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Sample records for carpal tunnel surgery

  1. Is one-stop surgery for carpal tunnel syndrome safe?

    DEFF Research Database (Denmark)

    Jørgensen, Louise Møller; Piil, Karin; Bashir, Asma

    2017-01-01

    OBJECTIVES: The aim of this study was to evaluate one-stop surgery (OSS) for carpal tunnel syndrome (CTS) regarding symptom relief and patient satisfaction. OSS in our setting means only one visit to the hospital for surgery and no hospital appointments for preassessment or follow-up. We hypothes...

  2. Is one-stop surgery for carpal tunnel syndrome safe?

    DEFF Research Database (Denmark)

    Jørgensen, Louise Møller; Piil, Karin; Bashir, Asma

    2017-01-01

    OBJECTIVES: The aim of this study was to evaluate one-stop surgery (OSS) for carpal tunnel syndrome (CTS) regarding symptom relief and patient satisfaction. OSS in our setting means only one visit to the hospital for surgery and no hospital appointments for preassessment or follow-up. We...

  3. Prospective Evaluation of Sleep Improvement Following Carpal Tunnel Release Surgery.

    Science.gov (United States)

    Tulipan, Jacob E; Kim, Nayoung; Abboudi, Jack; Jones, Christopher; Liss, Frederic; Kirkpatrick, William; Matzon, Jonas; Rivlin, Michael; Wang, Mark L; Ilyas, Asif M

    2017-05-01

    Sleep disturbance due to nighttime awakening is a well-documented symptom of carpal tunnel syndrome. While relief of nighttime waking following carpal tunnel release (CTR) has been demonstrated, the effect of CTR on overall sleep quality has not been fully investigated. We hypothesized that CTR would result in significant improvement in overall sleep quality as well as patients' overall satisfaction with their sleep habits. Cases of carpal tunnel syndrome with positive nerve studies, and treated with CTR, were prospectively enrolled. Demographic data, electromyography (EMG) severity, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Insomnia Severity Index (ISI) scale data were collected. A total of 398 patients were enrolled, with 99% available at 2 weeks and 64% available at 3-month final follow-up. At final follow-up, average Quick Disabilities of the Arm, Shoulder, and Hand score improved significantly from the preoperative value. Average ISI score on all 7 sleep categories on the survey improved significantly from before surgery to the first postoperative visit. However, the total ISI score did not further improve significantly between the 2-week and the 3-month postoperative visits. The ISI score improvements did not correlate with EMG severity. Patients undergoing CTR demonstrated significant improvement in mean scores for 7 aspects of sleep quality. Sleep improvement was unrelated to preoperative EMG severity and was experienced within 2 weeks of surgery. Therapeutic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... a passing cramp? It could be carpal tunnel syndrome. The carpal tunnel is a narrow passageway of ... three times more likely to have carpal tunnel syndrome than men. Early diagnosis and treatment are important ...

  5. Preservation of the ulnar bursa within the carpal tunnel: does it improve the outcome of carpal tunnel surgery? A randomized, controlled trial.

    Science.gov (United States)

    Forward, D P; Singh, A K; Lawrence, T M; Sithole, J S; Davis, T R C; Oni, J A

    2006-11-01

    It was hypothesized that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression. Patients consented to randomization to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (fifty-seven patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (sixty-one patients). Grip strength was measured, scar pain was rated, and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability preoperatively and at eight to nine weeks following the surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up. There was no difference between the groups with respect to age, sex, hand dominance, or side of surgery. Grip strength, scar pain, and the Patient Evaluation Measure score were not significantly different between the two groups, although there was a trend toward a poorer subjective outcome as demonstrated by the questionnaire in the group in which the ulnar bursa within the carpal tunnel had been preserved. Preserving the ulnar bursa within the carpal tunnel did, however, result in a lower prevalence of suspected wound infection or inflammation (p = 0.04). In this group of patients, preservation of the ulnar bursa around the median nerve during open carpal tunnel release produced no significant difference in grip strength or self-rated symptoms. We recommend incision of the ulnar bursa during open carpal tunnel decompression to allow complete visualization of the median nerve and carpal tunnel contents.

