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Nerve Entrapment Syndromes

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Imaging of the Hand and Wrist

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Compressive neuropathies (CN) occur when peripheral nerves (PN) are exposed to long-standing excessive pressure (Bard and Lioté 2007; Blancher and Kubis 2007; Graif et al. 1991; Hobson-Webb et al. 2008; Silvestri et al. 1995; Stewart 1993). The chronic compression is responsible for local internal changes in the nerve leading to impaired nerve function and clinical findings reflecting on the nerve affected as well as the duration of compression.

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References

  • Aagaard BD, Maravilla KR, Kliot M (1998) MR neurography. MR imaging of peripheral nerves. Magn Reson Imaging Clin North Am 6:179–194

    CAS  Google Scholar 

  • Aleman L, Berna JD, Reus M et al (2008) Reproducibility of sonographic measurements of the median nerve. J Ultrasound Med 27:193–197

    PubMed  Google Scholar 

  • Ashraf AR, Jali R, Moghtaderi AR, Yazdani AH (2009) The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome. Electromyogr Clin Neurophysiol 49:3–8

    PubMed  CAS  Google Scholar 

  • Bard H, Lioté F (2007) Les syndromes canalaires vus en rhumatologie. Rev Rhum Fr Ed 74:315–433

    Article  Google Scholar 

  • Bayrak IK, Bayrak AO, Kale M et al (2008) Bifid median nerve in patients with carpal tunnel syndrome. J Ultrasound Med 27:1129–1136

    PubMed  Google Scholar 

  • Beekman R, Visser LH (2002) Sonographic detection of diffuse peripheral nerve enlargement in hereditary neuropathy with liability to pressure palsies. J Clin Ultrasound 30:433–436

    Article  PubMed  Google Scholar 

  • Beekman R, Visser LH (2004) High-resolution sonography of the peripheral nervous system—a review of the literature. Eur J Neurol 11:305–314

    Article  PubMed  CAS  Google Scholar 

  • Bianchi S, Martinoli C (eds) (2007) Ultrasound of the musculoskeletal system. Springer, Berlin

    Google Scholar 

  • Bianchi S, Martinoli C, Abdelwahab IF (1999) High-frequency ultrasound examination of the wrist and hand. Skeletal Radiol 28:121–129

    Article  PubMed  CAS  Google Scholar 

  • Bianchi S, Martinoli C, Sureda D et al (2001) Ultrasound of the hand. Eur J Ultrasound 14:29–34

    Article  PubMed  CAS  Google Scholar 

  • Bianchi S, Montet X, Martinoli C et al (2004) High-resolution sonography of compressive neuropathies of the wrist. J Clin Ultrasound 32:451–461

    Article  PubMed  Google Scholar 

  • Bianchi S, Demondion X, Bard H et al (2007) Ultrasound of the median nerve (Echographie du nerf médian). Rev Rhum Ed Fr 74:376–383

    Article  Google Scholar 

  • Blancher A, Kubis N (2007) Physiopathogenie des syndromes canalaires. In: Les syndromes canalaires vus en rhumatologie. Revue du Rhumatisme 74:319–326

    Article  Google Scholar 

  • Boutte C, Gaudin P, Grange L et al (2009) [Sonography versus electrodiagnosis for the diagnosis of carpal tunnel syndrome in routine practice]. Rev Neurol 165:460–465

    Article  PubMed  CAS  Google Scholar 

  • Buchberger W, Schon G, Strasser K et al (1991) High-resolution ultrasonography of the carpal tunnel. J Ultrasound Med 10:531–537

    PubMed  CAS  Google Scholar 

  • Buchberger W, Judmaier W, Birbamer G et al (1992) Carpal tunnel syndrome: diagnosis with high-resolution sonography. AJR Am J Roentgenol 159:793–798

    Article  PubMed  CAS  Google Scholar 

  • Chen P, Maklad N, Redwine M et al (1997) Dynamic high-resolution sonography of the carpal tunnel. AJR Am J Roentgenol 168:533–537

    Article  PubMed  CAS  Google Scholar 

  • Duncan I, Sullivan P, Lomas F (1999) Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol 173:681–684

    Article  PubMed  CAS  Google Scholar 

  • El Miedany Y, Ashour S, Youssef S et al (2008) Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. Joint Bone Spine 75:451–457

    Article  PubMed  Google Scholar 

  • Fornage BD (1988) Peripheral nerves of the extremities: imaging with US. Radiology 167:179–182

    PubMed  CAS  Google Scholar 

  • Gassner EM, Schocke M, Peer S et al (2002) Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med 21:455–461

