Iranian Journal of Orthopedic Surgery

Abstract Introduction: Carpal tunnel syndrome (CTS) represents the most prevalent form of compressive neuropathy. Although electrodiagnostic assessments (EMG–NCV) are routinely used for diagnosis and demonstrate good accuracy, they are invasive procedures and can sometimes produce false‑negative outcomes. In recent years, high‑resolution ultrasonography has gained attention as a noninvasive, widely available, and cost‑efficient diagnostic option. The purpose of this study was to investigate the usefulness of sonographic evaluation in diagnosing CTS and to examine how its findings relate to clinical symptoms and electrophysiological results.
Materials & Methods: In this cross‑sectional diagnostic study, individuals with a clinical suspicion of carpal tunnel syndrome were assessed. Each participant underwent both EMG–NCV testing and bilateral wrist ultrasonography. Sonographic variables, including the cross‑sectional area (CSA) and the width of the median nerve at various points along the forearm and within the carpal tunnel, were compared among electrodiagnostic severity categories classified as normal, mild, moderate, and severe. The sensitivity and specificity were determined for chosen CSA and nerve‑width cutoff values.
Results & Discussion: 60 patients with the mean age of 49.5±10.4 years and mean BMI of 26.8±3.6 kg/m² being 90% female and 80% with bilateral involvement were studied. Age was not significantly associated with CTS severity (P=0.344), whereas higher BMI correlated with greater severity (P=0.01). Median nerve CSA width increased parallel with disease severity. In the right hand, a CSA cut off of 8.5 mm² at the carpal tunnel yielded 87.5% sensitivity and 81.7% specificity; in the left hand, a CSA cut off of 8 mm² provided 70% sensitivity and 95.5% specificity. Nerve width ≥ 5 mm showed high sensitivity but lower specificity.
Conclusion: Ultrasonography—especially assessing the cross‑sectional area of the median nerve—serves as a dependable, noninvasive, and precise complementary tool alongside EMG–NCV for both identifying and grading the severity of CTS.

Abstract Background: This study aimed to evaluate the relationship between changes observed in an ultrasonography before and after the surgical release of carpal tunnel syndrome (CTS).
Methods: This prospective study was performed on 15 candidates of CTS surgery during 2017-2018 who underwent an ultrasonography before and three months after the surgery. The structural changes in the median nerve and their correlation with the carpal tunnel were analized.
Results: According to ultrasonography results, the findings related to height, diameter and cross-sectional area  of the median nerve decreased in the pisiform region of carpal tunnel while they increased in the area of hamate hook (P=0.002 in pisiform and P=0.001 in hamate hook), which might be due to the elimination of nerve dysfunction in the pisiform and effective decrease of pressure on nerve in hamate hook.
Conclusion: In terms of evaluation of changes in the area of the median nerve, ultrasonography of the median nerve could be an effective and accurate technique to recognize the compression and follow up the nerve status in patients with CTS after surgery.
 

Abstract  Background: Some authors suggested using ultrasound in diagnosis of carpal tunnel syndrome (CTS), however the efficacy of ultrasound in determining the severity of disease is unclear. In current study, we aimed to investigate the diagnostic efficacy of ultrasound in determining the severity of CTS in comparison with NCV using measurement of cross-sectional area of median nerve. Methods: In a prospective study, 181 CTS suspected wrists (94 patients) were investigated. The cross-sectional area of the median nerve was measured using ultrasound and the severity of disease was determined based on criteria of El Miedany et al. Based on the NCV, the patients were divided into four groups of normal, mild, moderate or severe CTS. Finally, the mean cross-sectional area was compared between the groups and the kappa agreement coefficient for determining the severity of disease by the two methods was calculated. Results: The mean cross-sectional area increased significantly with increase in disease severity (p < /i>>.001). Conclusions: Determination of cross-sectional area of median nerve with ultrasound can be a useful tool in decision-making about surgical intervention in carpal tunnel syndrome. However, the clinical correlation is mandatory.  

