Ultrasonographic median nerve cross-section areas measured by 8-point "inching test" for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms.
Ultrasonographic median nerve cross-section areas measured by 8-point "inching test" for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms.
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DOI：
10.1186/1471-2342-11-22
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发表时间：
2011-12-21
影响因子：
2.7
通讯作者：
Chang WN
中科院分区：
文献类型：
--
作者：
Chen SF;Lu CH;Huang CR;Chuang YC;Tsai NW;Chang CC;Chang WN
在腕部的正中神经感觉传导的递增手掌刺激，即“微动试验”，提供了参考卡压的近端和远端节段的评估。本研究使用高分辨率超声（US）测量正中神经的横截面积（CSA），如“微动试验”，并与神经传导研究（NCS）的腕管综合征（CTS）的严重程度和持续时间相关。招募了来自135名CTS患者的212名“CTS手”和来自25名对照个体的50名无症状手（“A手”）。在微动试验中，在标记为i4、i3、i2、i1、w、o 1、o2和o3的8个点测量正中神经CSA。根据运动和感觉反应将NCS严重程度分为六组（即，阴性、极轻微、轻度、中度、重度和极端）。在NCS严重程度和临床CTS症状持续时间方面比较了美国研究的结果。NCS阴性的“CTS手”组CSA显著大于“A手”组。NCS阴性CTS组的CSA在入口、腕部折痕和出口处的截止值分别为12.5 mm 2、11.5 mm 2和10.1 mm 2。在212例“CTS手”中，32例为NCS阴性，40例为极轻度，43例为轻度，85例为中度，10例为重度，2例为极重度NCS。“CTS手”的CSA与不同NCS严重程度和CTS症状持续时间呈正相关。按临床症状持续时间划分，212例“CT手”中1个月组12例，>1个月≤12个月组82例，>12个月组118例。在“微动试验”中，i4-i3和i3-i2段是最常见的“阳性部位”。在i4和i3处测量的相应CSA（但不在i2处）显著大于在非“阳性部位”的点处测量的CSA。采用类似于“微动试验”的正中神经入口至出口8点测量CSA与NCS严重程度和CTS临床症状持续时间呈正相关，并能提供更多的解剖学变化信息。使用8点测量的NCS和US联合研究可能比单独NCS诊断CTS的阳性率更高。
Incremental palmar stimulation of the median nerve sensory conduction at the wrist, the "inching test", provides an assessment with reference to segments proximal and distal to the entrapment. This study used high-resolution ultrasonography (US) to measure the median nerve's cross-section areas (CSAs) like the "inching test" and to correlate with the nerve conduction study (NCS) severity and duration of carpal tunnel syndrome (CTS). Two hundred and twelve (212) "CTS-hands" from 135 CTS patients and 50 asymptomatic hands ("A-hands") from 25 control individuals were enrolled. The median nerve CSAs were measured at the 8-point marked as i4, i3, i2, i1, w, o1, o2, and 03 in inching test. The NCS severities were classified into six groups based on motor and sensory responses (i.e., negative, minimal, mild, moderate, severe, and extreme). Results of US studies were compared in terms of NCS severity and duration of clinical CTS symptoms. There was significantly larger CSA of the NCS negative group of "CTS-hands" than of "A-hands". The cut-off values of the CSAs of the NCS negative CTS group were 12.5 mm2, 11.5 mm2 and 10.1 mm2 at the inlet, wrist crease, and outlet, respectively. Of the 212 "CTS-hands", 32 were NCS negative while 40 had minimal, 43 mild, 85 moderate, 10 severe, and two extreme NCS severities. The CSAs of "CTS-hands" positively correlated with different NCS severities and with the duration of CTS symptoms. By duration of clinical symptoms, 12 of the 212 "CTS-hands" were in the 1 month group; 82 in >1 month and ≤12 months group, and 118 in >12 months group. In "inching test", segments i4-i3 and i3-i2 were the most common "positive-site". The corresponding CSAs measured at i4 and i3, but not at i2, were significantly larger than those measured at points that were not "positive-site". Using the 8-point measurement of the median nerve CSA from inlet to outlet similar to the "inching test" has positive correlations with NCS severity and duration of CTS clinical symptoms, and can provide more information on anatomic changes. Combined NCS and US studies using the 8-point measurement may have a higher positive rate than NCS alone for diagnosing CTS.