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...
Saved in:
Published in | Archives of rheumatology Vol. 38; no. 4; pp. 620 - 632 |
---|---|
Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Turkey
Turkish League Against Rheumatism
01.12.2023
Prof Sebnem Ataman, President Turkish League Against Rheumatism |
Subjects | |
Online Access | Get full text |
ISSN | 2148-5046 1309-0291 2618-6500 1309-0283 |
DOI | 10.46497/ArchRheumatol.2023.10022 |
Cover
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 |
AuthorAffiliation_xml | – name: 1 Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt |
Author_xml | – sequence: 1 givenname: Marwa orcidid: 0000-0003-0885-1144 surname: Yahia fullname: Yahia, Marwa – sequence: 2 givenname: Ahmed orcidid: 0000-0002-5437-0790 surname: El Shambaky fullname: El Shambaky, Ahmed – sequence: 3 givenname: Doaa orcidid: 0000-0003-3539-9835 surname: Lasheen fullname: Lasheen, Doaa |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38125057$$D View this record in MEDLINE/PubMed |
BookMark | eNqFkm1r1TAUx4tM3Jz7ClIRfNdrmoemfSWXMacwEERfh9MkbTPSpEtS4X57c-82tyuC5EXCefjl_M85r4sT550uinc12tCGdvzjNsjp-6TXGZK3G4ww2dQIYfyiOMNN3VYNQ-gkv2vaVgzR5rS4iPEWIVRT3jSIvCpOSVtjhhg_K-6uLMTko3d-DLBMuxKcKrXVMgWvDIzORxNL48qgLSTjXZl8GXfzknwuwMhD_LA6ufeBLTNFGTeWfiglhCVb0uqctjnHqeBn_aZ4OYCN-uLhPi9-fr76cfmluvl2_fVye1NJxlCqWM8BCJF4GDAZeKNRA0oBbzDQnoLEiimFOJYtYm3HW00ZkQ2nPfSsxpKR8-LTPXdZ-1krqV0KYMUSzAxhJzwYcexxZhKj_yXqTG057TLh_QMh-LtVxyRu_RqyyChw23WUkA61T1EjWC2MG3ymydlEKba8RRiRmu9Zm39E5aP0bGSe8GCy_Sjhw7OESYNNU_R23bc5Hge-fa7zj8DHGT81QgYfY9CDkCYdRplLMDbrFYfFEkeLJfaLJQ6LlQndX4THT_6f-xsp6dlt |
CitedBy_id | crossref_primary_10_32322_jhsm_1461031 |
Cites_doi | 10.1002/mus.10185 10.1055/s-0039-3402746 10.7759/cureus.7333 10.1186/1471-2474-4-9 10.1177/17531934211059808 10.1016/j.acra.2020.08.011 10.1016/j.ejrnm.2018.02.001 10.1097/PHM.0000000000001464 10.17826/cumj.745698 10.1016/j.ejrad.2018.09.027 10.5114/pjr.2021.111437 10.1186/s12891-020-03651-1 10.21608/mjcu.2021.203691 10.1109/IUS46767.2020.9251485 10.1016/j.ultrasmedbio.2019.07.409 10.1148/rg.2017160116 10.1016/j.ejrad.2018.02.005 10.1002/mus.880161220 10.2214/AJR.20.22840 10.1002/mus.20019 10.1097/WNP.0000000000000334 10.1016/0895-4356(92)90038-O 10.1186/s43055-021-00573-3 10.1016/j.ultrasmedbio.2013.02.016 10.1002/jum.15111 10.1148/radiol.13122901 10.1002/jum.14669 10.1002/jcu.20551 10.1016/j.clinph.2010.02.002 10.1002/jum.15478 10.21608/bjas.2021.214839 10.11152/mu.2013.2066.183.tat 10.1186/s12891-019-3033-y 10.1001/jama.282.2.153 10.1002/1097-4598(200008)23:8<1280::AID-MUS20>3.0.CO;2-Y 10.1002/mus.25462 10.4329/wjr.v8.i3.281 10.3758/BF03193146 |
