧平均(2.87±0.11) mm。结论...     

前臂正中神经损害运动神经传导检测的定位诊断价值

目的探讨运动神经传导检测对前臂正中神经损害患者的定位诊断价值。方法：对56例经临床诊断的腕管综合征（CTS）、前臂外伤后正中神经损害的患者,应用常规的运动神经传导检测,检测正中神经肘-腕、腋-肘运动传导速度（MCV）;跨病变节段神经传导检测,分别在肘窝、腋窝刺激,分别将记录电极在病变部位的远端及近端记录,比较其MCV、潜伏期、波幅变化,并与患者对侧对应点的传导检测作对照。结果：①常规运动神经检测方法可以判断神经损害的大致节段;②跨病变节段神经传导检测法可以定位神经损害部位。结论：常规神经传导检测配合跨病变节段神经传导检测有较高的神经损伤定位诊断价值。     

正中神经前臂段浅层肌支的应用解剖

目的测量正中神经前臂段浅层肌支的解剖学数据,为正中神经的创伤修复提供形态学依据。方法采用解剖剥离测量方法,对30侧10%甲醛固定的成人上肢标本正中神经发出的前臂段浅层肌支进行解剖学观察。结果正中神经前臂段浅层肌支的分支类型有1支型、2支型、3支型和4支型。其中,旋前圆肌支以3支型(87%),指浅屈肌支(90%)以4支型,桡侧腕屈肌支(96.7%)和掌长肌支(96.7%)以1支型出现率最多。正中神经前臂段浅层肌支主要集中于前臂的4%～65%。结论确定了正中神经前臂段浅层肌支在前臂的危险区间;讨论了有利于开展带神经血管蒂肌瓣移植的肌支类型。     

高频超声在周围神经肿瘤中的诊断价值

目的 探讨周围神经肿瘤的声像图特征及其高频超声的诊断价值.方法 38例经手术及病理证实的周围神经良性肿瘤患者(20例神经鞘瘤、10例神经纤维瘤及8例创伤性神经瘤),其中男性26例,女性12例,年龄14 ～ 76岁,平均年龄35.1岁.15例健康成人作为正常对照组,其中男性9例,女性6例,年龄24 ～ 38岁,平均年龄29.5岁.做高频超声检查,比较术前与术中探查结果.结果 正常周围神经纵切面高频超声显示为中等条索状,内有线性平行回声,横切面为圆形中等回声结构,内有点状强回声.20例神经鞘瘤纵切面可见瘤体两端呈"鼠尾状"与神经相连,12例呈中心型,8例为偏心型;10例神经纤维瘤纵切面可见瘤体两端与神经相连,10例均呈中心型,无偏心型.神经鞘瘤和神经纤维瘤与伴行神经呈偏心型关系上,具有统计学意义,而中心型关系未见明显差异.8例创伤性神经瘤中7例神经完全离断,高频超声显示连续性中断,近端形成神经瘤,1例神经不完全损伤,显示连续性部分中断.结论 高频超声可显示周围神经肿瘤的部位、大小及与周围组织神经的关系,对临床的诊断治疗有重要的指导价值.     

前臂外侧皮神经取代桡神经浅支一例

前臂外侧皮神经取代桡神经浅支,有关文献报道较少。我们制做上肢局解标本时,在一成年男尸的左上肢发现,桡神经浅支缺如,该神经所分布的区域被肌皮神经的前臂外侧皮神经所代替。现报告如下。1　前臂外侧皮神经由肌皮神经分出后在肘关节上方距肱骨内上髁平面的上方2.16cm处穿过深筋膜至皮下。经前臂前面的外侧下行,在距肱骨内上髁平面的下方7.3cm处分成前后两支。该神经起点处最宽径为3.51mm,厚1.20mm。其前支最宽径为1.33mm,厚0.79mm,经前臂前面的外侧下行达腕部。后支,较前支略粗大,最宽径1.53mm,厚1.24mm,经前臂前面的外侧下行于前臂中下段…     

The intrinsic arterial vascularity and morphology of the median nerve within the carpal tunnel: a microscopic study

Carpal tunnel syndrome (CTS) is the commonest peripheral nerve entrapment neuropathy and is more prevalent in females for reasons that are not fully understood. The aim of this study was to investigate the intrinsic arterial supply of the median nerve in the region of the carpal tunnel to determine if there are significant individual variations. The median nerve was excised intact from 34 cadaver hands (7 male, 13 female; 18 right, 16 left; age 66–100 years) and sectioned at three levels: 1 cm proximal to the transverse carpal ligament; at the entrance to the carpal tunnel; and 1 cm distal to the latter site. Photomicrographs of histological sections were analyzed using ImageJ and the following recorded: the shape and cross-sectional area (CSA) of the nerve and the total CSA of small arteries/arterioles (>80 μm²) within the nerve. The proportion of the nerve’s CSA occupied by arteries/arterioles was expressed as a ratio to compare vascularity at the three levels. There were no significant differences between hands or levels in males, but in right hands from female cadavers there was a statistically significant reduction in the intrinsic arterial vascularity of the median nerve at the entrance to the carpal tunnel as compared to proximal and distal levels and left hands (p < 0.05). Gender-based differences in the intrinsic arterial supply of the median nerve could be a factor predisposing to CTS.     

Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study

This study investigated the connections between the median nerve paraneural sheath and myofascial structures near it, from both macroscopic and microscopic points of view. Four samples of median nerve and surrounding tissues were excised from nine non-embalmed upper limbs for microscopic analysis. Ultrasound images were analysed in 21 healthy subjects and 16 carpal tunnel syndrome patients to evaluate median nerve transversal displacement during finger motion at carpal tunnel and forearm levels. An anatomical continuity between epimysium and paraneural sheath and a reduction of paraneural fat tissue from proximal to distal was found in all samples. Median nerve displacements at both levels were significantly reduced in carpal tunnel syndrome subjects (P < 0.001). It was observed that the median nerve is not an isolated structure but is entirely connected to myofascial structures. Therefore, unbalanced tension of epimysial fasciae can affect the paraneural sheath, limiting nerve displacement, and consequently this must be included in carpal tunnel syndrome pathogenesis.     

Coexistence of multiple anomalies in the carpal tunnel

We determined the frequency of anomalous structures within the carpal tunnels of 89 cadaveric forearm-hand specimens. We also examined these same specimens for variations in the branching pattern of the median nerve, and analyzed the range in length and width of the lumbricals. Many of the hands contained extra tendinous slips from the long flexors within the tunnel, subligamentous thenar branches of the median nerve, or lumbricals with bipennate origins. Only one hand had an anomalous muscle belly within the tunnel, two had persistent median arteries, two had high division of the median nerve in the distal forearm, and eight had lumbricals with lengths or widths that were greater or less than 2 standard deviations (SD) from the mean. Twenty-nine percent of all hands examined had two to five anomalies/variations per tunnel, whereas another 27% had one anomaly or variation per tunnel. More right hands (17%) than left (11%) contained two to five anomalous/variant structures per carpal tunnel. More right hands (19%) than left (8%) contained only one variant/anomalous structure per carpal tunnel. Anticipation of the frequency and multiplicity of anomalous structures and variations within this region is of importance to clinicians, particularly surgeons.     

Neurovascular responses to mental stress

The effects of mental stress (MS) on muscle sympathetic nerve activity (MSNA) and limb blood flows have been studied independently in the arm and leg, but they have not been studied collectively. Furthermore, the cardiovascular implications of postmental stress responses have not been thoroughly addressed. The purpose of the current investigation was to comprehensively examine concurrent neural and vascular responses during and after mental stress in both limbs. In Study 1, MSNA, blood flow (plethysmography), mean arterial pressure (MAP) and heart rate (HR) were measured in both the arm and leg in 12 healthy subjects during and after MS (5 min of mental arithmetic). MS significantly increased MAP (Δ15 ± 3 mmHg; P < 0.01) and HR (Δ19 ± 3 beats min⁻¹; P < 0.01), but did not change MSNA in the arm (14 ± 3 to 16 ± 3 bursts min⁻¹; n = 6) or leg (14 ± 2 to 15 ± 2 bursts min⁻¹; n = 8). MS decreased forearm vascular resistance (FVR) by −27 ± 7% ( P < 0.01; n = 8), while calf vascular resistance (CVR) did not change (−6 ± 5%; n = 11). FVR returned to baseline during recovery, whereas MSNA significantly increased in the arm (21 ± 3 bursts min⁻¹; P < 0.01) and leg (19 ± 3 bursts min⁻¹; P < 0.03). In Study 2, forearm and calf blood flows were measured in an additional 10 subjects using Doppler ultrasound. MS decreased FVR (−27 ± 10%; P < 0.02), but did not change CVR (5 ± 14%) as in Study 1. These findings demonstrate differential vascular control of the arm and leg during MS that is not associated with muscle sympathetic outflow. Additionally, the robust increase in MSNA during recovery may have acute and chronic cardiovascular implications.     

