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1.
World Neurosurg ; 139: 548, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32348893

RESUMO

Carpal tunnel syndrome represents compression of the median nerve in the carpal tunnel, which is defined by the carpal bones on the lateral, medial, and dorsal aspects and the transverse carpal ligament on the anterior aspect.1 Symptoms of carpal tunnel syndrome include paresthesia, anesthesia, paresis, and pain located in the median nerve distribution. In severe cases, there may be atrophy of median nerve-innervated thenar muscles. In the United States, carpal tunnel syndrome affects approximately 3.72% of the population.2 Conservative measures, such as bracing, steroid injections, and physical and occupational therapy, are commonly employed.1 However, many patients still require more definitive surgical management, which may be in the form of open or endoscopic procedures. Regardless of surgical approach, the clinical success rates of carpal tunnel release have been reported to be 75%-90%.3 Recurrence rates are 8.4%-15% over 4-5 years,4,5 with the lower end of this range representing the Agee single-portal technique. Endoscopic carpal tunnel release leads to reduced postoperative pain and an increase in transient neurologic deficits; however, no improvements have been reported in overall complication rate, subjective satisfaction, return to work, postoperative grip and pinch strength, and operative time.6 In this technical video, we present a case of single-incision endoscopic carpal tunnel release in a patient with severe symptoms after conservative measures failed. The patient experienced a noncomplicated postoperative course and demonstrated an excellent recovery at follow-up visits. Surgical decompression is an important treatment for refractory carpal tunnel syndrome, and videos such as this provide guidance for safe and effective treatment (Video 1).


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Endoscopia/métodos , Cirurgia Vídeoassistida/métodos , Eletromiografia/métodos , Feminino , Humanos , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade
2.
Pain Physician ; 23(2): E175-E183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214296

RESUMO

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. OBJECTIVES: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. STUDY DESIGN: A randomized, double-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Patients: 60 patients with CTS (> 6 months' duration). INTERVENTION: patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). MEASUREMENTS: assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well. RESULTS: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up. LIMITATION: We suggest a longer period could be reasonable. CONCLUSIONS: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration. KEY WORDS: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Dissecação/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Manejo da Dor/métodos , Resultado do Tratamento , Punho/diagnóstico por imagem , Punho/inervação , Punho/cirurgia
3.
Radiol Med ; 125(5): 481-490, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020529

RESUMO

OBJECTIVES: To systematically review the current literature concerning the role of superb microvascular imaging (SMI), a novel Doppler technique that enables detection of fine vessels and slow blood flow, in the evaluation of musculoskeletal disorders. METHODS: An online search of the literature was conducted for the period 2013 to April 2019 and included original articles written in English language. A data analysis was performed at the end of the literature search. RESULTS: Eight original articles with prospective design and one with retrospective design were included in this review: 4 studies focused on rheumatoid arthritis, 2 on rheumatoid and other arthritides, 1 on lateral epicondylosis and 2 on carpal tunnel syndrome. Sample size ranged from 26 to 83 patients. Despite some methodological differences, all studies compared the performance of SMI with that of a conventional Doppler technique such as power and color Doppler and found an improvement in vascularity detection with SMI. The main variations were in sample size, evaluated parameters and vascularity interpretation methods. Inter-observer agreement for SMI ranged from moderate to excellent. CONCLUSIONS: SMI is a promising tool for the diagnosis and treatment planning of different musculoskeletal disorders. Future investigations should include larger samples of patients with long-term follow-up.