ContentType | Journal Article |
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 |
Copyright_xml | – notice: Copyright © 2023, Turkish League Against Rheumatism. – notice: COPYRIGHT 2023 Turkish League Against Rheumatism – notice: Copyright Prof Sebnem Ataman, President Turkish League Against Rheumatism 2023 – notice: Copyright © 2023, Turkish League Against Rheumatism 2023 Turkish League Against Rheumatism |
DBID | AAYXX CITATION NPM 3V. 7X7 7XB 8FI 8FJ 8FK ABUWG AFKRA BENPR CCPQU EDSIH FYUFA GHDGH K9. M0S PQEST PQQKQ PQUKI PRINS 5PM |
DOI | 10.46497/ArchRheumatol.2023.10022 |
DatabaseName | CrossRef PubMed ProQuest Central (Corporate) Health & Medical Collection ProQuest Central (purchase pre-March 2016) Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central UK/Ireland ProQuest Central ProQuest One Turkey Database Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Health & Medical Complete (Alumni) ProQuest Health & Medical Collection ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition ProQuest Central China PubMed Central (Full Participant titles) |
DatabaseTitle | CrossRef PubMed ProQuest One Academic Eastern Edition ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) ProQuest One Community College ProQuest Hospital Collection Health Research Premium Collection (Alumni) ProQuest Central China ProQuest Hospital Collection (Alumni) ProQuest Central ProQuest Health & Medical Complete Health Research Premium Collection ProQuest One Academic UKI Edition Health and Medicine Complete (Alumni Edition) Turkey Database ProQuest One Academic ProQuest Central (Alumni) |
DatabaseTitleList | PubMed ProQuest One Academic Eastern Edition CrossRef |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EDSIH name: Turkey Database url: https://proxy.k.utb.cz/login?url=https://search.proquest.com/turkey sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2618-6500 1309-0283 |
EndPage | 632 |
ExternalDocumentID | PMC10728749 A780203179 38125057 10_46497_ArchRheumatol_2023_10022 |
Genre | Journal Article |
GeographicLocations | Germany |
GeographicLocations_xml | – name: Germany |
GroupedDBID | AAWTL AAYXX ABDBF ACUHS ADBBV ALMA_UNASSIGNED_HOLDINGS BAWUL CITATION DIK EBD EOJEC ESX HYE IAO IHR IHW INH ITC OBODZ OK1 PV9 RPM RZL TUS ~8M NPM --- 29Q 2WC 3V. 6PF 7X7 7XB 8FI 8FJ 8FK 8R4 8R5 ABUWG AFKRA AHMBA ALIPV BENPR BPHCQ BVXVI CCPQU EDSIH FYUFA GJB HMCUK INR K9. PQEST PQQKQ PQUKI PRINS PROAC Q2X RNS UKHRP 5PM |
ID | FETCH-LOGICAL-c550t-5b7aa33c2ff23f76e06adda762a4b4ac2d5dd072c8058978e453c674bab512c53 |
