A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior. Cerca de 5% dos pacientes com insuficiência renal crônica submetidos à hemodiálise apresentam esta condição. A história clínica e o exame físico continuam sendo as ferramentas mais adequadas para seu diagnóstico. Testes complementares têm sido usados para auxiliar o diagnóstico e o controle de tratamento; dentre eles os de avaliação da sensibilidade cutânea. O PSSD (Pressurespecified sensory device ) consiste de aparelho que incorpora transdutor de pressão acoplado a um computador capaz de determinar os limiares cutâneos de sensibilidade à pressão no território do nervo mediano(superfície volar do índex). O objetivo do estudo foi determinar através do PSSD os limiares cutâneos de pressão no território do nervo mediano antes e depois do tratamento cirúrgico da síndrome. Para tanto, os pacientes foram divididos em dois grupos: Grupo 1: pacientes portadores de insuficiência renal crônica e submetidos à hemodiálise com síndrome do túnel do carpo. Grupo 2: pacientes com síndrome do túnel do carpo sem insuficiência renal. Foram avaliados com o PSSD as seguintes medidas: limiares cutâneos de pressão no teste de um ponto estático, no teste de um ponto dinâmico, no teste estático de dois pontos e no teste dinâmico de dois pontos. Houve evolução positiva no pós operatório(menor limiar) de todos os parâmetros avaliados pelo PSSD no grupo 1, enquanto no grupo 2 houve melhora significativa em todos os parâmetros, excetuando-se os do teste dinâmico de um ponto / Carpal Tunnel Syndrome is the most common compressive neuropathy on the upper limb. About 5% of the patients with chronic renal insufficiency who are treated with hemodialysis present carpal tunnel syndrome. Clinical history and physical examination remain the most adequate tools for the diagnosis. Evaluation of sensory thresholds can be used to complement those parameters. The PSSD (Pressurespecified sensory device) is a tool that incorporates a pressure transducer linked to a computer capable of measuring the cutaneous pressure thresholds referred by the patient. The aim of this study was to determine the values of pressure thresholds with the PSSD before and after treatment of carpal tunnel syndrome. The patients were divided in two groups: Group 1: patients with carpal tunnel syndrome associated to chronic hemodialysis. Group 2: patients with carpal tunnel syndrome without renal insufficiency. The following measurements were performed: static one point, moving one point, static two points and moving two points. The results showed better results in the post operative measurements in all parameters assessed in group 1, and improvements in all parameters with exception of the moving one point test in group 2

Background - Hand intense occupational activities have been associated with an increase in the incidence of carpal tunnel syndrome (CTS). CTS is characterized by an impairment of median nerve function. To date, a dose-response relationship between wrist activity and median nerve performance has not been documented. Since repetitive hand/wrist activity in the workplace has significant implications, it is important to establish a scientific basis for the aetiology of work-related carpal tunnel syndrome. Methods -- In a laboratory environment, twenty-seven clinically confirmed asymptomatic female subjects performed continuous repetitive wrist motion in the flexion-extension plane during which an angle of 120 degrees was subtended about the neutral wrist position. Four levels of wrist activity, corresponding with 0 (static), 22 (Iow), 38 (medium) and 49 (high) repetitions per minute, were prescribed. Wrist motion was recorded using a state-of-the-art 3D electromagnetic tracking system (HumanTRAC). Mathematical descriptors of wrist kinematics, including cycle time, amplitude, angular velocity and angular acceleration, were calculated. Sensory median nerve response to imposed physical stressors was monitored antidromically and recorded using a clinical electroneurometer every ten minutes throughout the simulated work activities. Near-nerve skin temperature was recorded at three sites along the distal sensory branch of the median nerve every twenty minutes. Results - After adjusting for changes in near-nerve skin temperature, a significant within-subject effect of duration of exposure (time) was detected. Sensory median nerve conduction velocity differed statistically by 2.1 ms-1 between the static and high wrist activity conditions after 120 minutes of exposure, signifying adverse effects on nerve conduction that are uniquely attributable to repetitive hand motion. Wrist activity measures of mean angular acceleration presented a highly significant association with nerve performance, where nerve conduction decreased as wrist activity increased. Using regression analysis, a maximum safe wrist-workload exposure limit of 0.91 repetitions per minute is proposed. Limitations of this result are discussed. A biomechanical model is presented to calculate the effect of physical risk factors on tendon forces at the wrist. This model offers a method by which findings of the study can be employed for workplace exposure surveillance and development of ergonomic workstation design recommendations. Conclusions -- Across the study population of clinically asymptomatic female participants, a change in median nerve performance was observed. This significant effect was evoked due to imposed physical stressors. A dose response relationship between work intensity, exposure time and median nerve conduction velocity was demonstrated. The research explored in this thesis presents a foundation for the future development of a "Dynamic Median Nerve Stress Test". This test would involve the performance of a repetitive motion activity of the wrist during which changes in the function of the median nerve are closely monitored. The Dynamic Median Nerve Stress Test might prove to be valuable both as a provocative clinical test as well as an important research tool.

