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Sample records for carpal tunnel release

  1. Carpal tunnel release

    DEFF Research Database (Denmark)

    Larsen, Morten Bo; Sørensen, A I; Crone, K L;

    2013-01-01

    A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopi...... incision could be found. There were no serious complications in either group. The results indicate that the endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work....

  2. Pressure-morphology relationship of a released carpal tunnel.

    Science.gov (United States)

    Kim, Dong Hee; Marquardt, Tamara L; Gabra, Joseph N; Shen, Zhilei Liu; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2013-04-01

    We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure-morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p 62 mm(2) at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery.

  3. Myofascial release of carpal tunnel syndrome.

    Science.gov (United States)

    Sucher, B M

    1993-01-01

    Current treatment for carpal tunnel syndrome may be ineffective or associated with complications or recurrence. In the case reported here, a myofascial release by the physician combined with the patient's self-stretch reduced pain and numbness and improved electromyographic results. The manipulative approach releases the transverse carpal ligament,-and "opens" or dilates the canal. The patient stretches the wrist, digits, and thumb, including myofascial components. An aggressive, conservative approach lessens the need for surgery in mild to moderate cases. Studies with magnetic resonance imaging may be helpful to document canal size before and after treatment.

  4. Delayed ulnar neuropathy at the wrist following open carpal tunnel release.

    Science.gov (United States)

    Pingree, Matthew J; Bosch, E Peter; Liu, Patrick; Smith, Benn E

    2005-03-01

    Open carpal tunnel release is a common and successful treatment of median neuropathy at the wrist (carpal tunnel syndrome). We report a case of delayed ulnar neuropathy at the wrist with onset 2 months after open carpal tunnel release. Clinical findings, electrophysiological studies, magnetic resonance imaging, and surgical exploration demonstrated ulnar nerve compression at Guyon's canal resulting from translocation of the carpal tunnel contents. To our knowledge, this is an unreported complication of open carpal tunnel release that merits wide appreciation.

  5. Surgical efficacy of carpal tunnel release for carpal tunnel syndrome in acromegaly: report of four patients.

    Science.gov (United States)

    Iwasaki, N; Masuko, T; Ishikawa, J; Minami, A

    2005-12-01

    Although carpal tunnel syndrome is frequent in acromegaly, few acromegalics will be encountered by most hand surgeons. This paper considers the treatment of four cases of acromegaly in whom carpal tunnel syndrome arose, to discuss aspects of management of carpal tunnel syndrome in this patient group.

  6. Ulnar neuropathy at the wrist in a patient with carpal tunnel syndrome after open carpal tunnel release.

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    Kim, Nack Hwan; Kim, Dong Hwee

    2012-04-01

    Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5(th) digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.

  7. Ulnar Neuropathy at the Wrist in a Patient with Carpal Tunnel Syndrome after Open Carpal Tunnel Release

    OpenAIRE

    2012-01-01

    Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic t...

  8. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... arm. Just a passing cramp? It could be carpal tunnel syndrome. The carpal tunnel is a narrow passageway of ligament and ... difficult. Often, the cause is having a smaller carpal tunnel than other people do. Other causes include ...

  9. Splinting after Carpal Tunnel Release: Does it really Matter?

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    Shalimar A

    2015-07-01

    Full Text Available Splinting of the wrist after carpal tunnel release (CTR has been practised by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR have had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks or too short (48 hours only. The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting. Methods: All 30 of our patients underwent a standardized limited open CTR by a designated surgeon. Post operatively, they were randomized into a splinted (n=16 and a nonsplinted (n=14 group. The splint was kept for a week. Patients were reviewed at regular intervals of one week, two months and six months. At each follow up, these patients were clinically assessed for the following outcome measures: VAS (visual analogue score, 2PD (two-point discrimination, pinch grip, grip, Abductor Pollicis Brevis (APB power and completion of the Boston questionnaire. Results: All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release.

  10. Carpal Tunnel Release in Diabetic and Non-Diabetic Patients

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    Mohammad H Ebrahimzadeh

    2013-09-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a compression neuropathy that causes paresthesia, pain or numbness in the territory of median nerve. The aim of this study is to compare the open surgery outcome and patients` satisfaction in carpal tunnel syndrome among diabetic and non-diabetic patients. Methods: In a retrospective cohort study from April 2011 to June 2012, patients suffered from carpal tunnel syndrome at least 6 months, without response to conservative treatment, who had the inclusion and exclusion criteria, were evaluated by the usage of MHQ and WHOQOL-BREEF tests, one month before surgery and three months after that. Carpal tunnel decompression surgery was performed by two surgeons, experienced in hand surgery, which used the same surgical method. Statistical analysis was performed by SPSS 19.0. Results: 24 of patient (34.2% were male and 46 (65.8% were female and there was no significant difference between two groups (P>0.05. MHQ total score before and after surgery was respectively 50.22±7.13 and 63.49±11.28 and this difference was significant (P

  11. Complex Regional Pain Syndrome (CRPS Type II After Carpal Tunnel Release Surgery: Case Report

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    Hakan Tunç

    2010-08-01

    Full Text Available Summary Complex regional pain syndrome is a chronic syndrome characterised with dystrophic changes and neurovascular disordes of bone and skin of extremities. The most common etiological factors are trauma, ischemic heart disease, cerebral lesions, servical region disorders, infections, and surgical treatments. Carpal tunnel syndrome is the most common compressive neuropaty of the upper extremity. There are various surgical and conservative alternatives in the treatment of carpal tunnel syndrome. Complex regional pain syndrome has been reported as a complication of surgical carpal tunnel release in 2-5% of patients. In this case report clinical characteristics and rehabilitation outcomes of a patient with complex regional pain syndrome after carpal tunnel release surgery is presented. (Osteoporoz Dünyasından 2010;16:41-3

  12. Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis

    NARCIS (Netherlands)

    Vasiliadis, Haris S.; Nikolakopoulou, Adriani; Shrier, Ian; Lunn, Michael P.; Brassington, Ruth; Scholten, Rob J. P.; Salanti, Georgia

    2015-01-01

    Background The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather "blind" procedure and on the high number of severe

  13. Effects of perineural steroid injections on median nerve conduction during the carpal tunnel release

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    Stepić Nenad

    2008-01-01

    Full Text Available Background/Aim. The treatment outcome of the median nerve compressive neuropathy in the carpal zone due to carpal tunnel syndrome (CTS is represented by recovering the nerves sensibility, conductivity, condition and strength. Perineural application of betamethasone during the surgical decompression might result in faster recovery of compressed median nerve's conduction speed. Methods. In this study 40 patients with CTS were randomly divided in the two groups. In the first group (n = 20 we performed the surgical decompression of the median nerve by the open release of the carpal tunnel, and in the second group (n = 20 we applicated a perineural injection of 1 ml of betamethason immediately after the surgical decompression. We performed the electrodiagnostic (ED examinations 7, 30 and 90 days after the surgery, and measured the conduction speed of the median nerve in the carpal tunnel zone and the sensitivity conduction speed of the median nerve. Results. Significant differences in examined ED respective variable values in different time intervals were obtained. At the final measurements, 90 days after the surgical procedure, both groups evidenced a full recovery of the conduction speed in the carpal tunnel with statistically significant better results in the second group of the patients (t = -2.116; p = 0.043. Conclusion. Intraoperative application of the corticosteroid injection during the surgical decompression results in faster regaining of conduction speed of the median nerve.

  14. Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness

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    Al-Khayat Jehad

    2008-04-01

    Full Text Available Abstract Background Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988 can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view. Purpose The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia. Methods 33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS (ranging from 0 = no pain to 10 = maximum pain. Results One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min. The pain score related to injection was 2.5 (0.8 and to tourniquet was 3.6 (0.9. Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred. Conclusion Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.

  15. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament

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    Abicalaf, C.A. [Department of Radiology, University of Sao Paulo (Brazil)]. E-mail: abicalaf@uol.com.br; Barros, N. de [Department of Radiology, University of Sao Paulo (Brazil); Sernik, R.A. [Department of Radiology, University of Sao Paulo (Brazil); Pimentel, B.F. [Department of Orthopedic Surgery, University of Taubate, Sao Paulo (Brazil); Braga-Baiak, A. [Department of Radiology, University of Sao Paulo (Brazil); Braga, L. [Department of Radiology, University of Nebraska Medical Center (United States); Houvet, P. [Department of Radiology, Pitie Salpetriere Hospital, Paris (France); Brasseur, J.-L. [Department of Radiology, Pitie Salpetriere Hospital, Paris (France); Roger, B. [Clinique des Lilas, Paris (France); Cerri, G.G. [Department of Radiology, University of Sao Paulo (Brazil)

    2007-09-15

    Aim: To evaluate the cross-sectional area of the median nerve using ultrasound in carpal tunnel syndrome patients before and after endoscopic intervention. Material and methods: Twenty patients with carpal tunnel syndrome (15 women and five men; mean age 55 years) were prospectively evaluated. Informed consent was obtained from all participants. The study was approved by our Institutional Review Board (IRB). Median nerve cross-sectional area was evaluated at the proximal level before and at 4, 8, and 12 weeks after endoscopic release of the transverse ligament. In the present study, the median nerve cross-sectional area cut-off point was 10 mm{sup 2}. Repeated measures analysis of variance test (ANOVA) was applied to compare the reproducibility of ultrasound measurements before and after intervention. Results: The mean cross-sectional area of the median nerve was 15 mm{sup 2} (SD {+-} 2.1) before surgery; and 11.1 mm{sup 2} (SD {+-} 3); 9.2 mm{sup 2} (SD {+-} 2); and 8.6 mm{sup 2} (SD {+-} 1.6) at 4, 8, and 12 weeks after surgery. Repeated measures analyses of variance were found to be statistically significant (p < 0.001). Conclusion: The results of the present study demonstrated that there was a decrease in the cross-sectional area of the median nerve after the release of the transverse carpal ligament.

  16. Adequacy and long-term prognosis of endoscopic carpal tunnel release.

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    Hirooka T

    1999-02-01

    Full Text Available Forty-one hands of 37 patients with idiopathic carpal tunnel syndrome treated by endoscopic carpal tunnel release (ECTR were followed up for more than one year after surgery. Surgical results were evaluated using Kelly's criteria, the Semmes-Weinstein test, the static and moving 2-point discrimination tests, tip-pinch strength, and motor and sensory nerve conduction studies. Clinical results, according to Kelly's criteria three months after surgery, were excellent or good in 36 hands, and fair or poor in five hands. No recovery was evident at six months and 12 months after surgery in fair and poor hands. Based on these findings, we conclude that a neurolysis of the median nerve and release of constriction of the thenar muscle branch should be performed using the conventional open technique for patients with poor results three months after ECTR if the patients are dissatisfied with ECTR results.

  17. Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases.

    Science.gov (United States)

    Quaglietta, P; Corriero, G

    2005-01-01

    Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. Follow-up was performed at 1, 3 and 6 months and overall results were backed up by telephone questionnaire (Health Outcomes Carpal Tunnel Questionnaire, Health Outcomes, Bloomington, MN, USA). Results were favourable in 98% and 2% unfavorable for persistent pain. Rate of satisfaction of the patients was 90%. Average time of patient's return to work was 20 days. Eleven procedures (2.8%) were converted to open release. There was one case (0.2%) of incompleted section of the perineurium due to failure of endoscopic visualization of the ligament. In this case the procedure was converted to open and was completed with perineurium sutura. In six cases (1.5%) there were injury to superficial palmar arch. During the follow-up period there were no recurrences and no re-exploration. The mean preoperatively obtainable distal motor latency (DML) and sensory conduction velocity (SCV) values were 6.7 m/s and 29.2 m/s, respectively. The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.

  18. A prospective study of prognostic factors for duration of sick leave after endoscopic carpal tunnel release

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    Dalsgaard Jesper

    2009-11-01

    Full Text Available Abstract Background Endoscopic carpal tunnel release with a single portal technique has been shown to reduce sick leave compared to open carpal tunnel release, claiming to be a less invasive procedure and reducing scar tenderness leading to a more rapid return to work, and the purpose of this study was to identify prognostic factors for prolonged sick leave after endoscopic carpal tunnel release in a group of employed Danish patients. Methods The design was a prospective study including 75 employed patients with carpal tunnel syndrome operated with ECTR at two hospitals. The mean age was 46 years (SD 10.1, the male/female ratio was 0.42, and the mean preoperative duration of symptoms 10 months (range 6-12. Only 21 (28% were unable to work preoperatively and mean sick leave was 4 weeks (range 1-4. At base-line and at the 3-month follow-up, a self-administered questionnaire was collected concerning physical, psychological, and social circumstances in relation to the hand problem. Data from a nerve conduction examination were collected at baseline and at the 3-month follow-up. Significant prognostic factors were identified through multiple logistic regression analysis. Results After the operation, the mean functional score was reduced from 2.3 to 1.4 (SD 0.8 and the mean symptom score from 2.9 to 1.5 (SD 0.7. The mean sick leave from work after the operation was 19.8 days (SD 14.3. Eighteen patients (24% had more than 21 days of sick leave. Two patients (3% were still unable to work after 3 months. Significant prognostic factors in the multivariate analysis for more than 21 days of postoperative sick leave were preoperative sick leave, blaming oneself for the hand problem and a preoperative distal motor latency. Conclusion Preoperative sick leave, blaming oneself for the hand problem, and a preoperative distal nerve conduction motor latency were prognostic factors for postoperative work absence of more than 21 days. Other factors may be important

  19. A new tool for mini-open carpal tunnel release – the PSU retractor

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    Yuenyongviwat Varah

    2008-09-01

    Full Text Available Abstract Background Mini-open carpal tunnel release has become increasingly popular for the treatment of carpal tunnel surgery. The main advantages are shortening recovery time and return-to-work time. However, the risk of neurovascular injury still remains worrisome. Methods In this study, we developed a new retractor (herein called the PSU retractor modified from the widely used Senn retractor, with the aim of decreasing the risk of neurovascular problems from normal procedure. 3-Dimensional computer design software (SolidWorks® Office Premium 2007 SP3.1 was used to construct a 3-D PSU retractor prototype. An amputated arm from a 30-year-old woman diagnosed as synovial sarcoma at the shoulder was used to test the maximal visual length. A mini-surgical incision was performed at 3 cm distal to the transverse wrist crease and a tiny flexible ruler was inserted through the tunnel beneath the skin to measure the maximal visual length. Results Our new retractor showed significantly better maximal visual length compared to the Senn retractor (47.7(8.1 mm vs. 39.2(6.5 mm. In addition, most assessors expressed a higher satisfaction rate with the PSU retractor than with the Senn retractor (7.3 (1.9 vs. 6.3 (1.1. Conclusion In conclusion, we have developed a promising new retractor using a computer design program, which appears to be an improvement on the currently available equipment used for mini-open carpal tunnel surgery. However, further clinical studies are needed to confirm our initial findings.

  20. The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics

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    Marc A. Tanner

    2012-01-01

    Full Text Available Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined. Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly. Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.

  1. High Resolution Ultrasonography of Carpal Tunnel Syndrome Before and After Endoscopic Release of the Transverse Carpal Ligament: Correlation of Ultrasonography (US)Findings with Surgical Outcomes

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    Cha, Jang Gyu; Im, Soo Bin; Seok, Hyun; Yi, Beom Ha; Choi, Na Mi; Lee, Hae Kyung [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jin, Wook [East-West Neo Medical Center, Kyung Hee University, Seoul (Korea, Republic of)

    2008-03-15

    The aim of this study is to evaluate morphological changes of the medial nerve in patients with carpal tunnel syndrome (CTS) before and after endoscopic release of the transverse carpal ligament, and to correlate the ultrasonography (US) findings with the use of high resolution US and the surgical outcome for the median nerve. Thirty patients with CTS confirmed by a clinical and electrophysiological study underwent high resolution US. The US instrumentation was equipped with a high frequency linear transducer to measure the cross sectional area, flattening ratio and swelling ratio of the medial nerve at the distal radioulnar joint, proximal and distal carpal tunnel before and three months after surgery. The cross sectional area (CSA) of the median nerve at the distal radioulnar level showed a decrease from 0.13 {+-} 0.03 cm2 before surgery to 0.11 {+-} 0.03 cm2 after surgery, and the CSA of the proximal carpal tunnel showed a decrease from 0.17 {+-} 0.07 cm2 to 0.14 {+-} 0.05 cm2: these differences were statistically significant. There was no statistically significant correlation between the morphological change and symptom improvement. This study confirmed a decreasing CSA of the medial nerve at the distal radioulnar and proximal carpal tunnel in a postoperative patient with CTS, as determined by the use of high resolution US. No association was found between a change in the CSA of the median nerve and symptom improvement. A further study based on multiple measurements of the median nerve with a longer period is necessary to establish the association between a change in the CSA of the median nerve and symptom improvement

  2. A descriptive study of 972 consecutive cases of carpal tunnel release: role of ancillary procedures

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    Berkan Mersa

    2013-04-01

    Conclusion: Additional procedures is advocated as adjuncts to the carpal ligament release, in an effort to decrease the failure rate after operation in indicated cases. [Hand Microsurg 2013; 2(1.000: 18-22

  3. Carpal tunnel syndrome treatment

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    Emilio Filippucci

    2011-09-01

    Full Text Available Carpal tunnel syndrome, the most common peripheral neuropathy, results from compression of the median nerve at the wrist, and is a cause of pain, numbness and tingling in the upper extremities and an increasingly recognized cause of work disability. If carpal tunnel syndrome seems likely, conservative management with splinting should be initiated. Moreover, it has suggested that patients reduce activities at home and work that exacerbate symptoms. Pyridoxine and diuretics, since are largely utilised, are no more effective than placebo in relieving the symptoms. Non steroidal anti-inflammatory drugs and orally administered corticosteroids can be effective for short-term management (two to four weeks, but local corticosteroid injection may improve symptoms for a longer period. Injection is especially effective if there is no loss of sensibility or thenar-muscle atrophy and weakness, and if symptoms are intermittent rather than constant. If symptoms are refractory to conservative measures, the option of surgical therapy may be considered.

  4. [Carpal tunnel syndrome treatment].

    Science.gov (United States)

    De Angelis, Rossella; Salaffi, Fausto; Filippucci, Emilio; Grassi, Walter

    2006-01-01

    Carpal tunnel syndrome, the most common peripheral neuropathy, results from compression of the median nerve at the wrist, and is a cause of pain, numbness and tingling in the upper extremities and an increasingly recognized cause of work disability. If carpal tunnel syndrome seems likely, conservative management with splinting should be initiated. Moreover, it has suggested that patients reduce activities at home and work that exacerbate symptoms. Pyridoxine and diuretics, since are largely utilised, are no more effective than placebo in relieving the symptoms. Non steroidal anti-inflammatory drugs and orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injection may improve symptoms for a longer period. Injection is especially effective if there is no loss of sensibility or thenar-muscle atrophy and weakness, and if symptoms are intermittent rather than constant. If symptoms are refractory to conservative measures, the option of surgical therapy may be considered.

  5. Carpal tunnel syndrome and acromegaly.

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    Baum, H; Lüdecke, D K; Herrmann, H D

    1986-01-01

    50 patients with acromegaly and carpal tunnel syndrome have been examined electrophysiologically before and after transnasal operation of the pituitary adenoma. 32 of the 50 patients (64%) had symptoms of carpal tunnel syndrome. 13 of them had neurological deficits. 28 of the examined patients had pathological neurographical findings only. About 1 week post-operatively DL was decreased in 43%; in 10 out of 13 patients with neurological deficits DL decreased. GH was normalized in 80% and reduced to 5-10 micrograms/l in a further 10%. The investigation did not show whether the carpal tunnel syndrome only depended on a GH increase or on other factors also such as e.g., on the duration of symptoms or tissue changes. None of the patients had the transversal carpal ligament operated on. The coincidence between acromegaly and carpal tunnel syndrome was 64%. In 3 cases the carpal tunnel syndrome was the leading sign to the diagnosis of acromegaly.

  6. Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study.

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    Romeo, Pietro; d'Agostino, M Cristina; Lazzerini, A; Sansone, Valerio C

    2011-10-01

    "Pillar pain" is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density-focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for treating this condition. Our results show that in all of the treated patients, there was a marked improvement: the mean visual analogue scale (VAS) score decreased from 6.18 (±1.02) to 0.44 (±0.63) 120 d after treatment, and redness and swelling of the surgical scar had also decreased significantly.

  7. Clinical analysis on endoscopic carpal tunnel release and double incision carpal tunnel release for carpal tunnel syndrome%内镜下和双小切口手术方法治疗腕管综合征的疗效分析

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    周军; 杨丽; 于宝占; 王明钢

    2014-01-01

    目的:探讨内镜下腕管松解术和双小切口腕管松解术治疗腕管综合征的临床疗效和安全性差异。方法:将70例腕管综合征患者随机分为内镜下腕管松解术组(A组,35例)和双小切口腕管松解术组(B组,35例),随访24个月,采用Kelly分级评定法评价比较两种手术的术后临床疗效和安全性差异。结果:A组优良率为91.4%,B组优良率为88.6%,两组的优良率比较差异无统计学意义(x2=0.328,P>0.05);A组的住院时间及术后恢复工作时间显著优于B组,差异有统计学意义(t=3.859,t=2.293;P<0.05)。结论:双小切口腕管松解术及内镜下腕管松解术治疗腕管综合征均为有效的手术治疗方法,但内镜下腕管松解术的住院时间短、术后恢复更快。%Objective:To investigate the differences of clinical efficacy and safty for carpal tunnel syndrome with two different surgical methods. Methods: Seventy patients with carpal tunnel syndrome were randomly divided into two groups: endoscopic carpal tunnel release (A group, 35 patients) and double incision carpal tunnel release (B group, 35 patients), during the course of follow-up, the clinical efficacy and complications were analyzed and evaluated. Result: The excellent rate of A group and B group were 91.4%and 88.6%respectively, there was no significant difference between two groups(x2=0.328, P>0.05), but hospital stay and recovering time of A group were shorter than Group B (t=0.328, t=0.328; P<0.05). Conclusion: The endoscopic carpal tunnel release and double incision carpal tunnel release are both effective and safe for carpal tunnel syndrome, but endoscopic carpal tunnel release is superior with double incision carpal tunnel release with shorter hospital stay and recovering time.

  8. Pyridoxine as an adjunct in the treatment of carpal tunnel syndrome.

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    Amadio, P C

    1985-03-01

    Nineteen consecutive patients with carpal tunnel syndrome were treated with pyridoxine. Two thirds of the patients who specifically presented symptoms of median neuropathy eventually required surgical release. Although pyridoxine may have a place alongside other nonsurgical modalities in the treatment of carpal tunnel syndrome, surgical release continues to be indicated in many patients with carpal tunnel syndrome.

  9. The recurrent carpal tunnel syndrome.

    Science.gov (United States)

    Kern, B C; Brock, M; Rudolph, K H; Logemann, H

    1993-01-01

    Sixteen out of 720 patients with carpal tunnel syndrome who had undergone surgery since 1979 were reoperated for a "recurrence" (2.2%). Twelve of these patients had been originally operated on in our department. Thus, our own recurrence rate is 1.7%. Three patients deteriorated following surgery, 6 had an unsatisfactory improvement, and in 7 the symptoms recurred after initial improvement. Eight of the reoperated patients had a predisposing disease (terminal renal insufficiency, insulin-dependent diabetes mellitus, acromegaly). In 10 of the 16 cases the initial operation had been carried out by surgeons in the first three years of training. Reoperation revealed incomplete splitting of the transverse carpal ligament in 10 cases, compression of the median nerve by the scar in 4, injury of the muscular branch in 1, and an anatomical variant as cause of incomplete decompression in 1 patient. "Recurrences" after carpal tunnel surgery are predominantly due to inadequacies of the first procedure. A remarkable number of patients (50%) has predisposing diseases. Interfascicular or epineural neurolysis and complete exposure and neurolysis of the median nerve and its branches is necessary only in cases of recurrence. Their omission at the first surgery does not result in an increased recurrence rate. Our observations indicate that the number of operations for recurrent carpal tunnel syndrome can probably be reduced when the first operation is performed with care and experience. Patients with carpal tunnel syndrome secondary to a systemic disease are particularly at risk.

  10. Treatment considerations in carpal tunnel syndrome with coexistent Dupuytren's disease.

    Science.gov (United States)

    Nissenbaum, M; Kleinert, H E

    1980-11-01

    Twenty-nine patients with involvement of 31 hands presented with coexisting carpal tunnel syndrome and ipsilateral Dupuytren's disease. Analysis of the patient population showed a high proportion of women, dominant hand involvement, and repetitive manual trauma. Various treatment combinations were used and the results evaluated. Simultaneous surgical excision of Dupuytren's contracture and carpal tunnel release gave compromised long-term results, particularly among the women. To minimize complications, it is advised that carpal tunnel release not be performed at the same time as excision of Dupuytren's contracture.

  11. Raynaud's syndrome and carpal tunnel syndrome.

    OpenAIRE

    Waller, D G; Dathan, J R

    1985-01-01

    We report three cases of Raynaud's syndrome with digital ischaemic ulceration, in association with carpal tunnel syndrome. In all cases, the aetiology of the Raynaud's syndrome was probably unrelated to the nerve compression. However, symptoms were worse on the side of the median nerve lesion in two patients and worse on the side with the most severe nerve dysfunction in the third; symptoms were relieved by carpal tunnel decompression in two patients. We suggest that carpal tunnel syndrome ma...

  12. Electromyographic diagnosis of the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    K. Toyonaga

    1978-06-01

    Full Text Available Sensory conduction velocities of the median nerVe were studied from digit to palm and from palm to wrist in normal subjects and in patients with the carpal tunnel syndrome. Definite slowing was noted in the palm to wrist segment, even in the early carpal tunnel syndrome. It was noted that 37% of normal women over 40 years of age had electrophysiological evidence of the carpal tunnel syndrome.

  13. Electrodiagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Wang, Leilei

    2013-02-01

    This article discusses the historical aspects related to the understanding of carpal tunnel syndrome (CTS) and its diagnosis, highlighting observations about this disease that have yet to be challenged. This is followed by a discussion regarding the use of electrodiagnostic testing as a diagnostic tool for CTS, as well as the author's approach to making the diagnosis of CTS. Finally, conclusions about future directions in the diagnosis and treatment of this disorder are presented.

  14. Pharmacotherapy of carpal tunnel syndrome.

    Science.gov (United States)

    de Pablo, Paola; Katz, Jeffrey N

    2003-06-01

    Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. CTS is a compression neuropathy caused by elevated pressure in the carpal tunnel. CTS has the potential to substantially limit performance of activities of daily living for some individuals. The goal of therapy for CTS is to improve symptoms and reduce signs of the disease, as well as prevent progression and loss of hand function. There are several treatment alternatives to relieve the pressure on the median nerve, both surgical and conservative. The most common measures employed in the initial treatment of CTS are NSAIDs, local and systemic corticosteroids, diuretics and pyridoxine. However, CTS treatment usually includes a combination of pharmacotherapy with other strategies such as splinting and activity modification. Injections of corticosteroids into the carpal tunnel are often employed for cases not responding to conservative treatment. Surgery is superior to conservative therapies for most persistently symptomatic patients. The aim of this paper is to review the pharmacological agents used for relieving the symptoms of CTS.

  15. [Carpal tunnel syndrome. Current approaches].

    Science.gov (United States)

    Kouyoumdjian, J A

    1999-06-01

    A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal) or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low significance. Magnetic resonance could be a useful tool for selected atypical cases. Conservative treatment and controversies on surgery timing are discussed. Classical conduction studies on median nerve reveal a prolonged distal segmental sensory latency and also on distal motor latency. Increasing sensitivity may be reach using additional methods such as, median mixed mid-palm latency, comparative mid-palm latency median/ulnar, comparative sensory latency median/radial and median/ulnar, inching method from wrist to palm recording on index/middle finger and comparative motor median/ulnar recording on lumbrical/interosseous muscle.

  16. Ultrasonographic assessment of carpal tunnel biomechanics

    NARCIS (Netherlands)

    van Doesburg, M.H.M.

    2012-01-01

    In this thesis, we searched for a way to assess flexor tendon and median nerve biomechanics, as well as subsynovial connective tissue thickness (SSCT) in the carpal tunnel with ultrasound, and tried to see if these patterns would give a clue towards understanding the etiology of carpal tunnel syndro

  17. Extraskeletal chondroma casuing carpal tunnel syndrome: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ok Hwa; Kim, Yeon Hee [Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2014-03-15

    Carpal tunnel syndrome caused by extraskeletal chondroma has been scarcely reported in the literature. Authors report a case of carpal tunnel syndrome as a result of an extraskeletal chondroma arising within the carpal tunnel, and describe the radiological and pathological findings of the mass. We also discuss the differential diagnosis of the calcified space, occupying lesions that may occur in carpal tunnel.

  18. A randomized prospective study to assess the efficacy of two cold-therapy treatments following carpal tunnel release.

    Science.gov (United States)

    Hochberg, J

    2001-01-01

    A prospective randomized study was performed comparing the efficacy of controlled cold therapy (CCT) with the efficacy of ice therapy in the postoperative treatment of 72 patients with carpal tunnel syndrome. Immediately after surgery, patients applied either a temperature-controlled cooling blanket (CCT) or a standard ice pack over their surgical dressings. Pain was assessed by visual analog scale and swelling by wrist circumference preoperatively, immediately after surgery, and on postoperative day 3. Patients kept log books of daily treatment times. Narcotic use (of Vicodin ES) was determined by pill count at day 3 and by daily log book recordings. Patients who used CCT showed significantly greater reduction in pain, edema (wrist circumference), and narcotic use at postoperative day 3 than did those using ice therapy. This study indicates that after carpal tunnel surgery, the use of CCT, compared with traditional ice therapy, provides patients with greater comfort and lessens the need for narcotics.

  19. CARPAL TUNNEL SYNDROME IN CYCLISTS

    Science.gov (United States)

    Sousa, Daniel; Sassul, Nicolás

    2017-01-01

    Objectives: About a group of cyclists, professionals / amateurs, Mountain bike, road and triathlon; achieve a good diagnosis of the disease, with a good clinical examination and sectorized according EGM injury evoked potentials. Methods: Clinical examination and accurate test with different signs of pathology. EGM with evocative potential and conduction velocity. Results: After 25 track cyclists, 18 professionals, 22 male and 3 female; for 24 months. Through good clinical examination and EMG. We got that 70% had direct compression injuries Carpal tunnel for poor support on the handlebars. The rest were cervical praxis, by poor body position on the bike, taking cervico very steep angles / dorsal, during competitions or training for more than 2 hrs. Conclusion: A good prevention work with our teacher / cyclist in the position of deposrtista in ciclo simulador. Work in the gym, on tone and elongation of the upper limb. A good EGM, made with a specialist physiatrist. It leads to the correct diagnosis, leads to a good final treatment; which agreed that:* Cervical praxis, had good results with treatment Conservative / FST / vit.B12.* The Carpal tunnel own injuries, treatment was quirúrg. (Open surgery) with subsequent FST / vit..B12 with satisfactory return in time to sporting activity.

  20. 腕管综合征患者开放式松解手术效果的非客观研究%Non objective study of operation effect of carpal tunnel syndrome in patients with open carpal tunnel release

    Institute of Scientific and Technical Information of China (English)

    黄若强; 吕荼; 邱忠朋

    2015-01-01

    目的:采用患者源性的非客观功能评价量表评价腕管综合征患者开放式松解手术的疗效。方法对158例实施开放式腕管松解术腕管综合征患者采用Levine腕管综合征问卷调查表、DASH量表、UEFI量表和SF-36量表对患者手术实施前后的生理、心理和社会功能进行非客观评价。结果所有患者均未发生并发症。 Levine问卷调查表和DASH量表手术前后正中神经外膜松解患者和正中神经外膜未松解患者差值比较,差异无统计学意义(P>0.05),屈肌腱滑膜增生切除患者与屈肌腱滑膜未增生切除患者差值比较,差异无统计学意义(P>0.05)。 Levine问卷调查表的症状和功能评分手术前后差异有统计学意义(P0. 05 ); Between flexor tendon synovial hyperplasia resection pa-tients and flexor tendon synovial hyperplasia patients without resection had no significant differences in data difference ( P>0. 05 ) . Symptoms and function of Levine questionnaire score was statistically significant differences in the scores before and after operation (P<0. 01), suggested that carpal tunnel function improved obviously. Operation of DASH value before and after the difference was statistically significant (P<0. 01), especially the most obvious self-confidence and hand fine operation function improvement ( P<0. 01 ) . UEFI score before and after operation, the difference was statistically significant, suggested that the upper limb function were improved significantly ( P <0. 01). UEFI scale score before and after operation had significant difference (P<0. 01), suggested that the upper limb function improved. SF-36 scale score display operation before and after the 9 aspects were improved significantly (P<0. 05), with an improvement in their health was most obvious. Conclusions Carpal tunnel syndrome patients after open carpal tunnel release surgery can significantly improve symptoms, improve upper limb function, and pro-mote the

  1. Carpal tunnel syndrome - anatomical and clinical correlations.

    Science.gov (United States)

    Iskra, Tomasz; Mizia, Ewa; Musial, Agata; Matuszyk, Aleksandra; Tomaszewski, Krzysztof A

    2013-01-01

    Carpal tunnel syndrome (CTS) is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed. Common symptoms of CTS involve the hand and result from compression of the median nerve within the carpal tunnel. In general, CTS develops when the tissues around the median nerve irritate or compress on the nerve along its course through the carpal tunnel, however often it is very difficult to determine cause of CTS. Proper treatment (conservative or surgical) usually can relieve the symptoms and restore normal use of the wrist and hand.

  2. Carpal tunnel syndrome after 22 years of Colle's fracture

    Directory of Open Access Journals (Sweden)

    Goyal V

    2003-01-01

    Full Text Available Delayed carpal tunnel syndrome is rare. We describe the electrophysiological findings in a patient with Colle's fracture, who developed carpal tunnel syndrome 22 years after a wrist injury.

  3. Carpal tunnel syndrome: an unusual presentation of brachial hypertrophy.

    OpenAIRE

    Shenoy, K. T.; Saha, P. K.; Ravindran, M

    1980-01-01

    A patient with carpal tunnel syndrome in association with congenital hypertrophy of right upper limb is described. The median nerve also showed hypertrophy. The symptoms were relieved by decompression of the carpal tunnel.

  4. Meta-analysis of limited mini incision release and traditional open carpal tunnel release for treatment of carpal tunnel syndrome%有限小切口松解与常规切开松解修复腕管综合征的Meta分析

    Institute of Scientific and Technical Information of China (English)

    艾科热木•吾普尔; 加莎热特•杰力勒; 艾合买提江•玉素甫; 阿不来提•阿不拉; 阿布都黑力力•买买提艾力; 刘亚飞; 阿依娜孜; 黄勇; 杨朋斐

    2014-01-01

    BACKGROUND:Since 1991, many physicians try to combine the smal open-incision along the wrist crease with traditional carpal tunnel release that is simple and safe to reduce tissue damage and recurrence rate. But what kind of techniques is superior has been controversial. OBJECTIVE:To compare the efficacy and safety of limited mini incision (non-endoscopic) carpal tunnel release with traditional open carpal tunnel release for carpal tunnel syndrome. METHODS:Based on Cochrane Systematic Review, we searched through the MEDLINE (1966-01/2010-03), EMBASE (1966-01/2014-05), Cochrane Library (2014-05) and CBM disc (1979-01/2013-12), and relevant seven Chinese and English orthopedic journals by hand. Then, we colected al the randomized control trials related to carpal tunnel syndrome. The quality of trials was criticaly assessed. The Revman5.2.2 that provided by Cochrane Colaboration was used for data management and analysis on the evidence of the difference in the efficacy and safety of limited mini incision carpal tunnel release versus traditional open carpal tunnel release. RESULTS AND CONCLUSION: Totaly seven randomized controled trials were included by total retrieve and screening. The results of meta-analysis showed no significant differences in the scar tenderness, pilar pain, subjective satisfaction and recovery time between groups of limited mini incision carpal tunnel release and traditional open carpal tunnel release (P > 0.05). The rate of complications and operation time in group of limited mini incision carpal tunnel release were lower than those in group of traditional open carpal tunnel release (P   目的:对非内窥镜的有限小切口松解和传统腕管切开松解治疗腕管综合征的疗效进行系统评价。  方法:按照 Cochrane系统评价的方法,计算机检索MEDLINE(1966年1月至2010年3月)、EMBASE(1966年1月至2014年5月)、Cochrane图书馆(2014年5月)及中国生物医学文献数据库(1979年1月至2013年12

  5. A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release.

    LENUS (Irish Health Repository)

    Theopold, C

    2012-05-01

    We compared the aesthetic outcome of scars after closure of open carpal tunnel incisions with either absorbable 4-0 Vicryl Rapide or non-absorbable 4-0 Novafil. Patients were recruited in a randomized controlled trial and scars were scored at 6 weeks using a modified Patient and Observer Scar Assessment Scale. Scores demonstrated differences only for pain, vascularity and cross-hatching between both groups, though none of these were statistically significant. The dissolving and falling out of Vicryl Rapide was significantly more comfortable than removal of 4-0 Novafil sutures, assessed on a numerical analogue scale. There was no difference in infection rate between both study groups, supporting overall the use of Vicryl Rapide for the closure of palmar hand incisions, in light of the convenience and cost savings associated with absorbable sutures.

  6. Electrodiagnostic approach to carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Cherian Ajith

    2006-01-01

    Full Text Available An algorithm for an electrophysiological approach to carpal tunnel syndrome is proposed. This technical note takes into account the standard tests, comparison tests and needle electromyography. If the standard tests are negative, a comparison study can be done to identify cases of minimal or very mild carpal tunnel syndrome (CTS. If comparison studies are negative, CTS can be ruled out and a search for other causes have to be made. If the standard tests are positive, carpal tunnel syndrome can be divided into extreme, severe,moderate and mild cases. Motor comparison study is useful in extreme CTS cases. Needle electromyography is a must in all cases where the standard tests are positive. This streamlined approach allows accurate diagnosis with minimum essential tests.

  7. Prevalence of carpal tunnel syndrome in motorcyclists.

    Science.gov (United States)

    Manes, Harvey R

    2012-05-01

    Carpal tunnel syndrome is prevalent in patients who have a repetitive motion, vibration, or pressure exerted on the wrist joint for an extended period of time. The prevalence of this condition in the general population is approximately 5%. Motorcyclists subject themselves to high levels of vibration from the road and use their wrists to control the motorcycle's brakes, gas intake, and gears via the handlebars. Under these conditions, the author hypothesized that an increased prevalence of carpal tunnel syndrome would be observed in this population.

  8. Treatment of repetitive use carpal tunnel syndrome

    Science.gov (United States)

    Smith, Chadwick F.; Vangsness, C. Thomas; Anderson, Thomas; Good, Wayne

    1995-05-01

    In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit low level laser therapy unit was utilized in Group A, while an actual low level laser therapy unit was utilized in Group B. The difference between Groups A and B was statistically significant in terms of return to work, conduction study improvement, and certain range of motion and strength studies.

  9. Carpal Tunnel Syndrome in ARL Libraries.

    Science.gov (United States)

    Thornton, Joyce K.

    1997-01-01

    A survey of 72 member libraries in the Association of Research Libraries revealed the incidence of carpal tunnel syndrome (CTS) and the measures taken to cope with it. Recommends implementing proactive ergonomics programs; soliciting staff input for solutions; providing report guidelines; using external help; stressing preventive measures and…

  10. Employees' Knowledge of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Gandy-Goldston, Terrie M.

    A study examined employees' knowledge of the causes of carpal tunnel syndrome (CTS), its prevention, and their legal rights after being diagnosed with CTS. A 24-item questionnaire was administered to a random sample of 30 Chicago-area employees who had been afflicted with CTS. Of those surveyed, 99% considered their CTS injury related to their…

  11. Bilateral carpal tunnel syndrome in Graves' disease.

    Science.gov (United States)

    Manganelli, P; Pavesi, G; Salaffi, F

    1987-01-01

    Carpal tunnel syndrome (CTS) may be associated with endocrinopathies, such as hypothyroidism and acromegaly. A direct relationship between CTS and hyperthyroidism has recently been suggested. We now report a case in which bilateral CTS developed after treatment of Graves' disease, thus, questioning the possibility of a relationship between these two disease processes.

  12. Ulnar nerve entrapment in Guyon's canal due to recurrent carpal tunnel syndrome: case report.

    Science.gov (United States)

    Ozdemir, Ozgur; Calisaneller, Tarkan; Gulsen, Salih; Caner, Hakan

    2011-01-01

    Guyon's canal syndrome is a compression neuropathy of the ulnar nerve entrapment at the wrist. Compression of the ulnar nerve at the wrist by a ganglion, lipomas, diseases of the ulnar artery, fractures of the hamate and trauma are common etiologcal factors. Unlike Guyon's canal syndrome, carpal tunnel syndrome (CTS) is the most common nerve entrapment of the upper extremity. Although, open (OCTR) or endoscopic carpal tunnel release (ECTR) is highly effective in relieving pain, failure with carpal tunnel release is seldom seen. In this paper, we presented a patient with ulnar nerve entrapment associated with recurrent CTS and discussed the possible pathomechanism with a review of current literature.

  13. High resolution sonography of the carpal tunnel syndrome; Ecografia con alta risoluzione nello studio della sindrome del tunnel carpale

    Energy Technology Data Exchange (ETDEWEB)

    Ferrari, Francesco Saverio; Guazzi, Gianni; Belcapo, Luigi; Stefani, Paolo [Siena, Univ. (Italy). Istituto di Scienze Eidologiche e Radiologiche; Della Sala, Luca; Cozza, Sabino [Ospedale di Volterra, Pisa (Italy). Servizio di Radiologia; Mariottini, Aldo; Bolognini, Andrea [Siena, Univ. (Italy). Istituto di Neurochirurgia

    1997-04-01

    They investigated the reliability of some US signs in the diagnosis of the carpal tunnel syndrome. They carried out a single-blind study with 13-MHz high resolution probes and electromyography on 132 patients with clinical evidence of the carpal tunnel syndrome; a control group of 20 asymptomatic patients was also submitted to US. Eighty-six of 107 patients with US signs of the carpal tunnel syndrome were then submitted to surgical decompression while the extant 21 patients underwent conservative treatment and clinical follow-up. To diagnose the carpal tunnel syndrome they considered the following US patterns: median nerve changes palmar bowing of the flexor retinaculum, thickening of the transverse carpal ligament and increased depth of the carpal tunnel, as measured from the apex of the transverse carpal ligament convexity to the underlying carpal bone. Median nerve changes were unreliable signs and were missing in many cases: only 45 of 107 patients exhibited median nerve swelling before and/or its flattening in the carpal tunnel (42 %). Such indirect signs as the thickening of the transverse carpal ligament in chronic cases were demonstrated in 94 of 107 patients with the carpal tunnel syndrome (88 %) and canal depending in all unilateral carpal tunnel syndromes was shown in 92 of 107 patients (87 %); both these signs proved to be much more reliable. The palmar bowling of the flexor retinaculum was also difficult to demonstrate in surgical patients or in those with connective tissue fibrosis within the tunnel: this sign was demonstrated in 80 of 107 patients with the carpal tunnel syndrome confirmed with electromyography (75 %). Tanzer and Rietze reported median nerve changes observed at surgery in 43 % and 66 % of their patients. Recent MR findings in asymptomatic wrists have demonstrated that the normal median nerve has an elliptical shape inside the carpal tunnel. (Abstract Truncated)

  14. Carpal Tunnel Cross-Sectional Area Affected by Soft Tissues Abutting the Carpal Bones.

    Science.gov (United States)

    Gabra, Joseph N; Li, Zong-Ming

    2013-02-01

    The carpal tunnel accommodates free movement of its contents, and the tunnel's cross-sectional area is a useful morphological parameter for the evaluation of the space available for the carpal tunnel contents and of potential nerve compression in the tunnel. The osseous boundary of the carpal bones as the dorsal border of the carpal tunnel is commonly used to determine the tunnel area, but this boundary contains soft tissues such as numerous intercarpal ligaments and the flexor carpi radialis tendon. The aims of this study were to quantify the thickness of the soft tissues abutting the carpal bones and to investigate how this soft tissue influences the calculation of the carpal tunnel area. Magnetic resonance images were analyzed for eight cadaveric specimens. A medical balloon with a physiological pressure was inserted into an evacuated tunnel to identify the carpal tunnel boundary. The balloon-based (i.e. true carpal tunnel) and osseous-based carpal tunnel boundaries were extracted and divided into regions corresponding to the hamate, capitate, trapezoid, trapezium, and transverse carpal ligament (TCL). From the two boundaries, the overall and regional soft tissue thicknesses and areas were calculated. The soft tissue thickness was significantly greater for the trapezoid (3.1±1.2mm) and trapezium (3.4±1.0mm) regions than for the hamate (0.7±0.3mm) and capitate (1.2±0.5mm) regions. The carpal tunnel area using the osseous boundary (243.0±40.4mm(2)) was significantly larger than the balloon-based area (183.9±29.7mm(2)) with a ratio of 1.32. In other words, the carpal tunnel area can be estimated as 76% (= 1/1.32) of the osseous-based area. The abundance of soft tissue in the trapezoid and trapezium regions can be attributed mainly to the capitate-trapezium ligament and the flexor carpi radialis tendon. Inclusion of such soft tissue leads to overestimations of the carpal tunnel area. Correct quantification of the carpal tunnel area aids in examining carpal

  15. Subclinical carpal tunnel syndrome in acromegaly.

    Science.gov (United States)

    Kameyama, S; Tanaka, R; Hasegawa, A; Tamura, T; Kuroki, M

    1993-08-01

    Median nerve conduction was studied in 16 acromegalic patients with asymptomatic carpal tunnel syndrome (CTS) to examine the incidence of subclinical CTS. Thirteen patients (81%) and 23 hands (72%) demonstrated subclinical CTS, 10 bilaterally and three unilaterally in the dominant hand. The incidence reflects the greater sensitivity of the inching method for detecting focal conduction abnormalities. Two of three patients without subclinical CTS showed normal plasma somatomedin-C concentration despite growth hormone hypersecretion. Following adenomectomy, nerve conduction normalized in only six hands (26%). The postoperative persistence of the conduction delay implies that irreversible narrowing of the carpal tunnel rather than reversible soft tissue edema is the principal cause of CTS associated with acromegaly.

  16. Pictorial essay: Role of ultrasound in failed carpal tunnel decompression

    Directory of Open Access Journals (Sweden)

    Rajesh Botchu

    2012-01-01

    Full Text Available USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.

  17. Trophic ulcers in the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Abelardo Q.-C. Araújo

    1993-09-01

    Full Text Available A patient with carpal tunnel syndrome (CTS and trophic ulcers is described. Despite the healing of the ulcers after surgery for CTS, the severe sensory deficit and the electrophysiological tests have not shown any significant improvement. We think these findings argue against the hypothesis of the sensory deficit being responsible for the trophic ulcers. We favor a major role for the sympathetic disturbances as the main cause for those lesions.

  18. PROSPECTIVE COMPARISON OF ENDOSCOPIC AND OPEN SURGICAL METHODS FOR CARPAL TUNNEL SYNDROME

    Institute of Scientific and Technical Information of China (English)

    Ye Tian; Hong Zhao; Ting Wang

    2007-01-01

    Objective To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome.Methods A prospective, randomized study was performed on 70 hands in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004. Either open (36 hands in 30 patients) or endoscopic (34 hands in 32 patients) carpal tunnel release was performed randomly. Symptom improvement, complications, and the time of operation , in-hospital stay, and return to work between the two groups were assessed with average 2 years of follow-up. The electromyography was tested pre- and 3 months post-operation.Results There were no significant differences between the two surgical groups with regard to postoperative improvements of symptom, electromyography tests, and the incidence of complications. But it was statistically less in the rate of scar tenderness, the time of operation, in-hospital stay, and return to work in the endoscopic group compared with the open group (P< 0. 05).Conclusions The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome. And it has the advantages of slight scar tenderness, less operation time, less in-hospital stay, early functional recovery, safety, and high satisfaction rate compared with open methods.

  19. Idiopathic Carpal Tunnel Syndrome: Evaluation of the Depth of the Carpal Tunnel by Ultrasonography.

    Science.gov (United States)

    Elsaman, Ahmed Mohammed Mahrous Yousif; Thabit, Mohamed Nasreldin; Radwan, Ahmed Roshdy Al-Agamy; Ohrndorf, Sarah

    2015-11-01

    The objective of the work described here was to evaluate the depth of the carpal tunnel (DCT) in patients with idiopathic carpal tunnel syndrome (CTS) and healthy volunteers by ultrasonography (US), through measurement of the distance from the flexor retinaculum to the surface of the capitate bone at the carpal tunnel outlet, and compare it with other ultrasonographic and electrophysiologic parameters in CTS. The study was conducted in 60 non-diabetic patients with idiopathic carpal tunnel syndrome (unilateral n = 37, bilateral n = 23) evidenced by electrophysiologic diagnosis according to the criteria of the American Association of Electrodiagnostic Medicine (AAEM). Furthermore, 40 hands from 20 healthy volunteers were examined. Median nerve cross-sectional area (CSA); flattening ratio (FR), the ratio of the length to the width of the median nerve; and DCT at the canal outlet were measured for all participants. The mean age was 35.6 ± 9.48 y. The female-to-male ratio was 47:13 in the CTS patients. The sensitivity and specificity were 82% and 95% for CSA, 75% and 60% for FR and 75% and 87.5% for DCT, respectively. Differences between patients and healthy controls were significant for all three parameters, greatest for DCT, followed by CSA and then FR. We conclude that DCT increased in CTS and this new parameter is comparable in sensitivity and specificity to CSA and FR. DCT increased independently of the cause of the CTS (decrease in size of canal or increase in contents).

  20. Subclinical Carpal Tunnel Syndrome in Patients with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Soroosh Dabiri

    2012-07-01

    Full Text Available Background: Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients.Methods: The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied.Results: After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides.Conclusion: The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients.

  1. 小切口腕管松解术与传统腕管松解术治疗腕管综合征的效果比较%Effect comparison of less incision of the carpal tunnel release with tradi-tional carpal tunnel release

    Institute of Scientific and Technical Information of China (English)

    黄秦邶; 张基仁; 齐勇; 李驰; 关雨

    2015-01-01

    Objective To investigate the effect of less incision of the carpal tunnel release with traditional carpal tunnel release. Methods 32 cases and 46 wrists of idiopathic CTS from October 2006 to October 2008 in the first affiliated hospital of Liaoning medical university were selected;16 cases and 24 wrists in group A were treated with less incision of the carpal tunnel release,16 cases and 22 wrists in group B were treated with traditional carpal tunnel release.Inci-sion length,operating time,postoperative hospitalization time,the time required to resume normal lifestyle,two point dis-crimination,complications and postoperative follow-up between the two groups was compared respectively. Results The incision length,open/close incision time,actual operation time,postoperative hospitalization time,the time required to re-sume normal lifestyle in group A was shorter than that in group B respectively,with statistical difference (P0.05).The differences of excellent,good,medium and poor proportion be-tween two groups were not statistically significant (P>0.05). Conclusion The curative effect is same between two opera-tions.It has low incidence of adverse reactions,faster recovery after surgery.It is an effective method to cure the CTS.%目的:探讨小切口腕管松解切开术与传统腕管松解术治疗腕管综合征(CTS)的效果。方法选择2006年10月~2008年10月辽宁医学院附属第一医院手外科治疗的特发性CTS患者32例46腕,其中16例24腕采用小切口腕管松解术为A组,16例22腕采用传统腕管松解术为B组。比较两种腕管松解方法的切口长度、手术时间、术后住院时间、恢复工作时间、术后两点辨别觉、术后并发症及随访情况。结果 A组在切口长度、开/关切口时间、实际手术时间、术后住院时间、术后恢复工作时间等项目均短于B组,差异有统计学意义(P0.05);两组术后疗效的优、良、中、差各比例比

  2. Osteopathic manipulative medicine for carpal tunnel syndrome.

    Science.gov (United States)

    Siu, Gilbert; Jaffe, J Douglas; Rafique, Maryum; Weinik, Michael M

    2012-03-01

    Carpal tunnel syndrome (CTS) is 1 of the most common peripheral nerve entrapment disorders. Osteopathic manipulative medicine can be invaluable in diagnosing and managing CTS. Combined with a patient's history and a standard physical examination, an osteopathic structural examination can facilitate localizing the nerve entrapment, diagnosing CTS, and monitoring the disease process. Osteopathic manipulative treatment is noninvasive and can be used to supplement traditional CTS treatment methods. The authors also review the relevant anatomy involving CTS and the clinical efficacy of osteopathic manipulative medicine in the management of this disorder.

  3. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?☆

    OpenAIRE

    2013-01-01

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) accord...

  4. PERSISTENT MEDIAN ARTERY IN THE CARPAL TUNNEL

    Directory of Open Access Journals (Sweden)

    Raviprasanna.K.H

    2014-09-01

    Full Text Available Introduction: Persistent median artery originates from the anterior interosseous artery in proximal one-third of the forearm and accompanies median nerve. Median artery may regress in the forearm or enter palm through the carpal tunnel deep to flexor retinaculum of wrist and supply palm by anastomosing with the superficial palmar arch. Objective: In present study the objective was to study presence of persistent median artery accompanying median nerve and its termination Materials and Methods: The study included 50 human cadaver upper limb specimens at the Department of Anatomy, Mysore Medical College & Research Institute, Mysore during 2011-13. These specimens fixed in 10% formalin were finely dissected and persistent median artery was traced from origin to termination. Results: Out of 50 human cadaver specimens, persistent median artery was present in 4 specimens (8%. All the 4 median arteries originated from anterior interosseous artery and were of palmar type which reached palm. Out of 4 median arteries, 3 median arteries (6% took part in completion of superficial palmar arch, supplying the distal aspect of palm and 1 median artery (2% directly supplied radial two and half fingers without forming arch. Conclusion: Knowledge of unusual variations helps in proper treatment of disorders of the median nerve. Presence of persistent median artery usually will be asymptomatic but may cause symptoms of carpal tunnel syndrome or pronator teres syndrome when subjected to compression. Rarely this artery can be taken for reconstruction

  5. Description, reliability and validity of a novel method to measure carpal tunnel pressure in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Coppieters, Michel W; Schmid, Annina B; Kubler, Paul A; Hodges, Paul W

    2012-12-01

    Elevated carpal tunnel pressure is an important pathomechanism in carpal tunnel syndrome (CTS). Several invasive methods have been described for direct measurement of carpal tunnel pressure, but all have two important limitations. The pressure gauge requires sterilisation between uses, which makes time-efficient data collection logistically cumbersome, and more importantly, the reliability of carpal tunnel pressure measurements has not been evaluated for any of the methods in use. This technical note describes a new method to measure carpal tunnel pressure using inexpensive, disposable pressure sensors and reports the within and between session reliability of the pressure recordings in five different wrist positions and during typing and computer mouse operation. Intraclass correlation coefficients (ICC[3,1]) were calculated for recordings within one session for healthy participants (n = 7) and patients with CTS (n = 5), and for recordings between two sessions for patients with CTS (n = 5). Overall, the reliability was high. With the exception of two coefficients, the reliability of the recordings at different wrist angles varied from 0.63 to 0.99. Reliability for typing and mouse operation ranged from 0.86 to 0.99. The new method described in this report is inexpensive and reliable, and data collection can be applied more efficiently as off-site sterilisation of equipment is not required. These advances are likely to promote future research into carpal tunnel pressure, such as investigation of the therapeutic mechanisms of various conservative treatment modalities that are believed to reduce elevated carpal tunnel pressure.

  6. A clinical study on prevention of median nerve injury in endoscopic carpal tunnel release%腕管综合征内窥镜手术预防正中神经损伤的临床研究

    Institute of Scientific and Technical Information of China (English)

    姜晓琪; 陈臣; 叶作舟; 王斌; 史其林

    2011-01-01

    目的 介绍腕管综合征内窥镜手术(endoscopic carpal tunnel release,ECTR)预防正中神经损伤并发症的方法.方法 利用彩色多普勒超声仪(B超)对37例74手患者术前进行检测.结果 71例正中神经走行在桡侧腕屈肌腱与掌长肌腱之间,3例走行在掌长肌腱与尺侧腕屈肌腱之间,并术中确认.结论 正中神经变异走行在掌长肌腱与尺侧腕屈肌腱之间是ECTR的禁忌证,B超能准确定位正中神经与掌长肌腱关系,避免内窥镜手术损伤正中神经,更具有简单、经济、方便可靠等优点.%Objective To introduce a method of preventing median never injury during endoscopic carpal tunnel release (ECTR). Methods Ultrasonography of both wrists was done to 37 patients of carpal tunnel syndrome who were going to undergo open release of the transverse carpal ligament. Structures in the carpal tunnel were visualized to guide surgical decision-making. Results Ultrasonography showed that median never lies between the tendon of flexor carpi radialis and palmaris longus in 71 patients and lies between the tendon of palmaris longus and flexor carpi ulnaris in 3 patients. These findings were confirmed during the surgeries. Conclusion It is a contraindication of ECTR if median never lies between palmaris longus and flexor carpi ulnaris. Ultrasonography can accurately reveal the relative position of median never to the palmaris longus tendon. Pre-operative ultrasonography of the wrist is a simple, inexpensive and convenient method to exclude these contraindications and thus prevent median never injuries in ECTR.

  7. Area and shape changes of the carpal tunnel in response to tunnel pressure.

    Science.gov (United States)

    Li, Zong-Ming; Masters, Tamara L; Mondello, Tracy A

    2011-12-01

    Carpal tunnel mechanics is relevant to our understanding of median nerve compression in the tunnel. The compliant characteristics of the tunnel strongly influence its mechanical environment. We investigated the distensibility of the carpal tunnel in response to tunnel pressure. A custom balloon device was designed to apply controlled pressure. Tunnel cross sections were obtained using magnetic resonance imaging to derive the relationship between carpal tunnel pressure and morphological parameters at the hook of hamate. The results showed that the cross-sectional area (CSA) at the level of the hook of hamate increased, on average, by 9.2% and 14.8% at 100 and 200 mmHg, respectively. The increased CSA was attained by a shape change of the cross section, displaying increased circularity. The increase in CSA was mainly attributable to the increase of area in the carpal arch region formed by the transverse carpal ligament. The narrowing of the carpal arch width was associated with an increase in the carpal arch. We concluded that the carpal tunnel is compliant to accommodate physiological variations of the carpal tunnel pressure, and that the increase in tunnel CSA is achieved by increasing the circularity of the cross section.

  8. Carpal Tunnel Syndrome: The Risk to Educational Interpreters.

    Science.gov (United States)

    Stedt, Joe D.

    1989-01-01

    This paper describes Carpal Tunnel Syndrome and its ramifications for sign language users, in particular, educational interpreters. Discussed are the syndrome's incidence, causes, diagnostic procedures, medical and surgical interventions, and prevention guidelines. (JDD)

  9. Carpal tunnel syndrome associated with Kienböck disease

    Science.gov (United States)

    Shinohara, Takaaki; Nakamura, Ryogo; Nakao, Etsuhiro; Hirata, Hitoshi

    2016-01-01

    ABSTRACT We retrospectively reviewed 12 patients (3 men and 9 women, with a mean age of 72 years) who were surgically treated for carpal tunnel syndrome associated with Kienböck disease. All patients except 1 were incidentally diagnosed with Kienböck disease and had little or no wrist pain. Radiographic tests revealed advanced Kienböck disease in all patients. Intraoperative findings indicated that the site of maximum compression on the median nerve was located at the level of the carpal tunnel inlet in 11 patients, and the volar dislocated fragment of the lunate was located proximally adjacent to the floor of the carpal tunnel inlet. This disorder is most prevalent in elderly women, and even advanced Kienböck disease can present without wrist pain. Our findings suggest that palmar protrusion of the lunate may be the primary cause of carpal tunnel syndrome associated with Kienböck disease. PMID:27578910

  10. Description of patients with carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Aydelián Jevey González

    2015-11-01

    Full Text Available A descriptive study of patients diagnosed with carpal tunnel syndrome was carried out at “Manuel Piti Fajardo” Teaching Polyclinic of Las Tunas, from January to December, 2008. The study was aimed at describing them clinically and epidemiologically. The sample was made up of 50 patients older than 14 years old, who were characterized according to: age, sex, individual pathological antecedents factors associated to the triggering of theirsymptomatology, as well as clinical signs and symptoms. The results were processed using the descriptive statistics by means of percentage analysis. The prevailing results were: female patients, for a 76%; 41 to 50 age group, for a 40%; antecedents of osteoarthrosis, for a 34%. The factor which triggered the onset of the symptoms was the occupation of office worker, for a 46%, while 4 patients (8% came to the consultation office with more than 6 months of symptom evolution.

  11. Computer professionals and Carpal Tunnel Syndrome (CTS).

    Science.gov (United States)

    Ali, K Mohamed; Sathiyasekaran, B W C

    2006-01-01

    Carpal Tunnel Syndrome (CTS) is an important problem among computer professionals. Hence the prevalence of CTS among computer professionals and risk factors were studied. 648 subjects were selected from 4,276 computer professionals from 21 companies by with simple random sampling method. CTS was diagnosed based on clinical features. The prevalence of CTS was found to be 13.1% (95% CI 10.5-15.7%). Subjects with over 8 years of computer work, over 12 hrs of work per day and system administrators were at a higher risk for CTS (OR 3.3, 4.9 and 2.5 respectively). Flexed or extended hand position had higher risk for CTS. Higher risk for CTS was found with higher exposure to computer work. Ergonomic considerations are important in facilitating proper positioning of hand while working with a computer. Further studies on CTS risk factors among computer professionals are essential for planning prevention.

  12. Carpal tunnel syndrome - Part II (treatment,

    Directory of Open Access Journals (Sweden)

    Michel Chammas

    2014-10-01

    Full Text Available The treatments for non-deficit forms of carpal tunnel syndrome (CTS are corticoid infiltration and/or a nighttime immobilization brace. Surgical treatment, which includes sectioning the retinaculum of the flexors (retinaculotomy, is indicated in cases of resistance to conservative treatment in deficit forms or, more frequently, in acute forms. In minimally invasive techniques (endoscopy and mini-open, and even though the learning curve is longer, it seems that functional recovery occurs earlier than in the classical surgery, but with identical long-term results. The choice depends on the surgeon, patient, severity, etiology and availability of material. The results are satisfactory in close to 90% of the cases. Recovery of strength requires four to six months after regression of the pain of pillar pain type. This surgery has the reputation of being benign and has a complication rate of 0.2–0.5%.

  13. Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome.

    Science.gov (United States)

    Imai, Shinji; Kodama, Narihito; Matsusue, Yoshitaka

    2008-01-01

    Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.

  14. 改良微创术与开放手术治疗腕管综合征的疗效比较%Clinical comparative study of reforming endoscopic minimally invasive releasing versus open procedure for carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    唐哲明; 杨小辉; 首家保; 毛庆龙; 陈彬

    2011-01-01

    Objective It is to approach the feasihility and invasion of reforming endoscopic minimally invasive releasing ( REMIR ) procedure for carpal tunnel syndrome.Methods Sixty patients ( sixty sides ) with carpal tunnel syndrome were divided into REMIR group and open group randomly.REMIR group underwent minimally invasive single-cut semi-open operation by cutting the transverse carpal ligament and releasing the median nerve completely under the endoscope monitor, and open group underwent routine open surgery.Data of patients of two groups were compared.The index included operation time, blood loss,hospital stay, CRP, and two-point discrimination.Results The indexes of operation time, blood loss, hospital stay and CRP in REMIR group were decreased markedly than that in open group.Conclusion Minimally invasive single-cut semi-open operation by cutting the transverse carpal ligament and releasing the median nerve completely under the endoscope monitor is feasible and safe for the treatment of carpal tunnel syndrome with the advantages of little trauma and quick recovery.%目的 探讨改良内窥镜微创切开正中神经减压治疗腕管综合征的可行性及微创性.方法 将60例确诊的腕管综合征患者随机分为2组,治疗组利用半开放型内窥镜、推刀单切口术式切开腕管、解除正中神经压迫,对照组常规开放手术切开腕管松解减压正中神经.观察比较2组两点分辨觉、C反应蛋白量、手术时间、术中出血量及术后住院时间等指标.结果 治疗组术后C反应蛋白量、手术时间、术中出血量及术后住院时间等指标明显少于对照组(P均<0.05).结论 改良内窥镜微创切开正中神经减压术安全可行,并且具有创伤小、术后恢复快等优点.

