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Nouh MR, Abdel-Naby HM, El Sakka T, El-Shafei M. Peripheral nerve ultrasound: a survival guide for the practicing radiologist with updates. Ultrasound J 2025; 17:21. [PMID: 40138059 PMCID: PMC11947404 DOI: 10.1186/s13089-024-00387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/25/2024] [Indexed: 03/29/2025] Open
Abstract
Peripheral nerve injuries negatively impact patients' quality of life and healthcare resources. This review discusses using high-resolution neurosonography (HRNUS) for mapping peripheral nerves and detecting pathologic lesions. It emphasizes the importance of HRNUS in diagnosing nerve disorders and briefs the widely accepted schemes for peripheral nerve injury classification. It also highlights the non-intrusive, flexible, patient-friendly, and cost-effective nature of HRNUS, making it a valuable tool in managing nerve disorders. The authors recommend the use of HRNUS to enable precise diagnoses, prevent permanent disabilities, and contribute to the efficient utilization of healthcare resources.
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Affiliation(s)
- Mohamed Ragab Nouh
- Department of Radiology, Faculty of Medicine, Alexandria University, 1 Kolyat El-Teb Street Mahta El-Ramel, 2331, Alexandria, Egypt.
- Department of Radiology, Armed Force Hospital, King Abdulaziz Airbase, 31932, Dhahran, Kingdom of Saudi Arabia.
| | - Hoda Mohamed Abdel-Naby
- Department of Physical Medicine, Faculty of Medicine, Alexandria University, 1 Kolyat El-Teb Street Mahta El-Ramel, Alexandria, 2331, Egypt
| | - Tarek El Sakka
- Department of Radiology, Faculty of Medicine, Alexandria University, 1 Kolyat El-Teb Street Mahta El-Ramel, 2331, Alexandria, Egypt
| | - Mohamed El-Shafei
- Department of Radiology, Faculty of Medicine, Alexandria University, 1 Kolyat El-Teb Street Mahta El-Ramel, 2331, Alexandria, Egypt
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2
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Kim J, Kim MW, Kim JM. Enhanced diagnosis and severity assessment of carpal tunnel syndrome using combined shear wave elastography and cross-sectional area analysis: A prospective case-control study. PLoS One 2025; 20:e0320011. [PMID: 40127092 PMCID: PMC11932468 DOI: 10.1371/journal.pone.0320011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 02/12/2025] [Indexed: 03/26/2025] Open
Abstract
Carpal tunnel syndrome (CTS) is a prevalent neuropathy resulting from median nerve compression, typically diagnosed through electrodiagnostic studies. Shear wave elastography (SWE) has emerged as an essential imaging technique, especially in evaluating tissue elasticity, which could enhance the diagnosis and severity assessment of CTS. This study aimed to examine the combined effect of the median nerve's cross-sectional area (CSA) and elasticity assessed through SWE in diagnosing CTS and evaluating its severity. A total of 50 participants were involved in this prospective study, with 99 wrists analyzed (51 affected by CTS and 48 normal controls). Measurements of both CSA and elasticity were taken at the carpal tunnel inlet. The findings indicated that CSA and elasticity were considerably higher in CTS patients than in the controls. The combined parameter of CSA × elasticity outperformed other measures for differentiating between normal and CTS cases (Area Under the Curve 0.91, sensitivity 0.90, specificity 0.83, cutoff 753.7 kPa·mm²). This combined metric also showed potential for distinguishing CTS severity levels, particularly between mild and severe cases. Although CSA and elasticity alone had limitations in severity classification, their combined values illustrated significant distinctions across severity levels. Integrating SWE with CSA notably improves diagnostic accuracy for CTS and shows potential for severity grading. This approach offers a more detailed evaluation of the structural and mechanical changes in the median nerve, potentially enhancing both the diagnosis and management of CTS.
