• Biomedical Science Letters
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• v.26 no.3
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• pp.186-191
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• 2020

This study was designed to investigate the median nerve cross-sectional area of the upper extremity which is the main cause of CTS in the 20s and 30s. The median nerve cross-sectional area (MNC-area) of each part of the upper limb was measured in healthy 20s and 30s females and males without neurological diseases or other diseases. This MNC-area was compared with the hand, wrist, finger, and other body indexes. The research group was divided into 20s female and male groups, and the 30s were also divided into female and male groups. In the comparison between the ages, the hand, and wrist configurations in the 30s were significantly higher than those of the 20s. The mean median nerve cross-sectional area was significantly larger in the male group than in the female group in both 20s and 30s, and it was larger in both men and women than in the 20s. Hand and wrist configurations were also positively correlated with the median nerve cross-sectional area in both 20s and 30s. The median values of hand ratio and wrist ratio were 2.26 and 0.65, respectively. This median value of hand ratio was inversely correlated with the median nerve cross-sectional area. The median nerve cross-area of the 20s was 6.88~7.38 ㎟ in the male group and 5.69~6.99 ㎟ in the female group, respectively. The median nerve cross-area of the 30s was 6.32~8.89 ㎟ in the male group and 6.15~7.17 ㎟ in the female group, respectively. The mean median nerve cross-sectional area was positively correlated with body mass index in both groups. Most of the variables were higher in their 30s than in their 20s.

• The Journal of the Korea Contents Association
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• v.13 no.11
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• pp.288-296
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• 2013

The purpose of this study were carpal tunnel syndrome in stroke patients according to the degree of spasticity in the median nerve cross-sectional area, nerve conduction velocity, and to evaluate differences in upper extremity function. The subjects of this study was in adult patients with stroke 42 patients from 21 patients CTS group and 21 patients Non-CTS group were selected. Measurement of median nerve-cross sectional area, nerve conduction velocity, GST, FMAS, CTS-FSS was measured. The study results were each group between the unaffected side and the affected side CTS and Non-CTS group in each grade between groups unaffected side(p<.001), and affected side(p<.001) median nerve-cross sectional area, median motor and sensory nerve onset latency, there was a statistically significant difference. CTS and Non-CTS group between groups in each grade GST(p<.05), FMAS(p<.05), CTS-FSS(p<.001), there was a statistically significant difference. In this study, the carpal tunnel pathokinesiology ever presented by the contents of upper extremity functional training in stroke patients is one of the information that you need to consider when presented.

• Annals of Clinical Neurophysiology
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• v.12 no.2
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• pp.55-60
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• 2010

Background: The aim of this study is to identify the correlation between ultrasonographic findings of median nerve and clinical scale and electrophysiologic data in carpal tunnel syndrome. Methods: Forty three patients (79 hands) with electrophysiologically confirmed carpal tunnel syndrome were evaluated. Clinical symptoms were examined by Historical-Objective (Hi-Ob) scale. Electrophysiologic data and Padua scale were used for severity of electrophysiology. In ultrasonographic study, cross sectional area and flattening ratio of median nerve were measured at distal wrist crease level (DWC), 1cm proximal to distal wrist crease level, and 1cm distal to distal wrist crease level. The correlation between Hi-Ob scale, electrophysiologic data and ultrasonography was measured with Spearman rank test. Results: The mean Hi-Ob scale was 2.4. Mean Padua scale was 4.0. In ultrasnonographic study, cross sectional area and flattening ratio were $0.112\;cm^2{\pm}0.025$ and $3.0{\pm}0.6$ at 1cm proximal to DWC level, $0.118{\pm}0.026\;cm^2$ and $2.9{\pm}0.4$ at DWC level, and $0.107{\pm}0.032\;cm^2$ and $3.0{\pm}0.4$ at 1 cm distal to DWC level. Hi-Ob scale was not correlated with cross sectional area and flattening ratio of median nerve. Hi-Ob scale was correlated with Padua scale positively (r=0.44) and correlated with amplitudes of CMAP and SNAP, negatively (r=-0.33; r=-0.30). Cross sectional area of median nerve was significantly correlated with Padua scale, amplitudes and latencies of CMAP and amplitudes of SNAP. Conclusions: Ultrasonographic findings of median nerve and electrodiagnostic data had statistically significant correlation. Consequently, ultrasonography could be an adjunctive method in diagnosis of carpal tunnel syndrome.

