Dataset Information

Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals.

ABSTRACT:

Objective

Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds.

Methods

Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality.

Results

The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% CI] was 6.46mm² [6.09-6.84], 8.68mm² [8.22-9.13], and 8.60mm² [8.23-8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β=0.03mm², p=0.047). Men (9.42mm², [8.06-10.78]) had statistically larger proximal tunnel CSA (p = 0.03) as compared to women (7.71mm², [7.01-8.42]). No difference was noted in laterality.

Conclusion

A reference value for median nerve CSA in the carpal tunnel is 8.60mm². Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0mm² for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.

SUBMITTER: Roll SC

PROVIDER: S-EPMC10468154 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals.

Roll Shawn C SC Takata Sandy C SC Yao Buwen B Kysh Lynn L Mack Wendy J WJ

Journal of diagnostic medical sonography : JDMS 20230606 5

<h4>Objective</h4>Establish median nerve CSA reference values and identify patient-level factors impacting diagnostic thresholds.<h4>Methods</h4>Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-reg ...[more]

PMID: 37654772

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Project description:BackgroundMedian nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values.MethodsArticles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles.DiscussionA comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology.Systematic review registrationPROSPERO 2016 CRD42016037286.

Project description:Muscle mass has been traditionally assessed by measuring paraspinal muscle areas at the level of the third lumbar vertebra on computed tomography (CT). Neurological or neurosurgical patients seldom undergo CT scans of the lumbar region. Instead, temporal muscle thickness (TMT), cross-sectional area (TMA) and radiodensity measured from head CT scans are readily available measures of muscle mass and quality in these patient cohorts. The purpose of this retrospective study was to establish CT-based reference values for TMT, TMA and radiodensity for each decade of age from 0 to 100 years normalized by age and sex, and to define cut-off values for subjects at risk for sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP). Subjects diagnosed with a concussion at the Oulu University Hospital between January 2014 and December 2022 (n = 9254) were identified to obtain a reference population. Subjects with significant pre-existing co-morbidities were excluded. TMT, TMA and radiodensity were measured, measurement reliability was quantified, and sex-adjusted reference values were calculated for each age decade. Quantile regression was used to model age-related changes in muscle morphomics. A total of 500 subjects [250 (50.0%) males] with a mean age of 49.2 ± 27.9 years were evaluated. Inter- and intra-observer reliability was almost perfect for TMT and TMA, and substantial-to-almost perfect for radiodensity. The mean TMT, TMA and radiodensity were 5.2 ± 1.9 mm, 284 ± 159 mm2 and 44.6 ± 17.7HU, respectively. The cut-off values for reduced TMT, TMA and radiodensity for males/females using the European Working Group on Sarcopenia in Older People compliant criteria were ≤ 4.09 mm/≤3.44 mm, ≤ 166 mm2/≤156 mm2, and ≤ 35.5HU/≤35.2HU, respectively. We described a standardized CT-based TMT and TMA measurement protocol practical for clinical use with almost perfect reliability. Using the protocol, we produced quantile regression models for the detection of reduced TMT, TMA and radiodensity at the lowest 5th, 10th, 20th, 30th, 40th and 50th percentiles as well as the EWGSOP compliant criteria cut-off values for reduced muscle mass to facilitate generalizable radiological sarcopenia research.

Project description:BackgroundOwing to the compressive nature of the neuropathy, patients with carpal tunnel syndrome (CTS) have prolonged distal motor latency (DML), sensory nerve latency (SNL), median nerve swelling and restricted median nerve mobility. The purpose of this study was to noninvasively augment carpal tunnel space using radioulnar wrist compression (RWC) and evaluate its effects on median nerve pathological properties in patients with CTS. It was hypothesized that the RWC intervention would reduce the median nerve DML, SNL and cross-sectional area (CSA) and enhance longitudinal median nerve mobility in patients. with CTS.MethodsEleven patients diagnosed with CTS participated in this study. A portable RWC intervention splint was developed to apply 10 N of compressive force across the wrist. Three daily sessions of RWC were performed over 4 weeks of intervention (15 min per session, 45 min per day, 7 days per week). Each 15-min session consisted of three 5-min blocks of RWC, with a 1-min rest in between consecutive blocks. Patients were evaluated at Week 0 (baseline), Week 2 (mid-intervention) and Week 4 (end of intervention). DML and SNL of the median nerve were evaluated using established nerve conduction study techniques. Median nerve CSA at the distal wrist crease was obtained by ultrasound imaging. Median nerve motion associated with finger flexion/extension was captured by dynamic ultrasound imaging and quantified using a speckle cross-correlation algorithm. Finger flexion/extension was recorded using an electrogoniometer. The slope of the regressed linear equation of median nerve displacement as a function of finger flexion angle was used to quantify nerve mobility.ResultsPatients with CTS showed significantly decreased DML (p = 0.048) and median nerve CSA (p < 0.001) and increased nerve mobility (p < 0.001) at mid-intervention compared to baseline. However, DML, CSA and mobility of the median nerve did not differ significantly between Weeks 2 and 4 (p = 0.574, 1.00 and 0.139, respectively). Median nerve SNL was not significantly affected throughout the 4-week intervention (p = 0.330 for Week 0 vs. 2; p = 1.00 for Week 2 vs. 4).ConclusionThis study revealed that RWC intervention with 10-N force applied to the wrist in the radioulnar direction could restore impaired neurophysiological and biomechanical functions of the median nerve. The beneficial effects of RWC intervention for the median nerve were in evidence after a relatively short period of two weeks. These functional improvements could be explained by intermittent decompression of the median nerve via RWC-induced augmentation of the carpal arch.The translational potential of this articleBiomechanically manipulating the carpal tunnel by RWC decompresses the median nerve and has the potential to become an alternative treatment for CTS.

Dataset Information

Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals.

Objective

Methods

Results

Conclusion

Publications

Sonographic reference values for median nerve cross-sectional area: A meta-analysis of data from healthy individuals.

Similar Datasets

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