  15. A Comparison of Hand Pain and Hand Function after Z-plasty Reconstruction of the Transverse Carpal Ligament with Traditional Median Neurolysis in Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Majid Sajjadi Saravi

    2016-04-01

    Full Text Available Background: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome.   Methods: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period.   Results: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213. But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P

  16. Invited commentary on: Flexor retinaculum division: does it contribute to the success of carpal tunnel release of Krieger Y et al. International J of Ther and Rehab, March 2011, Vol. 18, no.3, p.139-42

    NARCIS (Netherlands)

    Huisstede, Bionka; Hoogvliet, Peter

    2011-01-01

    Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Open decompression of the median nerve is considered the standard surgical treatment for CTS. This article describes a study to assess and compare the clinical efficacy of operative treatment performed by transverse carpal

  17. Liberação do canal do carpo por mini-incisão transversa Transverse mini-incision for carpal tunnel release

    Directory of Open Access Journals (Sweden)

    Marcelo de Pinho Teixeira Alves

    2011-01-01

    activities or unrestricted work. RESULTS: There was prevalence of females (87.5% in Group 1; 91.3% in Group 2 and of electromyographic bilateral syndrome in both groups (75% patients of Group 1; 86% patients of Group 2. Scar discomfort and "pillar" pain were more frequent in Group 1, but there was no difference in the time elapsed before returning to work or daily activities between the groups. CONCLUSION: The mini-incision technique is a less invasive alternative, and enables complete release of the carpal tunnel, with less morbidity than classic longitudinal incision. Level of Evidence II, Therapeutic.

  18. Magnetic resonance neurography of median neuropathies proximal to the carpal tunnel

    Energy Technology Data Exchange (ETDEWEB)

    Thawait, Gaurav K. [Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Subhawong, Ty K.; Eng, John; Carrino, John A.; Chhabra, Avneesh [Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Thawait, Shrey K. [Yale University, Bridgeport Hospital, Department of Radiology, Bridgeport, CT (United States); Andreisek, Gustav [University Hospital Zurich, Department of Radiology, Zurich (Switzerland); Belzberg, Alan J. [Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, MD (United States)

    2012-06-15

    This review provides magnetic resonance neurography (MRN) imaging appearances of median neuropathy proximal to the carpal tunnel. Carpal tunnel syndrome (CTS) and its imaging have been extensively described in the literature; however, there is a relative paucity of information on the MR imaging appearances of different pathologies of the median nerve proximal to the carpal tunnel. (orig.)

  19. Gliding resistance of flexor tendon associated with carpal tunnel pressure: a biomechanical cadaver study.

    NARCIS (Netherlands)

    Zhao, C.; Ettema, A.M.; Berglund, L.J.; An, K.N.; Amadio, P.C.

    2011-01-01

    The purpose of this study was to investigate the effect of carpal tunnel pressure on the gliding characteristics of flexor tendons within the carpal tunnel. Eight fresh human cadaver wrists and hands were used. A balloon was inserted into the carpal tunnel to elevate the pressure. The mean gliding r

  20. A vertical mouse and ergonomic mouse pads alter wrist position but do not reduce carpal tunnel pressure in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Schmid, Annina B; Kubler, Paul A; Johnston, Venerina; Coppieters, Michel W

    2015-03-01

    Non-neutral wrist positions and external pressure leading to increased carpal tunnel pressure during computer use have been associated with a heightened risk of carpal tunnel syndrome (CTS). This study investigated whether commonly used ergonomic devices reduce carpal tunnel pressure in patients with CTS. Carpal tunnel pressure was measured in twenty-one patients with CTS before, during and after a computer mouse task using a standard mouse, a vertical mouse, a gel mouse pad and a gliding palm support. Carpal tunnel pressure increased while operating a computer mouse. Although the vertical mouse significantly reduced ulnar deviation and the gel mouse pad and gliding palm support decreased wrist extension, none of the ergonomic devices reduced carpal tunnel pressure. The findings of this study do therefore not endorse a strong recommendation for or against any of the ergonomic devices commonly recommended for patients with CTS. Selection of ergonomic devices remains dependent on personal preference.

  1. Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome

    Science.gov (United States)

    2016-01-01

    Objective To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. Methods Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. Results Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). Conclusion These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US. PMID:28119835

  2. [Acute carpal tunnel syndrome in a patient with Marfan syndrome].

    Science.gov (United States)

    Franke, J; Wenzel, W; Rehfuss, D; Keiner, H P; Manncke, K

    2008-05-01

    Acute carpal tunnel syndrome (ACTS) is rare and is mostly the result of fractures of the distal radius or the carpal bones. This paper gives the first report of an ACTS following contusion of the wrist as the result of an extensive haematoma of the flexor tendon sheath, which did not appear until 50 hours after the injury was sustained but then developed rapidly. The patient suffers from Marfan syndrome. This disease is associated with pathologic changes to the major vessels, and especially the aorta, and of the smaller peripheral vessels. It is assumed that the haematoma arose from an aneurysm of such a small vessel. The treatment of choice in ACTS is emergency incision of the carpal tunnel.

  3. Carpal tunnel syndrome - electrodiagnostic aspects of fifty seven symptomatic hands.

    OpenAIRE

    1999-01-01

    Electrodiagnostic data of fifty seven symptomatic extremities with carpal tunnel syndrome (CTS) are described. Practice recommendations made by American Academy of Neurology, American Association of Electrodiagnostic Medicine and American Academy of Physical Medicine and Rehabilitation regarding electrodiagnostic studies were considered while confirming CTS diagnosis by electrodiagnostic studies. Median sensory nerve conduction studies were the commonest abnormalities noted. The median orthod...

  4. Electrophysiological studies in mild idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Girlanda, P; Quartarone, A; Sinicropi, S; Pronestì, C; Nicolosi, C; Macaione, V; Picciolo, G; Messina, C

    1998-02-01

    Many techniques have been reported to improve the diagnosis of carpal tunnel syndrome (CTS), but there is no agreement on the diagnostic yield of these different methods. We used an electrophysiological protocol including the assessment of the orthodromic sensory conduction velocity of the median nerve along the carpal tunnel, comparison of median and ulnar sensory conduction between the ring finger and wrist, short segment incremental median sensory nerve conduction across the carpal tunnel recording from the III digit ('inching test'), the study of the refractory period of transmission (RPT) and calculation of the distoproximal ratio obtained by dividing the nerve conduction velocity in the median nerve between the third digit and the palm and between the palm and wrist in 41 patients with mild CTS (75 symptomatic hands) and in 45 control subjects. The distoproximal ratio calculation was the most sensitive technique (81%), but was also the least specific. The 'inching test', even though less sensitive, had the advantage of localising focal abnormalities of the median nerve along the carpal tunnel. RPT was abnormal in patients with recent symptoms. Combining the different techniques, an overall sensitivity of 92% was reached, 11% higher than the yield of the single best test suggesting that a multimodal approach could be useful. The best procedure for electrodiagnosis of mild CTS was to combine the median/ulnar comparison test with calculation of the disto-proximal ratio.

  5. EXTRACORPOREAL SHOCKWAVE THERAPY FOR POST BURN CARPAL TUNNEL SYNDROME

    Directory of Open Access Journals (Sweden)

    Hesham Galal Mahran

    2015-04-01

    Full Text Available Background: Carpal tunnel syndrome is considered the most common compression neuropathy of the upper extremity. It may lead to work disability and functional impairment. Burns are associated with swelling and eschar which forms a tight band constricting the circulation distally. Purpose: To investigate the effect of shockwave therapy on the carpal tunnel syndrome post burn. Subjects: Thirty male and female patients selected with manifestation of carpal tunnel syndrome post burn evaluated by electromyography, patients were divided randomly into two equal groups (A & B; group (A received shockwave therapy plus traditional physical therapy, while group (B received only traditional physical therapy (heating and stretching; Shock wave therapy protocol was two sessions per week for 12 weeks. Traditional physiotherapy was applied for both groups, 20 min for session 3times per week for 12 weeks. Evaluation: Electro diagnostic evaluation was done before treatment, one and three months post treatment. Results: There were improvement and significant increase in motor and sensory conduction velocities in shockwave group compared to those in the control group (p<0.05, also there were improvement and significant decrease in motor and sensory latencies in shockwave group compared to those in control group (p<0.05. Conclusion: Extracorporeal shockwave therapy provided a non-invasive, satisfied treatment option for carpal tunnel syndrome post burn.

  6. The illusion of severe carpal tunnel syndrome (CTS).

    Science.gov (United States)

    Gutmann, Ludwig; Nance, Christopher

    2010-02-01

    Thenar atrophy occurs in patients with severe carpal tunnel syndrome (CTS) of long-standing duration. In this report we present a young woman with mild bilateral CTS, based on electrophysiological studies, in whom marked thenar atrophy was on a congenital basis related to the VATER association (vertebral anomalies, anal atresia, tracheoesophageal fistula, and radial or renal abnormalities).

  7. Prevalence of Carpal Tunnel Syndrome among Individuals with Down Syndrome.

    Science.gov (United States)

    Christensen, Jens Erik Just; Peter, Peter Johannsen; Nielsen, Viggo Kamp; Mai, Jesper

    1998-01-01

    Forty-eight patients with Down syndrome were examined clinically and electrophysiologically for occurrence of carpal tunnel syndrome. Twenty-seven patients had normal findings, 13 had prolonged distal motor latency and reduced distal nerve conduction velocity, and 8 patients had one of these signs. Results show that prevalence of…

  8. [Carpal tunnel syndrome, amyloid tenosynovitis and periodic hemodialysis].

    Science.gov (United States)

    Clanet, M; Mansat, M; Durroux, R; Testut, M F; Guiraud, B; Rascol, A; Conte, J

    1981-01-01

    Since 1975, various entrapment neuropathies have been reported in patients undergoing periodic haemodialysis, the most frequent being the carpal tunnel syndrome. Ten patients on chronic haemodialysis developing 15 carpal tunnel syndromes (5 unilateral and 5 bilateral) are reported. Various causes for the renal failure were present and clinical signs of the carpal tunnel syndrome developed at a late stage. The arteriovenous fistula required for extrarenal epuration was antebrachial and of the laterolateral type, except in one case when it was lateroterminal. The carpal tunnel syndrome was always on the same side as the fistula, developing at a later stage on th contralateral side in the 5 cases of bilateral disorders. Lesions were severe, in 11 of the 15 cases. Some patients noted fluctuations in pain symptoms during haemodialysis, either improving or becoming worse. Gross pathological findings during operation (13 cases) were tenosynovitis with epineural hypervascularisation on the opposite side. In 9 cases, however, atypical hypertrophic tenosynovitis was observed. Histological examination in 12 cases demonstrated typical tenosynovitis in 3 patients, but granulomatous tenosynovitis with amyloid deposits was reported in 9 patients. Lesions were bilateral in 2 cases thus present, on the side opposite to the fistula. Ultrastructural study confirmed the amyloid nature of the deposits in 3 cases, the microfibrillary appearance (80 to 100 A) being characteristic of amyloid substance. This rare complication does not represent a common carpal tunnel syndrome, and three mechanisms may be involved in its induction : peripheral uraemic neuropathy, haemodynamic modifications resulting from the antebrachial arteriovenous shunt, and amyloid formation in the flexor synovial sheaths. In the latter case, the type of amyloid disease may be a primary systemic amyloidosis not previously detected, or an elective amyloid process localised to the tenosynovial and periarticular tissues.

  9. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

    Institute of Scientific and Technical Information of China (English)

    Radwa Mahmoud Azmy; Amira Ahmed Labib; Saly Hassan Elkholy

    2013-01-01

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4th and 5th fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve.

  10. Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers

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    Adham do Amaral e Castro

    2015-10-01

    Full Text Available AbstractObjective:To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations.Materials and Methods:Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome.Results:Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001, paresthesia (p < 0.0001, Tinel's test (p < 0.0001, Phalen's test (p< 0.0001, BCTQ score (p < 0.0001, and years of formal education (p < 0.0001. Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24.Conclusion:The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.

  11. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

    Science.gov (United States)

    Azmy, Radwa Mahmoud; Labib, Amira Ahmed; Elkholy, Saly Hassan

    2013-05-25

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4(th) and 5(th) fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4(th) and 5(th) fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4(th) and 5(th) fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve.

  12. Carpal tunnel and transverse carpal ligament stiffness with changes in wrist posture and indenter size.

    Science.gov (United States)

    Holmes, Michael W R; Howarth, Samuel J; Callaghan, Jack P; Keir, Peter J

    2011-11-01

    This study investigated the effects of loading and posture on mechanical properties of the transverse carpal ligament (TCL). Ten fresh-frozen cadaver arms were dissected to expose the TCL and positioned in the load frame of a servo-hydraulic testing machine, equipped with a load cell and custom made indenters. Four cylindrical indenters (5, 10, 20, and 35 mm) loaded the TCL in three wrist postures (30° extension, neutral and 30° flexion). Three loading cycles with a peak force of 50 N were applied at 5 N/s for each condition. The flexed wrist posture had significantly greater TCL stiffness (40.0 ± 3.3 N/mm) than the neutral (35.9 ± 3.5 N/mm, p = 0.045) and extended postures (34.9 ± 2.8 N/mm, p = 0.025). TCL stiffness using the 10 and 20 mm indenters was larger than the 5 mm indenter. Stiffness was greatest with the 20 mm indenter, which had the greatest indenter contact area on the TCL. The 35 mm indenter covered the carpal bones, compressed the carpal tunnel and produced the lowest stiffness. The complexity of the TCL makes it an important part of the carpal tunnel and the mechanical properties found are essential to understanding mechanisms of carpal tunnel syndrome. 

  13. Transverse Plane Tendon and Median Nerve Motion in the Carpal Tunnel : Ultrasound Comparison of Carpal Tunnel Syndrome Patients and Healthy Volunteers

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Henderson, Jacqueline; van der Molen, Aebele B. Mink; An, Kai-Nan; Amadio, Peter C.

    2012-01-01

    Background: The median nerve and flexor tendons are known to translate transversely in the carpal tunnel. The purpose of this study was to investigate these motions in differential finger motion using ultrasound, and to compare them in healthy people and carpal tunnel syndrome patients. Methods: Tra

  14. Endoscopic vs.Open Carpal Tunnel Release: Meta-analysis%内镜下腕管松解术与常规腕管切开松解术治疗腕管综合征的Meta分析

    Institute of Scientific and Technical Information of China (English)

    熊小龙; 余斌; 崔壮; 张凯瑞; 戴海飞; 陈志刚

    2011-01-01

    目的 对内镜下腕管松解术(endoscopic carpal tunnel release,ECTR)和常规腕管切开松解术(open carpal tunnel release,OCTR)治疗腕管综合征的疗效进行系统评价.方法 按照Cohrane系统评价的方法,计算机检索MEDLINE(1966年~2010年3月)、EMBASE(1966年~2010年3月)、Cochrane图书馆(2010年1月)及中国生物医学文献数据库(1979年~2009年12月),并手工检索相关的中英文骨科杂志.收集所有相关的随机对照试验,并评价纳入研究的方法学质量,采用Cochrane协作网提供的软件Revman4.2.2进行Meta分析,以获得ECTR与OCTR治疗腕管综合征的疗效及其安全性是否有差异的相关证据.结果 共纳入8个随机对照试验进行评价,Meta分析显示,ECTR组与OCTR组的术后并发症发生率、主观满意率、手术时间及术后手握力和捏力功能恢复差异无统计学意义(P>0.05);ECTR组术后疼痛发生率和恢复工作时间显著低于OCTR组(P<0.05).结论 与OCTR相比,ECTR可降低腕管综合征的术后疼痛发生率,缩短恢复工作时间;2种手术方式术后并发症发生率、主观满意度、手术时间、术后握力与捏力无统计学差异.因研究质量及样本的局限性,2种手术方法与手术时间和手功能的关系有待于进一步研究.%Objective To compare the efficacy and safety of endoscopic carpal tunnel release with open surgery for carpal tunnel syndrome. Methods Based on Cochrane Systematic Review, we searched through the MEDLINE, EMBASE, Cochrane Library and CBM disc, and relevant Chinese and English orthopedic journals by hand, and then collected all the randomized control trials (RCTs) that related to carpal tunnel syndrome. The quality of trials was critically assessed. The Revman4.2.2 that provided by Cochrane Collaboration were used for data management and analysis on the evidence of the difference in the efficacy and safety of endoscopic versus open carpal tunnel ( ECTR vs. OCTR) release. Results

  15. Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve relfect carpal tunnel syndrome severity?

    Institute of Scientific and Technical Information of China (English)

    Li Zhang; Aierken Rehemutula; Feng Peng; Cong Yu; Tian-bin Wang; Lin Chen

    2015-01-01

    Although ultrasound measurements have been used in previous studies on carpal tunnel syn-drome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately relfects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 pa-tients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Signiifcant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-section-al areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% speciifcity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% speciifcity. These results suggest that the inlet-to-outlet ratio relfected the severity of carpal tunnel syndrome.

  16. Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

    Directory of Open Access Journals (Sweden)

    Li Zhang

    2015-01-01

    Full Text Available Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5-17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe (moderate and severe carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

  17. Anatomia patológica da sinóvia de pacientes submetidos à liberação do túnel do carpo Pathological study of the synovial tissue of patients who underwent open carpal tunnel release

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    Pedro José Pires Neto

    2010-01-01

    Full Text Available OBJETIVO: Verificar se a biópsia da sinóvia do túnel do carpo é capaz de identificar patologias sistêmicas que não foram diagnosticadas clinicamente ou por exames laboratoriais. MÉTODO: 46 exames anatomopatológicos da sinóvia dos tendões flexores no túnel do carpo de pacientes submetidos à liberação aberta para o tratamento desta síndrome compressiva foram, retrospectivamente, analisados. Os autores propuseram uma nova classificação para a lesão de acordo com a intensidade do processo inflamatório. RESULTADOS: O exame anatomopatológico mostrou que 56,6% das lâminas foram classificadas como grau I (sem alterações inflamatórias, 32,6%, grau II (infiltrado leucocitário e fibrose discretos, além de hialinose, 4,3%, grau III (infiltrado leucocitário e fibrose intensos, presença de fibrina e neoformação vascular e 6,5%, grau IV (as alterações acima descritas associadas à presença de calcificação local e células gigantes. Dois pacientes com amiloidose foram classificados como graus I e II e não foram encontrados depósitos de material amilóide em suas lâminas. Dois pacientes portadores de hiperparatireoidismo e outro com insuficiência renal crônica foram classificados como grau IV. CONCLUSÃO: A realização da biópsia da sinóvia do túnel do carpo, além de agregar custos adicionais ao procedimento, não possibilitou o diagnóstico precoce de doenças sistêmicas em pacientes portadores de síndrome do túnel do carpo.OBJECTIVE: To determine whether a biopsy of the synovia of the carpal tunnel is able to identify systemic diseases that were not diagnosed by clinical examination and laboratory tests. METHODS: Anatomical pathology P examinations of synovial tissue were performed in 46 patients that underwent open carpal tunnel release. Anatomical pathology examination with hematoxylin-eosin staining determined the intensity of the inflammatory process and the authors proposed a new classification of the injury

  18. Carpal tunnel syndrome caused by a giant cell tumour of the flexor tendon sheath.

    Science.gov (United States)

    Meek, Marcel F; Sheikh, Zahid A; Quinton, David N

    2014-02-01

    A 76-year-old woman developed right carpal tunnel syndrome after being conservatively treated for tenosynovitis of the flexor tendons with associated mild carpal tunnel syndrome. A magnetic resonance imaging scan showed a tumour in the carpal tunnel. Re-exploration showed that the median nerve was being compressed by a giant cell tumour of the flexor tendon sheaths. Appropriate imaging is advised in patients with additional findings (such as swelling) or in patients with secondary carpal tunnel syndrome and incomplete response to conservative treatment, to exclude a space-occupying lesion.

  19. Electrophysiological evaluation of ulnar nerve in carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    刘娜

    2014-01-01

    Objective To evaluate the impairment of ulnar nerve and its relationship with sensory symptoms in the ulnar territory in patients with carpal tunnel syndrome(CTS)through electrophysiological approach.Methods We retrospectively reviewed 55 cases with CTS admitted in our hospital from January 2012 to February 2013.Patients with CTS were graded as mild-moderate(35 cases)andsevere(20 cases)according to Stevens standard and were divided into symptomatic and non-symptomatic group according

  20. Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome

    Science.gov (United States)

    Ott, Florian; Mattiassich, Georg; Kaulfersch, Christian; Ortmaier, Reinhold

    2013-01-01

    A patient was admitted reporting tingling pain and numbness in the right hand. Neurological examination—including nerve conduction studies—diagnosed carpal tunnel syndrome. Operative carpal tunnel release was performed without complications. Four months postoperatively the otherwise healthy patient presented again due to persistent complaints, although preoperative symptoms had improved. On this occasion, the patient reported loss of strength accompanied by rigidity in the wrist. Clinical examination showed some swelling adjacent to the operation wound. A postoperative ganglion cyst was suspected and a conservative treatment option—splinting the wrist—was chosen. Four weeks later the patient presented again with further swelling and increasing rigidity of the wrist. Surgical intervention was planned. Preoperative plain radiographs of the wrist revealed chronic palmar dislocation of the lunate to be the cause of the symptoms in our patient. Radiological signs of scapholunate advanced collapse arthritis (SLAC wrist) were also observed. PMID:23513027

  1. CARPAL TUNNEL SYNDROME PADA PEKERJA GARMEN DI JAKARTA

    Directory of Open Access Journals (Sweden)

    Lusianawaty Tana

    2012-10-01

    Full Text Available Carpal tunnel syndrome (CTS is a disorder caused by medianus nerve entrapment in carpal tunnel in the wrist and gives many symptoms as painfully, numbness, hyperesthesia at nerve medianus area. The objective of this study was to asses CTS in garment factory workers and determine the prevalence of CTS, CTS relation to age, sex, workhour, and repeated biomechanical pressure in hand/wrist. A cross sectional design was used in the study conducted in Jakarta in 2002, to 814 person sample with simple random sampling method. Data collection was done through interviews, inspections, and examinations. The study found that prevalence of CTS was 20.3% (n= 814 in work unit. Workers who worked with high repeated biomechanical pressure in right hand/wrist was 74.1%, in left hand/wrist were 65.5%. Carpal tunnel syndrome in female higher than CTS in male (p=0.04. There was 110 significant correlation between increased of age, workhour, repeated biomechanical pressure in hand/wrist and increased of CTS. For confirmation 10% cases CTS were examined by electroneurography and electromyography, and found that CTS was 35,3%.

  2. Median nerve deformation in differential finger motions : Ultrasonographic comparison of carpal tunnel syndrome patients and healthy controls

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Henderson, Jacqueline; Yoshii, Yuichi; van der Molen, Aebele B. Mink; Cha, Stephen S.; An, Kai-Nan; Amadio, Peter C.

    2012-01-01

    We investigated the median nerve deformation in the carpal tunnel in patients with carpal tunnel syndrome and controls during thumb, index finger, middle finger, and a four finger motion, using ultrasound. Both wrists of 29 asymptomatic volunteers and 29 patients with idiopathic carpal tunnel syndro

  3. Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit.

    Science.gov (United States)

    Kim, J H; Gong, H S; Lee, H J; Lee, Y H; Rhee, S H; Baek, G H

    2013-01-01

    We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

  4. Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: evidence of central processing in unilateral neuropathy.

    Science.gov (United States)

    Fernández-de-las-Peñas, César; de la Llave-Rincón, Ana Isabel; Fernández-Carnero, Josué; Cuadrado, María Luz; Arendt-Nielsen, Lars; Pareja, Juan A

    2009-06-01

    The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22-60 years), and 20 healthy matched females (aged 21-60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5-C6 zygapophyseal joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome.

  5. Occurrence of myofascial pain in patients with possible carpal tunnel syndrome - a single-blinded study

    DEFF Research Database (Denmark)

    Qerama, Erisela; Kasch, Helge; Fuglsang-Frederiksen, Anders

    2009-01-01

    There exits some similarity between symptoms of carpal tunnel syndrome (CTS) and myofascial pain related to trigger points (TPs) in the infraspinatus muscle.......There exits some similarity between symptoms of carpal tunnel syndrome (CTS) and myofascial pain related to trigger points (TPs) in the infraspinatus muscle....

  6. Supracubital perineurioma misdiagnosed as carpal tunnel syndrome: case report

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    Schols Ludger

    2004-11-01

    Full Text Available Abstract Background Perineuriomas have been defined as tumorous lesions of the peripheral nerves which derive from perineurial cell proliferation and may be associated with abnormalities on chromosome 22. Case presentation Three years after a painful cubital vein procaine injection, a 33 year-old man developed a median nerve lesion, initially diagnosed as carpal tunnel syndrome. Symptoms progressed despite appropriate surgery. Clinical and electrophysiological re-evaluation revealed a fusiform mass at the distal upper arm, confirmed by MRI. Immunohistochemical studies classified the tumor as a mixed perineurioma and neuroma. Conclusions Perineurioma mixed with neuroma may potentially caused by the previous trauma or cytotoxic effects of procaine.

  7. Effect of metabolic syndrome on the outcome of corticosteroid injection for carpal tunnel syndrome.

    Science.gov (United States)

    Roh, Y H; Lee, B K; Baek, J R; Park, M H; Noh, J H; Gong, H S; Baek, G H

    2016-11-01

    Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome.

  8. Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

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    Teona Sebe Ioana

    2015-11-01

    Full Text Available Dupuytren’s contracture is a fibroproliferative disease whose etiology and pathophysiology are unclear and controversial. It is a connective tissue disorder, which takes part in the palmar’s fibromatosis category and has common characteristics with the healing process. Dupuytren’s disease is characterized by the flexion contracture of the hand due to palmar and digital aponevrosis. It generally affects the 4th digital radius, followed by the 5th one. Without surgery, it leads to functional impotence of those digital rays and/or hand. It is associated with other diseases and situational conditions like Peyronie’s disease, the Lederhose disease (plantar fibromatosis, Garrod’s digital knuckle-pads, diabetes, epilepsy, alcoholism, micro traumatisms, stenosing tenosynovitis and not the least with carpal tunnel syndrome. The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve. Postoperative recovery in both diseases is crucial to the functionality of the affected upper limb and to the quality of the patient’s life. The patient, a 61 years old man, admitted to the clinic for the functional impotence of the right hand, for the permanent flexion contracture of the metacarpophalangeal joint (MCP and proximal interphalangeal joint (PIP of the 4th finger with extension deficit, for the damage of the thumb pulp clamp of the 4th finger, for nocturnal paresthesia of fingers I-III and pain that radiates into the fingertips. After clinical, paraclinical, imagistic and electrical investigations, surgery is practiced partial aponevrectomy

  9. A persisting median artery in a patient with symbrachydactyly and carpal tunnel syndrome.

    Science.gov (United States)

    Tollan, C J; Sivarajan, V

    2008-07-01

    A persisting median artery associated with carpal tunnel syndrome in a patient with symbrachydactyly has not been previously described in the literature. It is unclear whether there may be a developmental association between persistence of a median artery and Symbrachydactyly.

  10. Acute calcifying tendonitis--an unusual cause of carpal tunnel syndrome.

    Science.gov (United States)

    Din, R; Giannikas, K; El-Hadidi, M

    2001-03-01

    We report a rare case of acute calcifying tendinitis resulting in acute carpal tunnel syndrome. Acute medical staff should be aware of this condition and the importance of early referral to avoid long term median nerve neuropathy.

  11. Clinical study on treatment of Carpal tunnel syndrome using Scolopendrid herbal acupuncture

    Directory of Open Access Journals (Sweden)

    Lim Jeong a

    2005-02-01

    Full Text Available Objective : This study is performed for the purpose of examining into the efficacy of the scolopendrid herbal acupucture which has been used among the Korean people for the Carpal tunnel syndrome. Methods : 40 carpal tunnel syndrome patients who visited Won-kwang University Hospital during the period from January 1998 to December 2004 were analysed for clinical manifestations. After we divided patients into two classes at random, we treated them with scolopendrid herbal acupucture or not. Treatment efficiency was monitored through VAS(Visual Analog Scale and clinical symptom. Conclusion : We brought to the conclusion that the scolopendrid herbal acupucture has possibility to be efficient to cure the carpal tunnel syndrome patients. So we suggest the possibility to use this new remedy for the carpal tunnel syndrome.

  12. Lumbrical and interossei recording in carpal tunnel syndrome.

    Science.gov (United States)

    Preston, D C; Logigian, E L

    1992-11-01

    Median motor studies are commonly "normal" in mild carpal tunnel syndrome (CTS). This reflects either the sparing of motor compared to sensory fibers, or the inability of conventional studies to detect an abnormality. A novel approach to demonstrate early motor fiber involvement in CTS is the placement of the same active electrode lateral to the third metacarpal, allowing recording from the second lumbrical or the deeper interossei, when stimulating the median or ulnar nerves at the wrist, respectively. We compared the difference between these latencies in 51 normal control hands to 107 consecutive patient hands referred with symptoms and signs suggestive of CTS, who were subsequently proven to have electrophysiologic CTS by standard nerve conduction criteria. A prolonged lumbrical-interossei latency difference (> 0.4 ms) was found to be a sensitive indicator of CTS in all patient groups. It was also helpful in patients with coexistent polyneuropathy, where localization at the wrist was otherwise difficult.

  13. Carpal tunnel syndrome - electrodiagnostic aspects of fifty seven symptomatic hands.

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    Murthy J

    1999-10-01

    Full Text Available Electrodiagnostic data of fifty seven symptomatic extremities with carpal tunnel syndrome (CTS are described. Practice recommendations made by American Academy of Neurology, American Association of Electrodiagnostic Medicine and American Academy of Physical Medicine and Rehabilitation regarding electrodiagnostic studies were considered while confirming CTS diagnosis by electrodiagnostic studies. Median sensory nerve conduction studies were the commonest abnormalities noted. The median orthodromic sensory latencies were prolonged in 86% and sensory nerve action potential amplitude abnormalities were seen in 82%. Prolongation of the conduction in the short segment across the wrist in the median nerve was seen in 96.5% and the difference in the conduction between median and ulnar nerve across the wrist was significant in all the 57 extremities. The median motor latencies were prolonged in 67% of hands. Higher incidence of electrodiagnostic abnormalities observed in this study might be due to inclusion of patients with severe disease.

  14. Pyridoxine hydrochloride treatment of carpal tunnel syndrome: a review.

    Science.gov (United States)

    Aufiero, Elaine; Stitik, Todd P; Foye, Patrick M; Chen, Boqing

    2004-03-01

    It has been hypothesized that idiopathic carpal tunnel syndrome (CTS) is a manifestation of vitamin B6 deficiency. Some claim that B6 supplementation can alleviate symptoms. Others argue that pain relief occurs because of vitamin B6's anti-nociceptive properties or because B6 supplementation addresses an unrecognized peripheral neuropathy. Few studies on CTS and B6 employed electrodiagnostic techniques in diagnosis, and few showed a correlation between symptoms and improved electrodiagnostic parameters with supplementation. Other studies failed to measure or estimate B6 levels. Nevertheless, it appears reasonable to recommend vitamin B6 supplementation to people with CTS. Some patients will improve symptomatically with low risks of toxicity in recommended doses.

  15. Practical approach to electrodiagnosis of the carpal tunnel syndrome: A review

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    Keivan Basiri

    2015-01-01

    Full Text Available Despite being the most common entrapment neuropathy and the most common reason for referral to the electromyography (EMG laboratory, the diagnosis of carpal tunnel syndrome (CTS continues to be challenging due to a large number of electrodiagnostic (EDX tests available. We present a flowchart and propose a practical approach to the diagnosis of CTS using the available literature and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM guidelines and the Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome.

  16. Microsurgical open mini uniskin incision technique in the surgical treatment of carpal tunnel syndrome

    OpenAIRE

    Keramettin Aydin; Cengiz Cokluk; Nilgun Cengiz; Ayhan Bilgici

    2006-01-01

    Background: Patients who undergo carpal tunnel surgery sometimes complain of the restriction of the grip and pinch function, palmar tenderness, cosmetic problems, and scar formation at the site of the incision. Aims: We used a modified mini uni-skin incision with appropriate hand position for microscopic view in the surgical treatment of carpal tunnel syndrome to prevent cosmetic problems related with scar formation after surgery. Settings and Design: In this study we used two different ...

  17. Practical approach to electrodiagnosis of the carpal tunnel syndrome: A review.

    Science.gov (United States)

    Basiri, Keivan; Katirji, Bashar

    2015-01-01

    Despite being the most common entrapment neuropathy and the most common reason for referral to the electromyography (EMG) laboratory, the diagnosis of carpal tunnel syndrome (CTS) continues to be challenging due to a large number of electrodiagnostic (EDX) tests available. We present a flowchart and propose a practical approach to the diagnosis of CTS using the available literature and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and the Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome.

  18. Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

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    Michael Alexander Malahias

    2015-01-01

    Full Text Available Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

  19. RESEARCH PROGRESS OF TREATMENT OF CARPAL TUNNEL SYNDROME%腕管综合征治疗研究进展

    Institute of Scientific and Technical Information of China (English)

    冯仕明; 高顺红

    2011-01-01

    Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent literature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist splinting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more clinical researches, and surgical treatment is one method recommended by some scholars.%目的 对腕管综合征(carpal tunnel syndrome,CTS)的治疗研究现状作一综述.方法 查阅近年来国内外CTS治疗的相关文献,进行分析总结.结果 腕夹板、类固醇适用于轻、中度CTS患者,近期效果显著;治疗后复发的CTS患者需采取手术治疗.主要术式为腕管松解术,包括腕管切开松解减压术(传统型和小切口型)、内镜下腕管松解减压术等.结论 CTS的最佳治疗方法 尚无定论,部分学者推荐首选手术治疗.

  20. Correlation of segmental carpal tunnel pressures with changes in hand and wrist positions in patients with carpal tunnel syndrome and controls.

    Science.gov (United States)

    Luchetti, R; Schoenhuber, R; Nathan, P

    1998-10-01

    We investigated pressures at 1 cm intervals along the carpal tunnel in 39 patients with carpal tunnel syndrome (CTS) and 12 controls. Pressures were measured for relaxed and gripping hand positions in combination with neutral, extended, and flexed wrist positions. Patient pressures exceeded control pressures, were below the previously reported 30 mmHg threshold for four of five locations in the relaxed neutral position and were typically greater in extension than in flexion. In the neutral position, both patient and control pressures were slightly above threshold levels just distal to the tunnel. Maximum intratunnel pressures were generally found in the central part of the tunnel and minimum pressures in the distal tunnel. Gripping hand pressures in the tunnel were lowest with the wrist flexed. In both controls and CTS patients, only in the neutral wrist and relaxed hand positions were pressures highest at the point where nerve conduction studies have indicated the nerve is most likely to be compromised (in the midpalm just distal to the distal margin of the carpal tunnel).

  1. COMPARATIVE EFFECT OF CARPAL BONE MOBILIZATION VERSUS NEURAL MOBILIZATION IN IMPROVING PAIN, FUNCTIONAL STATUS AND SYMPTOMS SEVERITY IN PATIENTS WITH CARPAL TUNNEL SYNDROME

    Directory of Open Access Journals (Sweden)

    Vikranth .G .R

    2015-06-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a constellation of symptoms associated with compression of the median nerve at the wrist in carpal tunnel. The Purpose of this study is to find the comparative effective of carpal bone mobilization and neural mobilization in improving pain, Functional Status and Symptom Severity in patients with CTS. Method: An experimental study design, 30 subjects with carpal tunnel syndrome were randomized into 2 groups with 15 subjects each in Group A and Group B. Subjects in Group A received carpal bone mobilization and subjects in Group B received median nerve mobilization. The duration of intervention was for two weeks. Outcome measurements such as pain using VAS, The Functional Status Score (FSS and Symptom Severity Score (SSS using the Boston’s questionnaire for CTS were measured before and after two weeks of intervention. Results: Analysis using paired ‘t’ test found that there is a statistically significant improvement (p<0.05 in pain, Functional Status score and Symptom Severity score within the groups. Comparative analysis using independent ‘t’ test found that there is no statistically significant difference in improving pain, Functional Status score and Symptom Severity score between both the groups. Conclusion: It is concluded that median nerve mobilization and carpal bone mobilization shown to be effective on improving pain, Functional Status and Symptom Severity in the treatment of patients presenting with carpal tunnel syndrome. However there is no significant difference in improvements obtained between the neural mobilization and carpal bone mobilisation.

  2. Median nerve cross-sectional area and MRI diffusion characteristics: normative values at the carpal tunnel

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    Yao, Lawrence; Gai, Neville [Clinical Center, Radiology and Imaging Sciences, Bethesda, MD (United States)

    2009-04-15

    Enlargement of the median nerve is an objective potential imaging sign of carpal tunnel syndrome. Diffusion tensor MRI (DTI) may provide additional structural information that may prove useful in characterizing median neuropathy. This study further examines normal values for median nerve cross-sectional area (CSA), apparent diffusion coefficient (ADC), and fractional anisotropy (FA). Twenty-three wrists in 17 healthy volunteers underwent MRI of the wrist at 3 T. In 13 subjects, DTI was performed at a B value of 600 mm{sup 2}/s. Median nerve CSA, ADC, and FA were analyzed at standardized anatomic levels. Mean (SD) median nerve CSA within the proximal carpal tunnel was 10.0 (3.4) mm{sup 2}. The mean (SD) FA of the median nerve was 0.71 (0.06) and 0.70 (0.13) proximal to and within the carpal tunnel, respectively. There was a significant difference between nerve CSA and ADC, but not FA, at the distal forearm and proximal carpal tunnel. Nerve CSA, ADC, and FA did not differ between men and women or between dominant and non-dominant wrists. Nerve CSA at the proximal carpal tunnel was positively correlated with subject age and body mass index. Our results suggest a 90% upper confidence limit for normal median nerve CSA of 14.4 mm{sup 2} at the proximal carpal tunnel, higher than normal limits reported by many ultrasound studies. We observed a difference between the CSA and ADC, but not the FA, of the median nerve at the distal forearm and proximal carpal tunnel levels. (orig.)

  3. Effectiveness of low-level laser on carpal tunnel syndrome

    Science.gov (United States)

    Li, Zhi-Jun; Wang, Yao; Zhang, Hua-Feng; Ma, Xin-Long; Tian, Peng; Huang, Yuting

    2016-01-01

    Abstract Background: Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review. Methods: We conducted electronic searches of PubMed (1966–2015.10), Medline (1966–2015.10), Embase (1980–2015.10), and ScienceDirect (1985–2015.10), using the terms “carpal tunnel syndrome” and “laser” according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes. Results: Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MD = 2.04; 95% CI: 0.08–3.99; P = 0.04; I2 = 62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MD = 0.97; 95% CI: 0.84–1.11; P 95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups. Conclusion: This study revealed that low-level laser improve hand grip, VAS, and SNAP after 3 months of follow-up for mild to moderate CTS. More high-quality studies using the same laser intervention protocol are needed to

  4. Transverse plane tendon and median nerve motion in the carpal tunnel: ultrasound comparison of carpal tunnel syndrome patients and healthy volunteers.

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    Margriet H M van Doesburg

    Full Text Available BACKGROUND: The median nerve and flexor tendons are known to translate transversely in the carpal tunnel. The purpose of this study was to investigate these motions in differential finger motion using ultrasound, and to compare them in healthy people and carpal tunnel syndrome patients. METHODS: Transverse ultrasounds clips were taken during fist, index finger, middle finger and thumb flexion in 29 healthy normal subjects and 29 CTS patients. Displacement in palmar-dorsal and radial-ulnar direction was calculated using Analyze software. Additionally, the distance between the median nerve and the tendons was calculated. RESULTS: We found a changed motion pattern of the median nerve in middle finger, index finger and thumb motion between normal subjects and CTS patients (p<0.05. Also, we found a changed motion direction in CTS patients of the FDS III tendon in fist and middle finger motion, and of the FDS II and flexor pollicis longus tendon in index finger and thumb motion, respectively (p<0.05. The distance between the median nerve and the FDS II or FPL tendon is significantly greater in patients than in healthy volunteers for index finger and thumb motion, respectively (p<0.05. CONCLUSION: Our results suggest a changed motion pattern of the median nerve and several tendons in carpal tunnel syndrome patients compared to normal subjects. Such motion patterns may be useful in distinguishing affected from unaffected individuals, and in studies of the pathomechanics of carpal tunnel syndrome.

  5. Characteristics of the electrophysiological activity of muscles attached to the transverse carpal ligament in carpal tunnel syndrome.

    Science.gov (United States)

    Horiguchi, Gen; Aoki, Takafumi; Ito, Hiromoto

    2011-01-01

    The main cause of carpal tunnel syndrome (CTS) remains unknown. Stiffness of the subcutaneous area of the volar aspect of the carpal tunnel is present in many patients and suggests that the stiffness of muscles attached to the transverse carpal ligament is increased. We performed an electrophysiological study to investigate muscle activities and to clarify whether the stiffness of muscles attached to the transverse carpal ligament is involved in the pathogenesis of CTS. The subjects of this study included 16 patients with early CTS showing no motor dysfunction. Both thenar muscles (opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis) and hypothenar muscles (opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis) were investigated. Surface electrodes were placed on each muscle, and maximum voluntary contractions with the thumb and little finger in opposition were maintained for 3 seconds in all patients and in 7 control subjects. Electromyographs were subjected to fast Fourier transform analysis, and the root mean square (RMS) and the mean power frequency (MPF) were determined for each muscle. The RMS of the opponens pollicis was significantly less in hands affected by CTS (292.8 µV) than in healthy hands (405.9 µV). The RMS did not differ between affected hands and healthy hands for the other 2 thenar muscles but did differ significantly for the hypothenar muscles. The MPF did not differ between affected hands and healthy hands for any muscle. The results show that electrophysiological differences are present among muscles innervated by the median nerve and that hypothenar muscles originally unrelated to median nerve dysfunction are also affected in early CTS. These results suggest that modulation of muscles attached to the transverse carpal ligament is involved in the pathogenesis of CTS.

  6. Ulnar nerve entrapment at wrist associated with carpal tunnel syndrome.

    Science.gov (United States)

    Gozke, E; Dortcan, N; Kocer, A; Cetinkaya, M; Akyuz, G; Us, O

    2003-11-01

    In this study, ulnar nerve entrapments at the wrist were investigated using nerve conduction studies in cases with established diagnosis of carpal tunnel syndrome (CTS). Cases with cervical radiculopathy and polyneuropathy as well as patients with ulnar nerve entrapment at elbow were excluded from the study. Fifty-three cases (46 females, seven males) whose ages ranged between 20 and 72 years (mean: 49.31 +/- 13.78) were evaluated. Among 53 cases, 12 (22.6%) bilateral and 41 (77.3%) unilateral CTS were detected. Totally 65 wrists evaluated and prolongation of median nerve wrist-3rd digit distal sensory latencies (DSL; N: 59; 90.7%) and wrist-abductor pollicis brevis distal motor latencies (N: 48; 73.8%) were seen. In six wrists, diagnoses were established with the detection of an increase in the differences between wrist-4th digit DSL of median and ulnar nerve. This test was used if other test results were in normal limits. Prolongation of ulnar nerve wrist-5th digit DSL were found in 12 wrists (18.4%) in cases with CTS. Among these 12 wrists mild (N: 2), moderate (N: 7) and severe (N: 3) CTS were detected. Ulnar nerve motor conduction studies provided normal results. In conclusion, we are in the opinion that for the detection of associated ulnar nerve wrist entrapments, ulnar nerve conduction studies paying special attention to DSL convey importance in established cases with CTS.

  7. Concoradance of clinical and neurophysiologic diagnoses of carpal tunnel syndrome

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    Martić Vesna

    2015-01-01

    Full Text Available Introduction/Aim. Clinical presentation and neurophysiological examination are crucial in diagnosing carpal tunnel syndrome (CTS. The aim of this study was to determine sensitivity and specificity of clinical examination for diagnosing of CTS in relation to neurophysiological evaluation. Methods. The sample included 181 patients referred to the neurologist for further diagnosis of pain and parestesias in the arm (81 women and 100 men mean age 42 ± 14 years and 52 ± 16 years, respectively. All the patients were neurophysiologicly tested. Results. Out of 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiological findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0,51; specificity 0,95. Conclusion. Low sensitivity and high specificity suggest that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is the need for neurophysiological evaluation of patients with complains in the arm.

  8. The prevalence and severity of carpal tunnel syndrome during pregnancy

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    Saeid Khosrawi

    2012-01-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is the most common compression neuropathy of median nerve, which can occur or aggravate during pregnancy and sometimes needs surgery. Since early diagnosis leads to simpler and less risky treatments, this study evaluated the frequency and severity of CTS in pregnancy. Materials and Methods: In this descriptive cross-sectional study, 100 pregnant women who came to gynecology clinic of university hospitals were randomly selected. At first, they were asked for presence of clinical symptoms, and then clinical tests including Phalen and Tinel were conducted to diagnose CTS. Then, electrodiagnostic studies including sensory and motor distal latencies of median nerve were measured and compared with those of ulnar nerve, and then, nerve conduction velocity of median nerve across wrist was evaluated. Results: Among the studied pregnant women, 19% had CTS, out of whom 47.5% were bilateral and 26.3% had severe CTS. The prevalence in the first, second, and third trimesters were 11%, 26%, and 63%, respectively, and 42% were asymptomatic. Sensitivity and specificity of clinical signs as compared with electrodiagnostic findings were 52% and 23%, respectively. Conclusions: The prevalence of CTS is relatively high in pregnant women. The prevalence and severity of CTS increase and the rate of asymptomatic cases reduces with the age of pregnancy. Clinical examination and history taking could not diagnose all cases, and their sensitivity and specificity are much less than electrodiagnostic tests. Therefore, it is recommended that electrodiagnostic studies be conducted in pregnant women during the third trimester.

  9. Finite element simulation of the mechanical impact of computer work on the carpal tunnel syndrome.

    Science.gov (United States)

    Mouzakis, Dionysios E; Rachiotis, George; Zaoutsos, Stefanos; Eleftheriou, Andreas; Malizos, Konstantinos N

    2014-09-22

    Carpal tunnel syndrome (CTS) is a clinical disorder resulting from the compression of the median nerve. The available evidence regarding the association between computer use and CTS is controversial. There is some evidence that computer mouse or keyboard work, or both are associated with the development of CTS. Despite the availability of pressure measurements in the carpal tunnel during computer work (exposure to keyboard or mouse) there are no available data to support a direct effect of the increased intracarpal canal pressure on the median nerve. This study presents an attempt to simulate the direct effects of computer work on the whole carpal area section using finite element analysis. A finite element mesh was produced from computerized tomography scans of the carpal area, involving all tissues present in the carpal tunnel. Two loading scenarios were applied on these models based on biomechanical data measured during computer work. It was found that mouse work can produce large deformation fields on the median nerve region. Also, the high stressing effect of the carpal ligament was verified. Keyboard work produced considerable and heterogeneous elongations along the longitudinal axis of the median nerve. Our study provides evidence that increased intracarpal canal pressures caused by awkward wrist postures imposed during computer work were associated directly with deformation of the median nerve. Despite the limitations of the present study the findings could be considered as a contribution to the understanding of the development of CTS due to exposure to computer work.

  10. Carpal tunnel syndrome in general practice 1987 and 2001: incidence and the role of occupational and non-occupational factors.

    NARCIS (Netherlands)

    Bongers, F.J.M.; Schellevis, F.G.; Bosch, W.J.H.M. van den; Zee, J. van der

    2007-01-01

    Most studies on the incidence of the carpal tunnel syndrome and the relation of this disorder with occupation are population-based. In this study we present data from general practice. Aim: to compare incidence rates of carpal tunnel syndrome in 1987 and 2001, and to study the relationship between c

  11. [Carpal tunnel syndrome in acromegaly--4-case report and review of literature].

    Science.gov (United States)

    Imamura, H; Isu, T; Iwasaki, Y; Sugimoto, S; Abe, H; Tashiro, K

    1989-09-01

    Four cases of carpal tunnel syndrome in acromegaly were reported. These 4 cases were found in 21 acromegalies (19%). Besides change of features, they complained bilateral sensory disturbances of their hands. After transsphenoidal removal of pituitary adenoma, GH levels returned to the normal range and sensory disturbances were improved in all cases. Mechanism of carpal tunnel syndrome in acromegaly is that edematous synovial tissues compress the median nerve because oversecretion of growth hormone causes increase of sodium and water retention in the extracellular fluid. The patient who showes high basal level of growth hormone and/or acromegalic pattern by various tolerance tests does not always have the carpal tunnel syndrome. But this syndrome is apt to be found in active acromegaly. So the detection of the symptom showed by this activity such as hypersudation in our cases leads to the early diagnosis of acromegaly.

  12. Wrist Ultrasonography vs. Electrophysiological Studies in the Diagnosis of Carpal Tunnel Syndrome

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    Amirhossein Hashemi Attar

    2009-01-01

    Full Text Available   "nIntroduction: The carpal tunnel syndrome (CTS is the most common entrapment neuropathy and is caused by compression of the median nerve in the carpal tunnel. It is characterized by pain or paresthesia in areas innervated by the median nerve. Electrophysiological studies are gold standard diagnostic tests for CTS. The objective of this study was to compare ultrasonography and electrophysiological studies in the diagnosis of CTS. "nMaterials and Methods: This cross sectional study was conducted on 100 wrists of 50 consecutive patients referred to 22-Bahman hospital (Mashhad with the clinical diagnosis of CTS from spring 2007 to summer 2008. These patients suspicious for CTS in at least one of their wrists (based on their complaints and neurological examination including Tinel’s test and Phallen test, were referred for electrophysiological studies including nerve conduction velocity and electromyography. All the patients underwent ultrasonography of both wrists within a week after electrophysiological studies. Ultrasonographies were performed by a radiologist using a high frequency (12 MHz linear probe (PHILIPS Envisor C. The cross sectional area of the median nerve was measured at the carpal tunnel. Measurements equal or more than 10 mm2 were considered as the CTS. Ultrasonographic findings and also clinical examination (Tinel’s test and Phalen’s test were compared with electrophysiological studies (as the gold standard diagnostic test for each wrist separately. "nResults: Of the 100 wrists (50 patients, 53 wrists were diagnosed as CTS based on the electrophysiological studies. Ninety one percent of the wrists with CTS were in female patients. The mean age was 52.1 years (23-75 years. There was no predisposing factor for most cases; however, 6% were affected by diabetes, 6% by hypertriglyceridemia, and 2% by hypothyroidism. The sensitivity, specificity and accuracy of clinical examination (Tinel’s test and Phalen’s test were 59%, 88

  13. Sensory Conduction Along The Fourth Finger in Patients with Carpal Tunnel Syndrome

    OpenAIRE

    1998-01-01

    The aim of this study was to examine the value of sensory conduction along the median and ulnar nerves of the fourth finger in the diagnosis of carpal tunnel syndrome. 20 females with carpal tunnel syndrome as diagnosed by clinical and routine electrophysiological examinations were included in the study. By using the near-nerve technique, orthodromic sensory conduction along the thumb, 3rd, and 4th fingers for median; and 4th and 5th fingers for ulnar nerve study was performed. &ap...

  14. [Carpal tunnel syndrome and "trigger wrist" revealing a tendinous sheath fibroma].

    Science.gov (United States)

    Benhima, M A; Ait Essi, F; Abkari, I; Najeb, Y; Fikry, T

    2014-02-01

    The tendinous sheath fibroma (TSF) is a rare benign tumor, exceptionally responsible for carpal tunnel syndrome and "trigger" wrist: we found this association less than ten times in the English and French literature. We report the case of a 63-year-old right-handed carpenter who featured a triggering phenomenon of the right wrist during the flexion-extension movements and compression of the median nerve at the carpal tunnel, secondary to a TSF of the flexor digitorum superficialis. The diagnosis was suspected at the sonography and MRI, the tumor was excised and proven histologically to be a TSF. One year later, the patient remained free of symptoms.

  15. Demographic Characteristics of Our Patients with Carpal Tunnel Syndrome

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    Ebru Umay

    2011-09-01

    Full Text Available Aim: Carpal tunnel (CTS is the most common trap neuropathy but, still fully understood the cause of this and effective factors. In this study was aimed to the evaluation demographic features of the cases with CTS admitted to our electroneuromyography (ENMG laboratory. Material and Methods: In the study, 119 patients with CTS to evaluate our ENMG laboratory were received. All patients age, sex, dominant and affected hand, duration of education, marital status, height, weight, additional diseases, occupational, hand and wrist repetitive motion made, use of computer and smoking status was assessed. Patients’ body mass index (BMI was calculated. Results: 102 cases (85.7% females, mean age was 46.32 years ± 12: 18. While in 115 (96.6% cases using the right hand is dominant, in 85 cases (76.6% with bilateral involvement were at hand. While the rate of patient who between five to eight year duration of education had was 47.1%, 84% patients were married. Also, BMI were determined as 29.33± 3.01. According to the state in 22 patients with additional diseases, diabetes mellitus in 22, hypothyroidism in 4, also 1 patient had arthritis. The majority of our patients (70.6% housewives formed. The 67.2% rate of repetetive activities as making crafts, the computer usage at a rate of 11.8% had history. The rate of smoking was 19.3%.  Conclusions:  As a result, CTS, especially in middle-aged housewives and obese is a common syndrome. Despite many reasons to be reported in the etiology of idiopathic 85%. At a rate of 25.4% of women in our society is considered paid work, especially in terms of determining the etiology of the more detailed studies are needed to ousewives.

  16. Descompressão do túnel do carpo pela técnica endoscópica: estudo comparativo com a técnica convencional aberta Endoscopic carpal tunnel release: a comparative study to the conventional open technique

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    Leandro Pretto Flores

    2005-09-01

    Full Text Available OBJETIVO: A técnica endoscópica é alternativa minimamente invasiva à cirurgia convencional da síndrome do túnel do carpo, justificada pela possível diminuição da morbidade pós-operatória. Este estudo pretende comparar as duas técnicas com relação aos seus resultados imediatos, avaliando possíveis vantagens e desvantagens do procedimento endoscópico. MÉTODO: Foram comparados dois grupos de 15 pacientes operados, respectivamente, pela técnica convencional aberta e endoscópica. O pareamento dos grupos permitiu excluir diferenças estatísticas com relação aos critérios de avaliação pré-operatória. RESULTADOS: Todos os pacientes apresentaram resolução dos sintomas após os procedimentos. Em um paciente submetido à cirurgia endoscópica houve recidiva dos sintomas um mês após a cirurgia (6,6%. O tempo pós-operatório de uso de analgésicos orais e de retorno ao trabalho foi estatisticamente menor no grupo submetido à técnica endoscópica. CONCLUSÃO: A descompressão endoscópica do canal do carpo é cirurgia eficaz, oferecendo como vantagem sobre a técnica aberta o menor tempo de recuperação pós-operatória.OBJECTIVE: The endoscopic carpal tunnel release became a minimally invasive alternative to the standard open technique, because of its theoretical benefits for reducing the postoperative morbidity. The present study goals to compare both techniques about the immediate results of such procedures. METHOD: Two groups of 15 patients underwent, respectively, to the endoscopic and conventional carpal tunnel release surgery. There was no statistical difference between both groups about the preoperative clinical aspects. RESULTS: In all of the cases there were complete resolution of the preoperative symptoms immediately after the procedures. One patient from the endoscopic technique group developed recidive of the symptoms one month after the surgery (6.6%. The oral analgesics intake time and the labor returning time

  17. A Cross-Sectional Study of Musculoskeletal Health Literacy in Patients With Carpal Tunnel Syndrome.

    Science.gov (United States)

    Rosenbaum, Andrew J; Dunkman, Andrew; Goldberg, Daniel; Uhl, Richard L; Mulligan, Michael

    2016-09-01

    Background: Approximately 33% of Americans have inadequate health literacy, which is associated with infrequent use of preventative services, increased hospitalization and use of emergency care, and worse control of chronic diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients undergoing carpal tunnel release (CTR), as these individuals may be at increased risk of inferior outcomes. Methods: This cross-sectional study included individuals older than or equal to 18 years of age who were scheduled for elective CTR. Participants completed a demographic survey and the LiMP questionnaire during their preoperative office visit. The prevalence of limited health literacy was determined, with chi-square analysis used to determine the influence of demographic parameters. Results: The mean LiMP score was 6 ± 1.40. Limited musculoskeletal literacy was seen in 34% of participants (22/65). Analysis identified race (Caucasian), gender (female), higher education levels (≥college), current or prior employment in a health care field, and a prior physician visit for a non-carpal tunnel musculoskeletal complaint as being associated with higher literacy rates. Conclusions: Approximately one-third of patients scheduled for elective CTR have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning, as CTR is performed in the United States on roughly 500 000 individuals annually, at an estimated cost of 2 billion dollars. The identification of those most at risk is thus crucial, and will facilitate the development of education campaigns and interventions geared toward those who are most vulnerable.

  18. Interpreter's Wrist: Repetitive Stress Injury and Carpal Tunnel Syndrome in Sign Language Interpreters.

    Science.gov (United States)

    Stedt, Joe D.

    1992-01-01

    In a survey concerning repetitive stress injury (RSI) and carpal tunnel syndrome, 87 percent of the 40 sign language interpreters reported that they had at some time experienced at least 2 symptoms associated with RSI, and most interpreters knew others with RSI problems. Data indicate that RSI is a severe problem among sign language interpreters.…

  19. Sonographic Measurements of Subsynovial Connective Tissue Thickness in Patients With Carpal Tunnel Syndrome

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; van der Molen, Aebele Mink; Henderson, Jacqueline; Cha, Stephen S.; An, Kai Nan; Amadio, Peter C.

    2012-01-01

    Objectives-A major pathologic finding in patients with idiopathic carpal tunnel syndrome is noninflammatory fibrosis and thickening of the subsynovial connective tissue. The objective of this study was to determine the ability of sonography to depict this thickening by comparing subsynovial connecti

  20. Yoga Asanas for the Relief and Prevention of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Beleu, Steve

    This collection of yoga asanas (exercises) can help relieve the pain of carpal tunnel syndrome (CTS) and help prevent CTS among people who work on computer terminals. For maximum benefit, the exercises should be practiced daily or on as regular a schedule as possible. They are not intended to replace surgery or a physician's prescribed care. They…

  1. Dynamic sonographic measurements at the carpal tunnel inlet: Reliability and reference values in healthy wrists

    NARCIS (Netherlands)

    A. Filius (Anika); J.-W.H. Korstanje (Jan-Wiebe); R.W. Selles (Ruud); S.E.R. Hovius (Steven); H.P. Slijper

    2013-01-01

    textabstractIntroduction: Reliability and reference values are not well-established for most dynamic sonographic measurements of the median nerve (MN) and flexor tendons that may be used for diagnosing carpal tunnel syndrome (CTS). Methods: Wrists of 20 healthy participants were imaged using ultraso

  2. Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients

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    Mark van Suchtelen

    2014-09-01

    There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.

  3. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study.

    NARCIS (Netherlands)

    Ettema, A.M.; Zhao, C.; Amadio, P.C.; O'Byrne, M.M.; An, K.N.

    2007-01-01

    The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the u

  4. Median Nerve Deformation and Displacement in the Carpal Tunnel during Index Finger and Thumb Motion

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Yoshii, Yuichi; Villarraga, Hector R.; Henderson, Jacqueline; Cha, Stephen S.; An, Kai-Nan; Amadio, Peter C.

    2010-01-01

    The purpose of this study was to investigate the deformation and displacement of the normal median nerve in the carpal tunnel during index finger and thumb motion, using ultrasound Thirty wrists from 15 asymptomatic volunteers were evaluated Cross-sectional images during motion from full extension t

  5. Third trimester of pregnancy: Carpal tunnel syndrome, anxiety and depression

    Directory of Open Access Journals (Sweden)

    Tupković Emir

    2013-03-01

    Full Text Available This study measured the frequency of carpal tunnel syndrome (CTS and the levels of anxiety and depression in the third trimester of healthy pregnant women having regular prenatal visits. The study was performed at the Department of Neurophysiology Health Centre Tuzla in the period of January through April 2006. The group consisted of 40 pregnant women in the third trimester of pregnancy, age range of 25.6 ± 4.9 years. The control group consisted of healthy women, ages 31.1 ± 4.4 years. The electrophysiological parameters n. medians, the Beck Depression Inventory (BDI and Beck Anxiety Inventory (BAI were measured. The diagnosis of CTS is neurophysiologically confirmed in 12 pregnant women (30% and 75% showed clinical signs and symptoms of disease. Pain was measured by subjective pain scale ranked from 0 (absence of pain to 10 (severe pain. The mean value of BAI in control group was 8.6 ± 6.5, while in the group of pregnant women was 12.9 ± 6.9, which was significantly higher (p = 0.011. The mean value of BDI in control group was 4.2 ±4.4 and in the group of pregnant women was 8.7 ±5.9. which was significantly higher (p = 0.0008, The mean value of BAI in the group of women with CTS was 12.25 ± 6.7 which was not significantly higher than the compared to the control group (p = 0.113. The mean value of BDI in the group of pregnant women with CTS was 7.9 ± 6.4,which was significantly higher when compared to the control group (p = 0.037. The subjective assessment of pain in the group of women with CTS was 2.4 ±2.1. There was a slight correlation between pain intensity and degree of BAI (r = 0.289 and a negative correlation with the level of depression (r = - 0.297. The conclusion is that pregnant women with normal risk should make an extra effort in the treatment of unpleasant conditions such as CTS, anxiety and depression, which may impair the quality of life and have physical and psychological side effects on the future mother.

  6. Association Between Carpal Tunnel Syndrome and Abdominal Obesity

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    Ertuğrul Uzar

    2010-12-01

    Full Text Available OBJECTIVE: Obesity has been suggested as a risk factor for carpal tunnel syndrome (CTS. Previous studies on the association of CTS and obesity have generally considered body mass index (BMI. However, the relationships between CTS and waist circumference or waist-to-hip ratio (WHR, which are known as more sensitive measures for abdominal obesity, have not been studied previously. In this study, it was aimed to evaluate the role of BMI and abdominal obesity in patients with CTS. METHODS: Female patients who applied to the neurology outpatient clinics with pain, numbness, paresthesia, or dysesthesia in the hands were included. The patients were divided into two groups, according to the clinical evaluation, as CTS or non-CTS. CTS diagnosis was electrophysiologically confirmed in 44 patients. Thirty-one subjects who were not diagnosed as CTS electrophysiologically were recruited as the control group. Clinical findings, nerve conduction studies and anthropometric measurements (height, weight, BMI, hip circumference, waist circumference and WHR of CTS patients were compared with those of the control group. RESULTS: The CTS group had significantly higher BMI, waist circumference and WHR values compared to the control group (for each parameter, p< 0.0001. The rates of obesity in the CTS group were 55.8%, 47.7% and 34.9%, respectively, according to waist circumference, BMI and WHR measurements. In the CTS group, 16% of the patients, who were defined as non-obese according to BMI, were determined as obese according to waist circumference. In the CTS group, significant positive correlations were found between BMI and WHR and median-ulnar sensory interpeak latency of the fourth digit (r= 0.26, p< 0.05; r= 0.25, p< 0.05, respectively. CONCLUSION: In this study, it was found that abdominal obesity is an important risk factor for CTS, and nerve conduction may be affected by waist circumference, BMI and WHR. In addition to general obesity, abdominal obesity may

  7. Wrist immobilization after carpal tunnel release: a prospective study Avaliação prospectiva da imobilização do pulso após descompressão cirúrgica do nervo mediano no túnel do carpo

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    Roberto S. Martins

    2006-09-01

    Full Text Available This prospective study evaluates the possible advantages of wrist imobilization after open carpal tunnel release comparing the results of two weeks immobilization and no immobilization. Fifty two patients with idiopathic carpal tunnel syndrome were randomly selected in two groups after open carpal tunnel release. In one group (A, n=26 the patients wore a neutral-position wrist splint continuosly for two weeks. In the other group (B, n=26 no wrist immobilization was used. Clinical assessment was done pre-operatively and at 2 weeks follow-up and included the two-point discrimination test at the second finger and two questionnaires as an outcome measurement of symptoms severity and intensity. All the patients presented improvement in the postoperative evaluations in the three analyzed parameters. There was no significant difference between the two groups for any of the outcome measurements at the final follow-up. We conclude that wrist immobilization in the immediate post-operative period have no advantages when compared with no immobilization in the end result of carpal tunnel release.Neste estudo prospectivo avaliamos se há vantagens na imobilização pós-operatória do pulso após a cirurgia para o tratamento da síndrome do túnel do carpo comparando este tratamento com a ausência de imobilização. Cinqüenta e dois pacientes portadores de síndrome do túnel do carpo idiopática foram randomizados em dois grupos após a cirurgia. Em um grupo (grupo A, n=26 os pacientes utilizaram uma tala em posição neutra para imobiliza��ão do pulso por duas semanas. No outro grupo (B, n=26, nenhum tipo de imobilização foi adotada. A avaliação foi realizada antes da cirurgia e repetida após duas semanas e incluiu a mensuração da sensibilidade discriminatória no segundo dedo e dois questionários que avaliaram a gravidade e intensidade dos sintomas. Em todos os pacientes houve melhora nos parâmetros avaliados. Não houve diferen

  8. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.