  6. Independent Variables Affecting Outcome of Carpal Tunnel Release Surgery.

    Science.gov (United States)

    Watchmaker, Jacqueline D; Watchmaker, Greg P

    2017-04-01

    In making the decision to undergo carpal tunnel release (CTR), patients may consider probability of symptom resolution. Prior studies have examined potential preoperative variables that might influence the postoperative outcome. Few studies, however, contain the sample size, prospective design, and high participant completion rate to provide solid data from which to counsel patients. The purpose of this study was to prospectively evaluate factors that have been implicated or dismissed in past studies as sources of outcome variation following CTR surgery and provide patient-relatable facts that the surgeon might use in preoperative patient counseling. One thousand thirty-one consecutive patients undergoing open CTR were prospectively enrolled. Preoperative frequency of daytime numbness, nighttime awakening, and duration of symptoms were recorded in addition to physical exam, height, weight, gender, history of diabetes, history of thyroid disease, and severity of electrodiagnostic findings. After surgery, patients reported percent resolution of numbness at defined intervals. Age and gender are the only independent factors that predict the degree of resolution of numbness 6 months following surgery. All other studied variables are not independent factors nor are any paired combinations of factors. Below the age of 50, the average reported resolution of daytime numbness by 6 months is 97.3% (men 91.8% and women 99.4%). After age 50, there is a linear 0.77% decline in average resolution of daytime numbness per year. Age and gender but no other studied factors predict resolution of daytime numbness in a multivariate model of patients undergoing CTR.

  7. 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

  8. Carpal tunnel biopsy

    Science.gov (United States)

    ... tunnel Images Carpal tunnel syndrome Surface anatomy - normal palm Surface anatomy - normal wrist Carpal biopsy References Calandruccio ... CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. ...

  9. Carpal tunnel repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100078.htm Carpal tunnel repair - series—Normal anatomy To use the sharing ... in the wrist and the wrist bones (carpal tunnel). Review Date 4/18/2017 Updated by: C. ...

  10. Rate of infection after carpal tunnel release surgery and effect of antibiotic prophylaxis.

    Science.gov (United States)

    Harness, Neil G; Inacio, Maria C; Pfeil, Faith F; Paxton, Liz W

    2010-02-01

    To determine the rate of postoperative wound infection and the association with prophylactic antibiotic use in uncomplicated carpal tunnel release surgery. We performed a multicenter, retrospective review of all the carpal tunnel release procedures performed between January 1, 2005, and August 30, 2007. Data reviewed included the use of prophylactic antibiotics, diabetic status, and the occurrence of postoperative wound infection. We determined the overall antibiotic usage rate and analyzed the correlation between antibiotic use and the development of postoperative wound infection. The rate of surgical site infections in the 3003 patients who underwent carpal tunnel release surgery (group A) was 11. Antibiotic usage data were available for 2336 patients (group B). Six patients without prophylactic antibiotics had infection, as did 5 patients with prophylactic antibiotics. This difference was not statistically significant. Of the 11 surgical site infections, 4 were deep (organ/space) and 7 superficial (incisional). The number of patients with diabetes in the overall study population was 546, 3 of whom had infections. This was not statistically different from the nondiabetic population infection rate (8 patients). The overall infection rate after carpal tunnel release surgery is low. In addition, the deep (organ/space) infection rate is much lower than previously reported. Antibiotic use did not decrease the risk of infection in this study population, including patients with diabetes. The routine use of antibiotic prophylaxis in carpal tunnel release surgery is not indicated. Surgeons should carefully consider the risks and benefits of routinely using prophylactic antibiotics in carpal tunnel release surgery. Therapeutic III. Copyright 2010. Published by Elsevier Inc.

  11. Contested Claims in Carpal Tunnel Surgery: Outcome Study of Worker's Compensation Factors

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    Olney, James R; Quenzer, Delwin E; Makowsky, Michael

    1999-01-01

    We retrospectively analyzed the importance of factors relating to worker's compensation for 273 wrists in 211 consecutive patients who underwent primary carpal tunnel release. Patients were divided into three groups: non-work related, worker's compensation—uncontested, and worker's compensation—contested. Contested claims were those in which the worker's compensation carrier denied authorization for surgery, and in which such authorization was given following intervention by a plaintiff's att...

  12. Complications of Carpal Tunnel Release.

    Science.gov (United States)

    Karl, John W; Gancarczyk, Stephanie M; Strauch, Robert J

    2016-04-01

    Carpal tunnel release for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Complications, though rare, are potentially devastating and may include intraoperative technical errors, postoperative infection and pain, and persistent or recurrent symptoms. Patients with continued complaints after carpal tunnel release should be carefully evaluated with detailed history and physical examination in addition to electrodiagnostic testing. For those with persistent or recurrent symptoms, a course of nonoperative management including splinting, injections, occupational therapy, and desensitization should be considered prior to revision surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Carpal Tunnel Syndrome (For Kids)

    Science.gov (United States)

    ... OK for Kids? Your Teeth Heart Murmurs Carpal Tunnel Syndrome KidsHealth > For Kids > Carpal Tunnel Syndrome Print ... syndrome in the first place. Where Is This Tunnel? Take a look at the palm of your ...

