Ultrasonographic assessment of carpal tunnel syndrome

Principal Investigator: Douglas Hutchinson
Keywords: mucopolysaccharidosis , carpal tunnel syndrome Department: Orthopedic Surgery
IRB Number: 00059910 Co Investigator: Amy Moeller
Specialty: Orthopaedic Surgery, Orthopaedic Surgery, Orthopaedic Surgery, Orthopaedic Surgery
Sub Specialties: Pediatric Orthopaedic Surgery, Upper Extremity, Congenital Hand
Recruitment Status: Enrolling by invitation

Contact Information

Nousheen Alasti

Brief Summary

Aim-1. To correlate EMG findings and median nerve cross-sectional area in children with mucopolysaccharidosis.  Children with mucopolysaccharidosis are prone to developing compression neuropathies due to accumulation of glycosamionglycans in the soft tissues.  These patients often have cognitive impairment and are young at the time of presentation.  Therefore, assessing for carpal tunnel syndrome has required electromyographic testing under sedation or general anesthetic.  In adult populations, ultrasonography has become a new method of evaluating the median nerve within the carpal tunnel.  It is safe, quick, and does not involve general anesthetic or radiation.  Our hypothesis is that ultrasonography of the carpal tunnel in patients with mucopolysaccharidosis will prove to be an effective, reliable, and safe method to evaluate the median nerve, thus avoiding the need for EMG studies and anesthesia.

Aim-2. To determine the cross-sectional area of the median nerve using ultrasonography in a cohort of healthy children, ages 3-12.  Several studies have looked at normal cross-sectional area of the median nerve in healthy adults.  Carpal tunnel syndrome is most commonly seen in adult populations, and therefore no data exists on normal anatomy of the median nerve in children.  We therefore plan to evaluate a cohort of healthy children to determine a normal cross-sectional area of the median nerve.  This information will be beneficial in helping to treat those children afflicted with mucopolysaccharidosis.


Inclusion Criteria

1. For the first arm of the study (60 participants):

Children with mucopolysaccharidosis presenting to the clinic with signs or symptoms of carpal tunnel syndrome will be enrolled to receive both an EMG and carpal tunnel ultrasound of the upper extremities.

For the retrospective study, patients who have already undergone carpal tunnel release with existing electromyographic and ultrasonographic data.

 2. For the second arm of the study (100 participants):

Healthy children ages 3-12 with no acute upper extremity trauma or history of mucopolysaccharidosis.

25 additional participants requested in case of inconclusive ultrasound results, patient removal, or other unusable results.

 All Patients who are admitted for treatment in teh PCMC and University of Utah Pediatricdepartment will be asked to enroll.

Exclusion Criteria

1. First arm:

Children with mucopolysaccharidosis without pre-operative electromyographic assessment

2. Second arm:

Acute (<3month) wrist or hand surgery/injuries.  

Unable to obtain parental consent or patient assent.

History of mucopolysaccharidosis.

Non-english speaking.

Cognitive impairment.