Wu Han, Zhao Hong-Juan, Xue Wei-Li, Wang Yi-Chun, Zhang Wu-Yue, Wang Xiao-Lei
In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Front Neurol. 2022 Dec 16;13:1079737. doi: 10.3389/fneur.2022.1079737. eCollection 2022.
Carpal tunnel syndrome (CTS) is a common compression neuropathy of the median nerve in the wrist. Early diagnosis of CTS is essential for selecting treatment options and assessing prognosis. The current diagnosis of CTS is based on the patient's clinical symptoms, signs, and an electromyography (EMG) test. However, they have some limitations. Recently, ultrasound has been adopted as an adjunct diagnostic tool for electromyography (EMG). Ultrasound is a non-invasive and cost-effective technique. It provides a dynamic display of morphological changes in the median nerve and an assessment of CTS etiology such as tenosynovitis, mass compression, and tendon disease. This study aimed to investigate the value of conventional ultrasound and real-time shear wave elastography (SWE) in evaluation of median neuropathy in patients with carpal tunnel syndrome (CTS) before and after surgery.
First, the Boston Carpal Tunnel Questionnaire (BCTQ) was administered to patients with CTS. All subjects were measured at three levels: the distal 1/3 of the forearm, the carpal tunnel inlet, and the distal carpal tunnel using conventional ultrasound and SWE. Median nerve parameters were examined in patients with CTS 1 week after surgery.
The cross-sectional area (CSA) and stiffness of the median nerve at the carpal tunnel inlet and distal carpal tunnel were significantly higher in patients with CTS than in healthy controls ( < 0.001). The CSA and stiffness of the median nerve at the carpal tunnel inlet were statistically significantly significantly between pre- and postoperative patients with CTS ( < 0.001). The CSA and stiffness of the nerve in patients with CTS had a positive correlation with electrophysiology severity.
Conventional ultrasound and elastography are valuable in the diagnosis of CTS and are useful in the clinical assessment of patient's nerve recovery after operation.
腕管综合征（CTS）是一种常见的腕部正中神经受压性神经病变。早期诊断CTS对于选择治疗方案和评估预后至关重要。目前CTS的诊断基于患者的临床症状、体征以及肌电图（EMG）检查。然而，它们存在一些局限性。最近，超声已被用作肌电图（EMG）的辅助诊断工具。超声是一种无创且经济有效的技术。它能动态显示正中神经的形态变化，并评估CTS的病因，如腱鞘炎、肿块压迫和肌腱疾病。本研究旨在探讨传统超声和实时剪切波弹性成像（SWE）在评估腕管综合征（CTS）患者手术前后正中神经病变中的价值。
首先，对CTS患者进行波士顿腕管问卷（BCTQ）调查。所有受试者在前臂远端1/3、腕管入口和腕管远端三个部位使用传统超声和SWE进行测量。对CTS患者在术后1周检查正中神经参数。
CTS患者腕管入口和腕管远端正中神经的横截面积（CSA）和硬度显著高于健康对照组（<0.001）。CTS患者术前和术后腕管入口处正中神经的CSA和硬度在统计学上有显著差异（<0.001）。CTS患者神经的CSA和硬度与电生理严重程度呈正相关。
传统超声和弹性成像在CTS诊断中具有重要价值，且有助于对患者术后神经恢复进行临床评估。