MRI弥散加权成像表观扩散系数在低、高级别脑膜瘤鉴别诊断中的应用

目的 探讨常规MRI结合弥散加权成像(DWI)中表观扩散系数(ADC)在低、高级别脑膜瘤的鉴别诊断中的临床应用价值。方法 回顾性分析中国科学技术大学附属第一医院2018年1月-2019年8月68例脑膜瘤患者的临床资料,男29例、女39例,年龄24~78(48.62±10.28)岁。其中WHOⅠ级脑膜瘤52例(低级别组),WHO Ⅱ级12例、WHO Ⅲ级4例(高级别组)。患者术前均行常规MRI结合DWI检查。观察两组患者的MRI征象以及DWI特点;比较两组患者脑膜瘤实质和瘤周水肿部位ADC值以及肿瘤实质与对侧脑白质的相对表观扩散系数(rADC),利用ROC曲线分析最佳rADC值对低、高级别脑膜瘤的诊断效能。结果 两组患者基线资料差异均无统计学意义(P值均＞0.05)。高级别组脑膜瘤边缘不规整、强化不均匀、边缘水肿区、脑膜尾征和囊变、坏死、钙化区等影像学征象发生率明显高于低级别组脑膜瘤,差异均有统计学差异(P值均＜0.05)。52例低级别组脑膜瘤中,有38例DWI、ADC均呈等信号,14例DWI呈稍高信号、ADC呈稍低信号;16例高级别组脑膜瘤实质部分DWI呈高信号、ADC呈低信号,而囊变、出血坏死、钙化区呈高信号。低级别组、高级别组脑膜瘤肿瘤实质部分 ADC值分别为(0.94±0.14)×10^-3、(0.73±0.11)×10^-3 mm²/s,rADC值分别为(1.16±0.18)×10^-3、(0.95±0.14)×10^-3 mm²/s,低级别组脑膜瘤实质部分ADC和rADC值均明显高于高级别组脑膜瘤,差异均有统计学意义(t=5.491、4.277, P值均<0.01);低级别组、高级别组脑膜瘤的瘤周水肿区域ADC分别为(1.82±0.19)×10^-3、(1.88±0.21)×10^-3 mm²/s,rADC值分别为(2.29±0.24)×10^-3、(2.38±0.29)×10^-3 mm²/s,差异均无统计学意义(P值均>0.05);以rADC值诊断低级别组、高级别组脑膜瘤的最佳临界点为1.035×10^-3 mm²/s,其灵敏度为88.5%,特异度为87.5%。结论 常规MRI结合DWI中ADC值的测量对低、高级别脑膜瘤的鉴别诊断具有重要临床应用价值。     

脑深部核团MR弥散张量成像对帕金森病不同运动亚型的鉴别诊断价值

目的:探讨脑深部核团MR弥散张量成像(DTI)在帕金森病(PD)不同运动亚型中的鉴别诊断价值。方法:回顾性研究。纳入2017年10月—2019年12月南京大学医学院附属鼓楼医院47例PD患者的临床及MRI资料。按照统一PD评定量表第三部分(UPDRS Ⅲ)运动功能评分,将47例PD患者分为震颤为主型(TD)组30例和非...     

体素内不相干运动弥散加权成像在受压腰骶神经根诊断中的应用

目的 探讨MR体素内不相干运动(IVIM)弥散加权成像(DWI)在受压腰骶神经根诊断中应用的可行性。方法 前瞻性对照研究。纳入2017年4—10月30例腰椎间盘突出致神经根受压患者(观察组)的常规腰椎MR序列及3D-Fiesta序列、IVIM-DWI序列图像;另按性别、年龄匹配纳入30名健康志愿者作为对照组。在GE ADW 4.6工作站,使用MADC软件包测量对照组双侧L₄、L₅、S₁神经节的扩散系数(D)、灌注相关扩散系数(D*)、灌注分数(f)和表观扩散系数(ADC)值,以及观察组患者受压侧及其对侧神经根的D、D*、f、ADC值。比较对照组同节段左右两侧神经节和不同节段神经节各观察项目测量值,以及观察组受压侧神经根与对侧正常神经根各观察项目测量值。绘制受压神经根D值和ADC值的ROC曲线,评价诊断效果。结果 对照组L₄、L₅、S₁神经根的D值分别为(0.603±0.064)×10^-3 mm²/s、(0.624±0.079)×10^-3 mm²/s、(0.628±0.088) ×10^-3 mm²/s, D*值分别为(3.815±0.541) ×10^-3 mm²/s、(3.862±0.414)×10^-3 mm²/s、(3.915±0.611) ×10^-3 mm²/s; f值分别为0.454%±0.076%、0.484%±0.101%、0.445%±0.094%; ADC值分别为(0.934±0.085)×10^-3 mm²/s、(0.945±0.051)×10^-3 mm²/s、(0.953±0.064)×10^-3 mm²/s。观察组神经根受压侧D、D*、f、ADC值分别为(0.669±0.081)×10^-3 mm²/s、(3.852±0.776)×10^-3 mm²/s、0.528%±0.115%、(1.096±0.087)×10^-3 mm²/s,健侧D、D*、f、ADC值分别为(0.617±0.080)×10^-3 mm²/s、(3.961±0.684)×10^-3 mm²/s、0.479%±0.083%、(0.938±0.074)×10^-3 mm²/s。对照组同节段左右两侧神经节和不同节段神经节所测D、D*、f、ADC值,差异均无统计学意义(P值均＞0.05)。观察组受压侧神经根与对侧正常神经根比较:D和ADC值均升高,差异均有统计学意义(P值均＜0.01);D*、f值差异均无统计学意义(P值均＞0.05)。绘制并分析ROC曲线,D值对诊断神经根受压具有较高效能,其次是ADC值,D值的AUC为0.923(95%CI 0.803~0.987),ADC值的 AUC为0.895(95%CI 0.865~0.999)。结论 IVIM模型的MR DWI技术可用于腰骶神经根检查,且与单指数模型的MR DWI相比能更详细、准确地反映神经根受压后的病理改变。     

