Utility of sonoelastography for the evaluation of rotator cuff tendon and pertinent disorders: a systematic review and meta-analysis.

OBJECTIVES: Sonoelastography has been increasingly used to investigate musculoskeletal disorders. The aim of this meta-analysis was to investigate the utility of sonoelastography in diagnosing rotator cuff tendon pathology and pertinent disorders. METHODS: Searching through PubMed and Embase, we systemically reviewed clinical studies in which sonoelastography has been used for imaging rotator cuff tendon pathology and relevant disorders. The primary outcome was the standardized mean difference (SMD) of tendon elasticity between shoulders (or patients) with and without the designated pathological conditions. RESULTS: A total of 11 cross-sectional studies were included in the meta-analysis. The supraspinatus and infraspinatus tendons assessed by shear wave sonoelastography were likely to be stiffer in shoulders with adhesive capsulitis, with a SMD of 2.103 (95% confidence interval (CI), - 0.151 to 4.357, p = 0.067) and a SMD of 1.548 (95% CI, - 0.032 to 3.127, p = 0.055), respectively. Regarding rotator cuff tendinopathy, there was no significant difference in the elasticity of supraspinatus tendons evaluated by shear wave velocity (SMD = - 0.107; 95% CI, - 0.524 to 0.310, p = 0.615) or strain ratios (SMD = 0.153, 95% CI, - 2.134 to 2.440, p = 0.896). Only one study used shear wave sonoelastography to investigate patients with rotator cuff tendon tears and found tendon that elasticity was similar between diseased and normal shoulders. CONCLUSION: This meta-analysis revealed that supraspinatus and infraspinatus tendons tended to be stiffer in shoulders with adhesive capsulitis. Furthermore, no significant difference in tendon elasticity could be identified between shoulders with and without rotator cuff tendinopathy or tendon tears. KEY POINTS: • Supraspinatus and infraspinatus tendons are likely to have decreased elasticity in shoulders with adhesive capsulitis, as assessed by shear wave sonoelastography. • There was no significant difference in tendon elasticity between shoulders with and without rotator cuff tendinopathy or tendon tears when evaluated by strain and shear wave sonoelastography.

Ultrasound Parameters Other Than the Direct Measurement of Ulnar Nerve Size for Diagnosing Cubital Tunnel Syndrome: A Systemic Review and Meta-analysis.

OBJECTIVE: To investigate the diagnostic performance of available ultrasound (US) parameters, other than the direct measurements of ulnar nerve size, that is, cross-sectional area (CSA) and diameter, for diagnosing cubital tunnel syndrome (CuTS). DATA SOURCES: Databases, including PubMed and Embase, were searched from the earliest record of CuTS US to April 24, 2018. STUDY SELECTION: Published studies (N=13) comparing US parameters of ulnar nerves between patients with CuTS and patients without CuTS were included. DATA EXTRACTION: Study design, participants' demographics, diagnostic references of CuTS, and US parameters other than the direct measurements of the ulnar nerve size were retrieved from the included studies. DATA SYNTHESIS: This systematic review comprised 663 CuTS patients and 543 patients without CuTS. The pooled nerve swelling ratio in the CuTS group was significantly larger than that of the controls. The mean between-group differences of CSAMax or ME/CSAarm, CSAMax or ME/CSAforearm and CSAMax or ME/CSAwrist were 1.03 (95% confidence interval [CI], 0.77-1.29), 1.38 (95% CI, 0.93-1.82), and 0.83 (95% CI, 0.56-1.11), respectively. Regarding the swelling ratio of CSAMax or ME /CSAarm, the pooled sensitivity and specificity available from the 3 included studies were 0.67 (95% CI, 0.59-0.74) and 0.81 (95% CI, 0.75-0.86), respectively. Similarly, for the swelling ratio of CSAMax or ME/CSAforearm, the pooled sensitivity and specificity were 0.62 (95% CI, 0.54-0.69) and 0.86 (95% CI, 0.81-0.90), respectively. Other US parameters identified in this review included nerve-flattening ratio (maximum diameter/minimum diameter), nerve-to-tunnel ratio (ulnar nerve CSA/cubital tunnel CSA), nerve echogenicity, and intraneural vascularity, all of which were reported in a minority of included articles. CONCLUSIONS: Despite the insufficient number of pertinent studies to prove its superiority to other US measurements, the ulnar nerve-swelling ratio can be a complementary tool for diagnosing CuTS. The presence of intraneural vascularity, increased flattening ratio, and enlarged intraneural hypoechoic fraction also seem to be potential US indicators for CuTS diagnosis, which need to be validated with more prospective studies.