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Affiliation(s)
- Jaewon Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Min Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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3
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Zou Q, Guo X, Ni X, Chen X, Xu C, Yin Y, Huang C. Ultrasound-based grading of carpal tunnel syndrome: a comparative study of cross-sectional area and shear wave elastography at different wrist joint angles. Br J Radiol 2025; 98:58-67. [PMID: 39288303 DOI: 10.1093/bjr/tqae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 08/17/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVES Carpal tunnel syndrome (CTS) is a prevalent neuropathy where accurate diagnosis is crucial for effective treatment planning. This study introduces a novel approach for CTS grading using ultrasound, specifically through the analysis of the cross-sectional area (CSA) and shear wave elastography (SWE) of the median nerve in various wrist positions. METHODS Our research involved subjects from outpatient clinics, diagnosed with CTS through nerve conduction studies (NCS), and a control group of healthy individuals. High-frequency ultrasound and SWE measurements were conducted in 3 wrist positions: straight, 45° extension, and 45° flexion. RESULTS The key findings revealed significant differences in median nerve CSA and SWE values between the CTS and control groups across all wrist positions, with notable variances in SWE values correlating with wrist positioning. SWE demonstrated enhanced sensitivity and specificity in distinguishing between mild, moderate, and severe CTS, especially at 45° wrist flexion. In contrast, CSA measurements were limited in differentiating between the varying severity stages of CTS. CONCLUSIONS The study concludes that SWE, particularly at 45° wrist flexion, provides a more precise diagnostic benchmark for CTS severity grading than CSA. This advancement in non-invasive diagnostic methodology not only aids in accurate CTS grading but also has significant implications in formulating tailored treatment strategies, potentially reducing the reliance on more invasive diagnostic methods like NCS. ADVANCES IN KNOWLEDGE This study marks a significant advancement in the ultrasound diagnosis of CTS. It particularly highlights the importance of applying SWE technology across various wrist joint angles, offering a new diagnostic benchmark. This discovery provides data support and additional insights for achieving an early consensus on ultrasound-based grading diagnosis of CTS.
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Affiliation(s)
- Qijiu Zou
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Xiaoli Guo
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Xuejun Ni
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Xiaoyang Chen
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Cheng Xu
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Yifei Yin
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
| | - Chen Huang
- Department of Ultrasound, Affiliated Hospital of Nantong University, Nantong University, Jiangsu 226001, PR China
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Tomažin T, Pušnik L, Albano D, Jengojan SA, Snoj Ž. Multiparametric Ultrasound Assessment of Carpal Tunnel Syndrome: Beyond Nerve Cross-sectional Area. Semin Musculoskelet Radiol 2024; 28:661-671. [PMID: 39561748 DOI: 10.1055/s-0044-1790561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
Carpal tunnel syndrome (CTS), the most common mononeuropathy, results from compression of the median nerve within the fibro-osseous carpal tunnel. Diagnosis is typically based on clinical evaluation and confirmed by nerve conduction studies. However, ultrasound (US) has emerged as a valuable noninvasive adjunct for CTS confirmation, offering potential advantages over electrodiagnostic testing in terms of patient comfort and diagnostic accuracy. This review begins with a concise summary of carpal tunnel anatomy and CTS pathophysiology as a foundation for exploring the diverse applications of US in CTS evaluation. B-mode US assessment is presented with a focus on cross-sectional imaging and dynamic evaluations, including the transverse translocation and longitudinal gliding of the median nerve. We also review current methods for assessing vascularization in CTS and explore the usefulness of elastography in CTS evaluation. The advantages and limitations of each US method are elucidated, highlighting their practical utility in clinical practice.
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Affiliation(s)
- Tjaša Tomažin
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Suren Armeni Jengojan
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Žiga Snoj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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5
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Zhang H, Ning E, Lu L, Zhou J, Shao Z, Yang X, Hao Y. Research progress of ultrasound in accurate evaluation of cartilage injury in osteoarthritis. Front Endocrinol (Lausanne) 2024; 15:1420049. [PMID: 39211448 PMCID: PMC11358554 DOI: 10.3389/fendo.2024.1420049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Osteoarthritis (OA) is a prevalent cause of joint algesia, loss of function, and disability in adults, with cartilage injury being its core pathological manifestation. Since cartilage damage is non-renewable, the treatment outcome in the middle and late stages of OA is unsatisfactory, which can be minimized by changing lifestyle and other treatment modalities if diagnosed and managed in the early stages, indicating the importance of early diagnosis and monitoring of cartilage injury. Ultrasound technology has been used for timely diagnosis and even cartilage injury treatment, which is convenient and safe for the patient owing to no radiation exposure. Studies have demonstrated the effectiveness of ultrasound and its various quantitative ultrasound parameters, like ultrasound roughness index (URI), reflection coefficient (R), apparent integrated backscatter (AIB), thickness, and ultrasound elastography, in the early and accurate assessment of OA cartilage pathological changes, including surface and internal tissue, hardness, and thickness. Although many challenges are faced in the clinical application of this technology in diagnosis, ultrasound and ultrasound-assisted techniques offer a lot of promise for detecting early cartilage damage in OA. In this review, we have discussed the evaluation of ultrasonic cartilage quantitative parameters for early pathological cartilage changes.
