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Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular

Year 2007, Volume: 24 Issue: 3, 103 - 106, 29.12.2009

Abstract

A Rare Cause of Carpal Tunnel Syndrome: Ultrasonographic Findings of Bifid Median Nerve

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of median nerve because of many pathological reasons at the wrist. Several diseases are responsible in the etiopathogenesis of CTS and anatomical variation of the median nerve is one of these reasons. A woman aged 39 years old who had pain and numbness in her first three fingers applied electrophysiology unit. Electrophysiological studies showed grade 5 CTS on the right hand and grade 4 on the left. Ultrasonographic studies showed bilateral high cross sectional area of the median nerve at the levels of radioulnar joint, psiform and hamate and median nerves echo were low bilaterally. Median nerve cross sectional area was 18.8 mm2 on the left wrist at the psiform level. But median nerve has two branches with area of 21.2 mm2 and 14.3 mm2 at the right wrist. The ultrasonographic findings of bifid median nerve, a rare anatomical variation, were discussed along with the review of the literature.


Karpal tünel sendromu (KTS), median sinirin bilekte çeşitli patolojik durumlar nedeniyle oluşan tuzak nöropatisidir. KTS'nin etiyopatogenezinde oldukça fazla sayıda hastalık bulunmakta olup median sinirin anatomik varyasyonları bunlardan bazılarıdır. Otuzdokuz yaşında bir kadın hastada, bilateral birinci, ikinci ve üçüncü parmaklarda uyuşma ve ağrı şikayetleri ile başvurduğu elektrofizyoloji ünitesinde sağda evre 5, solda evre 4 KTS tespit edilmişti. Ultrasonografik değerlendirmede, bilateral median sinir kesit alanı radioulnar bileşke psiform kemik düzeyi ve hamat kemik düzeyinde artmış, sinirlerin ekosu belirgin azalmıştı. Solda pisiform kemik düzeyinde median sinir kesit alanı 18.8 mm2 ölçülürken, sağda 21.2 mm2 ve 14.3 mm2 kesit alanına sahip iki dal bulunmaktaydı. Bu olgu ile nadir bir anatomik varyasyon olan bifid median sinirin ultrasonografi bulguları literatür eşliğinde tartışıldı.

References

  • Padua L, LoMonaco M, Gregori B, et al. Neurophysiological classification and sensitivity in 500 carpal tunnel s y n- drome hands. Acta Neurol Scand. 1997; 96: 211–217.
  • Middleton WD, Kneeland JB, Kellman GM, et al. MR imaging of the carpal tunnel: normal anatomy and preliminary findings in the carpal tunnel syndrome. AJR Am J Roentgenol. 1987; 148: 307–316.
  • Mesgarzadeh M, Schneck CD, Bonakdarpour A, et al. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. Radiology. 1989; 171: 749–754.
  • Buchberger W, Schon G, Strasser K, et al. High- r e s o l u t i o n ultrasonography of the carpal tunnel. J Ultrasound Med. 1991; 10: 531–537.
  • Buchberger W, Judmaier W, Birbamer G, et al. Carpal tunnel syndrome: diagnosis with high-resolution sonography.AJR Am J Roentgenol. 1992; 159: 793–798.
  • Buchberger W, Judmaier W, Birbamer G, et al. The role of sonography and MR tomography in the diagnosis and therapeutic control of the carpal tunnel syndrome. Rofo. 1993; 159: 138–143.
  • Buchberger W. Radiologic imaging of the carpal tunnel. Eur J Radiol. 1997; 25: 112–117.
  • Lee D, van Holsbeeck MT, Janevski PK, et al. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiol Clin North Am. 1999; 37: 859–872.
  • Sarria L, Cabada T, Cozcolluela R, et al. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol. 2000; 10: 1920–1925.
  • Swen WA, Jacobs JW, Bussemaker FE, et al. Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist. J Rheumatol. 2001; 28: 62–69.
  • Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999; 173: 681–684.
  • Chen P, Maklad N, Redwine M, et al. Dynamic high- resolution sonography of the carpal tunnel. AJR Am J Roentgenol. 1997;168: 533–537.
  • Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg [Am]. 19772: 44–53. 14. Propeck T, Quinn TJ, Jacobson JA, et al. Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation. AJR Am J Roentgenol. 2000; 175: 1721–1725.
  • Iannicelli E, Almberger M, Chianta GA, et al. Bifid median nerve in the carpal tunnel: integrated imaging. Radiol Med (Torino). 2001; 101: 456–458.
  • Gassner EM, Schocke M, Peer S, et al. Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med. 2002; 21: 455–461.
Year 2007, Volume: 24 Issue: 3, 103 - 106, 29.12.2009

