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Neuro ultrasound in carpal tunnel syndrome

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ultrasound in carpal tunnel syndrome

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Neuro ultrasound in carpal tunnel syndrome

  1. 1. Dr.J.MANICKAVASAGAM NEUROLOGIST STANLEY MEDICAL COLLEGE&HOSPITAL
  2. 2.  The carpal tunnel is the fibro-osseous space between the carpal bones and the flexor retinaculum. It contains the eight flexor digitorum tendons, the flexor pollicus longus, the median nerve  Ultrasound can assess the anatomy of the median nerve and also identify pathology of the surrounding structures that may compress the nerve  Identification of space-occupying lesions in and around the median nerve, confirm abnormalities in the median nerve ( increased cross sectional area) that can be diagnostic of CTS, and help guide steroid injections into the carpal tunnel  Ganglion and synovial cysts  Tenosynovitis  Tumors
  3. 3.  In the transverse imaging plane the ulnar artery is the medial landmark of the carpal tunnel  The tunnel contains the flexor digitorum tendons which are hyper echoic  Anterior to the tendons is the median nerve  The median nerve has a characteristic appearance which differentiates it from the fibillar hyper echoic tendons  The nerve is hypo echoic with a hyper echoic borders and show multiple bright reflectors in the transverse imaging plane  The median nerve is rounded or oval in the proximal wrist and flattens progressively as it courses through the carpel tunnel  Within the tunnel the nerve is in intimate contact with the flexor retinaculum
  4. 4.  High resolution neuromuscular ultrasound imaging is available to directly observe responses to hand maneuvers that challenge the median nerve  how the MN responds to prehensile hand activity in CTS individuals, thereby providing a better understanding of the pathomechanics that lead to nerve compression.  Ultrasonography may be useful in patients with doubtful clinical picture, as a screening test, as well as in suspicion of intra-tunnel pathology  High-frequency US examination should be strongly considered as a new alternative diagnostic modality for the evaluation of CTS.  In addition to being of high diagnostic accuracy it is able to define the cause of nerve compression and aids treatment planning  US also provides a reliable method for following the response to therapy
  5. 5. Thank You

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