Diagnostic meta-analysis of the efficacy of ultrasonography for diagnosing carpal tunnel syndrome: A comparison between Asian and non-Asian populations.

BACKGROUND: Ultrasonography is used to diagnose carpal tunnel syndrome (CTS) according to various criteria. This diagnostic meta-analysis aimed to evaluate the efficacy of ultrasonography for diagnosing CTS, focusing on the cross-sectional area (CSA) of the median nerve (MN) at the inlet of the carpal tunnel and regional variations in diagnostic thresholds between Asian and non-Asian populations. METHODS: A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane Library. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Patient demographic data, diagnostic "gold standards", CSA cutoff values, and diagnostic results were extracted. Meta-analysis was performed to determine the sensitivity, specificity, and optimal CSA cutoff values. RESULTS: For the 25 included studies, a combined sensitivity of 88% and specificity of 84% for CSA measurements at the carpal tunnel inlet were obtained. The Asian group had a sensitivity of 84% and specificity of 86%, while the non-Asian group had a sensitivity of 91% and specificity of 82%. The mean CSA in the Asian group was significantly lower than that in the non-Asian group (12.93 mm2 and 14.77 mm2, respectively; p = 0.042). For the Asian group, the summary receiver operating characteristic curve had an area under the curve (AUC) of 0.92 with an optimal cutoff of 10.5 mm2; for the non-Asian group, an AUC of 0.94 was obtained with a cutoff of 11.5 mm2. CONCLUSION: Ultrasonography is a reliable diagnostic method for CTS, with distinct optimal cutoff values observed between Asian and non-Asian populations. Therefore, population-specific diagnostic criteria for CTS are recommended.

Cords of the Brachial Plexus and Their Branches Positioned Laterally to the Axillary Artery.

The brachial plexus, which supplies the upper limb, extends from the interscalene triangle in the root of the neck to the axilla and is closely related to the subclavian and axillary arteries. Variations in the formation, branching pattern, and relations are profound, and it is generally stated that variant anatomy of the plexus appears to be a rule rather than an exception. In previous studies, it was hypothesized that the anomalous development of the subclavian-axillary stem and the persistence of intersegmental arteries could induce variations in the plexus. In this study, all three cords of the brachial plexus (lateral, medial, and posterior) and their terminal branches are consistently found lateral to the third part of the axillary artery. Most of the studies reported variation in one or the other cord or its branches, but very few studies have reported about all cords lateral to the brachial plexus. The brachial plexus variations are usually also associated with the variations in the branches of the axillary artery, but in this study, no such variation is noted in the branches of the axillary artery. These differences impact the methods of surgery and the application of regional anesthesia. For successful outcomes, it is important to know how neurovascular relationships work, such as where the cords are in relation to the axillary artery. We report an interesting case of all cords and their branches positioned lateral to the axillary artery in the axilla in an adult male cadaver.

Ultrasound Cross-Sectional Area in Median Nerve Axonal Loss and Demyelination in Carpal Tunnel Syndrome.

Introduction: Ultrasound is an effective diagnostic tool for carpal tunnel syndrome (CTS). However, it is unclear how ultrasound correlates with axonal loss and/or demyelination on electrodiagnostic studies (EDS). The objective of this study is to determine whether ultrasound cross-sectional area (CSA) of the median nerve varies between patients with axonal loss or demyelination. Methods: A retrospective review was completed of patients who presented to an orthopaedic hand clinic with numbness/paresthesias over a 6-year period. Demographics, CTS symptoms scale 6 (CTS-6) scores, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, EDS results, and ultrasound results were collected. Median neuropathies were graded as normal, demyelination, or axonal loss using EDS reports. The data were analyzed with chi-square and t-tests. Results: In all, 383 hands were included (92 axonal loss, 182 demyelination only, and 108 neither). The average patient age was 52.2 and the average body mass index (BMI) was 31.7. The group consisted of 70.7% females, and 23.2% had diabetes. Patients with either axonal loss or demyelination had larger CSA and higher CTS-6 and BCTQ scores than patients with negative EDS. Patients with axonal loss also had larger CSA and higher CTS-6 and BCTQ scores than patients with demyelination only. The rates of positive ultrasound results between axonal loss and demyelination groups did not differ until the ultrasound cutoff was increased from 10 to 12 mm2. Conclusion: Rates of positive ultrasound results (CSA ≥ 10 mm2) do not differ between wrists with axonal loss or demyelination alone. Therefore, the character of carpal tunnel neuropathy does not affect ultrasound's diagnostic ability. Additionally, CSA increases as wrists develop axonal loss, and an increased ultrasound cutoff of 12 mm2 is correlated with this pathology.

