Ultrasonographic Assessment of the Safe Zone for Carpal Tunnel Intervention: A Comparison Between Healthy Individuals and Patients With Carpal Tunnel Syndrome

Objective@#To compare transverse and longitudinal safe zones using ultrasonography between healthy individuals and patients with carpal tunnel syndrome (CTS). @*Methods@#This was a prospective observational case-control study. Forty wrists from 20 healthy individuals and 40 wrists from 24 patients with CTS were examined. Patients with CTS were classified into three groups (mild, moderate, and severe CTS) based on electrodiagnostic findings. Using ultrasonography, we measured the distance between the median nerve and ulnar vessels to identify the transverse safe zone, and between the distal flexor retinaculum and superficial palmar artery arch to identify the longitudinal safe zone. @*Results@#The transverse and longitudinal safe zones were significantly different between participants with CTS and those without CTS. The transverse safe zone significantly differed between the mild and severe CTS groups, while the longitudinal safe zone was not significantly different between the groups. The cross-sectional area of the median nerve negatively correlated with the transverse and longitudinal safe zones. @*Conclusion@#Transverse and longitudinal safe zones were narrower in patients with CTS than in the healthy group. A significant difference was observed between patients with mild CTS and those with severe CTS. Furthermore, the cross-sectional area of the median nerve was directly proportional to the degree of narrowing of the transverse and longitudinal safe zones.

Scale-attentional U-Net for the segmentation of the median nerve in ultrasound images

Purpose@#The aim of this study was to develop a neural network that accurately and effectively segments the median nerve in ultrasound (US) images. @*Methods@#In total, 1,305 images of the median nerve of 123 normal subjects were used to train and evaluate the model. Four datasets from two measurement regions (wrist and forearm) of the nerve and two US machines were used. The neural network was designed for high accuracy by combining information at multiple scales, as well as for high efficiency to prevent overfitting. The model was designed in two parts (cascaded and factorized convolutions), followed by selfattention over scale and channel features. The precision, recall, dice similarity coefficient (DSC), and Hausdorff distance (HD) were used as performance metrics. The area under the receiver operating characteristic curve (AUC) was also assessed. @*Results@#In the wrist datasets, the proposed network achieved 92.7% and 90.3% precision, 92.4% and 89.8% recall, DSCs of 92.3% and 89.7%, HDs of 5.158 and 4.966, and AUCs of 0.9755 and 0.9399 on two machines. In the forearm datasets, 79.3% and 87.8% precision, 76.0% and 85.0% recall, DSCs of 76.1% and 85.8%, HDs of 5.206 and 4.527, and AUCs of 0.8846 and 0.9150 were achieved. In all datasets, the model developed herein achieved better performance in terms of DSC than previous U-Net-based systems. @*Conclusion@#The proposed neural network yields accurate segmentation results to assist clinicians in identifying the median nerve.

Is Palmar Cutaneous Branch of the Median Nerve More Swollen in Carpal Tunnel Syndrome?

Objective@#To investigate the characteristics of the palmar cutaneous branch of the median nerve (PCBMN) in patient with carpal tunnel syndrome (CTS) using high-resolution ultrasound. @*Methods@#Fourteen healthy volunteers (17 wrists) and 31 patients with CTS (41 wrists) were evaluated by high-resolution ultrasound. All patients were classified into three groups based on the electrophysiologic CTS impairment severity: mild, moderate, and severe. Using high-resolution ultrasound, the cross-sectional areas (CSAs) of the PCBMN were measured at the proximal wrist crease, bistyloid line, and distal wrist crease, and the largest CSA was defined as the maximal CSA. @*Results@#The maximal CSA of the PCBMN of the control, mild, moderate, and severe CTS groups were 0.27±0.08, 0.30±0.07, 0.35±0.10, and 0.47±0.13 mm2, respectively. The maximal CSA of the PCBMN was significantly larger in the severe CTS group than in the other groups. @*Conclusion@#The PCBMN could be concomitantly affected in patients with severe CTS.

