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Ultrasound Findings of the Median Nerve Following Carpal Tunnel Release
Jack Buchan, MD; Sophia Le, BS; Jonas Keller, BS; Phil Ross, MD
University of Cincinnati, Cincinnati, OH
Introduction Much of the literature surrounding ultrasound and carpal tunnel syndrome(CTS) has focused on the diagnostic capabilities of ultrasound. Previous studies have shown that in CTS ultrasound can have equal sensitivity to electrodiagnostic studies. However, the primary aim of this study was to follow the recovery of the median nerve after a carpal tunnel release with ultrasound. Our hypothesis was that the ultrasound findings of the median nerve would reliably improve following a carpal tunnel release and that improvement of ultrasound findings would correlate with patient reported outcomes.
Materials and MethodsThis is a prospective observational study. Patients undergoing a primary open carpal tunnel release and who have electrodiagnostic findings consistent with CTS are eligible for enrollment. Ultrasound parameters measured included the cross sectional area(CSA) of the median nerve at the proximal wrist flexion crease and the wrist-forearm ratio(WFR). These were measured pre-operatively and then again at two weeks and three months post operatively. A median nerve CSA>11mm
2 or a WFR>1.4 was considered diagnostic of CTS. Patient reported outcomes measures collected included the Boston Carpal tunnel questionnaire and PROMIS-UE.
Results For the 33 patients(34 wrists) enrolled to date the average preoperative CSA was found to be 14.0±3.6mm
2. Four patients with clinical CTS (12%) were found to have a CSA<11mm
2 and seven patients (21%) had a WFR<1.4 which would not be considered diagnostic of CTS. 14 patients have 3 months of follow up and were found to have a significant decrease in the CSA of the median nerve (12.0±4.0mm
2). WFR was not found to be significantly decreased. No correlation has been found between patient reported outcome scores at 3 months, either PROMIS-UE or BCTQ, and pre or post-operative ultrasound parameters.
Conclusions - Consistent with previous reports there appears to be a significant decrease in the post operative CSA of the median nerve following a carpal tunnel release, however it does not appear that by 3 months the CSA returns to what would be considered "normal”.
- The WFR does not appear to correlate as directly as the CSA and was not found to significantly decrease following a CTR.
- In contrast to previous studies, our preliminary results show no link between ultrasound findings with patient reported outcomes .
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