DEFINING NORMAL REFERENCE RANGE FOR THE CROSS-SECTIONAL AREA OF THE MEDIAN NERVE AT THE WRIST AND FOREARM USING HIGH-RESOLUTION ULTRASONOGRAPHY IN ASYMPTOMATIC PAKISTANI ADULTS
Keywords:median nerve, ultrasound, cross sectional area
AbstractBackground: Carpal tunnel syndrome (CTS) can be diagnosed easily on ultrasonography (USG); which is a cheap, non-invasive and readily available modality. However, there is wide normal variation in the normal values of cross-sectional area (CSA) of median nerve among different populations; therefore, its necessary to establish a normal range of variability in median nerve dimensions in different populations. Method: A total of 500 asymptomatic patients i.e., 1000 median nerves were evaluated at the distal wrist crease and mid-forearm by 3 expert radiologists independently. All patients having a positive nerve conduction study or history of carpal tunnel syndrome and wrist trauma were excluded. Ultrasound was performed with a 7.5–15 MHz high-frequency linear probe. SPSS v 20 was used to analyze data. Results: the study population had a mean age of 31.40±10.11 years with a female-to-male ratio of 1.36:1. Mean BMI was 22.15±4.34 Kg/m2. The mean cross-section area of the median nerve at the right wrist was calculated to be 6.8±1.96 mm2 and the left wrist was 6.6±1.96 mm2. The mean median nerve cross-section area at the right mid-forearm was 5.3±1.46 mm2 and the left mid-forearm was 5.2±1.50 mm2. A decrease in mean median nerve cross-section areas was noted by moving from wrist to forearm. Similarly, males showed higher median nerve CSA than females. Conclusion: Mean median nerve cross-section area was found to be different from Western countries. This warrants the utilization of the data of the Pakistani population to establish our own normal reference range for median nerve cross-sectional area to avoid misdiagnoses.
de Krom MC, de Krom CJ, Spaans F. [Carpal tunnel syndrome: diagnosis, treatment, prevention and its relevance to dentistry]. Ned Tijdschr Tandheelkd 2009;116(2):97–101.
Mohammadi A, Afshar AR, Masoudi S, Etemadi A. Comparison of High Resolution Ultrasonography And Nerve Conduction Study In The Diagnosis Of Carpal Tunnel Syndrome: Diagnostic Value Of Median Nerve Cross-Sectional Area. Iran J Radiol 2009;6(3):147–52.
Mondelli M, Filippou G, Gallo A, Frediani B. Diagnostic utility of ultrasonography versus nerve conduction studies in mild carpal tunnel syndrome. Arthritis Rheum 2008;59(3):357–66.
Padua L, Pazzaglia C, Caliandro P, Granata G, Foschini M, Briani C, et al. Carpal tunnel syndrome: ultrasound, neurophysiology, clinical and patient-oriented assessment. Clin Neurophysiol 2008;119(9):2064–9.
Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: Value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009;250(1):171–7.
Sernik RA, Abicalaf CA, Pimentel BF, Braga-Baiak A, Braga L, Cerri GG. Ultrasound features of carpal tunnel syndrome: a prospective case-control study. Skeletal Radiol 2008;37(1):49–53.
Hammer HB, Hovden IAH, Haavardsholm EA, Kvien TK. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology (Oxford) 2006;45(5):584–8.
Walker FO. Imaging nerve and muscle with ultrasound. Suppl Clin Neurophysiol 2004;57:243–54.
Werner RA, Jacobson JA, Jamadar DA. Influence of body mass index on median nerve function, carpal canal pressure, and cross-sectional area of the median nerve. Muscle Nerve 2004;30(4):481–5.
Hobson-Webb LD, Padua L. Median nerve ultrasonography in carpal tunnel syndrome: findings from two laboratories. Muscle Nerve 2009;40(1):94–7.
Burg EW Van, Bathala L, Visser LH. Difference in normal values of median nerve cross-sectional area between dutch and indian subjects. Muscle Nerve 2014;50(1):129–32.
Takata SC, Kysh L, MacK WJ, Roll SC. Sonographic reference values of median nerve cross-sectional area: A protocol for a systematic review and meta-analysis. Syst Rev 2019;8(1):1–7.
Ehler E. Median nerve ultrasonography in carpal tunnel syndrome. Clin Neurophysiol Pract 2017;2:186.
Mohammadi A, Afshar A, Etemadi A, Masoudi S, Baghizadeh A. Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med 2010;13:516–21.
Torres-Costoso A, Martínez-Vizcaíno V, Álvarez-Bueno C, Ferri-Morales A, Cavero-Redondo I. Accuracy of Ultrasonography for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018;99(4):758–65.e10.
Fisse AL, Katsanos AH, Gold R, Pitarokoili K, Krogias C. Cross-sectional area reference values for peripheral nerve ultrasound in adults: a systematic review and meta-analysis-Part I: Upper extremity nerves. Eur J Neurol 2021;28(5):1684–91.
Rojoa D, Raheman F, Rassam J, Wade RG. Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome. Sci Rep 2021;11(1):20935.
Lee RKL, Griffith JF, Ng AWH, Tipoe GL, Chan AWH, Wong CWY, et al. Cross-sectional area of the median nerve at the wrist: Comparison of sonographic, MRI, and cadaveric measurements. J Clin Ultrasound 2019;47:122–7.
Copyright (c) 2023 Rashed Nazer, Maria Rauf, Farheen Raza, Balqees Yawar Fiaz, Madiha Saeed Wahla , Raheela Aqeel
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.