En el examen del lado palmar se encuntra área de cicatrización en el pliegue de la muñeca, por debajo del nivel del pronador cuadrado. El tejido cicatricial alcanza al nervio mediano afectando un segmento que pierde focalmente el patrón fascicular y en esta región mide hasta 21 a 22 mm2 de diámetro axial. Se realizan mediciones elípticas del nervio a nivel del túnel carpiano proximal (pisiforme-escafoides): 13.0 mm2 y en el túnel carpiano distal (ganchoso-trapecio): 15.0 mm2, compatible con síndrome del túnel carpiano. No hay retracción del tendón palmar largo adyacente.
Referencias para túnel carpiano: Duncan et al: AJR Am J Roentgenol 1999; 173:681--684: área elíptica transversal del nervio mediano de 9 mm2 o más grande como indicativo de síndrome del túnel carpiano. Middleton el al: AJR Am J Roentgenol 1987;148:307--316): área elíptica de 9.8 mm2 en RMN. Wong et al: Radiology 2004; 232:93--99: In the right hand, with a cutoff of 0.09 cm2 at the level proximal to the tunnel inlet and 0.12 cm2 at the tunnel outlet, the sensitivity, specificity, and false-positive and false-negative rates were 94%, 65%, 12%, and 19%, respectively. In the left hand, with a cutoff of 0.10 cm2 at the level proximal to the tunnel inlet only, the sensitivity, specificity, and false-positive and false-negative rates were 83%, 73%, 15%, and 31%, respectively.
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