  14. Rehabilitation following carpal tunnel release

    NARCIS (Netherlands)

    Peters, Susan; Page, Matthew J.; Coppieters, Michel W.; Ross, Mark; Johnston, Venerina

    2016-01-01

    Background: Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. This is the first update of a review first published in 2013. Objectives: To review the effectiveness and safety of rehabilitation

  15. Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial.

    Science.gov (United States)

    Wong, Alison L; Martin, Janet; Wong, Michael J; Bezuhly, Michael; Tang, David

    2016-01-01

    In chronic disease management, shared medical appointments have been shown to improve clinic access, productivity and patient education. However, adoption of this model in surgical consultation is limited, and its effect on surgical patients' satisfaction, comfort and surgical risk recall is unknown. To determine whether shared medical appointments could be applied to carpal tunnel surgery consultation while being equally effective as individual consultation for risk recall, patient comfort and satisfaction. A prospective randomized trial involving 80 patients referred for carpal tunnel release consultation, in which patients were assigned to an educational discussion individually or as part of a shared appointment, was conducted. In a blinded fashion, patients were contacted preoperatively to assess their risk recall and postoperatively to rate their overall satisfaction, comfort and satisfaction with the surgeon. Patient demographics were equal. Surgical risk recall was equivalent between shared and individual consults (2.06±1.15 versus 1.64±1.04; P=0.11). More participants in the shared appointments condition remembered the specific risks of infection (61.1% versus 33.3%; P=0.020) and bleeding (30.6% versus 10.3%; P=0.028). There was no difference in overall satisfaction (8.70 versus 8.88; P=0.75), satisfaction with the surgeon (8.05 versus 8.13; P=0.92) or overall comfort (8.80 versus 8.31; P=0.46). Shared medical appointments for carpal tunnel surgery consultation were equivalent to individual consultation in terms of surgical risk recall, patient satisfaction and comfort. These results support the use of shared appointments for large-volume, low-variation surgery.

  16. Surgery for carpal tunnel syndrome under antiplatelet therapy.

    NARCIS (Netherlands)

    Boogaarts, H.D.; Verbeek, A.L.M.; Bartels, R.H.M.A.

    2010-01-01

    OBJECTIVE: Antiplatelet therapy is often instituted after cardiovascular or neurological ischemic events. In general, discontinuation of the antiplatelet medication for several days is warranted previous to surgery. However, discontinuation can lead to ischemic events. For some forms of surgery, the

  17. Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.

    Science.gov (United States)

    Fernández-de-Las Peñas, César; Ortega-Santiago, Ricardo; de la Llave-Rincón, Ana I; Martínez-Perez, Almudena; Fahandezh-Saddi Díaz, Homid; Martínez-Martín, Javier; Pareja, Juan A; Cuadrado-Pérez, Maria L

    2015-11-01

    This randomized clinical trial investigated the effectiveness of surgery compared with physical therapy consisting of manual therapies including desensitization maneuvers in carpal tunnel syndrome (CTS). The setting was a public hospital and 2 physical therapy practices in Madrid, Spain. One hundred twenty women with CTS were enrolled between February 2013 and January 2014, with 1-year follow-up completed in January 2015. Interventions consisted of 3 sessions of manual therapies including desensitization maneuvers of the central nervous system (physical therapy group, n = 60) or decompression/release of the carpal tunnel (surgical group, n = 60). The primary outcome was pain intensity (mean pain and the worst pain), and secondary outcomes included functional status and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire and the self-perceived improvement. They were assessed at baseline and 1, 3, 6, and 12 months by a blinded assessor. Analysis was by intention to treat. At 12 months, 111 (92%) women completed the follow-up (55/60 physical therapy, 56/60 surgery). Adjusted analyses showed an advantage (all, P physical therapy at 1 and 3 months in mean pain (Δ -2.0 [95% confidence interval (CI) -2.8 to -1.2]/-1.3 [95% CI -2.1 to -.6]), the worst pain (Δ -2.9 [-4.0 to -2.0]/-2.0 [-3.0 to -.9]), and function (Δ -.8 [-1.0 to -.6]/-.3 [-.5 to -.1]), respectively. Changes in pain and function were similar between the groups at 6 and 12 months. The 2 groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire at all follow-ups. In women with CTS, physical therapy may result in similar outcomes on pain and function to surgery. http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT01789645. This study found that surgery and physical manual therapies including desensitization maneuvers of the central nervous system were similarly effective at medium-term and long-term follow-ups for improving pain and

  18. 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 endoscopic...