Diabetes Increases Median Nerve Cross-Sectional Area but Not Disease Severity in Patients with Carpal Tunnel Syndrome.

Background: Ultrasonography (US) is a useful diagnostic modality for diagnosis of carpal tunnel syndrome (CTS). Diabetes mellitus is increasingly prevalent and is a risk factor for CTS. Given the increasing use of US in the diagnosis of CTS, our goal was to evaluate the influence of diabetes on CTS severity and the cross-sectional area (CSA) of the median nerve in patients with CTS. Methods: Patients with clinically diagnosed CTS were seen in the outpatient setting from October 2014 to February 2021. Median nerve CSA and patient reported severity measures were obtained: Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6. For patients with diabetes, additional parameters were collected including most recent A1c, insulin pharmacotherapy, and polypharmacy. Results: Ninety-nine patients (122 nerves) without diabetes and 55 patients (82 nerves) with diabetes were recruited for the study. Patients in the diabetes group were more obese and older and had a significantly increased median nerve CSA compared with patients without diabetes. Obesity was associated with higher median nerve CSA in all patients but not in patients with diabetes. There was no difference in disease severity in patients with and without diabetes as reported by BCTSQ or CTS-6 scores. In patients with diabetes, there was significantly decreased median nerve CSA with A1c of 6.5 or higher and a trend to decreased CSA with polypharmacy. There was no influence of insulin therapy on median nerve CSA. Conclusion: Diabetes is associated with higher median nerve CSA in patients with CTS of similar disease severity. The increased median nerve CSA in patients with diabetes may be reflective of diabetes-related microvascular changes. Interestingly, the trend to decreased median nerve CSA in patients with suboptimal diabetic control (A1c ≥ 6.5) may suggest eventual degenerative changes to the median nerve. In summary, clinicians should be cautious with interpreting a larger median nerve CSA as more severe CTS in patients with diabetes. Level of Evidence: Level 3 Diagnostic.

Neurofibroma Involving a Bifid Median Nerve in a Pediatric Patient: A Case Report.

Neurofibromas are benign peripheral nerve sheath tumors that typically develop within cutaneous nerve branches but can involve major nerves as well. They can be sporadic or associated with neurofibromatosis type 1. In this report, we describe the surgical treatment of a pediatric patient with neurofibromatosis type 1 presenting with a neurofibroma of a bifid median nerve. Involvement of the median nerve was not evident on preoperative examination or imaging, therefore altering the risk-benefit ratio of the procedure. After bifid nerve involvement was identified intraoperatively, the patient's parents were counseled on the risks and benefits of surgical excision before resuming the case. Ultimately, the neurofibroma was resected, and the patient experienced no neurological deficits after surgery.

An Evaluation of Minimal F-wave Sensitivity in Carpal Tunnel Syndrome.

Background and objective Several recent studies have explored whether F-waves can be a sensitive and useful tool for diagnosing carpal tunnel syndrome (CTS). In light of this, we aimed to measure the minimal F-wave latencies in patients with mild, moderate, and severe electrophysiologically diagnosed carpal CTS, as well as individuals without CTS, to determine at which point this parameter becomes sensitive to the syndrome. Materials and methods Nerve conduction studies were carried out in a room where a temperature of 22-24 °C was maintained. The F-waves of the median nerve in all patients and individuals in the control group were recorded. The F-wave with the highest velocity (minimal F) was categorized into the normal, mild, moderate, and severe groups for statistical analysis. All measurements were performed by the same electrophysiology-experienced neurologist. Results Post-hoc analysis demonstrated that the F latency values of the moderate and severe CTS groups were significantly higher than those of the control group (p<0.001 for all comparisons). Furthermore, the F latency values of the severe CTS group were significantly higher than those of the moderate group (p=0.026). Conclusions Based on our findings, minimal F-wave latency is a reliable indicator of moderate to severe CTS. This sensitivity significantly increases in severe cases while disappearing in the presence of mild CTS.

Anatomical Study of the Relationship between the Riché-Cannieu Anastomosis and the Kaplan Cardinal Line.