Is Abnormal Electrodiagnostic Finding Related to the Cross-Sectional Area of the Nerve Root in Cervical Radiculopathy?

Objective@#To assess the relevance of electrodiagnosis (EDX) in the cross-sectional area (CSA) of the nerve root of patients with cervical radiculopathy (CR) by using high-resolution ultrasonography (HRUS). @*Methods@#The CSAs of the cervical nerve roots at C5, C6, and C7 were measured bilaterally using HRUS in 29 patients with unilateral CR whose clinical symptoms, magnetic resonance imaging (MRI) findings, and EDX @*results@#corresponded with each other (CR-A group), and in 26 patients with unilateral CR whose clinical symptoms and MRI findings matched with each other but did not correspond with the EDX findings (CR-B group). Results The CSA of the affected side in each nerve root was significantly larger than that of the unaffected side in both the CR-A and CR-B groups. The side-to-side difference in the bilateral CSAs of the nerve root and the ratio of the CSAs between the unaffected and affected sides were statistically larger in the CR-A group than in the CR-B group. @*Conclusion@#The increased CSAs in the CR-A group reflect the physiological changes of the cervical nerve root, which is supported by the EDX findings.

Is Palmar Cutaneous Branch of the Median Nerve More Swollen in Carpal Tunnel Syndrome?

Objective@#To investigate the characteristics of the palmar cutaneous branch of the median nerve (PCBMN) in patient with carpal tunnel syndrome (CTS) using high-resolution ultrasound. @*Methods@#Fourteen healthy volunteers (17 wrists) and 31 patients with CTS (41 wrists) were evaluated by high-resolution ultrasound. All patients were classified into three groups based on the electrophysiologic CTS impairment severity: mild, moderate, and severe. Using high-resolution ultrasound, the cross-sectional areas (CSAs) of the PCBMN were measured at the proximal wrist crease, bistyloid line, and distal wrist crease, and the largest CSA was defined as the maximal CSA. @*Results@#The maximal CSA of the PCBMN of the control, mild, moderate, and severe CTS groups were 0.27±0.08, 0.30±0.07, 0.35±0.10, and 0.47±0.13 mm2, respectively. The maximal CSA of the PCBMN was significantly larger in the severe CTS group than in the other groups. @*Conclusion@#The PCBMN could be concomitantly affected in patients with severe CTS.

Is Abnormal Electrodiagnostic Finding Related to the Cross-Sectional Area of the Nerve Root in Cervical Radiculopathy?

Objective@#To assess the relevance of electrodiagnosis (EDX) in the cross-sectional area (CSA) of the nerve root of patients with cervical radiculopathy (CR) by using high-resolution ultrasonography (HRUS). @*Methods@#The CSAs of the cervical nerve roots at C5, C6, and C7 were measured bilaterally using HRUS in 29 patients with unilateral CR whose clinical symptoms, magnetic resonance imaging (MRI) findings, and EDX @*results@#corresponded with each other (CR-A group), and in 26 patients with unilateral CR whose clinical symptoms and MRI findings matched with each other but did not correspond with the EDX findings (CR-B group). Results The CSA of the affected side in each nerve root was significantly larger than that of the unaffected side in both the CR-A and CR-B groups. The side-to-side difference in the bilateral CSAs of the nerve root and the ratio of the CSAs between the unaffected and affected sides were statistically larger in the CR-A group than in the CR-B group. @*Conclusion@#The increased CSAs in the CR-A group reflect the physiological changes of the cervical nerve root, which is supported by the EDX findings.