Στην μελέτη μας - που σκοπό είχε την αναζήτηση των ηλεκτροφυσιολογιών παραμέτρων εκείνων οι οποίες πρωϊμώτερα καθίστανται παθολογικές σε αρχόμενη συμπιεστική βλάβη του μέσου νεύρου στον καρπό - εξετάσαμε συνολικά 72 ασθενείς (42 χέρια δεξιά, 30 αριστερά) από τους οποίους οι 66 ήταν γυναίκες και οι 6 άνδρες. Ο μέσος όρος ηλικίας των ασθενών ήταν 49.6±9.8 έτη. Όρος επιλογής των προς μελέτη ασθενών ήταν να παρουσιάζουν συμπτώματα και σημεία τέτοια ώστε κλινικά να τίθεται βάσιμα η υπόνοια συνδρομής καρπιαίου σωλήνα, ταυτόχρονα όμως, στον ηλεκτρονευρογραφικό έλεγχο η τιμή του τελικού κινητικού χρόνου να μην υπερβαίνει τα 4.2 msec, ώστε να εξασφαλίζεται το αρχόμενο - μη προχωρημένο της συμπιεστικής συνδρομής. Στην μελέτη χρησιμοποιήθηκαν και 43 μάρτυρες (19 χέρια δεξιά, 24 χέρια αριστερά). Οι μάρτυρες επελέγησαν με κριτήρια την παντελή απουσία συμπτωμάτων και σημείων από το περιφερικό νευρικό σύστημα και με τον περιορισμό της ουδέποτε λήψης νευροτοξικών ουσιών. Από αυτούς οι 31 ήταν γυναίκες και οι 12 άνδρες, είχαν δε μέσο όρο ηλικίας 41.3±16.4 έτη. Τόσο στους ασθενείς όσο και στους μάρτυρες μελετήθηκαν οι αισθητικές αγωγιμότητες με την ορθοδρομική μέθοδο. Σε κάθε χέρι η μελέτη έγινε με ερεθισμό ένα προς ένα όλων των δακτύλων (1ου, 2ου, 3ου και 4ου) και καταγραφή με επιφανειακό ηλεκτρόδιο στον καρπό από το μέσο νεύρο επιπλέον ερεθίστηκε και ο 5ος δάκτυλος και κατεγράφη το αισθητικό δυναμικό στον καρπό από το ωλένιο νεύρο. Τα αποτελέσματα αυτών των καταγραφών αφορούσαν όλες τις παραμέτρους του αισθητικού δυναμικού (λανθάνων χρόνος, εύρος, διάρκεια) καθώς και αλλοιώσεις της μορφολογίας του, από όλους τους δακτύλους. Στη συνέχεια προχωρήσαμε σε πολλαπλές συσχετίσεις κάθε μιας παραμέτρου σε διαφορετικούς δακτύλους, διαφορετικών παραμέτρων στον ίδιο δάκτυλο, αλλά και σε διαφορετικούς δακτύλους καθώς και στην απαρίθμηση των ανώμαλων κυματομορφών όπου αυτές εμφανίζονταν. Η στατιστική επεξεργασία όλων αυτών των δεδομένων κατέληξε στην συγκρότηση μιας κλίμακος ευαισθησίας ως προς την εγκαιρότερη αλλοίωση ηλεκτροφυσιολογιών παραμέτρων σε αρχόμενη συνδρομή καρπιαίου σωλήνα. Συμπερασματικά από τη μελέτη μας προκύπτουν τα εξής: 1) Η ανάδειξη δικόρυφου δυναμικού ενεργείας σε ερεθισμό είτε του 4ου είτε του 1ου δακτύλου είναι συχνό και ισχυρό εύρημα ως προς την τεκμηρίωση αρχόμενης συνδρομής καρπιαίου σωλήνα. 2) Σε αρχόμενη συνδρομή καρπιαίου σωλήνα πρώιμα παρατείνεται ο λανθάνων χρόνος από 4ο και από 1ο δάκτυλο, αλλοιώνονται όλες οι παράμετροι από τον 4ο δάκτυλο και παρατείνεται ο λανθάνων χρόνος από 3ο δάκτυλο. Δεν υπήρξε διαφοροποίηση των παραπάνω αποτελεσμάτων που να συσχετίζονται με το φύλο ή την ηλικία. / The purpose of the present work was to investigate cases with early median nerve entrapment neuropathy (carpal tunnel syndrome) and to identify the most sensitive neurophysiological parameter by which an early diagnosis of the syndrome can be established. We examined 72 patients (42 right hands and 30 left hands) 66 women and 6 men. The mean age was 49.6±9.8 years. The inclusion criteria were symptoms and signs compatible with the diagnosis of carpal tunnel syndrome and the distal motor latency to be less than 4.2msec. We also examined 43 control subjects (19 right hands and 24 left hands) 31 women and 12 men with a mean age 41.3±16.4 years The control subjects were free of peripheral neurological problems. In all patients and control subjects we studied the sensory conduction parameters using the orthodrom method. In all hands we stimulated all five fingers and we recorded the sensory potentials from the wrist for both nerves (the median nerve for the 4 first fingers and the ulnar nerve for the 5th finger). In all patients and controls median distal motor latency, amplitude and duration of compound sensory nerve action potentials and sensory nerve conduction velocity of all five fingers were measured. The statistical analysis of the results showed the following conclusions. 1. Double peak potentials after stimulation of the 4th finger was the most sensitive test for detecting early carpal tunnel syndrome. Double peak potentials after stimulation of the 1st finger was a less frequent finding. 2. In early carpal tunnel syndrome there is a prolongation of the latency of the 4th and 1st finger Also there are changes in all parameters of the 4th finger potential and there is a prolongation of the latency of 3rd finger. Finally there were no differences between male and female measurements.