IEDL.DBID | 7X7 |
ISSN | 2148-5046 1309-0291 |
IngestDate | Thu Aug 21 18:37:38 EDT 2025 Mon Jun 30 13:34:59 EDT 2025 Wed Feb 19 01:49:15 EST 2025 Wed Feb 12 07:16:48 EST 2025 Thu May 22 21:23:21 EDT 2025 Thu Jan 02 22:25:44 EST 2025 Sun Jul 06 05:06:53 EDT 2025 Thu Apr 24 23:12:40 EDT 2025 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 4 |
Keywords | Carpal tunnel syndrome functional assessment electrodiagnosis elastosonography elasticity |
Language | English |
License | https://creativecommons.org/licenses/by-nc/4.0 Copyright © 2023, Turkish League Against Rheumatism. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c550t-5b7aa33c2ff23f76e06adda762a4b4ac2d5dd072c8058978e453c674bab512c53 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 |
ORCID | 0000-0002-5437-0790 0000-0003-3539-9835 0000-0003-0885-1144 |
OpenAccessLink | https://pubmed.ncbi.nlm.nih.gov/PMC10728749 |
PMID | 38125057 |
PQID | 2899433908 |
PQPubID | 106047 |
PageCount | 13 |
ParticipantIDs | pubmedcentral_primary_oai_pubmedcentral_nih_gov_10728749 proquest_journals_2899433908 gale_infotracmisc_A780203179 gale_infotracacademiconefile_A780203179 gale_healthsolutions_A780203179 pubmed_primary_38125057 crossref_citationtrail_10_46497_ArchRheumatol_2023_10022 crossref_primary_10_46497_ArchRheumatol_2023_10022 |
PublicationCentury | 2000 |
PublicationDate | 2023-12-01 |
PublicationDateYYYYMMDD | 2023-12-01 |
PublicationDate_xml | – month: 12 year: 2023 text: 2023-12-01 day: 01 |
PublicationDecade | 2020 |
PublicationPlace | Turkey |
PublicationPlace_xml | – name: Turkey – name: Istanbul |
PublicationSubtitle | Turk Romatoloji Dergisi |
PublicationTitle | Archives of rheumatology |
PublicationTitleAlternate | Arch Rheumatol |
PublicationYear | 2023 |
Publisher | Turkish League Against Rheumatism Prof Sebnem Ataman, President Turkish League Against Rheumatism |
Publisher_xml | – name: Turkish League Against Rheumatism – name: Prof Sebnem Ataman, President Turkish League Against Rheumatism |
References | ref-1 ref-28 ref-29 ref-7 ref-6 ref-9 ref-8 ref-3 ref-2 ref-5 ref-4 ref-30 ref-15 ref-37 ref-16 ref-38 ref-13 ref-35 ref-14 ref-36 ref-11 ref-33 ref-12 ref-34 ref-31 ref-10 ref-32 ref-19 ref-17 ref-39 ref-18 ref-26 ref-27 ref-24 ref-25 ref-22 ref-23 ref-20 ref-21 |
