Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome

Authors, Editors, Case Information Author: Charis Hoppe, BSc Affiliation: University of California, San Francisco (UCSF) Co Author(s): William Berrigan, M.D. Senior Editor: Laura Mattson, DO Clinical Vignette: A 45-year-old female presented with intermittent numbness of the left hand in digits 1-3, worse at night, without significant weakness. Type of Probe Used: 2-14 Linear, RS85 Unlabeled Short Axis View of the Left Median Nerve at the Carpal Tunnel Inlet Unlabeled Short Axis View of the Left Carpal Tunnel Inlet Labeled Short Axis View of the Left Median Nerve at the Carpal Tunnel Inlet Labeled Short Axis View of the Left Carpal Tunnel Inlet. The median nerve is seen in short axis in the middle of the screen, with the cross sectional area measuring approximately 17mm2. Unlabeled Long Axis View of the Left Median Nerve at the Carpal Tunnel Inlet Unlabeled Long Axis View of the Left Carpal Tunnel Inlet Labeled Long Axis View of the Left Median Nerve at the Carpal Tunnel Inlet Labeled Long Axis View of the Left Carpal Tunnel Inlet. The median nerve is seen in long axis, crossing under the transverse carpal ligament (TCL) with the flexor tendons seen just deep to the nerve. The nerve appears widened/enlarged proximal to the ligament and tapered/narrowed as it crosses under the TCL. Interpretation Image Interpretation: The median nerve is hypoechoic and enlarged in appearance, measuring approximately 17mm2 at the wrist crease. The flexor tendons are normal in appearance without tear or evidence of tenosynovitis. Normal appearing Guyon's canal. Ultrasound findings are compatible with a clinical diagnosis of carpal tunnel syndrome. Teaching Pearl: Median nerve ultrasound is one evidence-based diagnostic tool for carpal tunnel syndrome. The most common measurement is median nerve cross-sectional area at the carpal tunnel inlet, with supportive findings including nerve hypoechogenicity, nerve flattening in the tunnel, reduced nerve mobility, and palmar bowing of the flexor retinaculum. Ultrasound can be both diagnostic and etiologic. It can identify tenosynovitis, a ganglion, a persistent median artery, masses, an anomalous muscle, or marked nerve enlargement suggesting atypical disease. Results should be interpreted with symptoms, physical examination, and electrodiagnostic testing when needed. References: 1. Cartwright MS, Hobson-Webb LD, Boon AJ, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012;46(2):287-293. doi:10.1002/mus.23389 2. Pelosi L, Arányi Z, Beekman R, et al. Expert consensus on the combined investigation of carpal tunnel syndrome with electrodiagnostic tests and neuromuscular ultrasound. Clin Neurophysiol. 2022;135:107-116. doi:10.1016/j.clinph.2021.12.012 3. Bianchi S, Hoffman DF, Tamborrini G, Poletti PA. Ultrasound findings in less frequent causes of carpal tunnel syndrome. J Ultrasound Med. 2020;39(12):2469-2482. doi:10.1002/jum.15349
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Left Median Nerve at the Carpal Tunnel Inlet

Labeled Short Axis View of the Left Median Nerve at the Carpal Tunnel Inlet

Unlabeled Long Axis View of the Left Median Nerve at the Carpal Tunnel Inlet

Labeled Long Axis View of the Left Median Nerve at the Carpal Tunnel Inlet

Interpretation

UPCOMING EVENTS

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