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Ultrasonographic examination of the carpal canal in dogs

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      Abstract

      The aim of this study was to determine the course of the median nerve and its adjacent structures in the carpal canals of 8 healthy dogs by using high-frequency transducers. Before performing ultrasonography, the transverse and posteroanterior diameters as well as the perimeter of the carpus were measured at just proximal to the side of the carpal pad. The anatomical structures were then determined at two levels of the carpal canal, which were named the proximal and distal levels, on the transverse sonograms. The cross-sectional areas, perimeters and the transverse and posteroanterior diameters of the median nerve were measured at these levels. Although all the measurements were larger at the proximal level, significant differences between the proximal and distal levels were determined for the cross-sectional area, the perimeter and the transverse diameter of the median nerve. On the transverse sonogram, the deep digital flexor tendon was seen in almost the center of the carpal canal like a comma shape and also it had a small concavity on the caudal side. The superficial digital flexor tendon was seen as an ovoid shape on the transverse sonograms and it was located nearly at the posterior side of the carpal canal. Both tendons were seen as intermediate-grade echogenic structures. The median artery was located inside of the concavity of the deep digital flexor tendon. Also, the median nerve was seen at the posteromedial side of the median artery. As a result of this study, the cross-sectional areas of the median nerve ranged between 1.01-2.68 mm2 at the proximal level and between 0.93-1.91 mm2 at the distal level.

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      Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?

      Our aim is to assess the optimal discriminatory sonographic criteria and relevant threshold values in patients with carpal tunnel syndrome (CTS) and to evaluate quantitative ultrasonography (US) as a tool for diagnosis and treatment of patients suffering from carpal tunnel syndrome in comparison with electrophysiological study. Seventy-eight patients with CTS and 78 asymptomatic controls were assessed and underwent ultrasonography of the wrists. All patients and controls completed a self-administered questionnaire. Electrophysiological testing was done for all patients and control subjects. Data from the patient and the control groups were compared to determine the diagnostic relations in patients with CTS and the grade of severity. There was a high degree of correlation between the conduction abnormalities of the median nerve as detected by electrodiagnostic tests, self-administered assessment and the measurement of the cross-sectional area of the nerve by US (P<0.05). Various levels of disease severity could also be illustrated by US, giving confident results for diagnosis, treatment planning and following the patients with CTS. In 16 patients (17%) tenosynovitis/localized swelling in the tendons in the carpal tunnel was the primary cause of CTS. A cut-off point of 10 mm(2) for the mean cross-sectional area of the median nerve was found to be the upper limit for normal values. Based on the results of this study, an algorithm for evaluation and management of CTS has been suggested. High-frequency US examination of the median nerve and measurement of its cross-sectional area 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.
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        High-resolution ultrasonography of the carpal tunnel.

        Twenty-eight wrists of 25 patients with carpal tunnel syndrome (CTS) and 28 wrists of 14 normal control subjects were studied with high-frequency real-time ultrasonography. Three general findings could be observed in CTS, regardless of its cause: swelling of the median nerve at the entrance of the carpal tunnel; flattening of the median nerve in the distal carpal tunnel; and increased palmar flexion of the transverse carpal ligament. Quantitative analysis proved these findings to be significant. We conclude that high-resolution sonography is able to diagnose median nerve compression in the carpal tunnel syndrome and to detect some of its potential causes.
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          The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome.

          The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.
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            Author and article information

            Affiliations
            [1 ]Department of Anatomy, Faculty of Veterinary Medicine, University of Adnan Menderes, PK: 17, 09016, Isikli-Aydin, Turkey.
            [2 ]Department of Radiology, Faculty of Medicine, University of Adnan Menderes, PK: 17, 09016, Isikli-Aydin, Turkey.
            Author notes
            Corresponding author: Tel: +90-256-247-07-00; Fax: +90-256-247-07-20, terkut@ 123456yahoo.com , eturan@ 123456adu.edu.tr
            Journal
            J Vet Sci
            JVS
            Journal of Veterinary Science
            The Korean Society of Veterinary Science
            1229-845X
            1976-555X
            March 2009
            31 March 2009
            : 10
            : 1
            : 77-80
            2801093
            19255528
            10.4142/jvs.2009.10.1.77
            Copyright © 2009 The Korean Society of Veterinary Science
            Categories
            Original Article

            Veterinary medicine

            ultrasonography, median nerve, carpal canal, dog

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