ultrasound in carpal tunnel syndrome

1. Dr.J.MANICKAVASAGAM
NEUROLOGIST
STANLEY MEDICAL COLLEGE&HOSPITAL

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.  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

6.  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

8. Thank You