Department of PMR, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedics/Hand Division, Mayo Clinic, Rochester, Minnesota, USA.
PM R. 2023 Jul;15(7):847-852. doi: 10.1002/pmrj.12876. Epub 2022 Nov 15.
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Although prior studies have explored the anatomic changes of the median nerve and carpal arch with different wrist deviations and positionings, the change in safe zone distance between the median nerve and ulnar artery with ulnar or radial wrist deviations has not been adequately investigated.
To identify the optimal wrist positioning that increases the safe zone distance between the median nerve and ulnar artery using ultrasound in patients with CTS.
Retrospective cohort study.
Quaternary medical center multidisciplinary outpatient hand clinic.
Twenty five patients (41 wrists) with clinical CTS who received an electrodiagnostic study (EDX) to evaluate CTS within 1 year prior to enrollment.
Ultrasound-identified safe zone distance measurements were obtained in each patient between the ulnar aspect of the median nerve and the radial aspect of the ulnar artery with the wrist in neutral radial-ulnar deviation as well as in passive ulnar and radial deviation.
The ultrasound-identified safe zone distance with the wrist in each of the three positions.
The interstructural safe zone distance was significantly greater when measured in the ulnarly deviated position (1.08 cm) compared with either the neutral (0.61cm, p < .001) or radially deviated positions (0.52 cm, p < .001). Interstructural safe zone distance did not differ between those with normal, mild, moderate, or severe classifications of pathology, or between dominant and nondominant limbs.
This study demonstrates that the ultrasound-measured interstructural safe zone distance was significantly greater in the ulnarly deviated position than in either the neutral position or radially deviated position. These findings may lead to improvement in the safety of ultrasound-guided injections.
腕管综合征（CTS）是最常见的周围神经卡压综合征。尽管先前的研究已经探讨了不同腕部偏斜和位置下正中神经和腕管弓的解剖结构变化，但尚未充分研究尺侧或桡侧腕偏斜时正中神经和尺动脉之间安全区距离的变化。
使用超声确定 CTS 患者中增加正中神经和尺动脉之间安全区距离的最佳腕部位置。
回顾性队列研究。
四级医学中心多学科门诊手诊所。
25 名（41 只腕）患有临床 CTS 的患者，这些患者在入组前 1 年内接受了电诊断研究（EDX）以评估 CTS。
使用超声测量每位患者正中神经尺侧和尺动脉桡侧之间的安全区距离，腕部处于中立尺桡偏斜以及被动尺偏和桡偏斜位置。
三种位置下腕部的超声识别安全区距离。
与中立位（0.61cm，p<0.001）或桡偏位（0.52cm，p<0.001）相比，尺偏位时结构间安全区距离明显更大（1.08cm）。在正常、轻度、中度或重度病理分类之间，以及在优势手和非优势手之间，结构间安全区距离没有差异。
本研究表明，与中立位或桡偏位相比，超声测量的结构间安全区距离在尺偏位时明显更大。这些发现可能会提高超声引导注射的安全性。
