Korean Journal of Radiology

  • 제22권7호
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  • Pages.1132-1141
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  • 2021
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Ultrasonography Findings of the Carpal Tunnel after Endoscopic Carpal Tunnel Release for Carpal Tunnel Syndrome

  • Alex Wing Hung Ng (Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong) ;
  • James Francis Griffith (Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong) ;
  • Carita Tsoi (Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong) ;
  • Raymond Chun Wing Fong (Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong) ;
  • Michael Chu Kay Mak (Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong) ;
  • Wing Lim Tse (Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong) ;
  • Pak Cheong Ho (Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong)
  • 투고 : 2020.08.28
  • 심사 : 2021.02.05
  • 발행 : 2021.07.01
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초록

Objective: To investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR). Materials and Methods: This prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0-3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared. Results: All patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months. Conclusion: Postoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR.

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참고문헌

  1. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol 2016;15:1273-1284 https://doi.org/10.1016/S1474-4422(16)30231-9
  2. Mosier BA, Hughes TB. Recurrent carpal tunnel syndrome. Hand Clin 2013;29:427-434 https://doi.org/10.1016/j.hcl.2013.04.011
  3. Taghizadeh R, Tahir A, Stevenson S, Barnes DE, Spratt JD, Erdmann MW. The role of MRI in the diagnosis of recurrent/persistent carpal tunnel syndrome: a radiological and intra-operative correlation. J Plast Reconstr Aesthet Surg 2011;64:1250-1252 https://doi.org/10.1016/j.bjps.2011.03.019
  4. Steyers CM. Recurrent carpal tunnel syndrome. Hand Clin 2002;18:339-345
  5. Botte MJ, von Schroeder HP, Abrams RA, Gellman H. Recurrent carpal tunnel syndrome. Hand Clin 1996;12:731-743 https://doi.org/10.1016/S0749-0712(21)00361-9
  6. Hybbinette CH, Mannerfelt L. The carpal tunnel syndrome. A retrospective study of 400 operated patients. Acta Orthop Scand 1975;46:610-620
  7. Ng AWH, Griffith JF, Lee RKL, Tse WL, Wong CWY, Ho PC. Ultrasound carpal tunnel syndrome: additional criteria for diagnosis. Clin Radiol 2018;73:214.e11-214.e18
  8. Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004;232:93-99 https://doi.org/10.1148/radiol.2321030071
  9. Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum 2002;46:1914-1921 https://doi.org/10.1002/art.10385
  10. Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol 2012;198:W181-W184 https://doi.org/10.2214/AJR.11.7012
  11. Mondelli M, Filippou G, Aretini A, Frediani B, Reale F. Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor? Scand J Rheumatol 2008;37:219-224 https://doi.org/10.1080/03009740801914850
  12. Cudlip SA, Howe FA, Clifton A, Schwartz MS, Bell BA. Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression. J Neurosurg 2002;96:1046-1051
  13. Tran TA, Williams LM, Bui D, Anthonisen C, Poltavskiy E, Szabo RM. Prospective pilot study comparing pre-and postsurgical CTSAQ and Neuro-QoL questionnaire with median nerve high-resolution ultrasound cross-sectional areas. J Hand Surg Am 2018;43:184.e1-184.e9 https://doi.org/10.1016/j.jhsa.2018.02.007
  14. El-Karabaty H, Hetzel A, Galla TJ, Horch RE, Lucking CH, Glocker FX. The effect of carpal tunnel release on median nerve flattening and nerve conduction. Electromyogr Clin Neurophysiol 2005;45:223-227
  15. Lee CH, Kim TK, Yoon ES, Dhong ES. Postoperative morphologic analysis of carpal tunnel syndrome using high-resolution ultrasonography. Ann Plast Surg 2005;54:143-146 https://doi.org/10.1097/01.sap.0000143799.88513.47
  16. Colak A, Kutlay M, Pekkafali Z, Saracoglu M, Demircan N, Sims,ek H, et al. Use of sonography in carpal tunnel syndrome surgery. A prospective study. Neurol Med Chir (Tokyo) 2007;47:109-115; discussion 115 https://doi.org/10.2176/nmc.47.109
  17. Abicalaf CA, de Barros N, Sernik RA, Pimentel BF, Braga-Baiak A, Braga L, et al. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament. Clin Radiol 2007;62:891-894 https://doi.org/10.1016/j.crad.2007.01.029
  18. Inui A, Nishimoto H, Mifune Y, Kokubu T, Sakata R, Kurosaka M. Ultrasound measurement of median nerve cross-sectional area at the inlet and outlet of carpal tunnel after carpal tunnel release compared to electrodiagnostic findings. Arch Orthop Trauma Surg 2016;136:1325-1330
