Grönfors Henri, Mäkelä Katri, Himanen Sari-Leena
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; and.
Department of Clinical Neurophysiology, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland.
J Clin Neurophysiol. 2025 Mar 19. doi: 10.1097/WNP.0000000000001157.
Aim of the study was to examine the associations between abductor pollicis brevis (APB) muscle stiffness evaluated by shear wave elastography and electrodiagnostic study findings in patients with carpal tunnel syndrome. The association between shear wave elastography and APB muscle echogenicity was also examined.
This prospective study included patients who were referred to electrodiagnostic studies because of upper limb symptoms. The electrodiagnostic studies consisted of nerve conduction studies and needle-electromyography. Abductor pollicis brevis muscle shear wave velocity was measured, and muscle echogenicity assessed using the Heckmatt grading scale.
In total, 97 hands were included in the nerve conduction studies. Of these, 53 APB muscles were further examined with needle-electromyography. Shear wave velocity correlated positively with the neurophysiologic severity of carpal tunnel syndrome (r = 0.449, P = 0.028, N = 26). Mean shear wave velocity was faster in the APB muscles with neurogenic findings (mean 2.72 m/second, ±SD 0.36) than muscles with normal findings (2.48 m/second, ±SD 0.34, P = 0.036). In receiver operating characteristic analysis, the best shear wave velocity cutoff value was 2.66 m/second. With this cutoff value, the sensitivity was 0.692, while the 1-specificity was 0.233. Only seven APB muscles showed increased echogenicity.
Shear wave velocity of APB muscle is positively associated with the neurophysiologic severity of carpal tunnel syndrome. Carpal tunnel syndrome-related axonal damage also seems to increase shear wave velocity in APB muscle; however, according to the receiver operating characteristic analysis, the method is not yet suitable for clinical use to define muscle denervation. The findings of this study show that shear wave elastography has potential as an additional clinical tool in the diagnostics of carpal tunnel syndrome.
本研究旨在探讨通过剪切波弹性成像评估的拇短展肌（APB）肌肉硬度与腕管综合征患者电诊断研究结果之间的关联。同时也研究了剪切波弹性成像与APB肌肉回声性之间的关联。
这项前瞻性研究纳入了因上肢症状而接受电诊断研究的患者。电诊断研究包括神经传导研究和针极肌电图检查。测量了拇短展肌的剪切波速度，并使用Heckmatt分级量表评估肌肉回声性。
共有97只手纳入神经传导研究。其中，53块APB肌肉进一步接受了针极肌电图检查。剪切波速度与腕管综合征的神经生理严重程度呈正相关（r = 0.449，P = 0.028，N = 26）。有神经源性表现的APB肌肉的平均剪切波速度（平均2.72米/秒，±标准差0.36）比表现正常的肌肉（2.48米/秒，±标准差0.34，P = 0.036）更快。在受试者工作特征分析中，最佳的剪切波速度临界值为2.66米/秒。以此临界值，敏感性为0.692，而1-特异性为0.233。只有7块APB肌肉显示回声性增加。
APB肌肉的剪切波速度与腕管综合征的神经生理严重程度呈正相关。与腕管综合征相关的轴突损伤似乎也会增加APB肌肉的剪切波速度；然而，根据受试者工作特征分析，该方法尚不适合临床用于定义肌肉失神经支配。本研究结果表明，剪切波弹性成像有潜力作为腕管综合征诊断中的一种额外临床工具。
