{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T01:23:29Z","timestamp":1775438609009,"version":"3.50.1"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The paretic wrist after stroke may exhibit median nerve conduction abnormalities, but factors underlying hemiplegic\u2013contralateral asymmetry remain uncertain. We compared electrodiagnostic and ultrasonographic wrist measures between sides and assessed predictors of side-to-side differences in distal motor latency (\u0394DML) and distal sensory latency (\u0394DSL). Methods: We retrospectively analyzed 85 patients with stroke. Distal motor latency (DML), distal sensory latency (DSL), wrist-to-forearm ratio (WFR), and median nerve inlet cross-sectional area (CSA) were measured bilaterally. Paired t-tests evaluated hemiplegic\u2013contralateral differences, and Wilcoxon signed-rank tests were performed as sensitivity analyses. Multivariable linear regression with robust (HC3) standard errors modeled \u0394DML as the primary outcome and \u0394DSL as the secondary outcome, with wrist flexor spasticity (Modified Ashworth Scale, MAS) specified a priori as the primary explanatory variable; extended models additionally included \u0394WFR. Sensitivity analyses re-specified MAS as an ordered category, and complementary linear mixed-effects models using raw bilateral latency values were fitted to assess the robustness of \u0394-based modeling. Results: The hemiplegic side showed higher DML (5.51 \u00b1 0.79 vs. 4.81 \u00b1 0.42 ms; mean difference 0.694; p &lt; 0.001), DSL (4.51 \u00b1 0.88 vs. 3.66 \u00b1 0.45 ms; mean difference 0.852; p &lt; 0.001), WFR (1.21 \u00b1 0.30 vs. 1.07 \u00b1 0.16; p = 0.008), and CSA (11.16 \u00b1 3.67 vs. 9.69 \u00b1 2.04 mm2; p = 0.032). MAS was associated with \u0394DML (\u03b2 = 0.336; p &lt; 0.001) and \u0394DSL (\u03b2 = 0.238; p = 0.015). \u0394WFR remained significant for \u0394DML (\u03b2 = 1.314; p &lt; 0.001) and \u0394DSL (\u03b2 = 1.371; p = 0.001), improving adjusted R2 from 0.251 to 0.370 for \u0394DML and from 0.142 to 0.253 for \u0394DSL. Findings remained directionally consistent when MAS was modeled as an ordered category. Complementary mixed-effects models using raw bilateral latency values showed significant hemiplegic-side-by-MAS interactions for both DML (\u03b2 = 0.425; 95% CI 0.275 to 0.575; p &lt; 0.001) and DSL (\u03b2 = 0.366; 95% CI 0.195 to 0.537; p &lt; 0.001). Conclusions: In chronic stroke hemiplegia, median nerve latencies and wrist morphology may differ between sides. Wrist flexor spasticity and side-to-side increases in WFR may be independently associated with greater latency asymmetry. These interlimb latency differences should be interpreted as physiological markers of side-to-side median nerve involvement at the wrist rather than as stand-alone diagnostic criteria for carpal tunnel syndrome.<\/jats:p>","DOI":"10.3390\/diagnostics16071088","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:19:32Z","timestamp":1775434772000},"page":"1088","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Wrist Flexor Spasticity and Hemiplegic\u2013Contralateral Median Nerve Latency Asymmetry After Stroke: A Bilateral Nerve Conduction and Ultrasound Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1926-3228","authenticated-orcid":false,"given":"Ki-Hyeok","family":"Ku","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1519-7945","authenticated-orcid":false,"given":"Seongmin","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Physical and Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung Chul","family":"Noh","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9364-2947","authenticated-orcid":false,"given":"Eo Jin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zeng, H., Chen, J., Guo, Y., and Tan, S. (2020). Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.616097"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.pmr.2015.06.008","article-title":"Upper Limb Motor Impairment After Stroke","volume":"26","author":"Raghavan","year":"2015","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1097\/PHM.0b013e31825f13a3","article-title":"Spasticity after stroke: An overview of prevalence, test instruments, and treatments","volume":"91","author":"Sommerfeld","year":"2012","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1056\/NEJMcp043511","article-title":"Clinical practice. Rehabilitation after stroke","volume":"352","author":"Dobkin","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.pmrj.2011.07.019","article-title":"Conduction and morphological changes in wrist nerves immediately after bilateral sanding exercises in hemiparetic subjects","volume":"3","author":"Huang","year":"2011","journal-title":"PM R"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.clinph.2021.12.012","article-title":"Expert consensus on the combined investigation of carpal tunnel syndrome with electrodiagnostic tests and neuromuscular ultrasound","volume":"135","author":"Pelosi","year":"2022","journal-title":"Clin. Neurophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1177\/15589447241278972","article-title":"Diagnostic