Abstract

References

  • Padua L, LoMonaco M, Gregori B, et al. Neurophysiological classification and sensitivity in 500 carpal tunnel s y n- drome hands. Acta Neurol Scand. 1997; 96: 211–217.
  • Middleton WD, Kneeland JB, Kellman GM, et al. MR imaging of the carpal tunnel: normal anatomy and preliminary findings in the carpal tunnel syndrome. AJR Am J Roentgenol. 1987; 148: 307–316.
  • Mesgarzadeh M, Schneck CD, Bonakdarpour A, et al. Carpal tunnel: MR imaging. Part II. Carpal tunnel syndrome. Radiology. 1989; 171: 749–754.
  • Buchberger W, Schon G, Strasser K, et al. High- r e s o l u t i o n ultrasonography of the carpal tunnel. J Ultrasound Med. 1991; 10: 531–537.
  • Buchberger W, Judmaier W, Birbamer G, et al. Carpal tunnel syndrome: diagnosis with high-resolution sonography.AJR Am J Roentgenol. 1992; 159: 793–798.
  • Buchberger W, Judmaier W, Birbamer G, et al. The role of sonography and MR tomography in the diagnosis and therapeutic control of the carpal tunnel syndrome. Rofo. 1993; 159: 138–143.
  • Buchberger W. Radiologic imaging of the carpal tunnel. Eur J Radiol. 1997; 25: 112–117.
  • Lee D, van Holsbeeck MT, Janevski PK, et al. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiol Clin North Am. 1999; 37: 859–872.
  • Sarria L, Cabada T, Cozcolluela R, et al. Carpal tunnel syndrome: usefulness of sonography. Eur Radiol. 2000; 10: 1920–1925.
  • Swen WA, Jacobs JW, Bussemaker FE, et al. Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist. J Rheumatol. 2001; 28: 62–69.
  • Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol. 1999; 173: 681–684.
  • Chen P, Maklad N, Redwine M, et al. Dynamic high- resolution sonography of the carpal tunnel. AJR Am J Roentgenol. 1997;168: 533–537.
  • Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg [Am]. 19772: 44–53. 14. Propeck T, Quinn TJ, Jacobson JA, et al. Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation. AJR Am J Roentgenol. 2000; 175: 1721–1725.
  • Iannicelli E, Almberger M, Chianta GA, et al. Bifid median nerve in the carpal tunnel: integrated imaging. Radiol Med (Torino). 2001; 101: 456–458.
  • Gassner EM, Schocke M, Peer S, et al. Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med. 2002; 21: 455–461.
There are 15 citations in total.

Details

Primary Language English
Journal Section Internal Medical Sciences
Authors

Mehmet Selim Nural This is me

İ.K. Bayrak This is me

A.O. Bayrak This is me

M.S. Nural This is me

H. Erdem Tilki This is me

Publication Date December 29, 2009
Submission Date October 15, 2009
Published in Issue Year 2007 Volume: 24 Issue: 3

Cite

APA Nural, M. S., Bayrak, İ., Bayrak, A., Nural, M., et al. (2009). Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular. Journal of Experimental and Clinical Medicine, 24(3), 103-106. https://doi.org/10.5835/jecm.v24i3.14
AMA Nural MS, Bayrak İ, Bayrak A, Nural M, Erdem Tilki H. Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular. J. Exp. Clin. Med. December 2009;24(3):103-106. doi:10.5835/jecm.v24i3.14
Chicago Nural, Mehmet Selim, İ.K. Bayrak, A.O. Bayrak, M.S. Nural, and H. Erdem Tilki. “Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular”. Journal of Experimental and Clinical Medicine 24, no. 3 (December 2009): 103-6. https://doi.org/10.5835/jecm.v24i3.14.
EndNote Nural MS, Bayrak İ, Bayrak A, Nural M, Erdem Tilki H (December 1, 2009) Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular. Journal of Experimental and Clinical Medicine 24 3 103–106.
IEEE M. S. Nural, İ. Bayrak, A. Bayrak, M. Nural, and H. Erdem Tilki, “Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular”, J. Exp. Clin. Med., vol. 24, no. 3, pp. 103–106, 2009, doi: 10.5835/jecm.v24i3.14.
ISNAD Nural, Mehmet Selim et al. “Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular”. Journal of Experimental and Clinical Medicine 24/3 (December 2009), 103-106. https://doi.org/10.5835/jecm.v24i3.14.
JAMA Nural MS, Bayrak İ, Bayrak A, Nural M, Erdem Tilki H. Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular. J. Exp. Clin. Med. 2009;24:103–106.
MLA Nural, Mehmet Selim et al. “Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular”. Journal of Experimental and Clinical Medicine, vol. 24, no. 3, 2009, pp. 103-6, doi:10.5835/jecm.v24i3.14.
Vancouver Nural MS, Bayrak İ, Bayrak A, Nural M, Erdem Tilki H. Karpal Tünel Sendromunun Nadir Sebebi: Bifid Median Sinirde Ultrasonografik Bulgular. J. Exp. Clin. Med. 2009;24(3):103-6.