超声评估类风湿关节炎和特发性腕管综合征的腕管。
Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome.
机构信息
Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
出版信息
Clin Rheumatol. 2021 Mar;40(3):1085-1092. doi: 10.1007/s10067-020-05293-z. Epub 2020 Jul 21.
OBJECTIVES
To comparatively assess the sonographic spectrum of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and in patients with idiopathic CTS.
METHODS
Fifty-seven RA patients and 25 idiopathic CTS patients were consecutively enrolled. The diagnosis of CTS in RA patients was made according to clinical history and examination. The following sonographic findings were assessed at carpal tunnel level: median nerve cross-sectional area (CSA) at the carpal tunnel proximal inlet, finger flexor tendons tenosynovitis, radio-carpal synovitis and intraneural power Doppler (PD) signal.
RESULTS
CTS was diagnosed in 15/57 RA patients (26.3%). Twenty-three RA wrists with CTS, 84 RA wrists without CTS and 34 idiopathic CTS wrists were evaluated. The average CSA of the median nerve was higher in idiopathic CTS than in RA wrists with CTS (17.7 mm vs 10.6 mm, p < 0.01). A higher rate of inflammation of synovial structures (flexor tendons sheath and/or radio-carpal joint) was found in RA wrists with CTS compared with those without CTS (p = 0.04) and idiopathic CTS (p = 0.02). Intraneural PD signal was more common in CTS (in both RA and idiopathic CTS) wrists compared with wrists without CTS (p < 0.01).
CONCLUSION
The sonographic spectrum of CTS in RA patients is characterized by an inflammatory pattern, defined by the presence of finger flexor tendons tenosynovitis and/or radio-carpal joint synovitis. Conversely, a marked median nerve swelling is the dominant feature in idiopathic CTS. Intraneural PD signal is a frequent finding in both conditions. Key Points • Carpal tunnel syndrome (CTS) associated with rheumatoid arthritis (RA) and idiopathic CTS have distinct ultrasound patterns. • The most characteristic sonographic features of CTS in RA patients are those indicative of synovial tissue inflammation at carpal tunnel level. Conversely, marked median nerve swelling is the dominant finding in idiopathic CTS. • Intraneural power Doppler signal is a frequent finding in both conditions. • In patients with CTS, differently from electrophysiology, US can provide clues prompting a rheumatology referral in case of prominent inflammatory findings at carpal tunnel level.
目的
比较评估类风湿关节炎（RA）患者与特发性腕管综合征（CTS）患者的腕管综合征超声谱。
方法
连续纳入 57 例 RA 患者和 25 例特发性 CTS 患者。RA 患者的 CTS 诊断根据临床病史和检查确定。在腕管水平评估以下超声表现：腕管近端入口处正中神经横截面积（CSA）、手指屈肌腱腱鞘炎、桡腕关节炎和神经内功率多普勒（PD）信号。
结果
15/57（26.3%）例 RA 患者诊断为 CTS。评估了 23 例 RA 伴 CTS 手腕、84 例 RA 无 CTS 手腕和 34 例特发性 CTS 手腕。特发性 CTS 手腕的正中神经 CSA 平均高于 RA 伴 CTS 手腕（17.7mm 比 10.6mm，p<0.01）。RA 伴 CTS 手腕的滑膜结构（屈肌腱鞘和/或桡腕关节）炎症发生率高于无 CTS 手腕（p=0.04）和特发性 CTS 手腕（p=0.02）。神经内 PD 信号在 CTS（RA 和特发性 CTS 均有）手腕中比无 CTS 手腕更常见（p<0.01）。
结论
RA 患者 CTS 的超声谱特征为炎症模式，表现为手指屈肌腱腱鞘炎和/或桡腕关节炎。相反，特发性 CTS 的主要特征是正中神经明显肿胀。神经内 PD 信号在两种情况下均为常见表现。关键点• 与类风湿关节炎（RA）相关的腕管综合征（CTS）和特发性 CTS 具有不同的超声模式。• RA 患者 CTS 的最典型超声特征是腕管水平滑膜组织炎症的表现。相反，特发性 CTS 的主要发现是正中神经明显肿胀。• 神经内功率多普勒信号在两种情况下均为常见表现。• 在 CTS 患者中，与电生理学不同，超声检查可提供线索，如果在腕管水平发现明显的炎症表现，可提示转介风湿病学。
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