• Annals of Clinical Neurophysiology
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• v.2 no.2
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• pp.89-94
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• 2000

Purpose : Carpal tunnel syndrome (CTS) is a disorder of median nerve at wrist. It is usually diagnosed through clinical manifestation and nerve conduction study (NCS). However, sometimes, NCS does not provide a reliable evidence to reach the diagnosis. Thus, authors performed this study to determine whether NCS was correlated with specific parameters measured on magnetic resonance imaging (MRI) which might become a potential complemental diagnostic tool. Methods : We performed MRI in 34 wrists of 18 patients with clinical manifestations of CTS and pathologic nerve conduction values and analyzed them at levels of the distal radioulnar joint, pisiform and hook of hamate, Results : Increase in the cross-sectional area of the median nerve at the pisiform level and flattening, increased signal intensity, and contrast enhancement of the median nerve at levels of the pisiform and hook of hamate were statistically significant. Change in cross sectional areas between the distal radioulnar joint and hamate and the signal intensities at levels of pisiform and hamate were well correlated with the median nerve conduction velocity. Conclusions : Characteristic MRI findings in CTS reported previously were well demonstrated and some of MRI parameters are well correlated with nerve conduction study. MRI, despite cost, may help in evaluating CTS.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.54-59
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• 2020

Background: The median nerve cross-sectional area (MNCSA) is a useful morphological parameter for the evaluation of carpal tunnel syndrome (CTS). However, there have been limited studies investigating the anatomical basis of median nerve flattening. Thus, to evaluate the connection between median nerve flattening and CTS, we carried out a measurement of the median nerve thickness (MNT). Methods: Both MNCSA and MNT measurement tools were collected from 20 patients with CTS, and from 20 control individuals who underwent carpal tunnel magnetic resonance imaging (CTMRI). We measured the MNCSA and MNT at the level of the hook of hamate on CTMRI. The MNCSA was measured on the transverse angled sections through the whole area. The MNT was measured based on the most compressed MNT. Results: The mean MNCSA was 9.01 ± 1.94 ㎟ in the control group and 6.58 ± 1.75 ㎟ in the CTS group. The mean MNT was 2.18 ± 0.39 mm in the control group and 1.43 ± 0.28 mm in the CTS group. Receiver operating characteristics curve analysis demonstrated that the optimal cut-off value for the MNCSA was 7.72 ㎟, with 75.0% sensitivity, 75.0% specificity, and an area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.69-0.95). The best cut off-threshold of the MNT was 1.76 mm, with 85% sensitivity, 85% specificity, and an AUC of 0.94 (95% CI, 0.87-1.00). Conclusions: Even though both MNCSA and MNT were significantly associated with CTS, MNT was identified as a more suitable measurement parameter.

• Journal of Acupuncture Research
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• v.35 no.1
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• pp.4-10
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• 2018

The aim of this report was to show the effects of acupotomy in patients with carpal tunnel syndrome. Four patients were treated with acupotomy twice. Visual analogue scale (VAS), Tinel's sign, Phalen's test, Boston carpal tunnel syndrome questionnaire (BCTQ), muscular strength test, and a cross-sectional area of median nerve was measured using ultrasound before and after treatment. In all 4 cases, the VAS score, BCTQ score and cross-sectional area of median nerve, all decreased and muscular strength test score increased. Tinel's sign and the Phalen's test changed from a positive to a negative in most cases. This report shows that acupotomy is an effective treatment for carpal tunnel syndrome. Further larger are needed to fully evaluate the beneficial effects of this treatment.

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1132-1141
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• 2021

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.

• Clinical Pain
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• v.20 no.1
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• pp.15-19
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• 2021

There are many wrist and hand diseases in which ultrasound can help in the diagnosis and treatment. Because many small structures are located, identifying anatomical locations and pathways is especially important. In De Quervain's syndrome, it is necessary to find tendon lesions located in the first compartment of the wrist. If injection therapy is required, administer the regimen accurately within the tendon sheath through ultrasound. In carpal tunnel syndrome, there are several methods to diagnose a disease by measuring cross-sectional area of the median nerve. Ultrasound has the advantage of administering injection therapy without damaging the nerve. Intersection syndrome can be diagnosed by observing swelling and hypoechoic appearances at the point where the tendons of the first compartment cross over the second compartment of the wrist. Ultrasound-guided injection is also safe and efficient. If there is a trigger finger lesion, the most representative findings is to observe a nodular hypoechoic thickening of the involved A1 pulley. When injection therapy is performed, it is effective to administer medication between pulley and flexor tendons as much as possible to reduce pressure on the attached structures.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.1
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• pp.64-72
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• 2008

Compression neuropathy around elbow and wrist are one of the common disturbing problems in the upper extremity. The understanding of normal nerve architectures and pathophysiologic changes in compression neuropathy is important to interpret the ultrasonographic images correctly. Compression neuropathies have characteristic ultrasonographic imaging features of flattened nerve at compression and hypoechoic swollen nerve with loss of fascicular patterns at proximal segments. Dynamic ultrasonographic imagings on motion can show dymanic subluxation of ulnar nerve and medial head of triceps muscle over the medial epicondyle in snapping triceps syndrome. Dynamic compression of median nerve also can be visualized in pronator teres syndrome by dynamic imaging studies. A quantitative measures of cross sectional area or compression ratio can be helpful to diagnose compression neuropathies, such as carpal tunnel syndrome or cubital tunnel syndrome. With the clinical features and electeophysiologic studies, the untrasonographic imagings are useful tool for evaluation of the compression neuropathies in the upper extremities.

• Clinical Pain
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• v.18 no.2
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• pp.70-75
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• 2019

Objective: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings. Method: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded. Results: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters. Conclusion: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.