    Science.gov (United States)

    Shiri, R; Pourmemari, M H; Falah-Hassani, K; Viikari-Juntura, E

    2015-12-01

    We aimed to estimate the effects of overweight and obesity on carpal tunnel syndrome (CTS), and to assess whether sex modifies the associations. Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate databases from 1953 to February 2015. Fifty-eight studies consisting of 1,379,372 individuals qualified for a meta-analysis. We used a random-effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. Overweight increased the risk of CTS or carpal tunnel release 1.5-fold (pooled confounder-adjusted odds ratio [OR] = 1.47, 95% CI 1.37-1.57, N = 1,279,546) and obesity twofold (adjusted OR = 2.02, 95% CI 1.92-2.13, N = 1,362,207). Each one-unit increase in body mass index increased the risk of CTS by 7.4% (adjusted OR = 1.074, 95% CI 1.071-1.077, N = 1,258,578). Overweight and obesity had stronger effects on carpal tunnel release than CTS. The associations did not differ between men and women, and they were independent of study design. Moreover, the associations were not due to bias or confounding. Excess body mass markedly increases the risk of CTS. As the prevalence of overweight and obesity is increasing globally, overweight-related CTS is expected to increase. Future studies should investigate whether a square-shaped wrist and exposure to physical workload factors potentiate the adverse effect of obesity on the median nerve.

  9. Efficacy of kinesiotaping in patients with the initial signs of carpal tunnel syndrome

    OpenAIRE

    I. G. Mikhaylyuk; N. N. Spirin; E. V. Sal’nikov

    2016-01-01

    Background. Carpal tunnel syndrome (CTS) is one of the most common tunnel neuropathies. Early symptoms are often limited by periodic and slight discomfort in the area of innervation of a median nerve on the hand, so the patients are not willing to be treated invasively. Thus, a noninvasive therapy, such as kinesiotaping, could be perspective.Objective. Assessment of the efficiency of a kinesiotaping monotheraphy of patients on initial stage of CTS.Materials and methods. We included 120 patien...

  10. Bilateral hand/wrist heat and cold hyperalgesia, but not hypoesthesia, in unilateral carpal tunnel syndrome.

    Science.gov (United States)

    de la Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César; Fernández-Carnero, Josué; Padua, Luca; Arendt-Nielsen, Lars; Pareja, Juan A

    2009-10-01

    The aim of the current study was to evaluate bilaterally warm/cold detection and heat/cold pain thresholds over the hand/wrist in patients with carpal tunnel syndrome (CTS). A total of 25 women with strictly unilateral CTS (mean 42 +/- 10 years), and 20 healthy matched women (mean 41 +/- 8 years) were recruited. Warm/cold detection and heat/cold pain thresholds were assessed bilaterally over the carpal tunnel and the thenar eminence in a blinded design. Self-reported measures included both clinical pain history (intensity, location and area) and Boston Carpal Tunnel Questionnaire. No significant differences between groups for both warm and cold detection thresholds in either carpal tunnel or thenar eminence (P > 0.5) were found. Further, significant differences between groups, but not between sides, for both heat and cold pain thresholds in both the carpal tunnel and thenar eminence were found (all P < 0.001). Heat pain thresholds (P < 0.01) were negatively correlated, whereas cold pain thresholds (P < 0.001) were positively correlated with hand pain intensity and duration of symptoms. Our findings revealed bilateral thermal hyperalgesia (lower heat pain and reduced cold pain thresholds) but not hypoesthesia (normal warm/cold detection thresholds) in patients with strictly unilateral CTS when compared to controls. We suggest that bilateral heat and cold hyperalgesia may reflect impairments in central nociceptive processing in patients with unilateral CTS. The bilateral thermal hyperalgesia associated with pain intensity and duration of pain history supports a role of generalized sensitization mechanisms in the initiation, maintenance and spread of pain in CTS.

  11. Carpal tunnel syndrome: Assessment of correlation between clinical, neurophysiological and ultrasound characteristics

    Directory of Open Access Journals (Sweden)

    B Hemeshwar Rao

    2012-01-01

    Full Text Available Objectives: To evaluate the relationship between symptoms, clinical severity, neurophysiological characteristics with median nerve cross-sectional area (CSA at the level of carpal tunnel inlet at ultrasonography (USG and its utility in diagnosis of carpal tunnel syndrome (CTS. Materials and Methods: Prospective study of 30 patients with symptoms of CTS, attending to the Neurology out patient department (OPD at University Teaching Hospital. A multidimensional assessment of CTS was done using historic and objective scale (Hi-Ob scale for clinical severity, Boston carpal tunnel questionnaire (BCTQ for patient-oriented measures, neuro physiologic studies of median nerve at wrist and USG to measure median nerve CSA at carpal tunnel inlet. Results: Thirty patients included in the study (22 women and 8 men. Mean of CSA was 12.69 mm 2 (SD2.67. Association between BCTQ score value and inlet values was assessed by Karl Pearson correlation coefficient ( r = 0.376, P = 0.04. There was positive association with BCTQ scores and CSA of median nerve at carpal tunnel inlet. To compare clinical severity scale (Hi-Ob and USG CSA, analysis of variance was performed (F value and Scheffe′s multiple comparison test was used to find group difference (grades 1 and 2 P < 0.001, grades1 and 2P P < 0.001, grade 2 differs with grade 2P P < 0.006. As the number of patients is less in minimal, mild and severe groups, the difference between neurophysiological groups and mean of CSA was not statistically significant. Conclusion: A positive correlation exists between USG findings and all the conventional measures of CTS severity.

  12. The Effect of Naproxen and Prednisolone in the Treatment of Mild to Moderate Carpal Tunnel Syndrome

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    P yazdan panah

    2016-03-01

    Full Text Available Background & aim: Carpal tunnel syndrome is the entrapment of the median nerve in carpal tunnel of the wrist. Symptoms of this syndrome are numbness, tingling, weakness or pain in the fingers and wrist. Treatment includes rest, avoiding the many activities available, splints, non-steroidal anti-inflammatory drugs, oral steroids, steroid injection in wrist and surgery. This study compared the effects of oral prednisolone and naproxen (non-steroidal anti-inflammatory drugs in the treatment of mild to moderate carpal tunnel syndrome. Methods: In the present clinical-trial study, 44 patients who had mild to moderate carpal tunnel syndrome were selected and randomly assigned into two treatment groups: group 1(n = 22 received naproxen 1000 mg daily for 4 weeks and the group 2 (n = 22 received oral prednisolone 20 mg, daily, in the first 2 weeks and 10 mg daily for 2 weeks. The 3 persons of the second group dropped out of treatment. Re-evaluation of treatment outcome was performed 2 months later. Collected data were analyzed using SPSS software. To describe the data, frequency tables were used. Furthermore, the Chi-square test was used to analyze the data. Results: 36(87.8% of the patients were males and 12.2% were females. The electro diagnostic studies were shown 16 hands (19.5% normal, 19 hands (23.2% had mild and 47 (57.3% had moderate involvement in beginning of treatment. Tingling fingers and pain in the prednisolone group had significantly lower rate than naproxen group (p< 0.05, but the symptoms were not significantly different in the two groups. Conclusion: The effects of treatments, relief of symptoms and the decrease intensity of carpal tunnel syndrome in patients who received prednisolone were more than naproxen.

  13. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review

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    Shi Qiyun

    2011-04-01

    nerve conduction studies was 2.3 (95% CI 1.2, 4.4, while RR was 2.03 (95% CI 1.28 to 3.22 for complication, both favoring surgery. Conclusion Both surgical and conservative interventions had treatment benefit in carpal tunnel syndrome. Surgical treatment has a superior benefit, in symptoms and function, at six and twelve months. Patient underwent surgical release were two times more likely to have normal nerve conduction studies but also had complication and side effects as well. Given the treatment differential and potential for adverse effects and that conservative interventions benefitted a substantial proportion of patients, current practice of a trial of conservative management with surgical release for severe or persistent symptoms is supported by evidence.

  14. A Case Report of Carpal Tunnel Syndrome with Raynaud's Phenomenon Treated by Bee Venom and Carthami Flos Pharmacopuncture

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    Choi Seok-woo

    2009-03-01

    Full Text Available Objectives : This study is to report the effect of Pharmacopuncture therapy on a patient suffering from the pain and cold intolerance of hand caused by Carpal tunnel syndrome with Raynaud's phenomenon. Methods : We had treated the patient diagnosed as Carpal tunnel syndrome with Raynaud's phenomenon by Sweet BV and CF pharmacopuncture. We injected Sweet BV and CF into acupuncture points on both hands - Sweet BV into Baxie (EX-UE9, CF into Naegwan (PC6 and Daereung (PC7.And then we evaluated her symptoms by VAS (Visual Analog Scale. Results : Clinical symptoms about Carpal tunnel syndrome with Raynaud's phenomenon were remarkably improved by Sweet BV and CF Pharmacopuncture. Conclusion : Therefore, we concluded that pharmacopuncture therapy - Sweet BV, CF etc. - may be useful to treat Carpal tunnel syndrome with Raynaud's phenomenon.

  15. Letter to Editor: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

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    Caliandro Pietro

    2008-02-01

    Full Text Available Abstract A response to Chalidis et al: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement. World J Surg Oncol 2007, 5:92.

  16. Transverse Ultrasound Assessment of Median Nerve Deformation and Displacement in the Human Carpal Tunnel during Wrist Movements

    OpenAIRE

    2013-01-01

    The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. In order to better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images...

  17. Study of tactile sensitivity by Semmes–Weinstein monofilaments in patients with carpal tunnel syndrome and healthy individuals

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    I. G. Mikhailyuk

    2014-01-01

    Full Text Available Surface sensitivity disorders are observed in many diseases of the central and peripheral nervous system. Surface sensitivity thresholds were estimated in healthy individuals and patients with carpal tunnel syndrome. There was a statistically significant (p < 0.001 increase in the sensitivity threshold in the distal phalanx of the index finger in patients with carpal tunnel syndrome as compared to healthy individuals, by evaluating the surface sensitivity by Semmes–Weinstein monofilaments.

  18. Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

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    Ihsan M. Ajeena

    2013-01-01

    Full Text Available Introduction. Carpal tunnel syndrome (CTS is the most commonly diagnosed entrapment neuropathy of the upper extremity. The objective of this study was to diagnose CTS and to assess its severity using high resolution ultrasound (HRUS depending on the results of nerve conduction study (NCS. Methods. A prospective cross-sectional study, in which HRUS was performed at 63 wrists of 35 female patients with different severity of CTS (as proved by NCS. Furthermore, 40 healthy volunteers (80 wrists underwent the same tests as the patients and have been chosen to match the patients in gender, age, and body mass index (BMI. The cross section area (CSA of the median nerve (MN was obtained using HRUS at the carpal tunnel inlet by direct tracing method. Results. There was a significant difference in the CSA of the MN at the tunnel inlet in CTS patients when compared with the control group. In fact, the CSA of the control group showed a significant difference from each of patients subgroups. Furthermore, a significant difference in the CSA was seen in between these subgroups. In conclusion, the US examination of the MN seems to be a promising method in diagnosing and grading of carpal tunnel syndrome.

  19. Ulnar sensory nerve impairment at the wrist in carpal tunnel syndrome.

    Science.gov (United States)

    Ginanneschi, Federica; Milani, Paolo; Mondelli, Mauro; Dominici, Federica; Biasella, Alessia; Biasella, Alessio; Rossi, Alessandro

    2008-02-01

    In previous studies, changes in impulse transmission of ulnar motor axons have been documented in patients with carpal tunnel syndrome (CTS). We examined ulnar sensory conduction in 144 CTS hands. In particular, conduction parameters of the dorsal ulnar cutaneous branch (DUC) running outside Guyon's canal were compared with those of the superficial sensory branches (U4 and U5) passing through the canal. U4 and U5 response amplitudes and U5 conduction velocity were significantly lower than in controls. Conduction parameters of the DUC were similar in both groups. Patients with more severely impaired median conduction had smaller ulnar sensory action potentials. We propose that the ulnar nerve may be subject to compression in Guyon's canal as a consequence of high pressure in the carpal tunnel of CTS patients. This may provide insights into the mechanisms underlying extra-median spread of sensory symptoms in CTS patients.

  20. Acute carpal tunnel syndrome of the hand following a cat bite.

    Science.gov (United States)

    Sbai, Mohamed Ali; Dabloun, Slim; Benzarti, Sofien; Khechimi, Myriam; Jenzeri, Abdesselem; Maalla, Riadh

    2015-01-01

    Cat bites at the hand are common situation in emergency departments. Neglected or poorly supported, these lesions sometimes lead to serious injuries that may compromise the function of the hand. Pasteurellamultocida is the most offending germ in these lesions, despite their sensitivity to antibiotics; it can sometimes lead to deep infections involving the skin, bones and joints. Acute carpal tunnel syndrome is exceptional after cat bite. We report a case of a 56 Year old female presenting with an acute carpal tunnel syndrome associated with compartment syndrome of the right hand 6 days after a cat bite of her right thumb. The patient was treated by surgery to relieve the median nerve. Microbiology identified PasteurellaMultocida.

  1. Bromocriptine for an acromegalic patient. Improvement in cardiac function and carpal tunnel syndrome.

    Science.gov (United States)

    Luboshitzky, R; Barzilai, D

    1980-10-17

    A 64-year-old woman with active acromegaly of 33 years' duration, severe carpal tunnel syndrome, and subclinical heart disease was treated with bromocriptine mesylate. Within eight months of therapy, basal growth hormone (GH) levels decreased from 90.0 to 7.0 ng/mL, and hand volume was reduced from 375 to 295 mL. Concomitantly, echocardiographic studies showed normal left ventricular size and function. Electromyographic studies demonstrated normal function in both median nerves. Bromocriptine may correct cardiac dysfunction and carpal tunnel syndrome in acromegaly either by reduction of GH oversecretion or by a direct effect of bromocriptine on dopamine receptors in the heart and peripheral nerve endings.

  2. Prevalence of Asymptomatic Neurophysiological Carpal Tunnel Syndrome in 130 Healthy Individuals

    Science.gov (United States)

    Alrawashdeh, Omar

    2016-01-01

    Diagnosis of carpal tunnel syndrome (CTS) is frequently confirmed by performing nerve conduction studies. Previous studies demonstrated that abnormal nerve conduction study (NCS) is suggestive of CTS among asymptomatic individuals. However, previous studies included individuals with risk factors for the syndrome. A NCS was performed on the median and ulnar nerves in 130 healthy individuals. About 15% of individuals in this study demonstrated electrodiagnostic evidence of carpal tunnels syndrome. Four cases have shown signs of isolated median neuropathy with normal median sensory component. Results indicated that the most widely used method for confirming diagnosis of CTS may have up to 15% of false positives. However, most of those showed changes of minimal CTS. Isolated prolongation of the median motor latency should be investigated further as they are usually classified as moderate to severe CTS and may undergo unnecessary surgeries. PMID:27994828

  3. Prevalence of asymptomatic neurophysiological carpal tunnel syndrome in 130 healthy individuals

    Directory of Open Access Journals (Sweden)

    Omar Alrawashdeh

    2016-11-01

    Full Text Available Diagnosis of carpal tunnel syndrome (CTS is frequently confirmed by performing nerve conduction studies. Previous studies demonstrated that abnormal nerve conduction study (NCS is suggestive of CTS among asymptomatic individuals. However, previous studies included individuals with risk factors for the syndrome. A NCS was performed on the median and ulnar nerves in 130 healthy individuals. About 15% of individuals in this study demonstrated electrodiagnostic evidence of carpal tunnels syndrome. Four cases have shown signs of isolated median neuropathy with normal median sensory component. Results indicated that the most widely used method for confirming diagnosis of CTS may have up to 15% of false positives. However, most of those showed changes of minimal CTS. Isolated prolongation of the median motor latency should be investigated further as they are usually classified as moderate to severe CTS and may undergo unnecessary surgeries.

  4. Our results of mini open approach in patients with carpal tunnel syndrome

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    Azad Yıldırım

    2015-12-01

    Full Text Available Objective: In this study, we aimed to evaluate the results of patients underwent surgical release with mini open surgical method due to Carpal tunnel syndrome (CTS and the surgical technique. Methods: 50 wrists of the 42 patients that we could reach after they were applied mini open surgical method between 2009- 2013 were analyzed retrospectively. After surgery, patients were followed for an average 47.4 months. CTS was detected in 26 of the patients in right hand, in 10 of the patients in left hand and in seven of them bilaterally. In 27 Preoperative patients advanced in 21 intermediate and in 2 mild Electromyography (EMG findings compliant with CTS were found. Results: We did not apply a second operation to any of our patients. None of the patients showed any post operative sensitivity on scar tissue and there was no neurovascular damage in any patients during the surgery. The patients returned to their daily activities average on the 10th day after the surgery [range 7-15 days]. In their follow up EMG was not done on a routine basis to the patients. Patients were followed clinically. Conclusion: The advantages of the surgery process we conducted with over pillar mini incision compared to other techniques that there is less pillar region pain and less scar tenderness, shorter return to work and the technique is efficient, cheap and easy to apply.

  5. Etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype wrist movements

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    Magdalena Lewańska

    2014-04-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is the most common neuropathy of upper limbs and a leading cause of upper extremity musculoskeletal disorders, in terms of work exposure, repetitive and forceful exertions of the hand and use of vibrating hand tools. The aim of the study was to evaluate etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype movements in wrist. Material and Methods: We conducted the retrospective analysis of 300 patients (261 women, 39 men, mean age 52 years (standard deviation: ±6.93 hospitalized with the suspicion of occupational CTS. Results: The study revealed high percentage (68.7% of diseases and systemic factors involved in the pathogenesis of CTS in the analyzed population, especially obesity (32%, thyroid diseases (28.7%, hormone replacement therapy and/or oophorectomy (16.3% and diabetes mellitus (12%. In 111 patients the coexistence of at least a couple of potential etiological factors of the neuropathy was recognized. Clinical analysis and occupational exposure allowed to diagnose occupational carpal tunnel syndrome in 18 (6% patients only. The undeniable long-term (20.2±9.3 years occupational exposure to repetitive, forceful movements in the wrist was observed in this group. Conclusion: The results of our study indicated that non-occupational etiological factors of CTS predominated and in 37% of patients at least several factors were found. The analysis showed the high prevalence of CTS in workers employed in various sectors of industry, including so called "blue collar" workers. Our study confirmed the multifactorial etiology of carpal tunnel syndrome, however, occupational agents contributed to only 6% of cases. Med Pr 2014;65(2:261–270

  6. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome

    OpenAIRE

    2003-01-01

    Abstract Background Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and deter...

  7. Early diagnosis of Carpal Tunnel Syndrome (CTS) in Indian patients by nerve conduction studies

    OpenAIRE

    2010-01-01

    The present study was carried out for early confirmation of clinically diagnosed patients of Carpal Tunnel Syndrome (CTS) by electro-diagnostic tests which included motor conduction, sensory conduction studies and F-wave studies. The aim of the study was early confirmation of clinically suspected patients of CTS by motor and sensory conduction studies of median and ulnar nerves. Eighty subjects of age group 30-50 years (40 clinically suspected patients of CTS, 40 as control group) were studie...

  8. The satisfactory effects of the other operations with carpal tunnel operation of the same hand

    Directory of Open Access Journals (Sweden)

    Atakan Aydin

    2012-08-01

    Conclusion: Comparison of pre- and postoperative DASH scores between the patients who underwent only carpal tunnel surgery and the patients who underwent combined surgery was statistically insignificant different (ANOVA F=0.022, p=0.883 and F=0.471, p=0.496, respectively. In both groups, none of our patients encountered with reflex sympathetic dystrophy, because of extreme sensitivity, desensitisation treatment was applied to 4 patients. [Hand Microsurg 2012; 1(2.000: 43-48

  9. Multiple Volar Carpometacarpal Dislocations with Associated Carpal Tunnel Syndrome: A Case Report

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    C Fletcher

    2015-09-01

    Full Text Available We report a rare injury involving volar fracture dislocations of the second to fifth carpometacarpal dislocations. Carpometacarpal dislocations are usually dorsally displaced and most commonly only involve the fourth and fifth joints. An associated carpal tunnel syndrome adds another dimension to the complexity and rarity of the injury in this index case. A high index of clinical suspicion and subsequent emergent management is of utmost importance to treat this unusual combination of injuries in order to avoid significant morbidity.

  10. Carpal tunnel syndrome: A rare manifestation of distal radius osteoid osteoma.

    Science.gov (United States)

    Basran, Sukhvinder Singh; Kumar, Sandeep; Jameel, Javed; Sajid, Imran

    2015-09-01

    Osteoid Osteoma is a benign bone tumor that normally affects long bones and rarely affects distal radius. Because of its nonspecific presentation in the wrist, it remains a diagnostic challenge. We report an unusual case of Osteoid Osteoma at distal radius having symptoms resembling that of carpal tunnel syndrome. The diagnosis was confirmed preoperatively with X-rays; bone scintigraphy, CT, and MRI, later histological examination confirmed the diagnoses. Surgical excision lead to a dramatic improvement in the condition of the patient.

  11. Gouty wrist arthritis causing carpal tunnel syndrome--a case report.

    Science.gov (United States)

    Sikkandar, M F; Sapuan, J; Singh, R; Abdullah, S

    2012-06-01

    A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.

  12. Comparison of high-resolution sonography and electrophysiology in the diagnosis of carpal tunnel syndrome

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    Meena Angamuthu Kanikannan

    2015-01-01

    Full Text Available Background: The diagnostic accuracy of high-resolution ultrasonography (HRUS in comparison to electro-diagnostic testing (EDX in carpal tunnel syndrome (CTS is debatable. Objective: The aim of this study was to compare the diagnostic accuracy of HRUS with EDX in patients with various grades of CTS and CTS associated with peripheral neuropathy (CTS + PNP. Materials and Methods: A prospective cohort of 57 patients with possible CTS was studied along with matched controls. The cross-sectional area (CSA of the median nerve at the inlet of carpal tunnel was assessed by a sonologist blinded to the clinical and EDX data. Palm wrist distal sensory latency difference (PWDSLD, second lumbrical-interosseus distal motor latency difference (2LIDMLD and CSA were compared in patients with different grades of severity of CTS and CTS+PNP. Results: Total 92 hands of 57 patients met the clinical criteria for CTS. Mean CSA at the inlet of carpal tunnel was 0.11 ± 0.0275 cm 2 . It had the sensitivity, specificity, positive predictive value and negative predictive values of 76.43%, 72.72%, 89.47% and 68%, respectively (P < 0.0001. Overall, HRUS had good correlation with PWDSLD and 2LIDMLD electro-diagnostic studies in all grades of CTS and CTS + PNP. Conclusion: HRUS can be used as a complementary screening tool to EDX. However, EDX has been found to be more sensitive and specific in mild CTS.

  13. Ultrasound features of carpal tunnel syndrome: a prospective case-control study

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    Sernik, Renato A.; Abicalaf, Claudia A.; Cerri, Giovanni G. [University of Sao Paulo, Department of Radiology, Sao Paulo (Brazil); Pimentel, Benedito F. [University of Taubate, Department of Orthopedics, Sao Paulo (Brazil); Braga-Baiak, Andresa [University of Sao Paulo, Post Graduation Program, Department of Radiology, Sao Paulo (Brazil); Braga, Larissa [University of Nebraska Medical Center, Omaha, NE (United States)

    2008-01-15

    The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29-78) in the symptomatic and 45.1 years (range 24-82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm{sup 2} (DT) and 9 mm{sup 2} (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm{sup 2} (DT) and 9 mm{sup 2} (IT) and several additional findings. (orig.)

  14. Pre- and post-operative diffusion tensor imaging of the median nerve in carpal tunnel syndrome

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    Hiltunen, Jaana [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); Aalto University School of Science, Advanced Magnetic Imaging Centre, Aalto (Finland); Kirveskari, Erika [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); Helsinki University Central Hospital, Department of Clinical Neurophysiology, Helsinki (Finland); Numminen, Jussi [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); University of Helsinki, Helsinki Medical Imaging Center, Helsinki (Finland); Lindfors, Nina; Goeransson, Harry [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Hari, Riitta [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); Aalto University School of Science, Advanced Magnetic Imaging Centre, Aalto (Finland); Helsinki University Central Hospital, Department of Clinical Neurophysiology, Helsinki (Finland)

    2012-06-15

    To use pre- and post-operative diffusion tensor imaging (DTI) to monitor median nerve integrity in patients suffering from carpal tunnel syndrome (CTS). Diffusivity and anisotropy images along the median nerve were compared among 12 patients, 12 age-matched and 12 young control subjects and correlated with electrophysiological neurography results. Slice-wise DTI parameter values were calculated to focus on local changes. Results of pre-operative patients and age-matched control subjects differed only in the distal nerve. Moreover, pre-operative patients differed significantly from young controls and post-operative patients. The main abnormalities were increased diffusivity and decreased anisotropy in the carpal tunnel and distal median nerve. Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. Slice-wise analysis showed high pre-operative diffusivity at the distal nerve. All groups had relatively large inter-subject variation in both diffusivity and anisotropy. DTI can provide information complementary to clinical examination, electrophysiological recordings and anatomical MRI of diseases and injuries of peripheral nerves. However, similar age-related changes in diffusivity and anisotropy may weaken DTI specificity. Slice-wise analysis is necessary for detection of local changes in nerve integrity. circle Diffusion tensor magnetic resonance imaging provides information complementary to conventional diagnostic methods. circle Age caused similar changes to diffusivity and anisotropy as carpal tunnel syndrome. circle Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. circle Inter-subject variation in diffusivity and anisotropy was considerable. (orig.)

  15. Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

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    Adham do Amaral e Castro

    2014-12-01

    Full Text Available Objective: To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods: We studied three groups of individuals: 1 patients waiting for bariatric surgery (preoperative; 2 individuals who had already undergone the procedure (postoperative; and 3 control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results: We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls. There was a higher prevalence of paresthesias (p=0.0003, clinical tests (p=0.0083 on the preoperative group when compared with controls (p<0.00001. There were lowe levels of paresthesias (p=0.0002 and median nerve area (p=0.04 in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05 in those who performed non-manual work. Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

  16. Low-power laser therapy for carpal tunnel syndrome:effective optical power

    Institute of Scientific and Technical Information of China (English)

    Yan Chen; Cheng-qiang Zhao; Gang Ye; Can-dong Liu; Wen-dong Xu

    2016-01-01

    Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efifca-cy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efifcacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside relfection and scattering laser power from human skin at the wrist, the effective laser power can be inferred. Using clinical measurements from 30 cases, we found that the effective laser power differed signiifcantly among cases, with the measured laser relfection coefifcient ranging from 1.8%to 54%. The relfection coefifcient for 36.7%of these 30 cases was in the range of 10–20%, but for 16.7%of cases, it was higher than 40%. Consequently, monitoring the effective optical power during laser irradiation is necessary for the laser therapy of carpal tunnel syndrome.

  17. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia

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    Marco Felipe Francisco Honorato Barros

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. MATERIAL AND METHODS: This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. RESULTS: The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01. In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. CONCLUSION: Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result.

  18. Anomalies of ulnar nerve conduction in different carpal tunnel syndrome stages.

    Science.gov (United States)

    Ginanneschi, F; Milani, P; Rossi, A

    2008-09-01

    Impairment of ulnar sensory fibers at the wrist has recently been documented in moderate/severe carpal tunnel syndrome (CTS). This has been interpreted as a consequence of compressive forces transmitted to Guyon's canal by high pressure in the carpal tunnel or comorbidity between ulnar neuropathy and CTS. The main aim of the present study was to identify any ulnar nerve conduction impairment in the early stages of CTS. The relation between ulnar and median nerve conduction in all CTS severity stages was also assessed. Ulnar nerve sensory conduction at the wrist was investigated in 580 hands with CTS. Significant changes in ulnar nerve conduction were present even in the early stages of CTS. A significant, positive correlation was also found between CTS severity and conduction abnormalities of ulnar sensory fibers. These findings make the hypothesis of comorbidity weak. Based on the above results and on reports of high pressure in Guyon's canal in CTS, ulnar nerve conduction abnormalities may be caused in part by compressive forces progressively transmitted to the canal by increasing pressure in the carpal tunnel with increasing CTS severity. This does not exclude other causative factors such as subclinical traumatic damage acting on median and ulnar fibers.

  19. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia☆

    Science.gov (United States)

    Barros, Marco Felipe Francisco Honorato; da Rocha Luz Júnior, Aurimar; Roncaglio, Bruno; Queiróz Júnior, Célio Pinheiro; Tribst, Marcelo Fernandes

    2015-01-01

    Objective To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. Material and methods This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. Results The DASH score improved from 65.17 to 16.53 six months after the operation (p dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. Conclusion Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result. PMID:26962490

  20. Association of Dental Practice as a Risk Factor in the Development of Carpal Tunnel Syndrome

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    Borhan Haghighi A.

    2013-03-01

    Full Text Available Statement of Problem: Carpal tunnel syndrome (CTS is an important cause of work disability. There is controversy over the relation between carpal tunnel syndrome and occupation. The aim of this study was to assess the relationship between the time-span of practicing dentistry and the role of dominant hands in the development of carpal tunnel syndrome.Materials and Method: In this descriptive cross sectional study, 40 dentists and dental students (15 women and 25 men undertook the electroneuro-diagnostic test in both hands by an electromyogram (EMG and they were also evaluated in terms of self- reported clinical symptoms.Results: 17.5% of participants were diagnosed to have decreased nerve conduction velocity while10% had reported clinical symptoms of CTS. Both dominant and non-dominant hands were involved. Within cases who were diagnosed as having median nerve neuropathy, 87.5% worked more than 20 hours per week. 57% had 17-23 years of dental practice experience and 14.2% of cases had10-16 years of practice in dentistry.Conclusion: The high rate of CTS symptoms, in both dominant and non-dominant hand among dental practitioners with more years of dental practice, indicates a prequisite for particular attention, then sufficient education on the major risk factors causing this problem. Early diagnosis of these symptoms may improve the future management of the disease.

  1. Estudo prospectivo comparativo entre a descompressão do canal do carpo pela mini-incisão transversa proximal e a incisão palmar longitudinal convencional Prospective comparative study between the proximal transverse incision and the conventional longitudinal incision for carpal tunnel release

    Directory of Open Access Journals (Sweden)

    Marcelo de Pinho Teixeira Alves

    2010-01-01

    frequent, employing various techniques. The goal of the surgery is to decompress the carpal tunnel, and by sectioning the transverse carpal ligament, releasing the median nerve. This paper's objective is to compare the surgical treatment of CTS by means of two incisions: the first is the classic longitudinal incision over the transverse carpal ligament, and the second is a mini-incision at the wrist crease and near the proximal border of the ligament. The mini-incision technique is a less invasive and equally effective technique for the treatment of CTS, with less morbidity when compared to the classic longitudinal incision.

  2. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals.

    Science.gov (United States)

    Kearns, Gary; Wang, Sharon

    2012-05-01

    This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS.

  3. Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

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    Dimitriou Christos G

    2007-08-01

    Full Text Available Abstract Background Leiomyomas of the deep soft tissue are quite uncommon and occur even more rarely in upper extremity. Case presentation A 32-year old manual laborer man presented with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed but the patient experienced only temporary relief of his symptoms. MRI examination revealed a deep palmary located mass with well-defined margins and ovoid shape. Intraoperatively, the tumor was in continuity with the flexor digitorum superficialis tendon of the middle finger causing substantial compression to median nerve. Histopathological findings of the resected mass were consistent with leiomyoma. After two years the patient was pain-free without signs of tumor recurrence. Conclusion Despite the fact that reports on deep soft tissue leiomyoma are exceptional, this tumor had to be considered as differential diagnosis in painful non-traumatic hand syndromes especially in young patients.

  4. [Diffuse tenosenovial giant cell tumor of the wrist revealed by carpal tunnel syndrome: report of a case].

    Science.gov (United States)

    Ait Essi, F; Younsi, A; Abkari, I; Benhima, M A; Najeb, Y; Latifi, M; Fakhri, A; Belaabidia, B

    2012-10-01

    Giant cell tumour of tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. It is the second most common soft tissue tumor of the hand after ganglion cyst. The localised (nodular) form is the most common. However, the less-common diffuse-type giant cell tumour is usually located in the peri-articular soft tissue. The authors report the case of a giant cell tumor of the tendon sheath arising from the carpal tunnel of the wrist in a 42-year-old woman. The patient presented a mild carpal tunnel syndrome and a mid-palmar swelling. We present an unusual localization of giant cell tumor of the tendon sheath, causing carpal tunnel syndrome.

  5. Randomized clinical trial of surgery versus conservative therapy for carpal tunnel syndrome [ISRCTN84286481

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    Turner Judith A

    2005-01-01

    Full Text Available Abstract Background Conservative treatment remains the standard of care for treating mild to moderate carpal tunnel syndrome despite a small number of well-controlled studies and limited objective evidence to support current treatment options. There is an increasing interest in the usefulness of wrist magnetic resonance imaging could play in predicting who will benefit for various treatments. Method and design Two hundred patients with mild to moderate symptoms will be recruited over 3 1/2 years from neurological surgery, primary care, electrodiagnostic clinics. We will exclude patients with clinical or electrodiagnostic evidence of denervation or thenar muscle atrophy. We will randomly assign patients to either a well-defined conservative care protocol or surgery. The conservative care treatment will include visits with a hand therapist, exercises, a self-care booklet, work modification/ activity restriction, B6 therapy, ultrasound and possible steroid injections. The surgical care would be left up to the surgeon (endoscopic vs. open with usual and customary follow-up. All patients will receive a wrist MRI at baseline. Patients will be contacted at 3, 6, 9 and 12 months after randomization to complete the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ. In addition, we will compare disability (activity and work days lost and general well being as measured by the SF-36 version II. We will control for demographics and use psychological measures (SCL-90 somatization and depression scales as well as EDS and MRI predictors of outcomes. Discussion We have designed a randomized controlled trial which will assess the effectiveness of surgery for patients with mild to moderate carpal tunnel syndrome. An important secondary goal is to study the ability of MRI to predict patient outcomes.

  6. Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel.

    Science.gov (United States)

    Kociolek, Aaron M; Tat, Jimmy; Keir, Peter J

    2015-02-05

    Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0° and 30° flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures.

  7. 不同手术方法治疗腕管综合征的临床疗效分析%Clinical effects of different surgical methods in the treatment of carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    陈浩宇; 王朝辉; 罗桦杰

    2012-01-01

    Objective To discuss the clinical effects and safety of treating carpal tunnel syndrome with two different surgical methods. Methods Fifty-eight patients with carpal tunnel syndrome were randomly divided into two groups. Group A (n=28) was treated by minimally invasive double small incision carpal tunnel release operation, and group B (n=30) was treated by endoscopic carpal tunnel release operation, and the patients were followed up for 14-36 months, then the clinical effects and safety of the two methods were analysed and evaluated. Results The excellent rate was 96.43% in group A and 96.67% in group B, snowing no statistically significant difference between the two groups (P>0.05). Group B got less postoperative complications and shorter time to return to work than group A (P<0.05). Conclusion The minimally invasive double small incision carpal tunnel release operation and the endoscopic carpal tunnel release operation are both effective in the treatment of carpal tunnel syndrome, but the latter is safer.%目的 探讨两种不同手术方法治疗腕管综合征的临床疗效和安全性.方法 对58例腕管综合征患者随机分为微创双小切口腕管松解术组(A组,28例)和内镜下腕管松解术组(B组,30例),随访14~36个月,主要观察术后并发症(包括瘢痕痛、手墩柱部痛、返支损伤及RSD)、恢复工作时间,并采用Kelly评定法评价临床疗效.结果 A组优良率为96.43%,B组优良率为96.67%,差异无统计学意义(P>0.05),B组的术后并发症及术后恢复工作时间优于A组(P<0 05).结论 微创双小切口腕管松解术及内镜下腕管松解术治疗腕管综合征都有效,但内镜下腕管松解的手术治疗方法更为安全.

  8. Prevalence of carpal tunnel syndrome and wrist osteoarthritis in long-term paraplegic patients compared with controls.

    Science.gov (United States)

    Akbar, M; Penzkofer, S; Weber, M A; Bruckner, T; Winterstein, M; Jung, M

    2014-02-01

    We compared functional and structural changes in the hands, in particular the prevalence of carpal tunnel syndrome, in 56 paraplegic patients who had been wheelchair dependent for over 25 years with a group of able-bodied volunteers (with matching criteria for gender and age). The hands were assessed by clinical examination, electrophysiology, disabilities of the arm shoulder and hand score and magnetic resonance imaging. Hand function was worse and wrist pain was experienced more often in the paraplegic patients, and they also had a significantly higher prevalence of carpal tunnel syndrome both clinically and electrophysiologically. The prevalence of wrist and trapeziometacarpal osteoarthritis was significantly higher in the right hand.

  9. Carpal tunnel syndrome during pregnancy%妊娠合并腕管综合征

    Institute of Scientific and Technical Information of China (English)

    孙丽洲; 刘丽萍

    2009-01-01

    文章提出了腕管综合征的病因与妊娠期水肿及体内激素水平变化有关,阐述了其临床表现、分级以及诊断,且目前以保守治疗为主.%The paper presents the etiology of carpal tunnel syndrome (CTS) is more likely to be rehted to edema and hormonal changes during pregnancy, and emphasizes the elinieal manifestation, classification and diagnosis. Conservative therapies are the most common initial treatments, especially during pregnancy.

  10. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.

    Science.gov (United States)

    Maeda, Yumi; Kim, Hyungjun; Kettner, Norman; Kim, Jieun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Ong-Sutherland, Rebecca; Mezzacappa, Pia; Libby, Alexandra; Mawla, Ishtiaq; Morse, Leslie R; Kaptchuk, Ted J; Audette, Joseph; Napadow, Vitaly

    2017-03-02

    Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor

  11. Critical analysis of the manoeuvres proposed for the diagnosis of the tunnel carpal syndrome

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    T. Vangelista

    2011-09-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy. It is mainly due to the compression of median nerve at the wrist and it may be idiopathic or secondary to different rheumatic or non rheumatic diseases, including occupational activities. Since signs and symptoms of CTS are characteristic, a careful examination of the affected patient may be very satisfactory for the diagnosis, in particular by mean of some manoeuvres. In this review we described and commented the tests considered most useful in the diagnosis of CTS. We also analysed the diagnostic values of electromiography, the most important electrodiagnostic study for the CTS.

  12. Low-power laser therapy for carpal tunnel syndrome: effective optical power

    OpenAIRE

    Yan Chen; Cheng-qiang Zhao; Gang Ye; Can-dong Liu; Wen-dong Xu

    2016-01-01

    Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efficacy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efficacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective op...

  13. Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors.

    Science.gov (United States)

    Andréu, José-Luis; Otón, Teresa; Silva-Fernández, Lucía; Sanz, Jesús

    2011-02-01

    Some occupational factors have been implicated in the development of disorders manifested as hand pain. The associations seem to be well documented in processes such as hand-arm vibration syndrome (HAVS) or writer's cramp. There are contradictory data in the literature about the relationships of trigger finger, De Quervain's tenosynovitis (DQT) and tenosynovitis of the wrist with occupational factors. In this article, we review current knowledge about clinical manifestations, case definition, implicated occupational factors, diagnosis and treatment of the most relevant hand pain disorders that have been associated with occupational factors, excluding carpal tunnel syndrome (CTS).

  14. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals

    OpenAIRE

    Kearns, Gary; Wang, Sharon

    2012-01-01

    This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomec...

  15. A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study.

    Science.gov (United States)

    Maddali Bongi, Susanna; Signorini, Massimo; Bassetti, Massimo; Del Rosso, Angela; Orlandi, Martina; De Scisciolo, Giuseppe

    2013-05-01

    In carpal tunnel syndrome (CTS), manual therapy interventions (MTI) reduce tissue adhesion and increase wrist mobility. We evaluated the efficacy of a MTI in relieving CTS signs and symptoms. Twenty-two CTS patients (pts) (41 hands) were treated with a MTI, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening; Phalen test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Median nerve was studied by sensory nerve conduction velocity (SNCV) and distal motor latency (DML). CTS was scored as minimal, mild, medium, severe and extreme. We considered as control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. At T0b, versus T0a, forearm pain and Phalen test positivity were increased and hand strength reduced (p < 0.05). BCTQ-SSS and BCTQ-FSS scores improved at T1 versus T0b (p < 0.05) with the amelioration maintained at T2. At T1, the number of pts with paresthesia, night awakening, hypoesthesia, Phalen test, hand strength reduction and hand sensitivity was reduced with the lacking of symptoms maintained at T2 (p < 0.05). No changes in SNCV, DML and CTS scoring were shown. MTI improved CTS signs and symptoms, with benefits maintained at follow-up. Thus, it may be valid as a conservative therapy.

  16. [Assessment of quality of pre- and postoperative information documents about carpal tunnel syndrome].

    Science.gov (United States)

    Facca, S; Sauleau, E; Robert, E; Gouzou, S; Clavert, P; Liverneaux, P

    2014-02-01

    Before surgery for carpal tunnel syndrome, oral patient information is partially understood and accepted. The objective of this study was to perform a documentation for patients, as recommended by the High Authority in Healthcare (HAS), then to compare the effectiveness of oral information. Our series included 37 patients who received the same information: preoperative shower, pathophysiology, and postoperative instructions. The first 18 (group 1) received only oral information. The following 19 (group 2) received oral, written and visual information. The information in Group 2 followed the methodology of McClune: promoter (Department of Hand Surgery), organizing committee (two teachers from the School of Decorative Arts, two teachers of the School of Medicine), group work (five art students, five medical students), panel of experts (three surgeons, two occupational therapists, one physiotherapist). Four documents were developed: a booklet, a diagram, an animation, a poster. Satisfaction was higher in group 2. Understanding and memorization were better in group 2. Fifty-six percent of patients in group 1 would have liked a paper, 12.5% videos, none went on the Internet. Twelve and a half percent of the patients in group 2 went on the Internet, 18.8% would have liked videos. Our results show that in terms of carpal tunnel syndrome, the written and visual information materials for patients significantly improve the efficacy of oral information. These documents may be extended to other pathologies in Hand Surgery.

  17. Conservative treatment of carpal tunnel syndrome: comparison between laser therapy and Fascial Manipulation(®).

    Science.gov (United States)

    Pratelli, Elisa; Pintucci, Marco; Cultrera, Pina; Baldini, Enrico; Stecco, Antonio; Petrocelli, Antonio; Pasquetti, Pietro

    2015-01-01

    The etiopathogenesis of Carpal Tunnel Syndrome (CTS) is multifactorial and most cases are classified as idiopathic (Thurston 2013). A randomized controlled trial was performed to compare the effectiveness of Fascial Manipulation(®) (FM) and Low-Level Laser Therapy (LLLT) for CTS. This prospective trial included 42 patients (70 hands with symptoms) with clinical and electroneuromyographic diagnosis of CTS. The patients were randomly assigned to receive multiple sessions of FM or multiple session of LLLT. The Visual Analogic Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were performed at baseline, end of treatment and after three months. The group that received FM showed a significant reduction in subjective pain perception and an increased function assessed by BCTQ at the end of the treatment and follow-up. The group that received LLLT showed an improvement in the BCTQ at the end of the treatment but the improvement level was not sustained at the three month follow-up. FM is a valid alternative treatment for CTS.

  18. Carpal tunnel syndrome and the use of computer mouse and keyboard: A systematic review

    Directory of Open Access Journals (Sweden)

    Atroshi Isam

    2008-10-01

    Full Text Available Abstract Background This review examines evidence for an association between computer work and carpal tunnel syndrome (CTS. Methods A systematic review of studies of computer work and CTS was performed. Supplementary, longitudinal studies of low force, repetitive work and CTS, and studies of possible pathophysiological mechanisms were evaluated. Results Eight epidemiological studies of the association between computer work and CTS were identified. All eight studies had one or more limitation including imprecise exposure and outcome assessment, low statistical power or potentially serious biases. In three of the studies an exposure-response association was observed but because of possible misclassification no firm conclusions could be drawn. Three of the studies found risks below 1. Also longitudinal studies of repetitive low-force non-computer work (n = 3 were reviewed but these studies did not add evidence to an association. Measurements of carpal tunnel pressure (CTP under conditions typically observed among computer users showed pressure values below levels considered harmful. However, during actual mouse use one study showed an increase of CTP to potentially harmful levels. The long term effects of prolonged or repeatedly increased pressures at these levels are not known, however. Conclusion There is insufficient epidemiological evidence that computer work causes CTS.

  19. Levels of endocrine hormones and lipids in male patients with carpal tunnel syndrome

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    Hülya Uzkeser

    2011-12-01

    Full Text Available Objectives: This study was performed to evaluate the relationship between endocrine hormones, lipid levels and clinical parameters in male patients with carpal tunnel syndrome (CTS.Materials and methods: Fifteen male patients with CTS and 16 healthy controls were included in the study. Serum free T3, free T4, thyroid-stimulating hormone (TSH, free testosterone, dehydroepiandrosterone sulfate, triglyceride and total cholesterol levels were analyzed. Symptom severity and hand function were assessed using the Boston Carpal Tunnel Questionnaire in clinical examination.Results: Serum free T3, free T4, TSH, free testosterone, dehydroepiandrosterone sulfate, triglyceride and total cholesterol levels were similar between CTS patients and controls (p> 0.05. Also, there was no statistically significant correlation between laboratory parameters and clinical characteristics in patients with CTS (p> 0.05.Conclusion: The serum free T3, free T4, TSH, free testosterone, dehydroepiandrosterone sulfate, triglyceride and total cholesterol levels seem within normal range in male CTS patients. Further studies are needed to investigate association endocrine factors, lipid levels such as triglyceride and total cholesterol with CTS in male and female patients.

  20. Duration of symptomatology and median segmental sensory latency in 993 carpal tunnel syndrome hands (668 cases

    Directory of Open Access Journals (Sweden)

    KOUYOUMDJIAN JOAO ARIS

    1999-01-01

    Full Text Available According to median sensory nerve action potential onset-latency to index finger in a 140 mm fixed distance, 993 carpal tunnel syndrome (CTS hands from 668 patients were grouped into MIld (3.0 to 3.5 ms, 384 hands, MOderate (3.6 to 4.4 ms, 332 hands, SEvere (> 4.4 ms, 135 hands and UNrecordable (142 hands and correlated with CTS symptomatology duration. All patients have sensory antidromic median-radial latency difference (MRD e > or = 1.0 ms without any doubt about CTS diagnosis. Patients with systemic disease, trauma or previous surgery were excluded. There is a remarkable cumulative percentage increase from 1 to 12 months in group UN (3.5% to 38.7%, 11 folds, much less than the group MI (13.8% to 54.6%, 3.9 folds. There is also a remarkable non-cumulative percentage increase in group UN, from 1 to 4-12 months; the group MI had a relatively uniform distribution in all symptomatic duration groups from 1 to > 60 months. The conclusion is that median nerve compression at carpal tunnel can lead to unrecordable potentials in a relatively short period from 1 to 12 months of evolution, suggesting acute/subacute deterioration. Electrophysiological evaluation must be done periodically in patients that underwent clinical treatment, since cumulative 38.7% of group UN was found in 12 months period.

  1. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Khalil, C.; Hancart, C.; Thuc, V.Le; Cotten, A. [Service de Radiologie Osteoarticulaire, Hopital Roger Salengro, CHRU de Lille (France); Chantelot, C. [Clinique d' Orthopedie, Hopital Roger Salengro, CHRU de Lille (France); Chechin, D. [Philips Medical Systems, Suresnes (France)

    2008-10-15

    The purpose was to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and tractography of the human median nerve with a 1.5-T MR scanner and to assess potential differences in diffusion between healthy volunteers and patients suffering from carpal tunnel syndrome. The median nerve was examined in 13 patients and 13 healthy volunteers with MR DTI and tractography using a 1.5-T MRI scanner with a dedicated wrist coil. T1-weighted images were performed for anatomical correlation. Mean fractional anisotropy (FA) and mean apparent diffusion coefficient (ADC) values were quantified in the median nerve on tractography images. In all subjects, the nerve orientation and course could be detected with tractography. Mean FA values were significantly lower in patients (p=0.03). However, no statistically significant differences were found for mean ADC values. In vivo assessment of the median nerve in the carpal tunnel using DTI with tractography on a 1.5-T MRI scanner is possible. Microstructural parameters can be easily obtained from tractography images. A significant decrease of mean FA values was found in patients suffering from chronic compression of the median nerve. Further investigations are necessary to determine if mean FA values may be correlated with the severity of nerve entrapment. (orig.)

  2. An epidemiological profile of cashiers holders carpal tunnel syndrome in a grocery store chain.

    Science.gov (United States)

    Costa, R; Barros, R; Campos, D; Lima, D; Barbosa, Geórgia

    2012-01-01

    Occupational diseases are those acquired in the work. Statistics show an increase number of cases, victims like typists, telephone's operators, cashiers and many others with varied levels of involvement. It is composed of disorders affecting the upper limbs being recognized by the Ministry of Social Welfare. Among these diseases stands out for its high occurrence Carpal Tunnel Syndrome (CTS). It has been considered a disease of the century, because its incidence has increased in 40.8% of repetitive stress disorders, with prevalence in females, and predominant age ranging from 25 to 40 years. It is characterized by pain and paresthesia in the first four fingers and wrists, and arm pain, weakness, numbness in the territory of the median nerve, preserving or not the palmar sensation and numbness in the median sensory distribution. This study aims to assess functional capacity and severity of symptoms presented by cashiers diagnosed with CTS. It is a descriptive and quantitative in nature. The population consists of 13 grocery store cashiers of both sexes, with a workload of 42 hours. We will be used as an instrument called the Boston Carpal Tunnel Questionnaire. That purports to be an effective means of measuring the numbness and pain in hands and wrists. Exclusion criteria we consider the subjects who have other diseases associated with CTS. The collection is with the possibility of partial results to be entered in a spreadsheet in Microsoft Excel for data analysis and subsequent discussion and correlation with the current literature.

  3. High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Takatoshi; Oki, Hodaka; Kinoshita, Shunsuke; Yamashita, Yoshiko; Takahashi, Hiroyuki; Hayashida, Yoshiko; Korogi, Yukunori [University of Occupational and Environmental Health School of Medicine, Department of Radiology, Kitakyushu (Japan); Oshige, Takahisa; Sakai, Akinori [University of Occupational and Environmental Health School of Medicine, Department of Orthopaedic Surgery, Kitakyushu (Japan); Matsuyama, Atsushi; Hisaoka, Masanori [University of Occupational and Environmental Health School of Medicine, Department of Pathology and Oncology, Kitakyushu (Japan)

    2014-03-15

    To correlate median nerve T2 signal and shape at the carpal tunnel with steroid injection (SI) response in carpal tunnel syndrome (CTS) patients. One hundred and sixty-three CTS wrists of 92 consecutive patients who were scheduled to undergo SI were prospectively evaluated with 3-T magnetic resonance imaging (MRI) and a nerve conduction study. All patients underwent axial high-resolution T2-weighted MRI (in-plane resolution of 0.25 x 0.25 mm). The CTS wrists were classified into three groups according to the nerve T2 signal and the flattening ratio at the hook of hamate level: group 1, high and oval; group 2, high and flat; group 3, low and flat. Clinical response to SI was evaluated at 6 months after injection. One hundred and thirteen of the 163 wrists (69.3 %) responded well to SI. The percentage of improvement was 81.7 % (49/60) in group 1, 69.9 % (51/73) in group 2, and 43.3 % (13/30) in group 3 (P < 0.01). On stepwise logistic regression analysis high-resolution MRI was the only significant independent factor for SI response in CTS patients (P < 0.01). High-resolution MRI correlates well with SI response in CTS patients and seems useful for predicting SI response. (orig.)

  4. Evaluation of the function status of the ulnar nerve in carpal tunnel syndrome.

    Science.gov (United States)

    Zhang, J; Liu, N; Wang, Y W; Zhang, Z C; Zheng, L N; Zhu, J

    2015-04-17

    Many carpal tunnel syndrome (CTS) patients have symptoms in both the median and ulnar digits more frequently than in the median digits alone. This is possibly because of close anatomical contiguity of the carpal tunnel and Guyon's canal, and the high pressure may also affect the latter, causing indirect compression of ulnar nerve fibers. Thus, we evaluated the functional status of the ulnar nerve in patients with CTS in order to investigate the relationship between ulnar nerve impairment and sensory symptoms of the ulnar territory. Electrophysiological studies were conducted in CTS patients and healthy controls. CTS patients were divided into the mild/moderate group and severe group; they were further divided into the symptomatic and asymptomatic subgroups according to the sensory symptom of the fifth digit region. The findings suggest that CTS patients could have coexisting ulnar nerve wrist entrapments that might exacerbate the severity of CTS. Sensory impairment in the ulnar territory was observed more frequently in the mild/moderate stage of CTS, which is associated with ulnar nerve involvement. These findings also suggest that damage to the ulnar nerve fibers caused by compression forces in Guyon's canal may underlie the ulnar spread of symptoms in CTS.

  5. Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients

    Directory of Open Access Journals (Sweden)

    Mark van Suchtelen

    2014-09-01

    Full Text Available Background:  This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS over time according to median nerve distal motor latency (DML on two electrodiagnostic tests.   Methods:  This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and  tober 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results: The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months. The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038. The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P =0.015.  Conclusions: There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.

  6. Clinical Outcome and Wound Healing following Carpal Tunnel Decompression: A Comparison of Two Common Suture Materials

    Directory of Open Access Journals (Sweden)

    Robert J. MacFarlane

    2014-01-01

    Full Text Available Introduction. Debate exists amongst surgeons regarding the ideal suture material for skin closure in carpal tunnel decompression (CTD. This study compares wound related complications, patient satisfaction, and functional outcome following open carpal tunnel decompression in patients undergoing wound closure with either of two common absorbable and nonabsorbable suture types. Materials and Methods. 53 patients underwent CTD with either 4/0 polypropylene (ProleneTM, n = 28 or 4/0 polyglactin (Vicryl RapideTM, n = 25 for skin closure. QuickDASH, VAS satisfaction scores, and Southampton wound scores were assessed preoperatively and at 2 and 6 weeks postoperatively. Results. At 6 weeks the mean QuickDASH scores postoperatively were 18.54 and 17.70 for absorbable and nonabsorbable sutures, respectively, (P = 0.86. The mean VAS scores were 0.61 and 0.42 (P = 0.91, respectively. All patients achieved a Southampton wound score of 0 by 6 weeks except one, who achieved 1C in the nonabsorbable group, equivalent to mild erythema. There were no complications in either group. Conclusion. Both suture types are safe and effective materials for CTD, and we recommend surgeons to choose according to personal preference, handling properties, and resources available for suture removal.

  7. Avaliação clínica a longo prazo - pelo sinal de Phalen, Tinel e parestesia noturna - dos pacientes submetidos a cirurgia de liberação do túnel do carpo com instrumento de Paine® Long-term clinical evaluation - by Phalen, Tinel sign and night paresthesia - of patients submitted to carpal tunnel release surgery with Paine® retinaculatome

    Directory of Open Access Journals (Sweden)

    Sergio Eiti Carbone de Paula

    2006-01-01

    Full Text Available A liberação do retináculo dos flexores para o tratamento da síndrome do túnel do carpo (STC é uma das cirurgias mais realizadas. Existem diversos métodos para a realização deste procedimento cirúrgico, como endoscópicos, via aberta clássica e mini-incisões. A longo prazo, poucos trabalhos mostram os resultados destas cirurgias. Este estudo tem como finalidade avaliar os pacientes submetidos à liberação do túnel do carpo com instrumento de Paine®, com no mínimo 84 meses de pós-operatório. Foram avaliados os parâmetros clínicos: teste de Phalen, sinal da percussão dolorosa e a queixa de parestesia noturna no pré e pós-operatório. Os resultados mostram que há significante melhora dos sinais avaliados (p....., quando comparados com a avaliação inicial, e que estes sinais clínicos permanecem negativos ao longo do tempo.The release of flexors retinaculum for carpal tunnel syndrome (CTS treatment is one of the most frequently performed surgeries. There are many methods for performing this surgical procedure, such as endoscopic, classical open port and mini-incisions. Few papers show the long-term results of those surgeries. This study is aimed to evaluate patients submitted to carpal tunnel syndrome release using the Paine® instrument, in at least 84 months postoperatively. The following clinical parameters were assessed: Phalen test, painful percussion sign, and complaints of nighttime paresthesia pre- and postoperatively. The results show that there is a significant improvement of the signs assessed (p....., when compared to baseline evaluation, and that those clinical signs remain negative with time.

  8. Type 2 diabetes seems not to be a risk factor for the carpal tunnel syndrome : a case control study

    NARCIS (Netherlands)

    Hendriks, Steven H.; van Dijk, Peter R.; Groenier, Klaas H.; Houpt, Peter; Bilo, Henk J. G.; Kleefstra, Nanne

    2014-01-01

    BACKGROUND: Previous studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycaemic control. Primary aim was to determine if type

  9. Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

    Science.gov (United States)

    Hernández-Cortés, P; Caba, M; Gómez-Sánchez, R; Gómez-Morales, M

    2011-11-09

    The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.

  10. Speckle-Tracking Sonographic Assessment of Longitudinal Motion of the Flexor Tendon and Subsynovial Tissue in Carpal Tunnel Syndrome

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Yoshii, Yuichi; Henderson, Jacqueline; Villarraga, Hector R.; Moran, Steven L.; Amadio, Peter C.

    2012-01-01

    Objectives-The aim of this study was to image both tendon and subsynovial connective tissue movement in patients with carpal tunnel syndrome and healthy control volunteers, using sonography with speckle tracking. To estimate accuracy of this tracking method, we used in vivo measurements during surge

  11. Battling Carpal Tunnel Syndrome through Ergonomics: A Case Study of Texas A&M's Library Provides Insights and Answers.

    Science.gov (United States)

    Thornton, Joyce K.

    1995-01-01

    Current library automation practices and new technologies have forced library managers to seek some means of reducing carpal tunnel syndrome, and a case study of Texas A&M's library provides insights. Highlights include identifying and assessing the injuries, adjusting work surfaces, testing and selecting new keyboards, and developing adjustable…

  12. Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements

    NARCIS (Netherlands)

    Y. Wang (Yuexiang); C. Zhao; S.M. Passe (Sandra); A. Filius (Anika); A.R. Thoreson (Andrew); P. An (Ping); P.C. Amadio (Peter )

    2014-01-01

    textabstractThe symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. To better understand the biomechanics of the abnormal nerve, it is first necessary to und

  13. Wrist small transverse incision treating carpal tunnel syndrome%腕部小横切口治疗腕管综合征

    Institute of Scientific and Technical Information of China (English)

    赵海涛; 胡旭梅

    2016-01-01

    Objective Design and application of small transverse incision for carpal tunnel release surgery, and analyze the treatment of carpal tunnel syndrome curative effect. Methods In palmaris longus muscle feet side distal cross striation 2cm long incision to expose the transverse carpal ligament near the edge and flexor tendon. Resection of edema of the flexor tendon synovial membrane. In the open under the transverse carpal ligament resection. Results Postoperative follow-up for 2 weeks, 32 cases of symptoms completely disappeared, thumb, shown in 3 finger two-point discrimination sense recovered to normal. Postoperative 1-year follow-up, 19 patients with preoperative fish muscle atrophy, muscle atrophy was significantly improved, the thumb opponens function recovered to normal. No cases of carpometacarpe scar pain and ulnar nerve and superficial palmar arch damage and Complications.Conclusion Small incision euthyphoria wrist carpal tunnel release, is a new effective method.%目的:设计及应用小横切口作腕管松解术,并分析其治疗腕管综合征的疗效。方法在掌长肌尺侧,远侧横纹作2cm 长的切口,显露腕横韧带近缘及指屈肌腱。切除水肿的屈肌腱滑膜。在直视下将腕横韧带部分切除。结果术后随访2周,32例的症状完全消失,拇、示、中3指指腹两点辨别觉恢复正常。术后1a 随访,19例术前大鱼肌萎缩者,肌萎缩明显改善,拇指对掌功能恢复正常。无1例产生腕掌部瘢痕痛及尺神经、掌浅弓损伤等并发症。结论腕部小切口直视下行腕管松解术,是一种有效的新方法。

  14. Treatment of carpal tunnel syndrome with atgesia%感觉过敏型腕管综合征的治疗

    Institute of Scientific and Technical Information of China (English)

    顾玉东; 史其林; 陈德松; 王涛; 张丽银

    2008-01-01

    Objective To report the treatment of 7 cases of carpal tunnel syndrome(CTS)with algesia.Methods One hundred and twenty eight cases of carpal tunnel syndrome within the period of March 2002 and March 2005 were retrospectively analyzed.There were 7 cases(4 female and 3 male)had algesia,4 cases were treated with endoscopic management of carpal tunnel release (ECTR) and 3 cases were treated with open management of carpal tunnel release(OCTR).These 7 cases were followed-up 1-4years(average 1.5 years)postoperatively.Results Two ECTR cases and 2 OCTR cases had bad therapeutic effect and the others had good effect.Both 2 bad-effect ECTR cases feel special pain when insert the catheter.Only inject Triamcinolone Acetonide-A within epineurium after completely release in the goodeffect OCTR ease.Conclusion CTS with algesia is a special type of CTS,the key to treat it is to protect epineurium.%目的 报道7例感觉过敏型腕管综合征的诊治特点.方法 收集与分析2002年3月至2005年3月间128例腕管综合征中感觉过敏型7例的病情及治疗特点.其中女性4例、男性3例.4例应用内镜治疗,3例切开治疗,经1~4年随访,平均随访时间1.5年.结果 内镜治疗中2例疗效差,均在术中插入扩张导管时出现异常疼痛,另外2例基本满意.3例切开治疗中,2例疗效差,1例基本满意.3例基本满意中,2例内镜插入导管时均未出现疼痛,另1例为单纯切断腕横韧带,并在神经外膜下注射激素.结论 感觉过敏型腕管综合征是一组特殊病例,保护神经外膜是治疗关键.

  15. Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome

    Science.gov (United States)

    Ren, Yi-Ming; Wang, Xi-Shan; Wei, Zhi-Jian; Fan, Bao-You; Lin, Wei; Zhou, Xian-Hu; Feng, Shi-Qing

    2016-01-01

    Abstract Background: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disease. Either surgical or conservative intervention for CTS patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical efficacy, safety, and cost of surgical versus nonsurgical intervention. Methods: The eligible studies were acquired from PubMed, Medline, Embase, Web of Science, Google, and Cochrane Library. The data were extracted by 2 of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias. Results: Thirteen studies including 9 randomized controlled trials (RCTs) and 4 observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The difference of clinical efficacy was statistically significant between surgical and nonsurgical intervention, and nonsurgical treatment was more effective (OR = 2.35, 95%CI = 1.18–4.67, P = 0.01). Meanwhile, different results were discovered by subgroup analysis. The pooled results of function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care at different follow-up times showed that the differences were not statistically significant between the 2 interventions. The difference of complications and side-effects was statistically significant and conservative treatment achieved better result than surgery (OR = 2.03, 95%CI = 1.28–3.22, P = 0.003). Sensitivity analysis proved the stability of the pooled results. Conclusion: Both surgical and conservative interventions had benefits in CTS. Nonsurgical treatment was more effective and safety than surgical treatment, but there were no significant differences in function improvement, symptom improvement, neurophysiological

  16. The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study

    Science.gov (United States)

    Marschall, Alexander; Ficjian, Anja; Husic, Rusmir; Zauner, Dorothea; Seel, Werner; Simmet, Nicole E.; Klammer, Alexander; Heizer, Petra; Brickmann, Kerstin; Gretler, Judith; Fürst-Moazedi, Florentine C.; Thonhofer, Rene; Hermann, Josef; Graninger, Winfried B.; Quasthoff, Stefan; Dejaco, Christian

    2016-01-01

    Objectives To investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS). Methods Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models. Results Short-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes. Conclusions Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings. PMID:27662617

  17. The responsiveness of sensibility and strength tests in patients undergoing carpal tunnel decompression

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    Miller Leanne

    2011-10-01

    Full Text Available Abstract Background Several clinical measures of sensory and motor function are used alongside patient-rated questionnaires to assess outcomes of carpal tunnel decompression. However there is a lack of evidence regarding which clinical tests are most responsive to clinically important change over time. Methods In a prospective cohort study 63 patients undergoing carpal tunnel decompression were assessed using standardised clinician-derived and patient reported outcomes before surgery, at 4 and 8 months follow up. Clinical sensory assessments included: touch threshold with monofilaments (WEST, shape-texture identification (STI™ test, static two-point discrimination (Mackinnon-Dellon Disk-Criminator and the locognosia test. Motor assessments included: grip and tripod pinch strength using a digital grip analyser (MIE, manual muscle testing of abductor pollicis brevis and opponens pollicis using the Rotterdam Intrinsic Handheld Myometer (RIHM. The Boston Carpal Tunnel Questionnaire (BCTQ was used as a patient rated outcome measure. Results Relative responsiveness at 4 months was highest for the BCTQ symptom severity scale with moderate to large effects sizes (ES = -1.43 followed by the BCTQ function scale (ES = -0.71. The WEST and STI™ were the most responsive sensory tests at 4 months showing moderate effect sizes (WEST ES = 0.55, STI ES = 0.52. Grip and pinch strength had a relatively higher responsiveness compared to thenar muscle strength but effect sizes for all motor tests were very small (ES ≤0.10 or negative indicating a decline compared to baseline in some patients. Conclusions For clinical assessment of sensibility touch threshold assessed by monofilaments (WEST and tactile gnosis measured with the STI™ test are the most responsive tests and are recommended for future studies. The use of handheld myometry (RIHM for manual muscle testing, despite more specifically targeting thenar muscles, was less responsive than grip or tripod

  18. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

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    Chung, Vincent C.H.; Ho, Robin S.T.; Liu, Siya; Chong, Marc K.C.; Leung, Albert W.N.; Yip, Benjamin H.K.; Griffiths, Sian M.; Zee, Benny C.Y.; Wu, Justin C.Y.; Sit, Regina W.S.; Lau, Alexander Y.L.; Wong, Samuel Y.S.

