park1腕管综合征得朝圣诊断的价值课件

The Diagnostic Value of Ultrasonographic Measurement in Carpal Tunnel Syndrome,Gi-Young Park1, Jung-Ho Bae2 Department of Rehabilitation Medicine, 1 Catholic University of Daegu School of Medicine, 2 Keimyung University School of Medicine,Nanjing,Carpal Tunnel Syndrome,Nerve Conduction Study,Imaging Studies for Diagnosis of CTS,Plain radiograph Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasonography,Ultrasonography,Transverse sonograms of carpal tunnel of wrist show normal appearance of median nerve (black arrows) and flexor tendons (white arrows). r = radial, u = ulnar,Objectives,To compare the ultrasonographic measurements in patients with CTS, diagnosed by NCS, to those obtained from control subjects To investigate their correlations with the severity of CTS determined by NCS To evaluate the diagnostic value of the ultrasonographic measurement being the highest correlating with NCS,Methods,Patients Characteristics,Values are mean standard deviation (range). 1. CTS: Carpal tunnel syndrome,Exclusion Criteria,Systemic conditions such as diabetes mellitus, thyroid disease, chronic renal failure under hemodialysis, rheumatoid arthritis, and myxedma Orthopedic conditions such as previous wrist fracture or surgery, and CTS surgery Clinical or electrodiagnostic evidence of an accompanying conditions such as cervical radiculopathy and polyneuropathy Ultrasonographic evidence of the bifid median nerve and mass lesions Negative NCS.,Neurophysiologic Grading Scale for CTS,Grade 0 (normal): no neurophysiological abnormalities Grade 1 (very mild): only in two sensitive tests (eg, inching, palm/wrist median/ulnar comparison, ring finger “double peak” Grade 2 (mild): orthodromic sensory conduction velocity form index finger to wrist 4.5 ms and 4.5 ms and 6.5 Grade 6 (extremely severe): surface motor potential from APB 0.2 mV, peak to peak,Bland JD. Muscle 23:1280-1283,Ultrasonography,SonoAce 9900 (Medison, Korea) 5 - 12 MHz liner transducer One physiatrist,Ultrasonographic Measurements,Cross-sectional area at 3 levels Distal radioulnar joint, pisiform, and hamate Flattening ratio at 3 levels Distal radioulnar joint, pisiform, and hamate Swelling ratio Palmar displacement of flexor retinaculun at pisiform,Cross Sectional Areas,Pisiform level,Swelling ratio: CSA at the level of the pisiform bone/CSA of the distal radioulnar joint,Flattening Ratio,Transverse diameter/anteroposterior diameter,Palmar Displacement,Pisiform level,Results,Neurophysiologic Grading Scale for CTS,Comparison of Cross Sectional Area,Values are mean standard deviation(mm2). *p.001 1. CTS: Carpal tunnel syndrome,Comparison of Flattening Ratio,Values are mean standard deviation. *p.001 1. CTS: Carpal tunnel syndrome,Comparison of Swelling Ratio and Palmar Displacement,Values are mean standard deviation. *p.001 1. CTS: Carpal tunnel syndrome,Correlation between Ultrasonographic Parameters and Neurophysiologic Grading Scale,Values are correlation coefficient. *p.01 1. CSA: cross sectional area,Areas Under Receiver Operating Characteristic Curves,1. ROC: receiver operating characteristic, 2. CSA: cross sectional area,Sensitivity and Specificity of Optimal Cut-off Values of Ultrasonographic Measurements,1. CSA: cross sectional area,Conclusion,Median nerve CSA at the pisiform had the highest correlation with the neurophysiological grading scale among the ultrasonographic measurements Its value being greater than or equal to 9 mm2 was found to be highly sensitive and specifi