Ultrasound measurements of the median nerve at the carpal tunnel in ambulant chronic stroke patients: comparison between paretic and non-paretic sides.
Mitsutoshi Shinoda, Motoyuki Abe
PMID 32038071WHAT IT FOUND
In chronic stroke, the median nerve was widest on the non-paretic side, especially in longer-standing cases, and slid less on the paretic side.
Four long-term patients had very wide nerves and suspected carpal tunnel signs.
Key findings
01The median nerve cross-sectional area was 9.93 ± 4.22 mm² on the non-paretic side and 7.47 ± 1.87 mm² in controls, and the difference was significant.
02The median nerve longitudinal sliding length was 5.75 ± 1.52 mm on the paretic side, 6.78 ± 1.58 mm on the non-paretic side, and 7.08 ± 1.87 mm in controls, with the paretic side significantly shorter.
03Four long-term stroke patients had suspected carpal tunnel syndrome on the non-paretic side, with cross-sectional areas from 12.5 to 27.2 mm², but no statistical analysis was performed.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study included only ambulant patients with a non-functional paretic hand and no history of carpal tunnel syndrome or diabetes, so it may not apply to non-ambulant patients, patients with a useful paretic hand, or patients with common carpal tunnel risk factors. Only 40 stroke patients and 25 controls were studied, and the four suspected carpal tunnel cases were too few for statistical analysis. The paper did not clarify how walking with or without crutches or a brace related to the ultrasound findings. The study did not include patients who could not walk independently.
Declared interests
No funding was received for this study, and the authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the larger non-paretic nerve area as proof that carpal tunnel syndrome is present in all chronic stroke patients. Only four patients had suspected carpal tunnel signs, and no statistical analysis was done for that small group.