    2016-01-01

    Background: The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods: We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results: Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] −0.20, 95% confidence interval [CI] −0.36 to −0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD −6.72, 95% CI −10.9 to −2.57), function (Functional Status Scale score MD −0.22, 95% CI −0.38 to −0.05), dexterity (time to complete blinded pick-up test MD −6.13 seconds, 95% CI −10.6 to −1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale −0.70, 95% CI −1.34 to −0.06), and not significant for sensation (first finger monofilament test −0.08 mm, 95% CI −0.22 to 0.06). Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting. Trial registration: Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health

  19. Surgical treatment of synovial hyperplasia carpal tunnel syndrome%滑膜增生型腕管综合征的手术治疗

    Institute of Scientific and Technical Information of China (English)

    李建强; 姜保国; 陈建海; 付中国; 王天兵

    2014-01-01

    Background Carpal tunnel syndrome is the most common compressive peripheral neuropathy,which is a couple of clinical syndromes caused by the oppression of the median nerve in the carpal tunnel.The tough of the transverse carpal ligament and thickness of its edge are the major factors in the oppression of the median nerve.Under normal circumstances,there is a large amount of tendon synovial in the carpal tunnel,which plays a role of nutrition and lubrication to the nerve. However,the tendon synovial hyperplasia,or even congestion and edema can cause or aggravate the oppression of the median nerve.Also,it will cause an inflammatory stimulate to the nerve.The major clinical manifestations of carpal tunnel syndrome are numbness and pain of three and a half fingers of the radial side.Usually,the pain radiates to the hand and forearm,accompanied with dysfunction of thumb opposition,thenar muscle atrophy and decreased grip and pinch strength.But in the synovial hyperplasia carpal tunnel syndrome,because of increased congestion at night and reflux disorder,there will be a significant night pain and numbness,which sometimes even makes the patients awake at a fixed time at night.These are the typical symptoms of synovial hyperplasia carpal tunnel syndrome. When the patients wake up,many will activate the fingers and wrists to relieve the pain,which promotes the synovial reflux in the carpal tunnel and reduces the pressure of carpal tunnel.As such reasons,there will be a phenomenon that clinical manifestations in the resting state do not fully meet the electrophysiological examination after activity.Patients who were diagnosed as synovial hyperplasia carpal tunnel syndrome were admitted to our hospital.We performed transverse carpal ligament release,carpal tunnel decompression,synovial tissue removal and median nerve release.The purpose of this study is to describe clinical characteristics of synovial hyperplasia carpal tunnel syndrome and analyzes the outcome of treatment

  20. Spatial-temporal features of thermal images for Carpal Tunnel Syndrome detection

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    Estupinan Roldan, Kevin; Ortega Piedrahita, Marco A.; Benitez, Hernan D.

    2014-02-01

    Disorders associated with repeated trauma account for about 60% of all occupational illnesses, Carpal Tunnel Syndrome (CTS) being the most consulted today. Infrared Thermography (IT) has come to play an important role in the field of medicine. IT is non-invasive and detects diseases based on measuring temperature variations. IT represents a possible alternative to prevalent methods for diagnosis of CTS (i.e. nerve conduction studies and electromiography). This work presents a set of spatial-temporal features extracted from thermal images taken in healthy and ill patients. Support Vector Machine (SVM) classifiers test this feature space with Leave One Out (LOO) validation error. The results of the proposed approach show linear separability and lower validation errors when compared to features used in previous works that do not account for temperature spatial variability.

  1. Wheelchair ergonomic hand drive mechanism use improves wrist mechanics associated with carpal tunnel syndrome.

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    Zukowski, Lisa A; Roper, Jaimie A; Shechtman, Orit; Otzel, Dana M; Hovis, Patty W; Tillman, Mark D

    2014-01-01

    Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression.

  2. Prevalence of carpal tunnel syndrome in cases with migraine and tension type headache

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    Volkan Solmaz

    2015-02-01

    Full Text Available Background: Carpal Tunnel Syndrome (CTS is the most frequent entrapment neuropathy; also Tension Type Headache (TTH and migraine headache are the most common forms of headaches. The aim of this study is to determine whether there is a relationship between carpal tunnel syndrome and migraine and/or TTH, and if so, to determine the factors causing this relationship. Methods: This study included 201 patients who were electro-physiologically diagnosed with idiopathic CTS and 100 controls. In addition to being examined for headaches, each patient's Body Mass Index (BMI was determined, and each was evaluated with Boston Questionnaire Form (BQF and a Beck Depression Scale (BDS. Results: The CTS group had significantly more patients with TTH and migraine headache than did the control group. In addition, the CTS group had a significantly higher frequency of headaches, and significantly higher BDS and BMI than did the controls. There were no significant differences in headache type and frequency of headache between those with mild CTS and those with mild-serious CTS. In addition, the Boston scores of CTS patients with headache were higher than those CTS patients without headache. Further, the monthly income levels of patients with CTS were lower than those of the control group. Conclusion: We found that primary headache is more frequent in CTS patients than in controls. This may be due to somato-autonomic reflexes and other common risk factors that can be seen in both CTS patients and those with headache, including obesity, depression and low level of income. [Int J Res Med Sci 2015; 3(2.000: 456-460

  3. A study of interpolation method in diagnosis of carpal tunnel syndrome

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    Alireza Ashraf

    2013-01-01

    Full Text Available Context: The low correlation between the patients′ signs and symptoms of carpal tunnel syndrome (CTS and results of electrodiagnostic tests makes the diagnosis challenging in mild cases. Interpolation is a mathematical method for finding median nerve conduction velocity (NCV exactly at carpal tunnel site. Therefore, it may be helpful in diagnosis of CTS in patients with equivocal test results. Aim: The aim of this study is to evaluate interpolation method as a CTS diagnostic test. Settings and Design: Patients with two or more clinical symptoms and signs of CTS in a median nerve territory with 3.5 ms ≤ distal median sensory latency <4.6 ms from those who came to our electrodiagnostic clinics and also, age matched healthy control subjects were recruited in the study. Materials and Methods: Median compound motor action potential and median sensory nerve action potential latencies were measured by a MEDLEC SYNERGY VIASIS electromyography and conduction velocities were calculated by both routine method and interpolation technique. Statistical Analysis Used: Chi-square and Student′s t-test were used for comparing group differences. Cut-off points were calculated using receiver operating characteristic curve. Results: A sensitivity of 88%, specificity of 67%, positive predictive value (PPV and negative predictive value (NPV of 70.8% and 84.7% were obtained for median motor NCV and a sensitivity of 98.3%, specificity of 91.7%, PPV and NPV of 91.9% and 98.2% were obtained for median sensory NCV with interpolation technique. Conclusions: Median motor interpolation method is a good technique, but it has less sensitivity and specificity than median sensory interpolation method.

  4. Predictors of normal electrodiagnostic testing in the evaluation of suspected carpal tunnel syndrome.

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    Watson, Jeffrey; Zhao, Meijuan; Ring, David

    2010-12-01

    Electrodiagnostic studies (electromyography and nerve conduction velocity; EMG/NCV) are used to confirm the diagnosis of carpal tunnel syndrome (CTS) and to evaluate its severity. We investigated the hypothesis that normal electrodiagnostic median nerve testing is predicted by 1) Physician pre-test confidence in the diagnosis of CTS, and 2) Puzzling patient factors. One hundred and forty consecutive patients who underwent electrodiagnostic testing to evaluate for possible CTS were reviewed retrospectively. Both physician confidence in the diagnosis of CTS and puzzling patient factors (heightened illness concern, disproportionate complaints, and vague/nonanatomical/noncharacteristic symptoms) were recorded. Electrodiagnostic testing was used as the reference standard for diagnosis of CTS. Electrodiagnostic testing confirmed CTS in 115 patients and was within normal limits in 25 patients. Low physician confidence in the diagnosis of CTS was highly predictive of a normal electrodiagnostic test (p < 0.001), with high sensitivity (97%), moderate specificity (40%), and high overall accuracy (87%). Puzzling patient factors were moderately predictive of normal electrodiagnostic testing (p < 0.001), with low sensitivity (16%), high specificity (96%), and high overall accuracy (81%). The best multivariable model retained younger age, negative Phalen's test, and low physician confidence as the best predictors of normal electrodiagnostic testing and explained 35% of the variation in test results. A model with low confidence alone explained 19% of the variation in test results. Physician intuition as recorded in the medical record in terms of puzzlement and low confidence are very specific and accurate predictors of normal electrodiagnostic testing in the setting of suspected carpal tunnel syndrome.

  5. Short-distance sensory stimulation technique in the early diagnosis of carpal tunnel syndrome

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    Betül Çevik

    2013-12-01

    Full Text Available Aim. Normal results obtained from nerve conduction studies do not exclude the diagnosis of carpal tunnel syndrome (CTS. We intended to increase diagnostic sensitivity of nerve conduction studies in the early stage CTS by stimulating shorter palm-wrist segment, and excluding distal region outside the entrapment site of the median nerve which is unaffected from pathologic changes. Methods. In this prospective study, 41 patients (66 hands with clinically diagnosed CTS with normal conventional electrophysiologic examinations were stimulated with electrodes placed at 8, 7, 6, 5, 4 cm from the distal wrist crease (DWC on the palm-wrist segment, and the conduction velocities, latencies, and the differential latencies (conduction delay were compared with those of 34 patients (68 hands in the control group. Results. Conduction delay recorded between 4-5, 5-6, 6-7, 7-8 cm. away from DWC of both groups was statistically insignificant (p>0.1, while the conduction velocities and the latencies obtained from the electrodes placed on 4, 5, 6, 7, and 8 cm away from DWC differed statistically significantly between two groups (p<0.001. Conclusion. In electrophysiologic examinations performed to confirm the diagnosis of CTS, assessment of shorter palm-wrist segment, and stimulation of a predetermined location 4 or 5 cm distal to DWC are sufficient to detect a slight and localized conduction delay in the carpal tunnel. This method eliminated slowing-down effect of distal segment on normal nerve conduction velocities yielding higher degrees of (up to 92.4 % sensitivity.

  6. Enhanced expression of Wnt9a in the flexor tenosynovium in idiopathic carpal tunnel syndrome.

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    Yamanaka, Yoshiaki; Menuki, Kunitaka; Zenke, Yukichi; Hirasawa, Hideyuki; Sakai, Akinori

    2015-10-01

    This study aimed to clarify the association between abnormal Wnt signaling and the cause of idiopathic carpal tunnel syndrome (ICTS) and whether an association exists between Wnt signaling and cell proliferation in the flexor tenosynovium. The subjects included nine patients with ICTS; the controls were nine patients with distal radius fractures without any symptoms of carpal tunnel syndrome. We extracted mRNA from the flexor tenosynovium and compared the expression levels of genes encoding 17 types of Wnt in both subjects and controls via quantitative real-time polymerase chain reaction (PCR). Expression levels of factors involved in cell proliferation, such as estrogen-responsive finger protein, epidermal growth factor receptor, heparin binding-epidermal growth factor-like growth factor, insulin-like growth factor-1, and vascular endothelial growth factor (VEGF) were also measured using quantitative real-time PCR. In addition, we compared the Wnt and MIB-1 protein expression levels to clarify the effect of Wnt on cell proliferation. Quantitative real-time PCR revealed significantly greater expression of the gene encoding Wnt9a in subjects with ICTS than in controls and also revealed a positive correlation between the expression of genes encoding Wnt9a and VEGF in subjects with ICTS. Quantitative evaluation using immunohistochemical staining also indicated more marked Wnt9a expression in subjects than in controls. However, there was no relationship between the expression of Wnt9a and the cell proliferation index MIB-1. These results indicate that Wnt9a expression is enhanced in ICTS and that Wnt9a may be involved in VEGF expression in ICTS.

  7. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome.

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    Tai-Tzung Kuo

    Full Text Available Carpal tunnel syndrome (CTS is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS. Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion-extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for

  8. Effect of Wrist Deviation on Median Nerve Cross-Sectional Area at Proximal Carpal Tunnel Level

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    Ping Yeap LOH

    2015-10-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is one of the most common musculoskeletal disorders among computer users. Computer users exhibit various wrist angles while typing. Dynamic changes of wrist angle may cause different degrees of median nerve compression. The objective of this study was thus to investigate the effects of the combination of wrist flexion-extension with wrist deviation on median nerve cross-sectional area (MNCSA.Methods:  Eight right-handed participants were recruited in this study. Both wrists were examined by sonographic ultrasound (US at the proximal carpal tunnel level in the transverse plane. A total of nine wrist positions were examined, including wrist neutral (WN, wrist flexion (WF30°, and wrist extension (WE30°, together with three wrist deviation conditions, namely, without radial deviation (RD and ulnar deviation (UD, with maximal RD and with maximal UD. MNCSA was measured by tracing method with ImageJ.Results: Paired t-test showed a significant difference of WN MNCSA between the dominant hand (7.93 ± 0.63 mm2 and the non-dominant hand (6.98 ± 0.42 mm2 (P<0.001. Two-way repeated-measures ANOVA (handedness as an independent factor showed that WF30° and WE30° caused significant differences of MNCSA when compared with WN (P<0.001. However, wrist RD/UD did not have a significant interaction with the changes of MNCSA in WN, WF and WE positions.Conclusion: The results indicate a significant reduction of MNCSA when WN changed to WF and WE. Wrist RD and UD did not cause significant changes of MNCSA at different wrist positions. Keywords: Median nerve, Ultrasound, Wrist active holding, Nerve deformation

  9. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors

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    Bongers, Frans JM; Schellevis, Francois G; van den Bosch, Wil JHM; van der Zee, Jouke

    2007-01-01

    Background Most studies on the incidence of the carpal tunnel syndrome and the relation of this disorder with occupation are population-based. In this study we present data from general practice. Aim To compare incidence rates of carpal tunnel syndrome in 1987 with those in 2001, and to study the relationship between carpal tunnel syndrome and occupation. Design of study Analysis of the data of the first and second Dutch National Survey of General Practice, conducted in 1987 and 2001, respectively. Setting General practices in The Netherlands. Method One hundred and three general practices in 1987 with 355 201 listed patients, and 96 practices with 364 998 listed patients in 2001, registered all patients who presented with a new episode of carpal tunnel syndrome. Patient and GP populations were representative for The Netherlands. Results The crude incidence rate was 1.3 per 1000 (95% confidence interval [CI] = 1.0 to 1.5) in 1987, and 1.8 per 1000 (95% CI = 1.7 to 2.0) in 2001. In males it was 0.6 (95% CI = 0.5 to 0.7) and 0.9 (95% CI = 0.8 to 1.0) respectively; in females 1.9 (95% CI = 1.7 to 2.1) and 2.8 (95% CI = 2.6 to 3.1). At both study periods, peak incidence rate occurred in the 45–64-year age group: in 2001 this peak reached 4.8 per 1000 (95 CI = 4.1 to 5.4) for females and 1.6 (95 CI = 1.2 to 2.0) for males. Women who performed unskilled and semi-skilled work had 1.5 times greater risk of acquiring carpal tunnel syndrome than women with higher-skilled jobs (P<0.001). In men no relationship of this kind was found. Conclusion In 2001 the crude incidence rate of carpal tunnel syndrome was 1.5 times higher than in 1987, but the difference was not statistically significant after subdividing by age and sex. In both years the female:male ratio was 3:1. Incidence rates were related to the job level of women, but not of men. PMID:17244422

  10. Efficacy of kinesiotaping in patients with the initial signs of carpal tunnel syndrome

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    I. G. Mikhaylyuk

    2016-01-01

    Full Text Available Background. Carpal tunnel syndrome (CTS is one of the most common tunnel neuropathies. Early symptoms are often limited by periodic and slight discomfort in the area of innervation of a median nerve on the hand, so the patients are not willing to be treated invasively. Thus, a noninvasive therapy, such as kinesiotaping, could be perspective.Objective. Assessment of the efficiency of a kinesiotaping monotheraphy of patients on initial stage of CTS.Materials and methods. We included 120 patients with the initial stage of CTS: 51 men and 69 women aged from 24 till 54 years old. The main group included 70 people, and the control group – 50 patients. The main group was treated within 2 months by kinesiotaping only, control group was observed without any therapeutic intervention.Results. 60 % of the patients from the main group reported beneficial effect of kinesiotaping on clinical symptoms of the CTS.Conclusions. Kinesiotaping monotherapy at initial stages of CTS in our cohort relieves subjective symptoms in the majority of patients. To recommend kinesiotaping as an effective and safe method on initial stages of CTS to patients unwilling to undergo standard invasive treatment methods, a larger multicenter study is needed.

  11. Diagnosis of carpal tunnel syndrome: interobserver reliability of the blinded scratch-collapse test.

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    Blok, Robin D; Becker, Stéphanie J E; Ring, David C

    2014-06-01

    The reliability of the scratch-collapse test for diagnosis of carpal tunnel syndrome (CTS) has not been tested by independent investigators. This study measured the reliability of the scratch-collapse test comparing the treating hand surgeon and blinded evaluators. We performed a prospective observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing. The treating hand surgeon performed the scratch-collapse test. Next, the test was administered by one of the six observers, unaware of the patient's symptoms and the diagnosis made by treating hand surgeon. The kappa statistic (κ) was used to calculate the interrater reliability between the treating hand surgeons and blinded scratchers. The agreement between the blinded observers and the hand surgeons on the scratch-collapse test was substantial 0.63 (95 % CI, 0.34-0.87; p scratch test in our sample was 32 %. In a small study with a spectrum bias favoring electrophysiologically confirmed CTS the reliability was lower than that reported by the inventors of the test, but was still substantial. We propose a larger study of patients with a greater variety of electrodiagnostic test results using fewer observers with more experience.

  12. Comparison of the Effects between Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome (Randomized, Controlled Clinical Trial

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    Ji-young Ku

    2010-12-01

    Full Text Available Objectives : The purpose of this study is to compare the effects of Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome. Methods : From February to September 2010, the number of patients with Carpal Tunnel Syndrome who volunteered for this clinical study was 16 and 7 out of 16 patients complained both hands. Total 23 cases of hands were randomly divided by 2 groups. We injected Sweet Bee Venom Pharmacopuncture on PC7(Daereung twice a week for 4weeks for experimental group(n=11, and Scolopendrid Pharmacopuncture with the same methods for control group(n=12. One case was dropped out due to itchiness of allergic response in the experimental group. Improvement of the symptoms was evaluated by Visual Analogue Scale, Pain Rating Scale, Tinel’s sign, Phalen’s sign and Nerve Conduction Velocity. Nerve Conduction Velocity was checked at baseline and the end of the trial and others were checked at baseline, after 2 and 4 weeks. Results : Both groups showed significant improvement in Visual Analogue Scale, Pain Rating Scale, but no significant difference between two groups. Only the control group showed significant reduction of the‘ poitive response’in the Tinel’s sign and Phalen’s sign. However, no groups improved in Nerve Conduction Velocity. Conclusions : These results showed that Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture could decrease the symptoms of Carpal Tunnel Syndrome. Further studies will be required to examine more cases for the long period and use more various concentration and amount pharmacopuncture for the effect on Carpal Tunnel Syndrome.

  13. Early diagnosis of Carpal Tunnel Syndrome (CTS in Indian patients by nerve conduction studies

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    Dr. Geetanjali Sharma MD

    2010-07-01

    Full Text Available The present study was carried out for early confirmation of clinically diagnosed patients of Carpal Tunnel Syndrome (CTS by electro-diagnostic tests which included motor conduction, sensory conduction studies and F-wave studies. The aim of the study was early confirmation of clinically suspected patients of CTS by motor and sensory conduction studies of median and ulnar nerves. Eighty subjects of age group 30-50 years (40 clinically suspected patients of CTS, 40 as control group were studied. Motor and Sensory conduction velocities, distal motor and sensory latencies and F wave latencies of median and ulnar nerves were performed using RMS EMG EP Mark –II. Statistically significant (P < 0.001 slowing of motor conduction velocities for both nerves was seen in the CTS group as compared to control group. Decrease in sensory conduction velocity was more pronounced in CTS group as compared to Control group. Statistically significant (P < 0.001 increase in distal motor and sensory latencies was also observed for both median and ulnar nerves in the CTS group as compared to Control group, with more increase in distal motor latency than sensory latency. Increase in F wave latencies of both nerves was seen in the CTS group. Electrophysiological studies confirmed the early diagnosis of CTS with a high degree of sensitivity. Present results confirm selective slowing of sensory & motor conduction within wrist to palm segment in patients of CTS which is attributable to compression by the transverse carpal ligament or to a disease process of the terminal segment.

  14. [Carpal tunnel syndrome in workers engaged in the assembly of manufactured products in various industries in the province of Brescia].

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    Barbieri, P G

    1996-01-01

    Tests were carried out on five manual assembly departments in a variety of different factories, in order to assess the risks associated with the onset of Carpal Tunnel Syndrome and to describe the prevalence of this disorder among exposed workers. The application of the risk analysis method proposed by the EPM Research Unit in Milan (Italy) demonstrated the presence of numerous jobs featuring both a high frequency of actions per minute and a total lack of recovery times, in addition to a variety of incongrous upper limb postures. The clinical and instrumental investigation diagnosed 76 cases of Carpal Tunnel Syndrome among the 170 exposed workers. 62% of the cases was bilateral and 24% was associated with Guyon Channel Syndrome. In two of the five departments reviewed, the carpal tunnel disorders detected were endemic, and featured unusually high prevalence. The situation had been seriously underestimated by the company technical and medical staff, resulting in a failure to call for the urgent adoption of individual protection and collective prevention measures. The authors recommend that an extensive and adequate occupational risk assessment analysis be performed: the local occupational health services could play a critical role in identifying the highest risk industries and the diseases diagnosed in a hospital environment.

  15. Value of F-wave studies on the electrodiagnosis of carpal tunnel syndrome

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    Alemdar M

    2015-08-01

    Full Text Available Murat Alemdar Sakarya University Education and Research Hospital, Sakarya, Turkey Background: F waves are late electrophysiological responses to antidromic activation of motor neurons and are used to evaluate the conduction along the whole length of peripheral nerves. We aimed to determine the diagnostic efficacies of minimum median nerve F-wave latency (FWL and median-to-ulnar nerve F-wave latency difference (FWLD on carpal tunnel syndrome (CTS. Materials and methods: The electrophysiological studies consisted of sensory and motor nerve conduction and F-wave studies of the median and ulnar nerves. The best cut-off points of minimum median nerve FWL and FWLD for the diagnosis of CTS were detected for the whole study group and for different height subgroups (Group 1: 150–159 cm, Group 2: 160–169 cm, and Group 3: over 170 cm. The diagnostic efficacies of minimum median nerve FWL and FWLD were calculated for the whole CTS group and for the mild CTS group, separately. Results: The best cut-off point of minimum median nerve FWL on the diagnosis of CTS was determined as 24.60 ms for the whole group. It was 23.90 ms for Group 1, 24.80 ms for Group 2, and 28.40 ms for Group 3. The usage of these stratified cut-off points yielded a higher total diagnostic efficacy rate than single cut-off point usage (79.9% vs 69%, respectively; P=0.02. The best cut-off point of FWLD on the diagnosis of CTS was 0.80 ms for the whole group. It was 0.55 ms for Group 1, 0.30 ms for Group 2, and 0.85 ms for Group 3. Both the single cut-off point usage and the stratified chart usage for FWLD had equal diagnostic efficacy (85.1%. In the mild CTS group, diagnostic efficacy was 55.5% for minimum median nerve FWL and 78.8% for FWLD (P=0.0001. Conclusion: Median-to-ulnar nerve FWLD yields a higher diagnostic efficacy than minimum median nerve FWL on the diagnosis of CTS. However, the sensitivities of both parameters are not satisfactory for the extremities with mild CTS

  16. A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome

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    Koh, Sung Hye [Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722 (Korea, Republic of); Kwon, Bong Cheol, E-mail: hallymradms@gmail.com [Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Park, Chanyeong [Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Hwang, Su Yeon; Lee, Joon Woo [Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707 (Korea, Republic of); Kim, Sam Soo [Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722 (Korea, Republic of)

    2014-11-15

    Highlights: • The good parameters of both scans in CTS diagnosis were CSA(P1), FA(P1) and FA(P0). • Median nerve signal intensity and flexor retinacular bowing were not significantly different between CTS and controls. • The prestenotic swelling of median nerve of CTS was demonstrated as relatively large CSA and low FA value at P1 level. • Combination of both scans in evaluation of carpal tunnel increased diagnostic performance, and provided merits of both scans. - Abstract: Purpose: To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS). Materials and methods: We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1 cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans. Results: The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P > 0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each. Conclusion: The individual performances of both scans were not significantly different in diagnosing CTS

  17. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity.

    Science.gov (United States)

    Karadag, Omer; Kalyoncu, Umut; Akdogan, Ali; Karadag, Yesim Sucullu; Bilgen, Sule Apras; Ozbakır, Senay; Filippucci, Emilio; Kiraz, Sedat; Ertenli, Ihsan; Grassi, Walter; Calgüneri, Meral

    2012-08-01

    Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA). High frequency ultrasonography (US) is a sensitive and specific method in diagnosis of CTS. This study is aimed to: firstly assess diameter frequency of CTS in RA with US and compare with a control group; secondly, investigate relationship of CTS with disease activity. One hundred consecutive RA patients (women/men: 78/22) fulfilling ACR 1987 RA criteria and 45 healthy controls (women/control: 34/11) were enrolled into study. Disease activity parameters, RA and CTS patient global assessment and health assessment questionnaire (HAQ-DI) were recorded. Both patient and control group were questioned about secondary causes of CTS, and Katz hand diagram, Boston CTS questionnaire and Phalen ve Tinel tests were applied once for each hand. Wrist joint and carpal tunnel were assessed with US grey scale and power Doppler US, then cross-sectional area of median nerve (CSA) was calculated. Patients with median nerve CSA between 10.0 and 13.0 mm(2) were evaluated with electromyography (EMG). CTS was diagnosed if CSA of median nerve >13.0 mm(2) or CTS was shown with NCS. Although there was no difference between RA patients and controls in age, sex, history of DM (+) and goitre, CTS was more frequent in RA group (respectively, 17.0% vs. 4.4%, P = 0.038). In RA group with CTS, age, history of DM, disease duration, HAQ-DI score, CTS patient global score, Boston symptom severity and functional status scores were elevated compared to without CTS [respectively, 57 (36-73) vs. 50 (24-76), P = 0.041; 35.3% vs. 6.0%, P 0.05). Sensitivity of Katz hand diagram was higher than Tinel and Phalen tests (respectively, 100, 60.0, 66.7%). Boston symptom and functional scores of RA patients with CTS diagnosed by EMG were increased than patients CTS (-) by EMG [respectively, 3.05 (1.90-4.27) vs. 1.55 (1.0-2.90), P = 0.002; 3.25 (1.73-3.82) vs. 1.12 (1.0-2.10), P = 0.008]. CTS

  18. The relationship between physical factors (Wrist ratio and electrophysiologic factors of median nerve in carpal tunnel syndrome in women

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    Oliaiy Gh

    1997-08-01

    Full Text Available Carpal tunnel syndrome (CTS is considered by researchers because of its high prevalence, and several studies have been done to find the causes and factors which increase the chance for the syndrome. These studies have shown relationships between this syndrome with some physical parameters like wrist dimensions, weight and systemic conditions. There is no investigation on risk factors in CTS in our country. So the main goal of this research is to find and introduce predisposing factors for carpal tunnel syndrome. Methods: Seventy patients and 33 controls 22 to 70 years old were studied. Standard methods for median and ulnar nerve studies were used and questionnaires included physical measurements, history of diseases and personal information were completed for each person. Results: Patients had higher wrist ratio (mean difference, 0.0267, P<0.001, weight (mean difference: 6.098, P<0.001 and body mass index (mean difference: 3.376, P<0.001. Regression analysis showed strong positive relation between wrist ratio and median latencies. The strongest correlation was found between wrist ratio and median minus ulnar distal sensory latencies (Y2=0.4014, P<0.0001. No relation was found between weight and body mass index with median latencies. Seventy-nine percent of patients and 48.5% of controls had wrist ratio of 0.7 or greater (P<0.05. Seventy-two percent of patients with repetetive hand activities and 78% with associated conditions had wrist ratio of 0.7 or greater. Seventy-six percent had wrist ratio less than 0.7. No relationship was found between obesity, diabetes, thyroid disorders, rheumatoid arthritis, taking oral contraceptive, hysterectomy, oophorectomy, menopause and repetetive hand activities with involvement of carpal tunnel syndrome. Discussion: Wrist dimensions seem to be an important predictor for carpal tunnel syndrome also in patients with associated conditions. If individuals with squarer wrists are involved in special conditions

  19. Er:YAG laser for the surgical treatment of the carpal tunnel syndrome

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    Russ, Detlef; Ebinger, Thomas; Illich, Wolfgang; Steiner, Rudolf W.

    2003-10-01

    We developed a new surgical procedure to improve the recurrence rate using an Er:YAG laser as dissection tool for the carpal ligament with the objective to ablate a small amount of the carpal ligament and to denaturate its ends. The Er:YAG Laser was transmitted to the applicator via a GeO fiber. With this system we proceeded 10 carpal ligament dissections without any complications in the follow-up period. All patients were free of pain and recurrence.

  20. Síndrome do túnel do carpo: aspectos atuais Carpal tunnel syndrome: present approaches

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    JOÃO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Baseado na experiência eletrofisiológica do autor em 668 pacientes e em dados de literatura, foi realizada revisão sobre síndrome do túnel do carpo (STC analisando aspectos clínico-epidemiológicos e de conducão nervosa. O nervo mediano sofre desmielinização nodal ou segmentar por compressão no túnel do carpo, 3-4 cm distal à prega do punho. O complexo sintomátíco inclui dormência e fomigamento noturno nas mãos, frequentemente bilateral e mais comum em mulheres na faixa etária de 40-60 anos. São descritos casos familiares em que a herança poderia determinar ligamento transverso do carpo mais espesso. Fatores antropomórficos podem também representar risco adicional porém com pouca significância estatística. Ressonância magnética pode ser útil em casos selecionados e atípicos. São discutidos aspectos do tratamento conservador e controvérsias do tratamento cirúrgico. Na condução nervosa clássica observa-se aumento de latência distal sensitiva (segmentar e motora do nervo mediano. Métodos adicionais de sensibilização incluem latência palma-punho do mediano (misto, diferença de latência palma-punho mediano/ulnar (misto, diferença de latência mediano/radial e mediano/ulnar (sensitivo, técnica da centimetragem punho-palma com registro no II/III dedos e diferença mediano/ulnar com registro lumbrical/interósseo (motor.A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low

  1. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome

    Science.gov (United States)

    Azadeh, Hamid; Dehghani, Mohammad; Zarezadeh, Abolghasem

    2010-01-01

    BACKGROUND: Patients with carpal tunnel syndrome (CTS) often complain of prominent pain in shoulder and arm, also there are patients that have pain in their shoulder and arm which is due to myofascial trigger point (MTP) located in their upper trapezius muscle. Despite the frequency of this observation, few studies have previously sought to establish possible relationship between the CTS and MTP in shoulder area. METHODS: Samples were 160 patients (221 hands) consist of 130 females and 30 males, with suspected diagnosis of CTS, from March 2008 to October 2008. In this study after performing electrodiagnosis searches, another evaluation was performed to find out if there was any sign of myofascial trigger point. The correlation between these two was sought. RESULTS: It was found that all of 36 hands with normal electrodiagnostic findings had myofascial trigger points in their upper trapezius muscle. Out of 185 hands, 130 hands (70%) with electrophysiological evidences of CTS showed myofascial trigger points in their trapezius muscles. Statistical analysis revealed significant (p < 0.001) reverse correlation between the severity of CTS and the presence of MTP. CONCLUSIONS: The findings of this study imply the significant correlation between occurrence of CTS and MTP. It is suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS. PMID:21526092

  2. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-08-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment.

  3. Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?

    Science.gov (United States)

    Schmid, A B; Soon, B T C; Wasner, G; Coppieters, M W

    2012-02-01

    Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central pain mechanisms. As previous studies included patients with shoulder/arm symptoms or neck pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the pain during thermal pain testing significantly higher than healthy participants. This was especially apparent for heat pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and arm pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated pain ratings may however be an early indication of central pain mechanisms.

  4. Carpal tunnel syndrome: Analysis of online patient information with the EQIP tool.

    Science.gov (United States)

    Frueh, F S; Palma, A F; Raptis, D A; Graf, C P; Giovanoli, P; Calcagni, M

    2015-06-01

    Patients suffering from carpal tunnel syndrome (CTS) actively search for medical information on the Internet. The World Wide Web represents the main source of patient information. The aim of this study was to systematically assess the quality of patient information about CTS in the Internet. A qualitative and quantitative assessment of websites was performed with the modified Ensuring Quality Information for Patients (EQIP) tool that contains 36 standardized items. Five hundred websites with information on CTS treatment options were identified through Google, Bing, Yahoo, Ask.com and AOL. Duplicates and irrelevant websites were excluded. One hundred and ten websites were included. Only five websites addressed more than 20 items; quality scores were not significantly different between the various providing groups. A median of 15 EQIP items was found, with the top website addressing 26 out of 36 items. Major complications such as median nerve injury were reported in 27% of the websites and their treatment in only 3%. This analysis revealed several critical shortcomings in the quality of the information provided to patients suffering from CTS. There is a collective need to provide interactive, informative and educational websites for standard procedures in hand surgery. These websites should be compatible with international quality standards for hand surgery procedures.

  5. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Hamid Azadeh

    2010-01-01

    Full Text Available Background: Patients with carpal tunnel syndrome (CTS often complain of prominent pain in shoulder and arm, also there are patients that have pain in their shoulder and arm which is due to myofascial trigger point (MTP located in their upper trapezius muscle. Despite the frequency of this observation, few studies have previously sought to establish possible relationship between the CTS and MTP in shoulder area. Methods: Samples were 160 patients (221 hands consist of 130 females and 30 males, with suspected diagnosis of CTS, from March 2008 to October 2008. In this study after performing electrodiagnosis searches, another evaluation was performed to find out if there was any sign of myofascial trigger point. The correlation between these two was sought. Results: It was found that all of 36 hands with normal electrodiagnostic findings had myofascial trigger points in their upper trapezius muscle. Out of 185 hands, 130 hands (70% with electrophysiological evidences of CTS showed myofascial trigger points in their trapezius muscles. Statistical analysis revealed significant (p < 0.001 reverse correlation between the severity of CTS and the presence of MTP. Conclusions: The findings of this study imply the significant correlation between occurrence of CTS and MTP. It is suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS.

  6. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome

    Science.gov (United States)

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-01-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment. PMID:27630413

  7. Diagnostic value of quantitative sensory testing (QST) in carpal tunnel syndrome.

    Science.gov (United States)

    Borg, K; Lindblom, U

    1988-12-01

    The initial sensory symptoms of carpal tunnel syndrome (CTS) are usually intermittent and the clinical neurological examination is often normal. The aim of the present study was to determine the rate of impairment of different somatosensory modalities in CTS by means of the following tests: vibrametry, tactile pulses, von Frey hairs, two-point discrimination (2-PD), graphesthesia and warm and cold perception thresholds. The material consisted of 33 hands with CTS from 22 patients. Each of the first 3 tests was abnormal with elevated thresholds in 17 CTS hands (52%), 2-PD was abnormal in 10 hands (30%), graphesthesia in 8 hands (24%), and warm and cold thresholds in only 5 hands (15%). There was an overlap so that at least one test was abnormal in 27 of the 33 CTS hands (82%). Thus, impairment of sensibility can be demonstrated in a majority of patients with CTS if more than one test is applied. Vibrametry and von Frey hairs are recommended instead of the commonly used 2-PD, since abnormality was more often revealed and since they are equally easy to apply. No individual test was sensitive enough to qualify as a diagnostic criterion when it was applied with the hand in resting position. A significant increase in both sensitivity and specificity can be expected for any test if it is combined with provocation, such as wrist flexion, as has been demonstrated for vibrametry.

  8. Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Makanji, H S; Becker, S J E; Mudgal, C S; Jupiter, J B; Ring, D

    2014-02-01

    This prospective study measured and compared the diagnostic performance characteristics of various clinical signs and physical examination manoeuvres for carpal tunnel syndrome (CTS), including the scratch collapse test. Eighty-eight adult patients that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Attending surgeons documented symptoms and results of standard clinical manoeuvres. The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen's test (67%), Durkan's test (77%), Tinel's test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan's test (18%) and CTS-6 lax (13%). The sensitivity of the scratch collapse test was not superior to other clinical signs and physical examination manoeuvers for CTS, and the specificity of the scratch collapse test was superior to that of Durkan's test and CTS-6 lax. Further studies should seek to limit the influence of a patient's clinical presentation on scratch test performance and assess the scratch test's inter-rater reliability.

  9. Upper Limb Neurodynamic Test 1 and symptoms reproduction in carpal tunnel syndrome. A validity study.

    Science.gov (United States)

    Vanti, Carla; Bonfiglioli, Roberta; Calabrese, Monica; Marinelli, Francesco; Guccione, Andrew; Violante, Francesco Saverio; Pillastrini, Paolo

    2011-06-01

    The aim of this study was to estimate the validity of the Upper Limb Neurodynamic Test 1 (ULNT1) for the diagnosis of Carpal Tunnel Syndrome (CTS) with blind comparison to a reference criterion of a compatible clinical presentation and abnormal nerve conduction. 47 subjects with suspected CTS were enrolled. All patients were tested with nerve conduction studies and ULNT1. Considering results as positive in the presence of reproduction of symptoms on affected upper limb, or side-to-side differences in elbow extension, or symptoms modified by lateral neck side-bending, we estimated sensitivity as 91.67%, specificity as 15%, positive likelihood ratio as 1.0784, negative likelihood ratio as 0.5556, and post-test probability for negative test as 40%. Using a new criterion, i.e. the reproduction of symptoms only in the first three digits of the affected hand, we estimated sensitivity as 54.17%, specificity as 70%, positive and negative likelihood ratios as 1.8056 and 0.6548, respectively, and post-test probability for positive test as 68%. Our investigation suggests that the reproduction of the typical current CTS symptoms in the affected hand during ULNT1 testing, improves estimation of the probability of the presence of this condition, even if this test alone cannot be used to diagnose CTS.

  10. Epithelioid Sarcoma of the Forearm Arising from Perineural Sheath of Median Nerve Mimicking Carpal Tunnel Syndrome

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    Hiromasa Fujii

    2009-01-01

    Full Text Available We report here a case of epithelioid sarcoma in the forearm of a 33-year-old male presenting with symptoms and signs of carpal tunnel syndrome originating from the direct involvement of the median nerve. Due to the slow growing of the tumor, the patient noticed the presence of tumor mass in his forearm after several months from the initial onset of the symptoms. Magnetic resonance imaging showed an 8×4 cm mass involving the median nerve in the middle part of the forearm, and histological analysis of the biopsy specimen revealed the diagnosis of epithelioid sarcoma. Radical surgical resection was performed in conjunction with adjuvant chemotherapy. The function of the flexors were restored by the multiple tendon transfers (EIP→FDS; ECRL→FDP; BrR→FPL; EDM→opponens with superficial cutaneous branch of radial nerve transfer to the resected median nerve. The function of the affected hand showed excellent with the DASH disability/symptom score of 22.5, and both the grasp power and sensory of the median nerve area has recovered up to 50% of the normal side. The patient returned to his original vocation and alive with continuous disease free at 3.5-year follow-up since initial treatment.

  11. Etiological factors for developing carpal tunnel syndrome in people who work with computers

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    Magdalena Lewańska

    2013-02-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is the most frequent mononeuropathy of upper extremities. From the early 1990's it has been suggested that intensive work with computers can result in CTS development, however, this relationship has not as yet been proved. The aim of the study was to evaluate occupational and non-occupational risk factors for developing CTS in the population of computer-users. Material and Methods: The study group comprised 60 patients (58 women and 2 men; mean age: 53.8±6.35 years working with computers and suspected of occupational CTS. A survey as well as both median and ulnar nerve conduction examination (NCS were performed in all the subjects. Results: The patients worked with use of computer for 6.43±1.71h per day. The mean latency between the beginning of employment and the occurrence of first CTS symptoms was 12.09±5.94 years. All patients met the clinical and electrophysiological diagnostic criteria of CTS. In the majority of patients etiological factors for developing CTS were non-occupational: obesity, hypothyroidism, oophorectomy, past hysterectomy, hormonal replacement therapy or oral contraceptives, recent menopause, diabetes, tendovaginitis. In 7 computer-users etiological factors were not identified. Conclusion: The results of our study show that CTS is usually generated by different causes not related with using computers at work. Med Pr 2013;64(1:37–45

  12. False Positive Results of Carpal tunnel syndrome in Electro Diagnosis Tests

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    MR Emad

    2010-07-01

    Full Text Available Introduction & Objective: Carpal tunnel syndrome is identified due to compression of median nerve at wrist and develops symptoms such as wrist pain, paresthesia, numbness and the dysfunction of the hands. The gold standard to diagnose, determining prognosis and planning treatment process based on the severity of nerve involvement are electro-diagnosis tests. The purpose of this study was to specify the least and the most false positive results in common electro-diagnosis tests. Materials & Methods: This descriptive study was conducted at Shiraz University of Medical Sciences in 2009. Twelve different electro-diagnosis tests on fifty-five normal cases (110 available hands, which never had experienced the symptoms of this syndrome, were carried out. The data was statistically analyzed by SPSS software, using T test and Cochran's `Q. Results: There were false positive results in many of the performed tests. The most false-positive result was in- difference between median and ulnar motor distal latencies- test with the rate of 15.5% and the lowest false positive result was in- difference between median and ulnar sensory distal latencies of digit 4- test with the rate of 0%. Conclusion: This study revealed that tests which evaluate the differences between median and ulnar or radial nerves sensory distal latency (in the finger 4 and or 1, respectively, had less false positive results, and are more reliable in suspected cases of this syndrome. Also by using several different electro-diagnostic tests, rapid and efficient diagnosis can be achieved.

  13. Pyridoxine metabolism in carpal tunnel syndrome with and without peripheral neuropathy.

    Science.gov (United States)

    Byers, C M; DeLisa, J A; Frankel, D L; Kraft, G H

    1984-11-01

    The role of insufficient pyridoxine as an etiologic factor in the development of carpal tunnel syndrome (CTS) has been reported and has led to the empirical use of pyridoxine to treat CTS. Previous studies have not employed standardized electrodiagnostic criteria to objectively determine the presence of CTS or to rule out peripheral neuropathy (PN). The present study categorized subjects with symptoms suggestive of CTS into four groups by standardized electrodiagnostic criteria: (1) CTS, (2) PN, (3) CTS and PN, (4) normal. At least seven subjects were in each group. Erythrocyte glutamine oxaloacetic acid transaminase (EGOT) activity with and without in vitro enhancement with pyridoxal phosphate was used as a means of identifying subjects with and without pyridoxine metabolic abnormalities. A significant difference in pyridoxine metabolic activity (PMA) was found between groups by both chi square (p less than 0.05) and analysis of variance (p less than 0.05). Further evaluation showed that this difference was associated with the presence or absence of PN (p less than 0.05). There was no difference in PMA when groups were separated on the basis of CTS. Results showed that a PMA abnormality was a factor highly correlated with the presence of PN but not CTS. This finding suggested that the positive response reported previously in subjects with CTS taking supplemental pyridoxine may actually be related to an unrecognized PN, which was compounding the symptomatology.

  14. The Effect of Provocative Tests on Electrodiognosis of Clinical Carpal Tunnel Syndrome

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    MR Emad

    2006-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Nerve conduction study is the most sensitive test for diagnosis of carpal tunnel syndrome (CTS. This test is normal in some patients with mild CTS. Median nerve conduction study evaluation after a provocative test (e.g. wrist flexion may be helpful for diagnosis of mild CTS. This study aimed to determine the effect of wrist flexion on median nerve conduction in patients suspected to CTS and in healthy subjects. Materials & Methods: In this case-controlled study, 20 patients (20 hands with clinical signs of CTS and normal routine electrodiagnosis test results and 20 healthy subjects were investigated. Measured parameters included: median nerve distal sensory latency (DSL, nerve conduction velocity (NCV, compound nerve action potential (CNAP, distal motor latency (DML and compound muscle action potential amplitude (CMAP AMP. The above noted parameters were measured before and after 5 minutes of full wrist flexion. Data were collected by filling out a questionnaire and were analyzed using Paired T-test. Results: Distal Sensory Latency increment and NCV decrement after 5 minutes wrist flexion in the patients group were statistically significant (p<0.05. The same parameters did not show a significant incremental or decremental change in the control group. Conclusion: Median nerve DSL and NCV measurement after 5 minutes wrist flexion may be helpful in determining more sensitive parameters in the electrodiagnosis of CTS.

  15. Diagnostic Value of Ultrasound Compared to Electro Diagnosis in Carpal Tunnel Syndrome

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    Seyed Mansour Rayegani

    2014-10-01

    Full Text Available Introduction: Carpal Tunnel Syndrome (CTS is one of the main causes of disability. The diagnosis of CTS confirm by electrodiagnostic tests. Sonography is an alternative method for diagnosis of CTS that can investigate anatomy and probable pathology. The aim of this study is to investigate the multiple sonographic diagnostic criteria and compare its diagnostic value with electrodiagnosis. Materials and Methods:In this descriptive-cross sectional study, 84 wrists (42 patients with CTS and 42 individuals without any clinical signs in upper limb were investigated. Symptomatic patients underwent clinical examination, standard electrodiagnostic evaluation of upper limb and sonographic investigation of median nerve in forearm and wrist. The control group underwent sonographic investigation. Results: Cross Sectional Area (CSA of Median nerve at distal wrist crease, at the level of Hamate hook and Trapezium, the amount of flexor retinaculum bowing, ratio of CSA at the forearm to distal wrist crease and ratio of CSA at the Pisiform level to distal wrist crease had significant difference in the case group compared to the control group (P-value

  16. Test-retest reliability of transcarpal sensory NCV method for diagnosis of carpal tunnel syndrome

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    Seyed Mostafa Jazayeri

    2015-01-01

    Full Text Available Background: Carpal Tunnel Syndrome (CTS is the most frequent entrapment neuropathy affecting the upper extremity. There are a variety of electrodiagnostic methods available for documenting median neuropathy in CTS. In some studies, determining the sensory NCV across the palm-wrist segment has been introduced as the most sensitive diagnostic procedure for CTS. The aim of this study was to investigate the test-retest reliability of transcarpal median sensory NCV method for the diagnosis of CTS. Materials and Methods: Twenty-three patients with clinical symptoms of CTS were tested two times by two different practitioners in one session and again by the first practitioner after one week. Stimulation of the median nerve was performed in the wrist and palm, with a conduction distance maximum of 7 cm, reliabilities of median nerves sensory nerve action potential latencies with stimulation at wrist and palm (W-SNAP, P-SNAP and its transcarpal NCV were assessed with intraclass correlation coefficient (ICC. Results: Comparison of the obtained values, which were done by two practitioners in one session showed ICC of W-SNAP latency, P-SNAP latency and transcarpal NCV of 0.93, 0.88 and 0.87, respectively and values that were done by one practitioner in two sessions with one-week interval showed ICC of 0.60, 0.50 and 0.47, respectively. Conclusion: Our findings suggest excellent interpractitioner test-retest reliability of transcarpal median sensory NCV method for diagnosing CTS.

  17. Tunnel design considering stress release effect

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    Van-hung DAO

    2009-01-01

    In tunnel design,the determination of installation time and the stiffness of supporting structures is very important to the tunnel stability.This study used the convergence-confinement method to determine the stress and displacement of the tunnel while considering the counter-pressure curve of the ground base,the stress release effect,and the interaction between the tunnel lining and the rock surrounding the tunnel chamber.The results allowed for the determination of the installation time,distribution and strength of supporting structures.This method was applied to the intake tunnel in the Ban Ve Hydroelectric Power Plant,in Nghe An Province,Vietnam.The results show that when a suitable displacement u0 ranging from 0.0865 m to 0.0919 m occurrs,we can install supporting structures that satisfy the stability and economical requirements.

  18. Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome.

    Science.gov (United States)

    Filius, Anika; Scheltens, Marjan; Bosch, Hans G; van Doorn, Pieter A; Stam, Henk J; Hovius, Steven E R; Amadio, Peter C; Selles, Ruud W

    2015-09-01

    Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross-sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70-71% and specificity of 80-84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel.

  19. The best cutoff point for median nerve cross sectional area at the level of carpal tunnel inlet.

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    Payam Sarraf

    2014-08-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy. It accounts 90% of all entrapment neuropathies all over the world. Ultrasound is a non-invasive, cost effective and available para-clinical method which could be applied for CTS diagnosis. Cross-sectional area of the median nerve at the level of the inlet is considered as a diagnostic criterion in CTS cases. In this study, thirty-eight patients with electrophysiologically confirmed idiopathic CTS and 22 healthy controls were enrolled. Seventy-one affected nerves and 42 unaffected nerves were evaluated within 14 days after electrophysiological examination. The largest cross-sectional area (CSA was measured at the level of the carpal tunnel inlet and the maximum nerve perimeter was also recorded by means of the software. Mean CSA and perimeter were 14.02 ± 4.5 mm2 and 1.7±0.28m in all patients and 8.2±2.1 mm2, 1.3±0.19 m in controls (P<0.001, P<0.001. Mean CSA and Perimeter were significantly different between patient's groups and control. The best cut off point for CSA of the tunnel inlet was 10.5 mm2 with sensitivity and specificity of 80% and 76% (AUC (Area under the Curve = 0.9, P<0.001. The best cut off point for inlet perimeter was 1.44 m with sensitivity and specificity of 85% and 77 % (AUC=0.87, P<0.001. Our findings showed that median nerve CSA at carpal tunnel inlet could be used as the diagnostic criteria for CTS.

  20. Comparison of the electrophysiologic results after two different surgical decompressions of carpal tunnel syndrome%腕管综合征两种减压手术后肌电图检测结果的分析比较

    Institute of Scientific and Technical Information of China (English)

    吴佩蓉; 付备刚; 陆耀刚; 娄玉健; 马明; 王秀会

    2013-01-01

    Objective To investigate the extent of electmphysiologic improvement of the two procedures of median nerve decompression after comparing the mid-to long-term electrophysiologic results of endoscopic and open carpal tunnel release of patients with intermediate to severe carpal tunnel syndrome.Methods The clinical data of 46 cases (59 wrists) of carpal tunnel syndrome (CTS) were treated in two groups according to the randomized operation mode,endoscopic carpal tunnel release (ECTR) group (32 wrists in 24 cases) and open carpal tunnel release (OCTR) group (27 wrists in 22 cases).Nerve conduction study was carried out to record compound muscle action potential (CMAP),sensory nerve action potential (SNAP) and sensory nerve conduction velocity (SNCV) one year after the carpal tunnel release.CMAP latency,SNAP amplitude and SNCV were analyzed and compared between the two groups.Results The differences in abductor policis brevis CMAP latency and SNCV one year postoperatively were of statistical significance between the ECTR group and the OCTR group.However,there were no statistically significant differences between the SNAP amplitudes of the two groups.Conclusion The mid-to long-term neuroelectrophysiologic results indicated that the improvement of electrophysiologic indices of conventional OCTR is better than those of the ECTR in treating intermediate to severe carpal tunnel syndrome.%目的 通过分析比较中、重度腕管综合征传统与内窥镜微创减压手术后中远期肌电图检测结果的差异,探讨两种方法治疗腕管综合征后肌电指标改善的程度.方法 选择中、重度腕管综合征患者共46例59腕,按手术方法的不同分为两组,其中传统切开减压组22例27腕、内窥镜微创减压组24例32腕,于术后1年进行肌电图检测,对复合肌肉动作电位(compound muscle action potential,CMAP)潜伏期、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉传导速度(sensory nerve conduction

  1. 腕管内压测量及其临床意义%Carpal tunnel internal pressure measurement and its clinical significance

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    罗特坚; 刘冬强; 全金海; 肖亮; 徐运碧; 伍日萍

    2011-01-01

    Objective To research into the etiology of carpal tunnel syndrome and seek for the best therapy. Methods The internal pressure of carpal tunnel above and under transverse carpal ligament were measured by blood pressure monitor and the thickness of transverse carpal ligament was observed. Results The internal pressure of carpal runnel was ( 1.39 ±1.14) mmHg and ( 1.81 ±0.72)mmHg above the ligament while it was (3.02 ± 1.12) mmHg and ( 3.15 ± 1.23 ) mmHg below the ligament. The thickness of transverse carpal ligament was (0.13 ±0.06)mm. No results of internal pressure could be detected by this blood pressure monitor after cutting off transverse carpal ligament. Conclusion The internal pressure of carpal tunnel is connected with the thickness of transverse carpal ligament. The factor that makes transverse carpal ligament thicker is one of the inducing factors of carpal tunnel syndrome.%目的探讨腕管综合症的发病原因,寻找治疗腕管综合症的最佳方法.方法利用通过造改的血压测量器,测量腕管在碗横韧带上、下方的内压;观察测量腕横韧带的厚度.结果腕管内压力在韧带上方左侧为(1.39±1.14)mmHg,右侧为(1.81±0.72)mmHg,在韧带下方左侧为(3.02±1.12)mmHg,右侧为(3.15±1.23)mmHg;腕横韧带的厚度为(0.13±0.06)mm.切断腕横韧带后用此种压力测量器尚未测出腕管内压.结论腕管内压的维持与腕横韧带的厚度有一定关系,某种因素造成腕横韧带的增厚是腕管综合症的发病原因之一.

  2. Factors influencing the recovery of pinch strength: an analysis in patients with severe carpal tunnel syndrome%影响重度腕管综合征术后捏力恢复因素的临床分析

    Institute of Scientific and Technical Information of China (English)

    茅天; 谢仁国; 汤锦波; 王古衡; 邢树国

    2014-01-01

    Objective To analyze the factors that influence the postoperative recovery of palmar pinch,key pinch,and tip pinch forces in patients with severe carpal tunnel syndrome.Methods From May 2009 to June 2011,24 patients with severe carpal tunnel syndrome were treated with carpal tunnel release.Among them 21 were follow-up for 10 to 42 months postoperatively.Forces of tip pinch,key pinch and palmar pinch were measured.Correlation analysis was conducted to assess the relationship between pinch force and postoperative recovery time,grip strength and touch sensation recovery of the affected side.Results There were significant differences between pinch forces of the affected side and the contralateral side.Postoperative pinch strength and grip strength were positively correlated.Pinch force was not related to postoperative recovery time and touch sensation recovery.Conclusion Forces of three types of pinch were significantly lower than those of the contralateral side in patients with severe carpal tunnel syndrome who undergo carpal tunnel release surgery.Postoperative pinch strength recovery is related to grip strength.%目的 探讨影响重度腕管综合征术后指尖型、指侧型和指头型三种捏力恢复的因素.方法 从2009年5月至2011年6月,我们采用腕管切开减压术治疗重度腕管综合征24例,随访21例.术后随访时间为10~ 42个月,对指尖型、指侧型和指头型三种捏力进行测量,将结果与健侧捏力、术后恢复时间、患侧握力、患侧触觉恢复程度等因素进行相关性分析.结果 患者术后患侧与健侧三种捏力比较差异有统计学意义;术后捏力恢复与握力呈正相关;与术后恢复时间、触觉恢复程度无关.结论 重度腕管综合征切开减压术后患侧三种捏力均比健侧差,术后捏力恢复与握力有相关性.

  3. Pulsed magnetic field versus ultrasound in the treatment of postnatal carpal tunnel syndrome: A randomized controlled trial in the women of an Egyptian population

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    Dalia M. Kamel

    2017-01-01

    Full Text Available The aim of this study was to compare the effects of pulsed electromagnetic field versus pulsed ultrasound in treating patients with postnatal carpal tunnel syndrome. The study was a randomized, double-blinded trial. Forty postnatal female patients with idiopathic carpal tunnel syndrome were divided randomly into two equal groups. One group received pulsed electromagnetic field, with nerve and tendon gliding exercises for the wrist, three times per week for four weeks. The other group received pulsed ultrasound and the same wrist exercises. Pain level, sensory and motor distal latencies and conduction velocities of the median nerve, functional status scale and hand grip strength were assessed pre- and post-treatment. There was a significant decrease (P  0.05. In conclusion, while the symptoms were alleviated in both groups, pulsed electromagnetic field was more effective than pulsed ultrasound in treating postnatal carpal tunnel syndrome.

  4. Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

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    Barbosa Rafael Inácio

    2012-12-01

    Full Text Available Abstract Background Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration Brazilian Clinical Trials Registry (ReBec - 75ddtf / Universal Trial Number: U1111-1121-5184

  5. Carpal tunnel syndrome assessed with diffusion tensor imaging: Comparison with electrophysiological studies of patients and healthy volunteers

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    Wang, Chien-Kuo, E-mail: n044206@mail.hosp.ncku.edu.tw [Department of Radiology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Jou, I-Ming, E-mail: jming@mail.ncku.edu.tw [Department of Orthopedics, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Huang, Han-Wei, E-mail: veivei@mail.ncku.edu.tw [Department of Neurology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Chen, Pei-Yin, E-mail: chenpeiyin@gmail.com [Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, 345 Zhuangjing Road, Douliu City, Yunlin County 640, Taiwan (China); Tsai, Hong-Ming, E-mail: sjfhmt@mail.ncku.edu.tw [Department of Radiology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Liu, Yi-Sheng, E-mail: sanderz@ms60.url.com.tw [Department of Radiology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Lin, Chou-Ching K., E-mail: cxl45@mail.ncku.edu.tw [Department of Neurology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China)

    2012-11-15

    The main goal of this study was to investigate the applicability of parameters derived from diffusion tension imaging (DTI) in diagnosing carpal tunnel syndrome (CTS). Forty subjects were recruited, of which 19 were normal controls and 21 belonged to the CTS group. DTI of median nerves evaluated at 4 levels of the wrist (distal radius, pisiform bone, middle portion of the carpal tunnel, and hamate bone) and conventional MRI of the wrist was performed in normal and CTS subjects in two finger postures (extension and flexion). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were derived from DTI, and parameters related to abnormal hyperintensity of the median nerve were derived from conventional MRI. Electrophysiological tests, including nerve conduction velocity and F wave were also performed for comparison. The results of FA and ADC measurements did not depend on the measuring location and finger posture. Mean FA was decreased while mean ADC was increased by CTS. FA and ADC at the middle portion of the carpal tunnel was 0.47 {+-} 0.05 and 1.37 {+-} 0.12 ( Multiplication-Sign 10{sup -3} mm{sup 2}/s) for the control group and 0.42 {+-} 0.04 and 1.50 {+-} 0.15 ( Multiplication-Sign 10{sup -3} mm{sup 2}/s) for the CTS group, respectively. The linear correlations of FA and ADC versus electrophysiological indicators of CTS were significant (R{sup 2} ranged from 0.09 to 0.36), indicating FA and ADC from DTI had significant correlation with the existence and severity of CTS.

  6. Clinical characteristics, neurophysiological grade and outcome of patients with carpal tunnel syndrome A retrospective study

    Institute of Scientific and Technical Information of China (English)

    Jingxia Dang

    2007-01-01

    BACKGROUND: Carpal tunnel syndrome (CTS) is diagnosed mainly according to clinical symptoms, physical sign and neurodiagnostic laboratory examination. The therapeutic effect of conservative management and surgical operation in treating CTS need to be further observed and evaluated. OBJECTIVE: To analyze the clinical characteristics, neurophysiological grade and outcome in patients with CTS.DESIGN: Retrospective case-analysis.SETTING: Department of Neurology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University. PARTICIPANTS: Totally 161 patients with suspected CTS from National Neuroscience Institute of Singapore referred to the Neurodiagnostic Laboratory for the confirmatory testing between January and September 2002. The involved patients, 137 male and 24 female, were aged 21-85 years. METHODS:①The condition of diabetes mellitus complicated by abnormal thyroid function was observed.②The effect on predominant hand, and paraesthesia were observed.③Neuroelectrophysiological studies were performed and the results were graded into mild, moderate and severe CTS according to the American Association of Electrodiagnostic Medicine (AAEM) criteria.④Conservative management and surgical intervention were followed up 3 months later, and symptoms and physical sign basically disappeared, and function was basically recovered, which indicated that disease condition improved.MAIN OUTCOME MEASURES:①Condition of CTS complicated by metabolic disease;②Effects on predominant hand and paraesthesia;③Electrophysiological grading; ④Prognosis.RESULTS: Totally 161 patients participated in the final analysis.①Condition of CTS complicated by metabolic disease: Among 161 patients, 17.4% (28/161) were documented to have diabetes mellitus and 7(4.3%) had hypothyroidism.②Effects on predominant hand and paraesthesia: Dominant hand involvement was present in 134 patients (83.2%) and more than 75% had onset of symptoms in the dominant hand. Sensory symptoms like

  7. The association of Raynaud's syndrome with carpal tunnel syndrome: a meta-analysis.

    Science.gov (United States)

    Hartmann, Peter; Mohokum, Melvin; Schlattmann, Peter

    2012-03-01

    Carpal tunnel syndrome (CTS) has traditionally been included among the diseases associated with Raynaud's syndrome (RS). The prevalence of RS in patients suffering from CTS is not well defined. The objective of this paper was to assess the prevalence of RS in patients with CTS-a meta-analysis of published data was performed. The PubMed database of the National Library of Medicine and ISI Web of Knowledge was used for studies dealing with RS and CTS. The studies provided sufficient data to estimate the prevalence of RS in patients of CTS. A forest plot was determined by the revealed prevalence. Statistical analysis was based on methods for a random effects meta-analysis and a finite mixture model for proportions. Publication bias was investigated with the linear regression test (Egger's method). A meta-regression was conducted by the year of publication. Eight eligible studies, contributing data on 675 subjects, were included in this meta-analysis. For CTS, a pooled prevalence of 15.5% and 95% CI (95% CI 0.043, 0.318) were obtained. Statistically publication bias was present (P value 0.143). A mixture model analysis found five latent classes. The meta-regression indicated that the estimated prevalence increased when the year of commencement increased, too. Within the decade (1957-1967), the odds ratio increased from 1 (95% CI 1.065, 1.112) to 2.340 (95% CI 1.886, 2.903). Despite some heterogeneity, there is a possible indication of an association between RS and patients with CTS.

  8. Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent.

    Science.gov (United States)

    Zhang, Wei; Johnston, Jamie A; Ross, Mark A; Sanniec, Kyle; Gleason, Elizabeth A; Dueck, Amylou C; Santello, Marco

    2013-01-01

    Carpal tunnel syndrome (CTS) impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips) or a combination of CTS-affected and non-affected digits ('mixed' grips), we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS-affected and non

  9. Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent.

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    Full Text Available Carpal tunnel syndrome (CTS impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips or a combination of CTS-affected and non-affected digits ('mixed' grips, we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS

  10. Relationship of age, body mass index, wrist and waist circumferences to carpal tunnel syndrome severity.

    Science.gov (United States)

    Komurcu, Hatice Ferhan; Kilic, Selim; Anlar, Omer

    2014-01-01

    Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18-35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36-64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference.

  11. Early diagnosis of carpal tunnel syndrome: comparison of digit 1 with wrist and distoproximal ratio.

    Science.gov (United States)

    Sharma, K R; Rotta, F; Romano, J; Ayyar, D R

    2001-01-01

    Our objective in this study was to compare the sensitivity and specificity of the median sensory nerve conduction velocity (SNCV) from digit 1 to wrist with those of the distoproximal (D/P) ratio of the median SNCV from palm to digit 3/palm to wrist in the diagnosis of mild carpal tunnel syndrome (CTS) by using a receiver operating characteristic (ROC) curve. To achieve this objective, we studied prospectively (January 1997-October 1998) 370 patients referred for CTS. One hundred forty-two patients (38.4%) with moderate to severe CTS and 15 patients (4.1%) with multiple (> or = 3) compressive neuropathies in upper limbs with subclinical peripheral neuropathy were excluded. The remaining 213 patients (302 hands with mild CTS; 167 women; mean age, 50 y +/- 12 y) and 38 controls (71 hands; 25 women; mean age, 47 y +/- 13 y) had median and ulnar nerve conduction studies. ROC curves were constructed for median SNCV digit 1 to wrist and median SNCV D/P ratio from the patients' and controls' data. The median SNCV at or = 1.12, corresponding to an optimal cutoff point on ROC curve, discriminated 67.2% of mild CTS from controls with specificity of 97.2%. Of the 10.3% (31/302) of hands in which digit 1 to wrist was within normal limits at the selected optimal cutoff value ( or = 1.12), and 3.3% (10/302) had a normal electrophysiologic examination. The likelihood ratio (true-positive ratio to false-positive ratio, assessing the discriminative power of a test) of the median SNCV digit 1 to wrist, at an optimal point on ROC curve (63.9), was higher than that of the median SNCV D/P ratio (23.9, chi2 = 36.9, P wrist is more sensitive than the median SNCV D/P ratio in the diagnosis of mild CTS.