Carpal tunnel syndrome (CTS) is one of the most common injuries responsible for lost time claims to the Workplace Safety and Insurance Board (WSIB). The main purpose of this study was to determine whether measurable sensorimotor changes exist in asymptomatic individuals who are at risk for CTS such that sensory impairment and/or functional tests may be used in the early detection and intervention to reduce the impact of CTS on individuals, industry and the health care system. Participants were recruited into three strata: (1) individuals diagnosed with mild CTS, (2) asymptomatic individuals who were deemed to be at risk of developing CTS due to exposure to etiological risk factors and (3) asymptomatic individuals who were deemed to be at minimal risk of developing CTS based on non-exposure to risk factors. The main outcome measures included two-point discrimination ability, pressure acuity, vibration sense, Purdue Pegboard Test performance and tracking error and tracking variance on a manual tracking task performed at two different speeds. Seven individuals with CTS, fourteen individuals at risk of developing CTS and nine control individuals with minimal risk participated. The CTS group was significantly different from the at-risk and control groups on the main and work sections of the DASH questionnaire, and the symptom severity scale and functional status scale of the Boston Carpal Tunnel Questionnaire. The only outcome measure that showed a significant difference between the at-risk and the minimal risk group was the assembly task of the Purdue Pegboard Test (p = 0.044), however other measures including median nerve conduction latencies, and manual tracking abilities showed promise that with further recruitment, a significant difference may be seen. The sensory impairment tests did not demonstrate degradation in sensory function in individuals at risk of developing CTS, however analysis of sensory nerve conduction latencies and some aspects of fine motor skills testing did show some promise in their ability to detect individuals at risk of developing CTS. A future prospective study that follows individuals at risk of developing CTS may determine that it is possible to implement a screening tool for the early identification and treatment of CTS. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2009-09-15 12:15:45.208

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T22:12:05Z (GMT). No. of bitstreams: 1 Kaleff_PauloRoland_M.pdf: 1919373 bytes, checksum: 0201e35b3a65c9c00ada905f14f6a364 (MD5) Previous issue date: 2009 / Resumo: Propósito:Avaliação de técnica de incisão transversa limitada no tratamento da síndrome do túnel do carpo, quanto à segurança cirúrgica e efetividade na abertura do Retináculo Flexor(RF). Método: Estudo prospectivo de Trinta procedimentos realizados em vinte e oito pacientes submetidos à técnica com incisão transversa mínima. A segurança da técnica e a abertura total do RF foram avaliadas através de questionário baseado em observações clinicas e inspeção endoscópica, respectivamente. Resultados: Não foram observadas complicações maiores. Um único paciente apresentou neuropraxia de N. interdigital. Dois pacientes apresentaram hematoma local pequeno. Em dois dos cinco primeiros casos, durante a inspeção endoscópica, observou-se abertura incompleta do RF, sendo necessária abertura complementar. Todos os pacientes apresentaram melhora do quadro clínico de dor noturna e parestesias. Conclusão: A técnica foi executada com segurança no grupo analisado, sem a ocorrência de complicações graves, e com abertura do RF na quase totalidade dos casos. Uma avaliação de longo prazo e com um número maior de pacientes é necessária. / Abstract: Purpose: To evaluate the application of a limited transverse incision technique to treat the Carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the Flexor Retinaculum (FR). Method: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively. Results: No major complications were observed. Two cases presented small local hematoma. One patient presented with transient neuropraxia of digital branch. In two of the first five cases, incomplete FR opening was identified during endoscopic revision with need of complementary opening. All patients showed symptom relief. Conclusion: The technique was safely performed on the prospection group, no major complications were detected and the opening of FR was observed in the majority of the patients. Long term results and with a larger series of patients should be evaluated in further studies. / Mestrado / Neurologia / Mestre em Ciências Médicas

A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior. Cerca de 5% dos pacientes com insuficiência renal crônica submetidos à hemodiálise apresentam esta condição. A história clínica e o exame físico continuam sendo as ferramentas mais adequadas para seu diagnóstico. Testes complementares têm sido usados para auxiliar o diagnóstico e o controle de tratamento; dentre eles os de avaliação da sensibilidade cutânea. O PSSD (Pressurespecified sensory device ) consiste de aparelho que incorpora transdutor de pressão acoplado a um computador capaz de determinar os limiares cutâneos de sensibilidade à pressão no território do nervo mediano(superfície volar do índex). O objetivo do estudo foi determinar através do PSSD os limiares cutâneos de pressão no território do nervo mediano antes e depois do tratamento cirúrgico da síndrome. Para tanto, os pacientes foram divididos em dois grupos: Grupo 1: pacientes portadores de insuficiência renal crônica e submetidos à hemodiálise com síndrome do túnel do carpo. Grupo 2: pacientes com síndrome do túnel do carpo sem insuficiência renal. Foram avaliados com o PSSD as seguintes medidas: limiares cutâneos de pressão no teste de um ponto estático, no teste de um ponto dinâmico, no teste estático de dois pontos e no teste dinâmico de dois pontos. Houve evolução positiva no pós operatório(menor limiar) de todos os parâmetros avaliados pelo PSSD no grupo 1, enquanto no grupo 2 houve melhora significativa em todos os parâmetros, excetuando-se os do teste dinâmico de um ponto / Carpal Tunnel Syndrome is the most common compressive neuropathy on the upper limb. About 5% of the patients with chronic renal insufficiency who are treated with hemodialysis present carpal tunnel syndrome. Clinical history and physical examination remain the most adequate tools for the diagnosis. Evaluation of sensory thresholds can be used to complement those parameters. The PSSD (Pressurespecified sensory device) is a tool that incorporates a pressure transducer linked to a computer capable of measuring the cutaneous pressure thresholds referred by the patient. The aim of this study was to determine the values of pressure thresholds with the PSSD before and after treatment of carpal tunnel syndrome. The patients were divided in two groups: Group 1: patients with carpal tunnel syndrome associated to chronic hemodialysis. Group 2: patients with carpal tunnel syndrome without renal insufficiency. The following measurements were performed: static one point, moving one point, static two points and moving two points. The results showed better results in the post operative measurements in all parameters assessed in group 1, and improvements in all parameters with exception of the moving one point test in group 2

The aim of this study was to evaluate the therapeutic effect of rehabilitation in patients with carpal tunnel syndrome. The study focused on a comparison between electromyographic findings, the findings of physioterapist-led clinical examinations and the patient's subjective feelings, illustrated by a visual analogue scale of pain intensity. These three types of examinations were carried out prior to the commencement of rehabilitation and following 8 rehabilitation sessions (within a period of 2 months) in a cohort of 15 patients, and correlations between them were described. Given the high prevalence of the disease, an effort was made to find objective examination criteria without the need to resort to electromyography. Powered by TCPDF (www.tcpdf.org)