Clinical Value of Physical Examination and Electromyography in Acute and Chronic Lumbosacral Radiculopathy

Objective@#To investigate the diagnostic accuracy of two physical examinations (straight leg raise [SLR] and Bragard test) and electromyography (EMG) in patients with lumbosacral monoradiculopathy in acute and chronic state on confirmation of different diagnostic criteria (MRI vs MRI and diagnostic selective nerve root block [DSNRB]). Method: We identified 297 participants retrospectively from the departmental database. MRI evidence of L5 or S1 nerve root compression and a positive result in diagnostic SNRB served as reference standards. They were divided into two groups by the symptom duration: lasting more than 12 weeks in the chronic group and less than 12 weeks in the acute group. The diagnostic value of clinical tests and EMG were compared. @*Results@#The clinical tests (SLR and Bragard test) done in acute stage on detection by MRI and DSNRB had the highest sensitivity (68%) compared to the chronic stage (63%), but sensitivity was low (57%) on confirmation of MRI alone. However, there was no significant difference on sensitivity and specificity of EMG regardless of reference standards and symptom duration. Electromyography was a significant predictor of neuropathic abnormalities on both acute (OR, 6.3; 95% CI, 2.4 to 16.7; p＜0.01) and chronic (OR, 6.8; 95% CI, 2.9 to 16.3; p＜0.01). @*Conclusion@#In general, individual physical tests are easy to do and a combination of those tests could be a sensitive indicator of L5 or S1 radiculopathy.Furthermore, the use of provocation tests could provide useful information, especially in proceeding therapeutic selective nerve root block.

Clinical Value of Physical Examination and Electromyography in Acute and Chronic Lumbosacral Radiculopathy

Objective@#To investigate the diagnostic accuracy of two physical examinations (straight leg raise [SLR] and Bragard test) and electromyography (EMG) in patients with lumbosacral monoradiculopathy in acute and chronic state on confirmation of different diagnostic criteria (MRI vs MRI and diagnostic selective nerve root block [DSNRB]). Method: We identified 297 participants retrospectively from the departmental database. MRI evidence of L5 or S1 nerve root compression and a positive result in diagnostic SNRB served as reference standards. They were divided into two groups by the symptom duration: lasting more than 12 weeks in the chronic group and less than 12 weeks in the acute group. The diagnostic value of clinical tests and EMG were compared. @*Results@#The clinical tests (SLR and Bragard test) done in acute stage on detection by MRI and DSNRB had the highest sensitivity (68%) compared to the chronic stage (63%), but sensitivity was low (57%) on confirmation of MRI alone. However, there was no significant difference on sensitivity and specificity of EMG regardless of reference standards and symptom duration. Electromyography was a significant predictor of neuropathic abnormalities on both acute (OR, 6.3; 95% CI, 2.4 to 16.7; p＜0.01) and chronic (OR, 6.8; 95% CI, 2.9 to 16.3; p＜0.01). @*Conclusion@#In general, individual physical tests are easy to do and a combination of those tests could be a sensitive indicator of L5 or S1 radiculopathy.Furthermore, the use of provocation tests could provide useful information, especially in proceeding therapeutic selective nerve root block.

Could Ultrasound-Guided Stimulation of Sural Nerve Affect Nerve Conduction Study?

OBJECTIVE: To determine anatomical variation of the sural nerve (SN) by ultrasonography (US) and compare sensory nerve action potential (SNAP) of the SN obtained by a control method to that obtained with adjusted method using US. METHODS: Eighty legs of 40 healthy volunteers were enrolled. The location and formation of SN were investigated through US. Two methods of nerve conduction study (NCS) were then performed. In the control method, the cathode was placed 14 cm proximal to the lateral malleolus and the greatest SNAP amplitude was obtained by moving the cathode medially or laterally from just lateral to the calf-mid line. In adjusted NCS, the exact SN union site was stimulated in type 1. In other SN types, the stimulation was done directly over the nerve and the distance from the lateral malleolus was set to be 14 cm. RESULTS: It was found that 73.8% of the SNs were type 1, 22.5% were direct continuation of MSCN (type 2), and 3.8% were MSCN and LSCN without communicating (type 4). However, type 3 was not found. The union point in type 1 SN was 12.6±2.5 cm proximal to the lateral malleolus and 1.4±0.7 cm lateral to the calf-midline. After stimulation adjustment, SNAP amplitude in type 1 SN was significantly increased (20.7±5.5 μV vs. 27.1±6.7 μV). CONCLUSION: Anatomical variation of SN and its location were verified by US. US provides additional information for conducting sural NCS and helps obtain more accurate results.