  12. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature

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    Seror, P. [Laboratoire d' electromyographie, 146, avenue Ledru-Rollin, Paris 75011 (France)], E-mail: p.seror@wanadoo.fr

    2008-07-15

    We present a review of the international literature concerning sonography for the diagnosis of carpal tunnel syndrome (CTS). Analysis of the results and comparison with electrodiagnostic data provide a sensible albeit personal view on the relevance of sonography and whether it competes or is complementary to electrodiagnosis (EDX). Although EDX is considered as the gold standard for CTS diagnosis, one author chose surgical results to define CTS. The normal and threshold mean values for sonography are particularly variable from one study to another. The standard deviation (S.D.), when compared to mean values, makes normal and abnormal data overlap considerably and produces many false negatives when the specificity is high, and many false positives when the sensitivity is high. In fact, sonography is non-interpretable in only 10 to 15% of the population, and it affirms the median nerve lesion at the wrist in 55% of cases when EDX does it in more than 90% with common tests. Further more the specificity of sonography leads to a false positive diagnosis in 1 case out of 5 versus 1 out of 40 with EDX. The main conclusion is that there is no competition but rather a complementarity between sonography and EDX: sonography is certainly an efficient imaging technique but cannot replace proper EDX performed for upper limb paresthesiae. Namely, sonography can answer only one out of the 8 questions a complete EDX answer: Are sonographic images compatible with a median nerve lesion at the wrist? The answer to this solely question can be obtain with a partial EDX using a single conduction test (motor or sensitive), then duration and cost will be comparable to sonography but will be both more sensitive and specific. Finally, one must kept in mind that the final aim of all examinations in CTS is to determine the cause(s) of upper limb paresthesiae, not simply if there is a median nerve lesion at wrist or not.

  13. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome

    Science.gov (United States)

    Vahdatpour, Babak; Kiyani, Abolghasem; Dehghan, Farnaz

    2016-01-01

    Background: The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS. Materials and Methods: This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student’s t-test, and Chi-square test. Results: All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period. Conclusion: It is recommended to use ESWT as a conservative treatment in patients with CTS. PMID:27563630

  14. A Comparison of Boosting Tree and Gradient Treeboost Methods for Carpal Tunnel Syndrome

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    Gülhan OREKİCİ TEMEL

    2014-10-01

    Full Text Available Objective: Boosting is one of the most successful combining methods. The principal aim of these combining algorithms is to obtain a strong classifier with small estimation error from the combination of weak classifiers. Boosting based on combining tree has many advantages. Data sets can contain mixtures of nominal, ordinal and numerical variables. AdaBoost and Gradient TreeBoost are commonly used boosting procedure. Both methods are a stage wise additive model fitting procedure. Our goal in this study is to explain the both method and to compare the algorithm results on a neurology data set on the purpose of classification. Material and Methods: The data set consists of 4076 incidences in total. The condition of being a patient with Carpal Tunnel Syndrome (CTS or not was considered as the dependent variable. Boosting Tree and Gradient TreeBoost applications were conducted in Statistica 7.0 and Salford Predictive Modeler: TreeNet (R trial version 6.6.0.091. Results: In AdaBoost and Gradient TreeBoost algorithm, multiple trees are grown of the training data. 200 trees are produced for both models. 70 trees in the AdaBoost Algorithm and 196 trees in the Gradient TreeBoost algorithm are chosen as the optimal trees. Conclusion: The sensitivity or specify values in the test data of Gradient TreeBoost are high indicates that they can be used as a successful method in CTS diagnosis. . It is believed that the boosting methods will become very more and more popular in health science due to its easy implementation and high predictive performance.

  15. Amelioration by mecobalamin of subclinical carpal tunnel syndrome involving unaffected limbs in stroke patients.

    Science.gov (United States)

    Sato, Yoshihiro; Honda, Yoshiaki; Iwamoto, Jun; Kanoko, Tomohiro; Satoh, Kei

    2005-04-15

    Our previous study showed that overuse of the nonparetic hand and wrist of the nonparetic side following stroke result in significantly more abnormal on the nonparetic side than on the hemiparetic side in terms of electrophysiologic indices of median nerve function. The purpose of this study was to evaluate the effects of the orally administered mecobalamin, an analogue of vitamin B12, for carpal tunnel syndrome (CTS) in the nonparetic side in patients following stroke. In a randomized open label and prospective study of stroke patients, 67 received of 1500 mug mecobalamin daily for 2 years, and the remaining 68 (untreated group) did not. At baseline, sensory nerve conduction velocity, motor nerve conduction velocity, sensory nerve action potentials (SNAP) at the wrist, palm-to-wrist distal sensory latency, palm-to-wrist SNAP, motor nerve conduction velocity compound motor action potentials, and distal motor latency of median nerve were significantly more abnormal on the nonparetic side than on the hemiparetic side or in controls. Before the treatment 21 patients (31%) of untreated and 20 patients (30%) of treated group met electrophysiologic criteria for CTS. Sensory impairment of the nonparetic side had lessened in the treated group. After 2 years, all electrophysiologic indices of nonparetic side were significantly improved in the treated group compared with those in the untreated group. The improvement from baseline of electrophysiologic parameters in sensory nerve in the treated group was greater than the improvement measured in motor nerve. There were no side effects. Oral mecobalamin treatment is a safe and potentially beneficial therapy for CTS in stroke patients.

  16. Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP).

    Science.gov (United States)

    Zoicas, F; Kleindienst, A; Mayr, B; Buchfelder, M; Megele, R; Schöfl, C

    2016-07-01

    Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.

  17. [Outbreak of carpal tunnel syndrome of the upper limbs in automobile seat assemblers: results of exposure evaluation and clinical investigation].

    Science.gov (United States)

    Barbieri, P G; Colombini, D; Rocco, A; Custureri, F; Paderno, G

    1996-01-01

    A group of 59 female workers in the sewing and upholstery departments of a factory manufacturing automobile seats underwent clinical and instrumental tests following reports of several cases of suspected carpal tunnel syndrome. A risk evaluation analysis for disorders attributable to repeated trauma of the upper limbs (WMSDs) was simultaneously carried out using the protocol recommended by the EPM Research Unit in Milan. Evidence was found of a high frequency of elementary actions associated with considerable muscular involvement along with inadequate recovery periods. The clinical investigation revealed an unusually high percentage of carpal tunnel syndromes, often associated with Guyon channel syndrome. This disorder affects males and females equally, is often bilateral, and is not associated with known non-occupational factors. The widespread outbreak of work-related musculo-skeletal disorders reported in the departments in question may have arisen from a combination of significant risk factors relating to the types of activities performed, and the long service of the workers. It is reasonable to assume that failure to adopt technical preventive and organisational measures may have stemmed primarily from a poor evaluation of the relevant occupational risks, and from many years of substandard health surveillance practices.

  18. Does sensory relearning improve tactile function after carpal tunnel decompression? A pragmatic, assessor-blinded, randomized clinical trial

    Science.gov (United States)

    Jerosch-Herold, C.; Houghton, J.; Miller, L.; Shepstone, L.

    2016-01-01

    Despite surgery for carpal tunnel syndrome being effective in 80%–90% of cases, chronic numbness and hand disability can occur. The aim of this study was to investigate whether sensory relearning improves tactile discrimination and hand function after decompression. In a multi-centre, pragmatic, randomized, controlled trial, 104 patients were randomized to a sensory relearning (n = 52) or control (n = 52) group. A total of 93 patients completed a 12-week follow-up. Primary outcome was the shape-texture identification test at 6 weeks. Secondary outcomes were touch threshold, touch localization, dexterity and self-reported hand function. No significant group differences were seen for the primary outcome (Shape-Texture Identification) at 6 weeks or 12 weeks. Similarly, no significant group differences were observed on secondary outcomes, with the exception of self-reported hand function. A secondary complier-averaged-causal-effects analysis showed no statistically significant treatment effect on the primary outcome. Sensory relearning for tactile sensory and functional deficits after carpal tunnel decompression is not effective. Level of Evidence: II PMID:27402282

  19. Exposure-response relationships between movements and postures of the wrist and carpal tunnel syndrome among male and female house painters

    DEFF Research Database (Denmark)

    Heilskov-Hansen, Thomas; Mikkelsen, Sigurd; Svendsen, Susanne Wulff

    2016-01-01

    OBJECTIVES: To investigate exposure-response relationships between measured movements and postures of the wrist and the incidence of carpal tunnel syndrome (CTS), and any modifications by sex. METHODS: In 2011, we established a historical cohort of 9364 members of the Painters' Union in Denmark. ...

  20. Effects of Pain and Disability on Quality of Life in Patients with Carpal Tunnel Syndrome

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    Ayhan Öztürk1

    2013-09-01

    Full Text Available Objective: To evaluate the association between severity of carpal tunnel syndrome (CTS, pain, disability and to assess their effects on quality of life. Methods: CTS patients whose diagnosis were confirmed with nerve conduction studies were classified as “mild”, “moderate”, and “severe”. Pain evaluation was performed by “Pain Quality Assessment Scale (PQAS” in all patients. Short form-36 (SF-36 was used to assess quality of life and “Brief Disability Scale” was used in the evaluation of disability. Results: 93.1% of the patients were women, and 6.9% were men. Mean age was 44.20±8.76 years (range= 29–62. Mean duration of symptoms was 6.67±3.00 months (range=3-12 months. Most common symptom was paresthesia. Electrophysiological evaluations revealed moderate CTS in 43.8%, mild CTS in 44.8%, severe CTS in 6.9% of the patients. There was no significant association between CTS severity and time course subgroup of PQAS (p=0.222. But there was a statistically significant difference in the general pain subgroup and total scores of PQAS between moderate and severe CTS patients (p<0.05. There was a statistically significant difference in the mean scores of Brief Disability Questionnaire between patients with mild and severe CTS (4,46±3,61 and 11,50±4,94, p<0.05, respectively. A statistically significant negative correlation was found between the level of disability and physical function, pain, vitality, social function and mental health domains of SF-36. Conclusion: Quality of life is variably affected in patients with CTS due to the severity of CTS. On this aspect, it is important to diagnose and treat CTS on time to improve the quality of life of patients with CTS in early period, which is the best known and common compression neuropathy of upper extremity in community.

  1. How to make electrodiagnosis of carpal tunnel syndrome with normal distal conductions?

    Science.gov (United States)

    Lee, Wei-Ju; Liao, Yi-Chu; Wei, Shiew-Jue; Tsai, Chi-Wei; Chang, Ming-Hong

    2011-02-01

    The purpose of this study is to investigate which electrodiagnostic techniques are better in clinically diagnosed patients with carpal tunnel syndrome (CTS) and patients with CTS with normal distal conduction study. A total of 230 clinically diagnosed patients with CTS and 100 normal control subjects were enrolled. All subjects were evaluated by eight electrodiagnostic techniques, including conventional conduction studies: median distal sensory latency and distal motor latency; short distance conduction studies across wrist, including wrist-palm sensory conduction time and wrist-palm motor conduction velocity; comparison of median sensory conduction across the wrist with radial or ulnar nerves in the same limb (median-radial sensory latency difference [M-R] or median-ulnar sensory latency difference [M-U]); and comparison of median wrist-palm and palm-index conduction, including distoproximal conduction time difference and distoproximal conduction time ratio. Normal limits were derived by calculating the mean ± 2 standard deviations from the data of the controls. The sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve with 95% confidence interval of each test were calculated. In clinically diagnosed patients with CTS, M-R is the best diagnostic technique with significant difference in area under the receiver operating characteristic curve (0.912) compared with other tests except that of M-U. The sensitivity, specificity, positive predictive value, and negative predictive value of M-R were 84.3%, 98%, 99%, and 73.1%, respectively. Further evaluation of patients with CTS with normal distal latencies also revealed the best diagnostic value of M-R and M-U with significance to other tests in area under the receiver operating characteristic curve. In clinical practice, after conventional median distal sensory latency and distal motor latency studies, the authors suggest performing

  2. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests

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    Koyuncuoglu, Hasan Rifat [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Kutluhan, Suleyman [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey)]. E-mail: skutluhan@hotmail.com; Yesildag, Ahmet [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Oyar, Orhan [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Guler, Kezban [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Ozden, Ahmet [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey)

    2005-12-15

    The diagnosis of carpal tunnel syndrome (CTS) is mainly based on clinical findings and electrodiagnostic tests (EDT). However, EDT results do not support clinical findings in some cases. It has been recently suggested that ultrasonography (US) can be used to diagnose CTS. In this study, we aimed to investigate whether US has a diagnostic value for CTS in patients with negative EDT findings or not. EDT was performed on 319 wrists with clinical CTS findings in electrophysiology laboratory. Median and ulnar nerve conduction velocities were measured in all cases and electromyography was performed in patient with tenar atrophy and having suspicion involvement of brachial plexus as EDT. Fifty-nine wrists with negative EDT (study group) and 30 wrists from 15 healthy individuals (control group) were examined using US. The mean of cross-sectional areas (CSAs) measurements were found 8.83 {+-} 3.05 mm{sup 2} by tracing method (TM) and 8.51 {+-} 3.13 mm{sup 2} by ellipsoid formula (EF) in study group, and 7.63 {+-} 1.52 mm{sup 2} by TM and 7.66 {+-} 1.42 mm{sup 2} by EF in control group. The differences between study group and control group according to both TM and EF were significant (t-test p = 0.0079, p = 0.0460, respectively). In study group, CSAs were larger than 10.5 mm{sup 2} in 18 (30.51%) and 16 (27.12%) wrists according to TM and EF findings, respectively, and in only one wrist (3.33%) in control group by both TM and EF. The differences of ultrasonographic CTS numbers between study group and control group were significant (p = 0.0024 by TM, p = 0.0086 by EF). We confirmed the usefulness of quantitative US assessment in the diagnosis of CTS in the patients with negative EDT findings. If EDT findings are inadequate to confirm the CTS in the patients with clinical CTS, US studies may be helpful to diagnose.

  3. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome

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    Johnsson Ragnar

    2003-05-01

    Full Text Available Abstract Background Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS, with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and determine the properties of the most accurate test. Methods In a population-based study a questionnaire was mailed to a random sample of 3,000 persons. Of 2,466 responders, 262 symptomatic (numbness/tingling in the radial fingers and 125 randomly selected asymptomatic responders underwent clinical and electrophysiologic examinations. A standardized hand diagram was administered to the symptomatic persons. At the clinical examination, the examining surgeon identified 94 symptomatic persons as having clinically certain CTS. Nerve conduction tests were then performed on the symptomatic and the asymptomatic persons by blinded examiners. Analysis with receiver operating characteristic (ROC curves was used to compare the diagnostic accuracy of the nerve conduction tests in distinguishing the persons with clinically certain CTS from the asymptomatic persons. Results No difference was shown in the diagnostic accuracy of median nerve distal motor latency, digit-wrist sensory latency, wrist-palm sensory conduction velocity, and wrist-palm/forearm sensory conduction velocity ratio (area under curve, 0.75–0.76. Median-ulnar digit-wrist sensory latency difference had a significantly higher diagnostic accuracy (area under curve, 0.80. Using the optimal cutoff value of 0.8 ms for abnormal sensory latency difference shown on the ROC curve the sensitivity was 70%, specificity 82%, positive predictive value 19% and negative predictive value 98%. Based on the clinical diagnosis

  4. Effects of dividing the transverse carpal ligament on the mechanical behavior of the carpal bones under axial compressive load: a finite element study.

    Science.gov (United States)

    Guo, Xin; Fan, Yubo; Li, Zong-Ming

    2009-03-01

    Transecting the transverse carpal ligament (TCL) is a routine procedure to surgically treat carpal tunnel syndrome; yet, its mechanical consequences on carpal bones are unclear. In this study, our intent was to perform a computational analysis of carpal biomechanics resulting from TCL release. A three-dimensional finite element model of the wrist was constructed, which included all the carpal bones, the distal ulna and radius, the proximal metacarpals and the interosseous ligaments. Cartilage layers of each bone were modeled manually according to anatomic visualization software. The TCL was also modeled in three dimensions and added to the bone model. A 100-Newton axial load was applied to the upper section of the second and third metacarpals. The effects of dividing the TCL on the displacements of the carpal bones and the contact stress distribution in the midcarpal joints were studied using a finite element analysis method. When the TCL was divided, the axial compressive load resulted in the carpal bones deviating more radially. More specifically, the carpal bones on the radial side of the capitate and lunate (i.e. the trapezium, trapezoid, and scaphoid) moved further toward the radius, and the carpal bones on the ulnar side of the capitate and lunate (i.e. hamate, triquetrum, and pisiform) moved further toward the metacarpals. The contact stresses and contact locations in the midcarpal joints changed as a result of dividing the TCL. The changes in displacements of carpal bones and the contact stress distributions in the midcarpal joints due to TCL release may be implicated for some of the postoperative complications associated with carpal tunnel release.

  5. Alteration of proximal conduction velocity at distal nerve injury in carpal tunnel syndrome: demyelinating versus axonal change.

    Science.gov (United States)

    Chang, Ming-Hong; Liu, Lu-Han; Lee, Yi-Chung; Hsieh, Peiyuan F

    2008-06-01

    The objective of this study was to determine the cause of median forearm motor conduction velocity (FMCV) slowing in patients with carpal tunnel syndrome, due to either focal conduction abnormality over wrist or retrograde conduction slowing, and to decide whether the slowing is related to severity of compression or not. Fifty carpal tunnel syndrome patients confirmed by conventional nerve conduction study with abnormal electromyography of the abductor pollicis brevis muscle were group 1, and 100 with normal electromyography, group 2. One hundred volunteers served as controls. In addition to conventional nerve conduction study of median and ulnar nerves, palmar stimulations for median mixed and motor nerves were also performed to calculate wrist-palm mixed nerve conduction time and motor conduction velocity (W-P MCV). For group 1, group 2, and control subjects, respectively, W-P MCV were 19.73+/-7.65 (mean+/-SD), 32.7+/-6.83, and 52.75+/-6.4 m/s, whereas median FMCV were 48.63+/-8.32, 54.42+/-2.11, and 57.86+/-4.24 m/s. There was a significant reduction in the W-P MCV (62.6%, Pulnar FMCV and sensory nerve conduction study results did not, suggesting the reduction of median W-P MCV is not parallel with that of median FMCV in both patients groups. Furthermore, there is a poor correlation of median FMCV and W-P MCV in patient groups, implying conduction blockage of the large myelinating fibers at the wrist, leaving only slower axons to be measured, is not the likely cause of reduction of FMCV. In addition, the reduction of compound muscle action potential amplitude of abductor pollicis brevis muscle, conduction block at wrist and weak correlation of median FMCV and compound muscle action potential amplitude of abductor pollicis brevis exclusively occurred in group 1. Therefore, the retrograde conduction slowing really occurs among patients with carpal tunnel syndrome-markedly in those with abnormal electromyography and mildly in those with only demyelination. This

  6. Cultural adaptation of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome:A Turkish version study

    Institute of Scientific and Technical Information of China (English)

    Ilkerilhanli; Dilek Durmus; Gulhan Orekici

    2015-01-01

    Objective: Cultural adaptations of the questionnaires are important for easy use. We aimed to assess the reliability and validity of the Turkish Version of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome. Methods: To assess test-retest reliability, the Turkish “Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand”questionnaires were answered by patients and controls and were repeated a week later. For testing internal consistency, the Cronbach's alpha test was used. For testing validity, correlations between the subscales of the“Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand” questionnaire were measured in patient groups. One hundred patients with idiopathic Carpal Tunnel Syndrome and 50 healthy participants were included in the study. Results: In test-retest reliability, intraclass correlations of the subscales of the“Michigan Hand Outcomes Questionnaire”were high. Cronbach's alphas were found to be high in all subscales. There was no significant correlation between asthetics and pain scales. We found significant differences between patients and controls regarding all subscales of the“Michigan Hand Outcomes Questionnaire”. Correlations between subscales of the “Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand”questionnaire were significant. We found no difference between one-hand effected and two-hand effected patients, in terms of the “Michigan Hand Outcomes Questionnaire”, “Disabilities of Arm, Shoulder and Hand” questionnaire Function/Symptom and Work average scores. Conclusion: This study showed that the Turkish version of the“Michigan Hand Outcomes Questionnaire”is reliable and valid and can be used in Turkish patients with Carpal Tunnel Syndrome because it is comprehensible and practicable. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B

  7. Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle

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    Nermin Tanik

    2016-03-01

    Full Text Available ABSTRACT Carpal tunnel syndrome (CTS is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI and depression using the Beck Depression Inventory (BDI. The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4 questionnaire and a visual analogue scale (VAS. Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

  8. Advance in Diagnosis for Carpal Tunnel Syndrome (review)%腕管综合征的诊断进展①

    Institute of Scientific and Technical Information of China (English)

    李洋; 朱向阳; 黄怀宇

    2013-01-01

    Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, which include a series of symptoms results from median nerve injury. Electrical physical examination is the gold standard for diagnosis of CTS. More new technology, such as high frequency ultra-sound and magnetic resonance imaging, provides more information for the diagnosis of CTS.%  腕管综合征(CTS)是常见的周围神经病,是正中神经损伤后出现的一组临床症状。目前诊断 CTS 的金标准为电生理检查。高频超声和磁共振等影像学技术为 CTS 的诊断提供了新方法,能有效提高 CTS 诊断的敏感性和特异性。

  9. Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index

    Directory of Open Access Journals (Sweden)

    Kuyucu Mutlu

    2009-07-01

    Full Text Available Abstract The purpose of this study is to evaluate prospectively the sensitivities of conventional and new electrophysiological techniques and to investigate their relationship with the body mass index (BMI in a population of patients suspected of having carpal tunnel syndrome (CTS. In this study, 165 hands of 92 consecutive patients (81 female, 11 male with clinical diagnosis of CTS were compared to reference population of 60 hands of 30 healthy subjects (26 female and 4 male. Extensive sensory and motor nerve conduction studies (NCSs were performed in the diagnosis of subtle CTS patients. Also, the patients were divided into subgroups and sensitivities were determined according to BMI. The mean BMI was found to be significantly higher in the CTS than in the control group (p The newer nerve conduction techniques and combining different NCSs tests are more sensitive than single conventional NCS test for the diagnosis of suspected CTS. Meanwhile, CTS is associated with increasing BMI.

  10. The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

    Science.gov (United States)

    Deniz, Orhan; Aygül, Recep; Kotan, Dilcan; Ozdemir, Gökhan; Odabaş, Faruk Omer; Kaya, M Dursun; Ulvi, Hızır

    2012-05-01

    The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

  11. Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements.

    Science.gov (United States)

    Wang, Yuexiang; Zhao, Chunfeng; Passe, Sandra M; Filius, Anika; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C

    2014-01-01

    The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. To better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, to have a baseline for comparison with abnormal movements. Dynamic ultrasound images of both wrists of 10 asymptomatic volunteers were obtained during wrist maximal flexion, extension and ulnar deviation. To simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared with the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (p nerve displacement vector between finger flexion, wrist flexion with finger extension and wrist ulnar deviation with finger extension (all p's nerve motion in wrist flexion with finger extension (2.36 ± 0.79 normalized units [NU]), wrist flexion with finger flexion (2.46 ± 0.84 NU) and wrist ulnar deviation with finger extension (2.86 ± 0.51 NU) were higher than those in finger flexion (0.82 ± 0.33 NU), wrist extension with finger extension (0.77 ± 0.46 NU) and wrist extension with finger flexion (0.81 ± 0.58 NU) (p ulnar deviation could induce significant transverse displacement and deformation of the median nerve.

  12. Effect of Vitamin B6 on Clinical Symptoms and Electrodiagnostic Results of Patients with Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Mahnaz Talebi

    2013-08-01

    Full Text Available Purpose: Carpal tunnel syndrome (CTS refers to a cluster of signs and symptoms that stems from compression of the median nerve traveling through carpal tunnel. Surgery is a definite treatment for CTS; however, many conservative therapies have been proposed. The present study set out to assess the effect of vitamin B6 in patients with CTS. Methods: Forty patients (67 hands with mild-moderate CTS were initially selected and randomly assigned into two groups as follows: 1 Case group with 20 subjects (32 affected hands receiving vitamin B6 (120 mg/day for 3 months and splinting. 2 Control group with 19 subjects (35 affected hands only received splinting. One subject from the control group dispensed with continuing participation in the research. Daily symptoms and electrodiagnostic (NCV-EMG results were assessed at baseline and after 3 months. Results: Nocturnal awakening frequency due to pain, daily pain, daily pain frequency, daily pain persistence, hand numbness, hand weakness, hand tingling, severity of nocturnal numbness and tingling, nocturnal awakening frequency owing to hand numbness and tingling, and clumsiness in handling objects improved significantly in the vitamin B6-treated patients; even so, only problem with opening a jam bottle and handling phone significantly reduced in the control group. The median nerve sensory latency mean decreased following the treatment; and the median nerve sensory amplitude mean and sensory conduction velocity mean increased. Conclusion: The present study suggests that vitamin B6 treatment improves clinical symptoms and sensory electrodiagnostic results in CTS patients, and thus is recommended for CTS treatment.

  13. Clinical auxiliary diagnosis value of high frequency ultrasonographic measurements of the thickness of transverse carpal ligaments in carpal tunnel syndrome patients%高频超声测量腕横韧带厚度对腕管综合征的临床辅助诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐林; 陈方民; 王蕾; 张培训; 姜晓锐

    2016-01-01

    Objective:To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).Methods:In this study,48 patients (unilateral hand)with CTS were analyzed.The thickness of transverse carpal ligaments at the pisiform bone was measured using high-fre-quency ultrasound.Open carpal tunnel release procedure was performed in the 48 CTS patients,and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under di-rect vision.The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound.High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the ha-mate hook bone and pisiform bone,and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC)curve,sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS)ana-lyzed.Results:The thickness of transverse carpal ligaments in the CTS patients were (0.42 ±0.08)cm (high-frequency ultrasound)and (0.41 ±0.06)cm (operation)at hamate hook bone,and there was no significant difference between the two ways (t =0.672,P>0.05 ).The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0.385 cm,the sensitivity 0.775,and the specificity 0.788.The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950,and the specificity 1 .000.The transverse carpal ligaments thickness and wrist-in- dex finger sensory nerve conduction velocity (SCV),wrist-middle finger SCV showed a negative correla-tion.Conclusion:High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.%目的:评价高频超声对诊断腕管综合征(carpal tunnel syndrome,CTS)的价值及意义。方法:选择48例(单侧)CTS患者

  14. Carpal tunnel syndrome in association with hand-arm vibration syndrome: a review of claimants seeking compensation in the Mining Industry.

    Science.gov (United States)

    Burke, F D; Lawson, I J; McGeoch, K L; Miles, J N V; Proud, G

    2005-05-01

    Twenty six thousand eight hundred and forty-two miners seeking compensation were clinically assessed for vascular and neurosensory impairment arising from exposure to occupational hand-arm vibration (Hand-Arm Vibration Syndrome). They were also assessed clinically for Carpal Tunnel Syndrome which, if present, would result in additional compensation. Fifteen per cent were assessed as having both HAVS and CTS. Thirty-eight per cent of claimants had nocturnal wakening, 1.3% wasting of abductor pollicis brevis, 15% had a positive Tinel's test and 20% had a positive Phalen's test. The 15% prevalence reported is lower than the rates cited previously in several small population studies of workers exposed to vibration. This paper reports the results of the assessment process and discusses the difficulty of discriminating Carpal Tunnel Syndrome from diffuse neurosensory impairment arising from HAVS.

  15. Assessment from Functional Perspectives: Using Sensorimotor Control in the Hand as an Outcome Indicator in the Surgical Treatment of Carpal Tunnel Syndrome.

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    Hsiu-Yun Hsu

    Full Text Available To investigate whether sensorimotor control of the hand could be an outcome indicator after carpal tunnel release (CTR, this work examined changes in the results of patients' manual tactile test (MTT, pinch-holding-up activity (PHUA, two-point discrimination (2PD and Semmes-Weinstein monofilament (SWM tests. Participants included 30 predominantly sensory neuropathy CTS patients, as confirmed by a nerve conduction study. The MTT, precision pinch performance in PHUA and traditional sensibility (2PD and SWM tests were used to examine different aspects of sensory status at the time-points of two weeks before operation and one month post-operation, with a single-blind design. The results showed significant improvements in the sensory function as detected by the 2PD and SWM tests (p0.5, p<0.01 are better than that of two-point discrimination test (effect size<0.5, p<0.001. However, pinch strength saw a decline compared to baseline with a moderate effect sizes (effect size = 0.7, p<0.001. This cohort study found that the MTT and PHUA test can both meet all the statistical criteria with regard to assessing treatment outcomes for patients with CTS. In addition, the results of this work provide clinicians with the information that the sensorimotor functions of the hands, as assessed by MTT and PHUA, are responsive to clinical changes due to CTR.

  16. Comparison of High Resolution Ultrasonography and Nerve Conduction Study in the Diagnosis of Carpal Tunnel Syndrome: Diagnostic Value of Median Nerve Cross-Sectional Area

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    A. Mohammadi

    2009-11-01

    Full Text Available Background/Objective: Carpal tunnel syndrome (CTS is a common peripheral entrapment neuropathy. This study was performed to evaluate whether high-resolution ultrasonography may be an alternative diagnostic method for nerve conduction study (NCS in the diagnosis of carpal tunnel syndrome. "nPatients and Methods: 132 wrists of 82 patients and 152 wrists of controls were enrolled in the study. The cross sectional area of the median nerve was measured at the carpal tunnel inlet and outlet in all patients and controls. All patients had a nerve conduction study. Then comparison between ultrasonography and NCS was performed. Combination of clinical diagnosis and NCS was used as the gold standard. "nResults: The mean cross-sectional area (CSA of the median nerve at the tunnel inlet was 11.4±1.7 mm2 for the patient group and 5.78 ±0.9 mm2 for the control group (P<0.001. The mean cross-sectional area at the tunnel outlet was 9.9±1.2 mm2 for the patient group and 4.7±0.7 mm2 for the control group (P<0.001. The best cut-off value of CSA at the tunnel inlet and the outlet was 7.5 mm2. "nConclusion: In patients with clinical diagnosis of CTS we confirmed that the diagnostic value of ultrasonography is similar to NCS and sonography may be used in primary evaluation of CTS.

  17. Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial

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    Onur Armagan

    2014-08-01

    Full Text Available OBJECTIVE: The aim of this placebo-controlled study was to evaluate the effects of pulsed and continuous ultrasound treatments combined with splint therapy on patients with mild and moderate idiopathic carpal tunnel syndrome. METHODS: The study included 46 carpal tunnel syndrome patients who were randomly divided into 3 groups. The first group (n = 15 received a 0 W/cm2 ultrasound treatment (placebo; the second group (n = 16 received a 1.0 W/cm2 continuous ultrasound treatment and the third group (n = 15 received a 1.0 W/cm2 1:4 pulsed ultrasound treatment 5 days a week for a total of 15 sessions. All patients also wore night splints during treatment period. Pre-treatment and post-treatment Visual Analogue Scale, Symptom Severity Scale and Functional Status Scale scores, median nerve motor conduction velocity and distal latency and sensory conduction velocities of the median nerve in the 2nd finger and palm were compared. Clinicaltrials.gov: NCT02054247. RESULTS: There were significant improvements in all groups in terms of the post-treatment Functional Status Scale score (p<0.05 for all groups, Symptom Severity Scale score (first group: p<0.05, second group: p<0.01, third group: p<0.001 and Visual Analogue Scale score (first and third groups: p<0.01, second group: p<0.001. Sensory conduction velocities improved in the second and third groups (p<0.01. Distal latency in the 2nd finger showed improvement only in the third group (p<0.01 and action potential latency in the palm improved only in the second group (p<0.05. CONCLUSION: The results of this study suggest that splinting therapy combined with placebo and pulsed or continuous ultrasound have similar effects on clinical improvement. Patients treated with continuous and pulsed ultrasound showed electrophysiological improvement; however, the results were not superior to those of the placebo.

  18. Movement of the distal carpal row during narrowing and widening of the carpal arch width.

    Science.gov (United States)

    Gabra, Joseph N; Domalain, Mathieu; Li, Zong-Ming

    2012-10-01

    Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3 deg, 5.3 ± 1.3 deg, and 5.5 ± 3.5 deg, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components.

  19. CARPAL TUNNEL SYNDROME. ETIOLOGICAL, CLINICAL AND ELECTROPHYSIOLOGICAL ASPECTS OF 262 CASES

    Institute of Scientific and Technical Information of China (English)

    卢祖能; 汤晓芙

    1995-01-01

    Two hundred and sixty-two patients with carpal turmel syndrome (CTS) were analyzed retrospeetively. Results showed that middia-and older-age women were more apt to have CTS than men, and that the dominant hand was more frequently affected. Hormonal changes, repetitive and forceful movements, awkward positions of hand and wrist, and other factors may be associated with CTS. Typical clinical manifestations include pain and pareathesia in the median nerve territory, worsening at night or in the early morning, and being relieved by shaking the hand. Although the patients may localize the discomfort beyond the territory, sensory changes are variable and not entirely reliable. Conduction abnormalities often appeared selectively in the median nerve distal to the wriat in CTS. If the patient who is clinically suggestive of CTS shows normal conduction with conventional methods, palmar stimulation and inching technique is recommended. The diagnosis of CTS requires confirmation of illness history, symptoms and signs with objective electrodiagnostic tests.

  20. The application of carpal tunnel contents of measuring in the clinic%腕管内容物测量在临床中的应用

    Institute of Scientific and Technical Information of China (English)

    孙权; 张道卓; 张宇; 李海航; 田心; 朱悦汀; 杨丽丽; 宋微微; 李艳鑫; 孙世杰

    2012-01-01

    Objective To observe the carpal tunnel contents and describe their relationship. Methods Stainless steel vernier caliper was used to measure carpal tunnel contents, carpal canal morphology, carpal tunnel contents, the transverse carpal ligament thickness of 22 cases ( male 16, female 6 ), 44 specimens of adult cadaveric. Results Carpal tunnel was the fibrous tube, which was slightly flat, cylindrical. Male: internal and external diameter of Stenosis was (25 ±2.6) mm, anteroposterior diameter was ( 10.2 ±1.1) mm. Female: internal and external diameter of stenosis was ( 17 ±2. 5 ) mm, anteroposterior diameter was ( 10. 4 ± 1. 5 ) mm. The transverse carpal ligament of male: ( 25.5 ±4.7 ) mm long, ( 22. 1 ±2.2 ) mm wide, 2.3 mm thick, the lower bound from the distal wrist crease was ( 28.4 ±2.6 ) mm. The first carpal tunnel section of male was ( 189. 7 ± 17. 5 ) mm2 ,the second section was ( 182. 1 ± 13. 7 ) mm2 ,the third section was ( 223.4 ±29. 8 ) mm2. The first section of female was ( 172.4 ± 15. 2 ) mm2, the second section was ( 153. 1 ± 17. 3 ) mm2, the third section was( 178. 1 ±11.6 )mm2. Conclusion The carpal tunnel of male was wide and short, the carpal tunnel of female was narrow, the top half of transverse carpal ligament was thin, lower half was thick, tough and inelastic. Female carpal tunnel is the narrower than men, which was the cause of diseases.%目的 观测腕管内容物并描述其相互间关系,为临床手外科学和显微外科学中的应用提供参考.方法 采用游标卡尺对22具本成人尸体(男16具,女6具),44侧标本成人尸体标本腕管内容物测量,腕管解剖学观察、腕管内容物、腕横韧带的厚度测量等.结果 腕管为纤维性骨管,略呈扁圆柱形,男性:狭窄部内外径(25.0±2.6)mm,前后径(10.2±1.l)mm;女性:狭窄部内外径(17.0±2.5)mm,前后(10.4±1.5)mm.腕横韧带男性:长(25.5±4.7)mm,宽(22.1±2.2)mm,厚2.3 mm,下界距腕远纹(28.4±2.6)mm;女性:长(22.7±3.3)mm

  1. A longitudinal study of industrial and clerical workers: incidence of carpal tunnel syndrome and assessment of risk factors.

    Science.gov (United States)

    Gell, Nancy; Werner, Robert A; Franzblau, Alfred; Ulin, Sheryl S; Armstrong, Thomas J

    2005-03-01

    This study followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome (CTS). The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS. This prospective study followed 432 industrial and clerical workers over 5.4 years. Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening. On the basis of logistic regression, significant predictors for CTS include baseline median-ulnar peak latency difference, a history of wrist/hand/finger tendonitis, a history of numbness, tingling, burning, and/or pain in the hand, and work above the action level of the peak force and hand activity level threshold limit value. This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS.

  2. Acupuncture-Evoked Response in Somatosensory and Prefrontal Cortices Predicts Immediate Pain Reduction in Carpal Tunnel Syndrome

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    Yumi Maeda

    2013-01-01

    Full Text Available The linkage between brain response to acupuncture and subsequent analgesia remains poorly understood. Our aim was to evaluate this linkage in chronic pain patients with carpal tunnel syndrome (CTS. Brain response to electroacupuncture (EA was evaluated with functional MRI. Subjects were randomized to 3 groups: (1 EA applied at local acupoints on the affected wrist (PC-7 to TW-5, (2 EA at distal acupoints (contralateral ankle, SP-6 to LV-4, and (3 sham EA at nonacupoint locations on the affected wrist. Symptom ratings were evaluated prior to and following the scan. Subjects in the local and distal groups reported reduced pain. Verum EA produced greater reduction of paresthesia compared to sham. Compared to sham EA, local EA produced greater activation in insula and S2 and greater deactivation in ipsilateral S1, while distal EA produced greater activation in S2 and deactivation in posterior cingulate cortex. Brain response to distal EA in prefrontal cortex (PFC and brain response to verum EA in S1, SMA, and PFC were correlated with pain reduction following stimulation. Thus, while greater activation to verum acupuncture in these regions may predict subsequent analgesia, PFC activation may specifically mediate reduced pain when stimulating distal acupoints.

  3. Associations of cardiovascular risk factors, carotid intima-media thickness and manifest atherosclerotic vascular disease with carpal tunnel syndrome

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    Liira Helena

    2011-04-01

    Full Text Available Abstract Background The role of atherosclerosis in carpal tunnel syndrome (CTS has not previously been addressed in population studies. The aim of this study was to investigate the associations of cardiovascular risk factors, carotid artery intima-media thickness (IMT, and clinical atherosclerotic diseases with CTS. Methods In this cross sectional study, the target population consisted of subjects aged 30 or over who had participated in the national Finnish Health Survey in 2000-2001. Of the 7977 eligible subjects, 6254 (78.4% were included in our study. Carotid IMT was measured in a sub-sample of subjects aged 45 to 74 (N = 1353. Results Obesity (adjusted odds ratio (OR 2.4, 95% confidence interval (CI 1.1-5.4, high LDL cholesterol (OR 3.8, 95% CI 1.6-9.1 for >190 vs. 200 vs. Conclusions Our findings suggest an association between CTS and cardiovascular risk factors in young people, and carotid IMT and clinical atherosclerotic vascular disease in older people. CTS may either be a manifestation of atherosclerosis, or both conditions may share similar risk factors.

  4. Motor nerve conduction velocity and function in carpal tunnel syndrome following neural mobilization: A randomized clinical trial

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    Manu Goyal

    2016-01-01

    Full Text Available Introduction: Carpal tunnel syndrome (CTS is the most common nerve entrapment syndrome in the upper extremity leading to the functional disability. The consequence of the entrapment is the poor health of the nerve (conduction, mobility, and blood flow. Purpose of the Study: The aim of the study is to evaluate the effect of neural mobilization on the motor nerve conduction velocity and function in the CTS patients. Methods: Thirty CTS patients (only females were scrutinized on the basis of the inclusion and exclusion criteria. They were randomized into two groups A (n = 15 and B (n = 15 using simple random sampling. Group A patients were treated with the conventional physiotherapy regimen and Group B were provided neural mobilization. Results: The data analysis was done using SPSS version 22. The t-test reveals that there was statistically significant improvement in posttreatment values of Group B for numeric pain rating scale, symptom severity scale, function status scale, motor nerve conduction latency, and velocity at P≤ 0.05. Conclusions: Neural mobilization in the CTS patients improves the motor nerve conduction and functional status. It may be incorporated in the physiotherapy treatment protocol of CTS patients.

  5. Association between the catechol-o-methyltransferase val158met polymorphism with susceptibility and severity of carpal tunnel syndrome

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    Erkol İnal E

    2015-12-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy of the upper extremity. In this study, we aimed to clarify the relationships between the catechol-O-methyltransferase (COMT gene Val158Met (rs4680 polymorphism and development, functional and clinical status of CTS. Ninety-five women with electro diagnostically confirmed CTS and 95 healthy controls were enrolled in the study. The functional and clinical status of the patients was measured by the Turkish version of the Boston Questionnaire and intensity of pain related to the past 2 weeks was evaluated on a visual analog scale (VAS. The Val158Met polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP, method. We divided patients according to the genotypes of the Val158Met polymorphism as Val/Val, Val/Met and Met/Met. There were not any significant differences in terms of Val158Met polymorphisms between patients and healthy controls (p >0.05. We also did not find any relationships between the Val158Met polymorphism and CTS (p >0.05. In conclusion, although we did not find any relationships between CTS and the Val158Met polymorphism, we could not generalize this result to the general population. Future studies are warranted to conclude precise associations.

  6. Carpal tunnel syndrome: a case-control study evaluating its relationship with body mass index and hand and wrist measurements.

    Science.gov (United States)

    Farmer, J E; Davis, T R C

    2008-08-01

    This case-control study investigated the associations between the body mass index (BMI), hand and wrist measurements and carpal tunnel syndrome (CTS). The hands and wrists of 50 patients with CTS and 50 age- and sex-matched controls were measured. The right and left wrist indices (wrist depth/wrist width) were significantly greater in CTS patients (mean = 0.71. SD = 0.04) than in the controls (mean = 0.69 SD = 0.04). The hand index (hand length/palm width) and BMI were not significantly different in the two groups. The hand, but not the wrist, index was found to correlate with the BMI. These results provide some support for a causative association between wrist morphometry, as measured by the wrist index, and CTS, but this difference is too small to be of diagnostic value in clinical or epidemiological practice. The results could also suggest that the previously reported association between CTS and the hand index may be secondary to differences in the BMI.

  7. Effect of body mass index on ulnar nerve conduction velocity, ulnar neuropathy at the elbow, and carpal tunnel syndrome.

    Science.gov (United States)

    Landau, Mark E; Barner, Kristen C; Campbell, William W

    2005-09-01

    Both high and low body mass index (BMI) have been reported as risk factors for ulnar neuropathy at the elbow (UNE), and a high BMI as a risk factor for carpal tunnel syndrome (CTS). To determine whether the extremes of BMI are risk factors for UNE or CTS, and whether BMI affects calculation of median and ulnar motor nerve conduction velocity (NCV), we retrospectively analyzed the electrodiagnostic records of control patients, UNE patients, and CTS patients. The BMI was calculated for 50 patients with a sole diagnosis of UNE and compared to the BMI of 50 patients with CTS and 50 control subjects. The mean BMIs were 25.9 +/- 4.4, 30.1 +/- 5.5, and 28.3 +/- 5.6 for the UNE, CTS, and controls, respectively. By one-way analysis of variance, the difference in BMI between the UNE patients and the normal patients was significant (P ulnar motor NCV across the elbow but not with forearm NCV. Across-elbow (AE) ulnar motor NCV may be falsely increased in patients with a high BMI, probably due to distance measurement factors. Not only do relatively slender individuals have comparatively slower AE ulnar NCVs, they are also at increased risk for developing UNE. Patients with a high BMI are at increased risk for CTS.

  8. 肘管、腕管的超声解剖及其临床应用%Study on the anatomy and clinical implication of cubital and carpal tunnel with ultrasound

    Institute of Scientific and Technical Information of China (English)

    郭瑞军; 于亚东; 邵新中; 王明花; 田德虎; 张文云; 张经歧; 张晓丽

    2000-01-01

    目的 探讨高频超声对肘管、腕管综合征的诊断价值.方法 /应用高频超声观察30例正常人的肘管及腕管的超声解剖并对20例肘管综合征、10例腕管综合征患者术前行超声检查.结果 高频超声不仅能清晰显示构成肘管及腕管的骨质、软组织及其内容物,而且能够明确肘管和腕管综合征的病因以及尺神经和正中神经的形态学变化.结论 高频超声在肘管、腕管综合征的诊断及鉴别诊断中具有重要价值.%Objective To evaluate the diagnostic value of high frequency ultrasound in cubital and carpal tunnel syndrome. Methods High frequency ultrasonography of normal cubital and carpal tunnel were performed in 30 healthy volunteers. Then sonorgraphic examination was carried out in 20 patients with cubital tunnel syndrome and 10 patients with carpal tunnel syndrome before operation. Results Not only the structure of cubital and carpal tunnel cauld be showed clearly, but also the cause of the cubital and carpal tunnel syndrome could be distinct. Conclusion High frequency ultrasound is of high diagnostic value in cubital and carpal tunnel syndrome.

  9. MR demonstration of an anomalous muscle in a patient with coexistent carpal and ulnar tunnel syndrome. Case report and literature summary.

    Science.gov (United States)

    Zeiss, J; Jakab, E

    1995-01-01

    An aberrant muscle is demonstrated by magnetic resonance (MR) imaging in a patient presenting with focal wrist swelling and compression neuropathy of median and ulnar nerves following 4 months of carpentry work. The muscle originated from the palmaris longus tendon and ulnar antebrachial fascia at the lower half of the forearm as a single belly, then diverged medially from palmaris longus tendon and bifurcated. Both portions of the split muscle extended into the distal ulnar tunnel or Guyon's canal. One segment joined with the abductor digiti minimi muscle and the other with the flexor retinaculum. MR was able to clearly delineate this hypertrophied, symptomatic muscle anomaly. It may be helpful when mass effect is suspected in either tunnel, or in patients with atypical work-related carpal tunnel syndrome with evidence of significant ulnar neuropathy for evaluation of underlying anomalous musculature. Normal MR images of the wrist are included for comparison and the literature is reviewed.

  10. Clinical analysis of the correlation between preoperative severity and duration of symptoms and the outcomes of carpal tunnel decompression%腕管综合征严重程度及病程长短与手术疗效的相关性分析

    Institute of Scientific and Technical Information of China (English)

    徐梦媛; 章开衡; 蔡嬿娴; 沈华; 沈尊理; 张兆锋

    2016-01-01

    目的 探讨腕管综合征术前严重程度和病程长短与腕管切开减压术疗效的关系.方法 自2013年1月至2014年6月收治40例腕管综合征患者,术前根据严重程度和病程长短进行分组,术后按照腕管综合征功能评定标准评价,分析各组患者疗效优良率和优良分布.结果 严重程度组优良率:中度95.83%,重度92.31%,差异无统计学意义(P>0.05).然而两组的优良分布不同,中度患者术后功能恢复多是优,重度组则是良.病程各组优良率差异无统计学意义(P>0.05).统计患者术后恢复情况发现,患者的对掌功能恢复最好,感觉恢复次之,握力恢复最差.结论 病程对术后疗效没有影响.中、重度患者手术治疗后手功能均明显改善,但中度患者术后恢复较重度患者更好.此外,患者术后对掌功能恢复情况最好,握力恢复最差.%Objective To investigate the relationship between the severity and duration of preoperative symptoms and the outcomes of carpal tunnel release in patients with carpal tunnel syndrome.Methods Forty patients of carpal tunnel syndrome treated from January 2013 to June 2014 were divided into two groups,namely symptom severity group and symptom duration group,based on the severity and duration of the symptoms.Postoperative recovery of these patients was assessed using carpal tunnel syndrome evaluation criteria after standard carpal tunnel release.The excellent and good recovery rate in each group was calculated.The distribution of excellent and good recovery was analyzed.Results In symptom severity groups the excellent and good recovery rate was 95.83% in the moderate group and 92.31% in the severe group.The difference was not statistically significant(P > 0.05).However distribution of the recovery was quite different,showing more excellent recovery in the moderate group and more good recovery in the severe group.In symptom duration groups the recovery rates were not significantly

  11. Central sensitization does not identify patients with carpal tunnel syndrome who are likely to achieve short-term success with physical therapy.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Cleland, Joshua A; Ortega-Santiago, Ricardo; de-la-Llave-Rincon, Ana Isabel; Martínez-Perez, Almudena; Pareja, Juan A

    2010-11-01

    The aim of the current study was to identify whether hyperexcitability of the central nervous system is a prognostic factor for individuals with carpal tunnel syndrome (CTS) likely to experience rapid and clinical self-reported improvement following a physical therapy program including soft tissue mobilization and nerve slider neurodynamic interventions. Women presenting with clinical and electrophysiological findings of CTS were involved in a prospective single-arm trial. Participants underwent a standardized examination and then a physical therapy session. The physical therapy sessions included both soft tissue mobilization directed at the anatomical sites of potential median nerve entrapment and a passive nerve slider neurodynamic technique targeted to the median nerve. Pressure pain thresholds (PPT) over the median, radial and ulnar nerves, C5-C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle were assessed bilaterally. Additionally, thermal detection and pain thresholds were measured over the carpal tunnel and thenar eminence bilaterally to evaluate central nervous system excitability. Subjects were classified as responders (having achieved a successful outcome) or non-responders based on self-perceived recovery. Variables were entered into a stepwise logistic regression model to determine the most accurate variables for determining prognosis. Data from 72 women were included in the analysis, of which 35 experienced a successful outcome (48.6%). Three variables including PPT over the C5-C6 joint affected side 66 points were identified. If 2 out of 3 variables were present (LR + 14.8), the likelihood of success increased from 48.6 to 93.3%. We identified 3 factors that may be associated with a rapid clinical response to both soft tissue mobilization and nerve slider neurodynamic techniques targeted to the median nerve in women presenting with CTS. Our results support that widespread central sensitization may not be present in women with CTS who

  12. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

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    Ke, Ming-Jen; Chen, Liang-Cheng; Chou, Yu-Ching; Li, Tsung-Ying; Chu, Heng-Yi; Tsai, Chia-Kuang; Wu, Yung-Tsan

    2016-01-01

    Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 co...

  13. Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation.

    Science.gov (United States)

    Zhang, Wei; Johnston, Jamie A; Ross, Mark A; Smith, Anthony A; Coakley, Brandon J; Gleason, Elizabeth A; Dueck, Amylou C; Santello, Marco

    2011-01-01

    The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS), a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g) for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

  14. Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation.

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    Wei Zhang

    Full Text Available The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS, a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

  15. Efficacy of splinting and oral steroids in the treatment of carpal tunnel syndrome: A prospective randomized clinical and electrophysiological study

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    Mishra Sanjay

    2006-01-01

    Full Text Available Objective: To study the efficacy of splinting and oral steroids in the management of carpal tunnel syndrome (CTS. Design: Prospective, randomized, open-label, clinical and electrophysiological study with 3-month follow-up. Materials and Methods: Forty patients with CTS were randomly divided into splint group (N-20, wearing splint in neutral position for 4 weeks; and steroid group (N-20, who received oral prednisolone 20 mg/day for 2 weeks followed by 10 mg/day for 2 weeks. Clinical and electrophysiological evaluations were done at baseline and at 1-month and 3-month follow-up. Independent ′t′ test and paired ′t′ test were used for statistical analysis. Outcome Measures: Primary outcome measure was the symptom severity score and functional status score. Secondary outcome measures were median nerve sensory and motor distal latency and conduction velocity. Results: At the end of 3 months, statistically significant improvement was seen in symptom severity score and functional status score in both groups ( P P =0.001 at 3 months in steroid group, while insignificant improvement ( P =0.139 was observed in splint group. On comparing the clinical and electrophysiological improvement between the two groups, except for the functional status score, there was no significant difference at 3-month follow-up. Improvement in functional status score was significantly more in steroid group ( P =0.03. Conclusion : There was significant improvement in both groups, clinically as well as electrophysiologically, at 3 months. On comparing the efficacy of the two treatment methods, except for the functional status score, there was no significant difference between the two groups.

  16. Ultrasound assessment on selected peripheral nerve pathologies. Part I: Entrapment neuropathies of the upper limb - excluding carpal tunnel syndrome.

    Science.gov (United States)

    Kowalska, Berta; Sudoł-Szopińska, Iwona

    2012-09-01

    Ultrasound (US) is one of the methods for imaging entrapment neuropathies, post-traumatic changes to nerves, nerve tumors and postoperative complications to nerves. This type of examination is becoming more and more popular, not only for economic reasons, but also due to its value in making accurate diagnosis. It provides a very precise assessment of peripheral nerve trunk pathology - both in terms of morphology and localization. During examination there are several options available to the specialist: the making of a dynamic assessment, observation of pain radiation through the application of precise palpation and the comparison of resultant images with the contra lateral limb. Entrapment neuropathies of the upper limb are discussed in this study, with the omission of median nerve neuropathy at the level of the carpal canal, as extensive literature on this subject exists. The following pathologies are presented: pronator teres muscle syndrome, anterior interosseus nerve neuropathy, ulnar nerve groove syndrome and cubital tunnel syndrome, Guyon's canal syndrome, radial nerve neuropathy, posterior interosseous nerve neuropathy, Wartenberg's disease, suprascapular nerve neuropathy and thoracic outlet syndrome. Peripheral nerve examination technique has been presented in previous articles presenting information about peripheral nerve anatomy [Journal of Ultrasonography 2012; 12 (49): 120-163 - Normal and sonographic anatomy of selected peripheral nerves. Part I: Sonohistology and general principles of examination, following the example of the median nerve; Part II: Peripheral nerves of the upper limb; Part III: Peripheral nerves of the lower limb]. In this article potential compression sites of particular nerves are discussed, taking into account pathomechanisms of damage, including predisposing anatomical variants (accessory muscles). The parameters of ultrasound assessment have been established - echogenicity and echostructure, thickness (edema and related increase

  17. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

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    Melani Carla

    2008-10-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare. Incidence rates of in-hospital cases of CTS were estimated based on 1 codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence on regional databases; 2 demographic general population data for each region. We compared (using the χscore test age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs for married/unmarried men and women. Results Age-standardized incidence rates (per 100,000 person-years of in-hospital cases of CTS were 166 in women and 44 in men (106 overall. Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60 in women, and 1.42 (95% CI, 1.40–1.45 in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts. Conclusion This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  18. Primary somatosensory/motor cortical thickness distinguishes paresthesia-dominant from pain-dominant carpal tunnel syndrome.

    Science.gov (United States)

    Maeda, Yumi; Kettner, Norman; Kim, Jieun; Kim, Hyungjun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Libby, Alexandra; Mezzacappa, Pia; Mawla, Ishtiaq; Morse, Leslie R; Audette, Joseph; Napadow, Vitaly

    2016-05-01

    Paresthesia-dominant and pain-dominant subgroups have been noted in carpal tunnel syndrome (CTS), a peripheral neuropathic disorder characterized by altered primary somatosensory/motor (S1/M1) physiology. We aimed to investigate whether brain morphometry dissociates these subgroups. Subjects with CTS were evaluated with nerve conduction studies, whereas symptom severity ratings were used to allocate subjects into paresthesia-dominant (CTS-paresthesia), pain-dominant (CTS-pain), and pain/paresthesia nondominant (not included in further analysis) subgroups. Structural brain magnetic resonance imaging data were acquired at 3T using a multiecho MPRAGE T1-weighted pulse sequence, and gray matter cortical thickness was calculated across the entire brain using validated, automated methods. CTS-paresthesia subjects demonstrated reduced median sensory nerve conduction velocity (P = 0.05) compared with CTS-pain subjects. In addition, cortical thickness in precentral and postcentral gyri (S1/M1 hand area) contralateral to the more affected hand was significantly reduced in CTS-paresthesia subgroup compared with CTS-pain subgroup. Moreover, in CTS-paresthesia subjects, precentral cortical thickness was negatively correlated with paresthesia severity (r(34) = -0.40, P = 0.016) and positively correlated with median nerve sensory velocity (r(36) = 0.51, P = 0.001), but not with pain severity. Conversely, in CTS-pain subjects, contralesional S1 (r(9) = 0.62, P = 0.042) and M1 (r(9) = 0.61, P = 0.046) cortical thickness were correlated with pain severity, but not median nerve velocity or paresthesia severity. This double dissociation in somatotopically specific S1/M1 areas suggests a neuroanatomical substrate for symptom-based CTS subgroups. Such fine-grained subgrouping of CTS may lead to improved personalized therapeutic approaches, based on superior characterization of the linkage between peripheral and central neuroplasticity.

  19. A retrospective follow-up study of the postoperative outcomes of late stage carpal tunnel syndrome%晚期腕管综合征患者手术疗效的回顾性随访研究

    Institute of Scientific and Technical Information of China (English)

    刘靖波; 顾玉东; 劳杰; 董震

    2016-01-01

    Objective To assess the postoperative outcomes of 56 cases of late stage carpal tunnel syndrome through retrospective follow-up studies and provide treatment guidelines.Methods A retrospective study of 56 cases of late stage carpal tunnel syndrome (thenar muscle atrophy + + + or more) that were surgically treated from February 2010 to December 2011 was conducted.The recovery of thenar muscle atrophy,thenar muscle strength and sensation of the radial three digits was assessed.Results Postoperative follow-up period of these 56 cases ranged from 50 to 71 months,with an average of 64 months.Atrophy of the thenar muscles was entirely reversed in 28 cases (50%) and reversed to (+ +) in 8 cases (14.3%).No change of thenar muscle atrophy was seen in 20 cases (35.7%).Complete sensory recovery was observed in 51 cases,while the rest 5 cases had near normal sensation.The overall excellent and good rate of postoperative hand function recovery was 85.7 %.Conclusion Carpal tunnel release is effective in 85.7 % of late stage carpal tunnel syndrome patients.The decision to perform thumb opponensplasty at the same time should be made based on the requirements of individual patients.%目的 通过56例大鱼际肌肌肉萎缩(+++)以上的晚期腕管综合征患者的临床回顾性研究,评价晚期腕管综合征患者的手术疗效,为临床治疗提供指导.方法 收集我院自2010年2月至2011年12月手术的56例晚期腕管综合征患者的随访资料,评估患者术后大鱼际肌肌萎、肌力及感觉的最终恢复状况.结果 术后随访50 ~71个月,平均64个月,随访发现28例患者大鱼际肌肌萎完全恢复(50%),8例患者肌萎恢复至(++,14.3%),20例大鱼际肌肌萎无恢复(35.7%).51例患者感觉完全恢复(91.1%),5例明显缓解(8.9%),术后功能优良率为85.7%.结论 晚期腕管综合征患者经手术治疗后,疗效优良率仍可达85.7%,对晚期的腕管综合征患者是否一期行对掌功能重

  20. Neuroconduccion of the medium nerve in the carpal tunnel in data-entry personnel of two companies of telecommunications. Medellín. October-November 2005

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    Luis F. De Subiría

    2008-02-01

    Full Text Available Objetive: This study was carried out in order to know the comportment of the median nerve’s impulse speed at the carpal tunnel associated to the exposure time to the fingers’ repetitive motion risk factor. Methodology: This study was applied to data-entry personnel at two companies in the city of Medellin, Colombia, during October and November of 2005. Age, gender, labour exposure time, dominant hand and pathological antecedents associated to the carpal tunnel syndrome variables were investigated. Clinical test and a median nerve conduction test were applied to the workers. Discussion: 55 data-entry workers were evaluated, for a total of 110 hands. The survey included ages between 19 and 40 years old and an average age of 28; 86% of the studied subjects were women; 91% of surveyed subjects declared themselves as right-handed and 60% had a normal weight. Subjects had worked between 12 and 180 months as data-entry personnel with an average time of 83 months, working 48 hours a week. No relevant statistical link was found between labour exposure time and median nerve conduction. Results suggest that doing repetitive movements at work as the only risk factor is not a cause of nerve conduction disorder in the median nerve.

  1. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial.

    Science.gov (United States)

    Ke, Ming-Jen; Chen, Liang-Cheng; Chou, Yu-Ching; Li, Tsung-Ying; Chu, Heng-Yi; Tsai, Chia-Kuang; Wu, Yung-Tsan

    2016-12-02

    Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

  2. An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

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    Ahmet Boyacı

    2014-06-01

    Full Text Available Objectives: This study aimed to research the value of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS in patients with diabetes mellitus (DM and to examine the flow characteristics of the radial and ulnar arteries in diabetic patients with CTS. Methods: A total of 23 diabetic hands diagnosed with CTS from electrophysiological evaluation (DM-CTS, 47 asymptomatic diabetic hands (DM and 50 healthy hands (C as the control group were evaluated with high resolution ultrasonography. The median nerve was measured in the cross-sectional area (CSA, flattening ratio (FR and at the level of the carpal tunnel inlet [proximal (p] and the wrist crease [distal (d]. The radial and ulnar arteries were evaluated with both hands in a neutral position. Results: In the DM-CTS group, the CSA-p and CSA-d values were statistically signficantly greater compared to the DM and C groups (p0.05. The radial artery diameter was determined to be statistically significantly greater in the DM-CTS group than the C group (p<0.05. Conclusion: The median nerve CSA is significantly greater in diabetic CTS patients compared to patients with diabetes only and healthy controls. In the evaluation of CTS in diabetic patients, CSA measured with ultrasonography may be a diagnostic tool. J Clin Exp Invest 2014; 5 (2: 179-185

  3. Use of provincial health insurance plan billing data to estimate carpal tunnel syndrome morbidity and surgery rates.

    Science.gov (United States)

    Liss, G M; Armstrong, C; Kusiak, R A; Gailitis, M M

    1992-01-01

    Following a work refusal at a plant manufacturing ice cream novelties in Ontario, we were asked to document cases of cumulative trauma disorders (CTDs) and carpal tunnel syndrome (CTS) in this workplace. There were 17 employees with possible hand and wrist problems identified from Workers Compensation Board (WCB) Forms, and from a list prepared at the time of the refusal. After obtaining consents, confirmations of the diagnoses of CTDs, CTS, and of surgical procedures for CTS were obtained from the physicians involved. The relative risk for these disorders among plant employees was estimated in two ways: 1) the rate of CTS operations between 1979 and 1990 was compared to that in the general population using Ontario Health Insurance Plan (OHIP) data on physicians' billings for these operations; and 2) the frequency of WCB first payment claims for tendinitis and CTS during 1987 to 1989 at the plant was compared to that among the entire labor force of Ontario. CTDs had been diagnosed in all 17 workers: 9 had had operations for CTS, but one had had this operation prior to working at the plant. Compared to the remaining 8 workers who had CTS operations, an estimated 0.08 CTS operations would be expected among the 150 employees on the plant's seniority lists between 1979 and 1990, if the estimated rates in the general population were present at the plant, giving a Standardized Morbidity Ratio of 10.0 (95% confidence interval [CI] 4.3-19.7; one-sided p = 2.1 x 10(-6)). There were 6 WCB claims for tendinitis and CTS among plant employees during 1987 through 1989. This frequency was about 68 times that in the entire Ontario labor force (95% CI 24.7-150). This investigation has shown that CTDs, and particularly CTS, documented by medical records, have occurred at least 10 times more frequently than expected at this plant. Use of health insurance billing data to estimate CTS operation rates represents a simple method for estimating the burden of illness at the individual

  4. Diagnostic value by high-frequency ultrasound for carpal tunnel syndrome%高频超声对腕管综合征的诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘彦芝; 叶志宏; 杨婉玲; 朱吉修; 卢琼洁; 苏伟兰

    2016-01-01

    目的:探讨高频超声在腕管综合征(CTS)诊断中的临床价值。方法17例(24腕)职业性手臂振动病所致CTS患者作为观察组,20例(40腕)健康志愿者为对照组。采用高频超声观察腕管正中神经、9条肌腱及腕横韧带的形态、回声;在钩骨钩水平测量腕横韧带厚度、正中神经的内径;并在豌豆骨水平测量正中神经的横截面积并比较。结果观察组豌豆骨水平正中神经横截面积为(0.16±0.02)cm2、钩骨水平腕横韧带厚度为(0.40±0.05)cm,对照组分别为(0.09±0.02)cm2、(0.32±0.05)cm,比较差异均有统计学意义(P<0.05)。结论高频超声可清楚显示CTS患者腕管内容物的影像学变化,在CTS的诊断上具有很大价值。%ObjectiveTo investigate clinical value by high-frequency ultrasound in diagnosis of carpal tunnel syndrome (CTS).MethodsThere were 17 patients (24 wrists) with occupational hand-arm vibration disease-induced CTS as observation group and 20 healthy volunteers (40 wrists) as control group. Form and echo of carpal canal median nerve and 9 tendons and transverse carpal ligament were observed by high-frequency ultrasound. Transverse carpal ligament thickness and median nerve inner diameter were detected at hamate bone level, and median nerve cross sectional area was detected at pisiform bone level for comparison.ResultsThe observation group had median nerve cross sectional area at pisiform bone level as (0.16±0.02) cm2 and transverse carpal ligament thickness at hamate bone level as (0.40±0.05) cm, which were respectively (0.09±0.02) cm2 and (0.32±0.05) cm in the control group. Their differences all had statistical significance (P<0.05).Conclusion High-frequency ultrasound can clearly show imaging changes of carpal tunnel contents in CTS patients, and this method contains high value in diagnosis of CTS.