    PubMed  Google Scholar 

  • Graif M, Seton A, Nerubali J et al (1991) Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations. Radiology 181:405–408

    PubMed  CAS  Google Scholar 

  • Hobson-Webb LD, Massey JM, Juel VC et al (2008) The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 119:1353–1357

    Article  PubMed  Google Scholar 

  • Iannicelli A, Chianta GA, Salvini V et al (2000) Evaluation of bifid median nerve with sonography and MR imaging. J Ultrasound Med 19:481–485

    PubMed  CAS  Google Scholar 

  • Iannicelli E, Almberger M, Chianta GA et al (2001) Bifid median nerve in the carpal tunnel: integrated imaging. Radiol Med 101:456–458

    PubMed  CAS  Google Scholar 

  • Jamadar DA, Jacobson JA, Hayes CW (2001) Sonographic evaluation of the median nerve at the wrist. J Ultrasound Med 20:1011–1014

    PubMed  CAS  Google Scholar 

  • Kaymak B, Ozcakar L, Cetin A et al (2008) A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome. Arch Phys Med Rehabil 89:743–748

    Article  PubMed  Google Scholar 

  • Kele H, Verheggen R, Reimers CD (2002) Carpal tunnel syndrome caused by thrombosis of the median artery: the importance of high-resolution ultrasonography for diagnosis. Case report. J Neurosurg 97:471–473

    Article  PubMed  Google Scholar 

  • Klauser AS, Halpern EJ, De Zordo T et al (2009) Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 250:171–177

    Article  PubMed  Google Scholar 

  • Kwon BC, Jung KI, Baek GH (2008) Comparison of sonography and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Hand Surg Am 33:65–71

    Article  PubMed  Google Scholar 

  • Lanzetta M, Foucher G (1993) Entrapment of the superficial branch of the radial nerve (Wartenberg’s syndrome). A report of 52 cases. Int Orthop 17:342–345

    Article  PubMed  CAS  Google Scholar 

  • Martinoli C, Serafini G, Bianchi S et al (1996) Ultrasonography of peripheral nerves. J Peripher Nerv Syst 1:169–178

    PubMed  CAS  Google Scholar 

  • Martinoli C, Bianchi S, Derchi LE (2000a) Ultrasonography of peripheral nerves. Semin US CT MR 21:205–213

    Article  CAS  Google Scholar 

  • Martinoli C, Bianchi S, Gandolfo N et al (2000b) US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 20(Spec No):S199–S213 Discussion S213-197

    PubMed  Google Scholar 

  • Martinoli C, Bianchi S, Cohen M et al (2005) Ultrasound of peripheral nerves. J Radiol 86:1869–1878

    Article  PubMed  CAS  Google Scholar 

  • Mondelli M, Filippou G, Gallo A (2008) Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome. Arthritis Rheum 59:357–366

    Article  PubMed  Google Scholar 

  • Padua L, Pazzaglia C, Caliandro P et al (2008) Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 119:2064–2069

    Article  PubMed  CAS  Google Scholar 

  • Patel N, Harvie P, Ostlere SJ Ultrasound of accessory muscles at the Guyon canal. Session 6 European Society of musculoskeletal radiology, IX Annual Meeting. Abstract book, p 156

    Google Scholar 

  • Peer S, Bodner G (eds) (2008) High-resolution sonography of the peripheral nervous system, 2nd edn. Berlin, Springer

    Google Scholar 

  • Peer S, Bodner G, Meirer R et al (2001) Examination of postoperative peripheral nerve lesions with high-resolution sonography. AJR 177:415–419

    Article  PubMed  CAS  Google Scholar 

  • Pinilla I, Martin-Hervas C, Sordo G et al (2008) The usefulness of ultrasonography in the diagnosis of carpal tunnel syndrome. J Hand Surg Eur Vol 33:435–439

    Article  PubMed  CAS  Google Scholar 

  • Propeck T, Quinn TJ, Jacobson JA et al (2000) Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation. AJR Am J Roentgenol 175:1721–1725

    Article  PubMed  CAS  Google Scholar 

  • Sernik RA, Abicalaf CA, Pimentel BF et al (2008) Ultrasound features of carpal tunnel syndrome: a prospective case-control study. Skeletal Radiol 37:49–53

    Article  PubMed  Google Scholar 

  • Silvestri E, Martinoli C, Derchi LE et al (1995) Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 197:291–296

    PubMed  CAS  Google Scholar 

  • Smith J, Wisniewski SJ, Finnoff JT et al (2008) Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med 27:1485–1490

