Document Type : Original Article


1 Department of Rheumatology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Department of internal medicine , School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Department of Rheumatology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

4 Medical student, School of medicine, Islamic Azad University of Medical Science, Tehran branch.

5 Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

6 Resident of Internal Medicine , Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.



Carpal Tunnel Syndrome (CTS) is characterized by median nerve entrapment in the wrist. CTS is diagnosed by clinical symptoms, which are confirmed by electrodiagnostic studies. This study aimed to assess median nerve cross-sectional area and elastography in chronic hemodialysis patients. This case-control study was conducted on end-stage renal failure (ESRD) patients undergoing hemodialysis at Rasool Akram Hospital's Dialysis Unit. The healthy companions of the patients were included as control group. An experienced rheumatologist used a supersonic device with linear array probes and dynamic scanners (5-22 MHz) to perform the sonography. The current study was conducted on both hands. There was no statistically significant difference between 30 patients and 30 healthy individuals regarding age, weight, and body mass index. The cross-sectional area of median nerve in both hands was increased in the dialysis group compared to the control group. However, it was significantly higher in the patient group's right hand than in the control group (P = 0.031). Considering the causes of ESRD and parathormone levels, the cross-sectional area and mean right and left median nerve elastography were not different between the two groups. The results showed that the patient group had a larger right and left median nerve cross-sectional area than the control group. However, the median nerve elastographic indices did not differ between dialysis patients and healthy individuals.


Main Subjects

  •  1- Aubry S, Nueffer JP, Tanter M, Becce F, Vidal C, Michel F. Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology 2015; 274(3):821-9. doi: 10.1148/radiol.14140434.
  • 2- Maffulli N, Kenward MG, Testa V, Capasso G, Regine R, King JB. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med 2003; 13(1):11-5. doi: 10.1097/00042752-200301000-00003.
  • 3- Hsiao MY, Chen YC, Lin CY, Chen WS, Wang TG. Reduced Patellar Tendon Elasticity with Aging: In Vivo Assessment by Shear Wave Elastography. Ultrasound Med Biol 2015; 41(11):2899-905. doi: 10.1016/j.ultrasmedbio.2015.07.008.
  • 4- De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS. Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol 2009; 193(2):W134-8. doi: 10.2214/ajr.08.1843.
  • 5- Ilan DI, Tejwani N, Keschner M, Leibman M. Quadriceps tendon rupture. J Am Acad Orthop Surg 2003; 11(3):192-200. doi: 10.5435/00124635-200305000-00006.
  • 6- Thaunat M, Gaudin P, Naret C, Beaufils P, Thaunat O. Role of secondary hyperparathyroidism in spontaneous rupture of the quadriceps tendon complicating chronic renal failure. Rheumatology (Oxford) 2006; 45(2):234-5. doi: 10.1093/rheumatology/kei022.
  • 7- Palmer S, Birks C, Dunbar J, Walker R. Simultaneous multiple tendon ruptures complicating a seizure in a haemodialysis patient. Nephrology (Carlton) 2004; 9(5):262-4. doi: 10.1111/j.1440-1797.2004.00269.x.
  • 8- Tsourvakas S, Gouvalas K, Gimtsas C, Tsianas N, Founta P, Ameridis N. Bilateral and simultaneous rupture of the triceps tendons in chronic renal failure and secondary hyperparathyroidism. Arch Orthop Trauma Surg 2004; 124(4):278-80. doi: 10.1007/s00402-003-0628-3.
  • 9- Wright P. Carpal tunnel, ulnar tunnel, and stenosing tenosynovitis. In:Cambell's Operative Orthopaedics.Edited by by  Terry Canale ,10 edn. Mosby, United States;  2003:3761-78.
  • 10. Ralte P, Selvan D, Morapudi S, Kumar G, Waseem M. Haemostasis in Open Carpal Tunnel Release: Tourniquet vs Local Anaesthetic and Adrenaline. Open Orthop J 2010; 4:234-6. doi: 10.2174/1874325001004010234
  • 11.Dillon JP, Laing A, Hussain M, Macey A. Improved tolerability of open carpal tunnel release under local anaesthetic: a patient satisfaction survey. Arch Orthop Trauma Surg 2008; 128(2):125-7. doi: 10.1007/s00402-007-0460-2.
  • 12. Sever C, Kulahci Y, Oksuz S, Sahin C. The mini incision technique for carpal tunnel decompression using nasal instruments. Turk Neurosurg 2010; 20(3):353-7. doi: 10.5137/1019-5149.Jtn.2526-09.0.
  • 13. Macaire P, Singelyn F, Narchi P, Paqueron X. Ultrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study. Reg Anesth Pain Med 2008; 33(4):363-8. doi: 10.1016/j.rapm.2008.01.004.
  • 14. Gomes I, Becker J, Ehlers JA, Kapczinski F, Nora DB. Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients. Arq Neuropsiquiatr 2004; 62(3a):596-9. doi: 10.1590/s0004-282x2004000400006.
  • 15. Patil S, Ramakrishnan M, Stothard J. Local anaesthesia for carpal tunnel decompression: a comparison of two techniques. J Hand Surg Br 2006; 31(6):683-6. doi: 10.1016/j.jhsb.2006.08.008.
  • 16. Bland JD. Treatment of carpal tunnel syndrome. Muscle Nerve 2007; 36(2):167-71. doi: 10.1002/mus.20802.
  • 17.Hamanaka I, Okutsu I, Shimizu K, Takatori Y, Ninomiya S. Evaluation of carpal canal pressure in carpal tunnel syndrome. J Hand Surg Am 1995; 20(5):848-54. doi: 10.1016/s0363-5023(05)80442-3.
  • 18. Hirasawa Y, Ogura T. Carpal tunnel syndrome in patients on long-term haemodialysis. Scand J Plast Reconstr Surg Hand Surg 2000; 34(4):373-81. doi: 10.1080/028443100750059174.
  • 19.Sekiya H, Sugimoto N, Kariya Y, Hoshino Y. Carpal tunnel pressure in patients with carpal tunnel syndrome due to long-term hemodialysis. Int Orthop 2002; 26(5):274-7. doi: 10.1007/s00264-002-0366-0.
  • 20.Nakamoto HA, Ferreira MC, Tustumi F, Milcheski DA, Tuma P, Jr. Sensory testing in patients with hemodialysis-associated carpal tunnel syndrome submitted to surgical decompression. Ann Plast Surg 2014; 72(6):685-8. doi: 10.1097/SAP.0b013e31829d2288.
  • 21.Kurer MH, Baillod RA, Madgwick JC. Musculoskeletal manifestations of amyloidosis. A review of 83 patients on haemodialysis for at least 10 years. J Bone Joint Surg Br 1991; 73(2):271-6. doi: 10.1302/0301-620x.73b2.2005153.
  • 22. Saito A, Gejyo F. Current clinical aspects of dialysis-related amyloidosis in chronic dialysis patients. Ther Apher Dial 2006; 10(4):316-20. doi: 10.1111/j.1744-9987.2006.00383.x.
  • 23. Kim SJ, Shin SJ, Kang ES. Endoscopic carpal tunnel release in patients receiving long-term hemodialysis. Clin Orthop Relat Res 2000(376):141-8. doi: 10.1097/00003086-200007000-00020.
  • 24. Kang HJ, Koh IH, Lee WY, Choi YR, Hahn SB. Does carpal tunnel release provide long-term relief in patients with hemodialysis-associated carpal tunnel syndrome? Clin Orthop Relat Res 2012; 470(9):2561-5. doi: 10.1007/s11999-012-2309-4.
  • 25. Lu Y, Meng Z, Pan X, Qin L, Wang G. Value of high-frequency ultrasound in diagnosing carpal tunnel syndrome. Int J Clin Exp Med 2015; 8(12):22418-24.
  • 26. Yu G, Chen Q, Wang D, Wang X, Li Z, Zhao J. et al. Diagnosis of carpal tunnel syndrome assessed using high-frequency ultrasonography: cross-section areas of 8-site median nerve. Clin Rheumatol 2016; 35(10):2557-64. doi: 10.1007/s10067-016-3214-0.
  • 27. Gennisson JL, Deffieux T, Fink M, Tanter M. Ultrasound elastography: principles and techniques. Diagn Interv Imaging 2013; 94(5):487-95. doi: 10.1016/j.diii.2013.01.022.
  • 28. Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG. et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol 2015; 41(5):1126-47. doi: 10.1016/j.ultrasmedbio.2015.03.009.
  • 29. Kamaya A, Machtaler S, Safari Sanjani S, Nikoozadeh A, Graham Sommer F, Pierre Khuri-Yakub BT. et al. New technologies in clinical ultrasound. Semin Roentgenol 2013; 48(3):214-23. doi: 10.1053/
  • 30. Azami A, Maleki N, Anari H, Iranparvar Alamdari M, Kalantarhormozi M, Tavosi Z. The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome. Int J Rheum Dis 2014; 17(6):612-20. doi: 10.1111/1756-185x.12310.
  • 31 . Kantarci F, Ustabasioglu FE, Delil S, Olgun DC, Korkmazer B, Dikici AS. et al. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol 2014; 24(2):434-40. doi: 10.1007/s00330-013-3023-7.
  • 32. Liao YY, Lee WN, Lee MR, Chen WS, Chiou HJ, Kuo TT. et al. Carpal tunnel syndrome: US strain imaging for diagnosis. Radiology 2015; 275(1):205-14. doi: 10.1148/radiol.14140017.
  • 33. Tas S, Staub F, Dombert T, Marquardt G, Senft C, Seifert V. et al. Sonographic short-term follow-up after surgical decompression of the median nerve at the carpal tunnel: a single-center prospective observational study. Neurosurg Focus 2015; 39(3):E6. doi: 10.3171/2015.6.Focus15216.
  • 34. Ehler E. Median nerve ultrasonography in carpal tunnel syndrome. Clin Neurophysiol Pract 2017; 2:186-87. doi: 10.1016/j.cnp.2017.09.001.
  • 35. Wang LY, Leong CP, Huang YC, Hung JW, Cheung SM, Pong YP. Best diagnostic criterion in high-resolution ultrasonography for carpal tunnel syndrome. Chang Gung Med J 2008; 31(5):469-76.
  • 36. Mallouhi A, Pülzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography. AJR Am J Roentgenol 2006; 186(5):1240-5. doi: 10.2214/ajr.04.1715.
  • 37. Miyamoto H, Halpern EJ, Kastlunger M, Gabl M, Arora R, Bellmann-Weiler R. et al. Carpal tunnel syndrome: diagnosis by means of median nerve elasticity--improved diagnostic accuracy of US with sonoelastography. Radiology 2014; 270(2):481-6. doi: 10.1148/radiol.13122901.