Dynamic ultrasound examination of the median nerve during follow-up after wrist fracture/surgery.
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ABSTRACT:
SUBMITTER: Colak AF
PROVIDER: S-EPMC10834273 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Dynamic ultrasound examination of the median nerve during follow-up after wrist fracture/surgery.
Çolak Ahmet Furkan AF Yeşiloğlu Ayşe İrem Aİ Kaynar Alpaslan Fatih AF Kaymak Bayram B Özçakar Levent L
Journal of Yeungnam medical science 20240105 1
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Project description:Instability of the nerves, which does not follow traumatic injury, is relatively rare. The ulnare nerve is most typically involved. Median nerve instability is far less common. The identification of instability of the median nerve in the wrist is definitely an indication for ultrasound examination before carpal tunnel release.
| S-EPMC9324960 | biostudies-literature
Project description:The effect of wrist flexion-extension on the median nerve appearance, namely the cross-sectional area (MNCSA) and the longitudinal (D1) and vertical (D2) diameters, was investigated among older adults (N = 34). Ultrasound examination was conducted to examine the median nerve at different wrist angles (neutral; and 15°, 30°, and 45° extension and flexion), in both the dominant and nondominant hand. Median nerve behavior were significantly associated with wrist angle changes. The MNCSA at wrist flexion and extension were significantly smaller (P < .001) compared with the neutral position in both the dominant and nondominant hand. The D1 and D2 were significantly reduced at flexion (P < .001) and extension (P < .001), respectively, in both the dominant and nondominant hand. Our results suggest that a larger flexion-extension angle causes higher compression stress on the median nerve, leading to increased deformation of the MNCSA, D1, and D2 among older adults.
| S-EPMC4419528 | biostudies-literature
Project description:Background and purposeSupracondylar humerus fractures (SCHFs) are the most common elbow fractures in children. Traumatic median nerve injury and isolated lesions of its pure forearm motor branch, anterior interosseus nerve (AIN), have both been independently reported as complications of displaced SCHFs. Our main objectives were to characterize the neurological syndrome to distinguish median nerve from AIN lesions and to determine the prognosis of median nerve lesions after displaced SCHFs.MethodsTen children were prospectively followed for an average of 11.6 months. Patients received a standardized clinical examination and high-resolution ultrasound of the median nerve every 1-3 months starting 1-2 months after trauma. Electrodiagnostic studies were performed within the first 4 months and after complete clinical recovery.ResultsAll children shared a clinical syndrome with predominant but not exclusive affection of AIN innervated muscles. High-resolution ultrasound uniformly excluded persistent nerve entrapment and neurotmesis requiring revision surgery but visualized post-traumatic median nerve neuroma at the fracture site in all patients. Electrodiagnostic studies showed axonal motor and sensory median nerve neuropathy. All children achieved complete functional recovery under conservative management. Motor recovery required up to 11 months and differed between involved muscles.ConclusionsIt was shown that neurological deficits of the median nerve in displaced SCHFs exceeded an isolated AIN lesion. Notably, detailed neurological follow-up examinations and sonographic exclusion of persistent nerve compression were able to guide conservative therapy in affected children. Under these conditions the prognosis of median nerve lesions was excellent despite severe initial deficits, development of neuroma and axonal injury.
| S-EPMC11555132 | biostudies-literature
Project description:Introduction/aimsThere is a lack of consensus regarding median nerve movement in the carpal tunnel during composite finger flexion in healthy individuals. In this study we examined the amount and direction of median nerve movement and differentiate nerve mobility between dominant and nondominant sides in a large, healthy, young adult cohort.MethodsSonographic videos of the median nerve during composite finger motion from extension to full flexion were analyzed in 197 participants without median nerve pathology. Displacement of the nerve's centroid was calculated based on a change in the relative location of the nerve. Longitudinal nerve sliding was categorized as none, independently from the tendons, or with the tendons.ResultsIn short axis, median nerves moved within 1 mm vertically and 3 mm horizontally; no direction was predominant. About half of the nerves (52.5%) slid independently while 26.9% slid with the tendons; 21.3% did not slide at all. On the nondominant side, median nerves that slid with the tendons had a larger absolute vertical displacement than nerves that slid independently or did not slide at all (P < .01). Nerves on the dominant side moved in a radial direction more frequently than on the nondominant side (P = .02).DiscussionTransverse nerve movement during composite finger flexion in healthy individuals varies widely with no clear pattern in the direction of transverse movement or amount of longitudinal sliding. These data provide a foundation for future research to better understand the biomechanical contribution of nerve movement to median nerve pathologies.
