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. 2015 Sep;33(9):1332-40.
doi: 10.1002/jor.22909. Epub 2015 May 7.

Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome

Anika Filius  1   2   3 , Marjan Scheltens  4 , Hans G Bosch  5 , Pieter A van Doorn  4 , Henk J Stam  2 , Steven E R Hovius  1 , Peter C Amadio  3 , Ruud W Selles  1   2
Affiliations

Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome

Anika Filius et al. J Orthop Res. 2015 Sep.

Abstract

Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross-sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70-71% and specificity of 80-84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel.

Keywords: Carpal tunnel syndrome; biomechanics; displacement; tendon; ultrasound.

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Figures

Figure 1A-C
Figure 1A-C
Placement of the region of interest (ROI) for A. The MN with SSCT. B. The FDS3 with SSCT. C. The FDP3 with SSCT.
Figure 2A-B
Figure 2A-B
A. cross-sectional ultrasound image at the carpal tunnel inlet of a CTS patient during extension of all fingers. B. Manually placed polygons on the outside border of the MN, the FDS3, and FDP3.
Figure 3A-B
Figure 3A-B
MN/FDS3 ratio based on the longitudinal displacement of these structures. Significant differences are identified with corresponding p-values. A. Clinically graded CTS patients. B. CTS patients graded according to the NCS classification. Outliers are displayed as dots.
Figure 4A-B
Figure 4A-B
FDS3/FDP3 ratio based on the longitudinal displacement of these structures. Significant differences are identified with corresponding p-values. A. Clinically graded CTS patients. B. CTS patients graded according to the NCS classification. Outliers are displayed as dots.
Figure 5A-D
Figure 5A-D
Transversal displacement in millimeters in the x and y plane of the MN relative to the FDS3 and the FDS3 relative to the FDP3. A-B. Clinically graded CTS patients. C-D. CTS patients graded according to the NCS classification.
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