Ultrasonographic Assessment of Median Nerve and Carpal Tunnel Variations: Implications for the Interventional Management of Carpal Tunnel Syndrome.

IF 2.1 4区 医学 Q2 ACOUSTICS
Eric J Super, Marin S Smith, Matthew E Miller, Jay Smith, Xiaoning Yuan
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引用次数: 0

Abstract

Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Anatomic variations of the median nerve (MN) and carpal tunnel (CT) may predispose patients to CTS or increase procedural complexity and risk during carpal tunnel release (CTR). This study aimed to systematically evaluate the prevalence of 25 MN and CT anatomic variations and measurements using ultrasound (US) in patients referred for electrodiagnostic testing (EDX).

Methods: In this cross-sectional observational study, patients underwent diagnostic US exams of the MN (mid-brachium to distal CT), focused on variant anatomy that may predispose to CTS (bifid MN, Gantzer's muscle, lumbrical intrusion) or increase procedural complexity/risk (transligamentous thenar motor branches [TMBs], MN orientation ulnar to the palmaris longus [PL] tendon).

Results: Two hundred and twenty patients (mean age: 45.3 ± 13.0 years; 63.6% male; 294 UEs) were evaluated by US. Hundred and eight UEs met EDX criteria for CTS (EDX-CTS). The most common variations identified were lumbrical intrusion (81.3%), Gantzer's muscle (39.5%), and persistent median artery (22.8%), which were not associated with EDX-CTS. US revealed transligamentous (2.4%) and ulnar origin (4.5%) TMBs, which may increase injury risk during CTR. MN location was ulnar to the PL tendon in 70.4% of wrists, which can predispose to injury during landmark-guided CT injections.

Conclusions: This study demonstrated that US complements EDX and can systematically identify anatomic variations, including variants at risk during CTS interventions. No differences in the prevalence of variations were detected between patients with and without EDX-CTS. Diagnostic US can support procedural planning, improve safety, and lower injury risk.

正中神经和腕管病变的超声评估:对腕管综合征介入治疗的意义。
目的:腕管综合征(Carpal tunnel syndrome, CTS)是最常见的外周神经病变。正中神经(MN)和腕管(CT)的解剖变异可能使患者易患CTS或增加腕管释放(CTR)过程中的操作复杂性和风险。本研究旨在系统地评估25个MN和CT解剖变异的患病率,以及在进行电诊断测试(EDX)的患者中使用超声(US)测量的结果。方法:在这项横断观察性研究中,患者接受了MN(臂中至远端CT)的诊断性US检查,重点关注可能易患CTS的变异解剖(双裂MN、甘茨肌、蚓状侵入)或增加程序复杂性/风险(跨韧带大鱼际运动分支[TMBs]、MN方向尺侧至掌长肌[PL]肌腱)。结果:220例患者(平均年龄:45.3±13.0岁;男性63.6%;294例ue经US评价。108个ue符合CTS的EDX标准(EDX-CTS)。最常见的变异是蚓状侵入(81.3%),Gantzer肌(39.5%)和持续性正中动脉(22.8%),这些与EDX-CTS无关。超声显示跨韧带(2.4%)和尺侧起源(4.5%)TMBs,这可能增加CTR期间的损伤风险。在70.4%的患者中,MN的位置在尺侧至左肌腱,这在地标引导下的CT注射中容易造成损伤。结论:本研究表明,US与EDX互补,可以系统地识别解剖变异,包括在CTS干预期间存在风险的变异。在有EDX-CTS和没有EDX-CTS的患者之间没有发现变异的流行率差异。诊断性美国可以支持手术计划,提高安全性,降低伤害风险。
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来源期刊
CiteScore
5.10
自引率
4.30%
发文量
205
审稿时长
1.5 months
期刊介绍: The Journal of Ultrasound in Medicine (JUM) is dedicated to the rapid, accurate publication of original articles dealing with all aspects of medical ultrasound, particularly its direct application to patient care but also relevant basic science, advances in instrumentation, and biological effects. The journal is an official publication of the American Institute of Ultrasound in Medicine and publishes articles in a variety of categories, including Original Research papers, Review Articles, Pictorial Essays, Technical Innovations, Case Series, Letters to the Editor, and more, from an international bevy of countries in a continual effort to showcase and promote advances in the ultrasound community. Represented through these efforts are a wide variety of disciplines of ultrasound, including, but not limited to: -Basic Science- Breast Ultrasound- Contrast-Enhanced Ultrasound- Dermatology- Echocardiography- Elastography- Emergency Medicine- Fetal Echocardiography- Gastrointestinal Ultrasound- General and Abdominal Ultrasound- Genitourinary Ultrasound- Gynecologic Ultrasound- Head and Neck Ultrasound- High Frequency Clinical and Preclinical Imaging- Interventional-Intraoperative Ultrasound- Musculoskeletal Ultrasound- Neurosonology- Obstetric Ultrasound- Ophthalmologic Ultrasound- Pediatric Ultrasound- Point-of-Care Ultrasound- Public Policy- Superficial Structures- Therapeutic Ultrasound- Ultrasound Education- Ultrasound in Global Health- Urologic Ultrasound- Vascular Ultrasound
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