References_xml | – ident: ref-13 doi: 10.1002/mus.10185 – ident: ref-4 doi: 10.1055/s-0039-3402746 – ident: ref-18 doi: 10.7759/cureus.7333 – ident: ref-27 doi: 10.1186/1471-2474-4-9 – ident: ref-38 doi: 10.1177/17531934211059808 – ident: ref-3 doi: 10.1016/j.acra.2020.08.011 – ident: ref-29 doi: 10.1016/j.ejrnm.2018.02.001 – ident: ref-19 doi: 10.1097/PHM.0000000000001464 – ident: ref-23 doi: 10.17826/cumj.745698 – ident: ref-32 doi: 10.1016/j.ejrad.2018.09.027 – ident: ref-10 doi: 10.5114/pjr.2021.111437 – ident: ref-22 doi: 10.1186/s12891-020-03651-1 – ident: ref-7 doi: 10.21608/mjcu.2021.203691 – ident: ref-9 doi: 10.1109/IUS46767.2020.9251485 – ident: ref-20 doi: 10.1016/j.ultrasmedbio.2019.07.409 – ident: ref-6 doi: 10.1148/rg.2017160116 – ident: ref-25 doi: 10.1016/j.ejrad.2018.02.005 – ident: ref-35 doi: 10.1002/mus.880161220 – ident: ref-21 doi: 10.2214/AJR.20.22840 – ident: ref-28 doi: 10.1002/mus.20019 – ident: ref-24 doi: 10.1097/WNP.0000000000000334 – ident: ref-2 doi: 10.1016/0895-4356(92)90038-O – ident: ref-17 doi: 10.1186/s43055-021-00573-3 – ident: ref-26 doi: 10.1016/j.ultrasmedbio.2013.02.016 – ident: ref-39 doi: 10.1002/jum.15111 – ident: ref-31 doi: 10.1148/radiol.13122901 – ident: ref-33 doi: 10.1002/jum.14669 – ident: ref-37 doi: 10.1002/jcu.20551 – ident: ref-12 doi: 10.1016/j.clinph.2010.02.002 – ident: ref-30 doi: 10.1002/jum.15478 – ident: ref-11 doi: 10.21608/bjas.2021.214839 – ident: ref-15 doi: 10.11152/mu.2013.2066.183.tat – ident: ref-34 doi: 10.1186/s12891-019-3033-y – ident: ref-1 doi: 10.1001/jama.282.2.153 – ident: ref-14 doi: 10.1002/1097-4598(200008)23:8<1280::AID-MUS20>3.0.CO;2-Y – ident: ref-36 doi: 10.1002/mus.25462 – ident: ref-5 doi: 10.4329/wjr.v8.i3.281 – ident: ref-16 doi: 10.3758/BF03193146 – ident: ref-8 |
RelatedPersons | Heine, Heinrich (1797-1856) |
RelatedPersons_xml | – fullname: Heine, Heinrich (1797-1856) |
SSID | ssj0001476603 ssj0000328634 |
Score | 2.2625382 |
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... |
SourceID | pubmedcentral proquest gale pubmed crossref |
SourceType | Open Access Repository Aggregation Database Index Database Enrichment Source |
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 |
URI | https://www.ncbi.nlm.nih.gov/pubmed/38125057 https://www.proquest.com/docview/2899433908 https://pubmed.ncbi.nlm.nih.gov/PMC10728749 |
Volume | 38 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV3da9swED-2Fspexr6Xtss0GOzJ1JFlS34a3Ugpg4RSVsibkGSZBjY7bZyH_fe7kxWv3sPYY-JzYutO963fAXw0SqIhFbMkqzHSEcrZxHJuk7z2RVp7XvpwjnuxLC5vxLdVvooJt21sq9zrxKCoq9ZRjvyMAgORYYSuPm_uEpoaRdXVOELjMRzO0BOh0Q1yJYccC2HFFX1hmQoJKS9nR_AB9YQoRCnPCNv1-tbv0DVsqQrBswBIykcm6m9F_cBSjbsoH5ili2fwNPqT7LwXgOfwyDcv4GgRK-Yv4W6O7nHXolcdsamZaSoWh99UfZ_desvWDbuPbXGsa9n2189N1wY010BP1q9PGjL8FTJ3rK0Z1W7wm25HvTJsj33wCm4u5t-_XiZxzELiMDzpktxKY7LM8brmWS0Lnxao9AxqSSOsMI5XeVWlkjtFIwil8iLPXCGFNRa9BZdnr-GgaRv_FphJpZW2sDOLUaNDXhmVV6r2uS3DIeEJqP3KahcxyGkUxg-NsUhgih4xRRNTdGDKBPhw66YH4vifm94T-3R_pnTYzPpcKqrAojKawKdAQdsZn8SZeCoB34eAsUaUpyNK3IZufHkvIjqqga3-I7QTeNNLy_Dw6CqR-ylxTUZyNBAQ8Pf4SrO-DQDgGLLTmILy-N__eQJPaCn65ptTOOjud_4dulCdnYZ9MoXDL_Pl1TV-Wl4tpiHT9RuByiC0 |