Accuracy of Neuromuscular Ultrasound vs. Electrodiagnostic Studies for Carpal Tunnel Syndrome: Systematic Review and Meta-analysis of Paired Accuracy Studies","volume":"20","author":"Miller","year":"2025","journal-title":"Hand"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/j.pain.0000000000003757","article-title":"Familial risk of carpal tunnel syndrome among first-degree relatives and interaction with obesity and hyperglycemia: A population-based study in Korea","volume":"167","author":"Kim","year":"2026","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"259","DOI":"10.5535\/arm.240015","article-title":"Reference Standard of Median Nerve Conduction Study in Korea","volume":"48","author":"Lee","year":"2024","journal-title":"Ann. Rehabil. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1038\/s41572-024-00521-1","article-title":"Carpal tunnel syndrome","volume":"10","author":"Dahlin","year":"2024","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.11138\/FNeur\/2017.32.3.119","article-title":"Electrodiagnostic and nerve ultrasonographic features in upper limb spasticity: An observational study","volume":"32","author":"Picelli","year":"2017","journal-title":"Funct. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.3109\/02699052.2013.804202","article-title":"Spasticity after stroke: Physiology, assessment and treatment","volume":"27","author":"Thibaut","year":"2013","journal-title":"Brain Inj."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jocn.2020.05.050","article-title":"Effects of spasticity and hemiplegic posture on median nerve and carpal tunnel in stroke patients: Electrophysiological and ultrasonographic evaluation","volume":"77","author":"Kutlay","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"71","DOI":"10.11152\/mu-1219","article-title":"Effects of chronic flexed wrist posture on the elasticity and crosssectional area of the median nerve at the carpal tunnel among chronic stroke patients","volume":"1","author":"Aslan","year":"2018","journal-title":"Med. Ultrason."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/WNP.0000000000000696","article-title":"The Neurophysiological Severity of Carpal Tunnel Syndrome Cannot Be Predicted by Median Nerve Cross-Sectional Area and Wrist-to-Forearm Ratio","volume":"38","author":"Martikkala","year":"2021","journal-title":"J. Clin. Neurophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.morpho.2022.05.005","article-title":"The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis","volume":"107","author":"Asghar","year":"2023","journal-title":"Morphologie"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1393","DOI":"10.1002\/hsr2.1393","article-title":"Sonographic evaluation of median nerve cross-sectional area in a normal Iranian population: A cross-sectional study","volume":"6","author":"Rayegani","year":"2023","journal-title":"Health Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"i4515","DOI":"10.1136\/bmj.i4515","article-title":"Self controlled case series methods: An alternative to standard epidemiological study designs","volume":"354","author":"Petersen","year":"2016","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1093\/ije\/dyu081","article-title":"Exchangeability in the case-crossover design","volume":"43","author":"Mittleman","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/mus.23389","article-title":"Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome","volume":"46","author":"Cartwright","year":"2012","journal-title":"Muscle Nerve"},{"key":"ref_22","first-page":"121","article-title":"Neutral wrist splinting in carpal tunnel syndrome: A 3- and 6-months clinical and neurophysiologic follow-up evaluation of night-only splint therapy","volume":"42","author":"Premoselli","year":"2006","journal-title":"Eura Medicophys"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ise, M., Saito, T., Katayama, Y., Nakahara, R., Shimamura, Y., Hamada, M., Senda, M., and Ozaki, T. (2021). Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04771-y"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1161\/01.STR.20.7.864","article-title":"Measurements of acute cerebral infarction: A clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.hkjot.2017.06.001","article-title":"Application of the Korean Version of the Modified Barthel Index: Development of a keyform for use in Clinical Practice","volume":"29","author":"Hong","year":"2017","journal-title":"Hong Kong J. Occup. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3233\/NRE-2008-23304","article-title":"The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: Limb and muscle group effect","volume":"23","author":"Ansari","year":"2008","journal-title":"NeuroRehabilitation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1191\/026921599677595404","article-title":"A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity","volume":"13","author":"Pandyan","year":"1999","journal-title":"Clin. