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Ультразвуковое исследование срединного нерва при диагностике синдрома запястного канала

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Наиболее распространенным среди туннельных синдромов является синдром запястного канала (СЗК), вызванный компрессией срединного нерва. В иллюстрированном обзоре литературы представлены методика ультразвукового исследования срединного нерва и ультразвуковая картина срединного нерва при синдроме запястного канала. Проведен анализ критериев ультразвуковой диагностики синдрома запястного канала. Среди рекомендованных для практики критериев выделены: площадь поперечного сечения срединного нерва на входе в запястный канал и (или) выходе из него ?0,11 см2 (11 мм2), при высоком делении нерва на два ствола - ?0,12 см2 (12 мм2); разница площади поперечного сечения срединного нерва на входе в запястный канал и (или) выходе из него и площади поперечного сечения срединного нерва на границе средней и нижней третей предплечья >0,02 см2 (2 мм2) и (или) индекс увеличения площади поперечного сечения >1,93; изменение формы срединного нерва на продольных срезах по типу песочных часов с появлением участка компрессионной деформации под поперечной запястной связкой; снижение эхогенности и потеря пучковой дифференцировки срединного нерва на входе в запястный канал, в канале и (или) на выходе из канала; локальное усиление васкуляризации срединного нерва в зоне утолщения на запястье перед входом в запястный канал (только в сочетании с признаком значимого увеличения площади поперечного сечения срединного нерва).

Ключевые слова:
ультразвуковая диагностика, срединный нерв, синдром запястного канала (карпальный туннельный синдром), ultrasound, median nerve, carpal tunnel syndrome

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Median nerve ultrasound in carpal tunnel syndrome diagnosis (pictorial review)

Of all tunnel syndromes the most common is the carpal tunnel syndrome (CTS), causing by the median nerve compression. The pictorial review presents the median nerve examination technique and the ultrasound images of carpal tunnel syndrome. The ultrasound criteria for carpal tunnel syndrome diagnosis were analyzed, following of them are recommended for routine clinical practice: an increase of the median nerve cross-sectional area at the carpal tunnel entrance and (or) exit ?0.11 cm2 (11 mm2), in the bifid median nerve - ?0.12 cm2 (12 mm2); the difference in the median nerve cross-sectional areas at the level of carpal tunnel entrance (and) or exit and at the border of the middle and lower third of the forearm >0.02 cm2 (2 mm2) and (or) index of the cross-sectional area >1.93; the hourglass shape of the median nerve at the long-axis view with the area of nerve compression deformity under the transverse carpal ligament; decrease of nerve echogenicity and loss of the fascicular pattern at the carpal tunnel entrance, carpal tunnel and (or) carpal tunnel exit; local hypervascularity of the enlarged median nerve (necessarily combined with a significant increase of the median nerve cross-sectional area).

Keywords:
ультразвуковая диагностика, срединный нерв, синдром запястного канала (карпальный туннельный синдром), ultrasound, median nerve, carpal tunnel syndrome