S-15 1 Department of Biomedicine, DENOThe Centre, Division of Rheumatology AOUC, University of Florence, Florence, Italy; 2 Laboratory of Decision Engineering for Health Care Delivery Department of Electronics, Informatics and Systems, University of Calabria, Cosenza, Italy; 3 Department of Clinical Neurophysiology, Foundation Salvatore Maugeri, IRCCS, Montescano, Italy; 4 ESAOTE Spa, Italy. Francesca Bandinelli, MD Olga Kaloudi, MD Antonio Candelieri Maria Letizia Conforti, MD Roberto Casale, MD Stefano Cammarata Genesio Grassiri Irene Miniati, MD, PhD Student Daniela Melchiorre, MD Marco Matucci-Cerinic, MD, Prof. This study was supported by ESAOTE Spa (Genova, Italy) who generously provided the technical equipment. Please address correspondence and reprint requests to: Dr Francesca Bandinelli, Department of Biomedicine, DENOThe Centre, Division of Rheumatology AOUC, Viale Pieraccini 18, 50139 Florence, Italy. E-mail: bandin@hotmail.it Received on April 26, 2010; accepted in revised form on July 2, 2010. Clin Exp Rheumatol 2010; 28 (Suppl. 62): S15-S18. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2010. Key words: median nerve, systemic sclerosis, ultrasound Abbreviations: EMG: electromyography MN: median nerve MNA: median nerve area MNAP: median nerve antero-posterior diameter MNT: median nerve transversal diameter MNFR: median nerve flattening ratio mRSS: Modified Rodnan Skin Score RP: Raynaud phenomenon SSc: systemic sclerosis CTS: carpal tunnel syndrome US: ultrasound Competing interests: none declared. ABSTRACT Objectives. To investigate carpal tun- nel syndrome (CTS) with ultrasound (US) in asymptomatic SSc patients and to seek out the relationship between CTS and SSc clinical variables Methods. In 64 SSc patients (55 women and 9 men, mean age 57±14 years) and in 30 healthy controls, area (MNA), transverse (MNT) and anteroposterior (MNAP) diameters of MN at carpal tunnel were studied with US (My Lab 25 XVG US Esaote 18 MHz). MN flat- tening ratio (MNFR) was calculated. Duration of disease, subset (limited, diffuse), phase of skin involvement (oedematous, atrophic, fibrotic), modi- fied Rodnan skin score (mRSS) and fric- tion tendon rub were also recorded. Results. MNA (p<0.001), MNT (p<0.005) and MNFR (p<0.005) were significantly higher in the SSc patients than in controls, while no difference in MNAP was found. There was no corre- lation between median nerve (MN) and SSc clinical features (only lower MNAP correlated inversely with longer disease duration; Spearman coefficient -0.2). Conclusion. MN involvement is fre- quently present in all phases of asymp- tomatic SSc patients, independently to clinical variables. Introduction The association of Raynaud’s Pheno- menon (RP) with carpal-tunnel syn- drome (CTS) was first reported at the Mayo Clinic in 1957 (1). Oedema of hand and median nerve (MN) sensory symptoms frequently may precede the onset of RP (2). Blunt demonstrated that CTS is not only owing to mechani- cal factors, but also to neural ischemia resulting from vasospasm (3). Carpal tunnel tendon friction rub is considered a prognostic negative factor in SSc, and its relationship with CTS is not still well thought-out in literature (4). In SSc, early detection of MN involve- ment is important to prevent functional hand disability (5). Electromyography (EMG) often discloses significant re- duction of distal MN sensory and mo- tor conduction rate in SSc (6, 7) also in asymptomatic patients (6). High resolution ultrasound (US) of the car- pal tunnel is a feasible and emerging imaging tool for evaluating MN (8, 9), cheaper, faster and less invasive than EMG and more sensitive than clinical examination (10). In SSc, only few is- sues employed US in joint evaluation (11) and in particular, there are no stud- ies on early diagnosis of CTS. High- frequency 18MHz US offers consider- ably better resolution than probes that previously estimated MN and, in SSc, was also employed in dermal thickness measurement (12). The aim of our work was to investigate, with US, MN in asymptomatic SSc pa- tients, and the relationship between CTS and SSc clinical variables (dura- tion of disease, subset, phase of skin involvement, Modified Rodnan Skin Score-mRSS- and tendon friction rub). Patients and methods Sixty-four Caucasian patients without motor and sensory symptoms (numb- ness and muscular weakness) and signs (muscular atrophy) were recruited at the Department of Biomedicine, Division of Rheumatology of the University of Florence and classified as limited or diffuse SSc subsets, according to inter- national consensus criteria (13). Local ethical committee approved the study and an informed consensus was signed by patients and controls. Thirty healthy volunteers matched for age, sex (same ratio male-female) and Early detection of median nerve syndrome at the carpal tunnel with high-resolution 18 MHz ultrasonography in systemic sclerosis patients F. Bandinelli 1 , O. Kaloudi 1 , A. Candelieri 2 , M.L. Conforti 1 , R. Casale 3 , S. Cammarata 4 , G. Grassiri 4 , I. Miniati 1 , D. Melchiorre 1 , M. Matucci-Cerinic 1