Risk Assessment of Injury to Palmar Cutaneous Branch of the Median Nerve Using High-Resolution Ultrasound

OBJECTIVE: To evaluate the relationship between the palmar cutaneous branch of median nerve (PCBMN) and surrounding anatomical structures by using high-resolution ultrasound (HRUS) to assess the risk of PCBMN injury. METHODS: The PCBMN course and the characteristics of bilateral distal forearms and wrists of 30 healthy volunteers were identified. The distance between PCBMN and other anatomical structures at three different levels along its course were measured using HRUS. Moreover, the depth of PCBMN from skin and its cross-sectional area (CSA) were measured. RESULTS: HRUS showed the PCBMN in all subjects. PCBMN branched off from the radial aspect of the median nerve (MN) at 4.69±0.89 cm proximal to the bistyloid line (BSL) and extended radially toward the flexor carpi radialis (FCR) tendon. PCBMN was within the ulnar edge of FCR tendon sheath, and became more superficial and perforated the antebrachial fascia between the FCR tendon laterally and the palmaris longus (PL) tendon medially. PCBMN was located at 4.08±0.72 mm on the ulnar aspect of the FCR tendon and 4.78±0.36 mm radially on the PL tendon at BSL. At the distal wrist crease level, the PCBMN was located at 5.68±0.58 mm on the ulnar side of the FCR tendon. The PCBMN depth from skin at BSL and its branching point was 1.92±0.41 and 7.95±0.79 mm, respectively. The PCBMN CSA was 0.26±0.15 mm² at BSL. CONCLUSION: HRUS can be used to identify PCBMN and its relationship with other anatomical structures. Our data can be used to predict PCBMN location, and prevent complications associated with invasive procedures involving the wrist.

Predictive Variables for Sonographically Guided Corticosteroid Injection in Mild-to-Moderate Carpal Tunnel Syndrome

OBJECTIVE: To assess the predictive variables after sonographically guided corticosteroid injection in carpal tunnel syndrome. METHODS: A prospective, observational study was carried out on 25 wrists of 20 consecutive patients with carpal tunnel syndrome, confirmed by the American Association of Neuromuscular and Electrodiagnostic Medicine criteria, which includes clinical history, symptoms, and evidence of slowing of distal median nerve conduction. Visual analogue scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were asked to the patients before and 4 weeks after the procedure. On a basis of VAS difference before and after the procedure, we divided the patients into two groups: more than 50% of VAS improving (good response group) and less than 50% of VAS improving (poor response group). Also, nerve conduction studies and ultrasound evaluations were performed prior to sonographically guided corticosteroid injection and at 4 weeks after the procedure. The cross-sectional area (CSA) of median nerve at maximal swelling point around wrist was measured by manual tracing using ultrasonography. With assessments mentioned above, we tried to assess predictive variables for prognosis after sonographically guided corticosteroid injection in carpal tunnel syndrome. RESULTS: The CSA of median nerve at wrist measured before the procedure was significantly larger in good response group than in poor response group. Furthermore, the CSA of median nerve at wrist, symptom severity scale of BCTQ, motor/sensory latency and sensory amplitude were correlated with VAS improving. CONCLUSION: The CSA of median nerve at wrist is the strongest predictive value for sonographically guided corticosteroid injection in mild-to-moderate carpal tunnel syndrome.

Relation of Urinary Retention and Functional Recovery in Stroke Patients During Rehabilitation Program

