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Updated: Aug 31, 2025

Screening of Axonal Degeneration in Carpal Tunnel Syndrome Using Ultrasonography and Nerve Conduction Studies
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A systematic review on nutcracker syndrome and proposed diagnostic algorithm.

Domenico R Nastasi1, Annabel R Fraser1, Aman B Williams1

  • 1Department of Vascular and Endovascular Surgery, Gold Coast University Hospital, Southport, QLD, Australia.

Journal of Vascular Surgery. Venous and Lymphatic Disorders
|August 25, 2022
PubMed
Summary
This summary is machine-generated.

Nutcracker syndrome (NCS) diagnosis is challenging due to varied symptoms. This review proposes a diagnostic framework using clinical features and imaging like ultrasound and venography for better patient management.

Keywords:
CompressionDiagnosisFrameworkNutcrackerVenous

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Area of Science:

  • Vascular Medicine
  • Nephrology
  • Radiology

Background:

  • Nutcracker syndrome (NCS) is a venous compressive disease with diverse clinical presentations and imaging findings, complicating diagnosis.
  • Accurate diagnosis of NCS is crucial for managing debilitating symptoms.

Purpose of the Study:

  • To systematically review diagnostic criteria for Nutcracker syndrome (NCS).
  • To propose a comprehensive framework for clinical decision-making in NCS diagnosis.

Main Methods:

  • Systematic review of observational studies and case series within the last 10 years.
  • Extraction and synthesis of data on clinical features, demographics, and radiologic criteria for NCS.
  • Development of a diagnostic framework based on synthesized findings.

Main Results:

  • 14 studies and 384 patients with NCS were included.
  • Common symptoms include hematuria (69.5%), left flank/abdominal pain (48.4%), pelvic pain (23.1%), and varicocele (15.8%).
  • Ultrasound and CT were common, with >80% left renal vein stenosis frequently used; venography with pressure gradient measurement is key for intervention candidates.

Conclusions:

  • Nutcracker syndrome (NCS) diagnosis and management are challenging.
  • A comprehensive diagnostic framework integrating clinical evaluation, imaging (ultrasound, CT/MRI), and venography is proposed to aid clinical decision-making.