14/07/2023
Pathophysiology and pathomechanics is multifactorial: Increased intracarpal pressure Decreased MN mobility (from fibrous fixation) Median nerve deformation (ie, compression, stretching, traction) Increased stiffness of the synovium and flexor retinaculum Relative thenar muscle hypertrophy or increased thenar muscle mass with intrusion into the carpal tunnel Flexor tendon thickening and tightening during activity Carpal tunnel syndrome is a dynamic disease Neuro sonography is a valid accurate tool in evaluation of Carpal Tunnel Syndrome Dynamic sonography is valuable in assessment of a dynamic disease CTS US guided Hydrorelease is a new minimally invasive treatment option for CTS patients Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel Stefanie Evers, MD,1,4,5 Andrew R. Thoreson, MS,1 Jay Smith, MD,2 Chunfeng Zhao, MD,1 Jennifer R. Geske, MS,3 and Peter C. Amadio, MD1 Twelve fresh frozen human cadaver hands were used. Median nerve gliding resistance was measured at baseline and post-hydrodissection, by pulling the nerve proximally and then returning it to the origin. Six specimens were treated with hydrodissection, and 6 were used as controls. In the hydrodissection group there was a significant reduction in mean peak gliding resistance of 92.9 ± 34.8 mN between baseline and immediately post-hydrodissection (21.4% ± 10.5%, p= .001). No significant reduction between baseline and the second cycle occurred in the control group: 9.6 ± 29.8 mN (0.4% ± 5.3%, p= .467). https://www.ncbi.nlm.nih.gov/pmc/arti... 1.Dynamic Ultrasound A Useful Tool to Demonstrate Adhesions Postcarpal Tunnel Surgery Mei-Ting Wang 1, Yi-Chian Wang 1, Huey-Wen Liang 1, Geoffrey Sithamparapillai Samuel 2* https://www.sciencedirect.com/science...We suggest that the observation of the displacement of the MN during active finger movement can be integrated into the examination of carpal tunnel syndrome patients both before and after surgical intervention and herein include an easy to follow protocol for such examinations 2. ASSESSING THE RELIABILITY OF ULTRASOUND IMAGING TO EXAMINE PERIPHERAL NERVE EXCURSION: A SYSTEMATIC LITERATURE REVIEW Ben Kasehagen,* Richard Ellis,† Rodney Pope,* Nicholas Russell,* and Wayne Hing* * Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia; and † Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand The overall analysisindicated a “strong” level of evidence of moderate to high reliability of using USI to assess nerve excursion https://www.ncbi.nlm.nih.gov/pubmed/2... 3. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome Tai-Tzung Kuo1,2, Ming-Ru Lee1, Yin-Yin Liao1,3, Jiann-Perng Chen4, Yen-Wei Hsu5, Chih- Kuang Yeh1* The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for quantitatively estimating median nerve dysfunction in CTS patients https://www.ncbi.nlm.nih.gov/pubmed/2...
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Pathophysiology and pathomechanics is multifactorial: Increased intracarpal pressure Decreased MN mobility (from fibrous fixation) Median nerve deformation ...