OBJECTIVE: To investigate the relationship between urinary retention and short-term functional recovery in subacute stage after stroke. METHODS: The medical records of 94 patients admitted to the rehabilitation unit of Korea University Guro Hospital were reviewed retrospectively. The postvoid residual urine (PVR) was measured at least once a day using a bladder scan, and urinary retention (UR) was defined when the daily PVR volume consistently checked more than 100 mL. Clinical data and functional outcomes of patients in the rehabilitation ward were collected. Functional outcomes were measured using the Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Functional Ambulation Category (FAC) level, Fugl-Meyer Assessment (FMA), and Modified Barthel Index (MBI) at admission (or transfer) and discharge. The data of patients with and without urinary retention were compared and analyzed. RESULTS: Of the 94 participants, 25 patients were classified to the UR group and 69 were classified to the non-UR group. At the initial stage of rehabilitation, the scores of MMSE, BBS, FAC, MBI were significantly worse in the UR group (p<0.05). Both groups showed significant improvements of all functional outcomes after rehabilitation (p<0.05). The non-UR group showed more prominent recovery of BBS, FAC, MBI scores (p<0.05). CONCLUSION: Urinary retention in post-stroke patients is significantly related to the poor functional status at initial stage of rehabilitation, and also to poor recovery after rehabilitation.

Contrast Spread in the Superoposterior Approach of Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy

OBJECTIVE: To observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy. METHODS: Thirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection. The contrast spread was graded anteroposteriorly and vertically in the epidural space. The effect of SP TFESI was evaluated by proportional pain score reduction. RESULTS: Levels injected were L4-5 (n=20) and L5-S1 (n=11). Seventeen cases were lateral, and 14 were central herniated disc (HD). Baseline mean visual analog scale score was 6.23. Contrast dispersed dorsally in all the cases, and 45.2% cases showed a concurrent ventral spread. The proportion of the pain reduction after 2 weeks showed no difference between the two groups. In vertical spreading analysis, mean cephalic/caudal grades were 1.40/1.55 at L4-5 level and 1.73/1.64 at L5-S1 level. The HD location had no effect on contrast dispersion. CONCLUSION: In SP TFESI, ventral contrast spread did not guarantee a better effect; however, the extent of cephalic flow in ventral expansion group correlated with the proportion of pain reduction.

Clinical Usefulness of Long-term Application of Fentanyl Matrix in Chronic Non-Cancer Pain: Improvement of Pain and Physical and Emotional Functions

BACKGROUND: Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. METHODS: This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patient's response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. RESULTS: The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. CONCLUSIONS: The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.

Sonoanatomical Change of Phrenic Nerve According to Posture During Ultrasound-Guided Stellate Ganglion Block

OBJECTIVE: To evaluate the risk of phrenic nerve injury during ultrasound-guided stellate ganglion block (US-SGB) according to sonoanatomy of the phrenic nerve, and determine a safer posture for needle insertion by assessing its relationship with surrounding structure according to positional change. METHODS: Twenty-nine healthy volunteers were recruited and underwent ultrasound in two postures, i.e., supine position with the neck extension and head rotation, and lateral decubitus position. The transducer was placed at the anterior tubercle of the C6 level to identify phrenic nerve. The cross-sectional area (CSA), depth from skin, distance between phrenic nerve and anterior tubercle of C6 transverse process, and the angle formed by anterior tubercle, posterior tubercle and phrenic nerve were measured. RESULTS: The phrenic nerve was clearly identified in the intermuscular fascia layer between the anterior scalene and sternocleidomastoid muscles. The distance between the phrenic nerve and anterior tubercle was 10.33±3.20 mm with the supine position and 9.20±3.31 mm with the lateral decubitus position, respectively. The mean CSA and skin depth of phrenic nerve were not statistically different between the two positions. The angle with the supine position was 48.37°±27.43°, and 58.89°±30.02° with the lateral decubitus position. The difference of angle between the two positions was statistically significant. CONCLUSION: Ultrasound is a useful tool for assessing the phrenic nerve and its anatomical relation with other cervical structures. In addition, lateral decubitus position seems to be safer by providing wider angle for needle insertion than the supine position in US-SGB.