Assuntos
Microvasos/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artrite/diagnóstico por imagem , Artrite/fisiopatologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Velocidade do Fluxo Sanguíneo , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Microvasos/fisiopatologia , Doenças Musculoesqueléticas/fisiopatologia , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Cotovelo de Tenista/diagnóstico por imagem , Cotovelo de Tenista/fisiopatologia , Ultrassonografia Doppler em Cores/métodos
4.
J Bone Miner Metab ; 38(1): 78-85, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31414282

RESUMO

The RDT population, initially at 215 patients, exceeded 300,000 in 2011, with a total of 329,609 patients at the end of December 2016. In our Institute, the number of patients with destructive spondylosis is increasing with the increase in the number of dialysis patients in Japan. We had 14 Cases in the 1990s, and then 82 cases in the 2000s and have already had 131 cases in the 2010s. The purpose of this study was to investigate the incidence of dialysis-related amyloidosis (DRA) such as destructive spondyloarthropathy (DSA), dialysis amyloid arthropathy (DAA), and carpal tunnel syndrome (CTS). In addition, another purpose was to examine the risk factors of the DRA. DAA made its own assessment on radiographs based on stage. Survey items were patient's basic data, laboratory data and X-ray view. Patient's basic data included such as sex, age, height, and weight and RDT-related factors such as kidney disease that led to RDT, age at start of RDT, RDT history, medical history (past and present), and history of surgery. The frequency of DRA was examined by medical history and radiological examination in 199 dialysis patients who obtained informed consent. The patients were divided into two groups according to the presence or absence of DRA, and risk factors of DRA were investigated from the medical history, basic data of patients, and blood tests. Of the 199 patients on regular dialysis therapy, 41 (20.6%) showed DRA. Based on the X-ray images, 21 patients (10.6%) showed DSA, while 22 patients (11.1%) showed DAA. Sixteen patients (8.0%) had CTS, determined through a history of surgery. Regarding overlap of conditions, 14 had both DSA and DAA, 3 had both DSA and CTS, and 2 had both DAA and CTS. There were statistically significant differences between the two groups in the cause of disease in Chronic glomerulonephritis and Diabetic Nephropathy, age at the start of RDT, period of RDT, body weight, blood platelet count, and blood Ca level. When multivariate analysis was performed on these items, statistical differences were recognized only during the dialysis period. In conclusion, long dialysis period was a risk factor for DRA.


Assuntos
Amiloidose/epidemiologia , Amiloidose/etiologia , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/etiologia , Diálise Renal/efeitos adversos , Espondiloartropatias/epidemiologia , Espondiloartropatias/etiologia , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico por imagem , Síndrome do Túnel Carpal/diagnóstico por imagem , Análise Fatorial , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Espondiloartropatias/diagnóstico por imagem , Adulto Jovem
5.
Radiol Med ; 125(2): 197-203, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31773457

RESUMO

OBJECTIVE: To assess the discriminative power of radiomics of peripheral nerves at 1.5T MRI, using common entrapment neuropathies of the upper limb as a model system of focal nerve injury. MATERIALS AND METHODS: Radiomics was retrospectively done on peripheral nerve fascicles on T1-weighted 1.5T MRI of 40 patients with diagnosis of mild carpal (n = 25) and cubital tunnel (n = 15) syndrome and of 200 controls. Z-score normalization and Mann-Whitney U test were used to compare features of normal and pathological peripheral nerves. Receiver operating characteristic analysis was performed. RESULTS: A total of n = 104 radiomics features were computed for each patient and control. Significant differences between normal and pathological median and ulnar nerves were found in n = 23/104 features (p < 0.001). According to features classification, n = 5/23 features were shape-based, n = 7/23 were first-order features, n = 11/23 features were classified as gray level run length matrix. Nine of the selected features showed an AUC higher that 0.7: minimum AUC of 0.74 (95% CI 0.61-0.89) for sum variance and maximum AUC of 0.90 (95% CI 0.82-0.99) for zone entropy. CONCLUSION: Features analysis demonstrated statistically significant differences between normal and pathological nerve. The results suggested that radiomics analysis could assess the median and ulnar nerve inner structure changes due to the loss of the fascicular pattern, intraneural edema, fibrosis or fascicular alterations in mild carpal tunnel and mild cubital tunnel syndromes even when the nerve cross-sectional area does not change.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Ulnar/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Arch Gynecol Obstet ; 300(3): 623-631, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31267198

