Article

BACKGROUND: To date, there have been conflicting suggestions regarding the
initial pathogenesis of carpal tunnel syndrome (CTS). It has been characterized
as either inflammation of the median nerve caused by compression or
noninflammatory fibrosis of the subsynovial connective tissue (SSCT). OBJECTIVE:
To investigate the initial pathogenesis of CTS, we compared the deformation and
displacement of the median nerve in accordance with the electrophysiological
severity between patients with CTS (via the Bland scale) and healthy controls.
DESIGN: Cross-sectional, case-control study. SETTING: General teaching hospital,
rehabilitation unit. PATIENTS: Thirteen hands of 10 healthy participants and 39
hands of 27 patients with CTS were recruited and classified into 4 groups (stage
0-3) according to the severity of the electrodiagnostic test results. METHODS:
Ultrasound images of the median nerve in response to the wrist and finger motions
were analyzed. MAIN OUTCOME MEASURE: We measured the deformation of the median
nerve (the maximal change values of the median nerve area, and aspect ratio of
the minimum-enclosing rectangle [MER]) and movement of the median nerve (the
maximal change value of the median nerve displacement) in response to the motions
of wrists and finger. The maximal change value of the median nerve displacement
was normalized with respect to the width of the wrist. Moreover, the maximal
change values of the median nerve area, and the aspect ratio of the MER, were
also normalized to the median nerve area and the aspect ratio of the MER in
wrist-neutral position with finger extension. RESULT: CTS patients in stage 3
showed a significantly lower normalized maximal change of the median nerve
movement compared with CTS patients in stages 0, 1, and 2 (P <.001). Regarding
the deformation of the median nerve, however, there were statistically
significant differences among all groups (area, P < .001; MER, P <.001).
According to multivariate logistic regression analysis, the normalized maximal
change of the aspect ratio of the MER is a meaningful parameter in diagnosing the
initial stage of CTS (P < .01). CONCLUSION: These results showed that the
deformation of the median nerve may be associated with the initial pathogenesis;
however, further studies are necessary to validate the findings of this study.
LEVEL OF EVIDENCE: III.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS