Division of Anatomy, Medical University of Vienna, Vienna, Austria.
Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria.
Eur J Phys Rehabil Med. 2024 Aug;60(4):671-679. doi: 10.23736/S1973-9087.24.08491-0. Epub 2024 Jul 15.
Reduced longitudinal median nerve gliding is a new promising diagnostic feature in carpal tunnel syndrome (CTS). However, the complexity of existing ultrasound analysis protocols undermines the application in routine clinical practice.
To provide a simple method for assessing longitudinal gliding with ultrasound, without the need for post-hoc image analysis.
The population included 48 patients with idiopathic CTS diagnosed by electrodiagnostic testing and ultrasound, as well as 15 healthy controls. Twelve, non-frozen, non-embalmed body donors were enrolled.
Longitudinal gliding of the median nerve in the carpal tunnel was visualized in all patients with idiopathic CTS and healthy controls. All ultrasound videos were pseudonymized, equipped with a scale, and randomized. Videos were analyzed by four independent radiologists, all blinded to clinical characteristics. The endpoint was gliding rated as millimeters. Validity of the technique was tested by using speckle tracking software, and in body donors, directly measuring nerve excursion in situ, simultaneously to ultrasound.
Gliding differed significantly between controls and patients with CTS, decreasing with incremental CTS severity. A cut-off value of 3.5 mm to identify patients with CTS, yielded 93.8% sensitivity and 93.3% specificity. Intraclass correlation coefficient among senior author and raters was 0.798 (95% CI 0.513 to 0.900, P<0.001), indicating good reliability. Speckle tracking and especially direct validation in body donors correlated well with ultrasound findings.
First, longitudinal median nerve gliding can reliably be assessed using this simple technique without the need for complicated procedures. Second, a decrease in gliding was found with progressive severity of CTS. Reproducibility for measured distances is good among raters.
An easy to apply sonography parameter would bolster the diagnostic ability of specialists in physical medicine and rehabilitation in daily routine.
正中神经纵向滑行减少是腕管综合征（CTS）的一种新的有前途的诊断特征。然而，现有的超声分析协议的复杂性阻碍了其在常规临床实践中的应用。
提供一种简单的方法来评估超声下的纵向滑动，而无需进行事后图像分析。
1）回顾性队列研究，由外部盲法审核员验证；2）在尸体捐赠者中进行概念验证。
1）门诊诊所；2）解剖学系。
该人群包括 48 名经电诊断测试和超声诊断为特发性 CTS 的患者，以及 15 名健康对照者。招募了 12 名非冷冻、非防腐的尸体捐赠者。
对所有特发性 CTS 患者和健康对照者进行正中神经在腕管内的纵向滑行可视化。所有超声视频均进行匿名处理，配备比例尺，并进行随机化。视频由四位独立的放射科医生进行分析，他们均对临床特征不知情。终点是滑动距离，以毫米计。通过使用斑点跟踪软件和在尸体捐赠者中同时进行的超声原位神经移位直接测量来测试该技术的有效性。
对照组和 CTS 患者之间的滑行差异显著，随着 CTS 严重程度的增加而减少。将 3.5 毫米作为识别 CTS 患者的截断值，其敏感性为 93.8%，特异性为 93.3%。高级作者和评估者之间的组内相关系数为 0.798（95%CI 0.513 至 0.900，P<0.001），表明可靠性良好。斑点跟踪，特别是在尸体捐赠者中的直接验证与超声结果相关性良好。
首先，使用这种简单的技术可以可靠地评估正中神经的纵向滑动，而无需进行复杂的操作。其次，随着 CTS 严重程度的增加，滑行减少。评估者之间测量距离的重现性良好。
易于应用的超声参数将增强物理医学与康复专家在日常工作中的诊断能力。
