Presentation
Tingling and numbness of the fingers
Patient Data
The median nerve trunk shows normal properties in the forearm in the form of normal surface area (measuring about 5 mm2) and preserved nerve bundles. At the carpal tunnel level, the nerve is bulky (measuring about 19 mm2), and shows diffuse hypoechogenicity with indistinct nerve fascicles. Elastography and shear wave studies exhibit nerve stiffness.
Dynamic examination of the median nerve shows a noticeable increase in the nerve surface area at the carpal tunnel compared to the forearm. There is bowing and interstitial oedema of the flexor retinaculum denoting significant nerve compression
Nerve conduction study showed:
prolonged distal latency (DL)
low amplitude (3.9 mV)
decreased nerve conduction velocity (<40 m/s)
no sensory response
Conclusion: Carpal tunnel syndrome with secondary axonal changes
Case Discussion
Ultrasound is a valuable tool in the assessment of median neuropathy. This is a case of a patient diagnosed with carpal tunnel syndrome based on the sonographic findings which was confirmed later by the nerve conduction study.
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