{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:49:11Z","timestamp":1777877351193,"version":"3.51.4"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":119,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Brachial Plex Peripher Nerve Inj"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Considerable between-center variability exists in the upper limit of normal (ULN) for the cross-sectional area (CSA) of the median nerve (MN) used to support the diagnosis of carpal tunnel syndrome (CTS).<\/jats:p>\n                  <jats:p>To evaluate whether a Dutch wrist circumference\u2013dependent (WCD) equation for the ULN of MN CSA provides comparable classification of abnormal CSA in Italian and Dutch CTS populations.<\/jats:p>\n                  <jats:p>Wrist circumference (WC) and MN CSA were measured in 55 Italian (85 wrists) and 175 Dutch (175 wrists) patients with CTS. Abnormal wrists were identified using three thresholds: ULN9 (9\u2009mm2), ULN11 (11\u2009mm2), and a WCD equation ( y\u2009=\u20090.88 * x \u2212 4, with y as ULN in mm2\n                  x as WC in cm). Findings were compared with electrodiagnostic results.<\/jats:p>\n                  <jats:p>No significant differences in WC or MN CSA were observed between groups. The proportion of abnormal wrists in the Italian and Dutch populations, respectively, was 83.5 and 78.3% (ULN9, p\u2009=\u20090.321), 49.4 and 50.3% (ULN11, p\u2009=\u20090.895), and 61.1 and 55.4% (WCD, p\u2009=\u20090.379). Among 12 Italian patients with small wrists, abnormal results were found in 75.0% (ULN9), 25.0% (ULN11), and 66.7% (WCD). All Italian patients had abnormal electrodiagnostic testing results, compared with 66.3% of Dutch patients (p\u2009&lt;\u20090.0001).<\/jats:p>\n                  <jats:p>The WCD ULN for MN CSA yielded similar results in Italian and Dutch patients with CTS, and may be particularly useful in individuals with smaller wrists.<\/jats:p>","DOI":"10.1055\/a-2837-4022","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:48:51Z","timestamp":1777589331000},"page":"e7-e12","source":"Crossref","is-referenced-by-count":0,"title":["Wrist Circumference\u2013Dependent Thresholds for the Median Nerve in Carpal Tunnel Syndrome: A Cross-Cohort Comparison"],"prefix":"10.1055","volume":"21","author":[{"given":"Tom B. G.","family":"Olde Dubbelink","sequence":"additional","affiliation":[{"name":"Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, the Netherlands"},{"name":"Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Ginanneschi","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Falsetti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, Department of Medical, Surgical and Neurological Sciences, University Hospital of Siena, Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Meulstee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald H. M. A.","family":"Bartels","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands"},{"name":"Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wim I. M.","family":"Verhagen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/S1474-4422(16)30231-9","article-title":"Carpal tunnel syndrome: clinical features, diagnosis, and management","volume":"15","author":"L Padua","year":"2016","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.cnp.2018.02.005","article-title":"Nerve conduction studies and EMG in carpal tunnel syndrome: do they add value?","volume":"3","author":"M Sonoo","year":"2018","journal-title":"Clin Neurophysiol Pract"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.ultrasmedbio.2012.02.026","article-title":"Ultrasonography for diagnosing carpal tunnel syndrome: a meta-analysis of diagnostic test accuracy","volume":"38","author":"T W Tai","year":"2012","journal-title":"Ultrasound Med Biol"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"793","DOI":"10.2214\/ajr.159.4.1529845","article-title":"Carpal tunnel syndrome: diagnosis with high-resolution sonography","volume":"159","author":"W Buchberger","year":"1992","journal-title":"AJR Am J Roentgenol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/mus.10227","article-title":"Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature","volume":"27","author":"R Beekman","year":"2003","journal-title":"Muscle Nerve"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"577052","DOI":"10.3389\/fneur.2020.577052","article-title":"Augmented diagnostic accuracy of ultrasonography for diagnosing carpal tunnel syndrome using an optimised wrist circumference-dependent cross-sectional area equation","volume":"11","author":"T BG Olde Dubbelink","year":"2020","journal-title":"Front Neurol"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1007\/s10072-019-03756-z","article-title":"The controversy of the normal values of ultrasonography in carpal tunnel syndrome: diagnostic accuracy of wrist-dependent CSA revisited","volume":"40","author":"F GCM De Kleermaeker","year":"2019","journal-title":"Neurol Sci"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/BF03344156","article-title":"Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr)","volume":"29","author":"E Cacciari","year":"2006","journal-title":"J Endocrinol Invest"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"625565","DOI":"10.3389\/fneur.2021.625565","article-title":"Wrist circumference-dependent upper limit of normal for the cross-sectional area is superior over a fixed cut-off value in confirming the clinical diagnosis of carpal tunnel syndrome","volume":"12","author":"T BG Olde Dubbelink","year":"2021","journal-title":"Front Neurol"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s10072-010-0258-9","article-title":"Usefulness of additional measurements of the median nerve with ultrasonography","volume":"31","author":"F Claes","year":"2010","journal-title":"Neurol Sci"},{"issue":"11","key":"ref13","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1097\/PHM.0b013e31829b4bd8","article-title":"Comparing a new ultrasound approach with electrodiagnostic studies to confirm clinically defined carpal tunnel syndrome: a prospective, blinded study","volume":"92","author":"F Claes","year":"2013","journal-title":"Am J Phys Med Rehabil"},{"issue":"11","key":"ref14","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.3390\/diagnostics12112621","article-title":"A novel ultrasonographic anthropometric-independent measurement of median nerve swelling in carpal tunnel syndrome: the \u201cnerve\/tendon ratio\u201d (NTR)","volume":"12","author":"P Falsetti","year":"2022","journal-title":"Diagnostics (Basel)"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1136\/jnnp.2007.115337","article-title":"High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome","volume":"79","author":"L H Visser","year":"2008","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"74","key":"ref16","first-page":"75","article-title":"Regional inequality and convergence in Southern Europe. Evidence from height in Italy and Spain, 1850-2000","volume":"XXV","author":"J M Mart\u00ednez-Carri\u00f3n","year":"2017","journal-title":"Rev Econ Apl"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"4556","DOI":"10.1038\/s41467-020-18418-4","article-title":"Dutch population structure across space, time and GWAS design","volume":"11","author":"R P Byrne","year":"2020","journal-title":"Nat Commun"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/mus.24124","article-title":"Difference in normal values of median nerve cross-sectional area between Dutch and Indian subjects","volume":"50","author":"E W Burg","year":"2014","journal-title":"Muscle Nerve"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"9217","DOI":"10.1038\/s41598-022-13058-8","article-title":"A systematic review: normative reference values of the median nerve cross-sectional area using ultrasonography in healthy 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Moschovos","year":"2019","journal-title":"Clin Neurophysiol"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.3390\/jcm12072515","article-title":"Potential relationships between the median nerve cross-sectional area and physical characteristics in unilateral symptomatic carpal tunnel syndrome patients","volume":"12","author":"A Ikumi","year":"2023","journal-title":"J Clin Med"},{"issue":"06","key":"ref24","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.asjsur.2019.08.001","article-title":"Value of cross-sectional area of median nerve by MRI in carpal tunnel syndrome","volume":"43","author":"J S Park","year":"2020","journal-title":"Asian J Surg"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1471-2342-11-22","article-title":"Ultrasonographic median nerve cross-section areas measured by 8-point \u201cinching test\u201d for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study 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