Can ultrasound imaging be used for the diagnosis of carpal tunnel syndrome in diabetic patients? A systemic review and network meta-analysis.

BACKGROUND: High-resolution ultrasound (US) becomes a reliable tool for diagnosing carpal tunnel syndrome (CTS), but whether it can be applied to patients with preexisting diabetes mellitus (DM) remains unclear. METHODS: We searched PubMed and Embase and systemically reviewed studies exploring the median nerve CSAs at the wrist level by US imaging. Nine studies enrolling at least one subgroup comprising patients with both DM and CTS were included for network meta-analysis. The primary outcome was the inter-group difference of the wrist-level median nerve CSA. RESULTS: The median nerve size at the wrist level was larger in patients with only CTS than in patients with only DM [CSA difference = 3.14 mm2, 95% confidence interval (CI) 1.92-4.35]. Patients with DM and CTS had a slightly enlarged median nerve CSA than did patients with only CTS, but the difference was not statistically significant (0.52 mm2, 95% CI - 0.54 to 1.59). According to rank probabilities, median nerve CSAs in patients with DM and CTS were likely to be ranked as the largest, followed by patients with only CTS, patients with only DM, and healthy controls. Furthermore, median nerve CSAs seemed smaller in patients with than without diabetic polyneuropathy. CONCLUSIONS: Although DM causes swelling of the median nerve at the wrist level, patients with CTS have a larger CSA regardless of preexisting DM. The add-on effect of DM on median nerve CSAs in patients with CTS is limited. Diabetic polyneuropathy tends to result in less swollen median nerves in the CTS population.

Utility of Ultrasound Elastography in Evaluation of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis.

We systematically reviewed observational studies investigating ultrasound elastography for median nerves in the carpal tunnel syndrome (CTS) population. PubMed and Embase were studied from the earliest record to April 2019. The primary outcome was the comparison of elasticity of the median nerve between participants with and without CTS, quantified by the standardized mean difference (SMD) and its 95% confidence interval. The median nerve is considered to be stiffer in the CTS population when the SMD of tissue strain is negative, or that of strain ratio, shear modulus and shear wave velocity are positive. The present meta-analysis included 17 studies, evaluating 1401 wrists. Our result showed that regardless of the ultrasound elastography mode (tissue strain, strain ratio, shear modulus and shear wave velocity) used, median nerves at the wrist level in patients with CTS were consistently stiffer than those in healthy controls. Importantly, ultrasound elastography revealed its potential in differentiating CTS of different severity.

Ultrasonographic images of the hand in a case with early eosinophilic fasciitis.

Eosinophilic fasciitis (EF), a rare rheumatic disease, usually affects the limbs symmetrically and generally spares the hands and feet. Cases of unilateral hand involvement are rarely reported. Here, we report such a rare case. Ultrasonography demonstrated thickening of the overlying skin and subcutaneous tissue, peripheral deep fascia, myositis of lumbrical muscles and adductor pollicis muscle, and edema surrounding flexor digitorum tendons. It reminds us that EF should be considered in the differential diagnosis of unilateral painful hand swelling despite being uncommon. Ultrasonography can be used to aid the diagnosis and monitor therapeutic response in patients with EF.