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-12T11:42:16Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE DIGITAL COM FICHA SEM ASSINAT.pdf: 7130468 bytes, checksum: 91f192851345cb3030b04950f2f04c1e (MD5) / Made available in DSpace on 2016-04-12T11:42:17Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE DIGITAL COM FICHA SEM ASSINAT.pdf: 7130468 bytes, checksum: 91f192851345cb3030b04950f2f04c1e (MD5) Previous issue date: 2015-07-03 / INTRODUÇÃO: A avaliação dos limiares dolorosos em pacientes com neuropatias compressivas é de grande utilidade quando se tenta explicar a presença de sintomas generalizados. Sabe-se que no processo de sensibilização periférica a liberação de prostaglandina e bradicinina altera receptores específicos TRPV1 levando a redução do limiar de disparo da fibra nervosa. Essa repetição leva a uma ampliação no campo receptivo cerebral com consequente sensibilização central. A síndrome do túnel do carpo (STC) é a mononeuropatia mais frequentemente diagnosticada, porém os estudos de limiares dolorosos são escassos e não avaliam segundo o grau de comprometimento do nervo. MÉTODOS: Foram avaliadas 160 mulheres divididas em Grupo A) Controle (n=40) e grupo B) pacientes com quadro clínico de síndrome do túnel do carpo (n=120) subdivididas de acordo com o grau de comprometimento neurofisiológico do nervo mediano no punho seguindo a classificação de Pádua em Grupo I (n=20): pacientes com sintomas sugestivos, porém sem confirmação da neuropatia do nervo mediano no punho (NNMP); Grupo II (n=20): NNMP discreta; Grupo III (n=20): NNMP leve; Grupo IV (n= 20): NNMP moderada; Grupo V (n=20): NNMP acentuada; Grupo VI (n=20): NNMP extrema. Realizaram-se algometria de pressão, estudo de condução nervosa, sensibilidade discriminatória entre dois pontos e foi aplicado o questionário de gravidade de sintomas de Boston. A algometria foi realizada em território inervado pelo nervo mediano após a passagem através do túnel do carpo, na região inervada pelo nervo cutâneo palmar, em território inervado pelo nervo ulnar e em áreas proximais ao túnel do carpo. Os valores algométricos em um mesmo grupo seguiram padrão de normalidade (Kolmogorov-Smirnov p <0.05). As comparações entre os grupos foram não-paramétricos (Shapiro- Wilk p= 0.1955) e, portanto, o teste de Kruskal-Wallis foi utilizado e o poshoc de Dunn quando houve diferença significativa. RESULTADOS: Houve diferença extremamente significativa entre o grupo controle e os grupos com NNMP discreta, NNMP leve, NNMP moderada e NNMP acentuada (p<0,0001). Porém, não houve diferença significativa em alguns pontos tanto na presença dos sintomas sem NNMP como na NNMP extrema. Portanto, os limiares reduzem à medida que a patologia se inicia e progride até certo ponto. Quando já não são mais obtidos potenciais sensitivos ou motores nos estudos de condução nervosa, os limiares dolorosos retornam aos valores próximos da normalidade. Sugere-se esse resultado à provável destruição de fibras finas, na qual já pode haver hipoestesia em substituição da hiperalgesia. Quanto à sensibilidade discriminatória entre dois pontos foi observado que quanto mais acentuada a NNMP maiores os valores da sensibilidade discriminatória, havendo diferença significativa entre o controle e os grupos III, IV, V e VI (p<0,0001). Quanto à escala de gravidade de sintomas, as queixas relacionadas à dor e dormência ou formigamento foram mais evidentes nos grupos I, III, IV e V. Enquanto a incapacidade de realizar atividades cotidianas predominou nos grupos III, IV e V. CONCLUSÃO: O limiar para sensação dolorosa é menor em pacientes com síndrome do túnel do carpo, tanto em território inervado pelo nervo mediano como em outras áreas. / INTRODUCTION: Pain threshold evaluation in compressive neuropathy is very useful for explain generalized symptoms. About peripheral sensitization process in the release of bradykinin and prostaglandin alters specific TRPV1 receptors leading to reduction of