Longitudinal Median Nerve Ultrasound Changes in Individuals With Spinal Cord Injury and an Age- and Sex-Matched Nondisabled Cohort

Minh Quan T Le; Elizabeth R Felix; Robert Irwin; Diana D Cardenas; Rachel E Cowan

doi:10.1016/j.arrct.2022.100238

Longitudinal Median Nerve Ultrasound Changes in Individuals With Spinal Cord Injury and an Age- and Sex-Matched Nondisabled Cohort

Arch Rehabil Res Clin Transl. 2022 Oct 17;4(4):100238. doi: 10.1016/j.arrct.2022.100238. eCollection 2022 Dec.

Authors

Minh Quan T Le¹, Elizabeth R Felix^{2

3}, Robert Irwin², Diana D Cardenas², Rachel E Cowan^{4

5}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL.
² South Florida SCI Model System, Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL.
³ Department of Physical Medicine and Rehabilitation, Miami Veterans Administration Medical Center, Miami, FL.
⁴ Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
⁵ The Miami Project to Cure Paralysis, Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL.

Abstract

Objectives: To assess the natural history for development of carpal tunnel syndrome (CTS) in persons with acute spinal cord injury (SCI) at 1 year postdischarge from initial rehabilitation and to assess baseline median nerve (MN) cross-sectional area (CSA) above/below 10 mm² correlates with any longitudinal changes in quantitative ultrasound (US) of the MN.

Design: A prospective cohort study of persons with acute SCI evaluated for CTS using quantitative US and compared to a group without SCI (non-SCI).

Setting: Academic medical center.

Participants: N=69 total (N=34 SCI, N=35 non-SCI). The average age in both groups was 28 and the SCI group included 30 males and 2 females and the non-SCI group included 30 males and 3 females.

Interventions: Not applicable.

Main outcome measures: The primary outcome was the change in quantitative US parameters of the MN, including CSA and grayscale, from baseline to 1-year follow-up in those with SCI and those without SCI. CTS symptomatology and physical exam sum score and US measures for dominant and nondominant arms were considered secondary outcomes.

Results: The SCI had darker nerves at baseline (P=.036, nondominant), greater CTS symptoms at follow-up (P≤.036, bilateral), and no differences in all change scores (all P≥.056). Individuals with smaller nerves at baseline had larger increases in nerve size (P=.029, nondominant) vs those with larger nerves. Change in CTS symptoms CSA (nondominant) and nerve echogenicity (dominant) were inversely associated with their respective baseline values (all P≤.045).

Conclusions: We observed few differences between the SCI group and the non-SCI control group and between those with smaller vs larger MN. In general, MN pathology changes (CTS symptoms and US variables) over 1 year were more common in the nondominant arm and appear to be a function of MN pathology at enrollment. Individuals with SCI may experience increased CTS symptoms as soon as 1 year after injury.

Keywords: Carpal tunnel syndrome; Median nerve; Rehabilitation; Spinal cord Injuries; Ultrasonography.