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    • #9152
      Linh
      Participant

      Dear Steve,

      The median nerve has a cutoff of 0.09cm2. But if the patient has a bifid median nerve, do you add them up at the level of the lunate and still use the same cutoff to say if there is CTS?

      Best regards,
      Steve

    • #9188
      Stephen Bird
      Keymaster

      There is published data suggesting that you can add the two areas together and ue a cut off of 11mm2 ( 0.11cm2)
      But the article states it is not as good as assessment of a non bifid nerve.
      In these cases I concentrate on the other components of the assessment (change in contour / step sign / fascicle oedema / crinkle cut chip sign / etc.)
      Check for space occupying lesions, solar arthritis, tenosynovitis etc.

      Remember when you have a bifid nerve it commonly has a persistent median artery accompanying it. (but not always). The PMA is usually between the 2 nerves or on the ulnar aspect of them. Check for PMA thrombosis as this may occur and create acute symptoms.

      Steve

    • #9197
      Linh
      Participant

      Dear Steve,

      Thanks for clarifying that. The radiologist just stated the measurement in her report and let the referring hand surgeon decide.

      I have seen PMA and always turn on Color as my senior had encountered thrombosis before. Such a rare occurence!

      Linh

    • #9309
      Stephen Bird
      Keymaster

      It is not as rare as you think,

      I have seen several cases and it is usually associated with using a vibrating piece of machinery like a jack hammer etc.

      Certainly worth a thought when the patient presents with really acute onset symptoms.

      Steve

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