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Affiliation(s)
- Huili Zhang
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Eryu Ning
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Lingfeng Lu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Jing Zhou
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhiqiang Shao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xing Yang
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
| | - Yuefeng Hao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
- Gusu School, Nanjing Medical University, Suzhou, China
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Zhang Y, Liu WY, Xue WL, Wu H, Yuan Y, Ma XY, Wang H, Zhou XL. Diagnostic efficiency of conventional ultrasound, shear wave elastography, and superb microvascular imaging in evaluating ulnar neuropathy at the elbow. Muscle Nerve 2024; 70:210-216. [PMID: 38828855 DOI: 10.1002/mus.28171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION/AIMS The current diagnosis of ulnar neuropathy at the elbow (UNE) relies mainly on the clinical presentation and nerve electrodiagnostic (EDX) testing, which can be uncomfortable and yield false negatives. The aim of this study was to investigate the diagnostic value of conventional ultrasound, shear wave elastography (SWE), and superb microvascular imaging (SMI) in diagnosing UNE. METHODS We enrolled 40 patients (48 elbows) with UNE and 48 healthy volunteers (48 elbows). The patients were categorized as having mild, moderate or severe UNE based on the findings of EDX testing. The cross-sectional area (CSA) was measured using conventional ultrasound. Ulnar nerve (UN) shear wave velocity (SWV) and SMI were performed in a longitudinal plane. RESULTS Based on the EDX findings, UNE severity was graded as mild in 4, moderate in 10, and severe in 34. The patient group showed increased ulnar nerve CSA and stiffness at the site of maximal enlargement (CSA mean at the site of max enlargement [CSAmax] and SWV mean at the site of max enlargement [SWVmax]), ulnar nerve CSA ratio, and stiffness ratio (elbow-to-upper arm), compared with the control group (p < .001). Furthermore, the severe UNE group showed higher ulnar nerve CSAmax and SWVmax compared with the mild and moderate UNE groups (p < .001). The cutoff values for diagnosis of UNE were 9.5 mm2 for CSAmax, 3.06 m/s for SWVmax, 2.00 for CSA ratio, 1.36 for stiffness ratio, and grade 1 for SMI. DISCUSSION Our findings suggest that SWE and SMI are valuable diagnostic tools for the diagnosis and assessment of severity of UNE.
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Affiliation(s)
- Yao Zhang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei-Yao Liu
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei-Li Xue
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Han Wu
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yan Yuan
- Ultrasound Department, Heilongjiang Red Cross Sengong General Hospital, Harbin, China
| | - Xin-Yuan Ma
- Orthopedics Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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7
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Wolny T, Glibov K, Wieczorek M, Gnat R, Linek P. Changes in Ultrasound Parameters of the Median Nerve at Different Positions of the Radiocarpal Joint in Patients with Carpal Tunnel Syndrome. SENSORS (BASEL, SWITZERLAND) 2024; 24:4487. [PMID: 39065886 PMCID: PMC11281217 DOI: 10.3390/s24144487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Ultrasound imaging (US) is being increasingly used to aid in the diagnosis of entrapment neuropathies. This study aims to evaluate the shear modulus and cross-sectional area (CSA) of the median nerve in patients with carpal tunnel syndrome (CTS). A total of 35 patients with CTS participated in the study. CSA and shear modulus testing were performed in shear wave elastography (SWE) mode in five positions of the right and left radiocarpal joints (intermediate position 0°, 45° of extension, maximum extension, 45° of flexion, and maximum flexion). There were significant side-to-side differences in the median nerve shear modulus at each wrist position as compared to the asymptomatic side. There were significant side-to-side differences in the median nerve CSA at each wrist position as compared to the asymptomatic side. Shear modulus increases in patients with CTS at different angular positions of flexion and extension of the radiocarpal joint. In individuals with CTS, the CSA of the median nerve is greater on the symptomatic side compared to the asymptomatic side. The CSA decreases in positions of maximum extension and 45° of flexion and in maximum flexion relative to the resting position.
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Affiliation(s)
- Tomasz Wolny
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| | - Katarzyna Glibov
- Department of Internal Diseases, Rehabilitation and Physical Medicine, Military Medical Academy, Memorial Teaching H of The Medical University of Lodz—Central Veterans Hospital, 90-419 Lodz, Poland;
| | - Michał Wieczorek
- Department of Neurological Rehabilitation, The Health Center in Mikołów Ltd., 43-190 Mikołów, Poland;
| | - Rafał Gnat
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
| | - Paweł Linek
- Musculoskeletal Elastography and Ultrasonography Laboratory, Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland; (R.G.); (P.L.)
