Ultrasound of Carpal Tunnel Syndrome

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In this radiology lecture, we review the ultrasound appearance of carpal tunnel syndrome! • Key teaching points include: • 1) Carpal tunnel syndrome results from median nerve compression and is the most common upper extremity entrapment neuropathy. • 2) With carpal tunnel syndrome, see hypoechoic enlargement of the median nerve as enters carpal tunnel with flattening of nerve = Notch sign, also volar bowing of flexor retinaculum. • 3) Median nerve area: Less than 8 mm2 = Normal; 8-12 mm2 = Borderline; greater than 12 mm2 = Abnormal. • 4) Most accurate to compare nerve area at proximal pronator quadratus muscle and carpal tunnel: Increase of 2 mm2 or more from proximal to distal = 99% sensitive and 100% specific for carpal tunnel syndrome. Measure inside the echogenic epineurium. • 5) Bifid median nerve: Normal variant in 15% of population, one trunk may take aberrant course through flexor digitorum superficialis musculature, and often associated with persistent median artery between the two trunks. • 6) Important to recognize persistent median artery pre-operatively due to potential injury. • 7) For diagnosis of carpal tunnel syndrome with bifid median nerve: Combined increase of 4 mm2 or more. • 8) After carpal tunnel release surgery, median nerve may return to normal diameter or remain enlarged regardless of clinical outcome. Retinaculum may appear thickened or disrupted. • 9) Carpal tunnel syndrome can be caused by extrinsic compression by a mass, ganglion cyst, or tenosynovitis. • Reference: Klauser AS, Halpern EJ, De Zordo T, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171-177. • To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-pr... • Click the YouTube Community tab or follow on social media for bonus teaching material posted throughout the week! • Website: https://Radquarters.com/ • Spotify Video Podcast: https://spoti.fi/462r0F2 • Apple Video Podcast: https://apple.co/3ZhHuGu • Instagram: / radquarters • Facebook: / radquarters • Twitter: / radquarters • Reddit: / radiologisthq

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