Fryźlewicz Agnieszka, Rusin Gabriela, Rudnicki Wojciech, Ułamek-Kozioł Marzena, Antczak Jakub
Department of Neurology, University Hospital in Krakow, Cracow, Poland.
Department of Radiology, University Hospital in Krakow, Cracow, Poland.
Int J Gen Med. 2025 Jan 23;18:357-369. doi: 10.2147/IJGM.S502961. eCollection 2025.
Ultrasonography is increasingly used to diagnose the carpal tunnel syndrome (CTS). Most frequently, the enlargement of the nerve cross-sectional area (CSA) at the tunnel inlet serves to confirm the diagnosis. Recent research has shown that the nerve diameter is decreased within the tunnel, when measured at the level of pisiforme or capitatum. The stenosis index (SI), which uses the ratio of the diameter of median nerve at the tunnel inlet to the diameter within the tunnel (SI diameter), was proposed as the diagnostic marker of CTS. In this study, we compared the diameter of the median nerve measured at the site of maximal stenosis (DMS) between patients with CTS and controls. Additionally, we investigated the diagnostic utility of the modified SI, which uses the ratio of CSA at the inlet to the diameter within the tunnel (SI CSA).
Forty-eight patients (72 hands) with CTS and 18 asymptomatic controls (28 hands) underwent electrodiagnostic testing and ultrasonography.
CSA at the inlet was larger in patients, whereas DMS showed only trend towards being smaller in CTS. CTS was also associated with more distal localization of maximal stenosis. Both SI diameter and SI CSA were higher in patients, however the discriminative effect of SI CSA was stronger. SI diameter, SI CSA, CSA at the inlet and DMS correlated with the electrodiagnostic severity grade of CTS. The post-hoc analysis revealed that patients with moderate and severe electrodiagnostic grade of CTS have smaller DMS, whereas patients with mild CTS did not differ from controls.
DMS seems to have only limited diagnostic potential in mild CTS, but it may be a marker of more advanced cases. CTS may be associated with the distal shift of DMS. SI CSA may have significant diagnostic potential in CTS.
超声检查越来越多地用于诊断腕管综合征（CTS）。最常见的是，通过测量腕管入口处神经横截面积（CSA）的增大来确诊。最近的研究表明，在豌豆骨或头状骨水平测量时，腕管内神经直径会减小。狭窄指数（SI），即腕管入口处正中神经直径与腕管内直径之比（SI直径），被提议作为CTS的诊断标志物。在本研究中，我们比较了CTS患者与对照组在最大狭窄部位（DMS）测量的正中神经直径。此外，我们还研究了改良SI的诊断效用，改良SI使用入口处CSA与腕管内直径之比（SI CSA）。
48例CTS患者（72只手）和18例无症状对照者（28只手）接受了电诊断测试和超声检查。
患者入口处的CSA较大，而CTS患者的DMS仅显示出变小的趋势。CTS还与最大狭窄的更远处定位有关。患者的SI直径和SI CSA均较高，然而SI CSA的鉴别效果更强。SI直径、SI CSA、入口处CSA和DMS与CTS的电诊断严重程度分级相关。事后分析显示，电诊断分级为中度和重度的CTS患者的DMS较小，而轻度CTS患者与对照组无差异。
DMS在轻度CTS中的诊断潜力似乎有限，但它可能是更严重病例的一个标志物。CTS可能与DMS的远端移位有关。SI CSA在CTS中可能具有显著的诊断潜力。