    PubMed  Google Scholar 

  • Spratt JD, Stanley AJ, Grainger AJ et al (2002) The role of diagnostic radiology in compressive and entrapment neuropathies. Eur Radiol 12:2352–2364

    PubMed  CAS  Google Scholar 

  • Stewart JD (1993) Compression and entrapment neuropathies. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy, 3rd edn. WB Saunders, Philadelphia, pp 1354–1379

    Google Scholar 

  • Tagliafico A, Pugliese F, Bianchi S et al (2008) High-resolution sonography of the palmar cutaneous branch of the median nerve. AJR Am J Roentgenol 191:107–114

    Article  PubMed  Google Scholar 

  • Taleisnik J (1973) The palmar cutaneous branch of the median nerve and the approach to the carpal tunnel. An anatomical study. J Bone Joint Surg Am 55:1212–1217

    PubMed  CAS  Google Scholar 

  • Toms AP, Anastakis D, Bleakney RR et al (2006) Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients. AJR Am J Roentgenol 186:805–811

    Article  PubMed  Google Scholar 

  • Touborg-Jensen A (1970) Carpal-tunnel syndrome caused by an abnormal distribution of the lumbrical muscles. Case report. Scand J Plast Reconstr Surg 4:72–74

    Article  PubMed  CAS  Google Scholar 

  • Valle M, Zamorani MP (2007) Nerve and vessels. In: Bianchi S, Martinoli C (eds) Ultrasound of the musculoskeletal system. Springer, Berlin, Heidelberg, pp 97–136

    Chapter  Google Scholar 

  • van Holsbeeck M, Introcaso JH (eds) (2001) Musculoskeletal ultrasound. Chicago, Mosby

    Google Scholar 

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Author information

Authors and Affiliations

  1. CIM SA, Cabinet Imagerie Medicale, Route de Malagnou 40, 1208, Geneva, Switzerland

    Stefano Bianchi

  2. Struttura Complessa di Radiodiagnostica, Ospedale Galliera, Via Volta, 16128, Genoa, Italy

    Lucio Molini

  3. Cabinet de Rhumatologie, Rue de la Faïencerie 6, 1227, Carouge-Geneva, Switzerland

    Marie Claude Schenkel

  4. CH8, Cabinet de Chirurgie de la Main, Rue Charles Humbert 8, Geneva, Switzerland

    Thierry Glauser

Authors
  1. Stefano Bianchi
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  2. Lucio Molini
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  3. Marie Claude Schenkel
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  4. Thierry Glauser
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Corresponding author

Correspondence to Stefano Bianchi .

Editor information

Editors and Affiliations

  1. Royal Orthopaedic Hospital, MRI Centre, NHS Foundation Trust, Bristol Road South, Birmingham, B31 2AP, United Kingdom

    A. Mark Davies

  2. Chapel Allerton Hospital, Department of Radiology, Leeds Teaching Hospitals, Chapel Town Road, Leeds, LS4 7SA, United Kingdom

    Andrew J. Grainger

  3. Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom

    Steven J. James

Key Points

Key Points

  • US bone landmarks of the carpal tunnel

    • Radial side proximal: tubercle of the scaphoid (rounded)

    • Ulnar side proximal: pisiform (rounded)

    • Radial side distal: trapezium (flat)

    • Ulnar side distal: hook of the hamate (pointed)

  • US appearance in peripheral nerves entrapment

    • Nerve swollen and hypoechoic proximal to the entrapment site

    • Nerve thinned at the level of the entrapment

    • Nerve swollen and hypoechoic distal to the entrapment site (less common)

    • Internal vascular signals proximal to the entrapment site (less common)

  • Clinical utility of US in CTS

    • Confirm the clinical diagnosis by showing changes in the MN

    • Assess the cause of nerve compression

    • Illustrate normal anatomic variants that can modify the surgical approach

  • Most common complication after CT release

    • Incomplete resection of the transverse carpal ligament (endoscopic approach)

    • Local fibrosis with thickening of the transverse carpal ligament

    • Nerve injuries (bifid median nerve) (endoscopic approach)

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© 2013 Springer-Verlag Berlin Heidelberg

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Bianchi, S., Molini, L., Schenkel, M.C., Glauser, T. (2013). Nerve Entrapment Syndromes. In: Davies, A., Grainger, A., James, S. (eds) Imaging of the Hand and Wrist. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2010_111

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  • DOI: https://doi.org/10.1007/174_2010_111

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11143-3

  • Online ISBN: 978-3-642-11146-4

  • eBook Packages: MedicineMedicine (R0)

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