  5. Value of Power Doppler and Gray-Scale US in the Diagnosis of Carpal Tunnel Syndrome: Contribution of Cross-Sectional Area just before the Tunnel Inlet as Compared with the Cross-Sectional Area at the Tunnel

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    Akcar, Nevbahar; Ozkan, Serhat; Mehmetoglu, Ozlem; Calisir, Cuneyt; Adapinar, Baki [Osmangazi University Hospital, Eskisehir (Turkmenistan)

    2010-12-15

    To determine the value of gray-scale and power Doppler ultrasonography in the evaluation of carpal tunnel syndrome (CTS). Median nerves at the carpal tunnel were evaluated by using gray-scale and power Doppler ultrasonography and by using accepted and new criteria in 42 patients with CTS (62 wrists) confirmed by electromyogram and 33 control subjects. We evaluated the cross-sectional area of the nerve just proximal to the tunnel inlet (CSAa), and at mid level (CSAb). We then calculated the percentage area increase of CSAb, and area difference (CSAb-CSAa). We measured two dimensions of the nerve at the distal level to calculate the flattening ratio. The power Doppler ultrasonography was used to assess the number of vessels, which proceeded to give a score according to the vessel number, and lastly evaluated the statistical significance by comparing the means of patients with control subjects by the Student t test for independent samples. Sensitivities and specificities were determined for sonographic characteristics mentioned above. We obtained the receiver operating characteristic (ROC) curve to assess the optimal cut-off values for the diagnosis of CTS. A statistically significant difference was found between patients and the control group for mean CSAb, area difference, percentage area increase, and flattening ratio (p < 0.001, p < 0.001, p < 0.001, p < 0.05, respectively). From the ROC curve we obtained optimal cut-off values of 11 mm{sup 2} for CSAb, 3.65 for area difference, 50% for the percentage of area increase, and 2.6 for the flattening ratio. The mean number of vessels obtained by power Doppler ultrasonography from the median nerve was 1.2. We could not detect vessels from healthy volunteers. Mean CSAbs related to vascularity intensity scores were as follows: score 0: 12.3 {+-} 2.8 mm{sup 2}, score 1: 12.3 {+-} 3.1 mm{sup 2}, score 2: 14.95 {+-} 3.5 mm{sup 2}, score 3: 19.3 {+-} 3.8 mm{sup 2}. The mean PI value in vessels of the median nerve was 4

  6. Effects of Carpal Tunnel Syndrome on adaptation of multi-digit forces to object mass distribution for whole-hand manipulation

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    Zhang Wei

    2012-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a compression neuropathy of the median nerve that results in sensorimotor deficits in the hand. Until recently, the effects of CTS on hand function have been studied using mostly two-digit grip tasks. The purpose of this study was to investigate the coordination of multi-digit forces as a function of object center of mass (CM during whole-hand grasping. Methods Fourteen CTS patients and age- and gender-matched controls were instructed to grasp, lift, hold, and release a grip device with five digits for seven consecutive lifts while maintaining its vertical orientation. The object CM was changed by adding a mass at different locations at the base of the object. We measured forces and torques exerted by each digit and object kinematics and analyzed modulation of these variables to object CM at object lift onset and during object hold. Our task requires a modulation of digit forces at and after object lift onset to generate a compensatory moment to counteract the external moment caused by the added mass and to minimize object tilt. Results We found that CTS patients learned to generate a compensatory moment and minimized object roll to the same extent as controls. However, controls fully exploited the available degrees of freedom (DoF in coordinating their multi-digit forces to generate a compensatory moment, i.e., digit normal forces, tangential forces, and the net center of pressure on the finger side of the device at object lift onset and during object hold. In contrast, patients modulated only one of these DoFs (the net center of pressure to object CM by modulating individual normal forces at object lift onset. During object hold, however, CTS patients were able to modulate digit tangential force distribution to object CM. Conclusions Our findings suggest that, although CTS did not affect patients’ ability to perform our manipulation task, it interfered with the modulation of specific grasp

  7. The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function, Cervical Range of Motion, and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Cleland, Joshua; Palacios-Ceña, María; Fuensalida-Novo, Stella; Pareja, Juan A; Alonso-Blanco, Cristina

    2017-03-01

    Study Design Randomized parallel-group trial. Background Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. Objective To compare the effectiveness of manual therapy versus surgery for improving self-reported function, cervical range of motion, and pinch-tip grip force in women with CTS. Methods In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores. Results At 12 months, 94 women completed the follow-up. Analyses showed statistically significant differences in favor of manual therapy at 1 month for self-reported function (mean change, -0.8; 95% confidence interval [CI]: -1.1, -0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. Conclusion Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted

  8. Treating Carpal Tunnel Syndrome by Acupuncture Combined with Chinese Medicine Paraffin%针刺结合中药蜡疗治疗腕管综合征

    Institute of Scientific and Technical Information of China (English)

    王野; 白一辰

    2016-01-01

    Objective To explore the effect of Acupuncture combined with Chinese Medicine Paraffin on Carpal Tunnel Syndrome. Methods Patients with Carpal Tunnel Syndrome were randomly allocated to a treatment group and a control group. The treatment group treated by acupuncture combined with Chinese Medicine Paraffin. The Chinese Medicine Paraffin before the acupuncture,once a day,4 weeks for a period of treatment. The other group treated by un-guent. Results The total effective rate(85% )of treatment group is higher than the control group(50% )(P < 0. 05). Conclusion Acupuncture combined with Chinese Medicine Paraffin in the treatment of Carpal Tunnel Syndrome method is effective,safety,easy to operate,curative effect is remarkable.%目的:观察针刺结合中药蜡疗联合疗法治疗腕管综合征的临床疗效。方法将符合试验纳入标准的40例腕管综合征患者随机分成治疗组和对照组,各20例。治疗组采用针刺结合中药蜡疗局部治疗,先中药蜡疗后针刺治疗,1次/ d,4周为1疗程,对照组予立舒(双氯芬酸钠凝胶)腕关节外用治疗。结果治疗组总有效率85%,明显高于对照组的50%(P <0.05)。结论针刺结合中药蜡疗治疗腕管综合征,能促进局部血液循环,减轻炎症反应,增强关节自身的新陈代谢,改善症状。

  9. Study on findings of electromyogram in patients with carpal ulnar tunnel Syndrome%腕尺管综合征肌电图检测分析

    Institute of Scientific and Technical Information of China (English)

    胡锋; 王伊敏; 周晶; 赵磊; 姜东林

    2012-01-01

    Objective To explore the findings of electromyogram in patients with carpal ulnar tunnel syndrome. Methods The examination of electromyogram including motor latency and amplitude of motor wave of ulnar nerve digitus minimus manus, velocity of sensory conduction and amplitude of sensory wave of ulnar nerve digitus were examined in 13 patients with carpal ulnar tunnel syndrome, and they were compared with those of uninjured side and their discrepancy was evaluated. Results In comparison with uninjured side, the motor latency of ulnar nerve was significantly prolonged ( P < 0. 01 ) , the amplitude of motor wave was significantly decreased ( P < 0. 01 ) , velocity of sensory conduction of ulnar nerve digitus minimus manus was slower and amplitude of sensory wave was decreased ( P < 0. 01 ). There were changes in electromyogram in abductor digital minimal muscle and interosseal muscle in quiescent and recon tract condition. Conclusion There are electro my ographic changes in patients with carpal ulnar tunnel syndrome, and it is important to examine electromyogram for its diagnosis and treatment in patients with this syndrome.%目的 探讨腕尺管综合征的肌电图表现.方法 对13例腕尺管综合征患者行肌电图检测,包括尺神经运动潜伏期、运动波幅、尺神经小指感觉传导速度、感觉波幅等,与其健侧对照比较,评估肌电图表现差异.结果 腕尺管综合征患者其患侧肌电图与健侧比较,尺神经运动潜伏期延长(P<0.01),运动波幅缩小(P<0.01),尺神经小指感觉传导速度减慢(P<0.01)、感觉波幅缩小(P<0.01),小指展肌、第Ⅰ骨间肌肌电图也出现静息状态及重收缩状态的改变.结论 腕尺管综合征患者存在肌电图的多项改变,早期检测对于其诊断及其治疗具有重要意义.

  10. Correlation between Female Sex Hormones and Electrodiagnostic Parameters and Clinical Function in Post-menopausal Women with Idiopathic Carpal Tunnel Syndrome

    Science.gov (United States)

    Mohammadi, Azam; Naseri, Mahshid; Namazi, Hamid; Ashraf, Mohammad Javad

    2016-01-01

    Objectives To investigate the role of sex-hormonal changes in idiopathic carpal tunnel syndrome (CTS) among post-menopausal women through measuring estrogen receptor (ER) expression in their transverse carpal ligament (TCL) and serum estrogen level, as well as determine the correlation between these factors and electrodiagnostic parameters and Boston score. Methods Biopsy samples of TCL were collected from 12 postmenopausal women who had undergone surgery for severe idiopathic CTS; control specimens were collected from 10 postmenopausal women without CTS who had undergone surgery for the other hand pathologies. To determine the distributions of ER in TCL, histological and immunohistochemical examinations were performed. Serum estrogen level was also measured. Electrodiagnosis and Boston questionnaire were used for CTS severity and determination of the patients' function. Results ER expression in TCL and serum estrogen level were not significantly different in the case group compared to the control group (P = 0.79 and P = 0.88, respectively). Also, there was no correlation between ER expression or serum estrogen level and electrodiagnostic parameters or Boston score. Conclusions Sex hormones cannot still be considered as the etiology of idiopathic CTS in postmenopausal women. The role of other factors such as wrist ratio and narrower outlet in females compared to the males should be considered along with hormonal changes. PMID:27617242

  11. Repeater F waves: a comparison of sensitivity with sensory antidromic wrist-to-palm latency and distal motor latency in the diagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Macleod, W N

    1987-05-01

    Thirty-five thousand six hundred supramaximal shocks were applied to 209 healthy and 147 entrapped median nerves (carpal tunnel syndrome--CTS) to characterize the backfiring behavior of the alpha motor neuron pool of abductor pollicis brevis in health and the modifying effect of a compressive neuropathy. A contraction of the normal subpopulation of active F-wave generators was found in CTS, while active neurons backfired at higher than normal frequencies (p less than 0.001). These modifications in spinal behavior are reflected in the % Repeater F-wave value, whose sensitivity in the detection of CTS approaches that of sensory wrist-to-palm latency estimation. This technique offers an alternative to latency measurement in the diagnosis of CTS. An economical strategy for the electrodiagnosis of CTS is proposed.

  12. 键盘操作引起的腕管综合征%Review on carpal tunnel syndrome induced by keyboard operation

    Institute of Scientific and Technical Information of China (English)

    宿芳; 张智君

    2004-01-01

    随着计算机的日益普及,键盘操作在为人们的工作、学习和生活带来帮助的同时,也带来了某些伤害。腕管综合征(carpal tunnel syndrome,CTS)是一种典型的由键盘操作等活动诱发的肌肉骨骼损伤疾病,主要源于某些手动和高重复性的活动。本文主要探讨键盘操作中CTS发生的临床特征、致病机制和诊治方法,并对今后的相关工作加以展望。

  13. 高频超声在诊断腕管综合征中的应用%High resolusion sonography in the diagnosis of carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    纪芳; 卢祖能

    2006-01-01

    腕管综合征(carpal tunnel syndrome,CTS)是正中神经在腕管内受压而表现出支配区功能障碍的一组症状和体征,也是最常见的周围神经嵌压综合征之一,通常根据其特征性临床和电生理所见即可做出诊断。虽然目前电生理检查被认为是诊断CTS的金标准,但它不能显示正中神经周围的毗邻结构,不能为进一步明确病因和手术提供更多的信息。现将近年来关于超声诊断CTS的应用进行综述。

  14. Advance in the ultrasound diagnosis of carpal tunnel syndrome%腕管综合征超声诊断的研究进展

    Institute of Scientific and Technical Information of China (English)

    付腾飞; 白跃宏

    2014-01-01

    腕管综合征是最常见的神经压迫病变。在过去的20年里,高频超声在腕管综合征的诊断中被认为是有效和可靠的。本文通过对腕管综合征的超声诊断指标及其准确性作一系统阐述,为未来研究提供理论依据和参考。%Carpal tunnel syndrome is the most common nerve entrapment .Over the past 20 years, high-resolution ultrasonography has been proposed as a valid and reliable means of confirming the diagnosis . This review systematically illustrated the ultrasound diagnostic criterion as well as its accuracy , in order to provide the principles and directions for future study .

  15. Difficulty of pinching behind the back: an atypical symptom of carpal tunnel syndrome related to a specific wrist position. Two case reports.

    Science.gov (United States)

    Shimizu, Satoru; Tachibana, Shigekuni; Fujii, Kiyotaka

    2012-01-01

    Carpal tunnel syndrome (CTS) may be overlooked in the absence of typical sensory symptoms. Two patients with CTS lacked the attendant sensory symptoms but experienced difficulties performing a pinching action behind the back (manipulation of the buckle of a baby sling or the hook of a brassiere), a mode of pinching that required wrist flexion. The causative mechanism was probably exacerbation of a latent weakness of the intrinsic muscles of the thumb by wrist flexion, in which the strength of the extrinsic flexors of the thumb and index finger were decreased due to loosening of the tendons. Such symptoms, induced by a specific wrist position, may be help to diagnose a latent weakness in the intrinsic muscles of the thumb, present in patients with CTS.

  16. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... Pharyngitis, Adenitis Syndrome (Juvenile) Polymyalgia Rheumatica Psoriatic Arthritis Raynaud's Phenomenon Reactive Arthritis Rheumatoid Arthritis Scleroderma Sjogren's Syndrome Spinal Stenosis Spondyloarthritis Systemic Lupus Erythematosus (Juvenile) Takayasu's ...

  17. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job ...

  18. Carpal tunnel syndrome

    Science.gov (United States)

    ... Weak grip or difficulty carrying bags (a common complaint) Weakness in one or both hands Exams and ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  19. Feasibility of a novel functional sensibility test as an assisted examination for determining precision pinch performance in patients with carpal tunnel syndrome.

    Directory of Open Access Journals (Sweden)

    Hsiu-Yun Hsu

    Full Text Available To understand the feasibility of a novel functional sensibility test for determining precision pinch performance in patients with carpal tunnel syndrome, this study investigates the validity, sensitivity and specificity of functional sensibility derived from a pinch-holding-up activity (PHUA test. Participants include 70 clinically defined carpal tunnel syndrome (CTS patients with 119 involved hands and 70 age- and gender-matched controls. To examine the discriminating ability of the functional sensibility test, the differences in the ability of pinch force adjustments to the inertial load of handling object between CTS and control subjects are analyzed. The results of functional sensibility are correlated with the severity of CTS to establish concurrent validity. The receiver operating characteristic (ROC curve is constructed to demonstrate the accuracy of the proposed test. The functional sensibility score significantly discriminates the patients and control groups (respectively, 12.94±1.72 vs. 11.51±1.15N in peak pinch force (FPPeak, p<0.001; 2.92±0.41 vs. 2.52±0.24 in force ratio, p<0.001 and is moderately correlated (r = 0.42-0.54, p<0.001 with the results of traditional sensibility tests (touch-pressure threshold and two-point discrimination test. In addition, there is a statistical difference in the results of functional sensibility (p<0.001 among the subgroups of CTS severity based on electrophysiological study. The sensitivity and specificity are 0.79 and 0.76, respectively, for the functional sensibility test. The areas under the ROC curve are 0.85 and 0.80 for the force ratio and FPPeak, respectively. In conclusion, the functional sensibility test could be feasibly used as a clinical tool for determining both the sensibility and precision pinch performance of hands for the patients with CTS.

  20. 超声对腕管综合征和肘管综合征的诊断价值%Diagnostic value of ultrasonography for carpal tunnel and cubital tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    王战业; 曹洪弘; 夏炳兰

    2014-01-01

    Objective To explore the diagnostic value of ultrasonography for carpal tunnel and cubital tunnel syndrome. Method Twenty-five healthy subjects were enrolled as control group and 35 patients with suspected carpal tunnel syndrome and 22 patients with suspected ulnar nerve compression were enrolled as disease group. The median nerve was examined by ultrasonography. The cross sectional area (CSA) at peas bone level and anteroposterior diameters (D1), anteroposterior diameters at hook bone level (D2) and distal level (D3) of median nerve, and CSA of the elbow ulnar nerve were measured. The difference values between D1 and D2 (D), D3 and D2 (d) were calculated. The ultrasonography findings in lesion group were compared with those observed during operation. Results Ultrasonography can display the morphological changes of median and ulnar nerves after compression. The CSA of median and ulnar nerves、D、d in lesion group were bigger than those in control group (P<0.03). The diagnostic accurate rates of ultrasonography for carpal tunnel and cubital tunnel syndromes were 97.9%and 95.4%, respectively. Conclusion High-frequency ultrasonography can diagnose carpal tunnel and cubital tunnel syndromes effectively.%目的:探讨超声对腕管综合征、肘管综合征的诊断价值。方法25例体检健康者为对照组,临床疑诊35例腕管综合征和22例尺神经卡压患者为病变组,超声探查正中神经豌豆骨水平横断面积及其前后径(D1)、钩骨勾水平前后径(D2)、钩骨勾水平远端前后径(D3),肘部尺神经横断面积,计算D1与D2差值(D),D3与D2差值(d),将病变组超声检查结果与术中所见进行比较。结果超声可显示正中神经、尺神经卡压后的形态变化,病变组正中神经横断面积、D、d及尺神经横断面积均大于对照组(P<0.03)。与术中所见比较,超声诊断腕管综合征、肘管综合征准确率分别为97.9%、95.4%。结

  1. The diagnosis and treatment of Dupuytren' s contracture combined with carpal tunnel syndrome%掌腱膜挛缩症合并腕管综合征的诊断和治疗

    Institute of Scientific and Technical Information of China (English)

    李建峰; 赵亮; 刘井达; 王小磊; 赵民; 李大村

    2012-01-01

    Objective To investigate the correlation of Dupuytren's contracture and carpal tunnel syndrome and evaluate the clinical outcomes of treating both diseases in one surgery. Methods From March 2003 to August 2011,8 cases of Dupuytren's contracture combined with carpal tunnel syndrome were surgically treated.Through an M-shaped palm incision and a Y-shaped incision extended to the finger,the palmar aponeurosis was partially removed and the flexor retinaculum was cut open to release the median nerve at the same time. Results Primary wound healing was achieved in all of the eight cases.There were no flap edge necrosis and hematoma formation.Numbness of the thumb,index finger and middle finger gradually reduced postoperatively.The numbness disappeared after 3 months.All patients were follow-up for 6 months to 2 years with no recurrence. Conclusion When more predisposing factors of both diseases occur in one patient,the probability of the occurrence of both Dupuytren' s contractue and carpal tunnel syndrome in one patient also increases significantly.The two diseases can be treated in one surgery.%目的 探讨掌腱膜挛缩症与腕管综合征的相关性及一次完成两种手术的治疗效果.方法 2003年3月至2011年8月,对8例掌腱膜挛缩症合并腕管综合征的患者,其中右手5例、左手3例,设计手掌部“M”形切口,或同时加手指的“Y”形切口,同时切除部分掌腱膜,行屈肌支持带切开、正中神经松解术.结果 术后全部伤口均Ⅰ期愈合,无皮瓣边缘坏死及血肿形成,术后拇、示、中指麻木逐渐减轻,术后3个月手指麻木全部消失.术后随访时间为6个月至2年,掌腱膜挛缩无复发.结论 掌腱膜挛缩症与腕管综合征两种疾病的诱发因素较多地发生在同一个体时,两种疾病同时并发的几率明显增加,可通过一次手术完成.

  2. 腕管内正中神经变异的声像图表现及其临床意义%Sonographic appearance and clinical significance of anatomic variation of carpal tunnel median nerve

    Institute of Scientific and Technical Information of China (English)

    傅强; 崔立刚; 李志强; 王金锐; 陈文; 贾建文

    2012-01-01

    Objective To investigate the incidence,sonographic appearance of the anatomic variation of carpal tunnel median nerve and its accompanying structures in healthy volunteers and explore the value of this variation in carpal tunnel syndrome.Methods A total of 360 hands of 180 healthy volunteers were included in the study.The full course of the median nerve in the forearm and carpal tunnel was examined with high-frequency ultrasound.The median nerve was first located in cross section at wrist and then with continuous cross-sectional scanning to observe the the full course of the median nerve in the forearm and carpal tunnel with high-frequency ultrasound.Results Anatomic variation of carpal tunnel median nerve and its accompanying structures were observed:① High division median nerve were found in 2 wrists (0.56 %) ;②Bifid median nerve were found in 17 wrists (4.72%) ;③Persistent median artery were found in 22 wrists (6.11%),and 2 wrists (0.56%) were also found accompanied vein.Aanatomic variation of carpal tunnel median nerve accompanied with persistent median artery were observed in 16 wrists (4.44 %).Conclusions High-frequency ultrasound was sensitive to diagnose the anatomic variation of carpal tunnel median nerve and its accompanying structures.Recognition of these variations can help us to make correct diagnosis of carpal tunnel syndrome.%目的 探讨腕管正中神经及伴行结构变异在人群中的发生率、超声表现及其在腕管综合征诊断中的意义.方法 对180位健康志愿者的360只手腕部腕管结构及前臂进行高频超声检查.检查前臂和腕部正中神经走行,先进行腕管结构的横断面扫查,确认正中神经位置后,采用连续横断面扫查法向近端前臂进行动态观察并适当结合纵断面扫查,记录图像资料.结果 腕管正中神经及伴行结构变异:①正中神经高位分叉2例(0.56%);②正中神经裂17例(4.72%);③腕部正中神

  3. Case-control study on transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after distal radius fracture%腕横韧带切除预防桡骨下端骨折迟发性腕管综合征的病例对照研究

    Institute of Scientific and Technical Information of China (English)

    王彦杰; 王世刚; 苗淑娟; 苏霞

    2011-01-01

    Objective :To investigate the effects of open reduction by palm side for the distal radius fracture and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after operation. Methods:From March 2000 to March 2007,32 patients (8 males and 24 females, ranging in age from 46 to 66 years) with distal radius fracture were treated with open reduction by palm side and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection; while 30 patients (7 males and 23 females ,ranging in age from 45 to 65 years) only with open reduction by palm side and T shape plate internal fixation. The incidences of delayed carpal tunnel syndrome between the two groups were compared. Results:Among 32 patients treated with open reduction by palm side and T shape plate internal fixation with anterior transverse carpal ligament resection, 3 patients had delayed carpal tunnel syndrome; while in 30 patients treated with open reduction by palm side and T shape plate internal fixation, 10 patients had delayed carpal tunnel syndrome. There was significant statistically difference (P<0.05%). Conclusion:Simultaneous anterior transverse carpal ligament resection can effectively prevent the delayed carpal tunnel syndrome occurrence for the distal radius fracture with open reduction by palm side.%目的:探讨桡骨下端骨折采用掌侧切口切开复位"T"形钢板内固定并I期行腕横韧带切除对术后发生迟发性腕管综合征的预防作用.方法:自2000年3月至2007年3月,桡骨下端骨折患者采用两种方法治疗.采用切开复位"T"形钢板内固定并I期行腕横韧带切除治疗32例,男8例,女24例;年龄46~66岁;B3型骨折21例,C1型骨折6例,C2型骨折4例,C3型骨折1例.采用单纯骨折切开复位"T"形钢板内固定治疗30例,男7例,女23例;年龄45~65岁;B3型骨折13例,C1型骨折9例,C2型骨折6例,C3型骨折2

  4. 拨针治疗腕管综合征108例疗效观察%Clinical observation on the treatment of 108 cases with carpal tunnel syndrome by teasing needle

    Institute of Scientific and Technical Information of China (English)

    石平清; 杨海梅

    2014-01-01

    Objective:To observe the curative effect of teasing needle on carpal tunnel syndrome. Methods:The clinical data of 208 cases with carpal tunnel syndrome in our hospital was retrospectively analyzed and all the patients were treated with teasing needle. Results: 118 cases were cured among 208 cases and the curative rate was 100%, of which 64 patients had symptoms disappeared, the symptoms of 14 patients disappeared after 2 days, no recurrence for 12 patients followed up for 5 months. Conclusion:The treatment of teasing needle for carpal tunnel syndrome is obviously effective with less recurrence.%目的:拨针治疗腕管综合征疗效观察。方法:回顾性分析我院收治腕管综合征208例的临床资料,对其采取拨针治疗。结果:208例,治愈118例,治愈率100%,其中64例患者当时症状消失,14例患者2天后症状消失,12例患者随访5个月内无复发。结论:运用拨针治疗腕管综合征,疗效显著,不易复发。

  5. 腕管综合征患者的神经电生理分析%Clinical analysis of electro-neurophysiological study on carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    闫晓海

    2011-01-01

    目的:探讨腕管综合征(CTS)患者神经电生理检测的临床诊断价值.方法:观察50例腕管综合征患者的神经电生理检测结果之间的关系.结果:50例腕管综合征患者76侧神经电生理做检测,正中神经SNAP传导异常为93.4%,正中神经SNCV传导异常为86.8%;尺神经SNAP传导异常为10.5%;尺神经SNCV传导异常为5.3%;腕部刺激拇短展肌DML传导异常为71.1%,小指展肌DML传导异常为1.3%.大鱼际肌EMG传导异常为39.5%,小鱼际肌EMG传导异常为3.9%.正中神经与尺神经各项电生理检测结果阳性率比较,差异均有统计学意义(均P<0.05).结论:正中神经的神经电生理检测对CTS的诊断有重要价值,也是确定正中神经的损伤程度、判断腕管综合征预后的重要指标.%Objective: To explore the clinical features in carpal tunnel syndrome and the value of electro-neurophysiolopcal examination in the diagnosis.Methods: The clinical date and the results of electro-neurophysiological examination of 50 cases of carpal tunnel syndrome were retrospectively studied.Results: Testing 76 hands of 50 cases, the abnonnal rate of median nerve SNAP was 93.4%, SNCV was 86.8%.The abnormal rate of ulnar nerve SNAP was 10.5%, SNCV was 5.3%, and 71.1% with neuron deficit in abductor pollicis brevis, the abnormal rate of digiti minimi DML was 1.3%, thenar muscle EMC was 39.5%, hypothenar muscle EMG was 3.9%.There were significant differences in the detected results of the median nerve and ulnar nerve (all P<0.05).Conclusion: Electro-neurophysiological examination of median nerve plays an important role in the diagnosis and the definite diagnosis and the judgement prognosis of carpal tunnel syndrome.

  6. The real role of forearm mixed nerve conduction velocity in the assessment of proximal forearm conduction slowing in carpal tunnel syndrome.

    Science.gov (United States)

    Chang, Ming-Hong; Lee, Yee-Chung; Hsieh, Peiyuan F

    2008-12-01

    The decrease of forearm median motor conduction velocity (CV) in carpal tunnel syndrome (CTS) is a common electrodiagnostic finding in clinical practice and is possibly secondary to either conduction block at wrist or retrograde conduction slowing (RCS). This study is attempted to confirm the existence of RCS and to explore why this controversy occurs for a long time. Eighty CTS patients and controls were recruited. In addition to conventional electrodiagnosis, subjects received further electrodiagnostic protocol. First, a recording electrode was placed over the wrist and then at elbow with palm stimulation to calculate indirect forearm mixed nerve CV (forearm-mix CV) that represented real measurement of nerve fibers through the carpal tunnel. Then, direct measurement of forearm-mix CV was performed with recording at the elbow and stimulation at the wrist. CTS patients had markedly prolonged distal motor and sensory latencies and significantly prolonged wrist-palm sensory and motor conduction. There was a significant decrease in forearm median motor CV; however, there was no difference in ulnar distal motor latency and forearm motor CV. The mild decrease of forearm median motor CV was not proportional to the marked reduction of W-P MCV and there was no demonstrated conduction block at wrist, implying the reduction of forearm median motor CV is unlikely due to conduction blockage or slowing of the large myelinating fibers at the wrist and RCS really occurs over the forearm median nerve. In addition, the direct Forearm-mix CV was similar in CTS and controls; however, there was a significant decrease in indirect forearm-mix CV only in the CTS. Moreover, the difference between direct and indirect forearm-mix CV was significantly greater and poor consistency of direct and indirect forearm-mix CV in CTS, suggesting that direct and indirect forearm-mix CV represent CV from quite different nerve fibers. Therefore, we conclude that RCS really does occur in CTS and the

  7. Avaliação da sensibilidade cutânea em pacientes com síndrome do túnel do carpo relacionada à hemodiálise Cutaneous sensibility assesment in hemodialysis- related carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Hugo Alberto Nakamoto

    2011-01-01

    Full Text Available OBJETIVO: Descrever a utilização do PSSD (Pressure specified sensory device para a realização do diagnóstico de Síndrome do Túnel do Carpo. MÉTODOS: O PSSD consiste de aparelho que incorpora um transdutor de pressão com duas extremidades rombas e com regulagem de distância entre elas, acoplado a um computador capaz de determinar os limiares cutâneos de pressão. Para tanto, os pacientes foram divididos em três grupos: Grupo 1- grupo controle, pacientes sem neuropatia no membro superior ou insuficiência renal. Grupo 2- pacientes com síndrome do túnel do carpo relacionada à hemodiálise. Grupo 3 - pacientes com síndrome do túnel do carpo sem insuficiência renal. RESULTADOS: Os resultados demonstraram haver um maior benefício do uso do PSSD para o diagnóstico da síndrome para os pacientes do grupo dois em dois dos quatro parâmetros avaliados quando comparados com os pacientes do grupo 3. CONCLUSÃO: O PSSD é útil para o diagnóstico da síndrome do túnel do carpo em pacientes hemodialíticos. Nível de Evidência II. Estudos diagnósticos.OBJECTIVE: Describe the use of the PSSD (Pressure specified sensory Device for the diagnosis of carpal tunnel syndrome. METHODS: The PSSD is a tool that incorporates a pressure transducer with two prongs, linked to a computer capable of measuring the cutaneous pressure thresholds. The patients were divided in two groups: Group 1- patients neither with superior limb neuropathy nor renal insufficiency. Group 2- patients with carpal tunnel syndrome related to hemodialysis. Group 2 - patients with carpal tunnel syndrome but no renal insufficiency. RESULTS: The results showed, for two of the four parameters measured, that the group 2 had more benefits for the diagnosis of carpal tunnel syndrome than group 3. CONCLUSION: The PSSD is useful as a diagnostic tool in hemodialysis-related carpal tunnel syndrome Level of Evidence: Level II, development of diagnostic.

  8. Transforming growth factor-β (TGF-β) expression is increased in the subsynovial connective tissues of patients with idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Chikenji, Takako; Gingery, Anne; Zhao, Chunfeng; Passe, Sandra M; Ozasa, Yasuhiro; Larson, Dirk; An, Kai-Nan; Amadio, Peter C

    2014-01-01

    Non-inflammatory fibrosis of the subsynovial connective tissue (SSCT) is a hallmark of carpal tunnel syndrome (CTS). The etiology of this finding and its relationship to the development of CTS remain poorly understood. Recent studies have found that transforming growth factor-β (TGF-β) plays a central role in fibrosis. The purpose of this study was to investigate the expression of TGF-β and connective tissue growth factor (CTGF), a downstream mediator of TGF-β, in the pathogenesis of CTS. We compared SSCT specimens from 26 idiopathic CTS patients with specimens from 10 human cadaver controls with no previous diagnosis of CTS. Immunohistochemistry was performed to determine levels TGF-β1, CTGF, collagen 1(Col1) and collagen 3 (Col3) expression. TGF-β1 (p tissue. In addition, a strong positive correlation was found between TGF-β1 and CTGF, (R(2) = 0.80, p < 0.01) and a moderate positive correlation between Col3 and TGF-β1 (R(2) = 0.49, p < 0.01). These finding suggest that there is an increased expression of TGF-β and CTGF, a TGF-β regulated protein, and that this TGF-β activation may be responsible for SSCT fibrosis in CTS patients.

  9. Transforming growth factor-β (TGF-β) expression is increased in the subsynovial connective tissue in a rabbit model of carpal tunnel syndrome.

    Science.gov (United States)

    Chikenji, Takako; Gingery, Anne; Zhao, Chunfeng; Vanhees, Matthias; Moriya, Tamami; Reisdorf, Ramona; An, Kai-Nan; Amadio, Peter C

    2014-01-01

    Carpal tunnel syndrome (CTS) is an idiopathic disease that results from increased fibrosis of the subsynovial connective tissue (SSCT). A recent study found overexpression of both transforming growth factor-β (TGF-β) and connective tissue growth factor (CTGF) in the SSCT of CTS patients. This study investigated TGF-β and CTGF expression in a rabbit model of CTS, in which SSCT fibrosis is induced by a surgical injury. Levels of TGF-β1 and CTGF at 6, 12, 24 weeks after injury were determined by immunohistochemistry A significant increase in TGF-β1 and a concomitant significant increase in CTGF were found at 6 weeks, in addition to higher cell density compared to normal (all p<0.05), Interestingly, CTGF expression was reduced at 12 and 24 weeks, suggesting that an initial insult results in a time limited response. We conclude that this rabbit model mimics the fibrosis found in human CTS, and may be useful to study pathogenetic mechanisms of CTS in vivo.

  10. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Emil Sundstrup

    2014-01-01

    Full Text Available Topical menthol gels are classified “topical analgesics” and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS. We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze or placebo (gel with a menthol scent during the working day and 48 hours later the other treatment (crossover design. Participants rated arm/hand pain intensity during the last hour of work (scale 0–10 immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol (P=0.026 and P=0.044, resp.. Pain intensity of the arm/hand decreased by −1.2 (CI 95%: −1.7 to −0.6 following topical menthol compared with placebo, corresponding to a moderate effect size of 0.63. In conclusion, topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain.

  11. STUDY OF COMPLICATIONS OF COLLES FRACTURE TO FIND OUT THE TRUE INCIDENCE OF EXTENSOR POLLICIS LONGUS TENDON RUPTURE AND CARPAL TUNNEL SYNDROME IN INDIAN POPULATION

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    Kulkarni

    2015-02-01

    Full Text Available Colles‟ fracture is confined to adult and usually is seen in women over the age of fifty who have fallen on the outstretched hand. EPL tendon is the most common extensor tendon to rupture after colles‟ fracture. To our belief the incidenc e of median nerve injury and EPL tendon rupture given in literature are much higher than what we see now a days, so with this aim we carried this study to find out the true incidence of CTS and EPL tendon rupture in Indian population. AIMS AND OBJECTIVES: To study 100 patients with colles‟ fracture for true incidence of Extensor Pollicis Longus (EPL Tendon rupture and Carpal Tunnel Syndrome (CTS in Indian Population. MATERIALS AND METHODS: In our study 100 patients with colles fracture were followed up at regural intervals and were evaluated clinically and radiogrphically to rule out complications like EPL tendon rupture and CTS. OBSERVATION AND RESULTS: In our study, we found 0% incidence of CTS and EPL tendon rupture. CONCLUS ION: Proper division of patients into displaced and un displaced fracture and treatment of displaced fracture being closed reduction and internal fixation with „K‟ wires and then cast application in neutral position i.e. supination without flexion at wrist joint and properly advised physiotheraphy after cast removal at one and half month should be advocated

  12. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Giorgio Pajardi

    2014-01-01

    Full Text Available We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS, scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n=60 served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n=60 received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation. Patients in Group C (n=60 received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05. Moreover, patients in Group B had a significantly lower number of positive Phalen’s tests at 3 months compared with the other study groups (P<0.05. We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.

  13. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Adèr Herman J

    2006-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a common disorder, often treated with surgery or wrist splinting. The objective of this economic evaluation alongside a randomized trial was to evaluate the cost-effectiveness of splinting and surgery for patients with CTS. Methods Patients at 13 neurological outpatient clinics with clinically and electrophysiologically confirmed idiopathic CTS were randomly allocated to splinting (n = 89 or surgery (n = 87. Clinical outcome measures included number of nights waking up due to symptoms, general improvement, severity of the main complaint, paraesthesia at night and during the day, and utility. The economic evaluation was performed from a societal perspective and involved all relevant costs. Results There were no differences in costs. The mean total costs per patient were in the surgery group EURO 2,126 compared to EURO 2,111 in the splint group. After 12 months, the success rate in the surgery group (92% was significantly higher than in the splint group (72%. The acceptability curve showed that at a relatively low ceiling ratio of EURO 2,500 per patient there is a 90% probability that surgery is cost-effective. Conclusion In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.

  14. The effect of methycobal on treating mild to moderate carpal tunnel syndrome: a clinical study%甲钴铵对轻中度腕管综合征治疗的有效性研究

    Institute of Scientific and Technical Information of China (English)

    吴鹏; 杨剑云; 陈琳; 虞聪

    2013-01-01

    Objective To investigate the effect of methycobal on treating mild to moderate carpal tunnel syndrome.Methods Forty-eight mild to moderate carpal tunnel syndrome patients were followed-up.24 patients (group A) took 3 drugs (bandazol,VitB1,VitB6) and 24 patients (group B) took 4 drugs (methycobal,bandazol,VitB1,VitB6) for 6 months.The patients offered their recent clinical symptoms and filled out the Boston Carpal Tunnel Questionnaire upon study enrollment,3 months and 6 months after treatment,respectively.Electrophysiologic study of the median nerve was done for patients at the start and end of the treatment.Results Recovery of clinical symptoms,the total symptom scores and electrophysiology of the medial nerve were improved in both group A and B,with group B being better.Conclusion Methycobal is effective on treating mild to moderate carpal tunnel syndrome.%目的 探讨甲钴铵治疗轻、中度腕管综合征的有效性.方法 随访24例口服三联药组(A组:地巴唑、维生素B1、维生素B6)及24例口服四联药(B组:甲钴铵、地巴唑、维生素B1、维生素B6)的轻中度腕管综合征患者.于入组时、治疗后3个月及6个月采集患者临床症状,填写症状评分表.入组及治疗6个月时,检测腕部正中神经电生理.结果 A及B组患者临床症状、症状总评分及腕部正中神经电生理均有明显恢复,B组恢复更佳.结论 甲钴铵可促进轻中度腕管综合征恢复.

  15. Study of the Reliability and Validity of Chinese Version of the Boston Carpal Tunnel Questionnaire%中文版波士顿腕管量表的信效度研究

    Institute of Scientific and Technical Information of China (English)

    雷玮; 钱晓路; 孙晓春

    2016-01-01

    目的:分析中文版波士顿腕管量表(Boston carpal tunnel questionnaire,BCTQ)的信效度.方法将英文版BCTQ经过翻译、回译和文化调适后,对195例腕管综合征患者进行问卷调查,评定该工具的信效度.结果中文版 BCTQ共19个条目2个维度,量表的Cronbachα系数为0.90~0.947.各条目的内容效度(content validity index,CVI)为0.9~1.0,全部条目的平均CVI为0.95.因子分析按2个维度分别进行,第1个维度提取2个公因子解释总变异的66.7%,第2个维度提取1个公因子解释总变异的73.25%.结论中文版BCTQ是一份具有较好信度和效度的评定工具,可用于我国腕管综合征患者的病情评估.%Objective To assess the reliability and validity of the Chinese version of the Boston Carpal Tunnel Questionnaire(BCTQ).Methods The English version of the Boston Carpal Tunnel Questionnaire (BCTQ)was translated,retroversion and was culture-adapted.Totally 195 cases were evaluated by questionnaire,and the reliability and validity were evaluated.Results The Chinese version of BCTQ was consisted of 19 items and 2 dimensions.The Cronbach’sαwas ranged from 0.90 to 0.947.The content validity index(CVI)was 0.9-1.0.The average CVI of all dimensions was 0.95.The factor analysis was conducted by two dimensions;the first dimension extracted 2 common factors which explained the 66.7%of total variance.The second dimension was extracted 1 common factor,which explained 73.25% of total variance.Conclusions The Chinese version of BCTQ has good reliability and validity,which can be applied in the disease evaluation of patients with carpal tunnel syndrome.

  16. Application of high-frequency ultrasound in the diagnosis of diabetic carpal tunnel syndrome%高频超声诊断糖尿病腕管综合征研究进展

    Institute of Scientific and Technical Information of China (English)

    李红波

    2015-01-01

    糖尿病(Diabetes mellitus,DM)能够引起多种神经系统并发症,导致自主神经、周围神经和中枢神经等病变,其发病机制尚不明确,DM患者出现腕管综合征(carpal tunnel syndrome,CTS)的概率高达40%,早期确诊率较低,极易漏诊或误诊.笔者就高频超声诊断糖尿病性腕管综合征的进展简要综述.

  17. 腕管综合征279例神经电生理分析%Electrophysiological study on 279 patients with carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    羊洁; 刘英; 邹艺; 李素荣; 胥勋成; 冯建华

    2016-01-01

    目的:探讨电生理检查指标在腕管综合征( CTS)诊断中的应用价值。方法以CTS患者279例为观察组,健康志愿者228例为对照组,行神经电生理检测。结果两组末梢运动潜伏期(DML)、复合肌肉动作电位(CMAP)波幅、前臂段运动传导速度(fMCV)、感觉神经动作电位(SNAP)波幅及腕-食指感觉传导速度(SCV)比较,差异均有统计学意义(P<0.05);尺神经电生理指标间差异均无统计学意义(P>0.05)。结论 CTS的诊断需要结合多项电生理检查指标以减少疾病的漏诊。%Objective To evaluate the application value of the electrophysiological examination index in the diagnosis of carpal tunnel syndrome ( CTS) .Methods Total of 279 CTS patients were used as observation group and 228 healthy volunteers were served as control group.Routine nerve conduction studies were performed in the both groups.Results There were significant differences in distal motor lantency ( DML) ,compound muscle action potential ( CMAP) amplitude,forearm period of motor conduction velocity ( FM-CV),sensory nerve action potential (SNAP) amplitude and finger-wrist sensory conduction velocity (SCV) between the two groups (P0.05).Conclusion We need the combination of a number of electro-physiological parameters to improve the diagnostic technology of CTS.

  18. The role of sensory nerve conduction study of the palmar cutaneous nerve in the diagnosis of carpal tunnel syndrome in patients with polyneuropathy

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    Ayse Tokcaer

    2007-01-01

    Full Text Available Background: Conventional methods in the diagnosis of carpal tunnel syndrome (CTS in patients with polyneuropathy (PNP are insufficient. Aims: We suggest that the comparison of the conduction of the median nerve with that of the neighboring peripheral nerves may be more beneficial in the diagnosis of entrapment neuropathy. Setting and Design: The median nerve sensory conduction in healthy volunteers, in cases of CTS, PNP cases without CTS and in cases of PNP in whom clinical findings point to CTS, were compared by palmar cutaneous nerve (PCN sensory conduction. Materials and Methods: Comparative parameters were difference of PCN-1st digits′ nerve conduction velocities (NCV, PCN/1st digit NCVs ratio, difference of 5th-2nd digits′ NCVs and 5th/2nd digits′ NCVs ratio. Statistical Analysis: The statistical analysis was performed by the SPSS package for statistics. Student t test and receiver operating characteristic were used. Results: Although the ratio of PCN-1st digit did not differ significantly between the control group and the polyneuropathy group, there was a significant difference between CTS and PNP+CTS groups and the control group ( P < 0.001 and P < 0.001, respectively. The ratio of PCN-1st digit nerve conduction velocity was also significantly different between polyneuropathy and PNP+CTS groups ( P < 0.001. Conclusion: To diagnose CTS on a background of polyneuropathy in mild cases in which sensory conduction is preserved, the ratio of sensory nerve conduction velocities of the palmar cutaneous nerve and the median nerve 1st digit-wrist segment may be a criterion.

  19. 轻中度腕管综合征药物治疗长短期疗效%Long- and short-term effects of drugs on treating mild-to-moderate carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    吴鹏; 杨剑云; 陈琳; 虞聪

    2012-01-01

    Objective To investigate the long- and short-term efficacy of drug combination therapy for mild-to-moderate carpal tunnel syndrome. Methods Twenty-four outpatients with mild-to-moderate carpal tunnel syndrome (35 involved carpals ) treated with 4 drugs (methycobalt bandazoU vitBl and vitBo) were followed up. The patients were asked to fill in the Boston carpal tunnel questionnaire (BCTQ) and their clinical symptoms were collected at each follow-up period (short-term at the 0 month, 4 months, 6 months after the start of treatment, and long-term at 1 year after the end of treatment). Sensory nerve conduction velocity CSNCV) of the involved radial three digital nerves was tested at the 0 month and 6 months after the start of treatment. Results The long- and short-term efficacy of drug treatment on mild-to-moderate carpal tunnel syndrome were 94.3% and 91. 4%, respectively. Obvious recovery of total BCTQ functional scores and SNCV were obtained after the drug treatment compared to the pre-treatment. Conclusion Both long- and short-term efficacy of drug combination therapy (methycobal, bandazol, vitBl and vitB6) for mild-to-moderate carpal tunnel syndrome are good.%目的 探讨轻中度腕管综合征药物治疗的长短期疗效.方法 门诊随访24例(35腕)口服四联药(弥可保、地巴唑、维生素B1、维生素B6)的轻中度腕管综合征病人.病人在入组时治疗4个月、6个月后及停药1年后来我院门诊随访,向医生汇报其近期临床症状表现,自评其患手功能并填写Boston腕管问卷调查表(BCTQ).病人在人组时及治疗6个月后,需接受患肢桡侧3指感觉神经传导速度(SNCV)检测.结果 药物治疗后病人临床症状明显好转,短期(4个月、6个月)临床有效率可高达94.3%,长期(停药后1年)临床有效率可高达91.4%.BCTQ功能总评分及桡侧3指SNCV也较治疗前有明显恢复.结论 弥可保联合地巴唑、维生素B1及维生素B6治疗轻中度腕管综合征有很好的长短期疗效.

  20. Carpal Fusion

    OpenAIRE

    2012-01-01

    Carpal fusion may be seen in hereditary and nonhereditary conditions such as acrocallosal syndrome,acromegaly, Apert syndrome, arthrogryposis, Carpenter syndrome, chromosomal abnormalities, ectrodactyly-ectodermal dysplasia-cleft (EEC) syndrome, the F form of acropectorovertebral dysgenesis or the F syndrome, fetal alcohol syndrome, Holt-Oram syndrome, Leopard syndrome, multiple synostosis syndrome, oligosyndactyly syndrome, Pfeiffer-like syndrome, scleroderma, split hand and foot malformatio...

  1. [Carpal instability].

    Science.gov (United States)

    Redeker, J; Vogt, P M

    2011-01-01

    Carpal instability can be understood as a disturbed anatomical alignment between bones articulating in the carpus. This disturbed balance occurs either only dynamically (with movement) under the effect of physiological force or even statically at rest. The most common cause of carpal instability is wrist trauma with rupture of the stabilizing ligaments and adaptive misalignment following fractures of the radius or carpus. Carpal collapse plays a special role in this mechanism due to non-healed fracture of the scaphoid bone. In addition degenerative inflammatory alterations, such as chondrocalcinosis or gout, more rarely aseptic bone necrosis of the lunate or scaphoid bones or misalignment due to deposition (Madelung deformity) can lead to wrist instability. Under increased pressure the misaligned joint surfaces lead to bone arrosion with secondary arthritis of the wrist. In order to arrest or slow down this irreversible process, diagnosis must occur as early as possible. Many surgical methods have been thought out to regain stability ranging from direct reconstruction of the damaged ligaments, through ligament replacement to partial stiffening of the wrist joint.

  2. Carpal Fusion

    Directory of Open Access Journals (Sweden)

    Jalal Jalalshokouhi*

    2012-05-01

    Full Text Available Carpal fusion may be seen in hereditary and nonhereditary conditions such as acrocallosal syndrome,acromegaly, Apert syndrome, arthrogryposis, Carpenter syndrome, chromosomal abnormalities, ectrodactyly-ectodermal dysplasia-cleft (EEC syndrome, the F form of acropectorovertebral dysgenesis or the F syndrome, fetal alcohol syndrome, Holt-Oram syndrome, Leopard syndrome, multiple synostosis syndrome, oligosyndactyly syndrome, Pfeiffer-like syndrome, scleroderma, split hand and foot malformation, Stickler syndrome, thalidomide embryopathy, Turner syndrome and many other conditions as mentioned in Rubinstein-Taybi's book. Sometimes there is no known causative disease.Diagnosis is usually made by plain X-ray during studying a syndrome or congenital disease or could be an incidental finding like our patients. Hand bone anomalies are more common in syndromes or other congenital or non-hereditary conditions, but polydactyly, syndactyly or oligodactyly and carpal fusions are interesting. X-ray is the modality of choice, but MRI and X-ray CT with multiplanar reconstructions may be used for diagnosis.

  3. Power grip, pinch grip, manual muscle testing or thenar atrophy – which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review

    Directory of Open Access Journals (Sweden)

    Kale Swati

    2007-11-01

    Full Text Available Abstract Background Objective assessment of motor function is frequently used to evaluate outcome after surgical treatment of carpal tunnel syndrome (CTS. However a range of outcome measures are used and there appears to be no consensus on which measure of motor function effectively captures change. The purpose of this systematic review was to identify the methods used to assess motor function in randomized controlled trials of surgical interventions for CTS. A secondary aim was to evaluate which instruments reflect clinical change and are psychometrically robust. Methods The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical interventions for CTS. Data on instruments used, methods of assessment and results of tests of motor function was extracted by two independent reviewers. Results Twenty-two studies were retrieved which included performance based assessments of motor function. Nineteen studies assessed power grip dynamometry, fourteen studies used both power and pinch grip dynamometry, eight used manual muscle testing and five assessed the presence or absence of thenar atrophy. Several studies used multiple tests of motor function. Two studies included both power and pinch strength and reported descriptive statistics enabling calculation of effect sizes to compare the relative responsiveness of grip and pinch strength within study samples. The study findings suggest that tip pinch is more responsive than lateral pinch or power grip up to 12 weeks following surgery for CTS. Conclusion Although used most frequently and known to be reliable, power and key pinch dynamometry are not the most valid or responsive tools for assessing motor outcome up to 12 weeks following surgery for CTS. Tip pinch dynamometry more specifically targets the thenar musculature and appears to be more responsive. Manual muscle testing, which in theory is most specific to the thenar musculature, may be more

  4. Analysis of therapeutic effects of Nicergoline in treatment of carpal tunnel syndrome%尼麦角林治疗腕管综合征疗效分析

    Institute of Scientific and Technical Information of China (English)

    唐娜; 李志军

    2013-01-01

    Objective: To observe the therapeutic effects of Nicergoline in treatment of mild and moderate carpal tunnel syndrome (CTS). Methods; Sixty-eight cases with CTS were randomly divided into 2 groups, treated with either Nicergoline or dibazol combined with corticosteroid. Therapeutic effects and electrophysiological parameters were observed after 4 weeks and 12 weeks, respectively. Results; Symptom severity score (SSS) and functional status score (FSS) in Nicergoline group improved significantly after 4 weeks, in comparison with baseline values (P<0.05) , and were more prominent at 12 weeks (P<0. 05). Compared with that of dibazol, Nicergoline was more effective at 12 weeks (P<0. 05). There were various degrees of improvement in electrophysiological values after Nicergoline treatment, the sensory latency differences between the median and the ulnar wrist-to-digit were the better parameters in the median nerve recovery after treatment than the median sensory distal latency. Conclusion;Nicergoline combined with corticosteroid could achieve long-term amelioration in treatment of mild or moderate CTS in respect of improving the clinical symptoms and electrophysiological parameters.%目的:观察尼麦角林治疗轻中度腕管综合征(CTS)的疗效.方法:将68例CTS患者随机分为2组,尼麦角林组给予尼麦角林联合皮质类固醇治疗,地巴唑组给予地巴唑联合皮质类固醇治疗,4、12周后观察临床疗效和神经电生理变化.结果:尼麦角林组治疗后4周痘状严重程度评分(SSS)和功能评分(FSS)较治疗前明显改善(均P <0.05);12周时其效果更为明显(P<0.05),与地巴唑组比较,有统计学差异(P<0.05).神经电生理指标表现为不同程度的改善,其中尤其以环指正中、尺神经感觉潜伏期差值恢复最显著.结论:尼麦角林联合皮质类固醇能有效改善轻中度CTS临床症状和电生理指标,并取得持久的缓解.

  5. 电针配合穴位注射治疗腕管综合征疗效观察%Observations on the Efficacy of Electroacupuncture plus Acupuncture Point Injection in Treating Carpal Tunnel Syndrome

    Institute of Scientific and Technical Information of China (English)

    叶爱萍; 邹燃

    2014-01-01

    Objective To assess the clinical efficacy of electroacupuncture plus acupuncture point injection in treating carpal tunnel syndrome. Method Sixty-three patients with carpal tunnel syndrome were allocated, using a random number table, to a treatment group (32 cases) and a control group (31 cases). The treatment group received electroacupuncture plus acupuncture point injection and the control group, conventional acupuncture. One course of treatment was given. After treatment, the clinical therapeutic effects and the recurrence rates based on the symptoms and signs were compared between the two groups. Result The total efficacy rates in the treatment and control groups were 93.8% and 77.4%, respectively. There was a statistically significant difference in clinical therapeutic effect between the two groups (P<0.05). There was a statistically significant posttreatment difference in the recurrence rate between the two groups of patients (P<0.05). Conclusion Electroacupuncture plus acupuncture point injection is easy to perform and has a good effect in treating carpal tunnel syndrome.%目的:评价电针配合穴位注射治疗腕管综合征的临床疗效。方法将63例腕管综合征患者按入组先后根据随机数字表法分为治疗组(32例)和对照组(31例)。治疗组予电针配合穴位注射治疗,对照组予普通针刺治疗,共治疗1个疗程。经治疗后,从症状和体征上比较两组临床疗效及复发率。结果治疗组、对照组总有效率分别为93.8%和77.4%,两组总有效率比较差异有统计学意义(P<0.05);两组患者治疗后复发率比较差异有统计学意义(P<0.05)。结论电针配合穴位注射治疗腕管综合征操作简单、疗效好。

  6. Clinical Efficacy of Pingle Zhanjin Tincture on Carpal Tunnel Syndrome:A Clinical Observation of 28 Cases%平乐展筋酊治疗腕管综合征28例临床观察

    Institute of Scientific and Technical Information of China (English)

    张晓强; 谭旭仪; 高书图; 高菲菲; 程春生; 李刚

    2014-01-01

    目的:观察平乐展筋酊外用治疗腕管综合征的疗效。方法:对纳入研究的28例腕管综合征患者给予平乐展筋酊外用治疗,治疗3周后观察患者治疗前后症状缓解情况,行正中神经电生理检查,并评价疗效。结果:痊愈4例,显效18例,有效5例,无效1例,总有效率96.4%;神经电生理检查结果表明:治疗后正中神经运动传导末端潜伏期降低,波幅上升,感觉神经传导速度增加,与治疗前比较,差异有统计学意义(P<0.01)。结论:平乐展筋酊外用治疗腕管综合征有较好疗效。%Objective: To observe the clinical effect of Pingle Zhanjin tincture on Carpal tunnel syndrome. Methods: The 28 cases of patients of Carpal tunnel syndrome were treated by external application of Pingle Zhanjin tincture. The remission of the symptom was observed, as well as the median nerve electrophysiological examination in 3 weeks, to evaluate the effi-cacy. Results: There were 4 cases with recovery, 18 cases markedly effective, 5 cases effective and 1 case ineffective, the to-tal efficiency of 96.4%. Physical examination findings electrical nerve showed that the median nerve motor conduction distal latency decreased, amplitude increased, and that the sensory nerve conduction velocity increased; there was statistical signifi-cance (P<0.05). Conclusion: Pingle Zhanjin Tincture can provide good clinical efficacy on Carpal tunnel syndrome.

  7. Study on the Value of Displacement Technology in Identifying Carpal Tunnel Syndrome and Cervical SpondylosisRadiculopathy%位移技术对鉴别腕管综合征与神经根型颈椎病的价值

    Institute of Scientific and Technical Information of China (English)

    徐士军; 董晓柳; 李智琳; 杨建国; 孙玉会

    2015-01-01

    Objective To study the value of displacement technique in the identification of carpal tun-nel syndrome and cervical spondylosis radiculopathy.Me thods A total of 200 patients diagnosed as carpal tunnel syndrome or cervical spondylosis radiculopathy in Department of Rehabilitation Medicine , Tangshan People's Hospital from Jan.2010 to Oct.2012 were selected as research objects.Both motor nerve conduction velocity and displacement determination in conventional phase were analyzed .Results After diagnosed by displacement technique,among the 200 patients,73 cases had cervical spondylosis radiculopathy,accounting for 36.5%,75 cases had carpal tunnel syndrome, accounting for 37.5%, three cases had root merger of carpal tunnel syndrome,accounting for 1.5%,four cases had cubital tunnel syndrome,accounting for 2.0%, and there were 45 patients with no abnormality found,accounting for 22.5%.For patients with carpal tunnel syndrome,their sensory nerve conduction velocity of thumb was (28.7 ±0.3) m/s,that of the index finger was (31.5 ±0.4) m/s,and that of the middle finger was (32.2 ±0.5) m/s,the wrist incubation period was (4.8 ±1.9) m/s, the motor nerve conduction velocity was (60 ±5) m/s;for patients with cervical spondy-losis radiculopathy,indicators mentioned above respectively were (43.5 ±9.9) m/s,(46.7 ±15.0) m/s, (45.4 ±16.4) m/s,(3.6 ±0.4) m/s,and (63 ±5) m/s.There were statistically significant differences of those indicators between the two diseases( P<0.05 ) .Conclusion Displacement technology contributes to the identification of nerve block,so as to effectively distinguish carpal tunnel syndrome from cervical spondy-losis radiculopathy.%目的 研究位移技术对于鉴别腕管综合征与神经根型颈椎病的临床应用价值. 方法选取2010年1月至2012年10月唐山市人民医院康复医学科拟诊为神经根型颈椎病或腕管综合征的患者200例,均进行常规阶段的运动神经传导速度和位移技术测定. 结果

  8. 手术治疗腕关节骨折脱位并发腕管综合征的临床效果%Clinical effect of surgery treating wrist joint fracture dislocation associat-ed with carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    吴滨滨; 李旭; 刘伟波

    2015-01-01

    Objective To investigate the clinical effect of the surgery treating wrist joint fracture dislocation associated with carpal tunnel syndrome. Methods Ninety patients with wrist joint fracture dislocation associated with carpal tunnel syndrome treated in our hospital from October 2011 to October 2014 were selected and divided into control group and study group.Control group was given non-surgical treatment and study group was given surgical treatment.The clinical efficacy between two groups was compared. Results After treatment,the excellent and good rate of control group was 62.5%and that of the study group was 82.0%,and there was a statistical difference between two groups (P<0.05).The study group was significantly better than the control group in the wrist joint mobility situation and median nerve recovery sit-uation,and there was a statistical difference (P<0.05). Conclusion Surgery treating wrist joint fracture dislocation asso-ciated with carpal tunnel syndrome has remarkable clinical effect and enables good postoperative recovery for patients, and surgical treatment is recommended to treat wrist joint fracture dislocation associated with carpal tunnel syndrome.%目的:探讨手术治疗腕关节骨折脱位并发腕管综合征的临床效果。方法选取本院2011年10月~2014年10月收治的腕关节骨折脱位并发腕管综合征患者90例,分为对照组与研究组,其中对照组采用非手术治疗,研究组采用手术方法治疗,比较两组患者的临床效果。结果治疗后,对照组的优良率为62.5%,研究组为82.0%,两组比较,差异有统计学意义(P<0.05);研究组患者的腕关节活动情况与正中神经恢复情况明显优于对照组,差异有统计学意义(P<0.05)。结论手术治疗腕关节骨折脱位并发腕管综合征的临床效果显著,患者术后恢复情况较好,建议采用手术治疗腕关节骨折脱位并发腕管综合征。

  9. Application of the Sensory nerve conduction studies in mild carpal tunnel syndrome%感觉神经传导检查比较法在诊断轻度腕管综合征中的应用

    Institute of Scientific and Technical Information of China (English)

    王会含; 张志新; 刘举; 王伟; 李瑞君

    2013-01-01

    Objective To find a sensitive clcctrodiagnostic indicators for patients who with mild carpal tunnel syn-dromc(CTS). Methods Retrospective Analysis 80 patient,including 92 hands, with carpal tunnel syndrom patiens who was clinical diagnosed by the hand surgeon of the First Hospital of Jilin University and was exactly treated by surgical, but those patients prompted that the potential period of the abductor pollicis brcvis compound action muscle (CAMP) and indcxmiddlc finger feels nerve conduction were normal by thcconvcntional clcctrodiagnostic examination, and now,a total of 80 patients with carpal tunnel syndrome by ncurophysiological analysis, using forward method records both the differences between median and ulnar palmar latencies and the difference between median and ulnar latencies from D4 stimulation,and the positive indicators of the potential latency is ≥ 0. 4ms,then calculate the positive coincidence rate, and use statistics analyzing these indicators. Results There arc 64 hands which the differences between median and ulnar palmar latencies is ≥ 0. 4ms; the positive rate was 69. 56%. There arc 83 hands which the difference between median and ulnar latencies from D4 stimulation is ≥ 0. 4ms; the positive rate of 90. 21 %. There arc 62 hands which potential latency is ≥ 0. 4ms in both of methods,Only 7 cases which in both of methods have no positive findings. Conclusion The difference between median and ulnar latencies from D4 stimulation have a high diagnoslic value for detecting the mild and atypical carpal tunnel syndrome.%目的 寻找诊断轻度腕管综合征(CTS)敏感的神经电生理指标.方法 回顾性分析经吉林大学第一医院手外科医生临床诊断,并经手术治疗疗效确实,但常规电生理检查提示拇短展肌复合肌肉动作电位的潜伏期(CAMP)及示、中指感觉神经传导检查正常的患者80人,共92例手的腕管综合征患者进行神经电生理分析,采用顺向法记录掌腕正中、

  10. Body mass index and carpal tunnel syndrome Índice de massa corporal e síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    JOAO ARIS KOUYOUMDJIAN

    2000-06-01

    Full Text Available Carpal tunnel syndrome (CTS has been correlated to body mass index (BMI increase. The present study was done in a Brazilian population to compare BMI values in the following groups: first, CTS vs. controls subjects, and, second CTS groups of increasing median sensory latency (MSL. According to MSL > or = 3.7 ms (wrist-index finger, 14 cm, median/ulnar sensory latency difference > or = 0.5 ms (ring finger, 14 cm or median palm-to-wrist (8 cm latency > or = 2.3 ms (all peak-measured, 141 cases (238 hands had CTS confirmation. All were symptomatic; previous surgery and polyneuropathy were excluded; mean age 50.3; 90.8% female. Controls subjects (n=243; mean age 43.0; 96.7% female and CTS cases had BMI calculated (kg/m². Controls subjects had a mean BMI of 25.43±4.80 versus 28.38±4.69 of all CTS cases, a statistically significant difference (p Síndrome do túnel do carpo (STC pode ser estar relacionada ao aumento de índice de massa corporal (IMC. O presente estudo foi realizado em uma população brasileira para comparar valores de IMC entre casos com STC e controles assintomáticos; os casos com STC foram ainda divididos em subgrupos de gravidade progressiva de acordo com a latência distal sensitiva do nervo mediano (LDS-M. Os casos de STC (141, 238 mãos foram confirmados com LDS-M > ou = 3,7 ms (punho-II dedo, 14 cm, diferença de latência mediano-ulnar > ou = 0,5 ms (punho-IV dedo, 14 cm ou latência palma-punho do nervo mediano > ou = 2,3 ms (8 cm, todos medidos no pico do potencial. Todos os casos eram sintomáticos; foram excluídos casos com polineuropatia e cirurgia prévia; a média de idade foi 50,3 anos e 90,8% dos casos eram do gênero feminino. Os controles assintomáticos (243 apresentavam média de idade de 43 anos sendo 96,7% do gênero feminino. O IMC foi calculado de acordo com a fórmula Kg/m². O grupo controle apresentou IMC de 25,43±4,8 contra 28,38±4,69 do grupo com STC (p<0,001. Os subgrupos de STC com aumento

  11. Axonal degeneration in association with carpal tunnel syndrome Degeneração axonal na síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Marcelo Ribeiro Caetano

    2003-03-01

    Full Text Available Median nerve entrapment in the palm to wrist segment is known as carpal tunnel syndrome (CTS. Electromyography is the best evaluation test to confirm the disease, as it shows a median reduced conduction velocity and/or conduction block; however, the usual CTS electrodiagnostic tests do not separate segmental demyelination alone from segmental demyelination plus secondary axonal degeneration. We studied 100 hands from CTS patients (classified as mild, moderate, and severe, and 50 hands from normal subjects. The median palmar sensory nerve action potential (SNAP amplitude was measured and compared between the two groups. It would be expected that SNAP was normal if no axonal degeneration had occurred. The results showed that in mild CTS group and part of moderate CTS group SNAP amplitude was normal, whereas in severe CTS group, and part of moderate group SNAP amplitude was reduced, proving that axonal degeneration was involved. As it is well stated that axonal lesions have worse prognosis than segmental demyelinating ones, this simple test may help to preditic the CTS outcome and treatment.A compressão do nervo mediano no segmento punho-palma produz uma entidade clínica conhecida como síndrome do túnel do carpo (STC. A eletroneuromiografia é o exame de escolha para o diagnóstico da STC, através da identificação de diminuição de velocidade e/ou bloqueio de condução quando estudamos a neurocondução do nervo mediano, no trecho do punho. Entretanto, as técnicas comumente usadas não conseguem separar a lesão em mielínica focal com ou sem degeneração axonal secundária. Avaliamos 100 mãos de pacientes com STC e comparamos com 50 mãos de um grupo controle. Medimos a amplitude do potencial de ação do nervo sensitivo do mediano, com estímulo na palma e captação no dedo, e comparamos entre os grupos controle e de pacientes (o grupo de STC foi subdividido em leve, moderado e grave. Era esperado que a amplitude do potencial

  12. The usefulness of terminal latency index of median nerve and f-wave difference between median and ulnar nerves in assessing the severity of carpal tunnel syndrome.

