Cascade Thickening of Nerves in Multilevel Tunnels

Aim of the study was to optimize ultrasound nerves examination technology in upper limb tunnel neuropathies. 201 median nerves (122patients aged 26- 70 years old with clinical and electrophysiological signs of carpal tunnel syndrome) and 110 ulnar nerves (88patients aged 20-74 years old with clinical and electrophysiological signs of cubital tunnel syndrome) were investigated. The control group included 135 median nerves (84 healthy volunteers aged 25-70 years old) and 141 ulnar nerves (91 healthy volunteers aged 24-77 years old). Cross-section area was measured at distal part of nerve (S1), at level of tunnels exit (S2), at level of tunnel (S3), at level of entrance to tunnel (S4), and at proximal part of nerve (S5). AUC values for segments within tunnel in carpal tunnel syndrome ranged from 0.787 to 0.930; in cubital tunnel syndrome - from 0.776 to 0.869. They were significantly higher than in remote segments (carpal tunnel syndrome - up to 0.591; cubital tunnel syndrome - up to 0.666). After merging segments, which had the highest sensitivity, in the single segment S2-4 max, and using maximum value of nerve cross sectional area in this merged segment as a cut-off, higher AUC value was achieved. Cut-off values of maximum nerve cross-sectional area within tunnel can be used for the diagnosis of carpal tunnel syndrome (norm - ≤ 12 mm², pathology - >12 mm², AUC - 0.974) and cubital tunnel syndrome (norm - ≤ 12 mm², pathology - >12 mm², AUC - 0.928).

ультразвуковое исследование периферических нервов, синдром запястного канала, невропатия срединного нерва, кубитальный туннельный синдром, невропатия локтевого нерва, площадь поперечного сечения, high resolution ultrasound of peripheral nerves, carpal tunnel syndrome, median nerve neuropathy, cubital tunnel syndrome, ulnar neuropathy at the elbow, cross-section area

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