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Anatomic Variations Within The Carpal Tunnel Identified By Ultrasound In Patients With Carpal Tunnel Syndrome
Mohammad S Kahrizi, M.D., Chelcy B Heck, P.A.-C., Raul A Rosario-Concepcion, M.D., Wesley D Troyer, D.O.; Keith T Aziz, M.D.
Mayo Clinic Florida, Jacksonville, FL
INTRODUCTION: Carpal tunnel syndrome (CTS) is one of the most common upper extremity pathologies encountered. Recent literature has demonstrated the utility of peripheral nerve ultrasound in diagnosing carpal tunnel syndrome. There are several anatomic variations within the carpal tunnel that have been described, and the presence of these anatomic variations may impact the planned approach for performing carpal tunnel release. The purpose of this study is to confirm that anatomic variations can be identified by ultrasonographic evaluation of the carpal tunnel, and characterize the prevalence of anatomic variations identified by ultrasound in patients with carpal tunnel syndrome.
MATERIALS AND METHODS: Patients who underwent peripheral nerve ultrasound for carpal tunnel syndrome at our institution from March 2023 to November 2024 were retrospectively identified. The ultrasound of each patient was reviewed, and the prevalence and presence of peripheral nerve anomalies within the carpal tunnel were recorded. Ultrasound was also used to measure median nerve cross-sectional area. Patient age, gender, laterality, median nerve diameter, and additional anatomic variations were assessed. Descriptive statistics were performed, as well as Chi-Square and regression analysis to determine correlations for anatomic differences. Statistical significance was set at p < 0.05.
RESULTS: A total of 113 wrists were analyzed, with 66 females (58.4%) and 47 males (41.6%). No significant association was found between gender and the presence of anatomical variations (p = 0.635). The overall mean median nerve cross-sectional area was 14.96 mm², with no significant gender difference (p = 0.418). Anatomical variations were observed in 30.1% of wrists, including bifid median nerve (15.93%), persistent median artery (9.73%), and their coexistence (8.85%). A Chi-Square test showed a significant association between bifid median nerve and persistent median artery (p < 0.001). Linear regression revealed a weak negative correlation between age and cross-sectional area (p = 0.023, R² = 0.047).
CONCLUSIONS: This study highlights the prevalence of ultrasonographically identified anatomic variations in patients with carpal tunnel syndrome. Variations, such as bifid median nerve and persistent median artery, were observed in 30.1% of cases, with a significant association between the two (p < 0.001). Our findings suggest that ultrasonographic evaluation can be used as an adjunctive tool to recognize anatomic variations in patients with carpal tunnel syndrome, and may be a useful adjunct for surgical planning and patient counseling.
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