RESUMO

PURPOSE: To estimate the prevalence of indicative signs and symptoms of carpal tunnel syndrome (CTS) during the third trimester of pregnancy; assess the severity of symptoms and functional impairment; evaluate associated factors; and to evaluate the complaint of CTS in pregnant women through ultrasonography (USG). METHODS: A cross-sectional study, in which participants were classified into two groups: presence and absence of indicative signs and symptoms of CTS. Severity of symptoms and functional status was assessed by the Boston Carpal Tunnel Questionnaire. USG was performed by multiplanar technique of static and dynamic evaluation. Association between USG and indicative signs and symptoms of CTS was estimated using Fischer's exact test and Poisson regression models were used to estimate the association of exploratory variables and indicative signs and symptoms of CTS. RESULTS: Altogether, 482 women were recruited and 111 presented indicative signs and symptoms of CTS, resulting in a prevalence of 23.03%. USG was not able to distinguish indicative signs and symptoms of CTS groups. Both the severity of the symptoms and the impairment of the manual function were mild. Being left-handed, gestational diabetes mellitus and maternal age were associated with indicative signs and symptoms of CTS. CONCLUSIONS: The high prevalence of indicative signs and symptoms of CTS and the difficulties that they can cause reinforce the importance of adequate diagnosis and treatment. Further studies are needed to assess the value of USG as a diagnostic method for CTS during pregnancy.


Assuntos
Síndrome do Túnel Carpal/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/etiologia , Estudos Transversais , Feminino , Humanos , Idade Materna , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/patologia , Terceiro Trimestre da Gravidez , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Ultrassonografia
8.
Medicine (Baltimore) ; 98(26): e16039, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261508

RESUMO

This study aimed to investigate the relationship between the change of median nerve cross-sectional area (CSA) and the severity of carpal tunnel syndrome (CTS) determined by electrodiagnostic study based on the area immediately proximal to the carpal tunnel inlet (IPCTI).From December 2016 to August 2017, 34 patients (8 men and 26 women; mean age, 61.68 years ± 11.83; range, 28-80 years) with CTS symptoms were recruited. Electrodiagnostic study was performed in all patients to categorize the severity of CTS according to Bland classification. The CSA of median nerve and carpal tunnel at IPCTI, and carpal tunnel inlet/outlet level was measured by one physician. The Kruskal-Wallis test was used for comparing the CSA of the median nerve and carpal tunnel among CTS severity groups divided by electrodiagnostic study. The Dunn procedure was used for post-hoc comparison.At IPCTI and the carpal tunnel inlet level, the CSA of the median nerve was statistically larger depending on the severity of CTS (P < .01, P < .01). In the post-hoc comparison, only the CSA measured at the IPCTI level could differentiate normal reference values from mild CTS indicating the early stage (P < .05).Measuring the CSA of median nerve in IPCTI level is the most sensitive method to diagnose the early stage CTS.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Eletrodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença
9.
BMC Med Imaging ; 19(1): 52, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272405

RESUMO

BACKGROUND: To evaluate the diagnostic accuracy of the median-to-ulnar nerve ratio (MUR) and the median-to-ulnar nerve difference (MUD) in patients with carpal tunnel syndrome (CTS). METHODS: In this study, 32 patients with CTS and 32 healthy volunteers were evaluated. All participants received a series of tests and ultrasound examination for the evaluation of the following criteria: cross-sectional area of the median nerve at the pisiform level (CSA-P), swelling ratio (SR), MUR, MUD, and flattening ratio (FR). RESULTS: CSA-P, SR, MUR, and MUD were all significantly larger in the patients with CTS than in the healthy volunteers. The areas under the receiver operator characteristic curves of MUD, MUR, CSA-P, and SR were 0.78, 0.75, 0.70, and 0.61 respectively. MUD had higher sensitivity (84%) than MUR, CSA-P, and SR (sensitivity: 63, 63, and 53%, respectively). CONCLUSIONS: By using the ulnar nerve area at the pisiform level as an internal control parameter, the MUD and MUR methods showed higher diagnostic accuracy than SR in patients with CTS. Further application of these methods in research and clinical settings is recommended. TRIAL REGISTRATION: Clinicaltrial.gov NCT03033173. Registered 18 January 2017. Retrospectively registered.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Ulnar/patologia , Adulto , Idoso , Síndrome do Túnel Carpal/patologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Nervo Ulnar/diagnóstico por imagem , Ultrassonografia
10.
Clin Rheumatol ; 38(10): 2933-2940, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31209710