Objective To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand.

Comparison of the Effectiveness of 2 Different Kinesio Taping Techniques Added to Exercises in the Treatment of Carpal Tunnel Syndrome: Randomized Controlled Trial, Double-Blind, Parallel Groups.

OBJECTIVE: To compare the effectiveness of I-tape and button hole kinesio taping (KT) techniques added to exercises in the treatment of carpal tunnel syndrome (CTS). DESIGN: Prospective randomized controlled blinded study. SETTING: Physical Medicine and Rehabilitation Outpatient Clinic. PARTICIPANTS: A total of 108 patients (165 wrists) diagnosed with CTS (N=108). INTERVENTIONS: Button hole technique (BG), I-band technique (IG), and exercises (EG). MAIN OUTCOME MEASURES: Visual analog scale (VAS), Douleur Neuropathique 4 Questions (DN4), Boston carpal tunnel syndrome questionnaire, and Jamar dynamometer were used. Median sensory nerve action potential (SNAP), compound muscle action potential (CMAP), median distal sensory latency (DSL), median distal motor latency (DML), sensory conduction velocity, and motor conduction velocity were recorded. Measurements were made at baseline, week 3, and week 12. RESULTS: Thirty-six patients were in each group. Significant statistical improvements in VAS and DN4 scores were found in the BG and IG compared with EG (P<.05). Statistically significant improvements in hand grip strength were observed in the IG compared with the EG (P<.05). Significant improvements in DML levels and motor conduction velocity were observed in the BG and IG compared with the EG (P<.05). A significant increase in sensory conduction velocity was detected in the BG compared with the other groups (P<.05). CONCLUSIONS: Both KT techniques are effective in terms of pain, functionality, symptom severity, grip strength, and electrophysiologically. The button hole technique was more effective in DSL, sensory conduction velocity, CMAP amplitude, and SNAP.

Lacertus syndrome: recent advances.

Lacertus syndrome consists in proximal median nerve entrapment with median nerve compression at the lacertus fibrosus, causing hand weakness and fatigue, forearm pain and occasional numbness. Recent advances emphasized the importance of clinical examination, due to limitations in electromyographic diagnosis and delayed diagnosis. The Hagert clinical triad, lacertus notch sign, lacertus antagonist test and taping help accurate diagnosis. Non-operative treatment should be tried; and surgical techniques, whether open or ultrasound-guided under WALANT (wide-awake, local anesthesia, no tourniquet) show promising outcomes. Improved awareness, accurate diagnosis and innovative treatments enhance patient care for this challenging condition.

T2 magnetic resonance imaging mapping and morphology of the median nerve before and after surgery in carpal tunnel syndrome.

INTRODUCTION/AIMS: T2 magnetic resonance imaging (MRI) mapping has been applied to carpal tunnel syndrome (CTS) for quantitative assessment of the median nerve. However, quantitative changes in the median nerve before and after surgery using T2 MRI mapping remain unclear. We aimed to investigate whether pathological changes could be identified by pre- and postoperative T2 MRI mapping of the median nerve in CTS patients after open carpal tunnel release. METHODS: This was a prospective study that measured median nerve T2 and cross-sectional area (CSA) values at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels pre- and postoperatively. Associations between T2, CSA, and nerve conduction latency were also evaluated. RESULTS: A total of 36 patients with CTS (mean age, 64.5 ± 11.7 years) who underwent surgery were studied. The mean preoperative T2 values significantly decreased from 56.3 to 46.9 ms at the proximal carpal tunnel levels (p = .001), and from 52.4 to 48.7 ms at the hamate levels postoperatively (p = .04). Although there was a moderate association between preoperative T2 values at the distal carpal tunnel levels and distal motor latency values (r = -.46), other T2 values at all four carpal tunnel levels were not significantly associated with CSA or nerve conduction latency pre- or postoperatively. DISCUSSION: T2 MRI mapping of the carpal tunnel suggested a decrease in nerve edema after surgery. T2 MRI mapping provides quantitative information on the median nerve before and after surgery.

Predictors of pain intensity in carpal tunnel syndrome: Development and validation of a model.