  19. Pre-surgery Disability Compensation Predicts Long-Term Disability among Workers with Carpal Tunnel Syndrome

    Science.gov (United States)

    Spector, June T.; Turner, Judith A.; Fulton-Kehoe, Deborah; Franklin, Gary

    2012-01-01

    Background We sought to identify early risk factors for work disability compensation prior to and after carpal tunnel syndrome (CTS) surgery, and to determine whether pre-surgery disability compensation is associated with long-term disability. Methods Washington State workers’ compensation administrative data and data from interviews with workers 18 days (median) after submitting new workers’ compensation claims for CTS were examined. Baseline risk factors for pre-surgery disability compensation and for long-term disability (≥365 days of work disability compensation prior to two years after claim filing) were evaluated for workers who underwent CTS surgery and had at least one day of disability compensation (N=670). Results After adjustment for baseline long-term disability risk factors, workers with pre-surgery disability compensation had over five times the odds of long-term disability. Baseline factors in multiple domains, including job, psychosocial, clinical, and worker pain and function, were associated with both pre-surgery disability compensation and long-term disability. Conclusions Risk factors for work disability prior to and after CTS surgery are similar, and early work disability is a risk factor for long-term CTS-related disability. An integrated approach to CTS-related disability prevention could include identifying and addressing combined risk factors soon after claim filing, more efficient use of conservative treatments and appropriate work modifications to minimize early work loss, and, when indicated, timely surgical intervention. PMID:22392804

  20. Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery.

    Science.gov (United States)

    Wade, Ryckie G; Wormald, Justin Cr; Figus, Andrea

    2018-02-01

    Carpal tunnel syndrome is a common problem and surgical decompression of the carpal tunnel is the most effective treatment. After surgical decompression, the palmar skin may be closed using either absorbable or non-absorbable sutures. To date, there is conflicting evidence regarding the ideal suture material and this formed the rationale for our review. To assess the effects of absorbable versus non-absorbable sutures for skin closure after elective carpal tunnel decompression surgery in adults on postoperative pain, hand function, scar satisfaction, wound inflammation and adverse events. We searched the following databases on 30 October 2017: the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, and Embase. We searched two clinical trials registries on 30 October 2017. We considered all randomised or quasi-randomised controlled trials comparing absorbable and non-absorbable sutures for skin closure after any form of carpal tunnel decompression surgery in adults. The unit of analysis was the hand rather than the patient. We performed meta-analysis of direct comparisons to generate standardised mean differences (SMDs) with 95% confidence intervals (CIs) in pain scores and risk ratios (RRs) with 95% CIs for dichotomous outcomes, such as wound inflammation. The primary outcome was postoperative pain. Secondary outcomes included hand function, scar satisfaction, scar inflammation and adverse events (complications). We assessed the quality of evidence for key outcomes using GRADE. We included five randomised trials (255 participants). The trials were all European (UK, Republic of Ireland, Denmark and the Netherlands). Where quoted, the mean age of participants was between 48 and 53 years. The trials measured outcomes between one and 12 weeks postoperatively.Meta-analysis of postoperative pain scores for absorbable versus non-absorbable sutures at 10 days following open carpal tunnel decompression (OCTD) produced a SMD of 0.03 (95% CI -0.43 to 0.48; 3

  1. Results of carpal tunnel release

    NARCIS (Netherlands)

    Prick, J.J.W; Blaauw, G.; Vredeveld, J.W.; Oosterloo, Sebe J.

    We evaluated, by means of a prospective study, the results of carpal tunnel release both clinically and electrophysiologically in 188 patients with a carpal tunnel syndrome. A questionnaire was completed by patient and surgeon pre- and post-operatively (6 and 12 months after operation), when

  2. Pathophysiology of carpal tunnel syndrome

    Science.gov (United States)

    Aboonq, Moutasem S.