RESUMO

OBJECTIVE: To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM). METHOD: Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. All injections were performed with ultrasonographic guidance. All patients were assessed by modified Boston Carpal Tunnel Questionnaire (FD score), CTS severity score (SS score), and neurophysiological and ultrasonographic assessments at baseline and 10 weeks after treatment. RESULTS: A significant improvement in mean FD score, SS score, DML (distal motor latency), SNCV (sensory nerve conduction velocity), PSL (peak sensory latency), Samp (sensory amplitude), and CSA (cross-sectional area of median nerve) observed in all groups (with exception of mean DML and Samp in the second group and mean Samp in the third group). Group III showed significant improvement in CSA especially when compared to group II by post hoc analysis (P = 0.005). CONCLUSIONS: Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 DM and is a safer alternative. Adding insulin injections after steroid shows more sonographic improvement than steroid alone. Key Points • Local insulin injection is as effective as steroid in treating mild to moderate CTS in type 2 diabetic patients. • Measuring CSA of median nerve at CT inlet by US is a better tool for monitoring median nerve changes after treatment. • Adding insulin injections after steroid has more sonographic improvement than steroid alone.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Insulina/administração & dosagem , Ultrassonografia , Adolescente , Adulto , Idoso , Síndrome do Túnel Carpal/complicações , Eletrofisiologia , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Acetato de Metilprednilosona/administração & dosagem , Pessoa de Meia-Idade , Condução Nervosa , Índice de Gravidade de Doença , Método Simples-Cego , Esteroides/administração & dosagem , Resultado do Tratamento , Punho/diagnóstico por imagem , Adulto Jovem
11.
Orthopedics ; 42(5): e460-e464, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185120

RESUMO

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Its diagnosis is based on clinical symptoms and neurophysiological evaluation. Recently, ultrasonography has been introduced as a promising noninvasive diagnostic alternative. In this study, the authors compared ultrasonography with neurophysiological findings for the diagnosis of CTS in 96 patients/hands with clinical symptoms of CTS. The latency, amplitude, distance, and velocity of the median and ulnar nerves were measured. Needle electromyography was performed in the abductor pollicis brevis, in addition to muscles of the arm and forearm, to exclude proximal median nerve, brachial plexus, or radicular abnormalities. Ultrasonography was based on the morphologic/anatomic changes of the median nerve cross-sectional area in the sagittal plane of the wrist at the level of the pisiform bone, the changes of its regional echogenicity, and the identification of coexisting pathologies, such as tenosynovitis, space-occupying lesions, supplementary muscles, and vessels, that may provoke indirectly an increase of the pressure in the carpal tunnel. Eighty-seven (90%) of the 96 patients/hands with clinical symptoms of CTS showed positive findings in both ultrasonography and nerve conduction studies. Six (6%) patients showed positive findings only in nerve conduction studies, and 3 (3%) patients showed positive findings only in ultrasonography; the difference was not statistically significant. The sensitivity and the specificity of nerve conduction studies compared with ultrasonography was 97% and 89% compared with 94% and 55%, respectively. A positive correlation and proportional increase of the ultrasonography measurements compared with the increase of the nerve conduction studies severity was observed. [Orthopedics. 2019; 42(5):e460-e464.].


