Role of ultrasound and magnetic resonance neurography in the detection of median nerve abnormalities in carpal tunnel syndrome

Abstract Background The most prevalent cause of peripheral nerve entrapment is carpal tunnel syndrome, which is characterized by compression of the median nerve at the wrist as a result of nearby or localized microvascular interference as well as structural alterations to the median nerve or adjacent tissues. However, no special information regarding the median nerve or its surroundings is provided by clinical examination or electrophysiological testing. The purpose of this study is to evaluate the effectiveness of magnetic resonance neurography (MRN) and ultrasound in identifying changes and abnormalities of the median nerve in carpal tunnel syndrome. Methods The twenty-five patients in this study ranged in age from 27 to 63 years old, with a mean age of 47. There were 18 female patients and seven male patients. All patients were sent to the radiology department from the orthopedics, neurology, outpatient clinic, and neurology department, at Ain Shams Hospital, Faculty of Medicine, Ain Shams University. All of the patients had clinically manifested pain along the median nerve distribution, each of the sixteen patients had hand paresthesia, and four had thenar muscle atrophy. Results In the current study, Ultrasound exhibits low negative predictive value of 67% and specificity of 67%, but high positive predictive value of 95%, sensitivity of 95%, and overall accuracy of 92%. On the other hand, (MRN) exhibits a low negative predictive value of 60% and a high specificity of 75% in the diagnosis of nerve entrapment, but it also displays a high positive predictive value of 95%, sensitivity of 90%, and overall accuracy of 88%. Regarding the assessment of the recurrence cause and post-surgical evaluation is more reliable by Magnetic Resonance Neurography examination. Conclusions Magnetic resonance neurography and high-resolution ultrasonography can be utilized to diagnose patients with median nerve entrapment and patients who cannot be diagnosed electrophysiologically. MRN is a more accurate method for detecting the exact location of nerve entrapment and evaluating nerve recovery after surgical intervention than nerve conduction studies and electromyography. Additionally, MRN can be used to identify causes that were not previously recognized based on physical examination and electrophysiological tests.