OBJECTIVE: Pain often accompanies carpal tunnel syndrome and affects patients' health-related quality of life. The aim was to develop and validate a predictive model for the pain intensity of carpal tunnel syndrome using demographic, clinical, electrophysiological, and ultrasound findings. METHODS: We conducted a secondary analysis of data from a large sample of patients (May 2017 to December 2022) with carpal tunnel syndrome. A total of 520 (53.0 %) mild, 276 (28.1 %) moderate, and 186 (18.9 %) severe syndromes were included in the complete data set of 982 hands (61.1 % female). The mean age was 57.8 (10.7) years and the median duration [interquartile range] of the symptoms was 4 [2,10] months. A regression model was developed and validated to predict pain intensity on a numerical rating scale using a tree-based machine learning algorithm. RESULTS: The validation of the regression model showed good performance with a root mean squared error, R-squared, and mean absolute error of 1.35, 0.42, and 1.05, respectively. Overall, the top significant predictors of pain intensity were compound motor nerve action potential latency, nocturnal pain, and thenar weakness. These were followed by the cross-sectional area of the median nerve, sensory nerve action potential, bowing of the flexor retinaculum, disease duration, and body mass index. We did not find strong associations between the median nerve transcarpal latency, age, sex, and diabetes with the pain intensity of carpal tunnel syndrome. CONCLUSION: Our model showed good performance in predicting the subjective pain intensity of carpal tunnel syndrome, even in the context of non-linear relations.

Forelimb lameness caused by Malignant peripheral nerve sheath tumors of the median nerve in a dog: a case report.

An 8-year-old Portuguese Water Dog presented with a 5-month history of left forelimb lameness. There was palmar pain. Ultrasonography revealed enlargement of the left median nerve. Subsequent MRI also showed enlargement of the median nerve in the distal palmar to the mid-forearm region. Rapid intraoperative diagnosis suggested Malignant peripheral nerve sheath tumors (MPNST) and a neurotomy was performed. The lameness had almost disappeared in 1 month after surgery. Recurrence occurred 26 months postoperatively and the forelimb was amputated. At 950 days after the neurotomy, radiography revealed lung metastasis, and the dog died 988 days after the neurotomy. Neurotomy for MPNST should be performed with caution until more information is available regarding methods for early detection, margin determination, and indication determination for neurotomy.

Peripheral nerve injuries associated with dislocated supracondylar fractures of distal humerus in children: incidence and need of surgical treatment.

PURPOSE: The objective of this study was to determine the incidence, necessity for neurosurgical intervention, and overall results of the treatment of pediatric peripheral nerve injuries associated with dislocated supracondylar fractures of the distal humerus. METHOD: A retrospective analysis of pediatric patients with supracondylar fractures treated from April 2019 to April 2022 with a minimum follow-up of 3 months was conducted. RESULTS: Of 453 included patients, there were 51 recorded peripheral nerve injuries. The ulnar nerve was the most frequently injured nerve. Nine patients required neurosurgical intervention, with the most common procedure being the release of entrapped nerves. The combination of a supracondylar fracture and arterial injury was identified as a significant risk factor for peripheral nerve injury (p < 0.001). Only one patient experienced an unsatisfactory outcome. CONCLUSION: Although the prognosis for peripheral nerve injuries in children with supracondylar fractures is generally favorable, these injuries must be properly identified. We recommend an active neurosurgical approach in children with persisting neurological deficits to minimize the risk of permanent neurological impairment.

The median nerve´s system of connective tissue distal to the pronator teres to the carpal tunnel.

BACKGROUND: Connective tissue serves a role beyond mere spatial filling. Furthermore, there is increasing evidence that connective tissue plays an important role in the pathogenesis of conditions such as carpal tunnel syndrome (CTS). According to our hypothesis, the median nerve (MN) is surrounded by a system of connective tissue distal to the pronator teres and extending up to, and including, the carpal tunnel. METHODS: To visualize the connective tissue surrounding the median nerve, we dissected the forearms of 15 body donors from pronator teres to the carpal tunnel, created plastination slices stained with Periodic Acid-Schiff (PAS), and injected ink into the seen spaces. We verified our findings with a segmentational analysis of radiological data of 10 healthy individuals. RESULTS: We macroscopically describe the median nerve´s system of connective tissue (MC) distal to the pronator teres and up to and including the carpal tunnel. This system creates, connects, and separates spaces. At least from the pronator teres to the carpal tunnel it also creates subspaces from proximal to distal. For the MC, we established a mean cross-sectional area of 153.1 mm2 (SD=37.15) in the carpal tunnel. The median nerve consistently resides at the center of this MC, which further connects to flexor muscles of the forearm, and to the radius bone. In the carpal tunnel, the MC creates subspaces inside. There, it also acts as the outermost internal layer enveloping flexor tendons, and the MN. DISCUSSION: The term MC does not negate but orders the existence of other "connectives", like subsynovial connective tissue, endo-, epi- or perineuria, epimysia, periostea, or peritendinea, to a hierarchy related to the median nerve. Diseases of the MN are common. Knowing the anatomy of the MC and how it relates to MN function may help clinicians recognize and understand conditions like CTS.