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Nervo Mediano/diagnóstico por imagem , Ultrassonografia , Eletromiografia , Feminino , Humanos , Nervo Mediano/fisiopatologia , Condução Nervosa , Sensibilidade e Especificidade , Nervo Ulnar/fisiopatologia
12.
Math Biosci Eng ; 16(4): 2250-2265, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31137210

RESUMO

Individual variations have been reported in the existing methods for examining peripheral entrapment neuropathy, by which limited sites can be examined. In this study, the patients with unilateral carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS) and radial nerve compression (RNC) were selected as research subjects and an ultrasound technique was proposed based on multilevel side-to-side image contrast for the diagnosis of unilateral peripheral entrapment neuropathy. According to the statistical analysis of 62 patients with CTS, CuTS or RNC, the diagnostic thresholds of the cross-sectional area swelling ratio (CSASR) for diagnosis of CTS, CuTS or RNC were 1.22, 1.51 and 1.50, respectively. The surgical therapeutic thresholds of CSASR for the treatment of CTS, CuTS and RNC were 1.48, 1.67 and 3.04, respectively. When the maximal CSASR of the diseased nerve was greater than or equal to the diagnostic threshold, the nerve compression could be diagnosed. If it was less than the diagnostic threshold, nerve compression was excluded. Conservative treatment was indicated when the maximal CSASR of the diseased nerve was less than the therapeutic threshold. When the maximal CSASR was greater than or equal to the therapeutic threshold, surgical treatment was indicated, and the nerve release procedure was selected. The novel multilevel side-to-side image contrast ultrasound technique proposed in this study can substantially reduce the impact of individual variation and explore the full course of the diseased nerve. It is a novel approach for diagnosis, treatment selection, and determination of treatment sites of unilateral peripheral entrapment neuropathy.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Diagnóstico por Computador/métodos , Processamento de Imagem Assistida por Computador/métodos , Ultrassonografia/métodos , Adulto , Idoso , Síndrome do Túnel Ulnar/diagnóstico por imagem , Fenômenos Eletrofisiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Radial/fisiopatologia , Neuropatia Radial/diagnóstico por imagem , Reprodutibilidade dos Testes , Adulto Jovem
13.
Skeletal Radiol ; 48(11): 1803-1809, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31114970

RESUMO

OBJECTIVE: The purpose was to evaluate, in a cadaveric cohort, the feasibility and the learning curve of ultrasound-guided percutaneous carpal tunnel release. MATERIALS AND METHODS: Fourteen carpal tunnel releases were carried out on unembalmed cadavers by a senior and a junior radiologist. Procedures were realized with an 18-MHz linear probe. An anatomical evaluation was first performed using ultrasound to detect any anatomical variant. After hydrodissection of the carpal tunnel with lidocaine, a 3-mm hook knife was introduced into the security zone to perform a retrograde section of the transverse carpal ligament (TCL) under ultrasound guidance. Anatomical dissection was performed for each wrist. The main evaluation criterion was the complete TCL section. The procedure duration (minutes), skin incision size (millimeters), the integrity of the median nerve, thenar motor branch, and palmar vascular arch were also evaluated. RESULTS: The senior operator was able to perform a complete release after training on three specimens and the junior operator after four specimens (p > 0.05). In most of the cases when complete release was not achieved, it was due to an incomplete section of the distal TCL (10 mm missing section on average). Mean duration time of procedure was 14 min (11 min for the senior versus 17 min for the junior, p > 0.05). Damage of neither the median nerve nor the vascular structure was observed. Mean size of the skin incision was 3 mm. CONCLUSION: The ultrasound-guided percutaneous release of the carpal tunnel is demonstrated to be a procedure with a rapid learning curve.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Competência Clínica/estatística & dados numéricos , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Radiologistas/estatística & dados numéricos , Ultrassonografia de Intervenção/métodos , Cadáver , Estudos de Viabilidade , Humanos , Curva de Aprendizado , Radiologistas/educação , Radiologistas/normas
14.
J Orthop Surg Res ; 14(1): 149, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126303

