Comparison of the median and ulnar nerves of rheumatoid arthritis patients and healthy subjects by ultrasound

Çiğdem Atan Uzun, İsmihan Sunar, Zafer Günendi, Feride Nur Göğüş, Çiğdem Atan Uzun, İsmihan Sunar, Zafer Günendi, Feride Nur Göğüş

Abstract

Objectives: In this study, we aimed to investigate ulnar and median nerve cross-sectional areas (CSAs) by ultrasonography in RA patients who had no signs or symptoms of neurologic involvement.

Patients and methods: This case-control study was conducted with 76 participants (72 females, 4 males; mean age: 53.2+10.9 years; range, 18 to 65 years) between April 2011 and April 2013. Of the participants, 38 were RA patients without any signs or symptoms of ulnar or median nerve involvement, and 38 were healthy subjects. All participants were evaluated with ultrasound. The median and ulnar nerve CSAs were measured at the proximal inlet of the carpal tunnel using the pisiform bone as a landmark.

Results: There were no statistically significant differences between patients and controls in terms of median and ulnar CSAs (p>0.05). There were no correlations between median and ulnar CSAs of the dominant hand and age, height, weight, and disease duration. The median nerve CSA was >10 mm2 in 24% of the RA patients and 14% of controls, but the difference was not statistically significant (p=0.20).

Conclusion: Similar median and ulnar CSAs were detected in RA patients and healthy controls. These findings cannot rule out a subclinical neurologic involvement.

Keywords: Median nerve; rheumatoid arthritis; ulnar nerve; ultrasonography.

Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Copyright © 2023, Turkish League Against Rheumatism.

Figures

Figure 1. Transverse scan of the wrist…
Figure 1. Transverse scan of the wrist demonstrating the median and ulnar nerves.

References

    1. Yang N, Coblyn JS. In: Neurologic Manifestations of Rheumatoid Arthritis. Cho T, Bhattacharyya S, Helfgott S, editors. New York: Springer; 2019. Neurorheumatology; pp. 63–72.
    1. Nadeau SE. Neurologic manifestations of connective tissue disease. Neurol Clin. 2002;20:151–178.
    1. Lee KH, Lee CH, Lee BG, Park JS, Choi WS. The incidence of carpal tunnel syndrome in patients with rheumatoid arthritis. Int J Rheum Dis. 2015;18:52–57.
    1. Sakthiswary R, Singh R. Has the median nerve involvement in rheumatoid arthritis been overemphasized. Rev Bras Reumatol Engl Ed. 2017;57:122–128.
    1. Buchberger W, Judmaier W, Birbamer G, Lener M, Schmidauer C. Carpal tunnel syndrome: Diagnosis with high-resolution sonography. AJR Am J Roentgenol. 1992;159:793–798.
    1. Lawande AD, Warrier SS, Joshi MS. Role of ultrasound in evaluation of peripheral nerves. Indian J Radiol Imaging. 2014;24:254–258.
    1. Bland JD. Carpal tunnel syndrome. Curr Opin Neurol. 2005;18:581–585.
    1. Milind J, Kothari D. Carpal tunnel syndrome: Clinical manifestations and diagnosis. 2020 [updated Jun 18, 2020. Available at: . [Accessed:11.09.2021]
    1. Smerilli G, Di Matteo A, Cipolletta E, Carloni S, Incorvaia A, Di Carlo M, et al. Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome. Clin Rheumatol. 2021;40:1085–1092.
    1. Gao PS, Ren SM, Liu L, Du ZH, Wang SM. Value of high-frequency ultrasound in the diagnosis of peripheral nerve compression in rheumatoid arthritis patients. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2016;38:327–330.
    1. Lanzillo B, Pappone N, Crisci C, di Girolamo C, Massini R, Caruso G. Subclinical peripheral nerve involvement in patients with rheumatoid arthritis. Arthritis Rheum. 1998;41:1196–1202.
    1. Ferry S, Pritchard T, Keenan J, Croft P, Silman AJ. Estimating the prevalence of delayed median nerve conduction in the general population. Br J Rheumatol. 1998;37:630–635.
    1. Karadag O, Kalyoncu U, Akdogan A, Karadag YS, Bilgen SA, Ozbakır S, et al. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: Prevalence and correlation with disease activity. Rheumatol Int. 2012;32:2313–2319.
    1. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–2581.
    1. Sarría L, Cabada T, Cozcolluela R, Martínez-Berganza T, García S. Carpal tunnel syndrome: Usefulness of sonography. Eur Radiol. 2000;10:1920–1925.
    1. El Miedany YM, Aty SA, Ashour S. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: Substantive or complementary tests. Rheumatology (Oxford) 2004;43:887–895.
    1. Reckelhoff KE, Li J, Kaeser MA, Haun DW, Kettner NW. Ultrasound evaluation of the normal ulnar nerve in guyon's tunnel: Cross-sectional area and anthropometric measurements. Journal of Medical Ultrasound. 2015;23:171–176.
    1. Yalcin E, Onder B, Akyuz M. Ulnar nerve measurements in healthy individuals to obtain reference values. Rheumatol Int. 2013;33:1143–1147.
    1. Valle M, Zamorani MP. In: Ultrasound of the Musculoskeletal System. Bianchi S, Martinoli C, editors. New York: Springer; 2007. Nerve and blood vessels; pp. 106–107.
    1. Wong SM, Griffith JF, Hui AC, Tang A, Wong KS. Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. Arthritis Rheum. 2002;46:1914–1921.
    1. McQueen FM, Ostergaard M. Established rheumatoid arthritis - new imaging modalities. Best Pract Res Clin Rheumatol. 2007;21:841–856.
    1. Kaya Subaşı P, Güler T, Yurdakul FG, Ataman Ş, Bodur H. Carpal tunnel syndrome in patients with rheumatoid arthritis and psoriatic arthritis: An electrophysiological and ultrasonographic study. Rheumatol Int. 2021;41:361–368.
    1. Yagci I, Akdeniz Leblebicier M, Mansiz Kaplan B, Ozturk Gokbakan D, Akyuz G. Sonographic measurements can be misleading for diagnosing carpal tunnel syndrome in patients with rheumatoid arthritis. Acta Reumatol Port. 2016;41:40–44.
    1. Onat Ş, ÖZ Ş, Orhan A, Ünsal-Delialioglu S, Ozel S. The Electrophysiologic and Sonographic Evaluation of Peripheral Nerves in Rheumatoid Arthritis Patients; >2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL, USA.
    1. Hammer HB, Haavardsholm EA, Kvien TK. Ultrasonographic measurement of the median nerve in patients with rheumatoid arthritis without symptoms or signs of carpal tunnel syndrome. Ann Rheum Dis. 2007;66:825–827.
    1. Hammer HB, Hovden IA, Haavardsholm EA, Kvien TK. Ultrasonography shows increased cross-sectional area of the median nerve in patients with arthritis and carpal tunnel syndrome. Rheumatology (Oxford) 2006;45:584–588.
    1. Anno S, Okano T, Mamoto K, Sugioka Y, Takeda S, Hashimoto A, et al. Comparison of median nerve stiffness with and without rheumatoid arthritis by ultrasound real-time tissue elastography: A propensity score matching study. Mod Rheumatol. 2020;30:481–488.

Source: PubMed

3
Subskrybuj