    Science.gov (United States)

    Park, Kang Min; Shin, Kyong Jin; Park, Jinse; Ha, Sam Yeol; Kim, Sung Eun

    2014-04-01

    The calculated electrophysiological parameters, such as terminal latency index (TLI), residual latency, modified F ratio, and F-wave inversion, have been investigated as a diagnostic tool for detection of early stage of carpal tunnel syndrome (CTS) in the literature. However, the correlation of these calculated electrophysiological parameters with the clinical severity of CTS has not been reported. The aim of this study was to determine the correlation of the calculated electrophysiological parameters and clinical severity in patients with CTS. A retrospective study was performed with 212 hands of 106 CTS patients. The CTS hands were classified as asymptomatic, mild, moderate, and severe according to the clinical severity. The distal motor latency and distal motor conduction velocity of median nerve, minimal F-wave latency of median and ulnar nerves, and sensory nerve conduction velocity in the finger-wrist and palm-wrist segment of median nerve (SNCV f-w and SNCV p-w) were obtained in a conventional nerve conduction study. The TLI, residual latency, and modified F ratio of the median nerve and the difference of minimal F-wave latencies between the median and ulnar nerves (F-diff M-U) were calculated. The distal motor latency, residual latency, and F-diff M-U were significantly increased according to the clinical severity of CTS. The motor conduction velocity, SNCV p-w, SNCV f-w, TLI, and modified F ratio were significantly decreased according to the clinical severity of CTS. In analyses of variance and Kruskal-Wallis test, we used the Scheffe test as a post-hoc comparison analysis. The TLI, F-diff M-U, and SNCV f-w showed a significant difference among all groups of each CTS severity. The sensitivity, specificity, and cut-off value of TLI, F-diff M-U, and SNCV f-w between asymptomatic and mild, mild and moderate, and moderate and severe CTS groups were calculated by using receiver operating characteristic curve analysis. The cut-off values of TLI, F-diff M-U, and

  13. 正中神经松解范围对重度腕管综合征术后疗效的临床研究%Clinical research on influence of relaxation extent in median nerve on results of surgical treatment for serious carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    魏锦辉; 谭伟欣

    2013-01-01

    Objective To explore the relationship between the scope of surgery to loosen median nerve entrapment with serious carpal tunnel syndrome and the curative effect after surgery.Methods Referencing to patients' condition and results of Electromyologram,we classified the serious ones from the patients with carpal tunnel syndrome.According to the patients' condition,they were randomly divided into 2 groups before the surgery.Every group had 20 cases.Every group had different scope of surgery.Follow up evaluation was carried out after surgery.Electromyologram (EMG) was applied regularly,and then we observed the clinical symptoms.Results By comparison in the two groups,managed by t-test,there were significant differences in the two groups (P < 0.01).Through the statistical analysis of the results,cases in group which were released transverse carpal ligament and nerve,displayed that the latency of compound muscle action potential (CMAP) in the abductor pollicis hrevis and sensory nerve action potential (SNAP)of ring finger has recovered most quickly through the EMG.The way of group C relieving clinical symptoms was best.Conclusions The scope of surgery which were released transverse carpal ligament and nerve,not only released the median nerve effectively,but also protected the continuity of nerve and the blood supply of nerve.It enhanced the recovery of CMAP and SNAP obviously.It also promoted the recovery of the sense in the peripheral part and the motor functions of the nerve.It was a simple and effective therapy for severe carpal tunnel syndrome.But concerning the complete damage to the median nerve,with muscular atrophy of abductions,it can only promote the sense in the peripheral part after treatment,not the motor functions.%目的 研究临床上重度腕管综合征正中神经卡压的手术松解范围与术后疗效的关系.方法 根据病情及电生理检测分度,筛选出腕管综合征中重度压迫者,随机分为两组,每组20例,给予不同的手

  14. Observation of nursing and prevention of mild and moderate carpal tunnel syndrome treated with traditional Chinese medicine smoking and spreading combined with ultrashort wave%中药熏敷结合超短波治疗轻中度腕管综合征的观察护理及预防

    Institute of Scientific and Technical Information of China (English)

    邹玲; 莫建英

    2014-01-01

    Objective To summarize the treatment and nursing effects of traditional Chinese medicine smoking and spreading combined with ultrashort wave for early mild and moderate carpal tunnel syndrome and to provide reference for nursing staffs. Methods Forty-eight patients with mild and moderate carpal tunnel syndrome were treated with traditional Chinese medicine smoking and spreading combined with ultrashort wave. Corresponding nursing measures were taken. The effects were observed. Results The total effective rate of traditional Chinese medicine smoking and spreading combined with ultrashort wave for mild and moderate carpal tunnel syndrome was above 95%. Conclusion In the treatment of mild and moderate carpal tunnel syndrome, traditional Chinese medicine smoking and spreading combined with ultrashort wave shows remarkable efficacy, is easy to operate and causes no side effects. Strengthening of health publicity and education can effectively prevent and reduce the occurrence of symptoms.%目的:总结对早期轻中度腕管综合征患者采用超短波配合中药熏敷治疗及护理效果,为护理人员提供借鉴。方法采用中药熏敷结合超短波治疗轻中度腕管综合征48例,结合相应的护理措施,观察效果。结果用中药熏敷法结合超短波治疗轻中度腕管综合征,总有效率达95%以上。结论中药熏敷法结合超短波治疗轻中度腕管综合征,疗效显著,操作简单,无副作用。加强健康宣教,能有效预防及减少症状的发生。

  15. 腕管综合征合并神经根型颈椎病患者神经传导测定特点分析%Nerve conduction characteristics of carpal tunnel syndrome patients with cervical spondylotic radiculopathy

    Institute of Scientific and Technical Information of China (English)

    徐士军; 李智琳; 杨建国; 孙玉会; 董晓柳

    2014-01-01

    Objective To analyze the nerve conduction characteristics of carpal tunnel syndrome patients with cervical spondylotic ra -diculopathy ,and to provide a better way to treat carpal tunnel syndrome .Methods Thirty patients of carpal tunnel syndrome with cer-vical spondylotic radiculopathy admitted to hospital from December 2011 to December 2012 were studied .And 30 healthy people were chosen as the control group .Distal sensory latency ( DSL) ,sensory nerve action potentials ( SNAP) ,cross-wrist sensory conduction ve-locity ( SCV) ,distal motor latency ( DML) and compound muscle action potential ( CMAP) of the median nerve and ulnar nerve were measured .We first tested sensory conduction ,and then measured motor conduction .These indicators were measured again 5 minutes af-ter median nerve compression test .Results Median nerve DSL of observation group was significantly longer than that of control group . The difference was statistically significant (P0.05). Parameters of median nerve and ulnar nerve in both observation group and control group were not significantly changed (P>0.05). Compared with control group,DSL and DML of median nerve in observation group were significantly prolonged (P 0.05).Conclusions DSL of carpal tunnel syndrome patients with cervical spondylotic radiculopathy was sig -nificantly prolonged due to pressure on the median nerve ,therefore,nerve conduction measurement contributes to the early diagnosis of carpal tunnel syndrome .%目的:探讨腕管综合征合并神经根型颈椎病患者神经传导测定特点并进行临床分析,为治疗提供可靠的依据。方法选取该院2010年12月-2012年12月收治的腕管综合征合并神经根型颈椎病患者30例,并选择同期健康体检者30例作为对照研究。测定正中神经和尺神经的感觉传导末端潜伏期( DSL )、感觉神经动作电位( SNAP )、跨腕关节感觉传导速度(SCV)、运动传导末端潜伏期(DML)及复合肌肉动作电

  16. A comparison of opioid use between WCB recipients and other Manitobans for knee, shoulder, back and carpal tunnel release procedures

    Science.gov (United States)

    Raymond, Colette B.; Ekuma, Okechukwu; Shafer, Leigh Anne

    2016-01-01

    Background This study's objectives were to evaluate whether WCB claimants with conditions requiring certain surgical procedures are more likely to be prescribed outpatient opioids than other Manitobans and whether those prescribed opioids are more likely to still be on opioid medications 6 months post procedure. Methods We compared 7,246 WCB claims for a number of surgical procedures to 65,032 similar procedures performed in other Manitobans. Logistic regression was used to explore the association between being a WCB claimant and being prescribed opioids, while controlling for type of surgical procedure and other potential confounders. Results WCB claimants were more likely than other Manitobans to be prescribed opioids (adjusted OR 1.38; 95%CI 1.30–1.47). Amongst those prescribed opioids, the odds of being still on opioids 6 months post‐procedure were not significantly elevated for WCB claimants (adjusted OR 1.09 95%CI 0.97–1.23). Conclusions WCB claimants are prescribed opioids more often than non‐claimants for similar procedures. Am. J. Ind. Med. 59:257–263, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. PMID:26792402

  17. The rehabilitation therapeutic effect of Super-Lizer on the early chronicity strain carpal tunnel syndrome%超激光治疗早期腕管综合征的康复疗效观察

    Institute of Scientific and Technical Information of China (English)

    郑夏茹; 兰才生; 邓惠文; 刘丽平; 刘志平

    2010-01-01

    Objective To investigate the rehabilitation therapeutic effect of Super-Lizer on the early chronicity strain carpal tunnel syndrome by lassitude. Methods Ninety-eight carpal tunnel syndrome patients were randomly divided into therapeutic group (53 cases) and control group (45 cases). The control group was treated with brake and rest on wrist joint. The therapeutic group was treated with Super-Lizer plus wrist brace in neutral position brake and rest in run-up position on wrist joint. The changes of clinical symptom,feeling,muscle power and electromyography in the hands after 2 weeks were detected.Then the results were analyzed. Results The clinical symptom,feeling,muscle power and electromyography in the hands of two groups were obviously improved after treatment, the therapeutic group significantly better than the control group in motor nerve conduction resume(P < 0.05 ). The cure and efficiency rate of the therapeutic group was 81.13%(43/53),the cure and efficiency rate of the control group was 57.78%(26/45),there was significantly better between two groups (P < 0.05). Conclusion The rehabilitation therapeutic effect of Super-Lizer on the early chronicity strain carpal tunnel syndrome is remarkable,worthy of clinical application.%目的 探讨超激光对慢性劳损所致早期腕管综合征的康复治疗效果.方法 将98例慢性劳损所致早期腕管综合征患者采用随机数字表法分为试验组53例和对照组45例.对照组给予腕部支具制动腕关节于中立位和手腕部抬高休息的方法,试验组在对照组治疗的基础上给予超激光治疗.治疗2周后观察两组患手临床症状及肌电图变化,并进行综合评估.结果 治疗2周后两组患手临床症状及肌电图变化均较治疗前有明显改善,其中试验组运动神经传导速度改善优于对照组(P<0.05).试验组治愈显效率为81.13%(43/53),对照组治愈显效率为57.78%(26/45),试验组治愈显效率明显高于对照组(P<0

  18. 神经电生理检查在22例腕管综合征患者中的应用%Electrophysiological analysis in carpal tunnel syndrome in 22 cases

    Institute of Scientific and Technical Information of China (English)

    万泉

    2011-01-01

    目的:对比分析腕管综合征(carpal tunnel syndrome,CTS) 患者的神经电生理特征.方法:对临床症状、体征符合CTS的22例患者进行正中神经和尺神经的运动与感觉传导速度测定,以及大鱼际肌、小鱼际肌的肌电图检测.结果:在22例患者中,双侧上肢均有病变者7例,单侧上肢病变者15例,共有29侧上肢病变.22例CTS患者中29条正中神经感觉传导潜伏期均延长,29条正中神经感觉传导速度均减慢,21条正中神经感觉诱发波幅降低,28条正中神经运动远端潜伏期延长,28条正中神经的复合肌肉动作电位波幅降低,1条正中神经运动远端潜伏期和诱发波幅正常.19块正中神经支配的大鱼际肌呈神经原性损害.结论:神经电生理检查在CTS的诊断与鉴别诊断中具有重要价值.%Objective:To find out the neural electrophysiological features in patients with carpal tunnel syndrome (CTS). Methods: We performed the measurement of motor nerve conduction velocity and sensory nerve conduction velocity on median nerve and ulnar nerve as well as electromyogram of abductor polleis brevis and abductor digiti minimi in 22 cases of CTS patients. Results: Of the 22 patients, bilateral lesions were found in 7 and unilateral in 15, and totally there were 29 lesions. The latency of 29 median nerves sensory conduction became delayed and the sensory conduction velocity were decreased. Reduced evoked amplitude was seen in 21 median nerves sensory nerves and delayed distal motor latency (DML) in 28 median nerves. In addition, 28 median nerves compound muscle action potential (CMAP) were found decreased. The DML and the evoked amplitude remained normal in only 1 median nerve. The neurogenic injury was seen in 19 abductor pollicis brevis controlled by the median nerve. Conclusion: Neural electrophysiological examination has great value in the diagnosis and differential diagnosis of CTS.

  19. Dor e parestesias nos membros superiores e diagnóstico da síndrome do túnel do carpo Pain and numbness in the arms and hands and carpal tunnel syndrome diagnosis

    Directory of Open Access Journals (Sweden)

    Valéria Ribeiro Nogueira Barbosa

    2006-12-01

    Full Text Available Nós avaliamos a freqüência e localização de dor e parestesias em pacientes com síndrome do túnel do carpo (STC e em indivíduos da população geral, pareados por gênero e idade. Determinamos a sensibilidade e a especificidade desses sintomas para o diagnóstico de STC. Dor foi um sintoma comum nos dois grupos de pacientes. Parestesia ocorreu com mais freqüência em pacientes com STC (p75% quando são localizadas nas mãos.We studied the frequency and localization of pain and numbness in patients with carpal tunnel syndrome (CTS, in comparison with individuals of the general population, matched for sex and age, and we determined the sensitivity and the specificity of these symptoms for the CTS diagnosis. Pain was a common symptom in the two groups of patients. Numbness occurred more frequently in CTS group (p<0.05. In CTS patients, pain complaints were present in neck (42.8%, arms (36.8% and hands (82.8%. Among controls, pain was more common in head (11.4%, trunk (37.1%, legs (22.8%. In our casuistics, in relation to the CTS diagnosis, the presence of pain and numbness have low sensitivity and high specificity when they occur in the arms, and high sensitivity and specificity when they occur in the hands.

  20. Carpal instability nondissociative.

    Science.gov (United States)

    Wolfe, Scott W; Garcia-Elias, Marc; Kitay, Alison

    2012-09-01

    Carpal instability nondissociative (CIND) represents a spectrum of conditions characterized by kinematic dysfunction of the proximal carpal row, often associated with a clinical "clunk." CIND is manifested at the midcarpal and/or radiocarpal joints, and it is distinguished from carpal instability dissociative (CID) by the lack of disruption between bones within the same carpal row. There are four major subcategories of CIND: palmar, dorsal, combined, and adaptive. In palmar CIND, instability occurs across the entire proximal carpal row. When nonsurgical management fails, surgical options include arthroscopic thermal capsulorrhaphy, soft-tissue reconstruction, or limited radiocarpal or intercarpal fusions. In dorsal CIND, the capitate subluxates dorsally from its reduced resting position. Dorsal CIND usually responds to nonsurgical management; refractory cases respond to palmar ligament reefing and/or dorsal intercarpal capsulodesis. Combined CIND demonstrates signs of both palmar and dorsal CIND and can be treated with soft-tissue or bony procedures. In adaptive CIND, the volar carpal ligaments are slackened and are less capable of inducing the physiologic shift of the proximal carpal row from flexion into extension as the wrist ulnarly deviates. Treatment of choice is a corrective osteotomy to restore the normal volar tilt of the distal radius.

  1. [Fractures of carpal bones].

    Science.gov (United States)

    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  2. Síndrome do túnel do carpo: estudo comparativo entre a medição ultrassonográfica e cirúrgica do nervo mediano nos casos moderados e severos da doença Carpal tunnel syndrome: comparative study between sonographic and surgical measurements of the median nerve in moderate and severe cases of disease

    Directory of Open Access Journals (Sweden)

    Marcelo de Pinho Teixeira Alves

    2013-02-01

    Full Text Available OBJETIVO: Comparar os perímetros ultrassonográfico e cirúrgico do nervo mediano, avaliar o diagnóstico da síndrome do túnel do carpo pela área seccional do nervo mediano, verificar associação entre área seccional do nervo mediano e gravidade da síndrome do túnel do carpo. MATERIAIS E MÉTODOS: Estudo de 30 pacientes com síndrome do túnel do carpo. Mediram-se a área seccional e o perímetro ultrassonográfico do nervo mediano. Avaliaram-se correlação clínica-ultrassonográfica e associação com a gravidade da doença. Compararam-se os perímetros ultrassonográfico e cirúrgico. Compararam-se classificação clínica com perímetro cirúrgico, área seccional e perímetro ultrassonográfico. RESULTADOS: Cinco perdas, 25 pacientes estudados; 60% dos pacientes com doença moderada, 60% de casos graves ultrassonográficos (área seccional > 0,15 cm². Distribuição não normal de perímetro cirúrgico (p = 0,5, distribuição normal de perímetro ultrassonográfico (p = 0. Diferença significativa entre perímetros (teste-t de amostras pareadas; p 0,09 cm² em todos os pacientes. CONCLUSÃO: Não houve associação entre perímetro ultrassonográfico e perímetro cirúrgico do nervo mediano. Área seccional do nervo mediano > 0,09 cm² foi válida para o diagnóstico. Não houve associação entre área seccional e gravidade da doença.OBJECTIVE: To compare sonographic and surgical measured perimeters of the median nerve; to evaluate the diagnosis of carpal tunnel syndrome by median nerve cross-sectional area; to verify the association between cross-sectional area of the median nerve and carpal tunnel syndrome severity. MATERIALS AND METHODS: Thirty patients with established carpal tunnel syndrome were studied. Cross-sectional area and sonographic perimeter of the median nerve were measured. The correlation between clinical and sonographic findings and association with carpal tunnel syndrome severity were evaluated. Sonographic

  3. Symptomatic carpal coalition: scaphotrapezial joint.

    Science.gov (United States)

    Campaigniac, Erin; Eskander, Mark; Jones, Marci

    2013-12-01

    Carpal coalition is an uncommon congenital abnormality that arises from incomplete cavitation of the common cartilaginous precursor that forms the carpal bones. When carpal coalition is discovered, it is typically an asymptomatic incidental radiographic finding, and is often bilateral. We present a case of symptomatic unilateral carpal coalition of the scaphotrapezial joint, which was treated by excising the fibrous coalition and placing an interposition fat graft. This treatment was effective in alleviating the patient's symptoms.

  4. Three-dimensional stiffness of the carpal arch.

    Science.gov (United States)

    Gabra, Joseph N; Li, Zong-Ming

    2016-01-01

    The carpal arch of the wrist is formed by irregularly shaped carpal bones interconnected by numerous ligaments, resulting in complex structural mechanics. The purpose of this study was to determine the three-dimensional stiffness characteristics of the carpal arch using displacement perturbations. It was hypothesized that the carpal arch would exhibit an anisotropic stiffness behavior with principal directions that are oblique to the conventional anatomical axes. Eight (n=8) cadavers were used in this study. For each specimen, the hamate was fixed to a custom stationary apparatus. An instrumented robot arm applied three-dimensional displacement perturbations to the ridge of trapezium and corresponding reaction forces were collected. The displacement-force data were used to determine a three-dimensional stiffness matrix using least squares fitting. Eigendecomposition of the stiffness matrix was used to identify the magnitudes and directions of the principal stiffness components. The carpal arch structure exhibited anisotropic stiffness behaviors with a maximum principal stiffness of 16.4±4.6N/mm that was significantly larger than the other principal components of 3.1±0.9 and 2.6±0.5N/mm (pcarpal tunnel which is accounted for by the stiff transverse ligaments that tightly bind distal carpal arch. The minimal principal stiffness is attributed to the less constraining articulation between the trapezium and scaphoid. This study provides advanced characterization of the wrist׳s three-dimensional structural stiffness for improved insight into wrist biomechanics, stability, and function.

  5. A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF as a reference tool

    Directory of Open Access Journals (Sweden)

    Leite José

    2006-12-01

    Full Text Available Abstract Background A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS, however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF. Methods The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical treatment for CTS. The outcomes assessed in these trials were identified, classified and linked to the different domains of the ICF. Results Twenty-eight studies were retrieved which met the inclusion criteria. The most frequently assessed outcomes were self-reported symptom resolution, grip or pinch strength and return to work. The majority of outcome measures employed assessed impairment of body function and body structure and a small number of studies used measures of activity and participation. Conclusion The ICF provides a useful framework for identifying the concepts contained in outcome measures employed to date in trials of surgical intervention for CTS and may help in the selection of the most appropriate domains to be assessed, especially where studies are designed to capture the impact of the intervention at individual and societal level. Comparison of results from different studies and meta-analysis would be facilitated through the use of a core set of standardised outcome measures which cross all domains of the ICF. Further work on developing consensus on such a core set is needed.

  6. Clinnical effect observation of small incision in the treatment of carpal tunnel syndrome%小切口治疗腕管综合征临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    李洋; 王虎; 单臣

    2015-01-01

    目的:探讨小切口治疗腕管综合征的临床效果。方法从2011年7月~2014年7月吉林省人民医院收治掌部腕管综合征的患者中选取典型患者42例(45侧),采用掌部小切口切断腕横韧带的治疗方法,术后进行随访,使用GSS评分对术前以及术后6个月患者功能恢复情况进行评估。结果排除2例(3侧)患者术中发现腕管内囊肿,改为传统切口手术,其余40例(42侧)患者手术均获得了成功,并且在术后没有出现并发症。采用GSS评分标准对术前和术后6个月患者疼痛、麻木感、夜醒、肌力减退、手指末端神经异感及总分进行评估[(5.65±0.89)、(3.79±1.06)、(2.67±0.67)、(4.49±0.95)、(3.35±0.78)、(20.10±4.65)比(0.94±0.50)、(0.86±0.35)、(0.35±0.09)、(1.00±0.40)、(0.46±0.20)、(3.61±0.06)分],术后随访评估分数较术前明显减低,差异有统计学意义(P<0.05)。结论小切口法治疗腕管综合征是一种效安全的手术方法,其具有手术时间相对较短、预后疗效比较好、并发症较少等优点,值得在临床应用和推广。%Objective To discuss the clinical effect of small incision in the treatment of carpal tunnel syndrome. Methods From July 2011 to July 2014 in Jilin Province People' Hospital 42 patients (45 sides) with metacarpus carpal tunnel syndrome were selected. All patients were given small incision of wrist transverse ligament surgery and followed up for 6 months. Functional recovery was evaluated by GSS standard. Results 2 cases (3 sides) were found cyst in wrist, given traditional incision surgery instead. Surgery of the other 40 cases (42 sides) were successful, and no complication happened. The pain, feeling of numbness, night waking, muscle loss, the end of finger abnormal feeling, and total scores in GSS scores after surgery were lower than those before surgery [(5.65±0.89), (3.79±1.06), (2.67±0.67), (4.49±0.95), (3.35±0.78), (20.10±4.65) v s (0.94±0

  7. 针灸阳池穴对腕管综合征疗效的影响%Effects of acupuncture and moxibustion of Yangchi point on carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    丁乾; 沈芳

    2013-01-01

    目的 探讨针法与灸法并用对阳池穴治疗腕管综合征(carpal tunnel syndrome,CTS)的影响.方法 收集2011年8月至2012年8月保定市第二中心医院中医科门诊CTS患者38例,按病例尾号随机分为两组各19例.治疗组采用电针治疗,对照组采用灸法治疗,两组患者均治疗5次/周,治疗2周后观察疗效.治疗前后根据视觉模拟评分(VAS)和整体症状分数表(GSS)得分情况进行系统疗效评价.结果 治疗后两组VAS、GSS评分[治疗组分别为(3.95±1.87)分、(13.42±7.81)分;对照组分别为(4.26±2.38)分、(14.63±9.97)分]均较同组治疗前[治疗组分别为(6.89±1.56)分、(25.58±8.09)分;对照组分别为(5.79±1.69)分、(20.37±8.67)分]减少(P<0.05),且治疗组疗效优于对照组(t值分别为-3.06、-3.39,P< 0.05).治疗结束后3个月随访,两组患者VAS、GSS评分[治疗组分别为(3.29±2.31)分、(8.06±7.77)分;对照组分别为(3.28±2.95)分、(10.44±9.82)分]均较同组治疗前[治疗组分别为(6.76±1.56)分、(24.76±8.17)分;对照组分别为(5.78±1.73)分、(20.33±8.92)分]减少(P<0.05),但两组治疗后VAS评分比较,差异无统计学意义(t=-1.49,P>0.05); GSS评分治疗组优于对照组(t=-2.64,P<0.05).结论 针刺可改善CTS患者的疼痛感、麻木感及运动能力.%Objective To explore the difference of treating carpal tunnel syndrome (CTS) with needling Yangchi point and moxibustion on Yangchi point.Methods 38 cases of CTS were randomly recruited into a treatment group (19 cases) and a control group (19 cases).The treatment group was treated with electric acupuncture on Yangchi point and the control group was treated with moxibustion on Yangchi point.VAS (visual analogue scale) and GSS (overall symptom score table) scores were measured before and after the treatment.Results After the treatment VAS,GSS scores were (3.95± 1.87),(13.42±7.81) in the treatment group and (4.26±2.38),(14.63±9.97) in the control

  8. The causal consciousness beta-neurexin promotes neuromediator release via vibrational multidimensional tunneling

    CERN Document Server

    Georgiev, D D

    2002-01-01

    Epiphenomenalism is shown to be absurd because the development of consciousness must be explainable through natural selection. A detailed neuromolecular basis of the neuromediator release is given and it is stressed on the possible key point where the quantum consciousness could act, namely the detachment of the calcium sensor v-SNARE synaptotagmin. The beta-neurexin molecules are tuned by the quantum coherent microtubule network at the very end of the GEL phases, so that the beta-neurexin molecule thermal vibrations could promote or suppress conformational changes via vibrational multidimensional tunneling, which drives synaptotagmin detachment from the SNARE complex under calcium ion binding. Following the synaptotagmin detachment membrane fusion takes place in SNARE dependent fashion and the presynaptic vesicle spills neuromediator in the synaptic cleft. Thus the quantum computational output causally affects the neuromediator release. The proposed model is critically compared with the trigger model of exoc...

  9. 家族性双侧腕管综合征一家系分析并文献复习%Analysis of familial bilateral carpal tunnel syndrome in a family and literature review

    Institute of Scientific and Technical Information of China (English)

    郝以姝; 袁宝玉; 张志珺

    2016-01-01

    Objective To analyze features of clinical manifestation, electrophysiology, imageology and molecular ge⁃netics of familial carpal tunnel syndrome (FCTS), especially research progress in genetics. Methods Clinical data, labo⁃ratory and electrophysiologyical results as well as medical images were collected from the propositus. In addition, genetic analysis around peripheral neuropathy was performed on the proband, son of the proband and the affected relatives in the family. Result Patients showed a typical bilateral CTS with early onset. The mode of inheritance in this family was auto⁃somal dominant.. Gene sequencing revealed point mutations in INF2, KIF1B, TRPV4 and SCN9A. Besides, the possibili⁃ty of having hereditary neuropathy with liability to pressure palsy(HNPP)or familial amyloidosis (FAP) was excluded by the molecular genetic studies. Conclusion Primary FCTS exists as a separate autonomic entity, which may be caused by other unknown genes and therefore warrants further exploration.%目的:分析家族性腕管综合征的临床表现、电生理、影像学及分子遗传学特点,尤其是遗传学的研究进展。方法收集家族性腕管综合征一家系中先证者的临床资料、实验室结果、电生理和影像学资料,同时对先证者、先证者之子以及家系中其他患病成员围绕周围神经病行基因学检测。结果家系中患病者均早年即出现典型的双侧腕管综合征,呈常染色体显性遗传模式。通过基因检测排除了合并有遗传性压力易感性周围神经病和家族性淀粉样变性的可能,同时发现了INF2、KIF1B、TRPV4、SCN9A这4个基因存在点突变。结论原发性家族性腕管综合征可能为其他基因异常引起的一种独立的疾病,然而其致病基因是未知的,仍有待我们进一步探索。

  10. Carpal tunnel syndrome: age, nerve conduction severity and duration of symptomatology Síndrome do túnel do carpo: correlação de idade, anormalidade de condução nervosa e tempo de sintomatologia

    Directory of Open Access Journals (Sweden)

    JOAO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Median sensory and motor distal latencies (SDL/MDL were correlated with age and duration of symptomatology in 1498 carpal tunnel syndrome (CTS patients (17-90 years old, 87.6% female. Patients were distributed in four groups according to distal latencies severity. There was an increase in age as long as SDL/MDL became more severe, ranging from 47.5 to 67 years old (mild to severe-absence potentials in both hands groups, respectively. There was a less dramatic increase in duration of complaints as long as SDL/MDL became more severe, ranging from 12 to 30.7 months (mild to severe-absence potentials in both hands groups, respectively. Aging correlates more positively than duration of complaints with severity of SDL/MDL in CTS. The effects of increasing median blockage in CTS are more severe as long as patients become older regardless duration of symptomatology.Latências distais sensitivas e motoras (LDS/LDM do nervo mediano foram correlacionadas com idade e duração da sintomatologia em 1498 pacientes com síndrome do túnel do carpo (STC; a idade variou de 17 a 90 anos e 87,6% eram do sexo feminino. Os casos foram distribuídos em quatro grupos de acordo com a gravidade das latências distais. Houve aumento de idade proporcional ao aumento de LDS/LDM, variando de 47,5 a 67 anos nos grupos leve e grave-ausência de potenciais nas duas mãos, respectivamente. Houve aumento menos dramático na duração da sintomatologia proporcional ao aumento de LDS/LDM, variando de 12 a 30,7 meses nos grupos leve e grave-ausência de potenciais nas duas mãos, respectivamente. O aumento da idade correlaciona-se melhor que a duração da sintomatologia com o aumento de LDS/LDM. Os efeitos do aumento do bloqueio do nervo mediano no STC são mais graves com o avanço da idade, independentemente da duração da sintomatologia.

  11. Electrophysiological evaluation of ulnar nerve in carpal tunnel syndrome%腕管综合征患者尺神经功能的神经电生理评价

    Institute of Scientific and Technical Information of China (English)

    刘娜; 张哲成; 郑丽娜; 朱炬; 张静

    2013-01-01

    目的 应用神经电生理方法评价腕管综合征(carpal tunnel syndrome,CTS)患者尺神经功能状态及其与尺神经支配区域感觉症状有无相互关系.方法 选取2012年1月至2013年2月就诊于我院的CTS患者55例,根据Stevens标准分为轻中度组35例、重度组20例,进一步按症状发作时是否伴有小指区域感觉症状分有症状组和无症状组,选择健康志愿者20名作为对照,应用Keypoint.net(Medoc Ltd)肌电图仪进行正中神经、尺神经电生理检测.结果 CTS组与对照组相比较,尺神经指5-腕感觉传导速度(SCV)减慢[(51.71±2.93) m/s与(58.62±3.21) m/s,t=8.80,P<0.01]、感觉神经动作电位(SNAP)波幅差异无统计学意义.Pearson相关性分析提示尺神经指5-腕SCV、SNAP波幅与正中神经末端运动潜伏期呈负相关,与正中神经复合肌肉动作电位波幅、指1-腕、指3-腕SCV、SNAP波幅呈正相关.轻中度组中与无症状组相比,有症状组尺神经指5-腕SCV减慢、SNAP波幅减低[(51.59±2.70) m/s与(53.72±2.58) m/s;(13.51±1.84) μV与(15.21 ±2.16)μV,t=2.24、2.30,均P<0.05],而重度组中只有2例出现小指区域感觉症状.结论 CTS患者存在尺神经腕部卡压性损害,随疾病进展加重;尺神经支配区感觉症状多发生于轻中度组CTS患者且可能与尺神经受累有关.%Objective To evaluate the impairment of ulnar nerve and its relationship with sensory symptoms in the ulnar territory in patients with carpal tunnel syndrome (CTS) through electrophysiological approach.Methods We retrospectively reviewed 55 cases with CTS admitted in our hospital from January 2012 to February 2013.Patients with CTS were graded as mild-moderate (35 cases) and severe (20 cases) according to Stevens standard and were divided into symptomatic and non-symptomatic group according to the presence of sensory symptom in little finger region.Twenty healthy volunteers were included as control.Median and ulnar nerves

  12. Effect of Median Nerve Compression Test on the Nerve Conduction Speed in Carpal Tunnel Syndrome%正中神经压迫试验对腕管综合征神经传导速度的影响

    Institute of Scientific and Technical Information of China (English)

    许惊飞; 王劲松; 何成奇

    2011-01-01

    目的 比较正中神经压迫试验对腕管综合征(carpal tunnel syndrome,CTS)患者正中神经传导速度的影响.方法 设置CTS组和对照组两个组别,共29例受试者纳入研究.CTS组为14例CTS患者,对照组为15例健康受试者.神经传导速度测定包括正中神经和尺神经的感觉传导末端潜伏期(distal sensory latency,DSL)、感觉神经动作电位(sensory nerve action potential,SNAP)、跨腕关节感觉传导速度(sensory conduction velocity,SCV)、运动传导末端潜伏期(distal motor latency,DML)及复合肌肉动作电位(compound muscle action potential,CMAP).先测感觉传导,再测运动传导.正中神经压迫试验5 min后再次测量上述指标.结果 正中神经压迫试验前后电生理检查考虑诊断CTS分别为22侧和24侧.压迫正中神经后,CTS组正中神经DSL较压迫前显著延长(P<0.05).CTS组尺神经和对照组正中神经及尺神经的各参数在压迫前后均无显著改变(P>0.05).与对照组相比,在压迫试验前后CTS组的正中神经DSL和DML均明显延长(P<0.05),尺神经DSL和DML均无显著改变(P>0.05).结论 正中神经压迫试验5 min能使CTS患者正中神经的感觉传导末端潜伏时明显延长,有助于提高神经传导测定对早期CTS的诊断率.%Objective To determine the effect of median nerve compression on median nerve conduction speed in patients with carpal tunnel syndrome (CTS). Methods In this case-control study, 29 subjects were enrolled. CTS group included 14 patients (22 hands) with CTS confirmed by electrodiagnostic studies, while the control group included 15 healthy subjects (30 hands). The across wrist nerve conduction of median and ulnar nerve was measured when the wrist was in neutral position. Measured parameters included distal sensory latency (DSL), sensory nerve action potential (SNAP), sensory conduction velocity (SCV), distal motor latency (DML) and compound muscle action potential (CMAP). Sensory nerve

  13. Experimental and numerical investigation of the emergency helium release into the LHC tunnel

    Science.gov (United States)

    Malecha, Ziemowit M.; Jedrusyna, Artur; Grabowski, Maciej; Chorowski, Maciej; van Weelderen, Rob

    2016-12-01

    An unexpected ejection of cryogen into large confined spaces can result in hazardous consequences. This paper presents the experimental results of the controlled release of liquid helium into the LHC tunnel at CERN. The experiment was designed to measure the oxygen concentration, temperature, and propagation of the helium-air mixture cloud in the LHC tunnel. This required the usage of novel, in-house manufactured, ultrasonic helium detectors. The experimental results showed an advantage of the ultrasonic sensors over traditional electrochemical sensors. Next, a minimal mathematical model was presented and implemented numerically. The experimental results contributed to the validation of the numerical model. A number of numerical calculations were performed in order to examine the consequences of a helium spill with different mass flows. This assisted in the evaluation of the critical helium mass flow, above which the oxygen concentration could drop below the safety limit. A satisfactory comparison of the experimental results and numerical calculations showed the accuracy of the assumptions of the proposed mathematical model.

  14. Carpal tunnel syndrome: treatment with small transverse incision Utilização de técnica de incisão transversal mínima no tratamento da síndrome do túnel do carpo

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    Paulo Roland Kaleff

    2010-02-01

    Full Text Available OBJECTIVE: To evaluate the application of a limited transverse incision technique to treat the carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the flexor retinaculum (FR. METHOD: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively. RESULTS: No major complications were observed. Two cases presented small local hematoma. One patient presented with transient neuropraxia of digital branch. In two of the first five cases, incomplete FR opening was identified during endoscopic revision with need of complementary opening. All patients reported relief of paresthesias and nocturnal pain symptoms. CONCLUSION: The technique was safely performed on the prospection group, no major complications were detected and the opening of FR was observed in the majority of the patients.OBJETIVO: Avaliação de técnica de incisão limitada no tratamento da síndrome do túnel do carpo, quanto à segurança clínica e efetividade na abertura do Retináculo Flexor (RF. MÉTODO: Estudo prospectivo de trinta procedimentos realizados em vinte e oito pacientes submetidos a técnica com incisão transversa mínima. A segurança da técnica e a abertura total do RF foram avaliadas através de questionário baseado em observações clinicas e inspeção endoscópica, respectivamente. RESULTADOS: Não foram observadas complicações maiores. Um único paciente apresentou neuropraxia de nervo interdigital. Dois pacientes apresentaram hematoma local pequeno. Em dois dos cinco primeiros casos observou-se uma abertura incompleta do RF, sendo necessária abertura complementar. Todos os pacientes apresentaram melhora do quadro clínico de dor noturna e parestesias. CONCLUSÃO: A técnica foi executada com segurança no grupo analisado, sem a ocorrência de

  15. The Binding And Release of Oxygen And Hydrogen Peroxide are Directed 1 By a Hydrophobic Tunnel in Cholesterol Oxidase

    Energy Technology Data Exchange (ETDEWEB)

    Chen, L.; Lyubimov, A.Y.; Brammer, L.; Vrielink, A.; Sampson, N.S.

    2009-05-12

    The usage by enzymes of specific binding pathways for gaseous substrates or products is debated. The crystal structure of the redox enzyme cholesterol oxidase, determined at sub-angstrom resolution, revealed a hydrophobic tunnel that may serve as a binding pathway for oxygen and hydrogen peroxide. This tunnel is formed by a cascade of conformational rearrangements and connects the active site with the exterior surface of the protein. To elucidate the relationship between this tunnel and gas binding and release, three mutant enzymes were constructed to block the tunnel or its putative gate. Mutation of the proposed gating residue Asn485 to Asp or tunnel residue Phe359 or Gly347 to Trp or Asn reduces the catalytic efficiency of oxidation. The K mO 2 increases from 300 +/- 35 microM for the wild-type enzyme to 617 +/- 15 microM for the F359W mutant. The k cat for the F359W mutant-catalyzed reaction decreases 13-fold relative to that of the wild-type-catalyzed reaction. The N485D and G347N mutants could not be saturated with oxygen. Transfer of hydride from the sterol to the flavin prosthetic group is no longer rate-limiting for these tunnel mutants. The steady-state kinetics of both wild-type and tunnel mutant enzymes are consistent with formation of a ternary complex of steroid and oxygen during catalysis. Furthermore, kinetic cooperativity with respect to molecular oxygen is observed with the tunnel mutants, but not with the wild-type enzyme. A rate-limiting conformational change for binding and release of oxygen and hydrogen peroxide, respectively, is consistent with the cooperative kinetics. In the atomic-resolution structure of F359W, the indole ring of the tryptophan completely fills the tunnel and is observed in only a single conformation. The size of the indole is proposed to limit conformational rearrangement of residue 359 that leads to tunnel opening in the wild-type enzyme. Overall, these results substantiate the functional importance of the tunnel for

  16. Comparative study between endoscopic technique by a proximal port and mini palmary incision in the surgical treatment of carpal tunnel syndrome Estudo comparativo entre a técnica endoscópica pelo portal proximal e a técnica de mini-incisão palmar no tratamento cirúrgico da síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Eduardo A.R. Pereira

    2003-01-01

    Full Text Available The authors present a prospective study comparing two surgical techniques for carpal tunnel release. A minimal - incision open decompression(3 is compared with an endoscopic release(2, that utilizes only a single proximal portal. There were operated on, 28 wrists in 28 patients, with clinical signs and EMG changes consistent on idiopathic carpal tunnel syndrome, that failed under previous conservative treatment. They were randomized into two groups , undertaken surgical treatment, either by endoscopic release or by open decompression. Grip strength (measured by dynamometric, sensitivity (measured by Semmes-Weinstein monofilaments, presence of pain and paresthesia, date of return to activities of daily living and complications were evaluated pre-operative and at 1, 2, 4, 6, 12 weeks after surgery. After 12 months average follow up, the results indicated that this proximal portal endoscopic technique can be safely performed, showing advantages over open conventional method, in terms of sooner return of grip strength, date of return to activities of daily living, and less incidence of pillar pain. No differences in paresthesia resolution, sensibility improvement or complications incidence were found.Os autores apresentam estudo prospectivo onde comparam duas técnicas cirúrgicas empregadas no tratamento de pacientes acometidos pela síndrome do túnel do carpo. A técnica de descompressão por via aberta, através de mini-incisão palmar(3, é analisada em relação à técnica por via endoscópica, descrita por Agee et al.(2, que utiliza apenas um único portal proximal. Foram operados, de forma randomizada, 28 punhos em 28 pacientes com o diagnóstico clínico e eletromiográfico de síndrome do túnel do carpo idiopático, e que não obtiveram melhora com o tratamento conservador prévio. Os seguintes parâmetros, foram analisados no pré-operatório e na primeira, segunda, quarta, sexta e décima segunda semanas de pós-operatório: força de

  17. 腕管综合征与尺神经腕部卡压相关性的神经电生理学分析%Electrophysiological analysis of relationship between carpal tunnel syndrome and ulnar nerve entrapment at wrist

    Institute of Scientific and Technical Information of China (English)

    刘晓琳; 殷文靖; 盛加根

    2011-01-01

    Objective To investigate the relationship between carpal tunnel syndrome (CTS) and ulnar nerve entrapment at wrist with neural eleetrophysiological methods. Methods Twenty patients ( 22 wrists) with CTS ( CTS group) and 20 healthy adults (20 wrists) (control group) were selected. Sensory conduction velocity, motor conduction velocity, distal sensory latency and distal motor latency of median nerve and ulnar nerve were measured and compared between two groups, and the differences in distal sensory latency between median nerve and ulnar nerve were calculated and compared between groups. Pearson correlation analysis was performed between sensory conduction velocity of median nerve and that of ulnar nerve in CTS group. Results Compared with control group, the sensory conduction velocity and motor conduction velocity of median nerve and the sensory conduction velocity of ulnar nerve were slower ( P 0.05). The difference in distal sensory latency between median nerve and ulnar nerve in CTS group was significantly larger than that in control group ( P < 0.05). Pearson correlation analysis revealed that the sensory conduction velocity of median nerve was significantly positively related to that of ulnar nerve in CTS group (r = 0. 802, P = 0.002). Conclusion There is correlation between CTS and ulnar nerve entrapment at wrist, and ulnar nerve entrapment at wrist should be attached great importance when dealing with patients with CTS.%目的 采用神经电生理学方法探讨腕管综合征(CTS)与尺神经腕部卡压的相关性.方法 选择20例(22腕)CTS患者(CTS组)和20名(20腕)健康成年志愿者(对照组),测量并比较两组正中神经和尺神经感觉传导速度、运动传导速度、感觉远端潜伏期和运动远端潜伏期,计算并比较正中神经与尺神经感觉远端潜伏期差值,对CTS组正中神经与尺神经感觉传导速度行Pearson相关分析.结果 与对照组比较,CTS组正中神经感觉和运动传导速度及尺神经

  18. Correlation study of electroneurophysiology and high frequency ultrasonic of carpal tunnel syndrome%腕管综合征高频超声检测所见与电生理检查结果相关性研究

    Institute of Scientific and Technical Information of China (English)

    曹洪弘; 王战业; 陈勇

    2016-01-01

    目的:探讨腕管综合征(CTS)患者高频超声检查正中神经结构改变与电生理结果的相关性,以作拟定临床治疗的参考。方法:对上肢麻木患者进行电生理检查,诊断为CTS后再进行高频彩超检查,重点测定受压正中神经最细处、最粗处的前后径,并计算最细处与最粗处之比。电生理主要检查正中神经运动传导末端潜伏期、波幅及感觉传导速度(SCV )及波幅,对超声检查结果及电生理结果进行相关性分析。结果:SCV与直径的 Pearson相关性为0.850,呈高度相关性;运动末端潜伏期与直径的Pearson相关性为0.419,呈中度相关性;感觉传导波幅与超声所测直径的 Pearson相关性为0.220,为弱相关性;运动传导波幅与超声所测直径的 Pearson相关性为0.256,为极弱相关或无相关性;所有电生理数据与神经细粗比的 Pearson数据均低于0.2,为极弱相关或无相关性。结论:正中神经SCV与最细处直径呈高度负相关,运动末端潜伏期与最细处直径呈中度负相关,与正中神经解剖改变有关。%Objective:To explore the correlation between the change of median nerve structure of carpal tunnel syndrome(CTS) and electrophysiology results ,and to direct its clinical treatment .Methods:After given clinical and electrophysiological diagnosis of CTS ,patients with upper limb underwent high frequent ultrasonic examination ,with ultrasonic focus on determination of the anteroposterior diameter , both in the thinnest and thickest places of median nerves under compression ,and then the ratio of data was analyzed .Electrophysiological measures focused on the distal motor latency of median nerves and sen‐sory conduction velocity and the amplitude .The relativity of the data was analyzed .Results:The sensory nerve conduction velocity and diameter were highly correlated(P=0 .850);distal motor latency and diam‐eter were moderately

  19. Síndrome do túnel do carpo: aspectos clínico-epidemiológicos em 668 casos Carpal tunnel syndrome: clinical and epidemiological studies in 668 cases

    Directory of Open Access Journals (Sweden)

    JOÃO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Foram estudados 668 pacientes (1059 mãos com síndrome do túnel do carpo entre janeiro de 1989 e junho de 1996. O critério de seleção e inclusão dos pacientes baseou-se na diferença de latência sensitiva > ou = 1,0 ms entre os potenciais de ação sensitivos dos nervos mediano e radial após estimulação no punho e registro no I dedo (diferença mediano-radial, DMR, representando diferença maior que 6 desvios-padrão (DP. Foi obtida DMR em 125 mãos normais (grupo controle com limite superior de normalidade de 0,43 ms (média + 2 DP. Todos os casos tiveram estudo eletrofisiológico bilateral, sendo excluídos casos com cirurgia prévia ou evidência de neuropatia periférica. A idade variou de 17 a 83 anos com média de 47,5 anos; 91,3% eram do sexo feminino; 72% referiam sintomatologia bilateral e 85,3% no período noturno/matinal. Dor, dormência e formigamento foram conjuntamente referidos por 64,4%, sendo que dor como sintoma isolado foi raro; além da mão, houve extensão do quadro álgico para outros territórios em 39,4%. Os sintomas ocorreram em todos dos dedos em 42,5% seguido do III, III-IV, I-II-III e II-III-IV dedos. Não houve correlação precisa com antecedentes traumáticos no punho. A duração da sintomatologia foi ampla, variando de 1 a >120 meses. A doença mais comumente referida pelos pacientes foi diabetes mellitus com 4,4% do total.Between January/1989 and June/1996, 1 059 carpal tunnel syndrome hands (CTS from 668 patients were studied. None had been previously operated and all had bilateral conduction studies; peripheral neuropathy was excluded. The patients were selected with sensory median/radial difference (MRD > or = 1.0 ms that strongly supports electrodiagnosis of CTS (standard deviation >6 after stimulation on wrist and recording on thumb. Normal MRD were obtained in 125 hands with upper limit of normality = 0,43 ms (mean + 2 SD. The age ranged from 17 to 83 years (mean 47.5 and 91.3% were female; the

  20. Carpal tunnel syndrome in the elderly: nerve conduction parameters Síndrome do túnel do carpo em idosos: parâmetros de condução nervosa

    Directory of Open Access Journals (Sweden)

    Thiago Guimarães Naves

    2010-02-01

    Full Text Available OBJECTIVE: To establish nerve conduction parameters for carpal tunnel syndrome (CTS electrodiagnosis in the elderly. METHOD: Thirty healthy subjects (65-86 years, 9 male and 21 female, were studied. Routine median and ulnar sensory and motor nerve conduction studies, median mixed palmar latency, comparative latency techniques median to ulnar (sensory, mixed and motor lumbrical-interossei, median to radial (sensory, and combined sensory index (CSI were performed in both hands. RESULTS: The upper limits of normality (97.5% were: median sensory distal latency 3.80 ms (14 cm; median motor distal latency 4.30 ms (8 cm; median palmar latency 2.45 ms (8 cm; lumbrical-interossei latency difference 0.60 ms (8 cm; comparative median to radial 0.95 ms (10 cm; comparative median to ulnar 0.95 ms (14 cm; comparative palmar median to ulnar 0.50 ms (8 cm; and CSI 2.20 ms. Sensory and mixed latencies were measured at peak. CONCLUSION: Our results establish new nerve conduction parameters for mild CTS electrodiagnosis in the elderly and will be helpful to reduce the number of false positive cases in this age.OBJETIVO: Estabelecer parâmetros de condução nervosa para o eletrodiagnóstico da síndrome do túnel do carpo (STC em idosos. MÉTODO: Foram estudadas 30 pessoas idosas (65-86 anos saudáveis. Foi realizado estudo de condução nervosa sensitiva e motora rotineira dos nervos mediano e ulnar, latência palmar mista do mediano, técnicas de comparação de latências mediano-ulnar (sensitivo, misto e motor lumbrical-interósseo e mediano-radial (sensitivo e índice sensitivo combinado (ISC em ambas as mãos. RESULTADOS: Os limites superiores de normalidade, 97,5% foram: latência distal sensitiva do mediano 3,80 ms (14 cm; latência distal motora do mediano 4,30 ms (8 cm, latência palmar do mediano 2,45 ms (8 cm, diferença de latência lumbrical-interósseo 0,60 ms (8 cm, comparação mediano-radial 0,95 ms (10 cm, comparação mediano-ulnar 0,95 ms (14

  1. Carpal tunnel syndrome and manual milking: nerve conduction studies in 43 cases Síndrome do túnel do carpo e ordenha: estudo de condução nervosa em 43 casos

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    João Aris Kouyoumdjian

    2006-09-01

    Full Text Available From 1989 to 2004, 3125 consecutive patients had electrodiagnosis of carpal tunnel syndrome (CTS; from these 43 cases (1.38% were associated to manual milking; mean age was 44.9 years and 88.4% were male. The mean time in the milking profession was 247 months; the mean daily milking time was 146 minutes; symptoms referred at electrodiagnostic consultation had lasted on average 34 months, 83% were bilateral. The median sensory nerve conduction study was abnormal in 75.6% to the right and 66.7% to the left hand. The median nerve motor distal latency (MDL was abnormal in 92.1% to the right and in 80.0% to the left hand. There were no differences between right and left for all electrophysiological parameters. In CTS related to manual milking most cases were men, with the MDL more affected than the sensory distal latencies and the electrophysiological abnormalities were found to be symmetric. Manual milking could be a natural model for occupational CTS. In contrast to idiopathic CTS, there was a greater involvement of motor fascicles; this finding is remarkable for CTS.No período de 1989 a 2004 foram diagnosticados por meio de eletroneuromiografia 3125 casos consecutivos de Síndrome do túnel do carpo (STC e destes, 43 (1,38% estavam associados com ordenha; a média de idade foi 44,9 anos e 88,4% eram do sexo masculino. O tempo médio de atividade profissional era 247 meses; o tempo médio de ordenha diária era 146 minutos; a sintomatologia referida na consulta eletrodiagnóstica tinha em média 34 meses de duração e 83% a referiam bilateralmente. O estudo da condução senstiva do nervo mediano estava anormal em 75,6% na mão direita e em 66,7% da mão esquerda. A latência distal motora (LDM do nervo mediano estava anormal em 92,1% à direita e em 80% à esquerda. Não havia diferença significante dos parâmetros eletrofisiológicos entre os lados direito e esquerdo. Na STC associada a ordenha, a maioria dos casos é de homens, a LDM est

  2. Carpal tunnel syndrome: long-term nerve conduction studies in 261 hands Síndrome do tunel do carpo: estudo evolutivo de parâmetros de condução nervoso em 261 mãos

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    Dante Guilherme Velasco Hardoim

    2009-03-01

    Full Text Available OBJECTIVE: To compare a long-term carpal tunnel syndrome (CTS on nerve conduction studies (NCS in hands treated non-surgically. METHOD: We retrospectively selected 261 symptomatic CTS hands (166 patients, all of them confirmed by NCS. In all cases, at least 2 NCS were performed in an interval greater than 12 months. Cases with associated polyneuropathy were excluded. NCS parameters for CTS electrodiagnosis included a sensory conduction velocity (SCV 4.25 ms (wrist to APB, 8 cm. RESULTS: 92.8% were women; mean age was 49 years (20-76; the mean interval between NCS was 47 months (12-150. In the first exam, the median sensory nerve action potential (SNAP and the compound action muscular potential were absent in 9.8% and 1.9%, respectively. In the second/last exam, SCV worsened in 54.2%, remained unchanged in 11.6% and improved in 34.2%. SNAP amplitude worsened in 57.7%, remained unchanged in 13.1% and improved in 29.2%. DML worsened in 52.9%, remained unchanged in 7.6% and improved in 39.5%. Overall, NCS parameters worsened in 54.9%, improved in 34.3% and remained unchanged in 10.8%. CONCLUSION: Long-term changing in NCS of CTS hands apparently were not related to clinical symptomatology and could lead to some difficulty in clinical correlation and prognosis. Aging, male gender and absent SNAP were more related to NCS worsening, regardless the mean interval time between the NCS.OBJETIVO: Comparar evolutivamente parâmetros de condução nervosa (CN na síndrome do túnel do carpo (STC em mãos não submetidas à cirurgia. MÉTODO: Foram selecionadas retrospectivamente 261 mãos (166 pacientes com STC sintomática confirmadas por CN e que posteriormente realizaram exame controle com intervalo >12 meses; foram excluídos casos com polineuropatia. Os parâmetros eletrodiagnósticos anormais foram: velocidade de condução sensitiva (VCS 4,25 ms, segmento pulso-APB (8 cm. RESULTADOS: 92,8% eram mulheres; a média de idade foi 49 anos (20-76; o tempo m

  3. Carpal tunnel syndrome with cervical spondylotic radiculopathy:a clinical and electrophysiological study%腕管综合征合并神经根型颈椎病的临床与电生理特点

    Institute of Scientific and Technical Information of China (English)

    汪仁斌; 刘尊敬; 汪伟; 董明睿; 孙少杰; 毛坤; 焦劲松; 严莉

    2015-01-01

    Objective To study the clinical and electrophysiological characteristics of carpal tunnel syndrome (CTS) with cervical spondylotic radiculopathy (CSR) and simple-CTS,and compare the effect of double crush with that of simple entrapment on a nerve and investigate the association between CTS and CSR.Method From January 2011 to August 2014,clinical data from 96 patients with double crush syndrome (DCS,CTS with CSR) and 165 patients with simple-CTS were examined,and the electrophysiologic parameters of median nerve in patients with DCS were compared with that in patients with simple-CTS.Results In 96 patients with DCS,most of them were female;neck and shoulder pain or simultaneously accompanied by numbness and pain of upper limb was observed in 34 patients,upper limb symptoms and hand weakness and muscle atrophy were observed in the other 62 patients,124 median nerves with abnormal conduction were found in these DCS patients,including 68 cases with unilateral abnormalities and 28 cases with bilateral abnormalities.Cervical radiculopathies of the C5-7 mainly involved in patients with DCS.223 median nerves with abnormal conduction found in the 165 patients with simple-CTS,including 107 cases with unilateral abnormalities and 58 cases with bilateral abnormalities.The average sensory nerve conduction velocity (SCV),motor nerve conduction velocity (MCV) and distal motor latency (DML) of median nerve for DCS and simple-CTS were(32 ±7) m/s vs (35 ±5) m/s,(55 ±7) m/s vs (57 ±5) m/s and (4.6 ± 1.6) ms vs (4.0 ± 0.8) ms,respectively,and their corresponding amplitudes were 6.4 μV vs 9.5 μV,10.9 mV vs 13.1 mV and 11.3 mV vs 14.1 mV,respectively.The SCV,MCV and DML and their corresponding amplitude of DCS were significantly greater decreased than that of simple-CTS (P < 0.01).Conclusion DCS is a common clinical syndrome,and patients with DCS may have neck and shoulder symptoms in addition to the common manifestations of simple-CTS.Abnormal conduction of median nerve of

  4. Clinical and electrophysiological evaluation of nocturnal splinting on carpal tunnel syndrome%腕管综合征夜间夹板治疗的临床和电生理评估

    Institute of Scientific and Technical Information of China (English)

    翁超; 初红; 彭彬; 柯应兵; 王文华; 董红娟; 卢祖能

    2010-01-01

    Objective To assess the effectiveness of nocturnal splinting on carpal tunnel syndrome (CTS) by clinical scores and nerve conduction studies (NCS), and explore their correlations.Methods Forty-one patients (64 wrists), chosen from 66 consecutive patients with CTS from April 2009 to January 2010 meeting the inclusion criteria, were enrolled. The enrolled subjects were clinically evaluated by symptom severity scale (SSS) and functional status scale (FSS), and electrophysiologically evaluated by conventional nerve conduction studies (NCS); distal motor latency (DML) of wrist-abductor pollicis brevis, sensory conduction velocity (SCV) of wrist-index finger and wrist-ring finger, and the differences of distal sensory latency between the median and ulnar nerves (△DSL) were measured. The patients were instructed to use each splint on dorsal and palmar surface of the hand, centered at the distal wrist crease, to fix the wrist in neutral posture at bedtime. SSS, FSS and NCS were evaluated before splinting and (3.03±1.16) months after splinting; the follow-up was completed in 29 patients (31 wrists).Results (1) The abnormality rates of DML, wrist-index finger SCV, wrist-ring finger SCV and△DSL were 85.9%, 78.1%, 81.3% and 96.9%, respectively. (2) The SSS scores (1.55±0.38), FSS scores (1.40±0.27) and△DSL (1.24±0.61) after splinting was significantly decreased as compared with those before splinting (1.77±0.38, 1.53±0.31, 0.97±0.60); and the DML [4.14±0.76 (ms)] after splinting was significantly shortened as compared with that before splinting [4.53±1.25 (ms)]. No improvement of clinical scores was noted in 9 patients (14 wrists, 45.8%) after splinting. (3) The SSS scores were less significantly correlated to DML (r=0.420, P=0.019), wrist-index finger SCV (r=-0.425, P=0.017),wrist-ring finger SCV (r=-0.519, P=0.003), and no correlation between SSS scores and△DSL was noted (r=0.189, P=0.309); no correlation between FSS scores and the parameters of NCS was

  5. Long-term outcomes of symptomatic electrodiagnosed carpal tunnel syndrome Síndrome do túnel do carpo: avaliação evolutiva de longo prazo após confirmação eletrodiagnóstica

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    Joao Aris Kouyoumdjian

    2003-06-01

    Full Text Available This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up. Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient to 4 (severe after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69%. Patient's satisfaction after surgical and non-surgical were respectively, 77.6% and 16% ("cure", 13.6% and 52% (much improved, 5.4% and 9.3% (little improved, 2.7% and 16% (unchanged, 0.7% and 6.7% (worsed. The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value O presente estudo tem por objetivo avaliar a terapia utilizada e o grau de satisfação dos pacientes que tiveram diagnóstico eletrofisiológico de síndrome do túnel do carpo (STC entre 1989 e 1994 (528 casos; foram respondidas 184 cartas entre 528 enviadas (34,8% sendo utilizadas 165. A gravidade do STC foi classificada de 0 a 4 de acordo com uma combinação de valores de latência distal sensitiva e amplitude do potencial de ação muscular composto do nervo mediano e diferença de latência sensitiva mediano/radial. As questões foram relativas a sintomatologia atual e terapêutica utilizada, cirúrgica ou conservadora. As respostas foram correlacionadas ao estudo de condução nervosa inicial, idade e tempo de sintomatologia. Os pacientes submetidos a cirurgia somaram 69% (114 casos. O benefício cirúrgico e não cirúrgico foi respectivamente de 77,6% e 16

  6. Electromyography and Ultrasound Application in Diabetic Patients Diagnosis of Carpal Tunnel Syn-drome%神经肌电图和超声检查在合并糖尿病的腕管综合征诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    王亚薇; 袁宇; 闫旭

    2015-01-01

    Objective To discuss the value of electrophysiology diagnosis on diabetic patients with carpal tunnel syndrome. Methods Twenty-five cases of diabetic patients (experimental group) and 10 healthy subjects (control group) were reviewed. Electromy-ography equipment was used to measure the nerve conduction velocities of all subjects and then the velocities were compared. Results The differences of median nerve distal motor latency, (5.01 ± 1.37) ms、(3.15 ± 0.55) ms, the sensory conduction velocities of finger 1-wrist (45.56±8.69) m/s、(57.90±2.47)m/s, finger3-wrist (42.03± 11.59) m/s、(58.20 ± 3.08) m/s and the ring finger LAT differences of median nerve and ulnar nerve (1.50 ± 1.50) ms、(0.12 ± 0.06) ms were statistically significant(P0.05). Using ultrasound examination to observe the median nerve cross-sectional area of the experimental group patients showed the positive rate of carpal tunnel syndrome was 77%. Conclusion By electrophysiological examination carpal tunnel syndrome of diabetic patients can be discovered earlier, with combination of ultrasound the presence and severity of compression can be displayed better, thus to implement accurate treatment for better results.%目的:探讨电生理检查对糖尿病患者的腕管综合征的诊断价值.方法:选取糖尿病患者25例(实验组)及10例健康体检者(对照组),采用神经肌电图仪器测定所有受试者神经传导速度并进行比较.结果:两组正中神经运动传导末端潜伏期(5.01±1.37)ms、(3.15±0.55)ms、指1-腕感觉神经传导速度(45.56±8.69)m/s、(57.90±2.47)m/s、指3-腕感觉神经传导速度(42.03±11.59)m/s、(58.20±3.08)m/s及环指正中/尺神经感觉传导潜伏期差值(1.50±1.50)ms、(0.12±0.06)ms,差异具有统计学意义(P0.05),应用超声检查观察实验中患者正中神经横截面积,诊断腕管综合征阳性率为77%.结论:通过电生理检查,可以早期发现糖尿病患者的腕管综合征,结合超声检查更好

  7. 手术治疗在腕关节骨折脱位并发腕管综合征的临床体会%Surgery in The Rist Fracture Dislocation Complicated by The Clinical Experience of The Carpal Tunnel Syndrome

    Institute of Scientific and Technical Information of China (English)

    杨永明; 袁伟东; 田跃

    2012-01-01

    Objective:Observation of surgery in the wrist fracture dislocation complicated by carpal tunnel syndrome, the clinical efficacy and summarize its clinical value.Methods:From January 2009 to January 2011, 49 cases of wrist fracture dislocation complicated by carpal tunnel syndrome patients, divided into 31 cases of non-surgical treatment group and surgical group of 25 cases, the observed treatment effects were compared for statistical analysis. Results: Non-surgical treatment group were excellent in 12 cases, good in 9 cases, are not satisfied with seven cases of failure of three cases, the total efficiency of 67.7%; surgical treatment were excellent in 10 cases, good in 12 cases, are not satisfied with three cases, no failures, the total efficiency of 88.0%, the two groups significantly different (P<0.05), with statistical significance.Conclusion:Surgical treatment of wrist fracture dislocation complicated by significant clinical effect of carpal tunnel syndrome, especially suitable for the primary injury of the median nerve to repair the ligaments of the wrist, for the complications of postoperative thumb on the palm dysfunction occurs, should actively take II of thumb is to promote palm functional reconstruction of the median nerve functional recovery and reduce complications appear.%目的:观察探讨手术治疗在腕关节骨折脱位并发腕管综合征的临床疗效,总结其临床价值.方法:选取我院2009年1月至2011年1月49例腕关节骨折脱位并发腕管综合征的患者,分为非手术治疗组31例和手术治疗组25例,观察比较两组治疗效果,进行统计学分析.结果:非手术治疗组优12例,良9例,不满意7例,失败3例,总有效率67.7%;手术治疗组优10例,良12例,不满意3例,无失败案例,总有效率88.0%,两组疗效比较差异显著(P<0.05),具有统计学意义.结论:手术治疗在腕关节骨折脱位并发腕管综合征的临床疗效显著,尤其适用于正中神经的原发伤,修复腕关节

  8. Correlation between MRI, clinical findings and electrophysiological investigation for diagnosis of idiopathic carpal tunnel syndrome%特发性腕管综合征的MRI、临床表现及电生理检测的相关性研究

    Institute of Scientific and Technical Information of China (English)

    姜璐璐; 高佩虹; 于继徐; 车峰远

    2012-01-01

    目的 探讨MRI、临床表现及电生理检测对特发性腕管综合征病情程度的诊断价值.方法 对30名特发性腕管综合征患者进行临床、电生理检测及腕部磁共振成像,所得参数之间进行相关性检验.结果 除豌豆骨水平正中神经面积外,其它MRI参数、临床表现、电生理检测参数之间无相关性.豌豆骨水平正中神经面积与两点辨别觉呈正相关(P<0.01),与感觉潜伏时呈正相关(P<0.05),与感觉传导速度(sensory conduction velocity,SCV)呈负相关(P<0.05).结论 经腕MRI测量的豌豆骨水平正中神经面积,是评估病情程度的一个敏感指标.%Objective To explore MRI,clinical evaluation and electrophysiological investigation in diagnostic value about the severity of idiopathic carpal tunnel syndrome. Methods Thirty patients with idiopathic carpal tunnel syndrome were assessed by MRI,clinical evaluation and electrophysiological investigation. Correlation tests were used to determine the relationships between all the measured parameters. Results With exception of median nerve area at pisiform level, there was not correlation between MRI parameters and findings obtained by clinical assessments and electrophysiological measurements. Crosssectional area of median nerve at pisiform level correlated positively with twopoint discrimination ( P < 0. 01), sensory latency { P < 0. 05 ) and negatively with sensory nerve conduction velocity( P < 0.05). Conclusion The area of median nerve measured by wrist magnetic resonance at pisiform level was a sensitive indicator to valuale the disese.