RESUMO

BACKGROUND: This study aims at investigating the outcome and electrophysiologic recovery of 150 carpal tunnel syndrome hands after single-portal endoscopic surgery. METHODS: Patients with the cross-sectional area of the median nerve being 13-15 mm2 on ultrasound or abnormal sensory nerve conduction velocity on EMG are assigned to endoscopic surgery that cuts the decompressing transverse ligament to avoid the emergence of severe symptoms, such as muscular atrophy and loss of hand function. RESULTS: Single-portal endoscopic release is a safe and efficacious option for carpal tunnel release. The findings demonstrate encouraging results. CONCLUSION: The endoscopic carpal tunnel release with the placement of a MicroAire system is a safe and effective method for treating carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Neuroendoscopia/métodos , Articulação do Punho/cirurgia , Adulto , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Prospectivos , Vietnã/epidemiologia , Articulação do Punho/diagnóstico por imagem
15.
J Ultrasound Med ; 38(11): 3043-3052, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30993769

RESUMO

OBJECTIVES: To determine the diagnostic capacity of ultrasound (US) in detecting carpal tunnel syndrome (CTS). METHODS: Volunteer adults with and without CTS symptoms were recruited from offices in metropolitan Manila, where employees' work was hand/wrist intensive. Carpal tunnel syndrome was independently diagnosed by a reference standard (positive findings on a physical examination and nerve conduction studies). Blinded US measurements were taken of the median nerve (cross-sectional area, hypervascularity, wrist-to-forearm ratio, wrist-forearm difference, swelling ratio, flattening ratio, and palmar bowing of the flexor retinaculum) at the carpal tunnel inlet and carpal tunnel outlet (CTO). RESULTS: A total of 117 eligible consenting participants (234 hands) were included, with 54 hands (23.1%) with a diagnosis of CTS. There were no anthropometric differences between arms with and without CTS. Men and women older than 33 years were 5 times more likely to report CTS than younger people. A CTO wrist-forearm difference of greater than 0.03 cm had the strongest association with CTS (odds ratio, 4.7; 95% confidence interval, 1.4-15.9), with an area under the curve of 0.58 (sensitivity, 94.4%; specificity, 21.7%). The area under the curve increased to 0.59 when the next strongest measurement (CTO hypervascularity of 1+: odds ratio, 3.8; 95% confidence interval, 1.8-8.1) was included (sensitivity, 98.1%; specificity, 27.7%). Adding further US parameters did not improve the diagnostic capacity of US for CTS. Diagnostic capacity was independent of age and the duration of CTS symptoms. CONCLUSIONS: Combining US findings for the CTO wrist-forearm difference and hypervascularity provides a sensitive, alternative diagnostic tool for CTS.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Filipinas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
16.
Muscle Nerve ; 60(1): 67-71, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30942930

RESUMO

INTRODUCTION: We assessed the potential use of quantitative ultrasound (QUS) in the evaluation hand muscles affected by upper extremity mononeuropathies. METHODS: The gray scale levels (GSLs) of abductor pollicis brevis (APB), abductor digiti minimi (ADM), and first dorsal interosseous (FDI) of 30 healthy and 30 upper extremity mononeuropathy patients were measured and compared with standard electrophysiological values. RESULTS: Mean GSL was elevated in 34 APBs of carpal tunnel syndrome patients and 18 FDIs of ulnar neuropathy patients (e.g., FDI mean GSL (interquartile range) 31.5 (27.3~43.8) arbitrary units for patients and 24.0(23.0~29.0) for healthy subjects (P = 0.020)). GSL correlated with motor response amplitudes (Spearman's rho (ρ) = -0.39, P = 0.002 in APB, ρ = -0.72, P = 0.002 in FDI, and ρ = -0.43, P = 0.013 in ADM). The APB GSL correlated with electromyographic severity and disease duration (ρ = 0.46, P < 0.001 and ρ = 0.45, P = 0.003). CONCLUSIONS: Muscle QUS may serve as a useful tool in upper extremity mononeuropathy evaluation. Further study of this concept is recommended.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Neuropatias Ulnares/diagnóstico por imagem , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Estudos de Casos e Controles , Cotovelo , Feminino , Mãos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mononeuropatias , Músculo Esquelético/fisiopatologia , Condução Nervosa , Estudos Prospectivos , Neuropatias Ulnares/fisiopatologia , Ultrassonografia
17.
J Clin Neurophysiol ; 36(4): 312-315, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31033651

