Prospective Evaluation of Median Nerve Cross-Sectionall Area and Power Doppler Signal Changes in Patients With Carpal Tunnel Syndrome
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-Summary
This prospective cohort study aims to evaluate median nerve cross-sectional area and intraneural vascularity using power Doppler ultrasonography in patients with carpal tunnel syndrome. Ultrasonographic findings will be compared between diabetic and non-diabetic patients. Clinical severity and electrophysiological findings will be correlated with ultrasonographic parameters.
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+Arms and interventions
- Doppler ultrasound (Diagnostic test): The predictive power of cross-sectional area and intraneural blood flow measured by ultrasound on surgical outcomes will be tested.
+Outcome measures
Primary outcomes
- Intraneural Vascularity [Baseline]: Intraneural blood flow will be evaluated using power Doppler ultrasonography at the level of the carpal tunnel inlet. The presence and degree of intraneural vascularity will be graded using a semi-quantitative scoring system:
0 = No detectable intraneural flow
1. = Single vessel signal
2. = Multiple vessel signals
3. = Marked hypervascularity
The total score ranges from 0 to 3. Higher scores indicate increased intraneural vascularity.
- Cross sectional Area [baseline]: The cross-sectional area of the median nerve will be measured using ultrasonography at the level of the pisiform bone (carpal tunnel inlet) and proximal to transvers carpal ligament. Measurements will be obtained by tracing the inner border of the hyperechoic epineurium.
Values will be recorded in square millimeters (mm²). Higher values indicate greater nerve swelling.
Secondary outcomes
- Boston Carpal Tunnel Questionnaire [Baseline, 3th and 6th months]: Change in Symptom Severity Score of the Boston Carpal Tunnel Questionnaire The Boston Carpal Tunnel Questionnaire is a patient-reported outcome measure consisting of 11 questions assessing symptom severity. Each item is scored from 1 (no symptoms) to 5 (most severe symptoms). The total score ranges from 11 to 55. Higher scores indicate worse symptom severity.
+Eligibility
Sex: All, ages: 18 Years to 75 Years
Inclusion Criteria:
* clinically and electrophysiologically confirmed carpal tunnel syndrome
* symptom duration > 3 months
* written informed consent
Exclusion Criteria:
* previous wrist surgery
* cervical radiculopathy
* inflammatory arthritis
* pregnancy
+Publications
- Erickson M, Lawrence M, Lucado A. The role of diagnostic ultrasound in the examination of carpal tunnel syndrome: an update and systematic review. J Hand Ther. 2022 Apr-Jun;35(2):215-225. doi: 10.1016/j.jht.2021.04.014. Epub 2021 Apr 14. PMID 34261588