  9. The therapeutic effect of ultrashort wave and acoustic frequency electricity on the early carpal tunnel syndrome%超短波、音频电对劳损所致腕管综合征早期的治疗作用

    Institute of Scientific and Technical Information of China (English)

    杨涓; 许志雄

    2008-01-01

    目的 探讨超短波、音频电对劳损所致腕管综合征(carpal tunnel syndrome,CTS)早期的治疗作用.方法 将15例(19手)劳损所致CTS患者予超短波、音频电治疗,2疗程后观察患手的感觉、肌力改善程度及肌电图变化,进行综合评估.结果 本组15例(19手)中,治愈11手,治愈率57.89%;显效5手,显效率26.32%;有效1手,有效率5.26%;无效2手,无效率10.53%.结论 超短波、音频电治疗劳损所致CTS早期疗效显著.

  10. 神经松解术结合健骨注射液治疗中老年腕管综合征的疗效观察%The treatment efficacy of neurolysis and jiangu injection in elderly patients with carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    崔书伟; 陈青; 徐世民

    2011-01-01

    目的 观察神经松解术结合健骨注射液治疗中老年腕管综合征(carpal tunnel syndrome,CTS)的疗效.方法 将2007年4月-2009年5月,来我院治疗的符合病例选择标准的CTS患者共86例随机分成治疗组和对照组.治疗组49例,采用神经松解术结合健骨注射液治疗;对照组37例,采用单纯神经松解术治疗.对两组患者的疗效进行评价.结果 神经松解术结合健骨注射液治疗CTS的疗效优于单纯神经松解术的疗效(P <0.05),差异有统计学意义.结论 采用神经松解术结合健骨注射液治疗中老年患者CTS的效果,优于单纯神经松解术的效果.

  11. Síndrome do túnel do carpo: controvérsias a respeito de diagnóstico clínico e eletrofisiológico e a relação com o trabalho Carpal tunnel syndrome: controversies regarding clinical and electrodiagnosis and its work-relatedness

    Directory of Open Access Journals (Sweden)

    JOSÉ TEOTONIO DE OLIVEIRA

    2000-12-01

    Full Text Available O diagnóstico de síndrome do túnel do carpo (STC apresenta dificuldades porque dormência e formigamento nos membros superiores e alterações de condução nervosa no nervo mediano são comuns na população, havendo baixa concordância entre sintomas e alterações eletrofisiológicas. O diagnóstico de STC deve ser feito somente na presença de sintomas característicos acompanhados de alterações eletrofisiológicas significativas. Os casos duvidosos devem ser observados. A associação da STC com certas atividades é controversa.The diagnosis of carpal tunnel syndrome (CTS may be difficult because paresthesias and tingling in the upper limbs are commonly reported in the general population. These symptoms are poorly correlated with changes of nerve conduction studies of the median nerve. CTS should be diagnosed only when typical symptoms are associated with significant electrophysiological abnormalities. The association of CTS with work is highly controversial.

  12. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

    Science.gov (United States)

    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

  13. The carpal bones in Poland syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Friedman, Talia [University of Manitoba, Department of Diagnostic Imaging, Winnipeg, MB (Canada); Reed, Martin [University of Manitoba, Department of Diagnostic Imaging, Winnipeg, MB (Canada); University of Manitoba, Children' s Hospital, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Children' s Hospital, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); Elliott, Alison M. [University of Manitoba, Children' s Hospital, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Children' s Hospital, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); University of Manitoba, Program of Genetics and Metabolism, Winnipeg, MB (Canada)

    2009-06-15

    Classical Poland syndrome is represented by unilateral aplasia of the sternocostal head of the pectoralis major muscle and ipsilateral simple syndactyly and brachydactyly. Various classifications of the severity of hand involvement have been proposed. Since its initial description, numerous studies have been made of the bony, soft tissue, organ, and hematological disturbances. However, carpal bone involvement has been largely overlooked. The purpose of this study was to evaluate the carpal bones in patients with Poland syndrome from a local (Manitoba) cohort as well as those from the literature. Hand radiographs from local patients and cases identified from the literature with confirmed Poland syndrome were examined for evidence of carpal bone involvement. Only cases with radiographs of adequate quality were included in the analysis. Clinical information (including gender and age) was necessary for evaluation of bone maturation. In total, seven local patients and 23 patients from the literature were evaluated. Ethics approval for study of the local patients was obtained by the Research Ethics Board of the University of Manitoba. Of the 23 literature patients, 12 patients (52%) had abnormal findings. Of the abnormal patients, four of 12 (33%) had carpal fusions, eight of 12 (67%) showed disharmonious ossification between the carpal and tubular bones and seven of 12 (58%) showed delay of carpal ossification. Of the local cohort, three patients were too young to characterize carpal involvement. Of the four remaining patients, two (50%) had abnormal carpal morphology, three out of four had disharmonious ossification and all four had delay of ossification of carpal bones. Carpal fusions, particularly of the scaphoid and trapezium, were common in both groups. Carpal bone anomalies (delay, disharmony, and/or fusions) are frequent in Poland syndrome and can occur in patients with either mild or severe hand involvement. Imaging of the unaffected hand is helpful in

  14. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    Science.gov (United States)

    Janmohammadi, Nasser

    2014-01-01

    Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle). Symptoms of the patient appeared during the third trimester of pregnancy. Electro diagnostic studies confirmed Guyon's tunnel syndrome. Surgical exploration revealed an anomalous arch of the ulnar nerve passing through the flexor carpi ulnaris (FCU) tendon. The anomalous arch of the ulnar nerve was released by resection of the segment of FCU tendon passing through the ulnar nerve arch. Therefore, in patients with Guyon's tunnel syndrome, the ulnar nerve anomaly should be kept in mind as a cause. Moreover, pregnancy may have a provocative effect on Guyon's tunnel syndrome similar to carpal tunnel syndrome (CTS).

  15. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    Directory of Open Access Journals (Sweden)

    Nasser Janmohammadi

    2014-07-01

    Full Text Available Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle. Symptoms of the patient appeared during the third trimester of pregnancy. Electro diagnostic studies confirmed Guyon's tunnel syndrome. Surgical exploration revealed an anomalous arch of the ulnar nerve passing through the flexor carpi ulnaris (FCU tendon. The anomalous arch of the ulnar nerve was released by resection of the segment of FCU tendon passing through the ulnar nerve arch. Therefore, in patients with Guyon's tunnel syndrome, the ulnar nerve anomaly should be kept in mind as a cause. Moreover, pregnancy may have a provocative effect on Guyon's tunnel syndrome similar to carpal tunnel syndrome (CTS.

  16. Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Mahmud Ahmad Ismail Mahmud

    2006-06-01

    Full Text Available O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm e o parâmetro eletrofisiológico em 38 pacientes com sintomas da síndrome do túnel do carpo (STC, submetidos a estudos de condução nervosa (ECN. As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN e parâmetros dos ECN, dividindo-se os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e com alteração eletrofisiológica grave. Correlação significante entre TNAm e parâmetros dos ECN foram encontrados (pThe purpose of this study was to evaluate, through a series of cases, the relationship between the adverse neural tension of median nerve (ANTm and the electrophysiological involvement in 38 patients with symptoms of the carpal tunnel syndrome (CTS, submitted to nerve conduction studies (NCS. The main measures had been ANTm (in degrees obtained through the test of neural tension provocation (TNTP and parameters of the NCS, divided into three groups: normal, without severe electrophysiological alteration and with severe electrophysiological alteration. Significant correlations were found between ANTm and parameters of the NCS (p<0.05, as well as between ANTm and the three groups defined by the electrophysiologic alteration (r s=+0.437, p=0.002. The TNAm values were significantly higher in the arms with electrophysiologic diagnoses (p=0.007. It is suggested that the ANTm does have a participation in the physiopathology of the CTS, and the useof therapeutical procedures that diminish the development of neural tension.

  17. Adaptation of the Transverse Carpal Ligament Associated with Repetitive Hand Use in Pianists.

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    Christiane Mhanna

    Full Text Available The transverse carpal ligament (TCL plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL's mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV. ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p < 0.05. Additionally, the increased SWV was location dependent for both pianist and non-pianist groups (p < 0.05, with the rTCL having a significantly greater SWV than the uTCL. Between groups, the rTCL SWV of pianists was 22.2% greater than that of the non-pianists (p < 0.001. This localized increase of TCL SWV, i.e. stiffening, may be primarily attributable to focal biomechanical interactions that occur at the radial TCL aspect where the thenar muscles are anchored. Progressive stiffening of the TCL may become constraining to the carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome.

  18. Carpal Ligament Injuries, Pathomechanics, and Classification.

    Science.gov (United States)

    Lee, Daniel J; Elfar, John C

    2015-08-01

    Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including 2 of the most common malalignment patterns: volar intercalated segment instability and the more common dorsal intercalated segment instability. Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research is likely to unify the disparate paradigms used to describe wrist instability.

  19. Complex carpal malformation without a cause.

    Science.gov (United States)

    Swanger, Ronald; Faulkner, Christyna; Maldjian, Catherine; Schlesinger, Iris; Magill, Richard; Weinberg, Brighita

    2009-11-01

    Carpal dislocation is an uncommon event. We present a 4-year-old male child who had the clinical appearance of a Madelung's deformity; however, he failed to fulfill the radiological criteria for a Madelung's deformity. The carpal bones had not yet ossified making it difficult to arrive at a diagnosis using radiograph alone. Magnetic resonance imaging was diagnostic because of the ability to delineate the carpal cartilaginous ossification centers. Chronic wrist dislocation should be considered in the differential diagnosis of a long-standing wrist deformity that clinically resembles a Madelung's deformity in a young child.

  20. Ultrasound assessment of transverse carpal ligament thickness: a validity and reliability study.

    Science.gov (United States)

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-06-01

    The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiologic factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measure the TCL thickness and to test the validity and reliability of this method. Three operators conducted two sessions of ultrasound examination on eight cadaveric specimens and eight healthy volunteers. A custom script was used to calculate TCL thickness along the TCL length from the ultrasound images. The ultrasound based TCL thickness of the cadaveric specimens was compared with the dissection based TCL thickness for validation. The results showed Pearson's correlation coefficients of 0.867-0.928, intraclass correlation coefficient (ICC) values of 0.726-0.865, a standard error of measurement of 0.02-0.07 mm and a minimal detectable difference of 0.05-0.15 mm. The high correlation coefficients and small errors indicate that the ultrasound based method is valid for measuring TCL thickness. Furthermore, ultrasound measurements showed excellent intraoperator and interoperator reliability with ICC values as 0.826-0.933 and 0.840-0.882, respectively. The ultrasound based TCL thickness was in the range of 0.93-2.34 (1.54 ± 0.33) mm and agreed well with previous studies. The ultrasound method developed in this study is a valuable tool to examine morphologic properties of healthy and pathologic TCLs.

  1. Carpal-tarsal osteolysis with elbow involvement

    Energy Technology Data Exchange (ETDEWEB)

    McDonald, Kirsteen; Toms, Andoni P.; Marshall, Thomas J. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich, Norfolk (United Kingdom); Armon, Kate [Norfolk and Norwich University Hospital, Department of Paediatrics, Norwich, Norfolk (United Kingdom); Johnson, Karl [Birmingham Children' s Hospital, Department of Radiology, Birmingham, West Midlands (United Kingdom)

    2007-11-15

    Carpal-tarsal osteolysis is a rare condition that manifests as the progressive resorption of carpal and tarsal bones in young children. The diagnosis of this condition is often difficult and delayed as the initial clinical presentation is non-specific. Radiographic changes occur gradually, are often not seen at presentation and depend on recognising loss of bone in the ossification centres of the carpus and tarsus. MRI demonstrates morphological abnormalities in the cartilaginous, as well as the osseous components, of the developing carpal and tarsal bones and therefore may be helpful in predating the radiographic changes. Ultrasound appears to contribute little to the diagnosis and may be misleading. Exclusion of other conditions, particularly juvenile idiopathic arthritis, is important in making the diagnosis. MRI can be useful in excluding an inflammatory arthropathy, and suggesting the diagnosis of carpal-tarsal osteolysis. (orig.)

  2. A study of 60 patients with percutaneous trigger finger releases: clinical and ultrasonographic findings.

    Science.gov (United States)

    Gulabi, D; Cecen, G S; Bekler, H I; Saglam, F; Tanju, N

    2014-09-01

    We present the clinical results and ultrasonographic findings of 61 trigger digits treated with percutaneous A1 pulley release. An endoscopic carpal tunnel knife was used for the release in the outpatient department. The mean follow-up period was 3.5 months. A total of 55 digits (90%) had complete relief of their triggering postoperatively. Six digits (10%) had Grade 2 triggering clinically in the early postoperative period.The complications included six cases of insufficient release (10%), scar sensitivity in one patient, short-term hypoaesthesia in three digits (5%), and flexor tendon laceration noted on postoperative ultrasonography in eight digits (13%). No neurovascular damage was noted on the postoperative ultrasonography. Ultrasonograpy provides information about tendon laceration and changes in thickness of the pulleys and confirm A1 pulley release after surgery, but it does not alter clinical decision-making. We believe that pre- and postoperative ultrasonograpy does not need to be included as a routine examination.

  3. Comparison of nerve conduction techniques in 95 mild carpal tunnel syndrome hands Síndrome do túnel do carpo leve: comparação de técnicas de condução nervosa em 95 mãos

    Directory of Open Access Journals (Sweden)

    JOAO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Electrodiagnosis of carpal tunnel syndrome (CTS were prospectively studied in 95 hands. The following techniques were studied in all hands and when at least one abnormal value was found (onset-measured, it was included on results: 1. wrist-index finger latency (WIF, abnormal > or = 2.8 ms, 140 mm; 2. palm-wrist latency (PW, abnormal > or = 1.8 ms, 80 mm; 3. comparison median/ulnar palm-wrist latency (CPW, abnormal > or = 0.4 ms; 4. comparison median/ulnar latency, wrist-ring finger (CMU, abnormal > or = 0.5 ms, 140 mm; 5. comparison median/radial latency, wrist-thumb (CMR, abnormal > or = 0.4 ms, 100 mm. All 95 CTS hands selected have the WIF Eletrodiagnóstico da síndrome do túnel do carpo (STC foi estudado prospectivamente em 95 mãos sintomáticas. As técnicas estudadas foram realizadas em todas mãos com latência medida no ínicio dos potenciais e pelo menos uma delas estava anormal dentro dos limites descritos: 1. Latência punho- II dedo (PD, anormal > ou = 2,8 ms, 140 mm; 2. Latência palma-punho (PP, anormal > ou = 1,8 ms, 80 mm; 3. Comparação de latência palma-punho mediano-ulnar (CP, anormal > ou = 0,4 ms, 80 mm; 4. Comparação de latência mediano-ulnar, punho- IV dedo (CMU, anormal > ou = 0,5 ms, 140 mm; 5. Comparação de latência mediano-radial, punho- I dedo (CMR, anormal > ou = 0,4 ms, 100 mm. Todas 95 mãos selecionadas tiveram PD <= 3,5 ms (STC leve. Concluiu-se que a CMR foi a técnica mais sensível para STC leve (97,8% e o único método comparativo com todos potenciais de ação obtidos; seguiram-se CP (88,4%, PP (84,2%, CMU (72,6% e PD (68,4%.

  4. Usefulness of additional nerve conduction techniques in mild carpal tunnel syndrome Utilidade de técnicas adicionais de condução nervosa para o dignóstico de síndrome do túnel do carpo leve

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    João Aris Kouyoumdjian

    2002-12-01

    Full Text Available This study was done to assess the percentage of abnormality in additional nerve conduction techniques after normal median distal latency (routine in mild carpal tunnel syndrome (CTS. Bilateral nerve conduction studies were carried out in 116 consecutive symptomatic CTS patients (153 hands. Mild cases were based on normal routine (Este estudo foi realizado para avaliação da percentagem de anormalidade de técnicas adicionais de condução nervosa no síndrome do túnel do carpo (STC leve quando o valor de latência distal sensitiva do nervo mediano (rotina está dentro dos limites normais. Condução nervosa bilateral foi realizada em 116 pacientes consecutivos com STC sintomático (153 mãos. A seleção foi feita baseada na rotina normal (< 3,7 ms, medida no pico, 14 cm e, pelo menos uma técnica anormal entre as seguintes: diferença sensitiva mediano-radial (MR; diferença sensitiva mediano-ulnar (MU4; diferença mediano-ulnar palmar (MUP; latência palmar do mediano (PW; e latência distal motora do mediano (MDL. Os valores normais da rotina foram separados em grupos desde 3,1 até 3,6 ms (< 3,7 ms, obtendo-se valores anormais entre 86,6 e 93,4% (MR, 40 e 81.7% (MU4, 20 e 71,2% (MUP, 0 e 41,1% (PW e 0 e 19,6% (MDL. A associação anormal mais frequente foi MR com MU4 em 90,1%, seguido de MR com MUP e MU4 com MUP. A técnica adicional isolada anormal mais frequente foi MR seguida de MU4 e MUP. O percentual de anormalidade da técnica MR foi muito elevada, independentemente do valor de corte na condução rotina (3,1 a 3,6 ms.

  5. Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome Influência do resfriamento nos parâmetros de condução nervosa mista do mediano e ulnar na síndrome do túnel do carpo

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    Rogério Gayer Machado de Araújo

    2007-09-01

    Full Text Available Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU in electrodiagnosis of carpal tunnel syndrome (CTS. Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands. Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands. PMU was obtained at the usual temperature, >32°C, and after wrist/hand cooling to Temperatura é uma variável comum e importante que modifica os parâmetros de condução nervosa na prática eletrodiagnóstica. Neste trabalho nós estudamos o efeito do esfriamento na diferença de latências palmares entre o nervo mediano e ulnar (PMU, segmento palma-pulso, utilizada rotineiramente para o eletrodiagnóstico da síndrome do túnel do carpo (STC. Foram estudados 22 controles (19 mulheres, média de idade 42,1 anos, 44 mãos e 25 pacientes (25 mulheres, média de idade 46,6 anos, 34 mãos com diagnóstico de STC leve. PMU foi obtida em temperatura usual (>32°C, e após resfriamento de mão/pulso em água com gelo (<27°C. Após o resfriamento houve aumento significativo na PMU e na latência mista palmar do nervo ulnar nos pacientes quando comparados aos controles. Nós concluímos que o resfriamento modifica significativamente a PMU e propomos que as latências obtidas em nervos submetidos à compressão reagem de maneira mais acentuada ao frio e isso poderia ser uma arma útil para o eletrodiagnóstico da STC incipiente. Da mesma forma, houve reação mais acentuada ao frio no estudo da latência mista palmar do nervo ulnar nos pacientes mas não nos controles, que poderia levantar a hipótese de compressão subclínica do nervo ulnar.

  6. Post-traumatic carpal instability.

    Science.gov (United States)

    Chantelot, C

    2014-02-01

    The complexity of the carpus explains the difficulty treating carpal injuries. Lesions are dominated by perilunate dislocation, scapholunate dislocation, and scaphoid fractures. The other injuries are trivial. Symptoms include pain and loss of wrist strength, reversible for an acute and well-treated lesion. Too often, these ligament injuries are diagnosed late. For delays longer than 6 weeks, ligament repair is ineffective. These old, complex lesions are potentially highly arthritic in the radiocarpal and mediocarpal joints. Improvements in wrist surgery have mitigated these chronic lesions. Various surgical techniques can preserve a functional wrist; wrist arthrodesis is no longer the only solution for these arthritic wrists. Over the past decade, arthroscopy has contributed to better understanding the injuries of the carpus as well as to better healing them. For acute or chronic ligament injuries without degenerative osteoarthritis, arthroscopy is the treatment of the future. This technique involves a long learning curve and the various arthroscopic techniques must be validated.

  7. Revisión sistemática de tratamientos fisioterapéuticos con mejor evidencia para el síndrome del túnel carpiano Systematic review of phisiotherapy treatments with better evidence for the carpal tunnel syndrome

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    C. S. Alvayay

    2008-10-01

    hay datos objetivados que indiquen que estas herramientas fisioterapéuticas disminuyen la compresión que afecta al nervio mediano.Introduction: The carpal tunnel syndrome (CTS is a pathology wich has a high incidence and it basically consist of a neuropathic compression of the median nerve at the wrist level. Initially, this compression is a nerve neuropraxia, but over the time and neglect this pathology evolves to axonotmesis and, in extreme cases, to neurotmesis. The symptoms and signs of this condition are very limiting to the patient. The pain and the parestesias in the dermatomic and myotomic regions of medial nerve will affect the manual performance of this patients decreasing the performance at work and life quality. Finally, the CTS ends in surgery. For these reasons it is necessary to use physiotherapeutic treatment techniques to avoid surgical procedures and abolish this signs and symptoms. Objetive: The aim of this study was to search and find the physiotherapeutic treatments with the best existing scientific evidence for the carpal tunnel syndrome with the aim of reducing the signs and symptoms as well as avoiding the surgical procedure. MATERIALS AND METHODS: we use the MEDLINE scientific searcher with de PUBMED datábase, later the papers were filtrated with the aim to obtain the best available evidence (according to the Oxford scale and finally were analyzed according to the PEDro scale to evalúate the works validity. Results: There were included three arricies: two randomized triáis (with a high score on the PEDro scale and a systematic review. Only this three papers approved the inclusión and exclusión criteria. CONCLUSIONS: The use of some physiotherapeutic treatments in doses and treatment time described in this review reduce significantly pain, subjective symptoms, distal motor latency, hand grip and finger pinch strength. However the treatment is symptomatic because there are no data indicating that these physiotherapeutic tools reduce the

  8. Arthroscopy of the wrist: anatomy and classification of carpal instability.

    Science.gov (United States)

    Cooney, W P; Dobyns, J H; Linscheid, R L

    1990-01-01

    Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

  9. Síndrome do túnel do carpo: correlação da comparação de latência sensitiva mediano-radial com condução nervosa rotina em 1059 mãos (668 casos Sensory median/radial latency difference versus routine conduction studies in 1059 carpal tunnel syndrome hands (668 cases

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    JOÃO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Foram estudados 668 pacientes (1 059 mãos com síndrome do túnel do carpo (STC entre janeiro de 1989 e junho de 1996. O critério de seleção e inclusão dos pacientes baseou-se na diferença de latência sensitiva >1,0 ms entre os potenciais de ação sensitivos (PAS dos nervos mediano e radial após estimulação simultânea no punho e registro no I dedo (diferença mediano-radial, DMR, representando diferença maior que 6 desvios-padrão (DP. DMR foi obtida em 125 mãos normais (grupo controle com limite superior de normalidade de 0,43 ms (média + 2DP. Todos casos tiveram estudo eletrofisiológico bilateral, sendo excluídos casos com cirurgia prévia ou evidência de neuropatia periférica. A idade variou de 17 a 83 anos com média de 47,5 anos; 91,3% eram do sexo feminino. Valor de DMR > 1,0 ms correlacionou-se em 95% dos casos com latência distal motora do nervo mediano >4,25 ms (80 mm e com latência distal sensitiva punho - II dedo >3,01 ms (VC 3,14 ms (VC 3,26 ms (VC 1,0 ms que indica diagnóstico seguro de STC em praticamente 100% dos casos suspeitos.Between January 1989 and June 1996, 1 059 carpal tunnel syndrome hands (CTS from 668 patients were studied. None had been previously operated and all had bilateral conduction studies; peripheral neuropathy was excluded. The patients were selected with sensory median/radial difference (MRD >1.0 ms that strongly supports electrodiagnosis of CTS (standard deviation > 6 after simultaneous stimulation on wrist and recording on thumb. Normal MRD were obtained in 125 hands with upper limit of normality = 0,43 ms (mean + 2SD. The age ranged from 17 to 83 years (mean 47.5 and 91.3% were female. MRD >1.0 ms correlates in 95% with median distal motor latency >4.25 ms (80 mm distance and with median distal sensory latency to index finger >3.01 ms, middle finger >3.14 ms and ring finger >3.26 ms, all of them 140 mm distance, antidromic and onset-measured. The results have brought new values for

  10. 高压氧联合甲钴胺治疗腕管综合征的神经电生理疗效观察%Observation on the effects of hypesbaric oxygen combined with mecobalamin on electrophysiological changes in the treatment of carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    朱连海; 丁莉; 李新玲; 陆珍辉; 凌卓敏

    2016-01-01

    目的 探讨高压氧联合甲钴胺治疗腕管综合征(CTS)的神经电生理疗效.方法 经患者知情同意,并签署知情同意书,将84例CTS患者分成甲钴胺组28例、高压氧组26例和高压氧联合甲钴胺组28例,甲钴胺组予甲钴胺治疗,高压氧组予高压氧治疗,高压氧联合甲钴胺组予甲钴胺及高压氧协同治疗,治疗前后均行电生理检查.结果 治疗后,高压氧联合甲钴胺组正中神经感觉神经传导速度(SCV)、运动神经传导速度(MCV)及运动神经复合肌动作电位(CMAP)波幅均高于治疗前(P<0.05),CMAP潜伏期(BML)低于治疗前(P<0.05);甲钴胺组治疗后[(30.22 ±3.18) m/s]正中神经SCV高于治疗前[(29.54±2.61) m/s](P<0.05);高压氧组治疗后正中神经SCV、MCV高于治疗前(P<0.05);高压氧组、高压氧联合甲钴胺组正中神经SCV、CMAP波幅较甲钴胺组明显提高(P<0.05);高压氧联合甲钴胺组正中神经SCV较高压氧组明显提高(P<0.05).结论 高压氧联合甲钴胺治疗CTS效果显著.%Objective To investigate the effects of hyperbaric oxygen (HBO) combined with mecobalamin on electrophysiological changes in the treatment of carpal tunnel syndrome (CTS).Methods Eighty-four cases of CTS were randomly divided into the mecobalamin group (n =28),the HBO group (n =28) and the HBO + mecobalamin group (n =28).The mecobalamin group was treated with mecobalamin,the HBO group received HBO therapy,and the latter group was given combined therapy,i.e.HBO plus mecobalamin.Both before and after treatment,all the patients received electrophysiological detection.Results After treatment,the median nerve sensory nerve conduction velocity (SCV),motor nerve conduction velocity (MCV),and the wave amplitude of the motor nerve compound muscle action potential (CMAP) of the combined group were all higher than those before treatment (P < 0.05),while CMAP latency (BML) was lower than that before treatment (P < 0.05).Following treatment,SCV of

  11. Physical Therapy as Good as Surgery for Carpal Tunnel Syndrome

    Science.gov (United States)

    ... the March issue of the Journal of Orthopaedic & Sports Physical Therapy . SOURCES: Cesar Fernandez de las Penas, P.T., ... New York City; March 2017, Journal of Orthopaedic & Sports Physical Therapy HealthDay Copyright (c) 2017 HealthDay . All rights reserved. ...

  12. Hour glass constriction in advanced carpal tunnel syndrome

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    Mohammad Dehghani

    2013-01-01

    Conclusion: We recommend epineurolysis for mild to moderate constriction and also end-to-end repair may be needed if extensive and severe constriction was found. It means that if we manage mild to moderate constriction sooner, it can prevent the need for further surgical procedure because of sever constriction.

  13. [Diagnostic validity of ultrasonography in carpal tunnel syndrome].

    Science.gov (United States)

    Bueno-Gracia, Elena; Haddad-Garay, María; Tricas-Moreno, José M; Fanlo-Mazas, Pablo; Malo-Urries, Miguel; Estebanez-de-Miguel, Elena; Hidalgo-Garcia, César; Ruiz de Escudero-Zapico, Alazne

    2015-07-01

    Introduccion. La ecografia ha emergido como una herramienta diagnostica alternativa de las neuropatias perifericas, como el sindrome del tunel carpiano (STC). Sin embargo, faltan datos sobre la validez diagnostica de las diferentes mediciones ecograficas para la deteccion del STC en entornos clinicos. Objetivo. Hallar la validez diagnostica de las mediciones ecograficas del area de seccion transversal del nervio mediano en la muñeca (AST-M) y de la ratio del area del nervio mediano entre la muñeca y el antebrazo (R-MA) en el diagnostico del STC, utilizando como tecnica de referencia el electroneurograma (ENG). Pacientes y metodos. Se realizaron mediciones ecograficas en 59 sujetos (97 muñecas) referidos para someterse a un ENG por sospecha de STC. Los examinadores que realizaron la ecografia desconocian los resultados del ENG. Posteriormente, se calcularon los puntos de corte mediante curvas ROC para cada una de las mediciones (AST-M y R-MA) y se analizo su validez diagnostica. Resultados. Con un punto de corte de 9,15 mm2, la medicion AST-M obtuvo una sensibilidad del 75,81%, una especificidad del 74,29%, una ratio de probabilidad positiva de 2,95 y una ratio de probabilidad negativa de 0,33. Para la medicion R-MA y un punto de corte de 1,56, los valores de sensibilidad, especificidad y ratios de probabilidad positiva y negativa fueron 70,97%, 71,43%, 2,48 y 0,4, respectivamente. Conclusion. Tanto el AST-M como la R-MA parecen ser medidas utiles en el diagnostico del STC tomando como prueba de referencia el ENG.

  14. Coordinate systems for the carpal bones of the wrist.

    Science.gov (United States)

    Coburn, James C; Upal, Mohammad A; Crisco, Joseph J

    2007-01-01

    The eight small and complexly shaped carpal bones of the wrist articulate in six degrees of freedom with each other and to some extent with the radius and the metacarpals. With the increasing number and sophistication of studies of the carpus, a standardized definition for a coordinate system for each the carpal bones would aid in the reporting and comparison of findings. This paper presents a method for defining and constructing a coordinate system specific to each of the eight carpal bones based upon the inertial properties of the bone, derived from surface models constructed from three-dimensional (3-D) medical image volumes. Surface models from both wrists of 5 male and 5 female subjects were generated from CT image volumes in two neutral wrist positions (functional and clinical). An automated algorithm found the principal inertial axes and oriented them according to preset conditions in 85% of the bones, the remaining bones were corrected manually. Six of the eight carpal bones were significantly more extended in the functional neutral position than in the clinical neutral position. Gender had no significant effect on carpal bone posture in either wrist position. Correlations between the 3-D carpal posture and the commonly used 2-D clinical radiographic carpal angles are established. 3-D coordinate systems defined by the anatomy of the carpal bone, such as the ones presented here, are necessary to completely describe 3-D changes in the posture of the carpal bones.

  15. Morphometrical variations of the carpal bones in thoroughbreds and ponies.

    Science.gov (United States)

    Abdunnabi, A H; Ahmed, Y A; Philip, C J; Davies, H M S

    2012-04-01

    There is scant morphological data for equine carpal bones despite the frequent pathology in Thoroughbreds (TB). This study aimed to identify morphological and morphometrical variations and similarities in carpal bones between and within TB and Ponies (Po). Carpal bones from nine TB and 13 Po were prepared by boiling and drying. Lateromedial width, dorsopalmar depth, proximodistal height, relative density and volume of each bone were measured. Normalized measurements of the radial (Cr) and third (C3) carpal bones were significantly different in all dimensions, and there were significant variations in relative sizes of articular facets of the ulnar (Cu), C3 and fourth (C4) carpal bones between the groups. Bilaterally, the proportionate volume of the intermediate carpal bone (Ci) was significantly greater in Po while that of Cu and C4 were significantly greater in TB. Relative density of most bones was greater in Po. The palmar tuberosity of the proximal surface of Ci and palmar tubercle on the palmar surface of Cu were more prominent and relatively larger in TB. In the second carpal bone (C2), the distal extent of the proximal articular surface on the palmar surface was greater in Po. The inconsistent first carpal bone (C1) was relatively larger in Po. Morphometrical similarities and differences in carpal bones between TB and Po indicate potential effects of selection for body size or fast exercise.

  16. Surgical Treatment of Trigger Finger: Open Release

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    Firat Ozan

    2016-01-01

    Full Text Available In this study, open A1 pulley release results were evaluated in patients with a trigger finger diagnosis. 45 patients (29 females, 16 males, mean age 50.7 ± 11.9; range (24-79, 45 trigger fingers were released via open surgical technique. On the 25 of 45 cases were involved in the right hand and 16 of them were at the thumb, 2 at index, 6 at the middle and 1 at ring finger. Similarly, at the left hand, 15 of 20 cases were at the thumb, 1 at the index finger, 2 at middle finger and 2 at ring finger. Average follow-up time was 10.2 ± 2.7 (range, 6-15 months. Comorbidities in patients were; diabetes mellitus at 6 cases (13.3%, hypertension at 11 cases (24.4%, hyperthyroidism at 2 cases (4.4%, dyslipidemia at 2 cases (4.4% and lastly 2 cases had carpal tunnel syndrome operation. The mean time between the onset of symptoms to surgery was 6.9 ± 4.8 (range, 2-24 months. Patient satisfaction was very good in 34 cases (75.4% and good in 11 (24.6% patients. The distance between the pulpa of the operated finger and the palm was normal in every case postoperatively. We have not encountered any postoperative complications. We can recommend that; A1 pulley release via open incision is an effective and reliable method in trigger finger surgery.

  17. Anatomia patológica da sinóvia de pacientes submetidos à liberação do túnel do carpo Pathological study of the synovial tissue of patients who underwent open carpal tunnel release

    OpenAIRE

    2010-01-01

    OBJETIVO: Verificar se a biópsia da sinóvia do túnel do carpo é capaz de identificar patologias sistêmicas que não foram diagnosticadas clinicamente ou por exames laboratoriais. MÉTODO: 46 exames anatomopatológicos da sinóvia dos tendões flexores no túnel do carpo de pacientes submetidos à liberação aberta para o tratamento desta síndrome compressiva foram, retrospectivamente, analisados. Os autores propuseram uma nova classificação para a lesão de acordo com a intensidade do processo inflama...

  18. Laserterapia de baixa intensidade no pós-operatório da síndrome do túnel do carpo Low-level laser therapy after carpal tunnel release

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    Marcelo de Pinho Teixeira Alves

    2011-01-01

    Full Text Available OBJETIVO: Avaliar o tratamento pós-operatório da síndrome do túnel do carpo (STC, utilizando-se a laserterapia de baixa intensidade (LBI. MÉTODO: Foram avaliados prospectivamente 58 pacientes portadores de STC, divididos aleatoriamente em dois grupos: tratamento com LBI (grupo 1 e placebo (grupo 2. Foi utilizado laser de 830nm, de gálio-alumínio-arsênico, e potência de 30mW. RESULTADOS: Houve predominância do sexo feminino, em ambos os grupos. A média de idade dos pacientes do grupo 1 foi de 44,3 anos e do grupo 2, de 51,9 anos. A média do tempo de evolução da doença foi aproximadamente dois anos em ambos os grupos. A média do tempo decorrido para alta do tratamento foi de 3,6 meses, em ambos os grupos, com menor número de pacientes queixosos no pós-operatório do grupo 1 do que do grupo 2. Ao fim do tratamento, no grupo 1, 29,41% dos pacientes apresentavam eletroneuromiografia alterada, enquanto que, no grupo 2, foram 63,64% dos pacientes após seis meses. CONCLUSÕES: Trata-se de estudo inicial sobre a terapêutica adjuvante utilizando LBI no pós-operatório da STC. A metodologia apresentada foi suficiente para a avaliação pós-operatória dos pacientes do estudo. Os pacientes submetidos à LBI após a cirurgia para STC foram beneficiados e obtiveram melhores resultados funcionais quando comparados ao grupo controle. A técnica foi eficaz e sem efeitos adversos nos pacientes estudados.OBJECTIVE: Evaluate the post-operative treatment of CTS, using the LLLT. METHOD: We prospectively evaluated 58 patients with CTS, randomly divided into two groups: treatment with LLLT (Group 1 and placebo (Group 2. A 830 nm gallium-aluminum-arsenic laser was used, with a power of 30 mW. RESULTS: There was female predominance in both groups. The mean age of the patients in Group 1 was 44.3 years and in Group 2, 51.9 years. The average duration of disease progression was around two years in both groups. The average time elapsed since discharge from treatment was 3.6 months in both groups, and fewer patients had postoperative complaints in Group 1 than in Group 2. At the end of the treatment, in Group 1, 29.41% of the patients presented electromyographic abnormalities, while in Group 2, 63.64% of the patients had abnormalities, after six months. CONCLUSION: This was an initial study on adjuvant therapy using postoperative LLLT on CTS. The method presented was sufficient for postoperative evaluation of the patients in this study. Patients undergoing LLLT after surgery for CTS were benefited and had better functional outcomes than shown by the control group. The technique was effective and did not have any adverse effects on the patients studied.

  19. 针刺与艾灸对腕管综合征患者周围神经电生理特征的影响%Effects of acupuncture and moxibustion on electrophysiological characteristics of peripheral nerve in patients with carpal tunnel syn-drome

    Institute of Scientific and Technical Information of China (English)

    丁乾; 沈芳

    2015-01-01

    目的:探讨针刺与艾灸对腕管综合征患者周围神经电生理特征的影响。方法选取2009年2月至2014年9月中医科门诊就诊的72例腕管综合征患者,根据患者自愿的方式分为针刺组、艾灸组及刺灸结合组,观察各组治疗前后的数字疼痛评估量表(NRS)评分、整体症状分数表(GSS)评分、电生理相关指标以及解剖相关指标,并进行组间比较。结果与治疗前相比,各组治疗后各项指标均明显好转( P ﹤0.05)。刺灸结合组 NRS、GSS 评分均低于针刺组、艾灸组( P ﹤0.05);刺灸结合组正中神经末端运动潜伏时(DML)低于艾灸组和针刺组;拇指-腕感觉传导速度(SCV)、拇指-腕感觉神经动作单位(SNAP)及中指-腕 SNAP 高于艾灸组和针刺组,差异均有统计学意义( P ﹤0.05);刺灸结合组豌豆骨正中神经横切面积(MNTA)、桡尺关节平面 MNTA 及扁平率(FRMN)均优于艾灸组和针刺组( P ﹤0.05)。结论艾灸、针刺可有效改善腕管综合征患者周围神经电生理相关指标,而针刺配合艾灸对于腕管综合征患者中神经DML、拇指-腕 SCV、拇指-腕 SNAP 及中指-腕 SNAP 方面等电生理指标的改善作用更明显。%Objective To investigate the effect of acupuncture and moxibustion on electrophysiological characteristics of peripheral nerve in patients with carpal tunnel syndrome(CTS). Methods Seventy - two CTS patients who visited the hospital from February 2009 to September 2014 were studied. According to the patient voluntariness,the patients were divided into acupuncture group,moxibustion group,and needling -moxibustion group. Numerical rating scale(NRS)pain score,global symptom score(GSS),electrophysiological and anatomical related indicators were observed before and after treatment and compared between groups. Results All items observed were significantly improved in each group af-ter treatment in

  20. Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients Distribuição sazonal e características demográficas da síndrome do túnel do carpo em 1039 pacientes

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    Irênio Gomes

    2004-09-01

    Full Text Available OBJECTIVE: To describe the demographic characteristics of gender, age, and presence of repetitive movements, intake of alcohol and non-steroid anti-inflammatories (NSAI, medical specialties that referred patients to nerve conduction studies and electromyography (NCS-EMG, school attainment, and seasonal distribution in patients with a neurophysiological diagnosis of carpal tunnel syndrome (CTS in the State of Rio Grande do Sul, Brazil. METHOD: A series of 1039 patients (1549 hands with neurophysiologically defined CTS was studied. Patients were referred for NCS-EMG in 3 universities and 2 private services, from August 2001 to January 2003. All patients completed a questionnaire containing demographic information. The diagnosis of CTS was established following a pre-established protocol, with defined diagnostic criteria. RESULTS: Around one fourth of patients had already performed NCS-EMG; the greatest frequency of CTS was observed in women (5.6:1 and in patients above the age of 40. Most patients reported performing repetitive movements in their daily routine (69.7%; 12.9% reported use of NSAI and 14.9% regular intake of alcoholic beverages. A greater frequency of CTS was observed in the months of July and August, when compared to the other months of the year. Around 2/3 of the study population had completed at least secondary school. Most requests of nerve conduction studies did not provide a diagnostic hypothesis (59.9% and neurophysiologic studies were requested mostly by traumatology/orthopedics (71.1%. CONCLUSION: We have concluded that, in our environment, CTS shows some demographical characteristics that are similar to what the literature describes. Also, we have found that most of our sample concluded at least secondary school, and was referred to neurophysiologic studies by orthopedists. To be pointed out is the seasonal distribution of CTS, which demonstrates a significant association with winter months.OBJETIVO: Descrever as caracter

  1. Clinical observation of extracts injection from rabbit skin inflamed by vaccinia virus combined with vitamin B1 and mecobalamine in treatment of moderate carpal tunnel syndrome%牛痘疫苗致炎兔皮提取物注射液联合维生素B1和甲钴胺治疗轻中度腕管综合征的疗效观察

    Institute of Scientific and Technical Information of China (English)

    辛晋敏

    2016-01-01

    the clinical efficacy and safety of extracts injection from rabbit skin inflamed by vaccinia virus combined with Vitamin B1 Injection and Mecobalamin Injection in treatment of moderate carpal tunnel syndrome.Methods Patients (138 cases) with moderate carpal tunnel syndrome in Changzhou Second People's Hospital from December 2014 to June 2015 were divided into control group (n= 65) and study group (n = 73). The patients in the control group were imadministered with Vitamin B1 Injection, 100 mg/time, once daily. And in the same time, patients in the control group were imadministered with Mecobalamin Injection, 0.5 mg/time, once daily. The patients in the treatment group were ivadministered with rabbit skin inflamed by vaccinia virus injection on the basis of the control group, 7.2 U/time, once daily. The patients in two groups were treated for 14 d. After treatment, the efficacy was evaluated, and nerve EMG indexes, VAS scores, symptom relief time, and BTCQ scores in two groups were compared.Results After treatment, the effective rate of the control and treatment group were 70.8% and 95.9%, respectively, and there was difference between two groups (P < 0.01). After treatment, SCV and SNAP amplitude in two groups were significantly increased, CMAP latency was significantly shortened, , and the difference was statistically significant in the same group (P < 0.05).After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, VAS score and BTCQ score were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). Pain relief time and duration of pain relief time in the treatment group were shorter than those in the control

  2. Reavaliação a longo prazo do tratamento cirúrgico da síndrome do túnel do carpo por incisão palmar e utilização do instrumento de Paine® Carpal tunnel syndrome: reassessment of long-term outcomes with the use of the Paine® retinaculatome during surgery through a palmar incision

    Directory of Open Access Journals (Sweden)

    Luciana Leonel dos Santos

    2005-01-01

    Full Text Available A síndrome do túnel do carpo (STC é a síndrome compressiva mais comum e a cirurgia de liberação do retináculo dos flexores uma das mais realizadas no mundo. Desde a via aberta clássica, mini-incisões até a endoscópica, o sucesso obtido com a cirurgia a curto prazo está bem estabelecido, porém os estudos a longo prazo ainda são escassos e avaliam, principalmente, sinais clínicos e sintomas. O objetivo deste estudo é avaliar os pacientes tratados pela incisão palmar e utilização do instrumento de Paine® com no mínimo seis anos de pós-operatório (98 meses em média. Foram feitas avaliações pré e pós-operatórias da força de preensão palmar, polpa-polpa, lateral e tridigital utilizando um dinamômetro de pressão. A sensibilidade dos dedos foi mensurada por meio de monofilamentos de nylon. Foi observado que com o passar do tempo houve melhora da sensibilidade e a força se manteve inalterada.Carpal tunnel syndrome (CTS is the most commonly diagnosed and treated entrapment neuropathy. Surgical treatment involving the clearance of the flexor retinaculum is widely employed. Open, minimally-invasive and endoscopic surgical techniques have all been described as treatment options for CTS and short-term success with these methods is well established. Long-term studies, however, are scarce and usually evaluate only clinical signs and symptoms. The objective of this study is to evaluate patients treated by a palmar incision and by the use of the Paine retinaculatome (6 years post-op minimum; mean is 98 months. We assessed palmar, pulp to pulp, lateral and tridigital prehension strength using a dynamometer. Finger sensitivity was measured using nylon monofilaments. We observed that while sensitivity improved with time, grip and prehension strength remained unchanged.

  3. [Numerical variants and congenital fusions of carpal bones].

    Science.gov (United States)

    Senecail, B; Perruez, H; Colin, D

    2007-03-01

    The number of carpal bones may be increased or decreased by the fact of anatomical variants or true congenital anomalies. Numerical increment arises from additional or from split bones. Over twenty accessory carpal bones have been described but the commonest are the os centrale carpi, the os radiale externum, the triangular bone and the styloideum bone. Additional carpal bones usually result from a failure of fusion of their ossification centers. A congenital origin is not clearly established for all these ossicles. The scaphoid and lunate may split into two or three bones and several cases of bipartite hamulus of the hamatum have been reported. A carpus with only seven bones results from the congenital absence of a normal bone, which mainly affects the scaphoid, lunate and triquetrum, or from a synostosis between two carpal bones, usually the lunate and triquetrum. Congenital fusions originate from an absence of joint cavitation into the embryo and chondrification of the joint interzone. Numerical carpal variants are uncommon as independent entities but occur with a relative high frequency in association with complex malformations of the hand. These anomalies are detectable on plain radiographs of the wrist, but CT-scan and MR-Imaging are useful to differentiate bipartite and accessory bones from carpal fractures or posttraumatic injuries, carpal fusions having to be distinguished from bony ankylosis.

  4. The carpal stretch test at the rheumatoid wrist.

    Science.gov (United States)

    Shimizu, Hiroyuki; Beppu, Moroe; Matsusita, Kazuhiko; Arai, Takeshi; Yoshida, Noriyuki

    2012-01-01

    The purpose of this study was to evaluate the radiographic changes of the carpus for rheumatoid wrists in patients who underwent the Sauvé-Kapandji procedure by examining the clinical results and comparing pre- and postoperative radiographic measurements. We studied 43 wrists in 37 patients who showed vertical laxity in the radiocarpal and midcarpal joint on preoperative carpal stretch test. Pain was improved in all patients and the forearm rotation angles of the wrist were significantly improved after the operation. The carpal collapse ratio was significantly reduced after the operation. The carpal collapse reduction rate was significantly greater in the group with than that in the group without midcarpal joint vertical laxity on the carpal stretch test. Although the Sauvé-Kapandji procedure was not sufficiently effective in preventing carpal collapse, it did have a protective effect against ulnar carpal shift. The results of our study showed that vertical laxity of the midcarpal joint was the risk factor of the carpal collapse after Sauvé-Kapandji procedure.

  5. Modelling Short-Term Maximum Individual Exposure from Airborne Hazardous Releases in Urban Environments. Part ΙI: Validation of a Deterministic Model with Wind Tunnel Experimental Data

    Directory of Open Access Journals (Sweden)

    George C. Efthimiou

    2015-06-01

    Full Text Available The capability to predict short-term maximum individual exposure is very important for several applications including, for example, deliberate/accidental release of hazardous substances, odour fluctuations or material flammability level exceedance. Recently, authors have proposed a simple approach relating maximum individual exposure to parameters such as the fluctuation intensity and the concentration integral time scale. In the first part of this study (Part I, the methodology was validated against field measurements, which are governed by the natural variability of atmospheric boundary conditions. In Part II of this study, an in-depth validation of the approach is performed using reference data recorded under truly stationary and well documented flow conditions. For this reason, a boundary-layer wind-tunnel experiment was used. The experimental dataset includes 196 time-resolved concentration measurements which detect the dispersion from a continuous point source within an urban model of semi-idealized complexity. The data analysis allowed the improvement of an important model parameter. The model performed very well in predicting the maximum individual exposure, presenting a factor of two of observations equal to 95%. For large time intervals, an exponential correction term has been introduced in the model based on the experimental observations. The new model is capable of predicting all time intervals giving an overall factor of two of observations equal to 100%.

  6. Tunnel fire dynamics

    CERN Document Server

    Ingason, Haukur; Lönnermark, Anders

    2015-01-01

    This book covers a wide range of issues in fire safety engineering in tunnels, describes the phenomena related to tunnel fire dynamics, presents state-of-the-art research, and gives detailed solutions to these major issues. Examples for calculations are provided. The aim is to significantly improve the understanding of fire safety engineering in tunnels. Chapters on fuel and ventilation control, combustion products, gas temperatures, heat fluxes, smoke stratification, visibility, tenability, design fire curves, heat release, fire suppression and detection, CFD modeling, and scaling techniques all equip readers to create their own fire safety plans for tunnels. This book should be purchased by any engineer or public official with responsibility for tunnels. It would also be of interest to many fire protection engineers as an application of evolving technical principles of fire safety.

  7. The role of proprioception and neuromuscular stability in carpal instabilities.

    Science.gov (United States)

    Hagert, E; Lluch, A; Rein, S

    2016-01-01

    Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.

  8. Global point signature for shape analysis of carpal bones

    Science.gov (United States)

    Chaudhari, Abhijit J.; Leahy, Richard M.; Wise, Barton L.; Lane, Nancy E.; Badawi, Ramsey D.; Joshi, Anand A.

    2014-02-01

    We present a method based on spectral theory for the shape analysis of carpal bones of the human wrist. We represent the cortical surface of the carpal bone in a coordinate system based on the eigensystem of the two-dimensional Helmholtz equation. We employ a metric—global point signature (GPS)—that exploits the scale and isometric invariance of eigenfunctions to quantify overall bone shape. We use a fast finite-element-method to compute the GPS metric. We capitalize upon the properties of GPS representation—such as stability, a standard Euclidean (ℓ2) metric definition, and invariance to scaling, translation and rotation—to perform shape analysis of the carpal bones of ten women and ten men from a publicly-available database. We demonstrate the utility of the proposed GPS representation to provide a means for comparing shapes of the carpal bones across populations.

  9. Vacuum phenomenon in equine carpal, metacarpophalangeal and metatarsophalangeal joints

    Directory of Open Access Journals (Sweden)

    R.D. Gottschalk

    1999-07-01

    Full Text Available In order to establish the incidence of vacuum phenomenon in horses' carpal, metacarpophalangeal and metatarsophalangeal joints, stress-flexed radiographs were madeof normal joints, joints withknownpathology and in anaesthetised horses with joints under traction. Focal intra-articular radiolucencies were identified in normal stress-flexed carpal, metacarpophalangeal and metatarsophalangeal joints. These radiolucencies can be confused with those associated with pathological conditions.

  10. Avaliação do questionário de Boston aplicado no pós-operatório tardio da síndrome do tunel do carpo operados pela técnica de retinaculótomo de paine por via palmar Evaluation of Boston questionnaire applied at late pos-operative period of carpal tunnel syndrome operated with the paine retinaculatome through palmar port

    Directory of Open Access Journals (Sweden)

    Lia Miyamoto Meirelles

    2006-01-01

    Full Text Available Entre os anos de 1995 e 1998, foram realizadas 112 cirurgias para tratamento da Síndrome do Túnel do Carpo (STC pela técnica de incisão palmar e utilização do retináculo de Paine. Com o objetivo de avaliar os resultados em longo prazo, os pacientes foram convocados. Houve o retorno de 44 pacientes. Deste total, três pacientes, por terem doenças associadas, foram excluídos, resultando, um total de 53 mãos analisadas. Apresentaremos os resultados da avaliação subjetiva, obtidos através da aplicação de um teste de auto-avaliação chamado de questionário de Boston. Este questionário consiste em perguntas que avaliam a gravidade dos sintomas e o estado funcional no momento da aplicação do mesmo. Através da aplicação do referido questionário encontramos um escore de 1,41 ± 0,57 para gravidade dos sintomas e 1,59 ± 0,93 para o estado funcional. Como este questionário não foi aplicado no pré-operatório deste grupo de pacientes analisados, comparou-se a pontuação obtida com as encontradas na literatura pertinente. Os resultados obtidos demonstraram que as pontuações pós-operatórias são similares àquelas existentes na literatura, mesmo sendo referidas a tempos diferentes de seguimento pós-operatórios, concluindo que havendo uma melhora dos sintomas, o questionário de Boston é sensível a esta mudança clínica.Between the years of 1995 and 1998, 112 surgeries were performed for treating Carpal Tunnel Syndrome (CTS using the technique of palmar incision employing the Paine retinaculum. With the objective of analyzing results in the long-term, the patients were called for review. Forty four patients returned. From these, three patients were excluded due to associated diseases, thus resulting in a total of 53 hands assessed. Here we present the results of the subjective evaluation achieved by applying a self-assessment test called Boston questionnaire. This questionnaire consists of questions evaluating symptoms

  11. Proposition d’un outil d’aide au diagnostic du syndrome du canal carpien pour les acteurs de la santé au travail Proposal of a tool for diagnosis of carpal tunnel syndrome for Personal of Health at Work Proposición de una herramienta de ayuda en el diagnóstico del síndrome del túnel carpiano para los actores de la salud en el trabajo

    Directory of Open Access Journals (Sweden)

    Florence Bazzaro

    2012-05-01

    Full Text Available Les acteurs de la santé au travail sont confrontés à un manque d’outils quantitatifs de suivi et de diagnostic du syndrome du canal carpien (SCC. Pour répondre à ce manque, un outil de diagnostic du SCC est proposé dans cette communication. Il est composé de deux tests : le test de la roue qui consiste à détecter des encoches sur une roue en mouvement et le test de la poutre qui détecte un niveau de sensibilité à une force exercée sur un doigt concerné par le SCC. Deux études expérimentales ont été conduites pour valider cet appareil. La première étude montre que les mesures effectuées avec l’appareil sont répétables, la seconde vise à étudier la sensibilité et la spécificité de l’outil en comparaison avec une étude électrodiagnostique. Les résultats montrent que l’appareil de détection du SCC a un excellent pouvoir discriminant permettant d’identifier les sujets sains et les sujets atteints du SCC.People involved with occupational health at work are faced with a lack of quantitative tools to monitor and diagnose Carpal Tunnel Syndrome (CTS. In order to fill this gap, we developed a device for rapid CTS diagnosis which is composed of two complementary quantitative tests: the wheel test, which consists in detecting notches on a rotating wheel, and the beam test, which consists in detecting various forces exerted on a finger. We conducted two experimental studies to validate this device. The first one demonstrated the repeatability of the measures. The second one studied the sensitivity and specificity of our tool as compared to an electro-diagnosis test. The results show that our CTS detection device has excellent discriminatory power that allows practitioners to differentiate between healthy and CTS-affected subjects.Los actores de la salud en el trabajo se enfrentan a una falta de herramientas cuantitativas de seguimiento y de diagnóstico del síndrome del túnel carpiano (STC. Como respuesta a esa

  12. Short tunnels.

    NARCIS (Netherlands)

    Schreuder, D.A.

    1965-01-01

    Before dealing with the question of lighting short tunnels, it is necessary define what is meant by a tunnel and when it should be called 'short'. Confined to motorized road traffic the following is the most apt definition of a tunnel: every form of roofing-over a road section, irrespective of it le

  13. Cubital tunnel syndrome due to heterotrophic ossification caused by radial head fracture: A case report

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    Seyitali Gumustas

    2014-04-01

    Full Text Available Compression of the ulnar nerve in the cubital tunnel is the second most common nerve entrapment syndrome in the upper extremity after carpal tunnel syndrome. Although various etiologies have been described, heterotrophic ossification is rarely seen. Heterotrophic ossification should be kept in mind as a cause of ulnar nerve entrapment after elbow trauma. Early diagnosis and surgical intervention are important in such cases before completion of the maturation phase. We report a case of heterotrophic ossification due to elbow trauma that caused cubital tunnel syndrome. [Hand Microsurg 2014; 3(1.000: 24-28

  14. Carpal ontogeny in Monodelphis domestica and Caluromys philander (Marsupialia).

    Science.gov (United States)

    Prochel, J A N; Sánchez-Villagra, Marcelo R

    2003-01-01

    Carpal bones have experienced numerous changes during marsupial evolution, even though their diversity and development remain poorly studied. The aim of this work was to document adult form and the pattern of mesenchymal tissue condensation and formation of chondrification and ossification centers in the hand of two marsupials. Two fundamental questions were asked: whether the loss of embryonic precursors was associated with the loss of adult elements, or whether there were developmental signs of ancestral mammalian elements that have been fused or lost in marsupial taxa. We were also interested to find out whether there is sexual dimorphismus in the carpals, as has been reported for some didelphids. Histological sections, cleared and stained specimens and macerated skeletons representing an ontogenetic series of Monodelphis domestica were used to document carpal development. Comparisons were made with perinatal stages of Caluromys philander and with adult specimens of other marsupials. A prenatal M. domestica in the 13th day after conception has a cell condensation that because of its position is homologized with a centrale, which is at birth already lost or fused. Neonatal M. domestica and C. philander have the number and arrangement of their adult carpal anatomy. Trapezium and trapezoid start ossification later than most other carpals, while pisiform and prepollex are the last to do so. Adult males of M. domestica have relatively larger and more robust pisiforms, compared to other carpals, than females. This sexual dimorphism develops relatively late as it was not recorded in male specimens around 160 days old. An extra sesamoid bone located just distal to the radius and proximo-palmar to the scaphoid was recorded in specimens of C. philander, C. derbianus and Didelphis virginiana.

  15. Computerized geometric features of carpal bone for bone age estimation

    Institute of Scientific and Technical Information of China (English)

    Chi-Wen Hsieh; Tai-Lang Jong; Yi-Hong Chou; Chui-Mei Tiu

    2007-01-01

    Background Bone age development is one of the significant indicators depicting the growth status of children.However, bone age assessment is an heuristic and tedious work for pediatricians. We developed a computerized bone age estimation system based on the analysis of geometric features of carpal bones.Methods The geometric features of carpals were extracted and analyzed to judge the bone age of children by computerized shape and area description. Four classifiers, linear, nearest neighbor, back-propagation neural network,and radial basis function neural network, were adopted to categorize bone age. Principal component and discriminate analyses were employed to improve assorting accuracy.Results The hand X-ray films of 465 boys and 444 girls served as our database. The features were extracted from carpal bone images, including shape, area, and sequence. The proposed normalization area ratio method was effective in bone age classification by simulation. Besides, features statistics showed similar results between the standard of the Greulich and Pyle atlas and our database.Conclusions The bone area has a higher discriminating power to judge bone age. The ossification sequence of trapezium and trapezoid bones between Taiwanese and the atlas of the GP method is quite different. These results also indicate that carpal bone assessment with classification of neural networks can be correct and practical.

  16. Carpal myxosarcoma and forelimb amputation in a ferret

    NARCIS (Netherlands)

    van Zeeland, Y.R.A.; Hernandez-Divers, S.J.; Blasier, M.W.; Vila-Garcia, G.; Delong, D.; Stedman, N.L.

    2006-01-01

    Vet Rec. 2006 Dec 2;159(23):782-5. Carpal myxosarcoma and forelimb amputation in a ferret (Mustela putorius furo). van Zeeland YR, Hernandez-Divers SJ, Blasier MW, Vila-Garcia G, Delong D, Stedman NL. Department of Small Animal Medicine, Faculty of Veterinary Medicine, University of Utrecht, Utrecht

  17. 等值地应力下岩质圆形隧道位移释放系数比较及应用%COMPARISONS AND APPLICATIONS OF DISPLACEMENT RELEASE COEFFICIENTS FOR A CIRCULAR ROCK TUNNEL SUBJECTED TO ISOTROPIC GEOSTRESSES

    Institute of Scientific and Technical Information of China (English)

    张常光; 曾开华

    2015-01-01

    The deformation of tunnel at early stage is of critical importance to determine the support pressure and stable deformation of rock mass using the convergence-confinement method. Some typical formulae of displacement release coefficient for deep circular rock tunnels were summarized,classified and compared in terms of the applicability and the spatial effect of tunnel face. The differences from the convergence-confinement analysis due to the different coefficients of displacement release,different positions of support installing and different control objectives were discussed. It was found that the coefficient of displacement release dependent on the ultimate plastic radius of rock mass was applicable to both the elastic and the elasto-plastic rocks and therefore had wide prospects of engineering applications. The coefficients of elastic displacement release were found to be only applicable to the elastic rock,while the commonly used coefficients of plastic displacement release were only suitable for the rock tunnel with a normalized radius of 2. The support designed according to the support pressure distant from the tunnel face could not be moved forward arbitrarily and a reasonable and timely support with different stiffness should be designed according to the properties of rock mass.%隧道前期变形是利用收敛约束法确定支护压力和围岩稳定变形的关键,在分析隧道开挖面空间效应机制的基础上,总结具有代表性的深埋岩质圆形隧道位移释放系数公式,对其进行分类、适用性及空间效应的比较,得到不同位移释放系数、不同支护施作距离和不同控制目标下的收敛约束差异。研究结果表明:以围岩塑性区最大半径为基础的位移释放系数对弹性围岩和各种弹塑性围岩均适用,具有广泛的工程应用前景;弹性位移释放系数仅适用于弹性围岩,常用塑性位移释放系数仅适用于相对半径为2的隧道围岩;不宜

  18. A wakeboarding injury presented as acute carpal syndrome and median nerve contusion after wrist strangulation: a case report

    Science.gov (United States)

    2009-01-01

    Background We present a case of combined median nerve contusion with immediate loss of sensation after the strangulation with a wakeboarding rope and prolonged referral to our department 72 hours after the injury accompanied by an acute carpal tunnel syndrome with immediate relief of numbness of a significant proportion of the median nerve following surgical decompression. Case presentation The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve. Conclusion In case of acute median neuropathy, urgent surgical intervention with exploration, decompression of both, the median nerve and the superficial branch of the median nerve, accompanied by compartment measurements of the forearm should be performed to regain or re-establish neurological integrity. PMID:19178709

  19. Simultaneous distal radial fractures and carpal bones injuries in children: a review article.