Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China.
Dis Markers. 2023 Feb 1;2023:3631193. doi: 10.1155/2023/3631193. eCollection 2023.
To evaluate the effect of wrist dorsiflexion/palmar flexion on median nerve excursion and cross-sectional area in patients with carpal tunnel syndrome.
From November 2019 to December 2021, 85 patients (110 affected wrists) who presented to our department and were diagnosed with carpal tunnel syndrome were collected and classified by severity as mild to moderate. Twenty-five healthy controls were selected during the same period, with a total of 50 healthy wrists. All patients and healthy volunteers underwent high-frequency ultrasonography to measure the vertical deviation between the median nerve and the transverse carpal ligament during wrist dorsiflexion/palmar flexion and the changes in the cross-sectional area of the median nerve in the pisiform plane. All patients with carpal tunnel syndrome underwent neurophysiological testing to measure median nerve sensory conduction velocity, sensory latency time, and sensorimotor point fluctuation amplitude.
The mean age of the patients was 50 ± 8 years, the proportion of males was 18%, and the disease course was 2.3 ± 1.2 years. In terms of severity grading, 38 patients (34.5%) had mild carpal tunnel syndrome, 30 patients (27.3%) had moderate carpal tunnel syndrome, and 42 patients (38.2%) had severe carpal tunnel syndrome. Compared with the control group, the distance between the proximal median nerve and the transverse carpal ligament, the distance between the distal median nerve and the transverse carpal ligament, and the cross-sectional area were decreased in the carpal tunnel syndrome group compared with those during wrist dorsiflexion, and the differences were statistically significant ( < 0.05). Compared with the control group, there were significant differences in the vertical distance and cross-sectional area between the median nerve and the transverse carpal ligament at the proximal and distal ends in the mild, moderate, and severe groups ( < 0.05). The proximal vertical distance of the median nerve was positively correlated with sensory latency ( < 0.05) and negatively correlated with sensory conduction velocity ( < 0.05). The vertical distance of the distal end of the median nerve was also significantly positively correlated with sensory latency ( < 0.05) and significantly negatively correlated with sensory conduction velocity ( < 0.05).
Wrist dorsiflexion/palmar flexion can affect median nerve deviation and cross-sectional area in patients with carpal tunnel syndrome. High-frequency ultrasound is helpful to detect such an effect and can also help determine the severity of carpal tunnel syndrome, which is worthy of clinical promotion.
评估腕背屈/掌屈对腕管综合征患者正中神经位移和横截面积的影响。
2019 年 11 月至 2021 年 12 月，收集我院收治的 85 例（110 个患腕）经临床和神经电生理检查确诊为腕管综合征且病情程度为轻中度的患者，并按严重程度分为轻度、中度和重度。同期选取 25 例健康志愿者作为对照组，共 50 个健康腕。所有患者和健康志愿者均接受高频超声检查，测量腕背屈/掌屈时正中神经与腕横韧带之间的垂直偏差以及钩骨平面正中神经的横截面积变化。所有腕管综合征患者均接受神经电生理检查，测量正中神经感觉传导速度、感觉潜伏期和感觉运动点波动幅度。
患者的平均年龄为 50 ± 8 岁，男性比例为 18%，病程为 2.3 ± 1.2 年。根据严重程度分级，38 例（34.5%）为轻度腕管综合征，30 例（27.3%）为中度腕管综合征，42 例（38.2%）为重度腕管综合征。与对照组相比，腕管综合征组患者腕背屈时近侧正中神经与腕横韧带的距离、远侧正中神经与腕横韧带的距离以及正中神经的横截面积均减小，差异有统计学意义（ < 0.05）。与对照组相比，轻度、中度和重度组患者正中神经近、远侧与腕横韧带的垂直距离和横截面积差异均有统计学意义（ < 0.05）。正中神经近侧垂直距离与感觉潜伏期呈正相关（ < 0.05），与感觉传导速度呈负相关（ < 0.05）。正中神经远侧末端的垂直距离也与感觉潜伏期显著正相关（ < 0.05），与感觉传导速度显著负相关（ < 0.05）。
腕背屈/掌屈可影响腕管综合征患者正中神经的偏移和横截面积。高频超声有助于检测这种影响，还可帮助判断腕管综合征的严重程度，值得临床推广。