  19. Chow JC, Hantes ME. Endoscopic carpal tunnel release: thirteen years' experience with the Chow technique. J Hand Surg Am 2002;27:1011-1018
  20. Lee RKL, Griffith JF, Ng AWH, Tipoe GL, Chan AWH, Wong CWY, et al. Cross-sectional area of the median nerve at the wrist: comparison of sonographic, MRI, and cadaveric measurements. J Clin Ultrasound 2019;47:122-127 https://doi.org/10.1002/jcu.22647
  21. Rivlin M, Kachooei AR, Wang ML, Ilyas AM. Electrodiagnostic grade and carpal tunnel release outcomes: a prospective analysis. J Hand Surg Am 2018;43:425-431 https://doi.org/10.1016/j.jhsa.2017.12.002
  22. Fowler JR. Nerve conduction studies for carpal tunnel syndrome: gold standard or unnecessary evil? Orthopedics 2017;40:141-142 https://doi.org/10.3928/01477447-20170419-01
  23. Rempel D, Evanoff B, Amadio PC, de Krom M, Franklin G, Franzblau A, et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 1998;88:1447-1451
  24. No authors listed. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (summary statement). American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology 1993;43:2404-2405 https://doi.org/10.1212/WNL.43.11.2404
  25. Siegmeth AW, Hopkinson-Woolley JA. Standard open decompression in carpal tunnel syndrome compared with a modified open technique preserving the superficial skin nerves: a prospective randomized study. J Hand Surg Am 2006;31:1483-1489 https://doi.org/10.1016/j.jhsa.2006.07.018
  26. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K, et al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol 2004;59:910-915 https://doi.org/10.1016/j.crad.2004.03.020
  27. Elnady B, Rageh EM, Ekhouly T, Fathy SM, Alshaar M, Fouda ES, et al. Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity. BMC Musculoskelet Disord 2019;20:634
  28. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250:171-177 https://doi.org/10.1148/radiol.2501080397
  29. Naranjo A, Ojeda S, Rua-Figueroa I, Garcia-Duque O, Fernandez-Palacios J, Carmona L. Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgery. Scand J Rheumatol 2010;39:409-412 https://doi.org/10.3109/03009741003685632
  30. Chappell CD, Beckman JP, Baird BC, Takke AV. Ultrasound (US) changes in the median nerve cross-sectional area after microinvasive US-guided carpal tunnel release. J Ultrasound Med 2020;39:693-702
  31. Vogelin E, Nuesch E, Juni P, Reichenbach S, Eser P, Ziswiler HR. Sonographic follow-up of patients with carpal tunnel syndrome undergoing surgical or nonsurgical treatment: prospective cohort study. J Hand Surg Am 2010;35:1401-1409 https://doi.org/10.1016/j.jhsa.2010.06.010
  32. Smidt MH, Visser LH. Carpal tunnel syndrome: clinical and sonographic follow-up after surgery. Muscle Nerve 2008;38:987-991 https://doi.org/10.1002/mus.20982
  33. Tas S, Staub F, Dombert T, Marquardt G, Senft C, Seifert V, et al. Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study. Neurosurg Focus 2015;39:E6
  34. Kim JK, Koh YD, Kim JO, Choi SW. Changes in clinical symptoms, functions, and the median nerve cross-sectional area at the carpal tunnel inlet after open carpal tunnel release. Clin Orthop Surg 2016;8:298-302 https://doi.org/10.4055/cios.2016.8.3.298
  35. Kleindienst A, Hamm B, Lanksch WR. Carpal tunnel syndrome: staging of median nerve compression by MR imaging. J Magn Reson Imaging 1998;8:1119-1125 https://doi.org/10.1002/jmri.1880080518
  36. Rempel D, Dahlin L, Lundborg G. Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J Bone Joint Surg Am 1999;81:1600-1610 https://doi.org/10.2106/00004623-199911000-00013
  37. Nakamichi KI, Tachibana S. Enlarged median nerve in idiopathic carpal tunnel syndrome. Muscle Nerve 2000;23:1713-1718 https://doi.org/10.1002/1097-4598(200011)23:11<1713::AID-MUS7>3.0.CO;2-G
  38. Akcar N, Ozkan S, Mehmetoglu O, Calisir C, Adapinar B. Value of power Doppler and gray-scale US in the diagnosis of carpal tunnel syndrome: contribution of cross-sectional area just before the tunnel inlet as compared with the cross-sectional area at the tunnel. Korean J Radiol 2010;11:632-639 https://doi.org/10.3348/kjr.2010.11.6.632
  39. Aboonq MS. Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh) 2015;20:4-9
  40. Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014;49:429-436
  41. Karabay N, Kayalar M, Ada S. Sonographic assessment of transverse carpal ligament after open surgical release of the carpal tunnel. Acta Orthop Traumatol Turc 2013;47:73-78 https://doi.org/10.3944/AOTT.2013.2890
  42. Junck AD, Escobedo EM, Lipa BM, Cronan M, Anthonisen C, Poltavskiy E, et al. Reliability assessment of various sonographic techniques for evaluating carpal tunnel syndrome. J Ultrasound Med 2015;34:2077-2088 https://doi.org/10.7863/ultra.15.01069