Shoulder Manipulation After Distention Arthrography: Does Audible Cracking Affect Improvement in Adhesive Capsulitis? A Preliminary Study

OBJECTIVE: To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder. METHODS: A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention. RESULTS: The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05). CONCLUSION: These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Conduction Study

OBJECTIVE: To verify the utility of the lateral femoral cutaneous nerve (LFCN) ultrasound-guided conduction technique compared to that of the conventional nerve conduction technique. METHODS: Fifty-eight legs of 29 healthy participants (18 males and 11 females; mean age, 42.7+/-14.9 years) were recruited. The conventional technique was performed bilaterally. The LFCN was localized by ultrasound. Cross-sectional area (CSA) of the LFCN and the distance between the anterior superior iliac spine (ASIS) and the LFCN was measured. The nerve conduction study was repeated with the corrected cathode location. Sensory nerve action potential (SNAP) amplitudes of the LFCN were recorded and compared between the ultrasound-guided and conventional techniques. RESULTS: Mean body mass index of the participants was 23.7+/-3.5 kg/m2, CSA was 4.2+/-1.9 mm2, and the distance between the ASIS and LFCN was 5.6+/-1.7 mm. The mean amplitude values were 6.07+/-0.52 microV and 6.66+/-0.54 microV using the conventional and ultrasound-guided techniques, respectively. The SNAP amplitude of the LFCN using the ultrasound-guided technique was significantly larger than that recorded using the conventional technique. CONCLUSION: Correcting the stimulation position using the ultrasound-guided technique helped obtain increased SNAP amplitude.

Correlation between Ultrasonography Findings and Electrodiagnostic Severity in Carpal Tunnel Syndrome: 3D Ultrasonography

BACKGROUND AND PURPOSE: To determine the correlation between the cross-sectional area (CSA) of the median nerve measured at the wrist using three-dimensional (3D) ultrasonography (US) and the electrophysiological severity of carpal tunnel syndrome (CTS). METHODS: We prospectively examined 102 wrists of 51 patients with clinical CTS, which were classified into 3 groups according to the electrodiagnostic (EDX) findings. Median nerve CSAs were measured using 3D US at the carpal tunnel inlet and at the level of maximal swelling. RESULTS: Ten wrists were negative for CTS. Of the 92 CTS-positive wrists, 23, 30, and 39 were classified as having mild, moderate, and severe CTS, respectively. The median nerve CSA differed significantly between the severe- and moderate-CTS groups (p=0.0007 at the carpal tunnel inlet and p<0.0001 at the maximal swelling site). There was a correlation between median nerve CSA and EDX parameters among those wrists with severe and mild CTS (p<0.0001 at both sites). CONCLUSIONS: The median nerve CSA as measured by 3D US could provide additional information about the severity of CTS, as indicated by the strong correlation with standard EDX findings.

Sonographic Evaluation of the Peripheral Nerves in Hereditary Neuropathy With Liability to Pressure Palsies: A Case Report

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominantly inherited disorder that affects peripheral nerves by repeated focal pressure. HNPP can be diagnosed by clinical findings, electrodiagnostic studies, histopathological features, and genetic analysis. Ultrasonography is increasingly used for the diagnosis of neuromuscular diseases; however, sonographic features of HNPP have not been clearly defined. We report the sonographic findings and comparative electrodiagnostic data in a 73-year-old woman with HNPP, confirmed by genetic analysis. The cross-sectional areas of peripheral nerves were enlarged at typical nerve entrapment sites, but enlargement at non-entrapment sites was uncommon. These sonographic features may be helpful for diagnosis of HNPP when electrodiagnostic studies are suspicious of HNPP and/or gene study is not compatible.

Lofgren's Syndrome-Acute Onset Sarcoidosis and Polyarthralgia: A Case Report

Lofgren's syndrome is an acute form of sarcoidosis characterized by erythema nodosum, bilateral hilar lymphadenopathy (BHL), and polyarthralgia or polyarthritis. This syndrome is common among Caucasians but rare in the Korean population. A 44-year-old woman was admitted to our hospital complaining of polyarthralgia. A chest radiograph revealed BHL and nodular shadows. Angiotensin-converting enzyme levels were within the normal range. Tissue biopsy from a mediastinum lymph node showed noncaseating granulomas. We diagnosed her with Lofgren's syndrome, an acute form of sarcoidosis.