nerve fiber firing threshold. This repetition leads to a brain receptive field expansion with consequent central sensitization. Carpal tunnel syndrome (CTS) is the most frequently diagnosed mononeuropathy, but painful thresholds studies are scarce and not evaluate according to nerve impairment degree. METHODS: We have evaluated 160 female divided into Group A) Control (n = 40), B) patients with symptoms suggestive of CTS (n = 120) subdivided according to the neurophysiologic impairment of median nerve at the wrist according to Padua classification into Group I (n = 20): patients with symptoms suggestive, but without confirmated wrist median nerve neuropathy (WMNN); Group II (n = 20): Discrete MNNW; Group III (n = 20): Light MNNW; Group IV (n = 20): Moderate MNNW; Group V (n = 20): Severe MNNW; Group VI (n = 20): Extreme MNNW. METHODS: Pressure algometry was held in 320 hands, as well as nerve conduction study and discriminatory sensitivity between two points. The Boston symptom severity questionnaire were applied to the patients. The algometry was held on areas innervated by the median nerve after crossing through the carpal tunnel, palmar cutaneous territory, ulnar cutaneous territory and proximal areas to the carpal tunnel. RESULTS: The algometry values within the same group were normal (Kolmogorov-Smirnov p <0.05). Comparisons between groups were non-parametric (Shapiro-Wilk p = 0.1955) and thus, the Kruskal-Wallis test was used and when there the significant difference pairwise comparisons were performed whit the Dunn test (poshoc). RESULTS: The comparison of algometry data showed extremely significant differences between control group and groups with discrete MNNW, light MNNW, moderate MNNW and severe MNNW (p <0.0001). However, there was no significant difference at some points both in the presence of symptoms without MNNW as in MNNW extreme. Therefore, pain thresholds showed direct relation to MNNW severity to a certain point. When sensory or motor potential were no longer obtained, painful thresholds returned close to normal values. We suggest this result could be due to small fibers destruction, when hyperalgesia would be replaced by hypoesthesia. As for discriminatory sensitivity between two points has been observed higher values were obtained as most affected by MNNW with a significant difference between control group and III, IV, V and VI groups (p <0.0001). As for the scale of severity of symptoms, the complaints with pain and numbness or tingling were more evident in I, III, IV and V groups. About the inability to perform daily activities predominated in III, IV and V groups. CONCLUSION: Pain threshold is lower in patients with carpal tunnel syndrome, either the median nerve innervated area or another areas.

Median Nerve Ultrasonography Examination Correlates for the Diagnosis of Moderate to Severe Carpal Tunnel Syndrome Objective: The aim of the study was to investigate the associations of cross-sectional area (CSA) of the median nerve measured by ultrasonography (US), the median to ulnar nerve ratio (MUR), the median to ulnar nerve difference (MUD) and the ratio of CSA of the median nerve to height squared (MHS) in relation to electrodiagnostic classification of moderate and severe carpal tunnel syndrome (CTS) and thus to identify patients suitable for surgical treatment. Materials and Methods: A prospective study was conducted in patients aged ≥ 18 years who underwent both median and ulnar nerve US and electrodiagnostic studies (EDS). 124 wrists of 62 patients were examined. The patients' characteristics were acquired through a questionnaire. CTS was diagnosed using EDS and classified according to the guidelines of the Czech Republic Association of Electrodiagnostic Medicine. The CSA of the median nerve and of the ulnar nerve were measured at the carpal tunnel inlet, i.e. at the level of the pisiform bone. Results: The median nerve swells at the wrist in CTS. Median nerve CSA at the tunnel inlet ≥ 12mm2 correlates with electrodiagnostic classification of moderate to severe carpal tunnel syndrome. At...

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