Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome

J Orthop Res. 2015 Sep;33(9):1332-40. doi: 10.1002/jor.22909. Epub 2015 May 7.

Abstract

Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross-sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70-71% and specificity of 80-84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel.

Keywords: Carpal tunnel syndrome; biomechanics; displacement; tendon; ultrasound.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Algorithms
  • Biomechanical Phenomena
  • Carpal Tunnel Syndrome / diagnostic imaging*
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Median Nerve / diagnostic imaging*
  • Middle Aged
  • Prospective Studies
  • Regression Analysis
  • Sensitivity and Specificity
  • Tendons / diagnostic imaging*
  • Tendons / pathology
  • Ultrasonography / methods*
  • Wrist / diagnostic imaging
  • Wrist Joint / diagnostic imaging