Abstract Background: Developmental dysplasia of the hip (DDH) is a common problem and inappropriate treatment may result in serious complications. Several techniques have been used to monitor the status of the hip after reduction. Each has its own problem so that ultrasound found a special place where the assessment is needed. The aim of this study was to determine the diagnostic value of transinguinal and transgluteal ultrasound in comparison to CT scan in the evaluation of femoral head position in acetabulum in DDH treatment in spica cast. Methods : A cross-sectional study was performed on 37 affected hips in 24 infants at the age of 9 to 36 months during one year in a teaching hospital in Tehran, Iran. After close or open reduction and applying spica cast, an opening was made over the anterior edge of the inguinal region and transinguinal and transgluteal ultrasound was performed to confirm the quality of reduction in the acetabulum. The sensitivity, specificity, positive and negative predictive values of the postoperative ultrasonography was compared with CT scan. Data analysis was done by statistical tests. Results: The rate of agreement between ultrasonography and CT scan results was 91% (p < /i>

Abstract Background: Diagnosis of carpal tunnel syndrome is based on clinical findings and these findings are used to confirm the diagnosis. Sonography is also a noninvasive method for diagnosis of carpal tunnel syndrome. The purpose of this study was to investigate the role of sonography and electrodiagnostic studies in diagnosis of this syndrome. Methods: In a prospective study, 76 hands with diagnosis of carpal tunnel syndrome (study group) were compared with 80 hands (control group) in a training hospital in Kerman-Iran. In both groups the diameter of median nerve was measured by sonography and electrodiagnostic studies were performed only on the study group. The study group, post surgery, was followed up for 6 months and the DASH preoperative functional scoring was compared with post operative scores. Results: The difference between the diameters of the median nerve measured by sonography (p=.0001) and also the difference between before and after-operation Dash Score in the patient group (p=.001) were statistically significant. Sonography was 95% sensitive and 93% specific for the diagnosis of carpal tunnel syndrome. A weak correlation was found between the severity of the disease in electrodiagnostic studies and sonography (p < .01, r=.38). No correlation was proved between the sonographic or electrodiagnostic findings and Dash score before and after the operation (p≥.05). Conclusion: sonography might be a suitable module for the diagnosis of carpal tunnel syndrome, but there were no correlation between its findings or electrodiagnostic findings and functional scores. Whether or not sonography could be substitute for electerodiagnostic tests, will need further investigation.

Abstract Background: Entrapment of flexor pollicis longus at the level of A1 pulley is the most common cause of snapping or painful thumb upon flexion and extension motion the so called which is called "Trigger Thumb". The aim of this study is to assess the efficacy of sonographically-guided intra tendon sheath corticosteroid injection in the management of trigger thumb. Methods: In a prospective study 104 patients (7 males, 97 females, 112 trigger thumbs) with the mean age of 52.11±7.63 who had trigger thumb underwent intra flexor sheath corticosteroid injection under the guide of ultrasound in a 2 year period in Rasht-Iran. Improvement was measured using the "Quinnell" grading system before and in intervals after 3 and 6 weeks 3, 6 and 12 months after injection. Results: From the 112 thumbs, 15 (13.4%) required reinjection and/or surgery. Twelve (80%) of these 15 thumbs were simply re-injected, 2 (13.3%) underwent surgery without re-injection but because of no improvement, underwent surgery. Reduction in Quinnell grade after the first injection was significant (p < .0001). One year after the first injection, 111 of 112 thumbs (99.1%) were symptom-free. Conclusion: Sonographically guided intra flexor sheath corticosteroid injectionis an effective method in the management of trigger thumb and would reduce the need for surgical release.

Abstract Background: ''Suprascapular nerve block'' is a well known technique for treating chronic shoulder pain. Ultrasonography-guided nerve block is a new technique hoping to decrease the complications of inadvertent injection of drug into the vessels or nerve sheet by increasing the accuracy and efficacy of the injections. Methods: In a trial clinical study, 50 Patients suffering from chronic shoulder pain were divided randomly into two groups. In the first group, nerve block was applied under the ultrasonograpy guide and in the second group using direct anatomic landmarks (Moore technique). Pain score was assessed using a visual analog scale (VAS) and shoulder function was evaluated by constant shoulder score (CSS) before the injection and after the block. The patients' satisfaction rate and efficacy were also evaluated and compared between the two groups. Results: There was no statistically significant difference between the two groups in pain or shoulder functional scores before the procedure (p≥.05). One week after the nerve block, the first group revealed significantly improvement in pain score p=.035). Although shoulder function improved in both groups, the difference was not significant. (p≥.05). One month later, pain and shoulder functional scores showed better improvement in group one compared to group two (p=.000). No complication occurred in either group. Conclusion: Ultrasonography-guided suprascapular nerve block has better outcome in pain score and shoulder function compared with ''blindly'' blocking the nerve.