RESUMO

PURPOSE: Electrodiagnostic studies do not differentiate severe lesions of the median nerve in the distal forearm from those within the carpal tunnel when compound muscle action potential over the abductor pollicis brevis and sensory nerve action potential are absent; needle electromyography showing denervation confined to the abductor pollicis brevis is presumed to suggest localization to the carpal tunnel, although the lesion may be in the forearm. Under these circumstances, the patient may undergo carpal tunnel release without benefit. This retrospective study looked at patients with clinical picture of severe carpal tunnel syndrome who had no compound muscle action potential or sensory nerve action potential on median nerve stimulation; the goal was to determine how often ultrasonic imaging pointed to a location other than the carpal tunnel. METHODS: Patients with clinical picture of severe carpal tunnel syndrome with no sensory nerve action potential and no compound muscle action potential over the abductor pollicis brevis and second lumbrical underwent ultrasonic imaging; criteria for localization to the carpal tunnel included significant increase in the cross-sectional area of the median nerve at the carpal tunnel inlet and increase in the wrist/forearm cross-sectional area ratio. RESULTS: In 42 of 46 cases, entrapment at the carpal tunnel was confirmed by ultrasonography; in four patients, other causes were located proximal to the carpal tunnel. CONCLUSIONS: Ultrasonic imaging is useful not only for confirming entrapment of the median nerve at the carpal tunnel in patients with nonlocalizing electrodiagnostic studies but also in detecting pathology in the forearm, which may mimic severe carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Neuropatia Mediana/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Estudos Retrospectivos , Adulto Jovem
18.
BMC Musculoskelet Disord ; 20(1): 157, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967143

RESUMO

BACKGROUND: Endoscopic carpal tunnel release (ECTR) has been gradually adopted for the treatment of severe carpal tunnel syndrome (CTS). However, perioperative assessment of neuroanatomical parameters of median nerve, which are important determinant of median nerve recovery, has rarely been reported. This one-year prospective study aimed to investigate the natural history of the neuroanatomical morphology of the median nerve after ECTR in severe CTS patients by high-frequency ultrasonography and assess the ability of neuroanatomical measures to quantify morphological recovery of the median nerve after ECTR. METHODS: This study recruited 31 patients (44 wrists) with a definitive diagnosis of severe CTS and underwent ECTR operation. The edema length (EL) of median nerve from the inlet of the carpal tunnel to the proximal wrist was detected on long axis imaging plane and the anteroposterior diameter (D) and cross-sectional area (CSA) at the inlet of the carpal tunnel on short axis imaging plane were detected by high frequency ultrasound. All these metrics were detected at 3 days before surgery and at the 2nd week, 4th week, 3rd month, 6th month and 12th month after surgery separately. RESULTS: There was no significant difference of each parameter between the 2-week postoperative (1.914 ± 0.598 cm in EL, 0.258 ± 0.039 cm in D and 0.138 ± 0.015 cm2 in CSA) and 3-days preoperative time points (P-EL =0.250; P-D = 0.125; P-CSA =0.712). From the fourth week to the third month after surgery, the parameters quickly improved. The EL (0.715 ± 0.209 cm), D (0.225 ± 0.017 cm) and CSA (0.117 ± 0.012 cm2) at the 3- month postoperative time points were more reduced than at the fourth week after surgery (P-EL < 0.001; P-D = 0.038; P-CSA =0.014). Thereafter, the neurological anatomy parameters recovered slowly. By the 12-month postoperative time points, the three parameters were neuroanatomically close to normal. Compared to the control group in D (0.213 ± 0.005 cm), there was no difference at the 12-month time point (0.214 ± 0.009 cm, P = 0.939). However, the difference in EL (0.098 ± 0.030 cm vs. 0.016 ± 0.011 cm) and CSA (0.103 ± 0.008 cm2 vs. 0.073 ± 0.005 cm2) between patients and healthy volunteers at the 12-month time point still existed (P-EL < 0.001; P-CSA < 0.001). CONCLUSIONS: Neuroanatomical parameters were gradually improved after ECTR surgery. The best time for US follow up is at 3-month postoperative time point for patients who do not show clinical improvement, since at this time the change is the greatest for most CTS patients. This study has been registered in Chinese Clinical Trial Registry: ChiCTR-ROC-17014068 (retrospectively registered 20-12-2017).