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3138\/ptc-2018-0086","article-title":"Interrater Reliability of the Modified Ashworth Scale with Standardized Movement Speeds: A Pilot Study","volume":"71","author":"Zurawski","year":"2019","journal-title":"Physiother. Can."},{"key":"ref_29","unstructured":"Harb, A., Margetis, K., and Kishner, S. (2025). Modified Ashworth Scale. StatPearls, StatPearls Publishing LLC."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1177\/1545968305284528","article-title":"Individuals with the dominant hand affected following stroke demonstrate less impairment than those with the nondominant hand affected","volume":"20","author":"Harris","year":"2006","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s12984-015-0103-8","article-title":"Robotic pilot study for analysing spasticity: Clinical data versus healthy controls","volume":"12","author":"Seth","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1177\/1545968311430824","article-title":"Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after stroke: A randomized controlled trial","volume":"26","author":"Rosales","year":"2012","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kasius, K.M., Claes, F., Verhagen, W.I.M., and Meulstee, J. (2019). Motor Nerve Conduction Tests in Carpal Tunnel Syndrome. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00149"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"169","DOI":"10.17712\/nsj.2017.3.20160638","article-title":"Clinical and electrophysiological evaluation of carpal tunnel syndrome: Approach and pitfalls","volume":"22","author":"Alanazy","year":"2017","journal-title":"Neurosciences"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5535\/arm.2012.36.1.72","article-title":"Ultrasonography of median nerve and electrophysiologic severity in carpal tunnel syndrome","volume":"36","author":"Kang","year":"2012","journal-title":"Ann. Rehabil. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cheraghali, M., Taftian, E., Fatehi, F., Okhovat, A.A., Shahbazi, N., and Fateh, H.R. (2026). Comparison of median nerve conduction parameters from the index and middle fingers in carpal tunnel syndrome: Toward a standardized electrophysiological evaluation protocol. PM R.","DOI":"10.1002\/pmrj.70101"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1177\/1558944719855442","article-title":"The Sensitivity and Specificity of Nerve Conduction Studies for Diagnosis of Carpal Tunnel Syndrome: A Systematic Review","volume":"16","author":"Demino","year":"2021","journal-title":"Hand"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3988\/jcn.2012.8.1.1","article-title":"Pitfalls in using electrophysiological studies to diagnose neuromuscular disorders","volume":"8","author":"Koo","year":"2012","journal-title":"J. Clin. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2891","DOI":"10.1109\/TBME.2014.2333034","article-title":"Examination of hand muscle activation and motor unit indices derived from surface EMG in chronic stroke","volume":"61","author":"Li","year":"2014","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Chang, Y.W., Hsieh, T.C., Tzeng, I.S., Chiu, V., Huang, P.J., and Horng, Y.S. (2019). Ratio and difference of the cross-sectional area of median nerve to ulnar nerve in diagnosing carpal tunnel syndrome: A case control study. BMC Med. Imaging, 19.","DOI":"10.1186\/s12880-019-0351-3"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.cnp.2019.04.006","article-title":"Neuromuscular ultrasound in clinical practice: A review","volume":"4","author":"Gonzalez","year":"2019","journal-title":"Clin. Neurophysiol. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1016\/j.clinph.2008.01.101","article-title":"The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome","volume":"119","author":"Massey","year":"2008","journal-title":"Clin. Neurophysiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Rayegani, S.M., Malekmahmoodi, R., Aalipour, K., and Nouri, F. (2024). The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07987-w"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12984-019-0623-8","article-title":"Stretch reflex excitability in contralateral limbs of stroke survivors is higher than in matched controls","volume":"16","author":"Afzal","year":"2019","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ware\u0144czak-Pawlicka, A., and Lisi\u0144ski, P. (2025). Is the Assessment of the Non-Paretic Lower Limb in Patients After Stroke Important When Planning Rehabilitation?. Sensors, 25.","DOI":"10.3390\/s25041082"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1002\/mus.20026","article-title":"Effect of aging on sensory nerve conduction study parameters","volume":"29","author":"Tong","year":"2004","journal-title":"Muscle Nerve"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1001\/jamaneurol.2016.3745","article-title":"Association Between Metabolic Syndrome Components and Polyneuropathy in an Obese Population","volume":"73","author":"Callaghan","year":"2016","journal-title":"JAMA Neurol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e70071","DOI":"10.1002\/pds.70071","article-title":"Core Concepts: Self-Controlled Designs in Pharmacoepidemiology","volume":"34","author":"Bots","year":"2025","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S0268-0033(96)00044-7","article-title":"Intracarpal canal pressures: The role of finger, hand, wrist and forearm position","volume":"12","author":"Werner","year":"1997","journal-title":"Clin. Biomech."