| S-EPMC8671362 | biostudies-literature
Project description:The present study investigated the effects of grip on changes in the median nerve cross-sectional area (MNCSA) and median nerve diameter in the radial-ulnar direction (D1) and dorsal-palmar direction (D2) at three wrist angles. Twenty-nine healthy participants (19 men [mean age, 24.2 ± 1.6 years]; 10 women [mean age, 24.0 ± 1.6 years]) were recruited. The median nerve was examined at the proximal carpal tunnel region in three grip conditions, namely finger relaxation, unclenched fist, and clenched fist. Ultrasound examinations were performed in the neutral wrist position (0°), at 30°wrist flexion, and at 30°wrist extension for both wrists. The grip condition and wrist angle showed significant main effects (p < 0.01) on the changes in the MNCSA, D1, and D2. Furthermore, significant interactions (p < 0.01) were found between the grip condition and wrist angle for the MNCSA, D1, and D2. In the neutral wrist position (0°), significant reductions in the MNCSA, D1, and D2 were observed when finger relaxation changed to unclenched fist and clenched fist conditions. Clenched fist condition caused the highest deformations in the median nerve measurements (MNCSA, approximately -25%; D1, -13%; D2, -12%). The MNCSA was significantly lower at 30°wrist flexion and 30°wrist extension than in the neutral wrist position (0°) at unclenched fist and clenched fist conditions. Notably, clenched fist condition at 30°wrist flexion showed the highest reduction of the MNCSA (-29%). In addition, 30°wrist flexion resulted in a lower D1 at clenched fist condition. In contrast, 30°wrist extension resulted in a lower D2 at both unclenched fist and clenched fist conditions. Our results suggest that unclenched fist and clenched fist conditions cause reductions in the MNCSA, D1, and D2. More importantly, unclenched fist and clenched fist conditions at 30°wrist flexion and 30°wrist extension can lead to further deformation of the median nerve.
| S-EPMC5036108 | biostudies-literature
Project description:BackgroundThe objective of this study was to evaluate the changes of the median nerve cross-sectional area (MNCSA) and diameters of the median nerve at different finger postures and wrist angles.MethodsTwenty-five healthy male participants were recruited in this study. The median nerve at wrist crease was examined at six finger postures, and repeated with the wrist in 30° flexion, neutral (0°), and 30° extension. The six finger postures are relaxed, straight finger, hook, full fist, tabletop, and straight fist.ResultsThe main effects of both finger postures and wrist angles are significant (p < 0.05) on changes of the MNCSA. Different finger tendon gliding postures cause a change in the MNCSA. Furthermore, wrist flexion and extension cause higher deformation of the MNCSA at different finger postures.DiscussionThe median nerve parameters such as MNCSA and diameter were altered by a change in wrist angle and finger posture. The results may help to understand the direct biomechanical stresses on the median nerve by different wrist-finger activities.
| S-EPMC6087621 | biostudies-literature
Project description:Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross-sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70-71% and specificity of 80-84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel.
| S-EPMC4529801 | biostudies-literature
Project description:Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.
| S-EPMC10422582 | biostudies-literature
Project description:This study investigated the effects of wrist angle, sex, and handedness on the changes in the median nerve cross-sectional area (MNCSA) and median nerve diameters, namely longitudinal diameter (D1) and vertical diameter (D2). Ultrasound examination was conducted to examine the median nerve at the proximal carpal tunnel in both dominant and nondominant hands of men (n = 27) and women (n = 26). A total of seven wrist angles were examined: neutral; 15°, 30°, and 45° extension; and 15°, 30°, and 45° flexion. Our results indicated sexual dimorphism and bilateral asymmetry of MNCSA, D1 and D2 measurements. MNCSA was significantly reduced when the wrist angle changed from neutral to flexion or extension positions. At flexion positions, D1 was significantly smaller than that at neutral. In contrast, at extension positions, D2 was significantly smaller than that at neutral. In conclusion, this study showed that MNCSA decreased as the wrist angle changed from neutral to flexion or extension positions in both dominant and nondominant hands of both sexes, whereas deformation of the median nerve differed between wrist flexion and extension.
| S-EPMC4320094 | biostudies-literature
Project description:Median nerve entrapment after supracondylar humeral fracture in children is rare. We report a case of Gartland type III supracondylar humeral fracture complicated by an entrapment of the median nerve following closed reduction and percutaneous pinning in a 5-year-old child. The diagnosis of entrapment was made 14 months post injury following progressive motor and sensory palsy. Resection and end-to-end suture were performed, leading to complete sensory and motor recovery eight months later. This nerve complication is often unnoticed and should be suspected systematically before and after reduction of all displaced supracondylar humeral fracture in children. The indication of resection-suture or nerve graft depends on the entrapment and the delay of the palsy.
| S-EPMC6875267 | biostudies-literature