MRI在腕管综合征诊断中的应用

目的：研究腕管综合征的MRI特征及临床治疗中的应用价值。方法：12例腕管综合征术前行MRI检查（以横断面为主），后经手术证实MRI的发现。结果：12例CTS的MRI表现为：正中神经入腕管时胀增粗12例，正中神经肿胀率（MNSR）2．25：1。正中神经腕管内受压变扁12例，正中神经扁平率（MNFR）3．4。T2WI像中正中神经信号增高12例。结论：MRI对腕管综合征的诊断及治疗方式的选择有重要的意义。     

高频电刺激指导肾动脉射频消融的实验研究

目的:用电刺激的方法指导肾脏去神经术(renal denervation,RDN)中射频消融靶点的选择,同时比较电刺激与射频消融时血压变化的异同。方法:成年健康昆明犬6只,行肾动脉造影排除肾动脉畸形后,每侧肾动脉从远段开始,由远及近选择数个位点进行电刺激并消融。连续记录术中血压的变化,术后通过软件分析血压的变化情况。采用常规HE和Masson染色观察肾动脉壁结构及其周围组织;采用酪氨酸羟化酶(tyrosine hydroxylase,TH)免疫组化染色观察消融后肾动脉去神经效果。结果:本实验中刺激/消融位点共计50个,其中对电刺激有反应的位点占34%,无反应位点占66%。对有反应位点进行120 s电刺激时,其收缩压按每20 s分段与基线血压相比分别变化(0.34±3.38)、(0.41±3.04)、(10.47±5.73)、(13.27±3.63)、(10.17±1.87)和(0.78±1.87)mm Hg;将120 s连续消融时的收缩压数据同样按每20 s与基线血压相比,变化分别为(0.88±3.44)、(-1.64±3.47)、(13.17±3.12)、(12.82±3.21)、(9.50±2.68)和(-6.09±2.21)mm Hg。无反应位点进行电刺激和射频消融时均无明显血压升高。组织病理学检查显示,有反应位点肾动脉神经面积为(0.51±0.28)mm~2,无反应位点处为(0.09±0.06)mm~2,差异有统计学显著性(P0.01);免疫组化染色表明消融部位神经TH的表达显著低于未消融部位(P0.01)。结论:高频电刺激可以标测肾交感神经,且电刺激指导下的射频消融能对肾动脉交感神经造成有效损伤。     

The effect of carpal tunnel release on median nerve flattening and nerve conduction

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and extensive surveys have been given on the time course of electrophysiological findings pre- and postoperatively. In patients with clinical and electrophysiological confirmed diagnosis of CTS surgical decompression of the carpal tunnel is a first line treatment and has proven to be successfull in 70 to 90% of all cases. The objective of this work was to study the morphological changes of the median nerve after endoscopic release of the carpal tunnel. We used high resolution ultrasound to quantify flattening of the median nerve and to calculate a flattening ratio before endoscopic release as well as 2 weeks and 3 months postoperatively. Ten patients with clinical and electrophysiological confirmed CTS were included in the study. There was significant normalization of the calculated flattening ratio of the median nerve already 2 weeks after surgical release, whereas nerve conduction studies needed a longer period of time to normalize and thus were still abnormal 3 months postoperatively. We conclude that ultrasound is a simple and excellent objective method for visualizing the morphological recovery of the median nerve very early after decompression surgery. In complex cases with unsatisfactory outcome ultrasonography may prove useful in confirming successfull or failed decompression of the median nerve.