Elastosonography and electrodiagnosis in relation to symptomatic and functional grading of carpal tunnel syndrome

Objectives: This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. Patients and methods: In the case-control study, 100 wrists of 57...

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Published inArchives of rheumatology Vol. 38; no. 4; pp. 620 - 632
Main Authors Yahia, Marwa, El Shambaky, Ahmed, Lasheen, Doaa
Format Journal Article
LanguageEnglish
Published Turkey Turkish League Against Rheumatism 01.12.2023
Prof Sebnem Ataman, President Turkish League Against Rheumatism
Subjects
Online AccessGet full text
ISSN2148-5046
1309-0291
2618-6500
1309-0283
DOI10.46497/ArchRheumatol.2023.10022

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Abstract Objectives: This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. Patients and methods: In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7±10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. Results: CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Conclusion: Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS.
AbstractList Objectives: This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. Patients and methods: In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39 [+ or -] 9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7 [+ or -] 10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. Results: CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Conclusion: Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS. Keywords: Carpal tunnel syndrome, elasticity, electrodiagnosis, elastosonography, functional assessment.
This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7±10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS.
PATIENTS AND METHODS The case-control study was conducted at the Faculty of Medicine, Benha University, Rheumatology, Rehabilitation, and Physical Medicine Department's electromyography (EMG) laboratory and musculoskeletal ultrasound unit, and the data of 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology clinical diagnostic criteria of CTS were analyzed. The Hi-Ob-Db score was indicated by the numbers 1-5: stage 0, no symptoms suggestive of CTS; Stage 1, only nocturnal paresthesia independent from the distribution and absence of deficit at abductor pollicis brevis (APB); Stage 2, nocturnal and diurnal paresthesia independent from the distribution and absence of deficit at APB; Stage 3, glove distribution of paresthesia and presence of deficit at APB but no plegia; Stage 4, MN distribution of paresthesia and presence of a deficit at APB but no plegia; and Stage 5, plegia of APB.12 Consequently, the patients underwent EDX according to the protocol recommended by the American Association of Electrodiagnostic Medicine in 200213 using a Neurowerk EMG unit with a four-channel evoked potential/EMG measuring system (SIGMA Medizin-Technik GmbH, Gelenau/Erzgebirge, Germany), and the CTS was classified according to Bland's14 classification system for CTS into six grades. [...]participants underwent a neuromuscular ultrasound evaluation using a linear high-frequency 6-15 MHz probe with an ultrasound machine (LOGIQ™ P9; GE Healthcare Life Sciences, Seoul, South Korea) equipped with elastography software for each wrist, MN cross-sectional areas (CSA) at the wrist, wrist/forearm ratio (WFR) and flattening ratio were obtained along with a subjective assessment of the MN echogenicity, mobility, and vascularity. Statistical analysis Power analysis was performed using G·Power version 3.1.9.7 (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany), with p=95% and cz=0.05.16 The total amount of participants required was at least 94 (divided into two groups, 48 patients and 48 controls), where the effect size was 0.75 (calculated from a previous study by Ibrahim and Heba17 and the dropout rate applied was 15%.
Objectives: This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the electrodiagnostic grading of primary carpal tunnel syndrome (CTS) patients. Patients and methods: In the case-control study, 100 wrists of 57 CTS patients (54 females, 3 males; mean age: 39±9.8 years; range, 20 to 60 years) clinically diagnosed according to the American Academy of Neurology Clinical Diagnostic Criteria were evaluated between December 2019 and December 2020. The control group included 110 nondiseased wrists of 55 sex- and age-matched healthy subjects (males 7, females 48; mean age: 35.7±10.3 years; range 20 to 58 years). Functional assessment using Hi-Ob-Db clinical scale, electrodiagnosis, ultrasonographic screening, and elasticity evaluation were done for all patients. Results: CTS patients had an increased stiffness of the median nerve compared to controls. Functional stages were positively correlated with the ultrasonographic parameters and the electrodiagnostic stages of CTS. The elastogram of clinically diagnosed patients was revealed more stiffness of the MN, with negative electrodiagnosis results. Conclusion: Clinically diagnosed CTS could be missed by the electrodiagnosis but then properly figured by ultrasonography and potentially graded by sonoelastography. Sonoelastography may be an effective method for early diagnosis and appropriate grading of CTS.
Audience Academic
Author El Shambaky, Ahmed
Yahia, Marwa
Lasheen, Doaa
AuthorAffiliation 1 Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt
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Copyright Copyright © 2023, Turkish League Against Rheumatism.
COPYRIGHT 2023 Turkish League Against Rheumatism
Copyright Prof Sebnem Ataman, President Turkish League Against Rheumatism 2023
Copyright © 2023, Turkish League Against Rheumatism 2023 Turkish League Against Rheumatism
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Issue 4
Keywords Carpal tunnel syndrome
functional assessment
electrodiagnosis
elastosonography
elasticity
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RelatedPersons Heine, Heinrich (1797-1856)
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Snippet Objectives: This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the...
This study focused on the symptomatic and the functional evaluation in correlations to median nerve elasticity, its ultrasound parameters, and the...
PATIENTS AND METHODS The case-control study was conducted at the Faculty of Medicine, Benha University, Rheumatology, Rehabilitation, and Physical Medicine...
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StartPage 620
SubjectTerms Age
Carpal tunnel syndrome
Diagnostic equipment (Medical)
Electromyography
Females
Heine, Heinrich (1797-1856)
Neurophysiology
Original
Ultrasonic imaging
Ultrasound imaging
Variables
Wrist
Title Elastosonography and electrodiagnosis in relation to symptomatic and functional grading of carpal tunnel syndrome
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