الفهرس 
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Abstract
Entrapment neuropathies are common clinical scenarios in practice. Diagnosis was based on the clinical picture and typical symptoms and signs. Clinical criteria was approved for diagnosis of these syndromes; carpal tunnel syndrome (CTS) and cubital tunnel syndrome (CuTS), but these criteria depends on typical signs and symptoms presentations and can’t diagnose cases who are presented with a typical symptoms like “writer’s cramp” or fatigue, pain in the shoulder only, cold sensitivity in the fingers, forearm pain, or numbness in the third finger only (Ibrahim et al., 2012b).
Ultrasound imaging of nerve in isolation or in conjunction with electrodiagnostic testing is a rapidly evolving field. Electrodiagnosis provides diagnostic information regarding the presence of neuropathy and useful prognostic information based on the severity of axon loss and demyelination. In contrast to electrodiagnosis, high-resolution ultrasound in nerve disease provides anatomic information about the nerve itself and surrounding structures (Boon, 2013).
In the current study, our aim was to evaluate the role of neuromuscular ultrasound in the assessment of entrapment neuropathies of median nerve at the wrist and ulnar nerve at the elbow; and to determine the relationships of ultrasound findings with the clinical severity of carpal tunnel syndrome and cubital tunnel syndrome, and the electrophysiological grading scale.
Out of 65 patients (58 females and 7 males) with suspected CTS, we assessed 100 wrists, of which 80 were electrophysiologically confirmed as CTS and 99 were ultrasonographically diagnosed as CTS diseased hands.
Out of 17 patients (5 females and 12 males) with suspected CuTS, we assessed 20 elbows, of which 18 were electrophysiologically confirmed as CuTS and 20 were ultrasonographically diagnosed as CuTS diseased elbows.
Concerning entrapment neuropathy of the median nerve at the wrist, diseased hands were found to have higher CSA of median nerve at the inlet, CSA at the outlet, inlet/forearm ratio, palmer bowing and median nerve flattening ratio than control group with statistically significant differences (p<0.001, p<0.001, p<0.001, p<0.001, p= 0.02 respectively). Patients with very severe neurophysiological grading scale have the significantly highest value of CSA of median nerve at the inlet and at the outlet, inlet/forearm and median nerve flattening ratios. Our results revealed, positive correlations of ultrasound parameters with patient‑oriented measures (both the symptom and functional severity scales), clinical severity scale as assessed by Hi‑Ob-Db scale, and electrophysiological grade. CSA of median nerve at the inlet and at the outlet, inlet/forearm ratio and palmer bowing were considered as sensitive and specific parameters for the diagnosis of CTS.
Concerning entrapment neuropathy of the ulnar nerve at the elbow, diseased elbows were found to have higher CSA of the ulnar nerve at the medial epicondyle, and ulnar nerve ratio at the three levels than controls with statistically significant differences (p=0.001, p<0.001, p<0.001, p<0.001 respectively). Patients with extreme neurophysiological grading scale have the significantly highest value of CSA max of the ulnar nerve, and CSA 2cm proximal to the medial epicondyle. CSA max/ forearm ratio was the only ultrasound parameter that had positive correlation with the clinical grading, while all of the studied ultrasound parameters had positive correlations with the neurophysiological classification for UNE. Cross sectional area of the ulnar nerve at the medial epicondyle (CSA max) was found to be the most sensitive parameter in the diagnosis of CuTS.