Carpal tunnel syndrome - with inverted notch sign

Case contributed by Dr Maulik S Patel


Clinical diagnosis of bilateral carpal tunnel syndrome. More on right side. 2 - 3 mths. Referred for Ultrasound.

Patient Data

Age: about 40 - 45 yrs.
Gender: Female
  • multiple short and log axis images of carpal tunnel with focus on median nerve evaluation.
  • mild increased cross sectional area of nerve is noted just proximal to tunnel  about 12 - 13 mm.
  • in the tunnel nerve cross section area: 7-10 mm.
  • just distal to tunnel, nerve division is noted. Both ulnar and radial divisions show hypoechogenecity, increased cross sectional area (7-8 mm in each division) with loss of normal nerve echopattern.
  • distally, tapening is noted in both divisions to the normal nerve diameter  and with normal echogenecity.
  • no solid / cystic mass lesion or tenosynovitis is noted in tunnel.

Case Discussion

Ultrasound findings are positive for carpal tunnel syndrome.

There is the presence of inverted notch sign.

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Case information

rID: 25567
Published: 30th Oct 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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