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Neuroendoscopia/métodos , Índice de Gravidade de Doença , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Eletrodiagnóstico/métodos , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Punho/anatomia & histologia , Punho/diagnóstico por imagem , Punho/cirurgia
19.
Biomed Res Int ; 2019: 9498656, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30915366

RESUMO

Objectives: Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods: Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results: Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions: The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.


Assuntos
Síndrome do Túnel Carpal/tratamento farmacológico , Terapia Combinada , Esteroides/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Terapia Combinada/métodos , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/efeitos dos fármacos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/efeitos dos fármacos , Nervo Mediano/patologia , Pessoa de Meia-Idade , Agulhas , Condução Nervosa/efeitos dos fármacos , Resultado do Tratamento
20.
J Orthop Surg Res ; 14(1): 91, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922412

RESUMO

BACKGROUND: Carpal tunnel syndrome (CTS) is common among patients receiving hemodialysis and deeply influences their daily life. Amyloid deposits are considered the main reason for median nerve compression, but its prevalence is unclear. Therefore, to determine the main region of amyloid deposition inside the carpal tunnel, we measured the cross-sectional area (CSA) of each component of the carpal tunnel in preoperative magnetic resonance imaging (MRI). METHODS: Thirty-five hemodialysis patients (HD group) and age- and sex-matched 35 non-hemodialysis patients (non-HD group), who underwent the first surgery for CTS in registered hospitals from 2005 to 2015, were retrospectively enrolled. CTS was diagnosed from clinical and electromyographic (EMG) findings. The CSA of carpal tunnel, each of the flexor tendons, and the median nerve at the level of the hook of hamate were measured in T1-weighted axial images in preoperative MRI, by using Synapse OP-A software. Statistical analysis was performed using the Student's t test and Pearson's chi-squared test. RESULTS: The mean age of the HD group was 65.9 years and the dialysis duration was 21.9 (11-35) years. The mean age of the non-HD group was 65.3 years. The CSA of carpal tunnel (p = 0.006), flexor tendon (p = 0.03), and flexor digitorum profundus (FDP) tendon (p = 0.04) were bigger in the HD group. However, the median nerve, the flexor digitorum superficialis (FDS) tendon, and the flexor pollicis longus tendon (FPL) were not significantly different between the two groups. The dialysis duration or age at surgery did not show any strong correlation to each CSA. CONCLUSIONS: We confirmed that hemodialysis caused expansion of the carpal tunnel due to amyloid deposition as previously described. Hemodialysis also caused expansion of the CSA of the flexor tendon, especially the FDP, possibly because of amyloid deposition inside the tendon. Furthermore, the duration of dialysis or age did not correlate with any CSA, which could be due to the good progress of the beta 2-microglobulin removal technique. Based on our results, FDS excision could be considered in case severe deposition of amyloid in FDP is observed during surgery.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/epidemiologia , Imagem por Ressonância Magnética/métodos , Diálise Renal/efeitos adversos , Idoso , Síndrome do Túnel Carpal/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Imagem por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Diálise Renal/tendências
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