Diagnostic ultrasonography and MRI have been used to help diagnose carpal tunnel syndrome and exclude other causes of hand and wrist symptoms. These technologies can identify swelling of the median nerve and abnormalities of the tunnel wall, its contents and surrounding area. They can also help determine why the median nerve is being squeezed, or compressed. For example, inflammation of structures in the tunnel like inflamed tendons might be causing the median nerve to be compressed. This can occur in rheumatoid arthritis . Other tendon abnormalities, such as excessive fat in the tunnel (also called a ganglion) also can be seen using MRI.
Glucocorticoid therapy is associated with an appreciable risk of bone loss, which is most pronounced in the first few months of use. In addition, glucocorticoids increase fracture risk, and fractures occur at higher bone mineral density (BMD) values than occur in postmenopausal osteoporosis. The increased risk of fracture has been reported with doses of prednisone or its equivalent as low as to mg daily [ 1 ]. Thus, glucocorticoid-induced bone loss should be treated aggressively, particularly in those already at high risk for fracture (older, prior fragility fracture). In other individuals, clinical risk factor and bone density assessment may help guide therapy. The prevention and treatment of glucocorticoid-induced bone loss will be reviewed here. The clinical features are reviewed separately. (See "Pathogenesis, clinical features, and evaluation of glucocorticoid-induced osteoporosis" .)