Reliability of Ultrasound Measurements of the Median Nerve in Asymptomatic Subjects Using a Handheld Device.

This study investigated the reliability of measuring the median nerve cross-sectional area (CSA) at the carpal tunnel inlet using a handheld ultrasound device (HUD) compared to a standard ultrasound system, focusing on intra- and inter-operator reproducibility among novice and expert operators. Employing a prospective cross-sectional design, 37 asymptomatic adults were assessed using both devices, with measurements taken by an expert with over five years of experience and a novice with less than six months. The CSA was determined using manual tracing and ellipse methods, with reproducibility evaluated through intraclass correlation coefficients (ICCs) and agreement assessed via Bland-Altman plots. Results showed a high degree of agreement between the devices, with excellent intra-operator reproducibility (ICC > 0.80) for the expert, and moderate reproducibility for the novice (ICCs ranging from 0.539 to 0.841). Inter-operator reliability was generally moderate, indicating acceptable consistency across different experience levels. The study concludes that HUDs are comparable to standard ultrasound systems for assessing median nerve CSA in asymptomatic subjects, with both devices providing reliable measurements. This supports the use of HUDs in diverse clinical environments, particularly where access to traditional ultrasound is limited. Further research with a larger sample and symptomatic patients is recommended to validate these findings.

Elastography of nerves in the wrists of cyclists.

Purpose: This study aimed to investigate changes in the elasticity of the median and ulnar nerves in cyclists. Material and methods: The study included 30 cyclists and 2 non-biking reference groups that included 32 healthy volunteers and 32 individuals with ulnar nerve entrapment neuropathies. All participants underwent physical, ultrasonographic, and elastographic examinations including assessment of nerve cross-sectional area (CSA) and stiffness (SWE). The cyclists' group was tested before and after a 2-hour workout. Results: The values of ulnar nerve CSA and stiffness in Guyon's canal in resting cyclists were 5.30 ± 1.51 mm2 and 49.05 ± 11.18 kPa, respectively. These values were significantly higher than in the healthy volunteers, but not higher than in the nerve entrapment group. Median nerve CSA and stiffness at rest were 9.10 ± 2.61 mm2 and 38.54 ± 14.87 kPa, respectively. Both values were higher than respective values in the healthy group. Cycling induced an increase in all these parameters, although the increase in nerve stiffness was more noticeable than in CSA. Conclusions: The elasticity of the median and ulnar nerve in cyclists remains within normal limits, questioning the belief that cyclists are at risk of nerve palsy in Guyon's canal. However, cycling workout does exert compression, resulting in transient oedema of both nerves. The dynamics of changes was more noticeable in SWE examination than in conventional ultrasound, which may depend on SWE sensitivity.

Effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers.

OBJECTIVES: To compare the effects of 1-hour computer use on ulnar and median nerve conduction velocity and muscle activity in office workers with symptomatic neck pain and asymptomatic office workers. METHODS: A total of 40 participants, both male and female office workers, with symptomatic neck pain (n = 20) and asymptomatic (n = 20), were recruited. Pain intensity, ulnar nerve conduction velocity, median nerve conduction velocity, and muscle activity were determined before and after 1 hour of computer use. RESULTS: There was a significant increase in pain intensity in the neck area in both groups (P < .001). The symptomatic neck pain group revealed a significant decrease in the sensory nerve conduction velocity of the ulnar nerve (P = .008), whereas there was no difference in the median nerve conduction velocity (P > .05). Comparing before and after computer use, the symptomatic neck pain group had less activity of the semispinalis muscles and higher activity of the anterior scalene muscle than the asymptomatic group (P < .05). The trapezius and wrist extensor muscles showed no significant differences in either group (P > .05). CONCLUSIONS: This study found signs of neuromuscular deficit of the ulnar nerve, semispinalis muscle, and anterior scalene muscle after 1 hour of computer use among office workers with symptomatic neck pain, which may indicate the risk of neuromuscular impairment of the upper extremities. The recommendation of resting, and encouraging function and flexibility of the neuromuscular system after 1 hour of computer use should be considered.