    2015-01-01

    Carpal tunnel syndrome (CTS) is the most common median nerve neuropathy, accounting for 90% of all neuropathies. Carpal tunnel syndrome presents in 3.8% of the general population, with a higher prevalence among women. There are several risk factors associated with CTS, including both medical and non medical factors. The pathophysiologic mechanisms involved in the median nerve compression and traction are thought to be complex, and as yet are not fully understood. The present review aimed to provide an overview of the pathophysiology of median nerve neuropathy in the carpal tunnel, and subsequent development of CTS. PMID:25630774

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

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    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)

  4. Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis

    Directory of Open Access Journals (Sweden)

    de Moraes Vinícius Ynoe

    2013-01-01

    Full Text Available Abstract Background The assessment of post-surgical outcomes among patients with Workers’ Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients’ time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients. Findings Two authors independently searched MEDLINE (Ovid, Embase (Ovid, CINAHL, Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for Workers’ Compensation patients versus their non-compensated counterparts. We assessed the studies’ quality using the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to work was longer for patients that were compensated and that there was a strong association between this outcome and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p  Conclusions This study demonstrated that compensated patients have a longer return to work time following carpal tunnel release and elective rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving compensation for their condition. Type of study/level of evidence Meta-analysis of prospective Studies/ Level III

  5. Changes in carpal tunnel compliance with incremental flexor retinaculum release.

    Science.gov (United States)

    Ratnaparkhi, Rubina; Xiu, Kaihua; Guo, Xin; Li, Zong-Ming

    2016-04-13

    Flexor retinaculum transection is a routine surgical treatment for carpal tunnel syndrome, yet the biomechanical and clinical sequelae of the procedure remain unclear. We investigated the effects of flexor retinaculum release on carpal tunnel structural compliance using cadaveric hands. The flexor retinaculum was incrementally and sequentially released with transections of 25, 50, 75, and 100 % of the transverse carpal ligament, followed by the distal aponeurosis and then the antebrachial fascia. Paired outward 10 N forces were applied to the insertion sites of the transverse carpal ligament at the distal (hamate-trapezium) and proximal (pisiform-scaphoid) levels of the carpal tunnel. Carpal tunnel compliance was defined as the change in carpal arch width normalized to the constant 10 N force. With the flexor retinaculum intact, carpal tunnel compliance at the proximal level, 0.696 ± 0.128 mm/N, was 13.6 times greater than that at the distal level, 0.056 ± 0.020 mm/N. Complete release of the transverse carpal ligament was required to achieve a significant gain in compliance at the distal level (p < 0.05). Subsequent release of the distal aponeurosis resulted in an appreciable additional increase in compliance (43.0 %, p = 0.052) at the distal level, but a minimal increase (1.7 %, p = 0.987) at the proximal level. Complete flexor retinaculum release provided a significant gain in compliance relative to transverse carpal ligament release alone at both proximal and distal levels (p < 0.05). Overall, complete flexor retinaculum release increased proximal compliance by 52 % and distal compliance by 332 %. The increase in carpal tunnel compliance with complete flexor retinaculum release helps explain the benefit of carpal tunnel release surgery for patients with carpal tunnel syndrome.

  6. Pain and carpal tunnel syndrome.

    Science.gov (United States)

    Duckworth, Andrew D; Jenkins, Paul J; Roddam, Philip; Watts, Adam C; Ring, David; McEachan, Jane E

    2013-08-01

    Pain is not a classical symptom of carpal tunnel syndrome (CTS), with the exception of numbness that is so intense that it is described by patients as painful. The primary aim of our study was to determine which factors correlated with pain for patients diagnosed with CTS. We prospectively assessed all patients diagnosed with CTS in our unit over a 1-year period. We recorded demographic details for all patients, including past medical history, body mass index, smoking, and occupation. The diagnosis and severity of carpal tunnel syndrome were established through a combination of history, clinical assessment, and nerve conduction studies. Of 275 patients diagnosed and treated for CTS, 183 were women (67%), the mean age was 55 years (range, 22-87 y), and 166 cases were bilateral (60%). The mean body mass index was 29.5 kg/m2 (range, 17-48 kg/m2), and 81 patients smoked (30%). Patients completed a Short Form-McGill pain questionnaire (SF-MPQ) as a measure of pain at initial presentation. We assessed outcome 1 year after intervention using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. We found no association between pain according to the SF-MPQ and the positive clinical signs of CTS or positive nerve conduction studies. Multivariate analysis demonstrated that smoking and bilateral disease independently correlated with the overall SF-MPQ, with similar findings on subanalysis. Independent factors associated with an increased improvement in the QuickDASH at 1 year were the presentation QuickDASH score, positive nerve conduction studies, and smoking. The only independent factors that correlated with pain at presentation of CTS were smoking and bilateral disease. Pain according to the SF-MPQ was not associated with classical clinical findings of the disease or with positive findings on nerve conduction testing. Prognostic I. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. 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.