linkProvider | ProQuest |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1Lb9QwEB5VRSpcEG-2FGokEKeou44TOweEKmi1pd0eUCvtzdiOo64EybabVdU_xW9kxnnQcEBcek2cTdbz9sx8A_DOKImGVEyiuMBIRyhnI8u5jZLCp-PC88yHPu7ZaTo9F1_nyXwDfnW9MFRW2enEoKjzytEZ-R4FBiLGCF19Wl5GNDWKsqvdCI2GLY79zTWGbKuPR1-Qvu85Pzw4-zyN2qkCkUNvvI4SK42JY8eLgseFTP04RRk3qBSMsMI4nid5PpbcKZq4J5UXSexSKayxaBwdTYlAlX9PUIoR5UfOZX-mQ9h0aZPIpsTFmGeTLXiLekmkIpN7hCX77cKv0RWtKOvB4wCAygcm8W_DcMsyDqs2b5nBw0fwsPVf2X7DcI9hw5dPYGvWZuifwuUBuuN1hV58i4XNTJmzdthO3tT1LVZsUbKrtgyP1RVb3fxc1lVAjw3rydo2h5QMf4XMK6sKRrkivFKvqTaHdVgLz-D8TgjwHDbLqvQvgZmxtNKmdmIxSnXIG0YluSp8YrPQlDwC1e2sdi3mOY3e-KEx9glE0QOiaCKKDkQZAe8fXTbAH__z0C6RTzc9rL3y0PtSUcYXld8IPoQVpD7wS5xpuyDw_xAQ12DlzmAlir0b3u5YRLdqZ6X_CMkIXjTc0n88umbk7krckwEf9QsIaHx4p1xcBMDxCVJDSZFt__udu3B_ejY70SdHp8ev4AFtS1P4swOb9dXav0b3rbZvgsww-H7XQvobhC5aSw |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3Nb9MwFLemTaq4IMZn2WBGAnGK2jpO7BwmNFirjbFqmpi0m7EdR6sESbemQvsX-at4z3HCwgFx2TVxmtTv2--93yPkrZYCDCmfRHEBkQ6X1kSGMRMlhUvHhWOZ833cp_P06IJ_vkwuN8ivthcGyypbnegVdV5ZPCMfYWDAY4jQ5agIZRFnh7MPy-sIJ0hhprUdp6HDmIV838ONhSaPE3f7E8K51f7xIdD-HWOz6ddPR1GYOBBZ8NTrKDFC6zi2rChYXIjUjVOQfw0KQ3PDtWV5kudjwazEaXxCOp7ENhXcaAOG0-IECTAHWwKsPgSCWx-n87Pz7sQHkevSJs2NaY0xyyYD8ga0Fk95JkaINHt-5dbgqFaYE2Gxh0dlPYP5t9m4Yzf7NZ13jOTsEXkYvFt60LDjNtlw5WMyOA35-yfkegrOel2Bjx-QsqkucxpG8eRN1d9iRRclvQlFerSu6Or2x7KuPLasX4-2uDnCpPAraHxpVVDMJMGVeo2VO7RFYnhKLu6FBM_IZlmV7gWheiyMMKmZGIhhLXCOlkkuC5eYzLcsD4lsd1bZgIiOgzm-K4iMPFFUjygKiaI8UYaEdY8uG1iQ_3loD8mnmg7XTrWoAyExHwyqcUje-xWoXOBLrA49EvB_EKart3K3txKUgu3fbllEBaW0Un9EaEieN9zSfTw4bugMC9iTHh91CxCGvH-nXFx5OPIJUEMKnr389zv3yAAEVn05np_skAe4K01V0C7ZrG_W7hX4drV5HYSGkm_3Lae_AY2yZSY |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Elastosonography+and+electrodiagnosis+in+relation+to+symptomatic+and+functional+grading+of+carpal+tunnel+syndrome&rft.jtitle=Archives+of+rheumatology&rft.au=Yahia%2C+Marwa&rft.au=Shambaky%2C+Ahmed+El&rft.au=Lasheen%2C+Doaa&rft.date=2023-12-01&rft.pub=Turkish+League+Against+Rheumatism&rft.issn=2148-5046&rft.volume=38&rft.issue=4&rft.spage=620&rft_id=info:doi/10.46497%2FArchRheumatol.2023.10022&rft.externalDocID=A780203179 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2148-5046&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2148-5046&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2148-5046&client=summon |