Somatosensory evoked spikes in normal adults detected by magnetoencephalography.

OBJECTIVE: Somatosensory evoked spikes (SESs) have been reported only in children aged under 14 years and are considered as an age-dependent phenomenon. However, we detected SESs in adult patients with epilepsy using magnetoencephalography (MEG). The present study investigated whether MEG can detect SESs in normal adults. METHODS: Spontaneous MEG was recorded during measurement of somatosensory evoked fields (SEFs) for bilateral electrical median nerve stimuli in 30 healthy adults. RESULTS: Bilateral SESs were observed in 10 adults but none in the other 20 subjects. SESs consisted of one or two peaks, and the first peak latency corresponded to that of the second peak (M2) of SEFs. The first SES peak was identical to the M2 in isofield map pattern, as well as location and orientation of the equivalent current dipole (ECD). M2 ECD strength in the 10 subjects with SESs was larger (p <0.0001) than in 20 without SESs. CONCLUSIONS: All-or-nothing detection of bilateral SESs by MEG in normal adults must depend on the signal-to-noise issue of symmetrical SEFs and background brain activity. SIGNIFICANCE: Our results further confirm the higher sensitivity of MEG compared to scalp EEG for the detection of focal cortical sources tangential to the scalp such as SESs.

Exploring pathogenic pathways in carpal tunnel syndrome: sterile inflammation and oxidative stress.

OBJECTIVES: The main objective of the current study was to find the association between oxidative stress, inflammatory markers, and electrophysiological profile with symptom severity in patients of carpal tunnel syndrome (CTS). METHODS: Thirty-two carpal tunnel syndrome patients and 32 controls were included in the study. Boston CTS questionnaire along with plasma oxidative stress markers including superoxide dismutase, malondialdehyde, and nitric oxide and inflammatory markers including IL-6 and TNF-α were compared with the electrophysiological parameters derived from nerve conduction studies. Statistical significance of the levels between groups was calculated using unpaired-t test after checking for normality with D'Agostino & Pearson omnibus normality test. RESULTS: We found that the median nerve conduction velocity was prolonged, amplitude was decreased, while the levels of oxidative stress markers like malondialdehyde (MDA), superoxidase dismutase (SOD), and nitric oxide (NO) were increased in CTS patients compared to controls. Inflammatory markers like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were also increased in CTS patients. We found that plasma SOD and TNF-α correlated well with the median motor amplitude. There was no other significant correlation between oxidative stress markers and inflammatory markers with nerve conduction studies or disease severity. Patients with mild disease also showed lesser levels of SOD, NO, IL-6, and TNF-α markers than patients with severe disease. CONCLUSIONS: CTS is probably a disease of sterile inflammation and disbalance of oxidative stress, with higher inflammatory and oxidative stress markers pointing to a more severe disease.

An arch worth revisiting: a study on the feline humeral supracondylar foramen and its evolutionary significance.

The supracondylar foramen with a (seemingly) osseous peripheral arch noticed on the medio-distal feline humeri had remained disputed among anatomists. Some scholars have argued in favor of homology between this foramen and the supracondyloid foramen formed in presence of the ligament of Struthers in humans. Other theories include its presence as a retinaculum holding the median nerve and brachial artery to their anatomical position in a flexed elbow. Unfortunately, these theories lack investigative rigor. The emergence of non-invasive imaging modalities, such as micro-computed tomography, has enabled researchers to inspect the internal anatomy of bones without dismantling them. Thus, a micro-computed tomographic investigation was conducted on three feline (Felis catus) humeri specimens while the internal anatomy of the supracondylar foramina was examined. Unlike the humerus, the thin peripheral arch of the feline supracondylar foramen failed to elicit any osseous trabeculae or foci of calcification. While adhering to the humeral periosteum at its origin, the non-osseous arch, typical of a muscular tendon, attaches into the bony saddle related to the medial humeral epicondyle suggestive of a tendon or aponeurotic extension of a (vestigial) brachial muscle, with the coracobrachialis longus emerging to be the most likely candidate.