Contribution of Ultrasonography and Magnetic Resonance Imaging to the Diagnosis of Carpal Tunnel Syndrome

Öz

Objective: The present study aimed to evaluate the contribution of ultrasonography (US) and magnetic resonance (MR) imaging to the diagnosis of patients diagnosed with carpal tunnel syndrome (CTS) based on clinical and electrodiagnostic studies.

Patients and Methods: A total of 41 wrists of 27 patients with positive findings in electromyography (EMG) studies performed due to a pre-diagnosis of CTS were included in the study to be examined by US and MR imaging. Patients with a history of wrist trauma, surgery, and steroid injection were excluded.

Results: The mean age of the cases was 46.1 years and 92.6% of the cases were female. Of the patients, 6 had right-sided, 7 had left-sided, and 14 had bilateral CTS. Primary and secondary findings that support CTS were detected by US and MR imaging in 90.2% and 92.7% of the 41 wrists, respectively. Moreover, degenerative cystic resorption of the carpal bones was detected in two, ganglion cyst was detected in one, and bifid median nerve was detected in one case.

Conclusion: US and MR imaging examinations in patients diagnosed with CTS based on clinical examination and/or electrodiagnostic studies are valuable in terms of both exhibiting the signs of median nerve injury and detecting concomitant anatomical and pathological conditions prior to the anticipated medical or surgical treatment.

Anahtar Kelimeler

• Carpal tunnel syndrome,median nerve entrapment neuropathy,ultrasonography,magnetic resonance imaging,electromyography

Karpal Tünel Sendromunda Ultrasonografi ve Manyetik Rezonans Görüntülemenin Tanıya Katkıları

Öz

Giriş: Çalışmada; klinik ve elektrodiagnostik inceleme sonucu karpal tünel sendromu (KTS) tanısı alan hastalarda ultrasonografi (US) ve manyetik rezonans (MR) görüntülemenin tanıya katkısını değerlendirmek amaçlanmıştır.

Hastalar ve Yöntem: KTS ön tanısı ile uygulanan elektromiyografi (EMG) incelemesi pozitif sonuçlanan 27 hastanın 41 el bileği, US ve MR ile tetkik edilmek üzere çalışmaya dahil edildi. El bileği bölgesini ilgilendiren geçirilmiş travma, operasyon ve steroid enjeksiyonu öyküsü olanlar çalışma dışı bırakıldı.

Bulgular: Olguların yaş ortalaması 46,1 yıl olup %92,6’sı kadındı. Tutulum olguların 6’sında sağ, 7’sinde sol ve 14’ünde bilateral idi. US ile 41 el bileğinin %90,2’sinde, MR ile %92,7’sinde KTS’yi destekleyecek primer ve sekonder bulgular saptandı. Ayrıca iki olguda karpal kemiklerde dejeneratif kistik rezorpsiyon, bir olguda ganglion kisti ve bir olguda bifid median sinir varyasyonu tespit edildi.

Sonuç: Klinik muayene ve/veya elektrodiagnostik tetkik ile KTS tanısı alan hastalarda US ve MR değerlendirmeleri; öngörülecek medikal veya cerrahi tedavi öncesinde gerek median sinirin hasarı ile ilişkili bulguları ortaya koyması gerekse yandaş anatomik ve patolojik durumları ortaya çıkarması yönünden yararlıdır.

Anahtar Kelimeler

• Karpal tünel sendromu,median sinir tuzak nöropatisi,ultrasonografi,manyetik rezonans görüntüleme,elektromiyografi

Kaynakça

1. 1. Middleton SD, Anakwe RE. Carpal tunnel syndrome. BMJ 2014;349:g6437.
2. 2. Dec P, Zyluk A. Bilateral carpal tunnel syndrome - A review. Neurol Neurochir Pol 2018;52(1):79-83.
3. 3. Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J 2012;6:69-76.
4. 4. Wipperman J, Goerl K. Carpal Tunnel Syndrome: Diagnosis and management. Am Fam Physician 2016;94(12):993-9.
5. 5. Sonoo M, Menkes DL, Bland JDP, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018;3:78-88.
6. 6. Steinbach LS, Smith DK. MRI of the wrist. Clin Imaging 2000;24(5):298-322.
7. 7. Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003;27(1):26-33.
8. 8. Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 2004;14(1):93-102, viii.