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8
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Dahlin LB, Zimmerman M, Calcagni M, Hundepool CA, van Alfen N, Chung KC. Carpal tunnel syndrome. Nat Rev Dis Primers 2024; 10:37. [PMID: 38782929 DOI: 10.1038/s41572-024-00521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder worldwide. The epidemiology and risk factors, including family burden, for developing CTS are multi-factorial. Despite much research, its intricate pathophysiological mechanism(s) are not fully understood. An underlying subclinical neuropathy may indicate an increased susceptibility to developing CTS. Although surgery is often performed for CTS, clear international guidelines to indicate when to perform non-surgical or surgical treatment, based on stage and severity of CTS, remain to be elucidated. Neurophysiological examination, using electrophysiology or ultrasonography, performed in certain circumstances, should correlate with the history and findings in clinical examination of the person with CTS. History and clinical examination are particularly relevant globally owing to lack of other equipment. Various instruments are used to assess CTS and treatment outcomes as well as the effect of the disorder on quality of life. The surgical treatment options of CTS - open or endoscopic - offer an effective solution to mitigate functional impairments and pain. However, there are risks of post-operative persistent or recurrent symptoms, requiring meticulous diagnostic re-evaluation before any additional surgery. Health-care professionals should have increased awareness about CTS and all its implications. Future considerations of CTS include use of linked national registries to understand risk factors, explore possible screening methods, and evaluate diagnosis and treatment with a broader perspective beyond surgery, including psychological well-being.
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Affiliation(s)
- Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden.
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Malin Zimmerman
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Orthopedics, Helsingborg Hospital, Helsingborg, Sweden
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin C Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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9
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El-Maghraby AM, Almalki YE, Basha MAA, Nada MG, El Ahwany F, Alduraibi SK, Alshehri SHS, Aldhilan AS, Almushayti ZA, Alduraibi AK, Aboualkheir M, Attia O, Amer MM, Basha AMA, Eladl IM. Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study. Orthop Res Rev 2024; 16:111-123. [PMID: 38741666 PMCID: PMC11090190 DOI: 10.2147/orr.s459993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). Materials and Methods This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28-57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. Results CSAu and CSAu-CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). Conclusion The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.
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Affiliation(s)
- Ahmed Mohamed El-Maghraby
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, 61441, Kingdom of Saudi Arabia
| | | | - Mohamad Gamal Nada
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Fatma El Ahwany
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Shaker Hassan S Alshehri
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Asim S Aldhilan
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, 52571, Kingdom of Saudi Arabia
| | - Mervat Aboualkheir
- Department of Internal Medicine, College of Medicine, Taibah University, Madinah, 42361Kingdom of Saudi Arabia
| | - Osama Attia
- Department of Internal Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Mona M Amer
- Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
| | | | - Ibrahim M Eladl
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, 44519, Egypt
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10
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Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. HAND SURGERY & REHABILITATION 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
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Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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11
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Robben E, Dusar FR, Weyns V, Rummens S, Degreef I, Peers K. Ultrasound measurement of subsynovial connective tissue thickness in the carpal tunnel: An intrarater/interrater reliability and agreement study. HAND SURGERY & REHABILITATION 2023; 42:505-511. [PMID: 37709255 DOI: 10.1016/j.hansur.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Non-inflammatory thickening of the subsynovial connective tissue (SSCT) in the carpal tunnel is commonly found in subjects with carpal tunnel syndrome (CTS), and quantification may shed light on CTS pathogenesis. To date, information on the reliability of ultrasound quantification of SSCT is scarce. Therefore, we investigated intrarater and interrater reliability/agreement for ultrasound quantification of SSCT thickness in subjects with and without CTS, and predictors for tissue thickness. MATERIAL AND METHODS Two investigators quantified SSCT thickness and thickness ratio on ultrasound in 16 healthy subjects (age, 24-65 years; 16 left/14 right wrists) and 17 subjects with CTS (age, 37-83 years; 14 left/14 right wrists). Intra- and inter-rater reliability/agreement were assessed on intraclass correlation coefficients, standard error of measurement and minimal detectable change. A mixed-effects model was used to evaluate potential predictors for SSCT thickness. RESULTS Intra- and inter-rater reliability analysis showed good to excellent intraclass correlation coefficients in both groups, ranging from 0.772 to 0.965. The maximum percentage standard error of measurement was 8%. The maximum minimal detectable change was 14% within raters, and 20% between raters. Both intra- and inter-rater reliability values for thickness ratio were poor. Presence of CTS (ß = 0.180; p = 0.015) correlated positively with SSCT thickness. CONCLUSIONS Ultrasound is a reliable method for quantification of SSCT thickness, but not for thickness ratio. Presence of CTS correlates positively with SSCT thickness.
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Affiliation(s)
- Elise Robben
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium.
| | - Frank-Robbrecht Dusar
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium
| | - Valerie Weyns
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium
| | - Sofie Rummens
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium
| | - Ilse Degreef
- KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium; University Hospitals Leuven, Department of Orthopaedic Surgery, Leuven, Belgium
| | - Koen Peers
- University Hospitals Leuven, Department of Physical and Rehabilitation Medicine, Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
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