MRI of the Carpal Tunnel 3 and 12 Months After Endoscopic Carpal Tunnel Release
- 1 February 2021
- journal article
- research article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 216 (2), 464-470
- https://doi.org/10.2214/ajr.20.23066
Abstract
OBJECTIVE. The purpose of this study was to study changes in the median nerve, retinaculum, and carpal tunnel on MRI after successful endoscopic carpal tunnel release (ECTR). SUBJECTS AND METHODS. In this prospective study, 35 wrists in 32 patients (five men, 27 women; mean age, 56.7 ± 6.8 [SD] years) with nerve conduction test–confirmed primary carpal tunnel syndrome were evaluated from May 2013 to September 2016. Clinical scores ranging from 0 to 4 (no improvement to symptoms completely resolved) and MRI morphologic features of median nerve and carpal tunnel were evaluated at baseline and 3 and 12 months after ECTR. The paired t test was used to compare MRI parameters before and after ECTR and their relationships to clinical improvement scores. RESULTS. All patients' conditions improved after ECTR with mean clinical improvement scores of 2.94 ± 1.0 at 3 months and 3.49 ± 0.56 at 12 months. Although median nerve swelling did decrease proximally, the nerve remained swollen (> 15 mm2) and flattened in all areas, even 12 months after ECTR. Additional changes occurred in median nerve caliber-change ratio, relative signal intensity, and carpal tunnel cross-sectional area. A retinacular gap was present in 33 (94%) wrists 3 months and six (17%) wrists 12 months after ECTR, and increased retinacular bowing persisted. CONCLUSION. After ECTR, undue swelling and flattening of the median nerve persist as long as 12 months after surgery, even in patients with a good surgical outcome. One should be wary of using these MRI findings as signs of persistent neural compression. The retinaculum reforms in most patients within 12 months of surgery but with a more bowed configuration.Keywords
This publication has 40 references indexed in Scilit:
- Magnetic Resonance Imaging After Endoscopic Carpal Tunnel ReleaseThe Journal of Hand Surgery, 2013
- Sonographic Follow-Up of Patients With Carpal Tunnel Syndrome Undergoing Surgical or Nonsurgical Treatment: Prospective Cohort StudyThe Journal of Hand Surgery, 2010
- Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgeryScandinavian Journal of Rheumatology, 2010
- Severity of Carpal tunnel syndrome assessed with high frequency ultrasonographyRheumatology International, 2009
- Magnetic resonance imaging compared with electrodiagnostic studies in patients with suspected carpal tunnel syndrome: predicting symptoms, function, and surgical benefit at 1 yearJournal of Neurosurgery, 2008
- Quantitative MR imaging of carpal tunnel syndrome.American Journal of Roentgenology, 1999
- Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.American Journal of Public Health, 1998
- Carpal Tunnel SyndromeNeurosurgery, 1995
- Magnetic resonance imaging in the evaluation of persistent carpal tunnel syndromeThe Journal of Hand Surgery, 1993
- Carpal tunnel syndrome: diagnosis with high-resolution sonography.American Journal of Roentgenology, 1992