Ans: carpal tunnel release- thumb is numb- what do you see!

And the ans. is

NS-RADS
PI3-M2
definitely worsening neuropathy post-intervention – muscle denervation edema and mild atrophy

The injury is I4- nearly I5 like near amputation of finger

Congratulations Dr Taneja, Dr Susie Mier, and Dr Singer!

I also added I4/nearly I5 to the score

Last time I mentioned similar for a lingual nerve- surgeon also classified as I4/5 intra-operatively.

Injury is right where the nerve was released with a nick and minimal continuity at that level.

Usually CTS release should be on the ulnar side of MN (not in this case). Incision could have been larger (incomplete release here).

Release of pain shouldn’t cause numbness- here thumb is numb- you can see three branches coursing to the thenar muscles- bright and thick with distal denervation. The tractography shows missing thumb branch tracts (red)- high ADC (1.5), low FA (0.3)

Join us for ISS nerve DTI session on fri in Barcelona if want to see more of DWI/DTI of nerves.

Also-Today if interested- join us for SABI webinar on How to brand yourself and build a niche!

Link to register-

acr-org.zoom.us/meeting/register/tZcld-CqqDotGtxauQfRqrHsY8hmsLPKgsbp

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Best!
AC

Avneesh Chhabra, M.D. M.B.A.
Professor, Radiology & Orthopedic Surgery
Chief, Musculoskeletal Radiology
Department of Radiology
5323 Harry Hines, Blvd. Dallas, Tx-75390-9316
Office: 214-648-2122
www.utsouthwestern.edu/radiology<www.utsouthwestern.edu/education/medical-school/departments/radiology/>

Begin forwarded message:

From: Avneesh Chhabra <Avneesh.Chhabra@utsouthwestern.edu>
Date: September 13, 2022 at 4:27:05 PM CDT
To: OCAD-MSK <ocad-msk@googlegroups.com>
Subject: carpal tunnel release- thumb is numb- what do you see

[image.png]

Tell us NS-RADS grade?

Avneesh Chhabra, M.D. M.B.A.

Professor Radiology & Orthopedic Surgery

Chief, Division of Musculoskeletal Radiology

UT Southwestern Medical Center, Dallas, Tx

5373 Harry Hines Blvd.

Dallas, Tx-75390-9178

Office: 214-648-2122

avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>

www.utsouthwestern.edu<www.utsouthwestern.edu/>

________________________________