9. 9. Sears ED, Lu YT, Wood SM, Nasser JS, Hayward RA, Chung KC, Kerr EA. Diagnostic testing requested before surgical evaluation for carpal tunnel syndrome. J Hand Surg Am 2017;42(8):623-9.e1.
10. 10. Kim S, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, et al. Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 2007;17(2):509-22.
11. 11. Klauser AS, Faschingbauer R, Bauer T, Wick MC, Gabl M, Arora R, et al. Entrapment neuropathies II: carpal tunnel syndrome. Semin Musculoskelet Radiol 2010;14(5):487-500.
12. 12. Wilson D, Allen GM. Imaging of the carpal tunnel. Semin Musculoskelet Radiol 2012;16(2):137-45.
13. 13. Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C. Carpal tunnel syndrome: diagnosis with high-resolution sonography. AJR Am J Roentgenol 1992;159(4):793-8.
14. 14. Nakamichi K, Tachibana S. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve 2002;26(6):798-803.
15. 15. Georgiev GP, Karabinov V, Kotov G, Iliev A. Medical ultrasound in the evaluation of the carpal tunnel: a critical review. Cureus 2018;10(10):e3487.
16. 16. Lee CH, Kim TK, Yoon ES, Dhong ES. Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome. Ann Plast Surg 2005;54(1):20-3.
17. 17. Vahed LK, Arianpur A, Gharedaghi M, Rezaei H. Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome. Eur J Transl Myol 2018;28(2):7380.
18. 18. Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 2000;20 Spec No:S199-213; discussion S213-7.
19. 19. Petrover D, Hakime A, Silvera J, Richette P, Nizard R. Ultrasound-guided rurgery for carpal tunnel syndrome: a new interventional procedure. Semin Intervent Radiol 2018;35(4):248-254.
20. 20. Weiss KL, Beltran J, Shamam OM, Stilla RF, Levey M. High-field MR surface-coil imaging of the hand and wrist. Part I. Normal anatomy. Radiology 1986 160(1):143-6.
21. 21. Middleton WD, Kneeland JB, Kellman GM, Cates JD, Sanger JR, Jesmanowicz A, et al. MR imaging of the carpal tunnel: normal anatomy and preliminary findings in the carpal tunnel syndrome. AJR Am J Roentgenol. 1987;148(2):307-16.
22. 22. Bordalo-Rodrigues M, Amin P, Rosenberg ZS. MR imaging of common entrapment neuropathies at the wrist. Magn Reson Imaging Clin N Am 2004;12(2):265-79, vi.
23. 23. Kanaan N, Sawaya RA. Carpal tunnel syndrome: modern diagnostic and management techniques. Br J Gen Pract 2001;51(465):311-4.
24. 24. Bonél HM, Heuck A, Frei KA, Herrmann K, Scheidler J, Srivastav S, et al. Carpal tunnel syndrome: assessment by turbo spin echo, spin echo, and magnetization transfer imaging applied in a low-field MR system. J Comput Assist Tomogr 2001;25(1):137-45.
25. 25. Cudlip SA, Howe FA, Clifton A, Schwartz MS, Bell BA. Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression. J Neurosurg 2002;96(6):1046-51.
26. 26. Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Kliot M. Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1995;37(6):1097-103.
27. 27. Jarvik JG, Yuen E, Haynor DR, Bradley CM, Fulton-Kehoe D, Smith-Weller T, et al. MR nerve imaging in a prospective cohort of patients with suspected carpal tunnel syndrome. Neurology 2002;58(11):1597-602.
28. 28. Pasternack II, Malmivaara A, Tervahartiala P, Forsberg H, Vehmas T. Magnetic resonance imaging findings in respect to carpal tunnel syndrome. Scand J Work Environ Health 2003;29(3):189-96.
29. 29. Deniz FE, Oksüz E, Sarikaya B, Kurt S, Erkorkmaz U, Ulusoy H, ve ark. Comparison of the diagnostic utility of electromyography, ultrasonography, computed tomography, and magnetic resonance imaging in idiopathic carpal tunnel syndrome determined by clinical findings. Neurosurgery 2012;70(3):610-6.
30. 30. Hersh B, D'Auria J, Scott M, Fowler JR. A comparison of ultrasound and MRI measurements of the cross-sectional area of the median nerve at the wrist. Hand (N Y) 2018:1558944718777833.
31. 31. Keberle M, Jenett M, Kenn W, Reiners K, Peter M, Haerten R, et al. Technical advances in ultrasound and MR imaging of carpal tunnel syndrome. Eur Radiol 2000;10(7):1043-50.
32. 32. Iannicelli E, Chianta GA, Salvini V, Almberger M, Monacelli G, Passariello R. Evaluation of bifid median nerve with sonography and MR imaging. J Ultrasound Med 2000;19(7):481-5.