Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release

Seung-Joo Lee; Ji-Sup Kim; Yun-Rak Choi; Sung-Jun Kim; Ho-Jung Kang

doi:10.4055/jkoa.2013.48.4.290

Journal List > J Korean Orthop Assoc > v.48(4) > 1013240

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Lee, Kim, Choi, Kim, and Kang: Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(4): 290-296.

Published online: 28 August 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.4.290

Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release

Seung-Joo Lee, M.D., Ji-Sup Kim, M.D., Yun-Rak Choi, M.D., Sung-Jun Kim, M.D.^*, Ho-Jung Kang, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

^*Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Ho-Jung Kang, M.D. Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. TEL: +82-2-2019-3410, FAX: +82-2-573-5393, KANGHO56@yuhs.ac

Received 15 February 2013 Revised 28 April 2013 Accepted 16 May 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate cross-sectional area of the median nerve using ultrasound in patients with carpal tunnel syndrome before and after endoscopic intervention, and to verify the level at which it can be used in prediction of outcome.

Materials and Methods

A prospective study was conducted in 21 patients who underwent endoscopic carpal tunnel release from March 2011 to March 2012. Median nerve cross-sectional area was measured before the operation and three months after the operation at the level of lunate, pisiform and hamate. The Boston questionnaire was evaluated before the operation and three months after the operation, and then allocated as two groups (group I: symptom improvement of more than 25%, group II: symptom improvement less than 25%). Then, differences of cross-sectional area between preoperative measurement and postoperative measurement on three levels were compared between the two groups.

Results

Nineteen patients were females and two were males ranging in age between 35-79 years (mean, 55.4 years). Significant differences were observed between the two groups at the lunate level. However, at the level of pisiform and hamate, no differences were observed between the two groups.

Conclusion

Measurement of median nerve cross-sectional area at the lunate level showed significant correlation with outcome of carpal tunnel release.

Keywords: carpal tunnel release, cross-sectional area, outcome, ultrasonography

Figures and Tables

Figure 1

Ultrasonographic measurement of median nerve (white arrow, circle) cross-sectional area at three different levels. (A) Lunate (L) level, (B) pisiform (P) level, (C) hamate (H) level.

Table 1

Patient Data

^*Based on classification of Stevens.12) EMG, electromyography; NCV, nerve conduction velocity; M, male; F, female; Rt, right; Lt, left.

Table 2

Baseline Characteristics of 21 Patients

Values are presented as number or mean±standard deviation.

Table 3

Ultrasonographic Data of Median Nerve Cross-Sectional Area (CSA) before and after the Operation at Three Different Levels

Values are presented as mean±standard deviation.

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