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"380","DOI":"10.2106\/00004623-198163030-00009","article-title":"The carpal tunnel syndrome. A study of carpal canal pressures","volume":"63","author":"Gelberman","year":"1981","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.2106\/00004623-199511000-00008","article-title":"Position of the wrist associated with the lowest carpal-tunnel pressure: Implications for splint design","volume":"77","author":"Weiss","year":"1995","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"105754","DOI":"10.1016\/j.clinbiomech.2022.105754","article-title":"The effects of wrist position and radioulnar wrist compression on median nerve longitudinal mobility","volume":"99","author":"Song","year":"2022","journal-title":"Clin. Biomech."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s11552-013-9532-7","article-title":"Contralateral electrodiagnosis in patients with abnormal median distal sensory latency","volume":"8","author":"Hoogstins","year":"2013","journal-title":"Hand"},{"key":"ref_54","first-page":"12","article-title":"Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index","volume":"4","author":"Ulvi","year":"2009","journal-title":"J. Brachial Plex. Peripher. Nerve Inj."},{"key":"ref_55","first-page":"216","article-title":"\u201cMild\u201d, \u201cModerate\u201d, or \u201cSevere\u201d Carpal Tunnel Syndrome? Depends on Who You Ask: Analysis of Existing Classification Systems in 665 Hands","volume":"24","author":"Savage","year":"2024","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.shaw.2014.01.003","article-title":"Meta-analysis: Association between wrist posture and carpal tunnel syndrome among workers","volume":"5","author":"You","year":"2014","journal-title":"Saf. Health Work"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.pmrj.2014.08.946","article-title":"Post-stroke spasticity: Predictors of early development and considerations for therapeutic intervention","volume":"7","author":"Wissel","year":"2015","journal-title":"PM R"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12984-025-01568-1","article-title":"Factors associated with upper extremity use after stroke: A scoping review of accelerometry studies","volume":"22","author":"Poitras","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1002\/mus.20125","article-title":"Influence of body mass index on median nerve function, carpal canal pressure, and cross-sectional area of the median nerve","volume":"30","author":"Werner","year":"2004","journal-title":"Muscle Nerve"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/1743-0003-11-137","article-title":"Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: A review","volume":"11","author":"Nordin","year":"2014","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e25812","DOI":"10.1097\/MD.0000000000025812","article-title":"Cross-sectional area reference values for high-resolution ultrasonography of the upper extremity nerves in healthy Asian adults","volume":"100","author":"Bae","year":"2021","journal-title":"Medicine"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Kim, M.G., Lee, S.A., Park, E.J., Choi, M.K., Kim, J.M., Sohn, M.K., Jee, S.J., Kim, Y.W., Son, J.E., and Lee, S.J. (2022). Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19169975"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jocn.2017.01.006","article-title":"Is carpal tunnel syndrome present in acute stroke patients? An investigative study using clinical and imaging screening tools","volume":"39","author":"Lin","year":"2017","journal-title":"J. Clin. Neurosci."},{"key":"ref_64","first-page":"91","article-title":"Subclinical carpal tunnel syndrome in patients with acute stroke","volume":"11","author":"Moghtaderi","year":"2012","journal-title":"Iran. J. Neurol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"413","DOI":"10.5535\/arm.240079","article-title":"Discordance Between Spine-Hip and Paretic-Nonparetic Hip Bone Mineral Density in Hemiplegic Stroke Patients: A Multicenter Retrospective Study","volume":"48","author":"Yoo","year":"2024","journal-title":"Ann. Rehabil. Med."},{"key":"ref_66","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":"Padua","year":"2016","journal-title":"Lancet Neurol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/7\/1088\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:31:11Z","timestamp":1775435471000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/7\/1088"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":66,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["diagnostics16071088"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16071088","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}