Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
College of Computing and Engineering, Nova Southeastern University, Fort Lauderdale, Florida, USA.
J Ultrasound Med. 2021 Aug;40(8):1555-1568. doi: 10.1002/jum.15535. Epub 2020 Oct 19.
The mobility (transverse movement) of the median nerve (MN) is decreased in patients with carpal tunnel syndrome and can be measured noninvasively by ultrasound. To date, there are few prognostic features to help predict the outcome of 2 commonly performed treatments: surgical carpal tunnel release and corticosteroid injection. This study aimed to assess the changes in nerve mobility after the intervention and to correlate this with treatment and the disease severity.
A total of 181 patients with carpal tunnel syndrome with different electrophysiologic severities were recruited and assessed by dynamic ultrasound scanning of the MN before and after treatment. The dynamic ultrasound images were collected while the patients performed finger and wrist flexion.
For both injection and carpal tunnel release, the nerve displacement increased with wrist flexion, from a mean ± SD of 7.0 ± 2.4 to 7.9 ± 2.7 mm (P < .005). Patients who underwent surgery showed greater improvement (P < .005) in nerve mobility compared to those who underwent injection. We also observed that the increase in nerve mobility was predominantly in patients with more nerve damage at baseline.
This study shows that the dynamic behavior of the MN changes in response to treatment and lays a foundation for future studies to assess the prognostic potential of nerve mobility measurement.
腕管综合征患者的正中神经（MN）活动度（横向运动）降低，可通过超声进行非侵入性测量。迄今为止，很少有预后特征可以帮助预测两种常见治疗方法（手术腕管松解和皮质类固醇注射）的结果。本研究旨在评估干预后神经活动度的变化，并将其与治疗和疾病严重程度相关联。
共招募了 181 名不同电生理严重程度的腕管综合征患者，并在治疗前后通过 MN 的动态超声扫描进行评估。在患者进行手指和手腕弯曲时采集动态超声图像。
对于注射和腕管松解，神经位移随手腕弯曲而增加，从平均±标准差 7.0±2.4 毫米增加到 7.9±2.7 毫米（P<.005）。与接受注射治疗的患者相比，接受手术治疗的患者神经活动度的改善更大（P<.005）。我们还观察到，在基线时神经损伤更严重的患者中，神经活动度的增加更为明显。
本研究表明 MN 的动态行为会随着治疗而发生变化，为未来评估神经活动度测量的预后潜力的研究奠定了基础。