  8. Outcomes of open carpal tunnel decompression.

    Science.gov (United States)

    Nanavati, Nikhil; Walker-Bone, Karen; Stanworth, Helen; Williams, Christopher

    2013-02-15

    Carpal tunnel syndrome (CTS) is the commonest peripheral neuropathy in the UK. The aim of this study was to characterise the satisfaction and evaluate the symptoms of postoperative patients having undergone open carpal tunnel decompression. A questionnaire comprising of 6 sections was sent to 241 eligible participants. Subjects were asked to provide their demographic information and to quantify preoperative and postoperative numbness and tingling. The target population was also asked to indicate areas of postoperative numbness and tingling on a Katz hand diagram. Symptom severity and quality of life scores were also assessed. This study received 89 usable responses. From analysis of the Katz hand diagrams if was possible to distinguish that 17 subjects (19.1%) had 'persistent' symptoms following carpal tunnel decompression and 72 subjects (80.9%) showed signs of symptomatic improvement. The 17 individuals with persistent symptoms were further assessed for significance between variables. Of these, most were of older age, mainly female, unemployed, with lower mental health and vitality scores. With significance testing, it was shown that lower mental health scores may contribute to a poorer response to surgery (p=0.096). Most subjects experienced a positive response to surgical intervention, however, it may be necessary to screen patients for signs of depression before undertaking any surgery. By taking a more holistic preoperative assessment and aiding patients to seek treatment for any mental health conditions, this study postulates that outcomes of open carpal decompression could be improved.

  9. Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

    Directory of Open Access Journals (Sweden)

    Nazım Karalezli

    2013-01-01

    Full Text Available Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1 the transverse carpal ligament and the distal forearm fascia intact, (2 only the transverse carpal ligament incised, (3 the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.

  10. Trophic ulcers in the carpal tunnel syndrome

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    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.

  11. 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.

  12. Surgical ultrasound-guided carpal tunnel release.

    Science.gov (United States)

    Apard, T; Candelier, G

    2017-10-01

    Ultrasound-guided surgery is a new trend stemming from the introduction of high-frequency linear probes and better quality screens. Surgical treatment of carpal tunnel syndrome is increasingly being performed under ultrasound guidance. Knowledge of musculoskeletal ultrasonography is obviously mandatory. Several types of cutting instruments (miniature knife, Gigli saw or hook) and surgical approaches (wrist or palm) have been described. Ultrasonography allows the wide-awake and local anesthesia with no tourniquet (WALANT) technique to be used in the context of ambulatory patient care. The practitioner must be aware of all the possible intraoperative and postoperative complications, and be able to treat them. The aim of this review is to analyze the literature on the feasibility and outcomes of surgical ultrasound-guided carpal tunnel release, and to compare it to the other validated techniques. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  13. Diagnosis of Carpal Tunnel Syndrome

    OpenAIRE

    Keith, Michael Warren; Masear, Victoria; Chung, Kevin; Maupin, Kent; Andary, Michael; Amadio, Peter C.; Barth, Richard W.; Watters, William C.; Goldberg, Michael J.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.

    2009-01-01

    This clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decision-making processes involved in managing the diagnosis of carpal tunnel syndrome. The methods used to develop this clinical practice guideline were designed to combat bias, enhance transparency, and promote reproducibility. The guideline’s recommendations are as follows: The physician should obtain an accurate patient history. The physician should perform a physica...

  14. PA01.49.Carpal tunnel syndrome: A case report

    OpenAIRE

    Gandhi, Rahul S; Manoj Kumar, A K

    2012-01-01

    Purpose: Carpal tunnel syndrome is an entrapment neuropathy of median nerve causing paraesthesia, pain, numbness and other symptoms in the distribution of median nerve due to its compression at wrist in carpal tunnel. Modern medicine prescribes surgery for its treatment. We report a case that was treated completely without any recurrence. Method: Case presentation: A female patient aged 23 years presented with numbness in the middle finger of left hand associated with paraesthesia, morning st...

  15. Diagnosis of Carpal Tunnel Syndrome

    Science.gov (United States)

    Keith, Michael Warren; Masear, Victoria; Chung, