Carpal tunnel syndrome - with inverted notch sign

Case contributed by Maulik S Patel
Diagnosis almost certain

Presentation

Symptoms of carpal tunnel syndrome. Referred for evaluation of carpal tunnel evaluation.

Patient Data

Age: 40 yrs
Gender: Female

There is edematous median nerve distal to carpal tunnel.  The cross-sectional area of nerve proximal to the tunnel - 10 mm.  The cross-sectional area of nerve distal to the tunnel - 21 mm.

There is no tenosynovitis/tendinosis/ganglion cyst.

Case Discussion

In carpal tunnel syndrome, there is median nerve compression resulting in the nerve edema ( increased cross-sectional area ). If the maximum cross-sectional area of the nerve is near the proximal end of the carpal tunnel, it is called a notch sign. And when the maximum cross-sectional area is distal to the carpal tunnel, it is called an inverted notch sign.

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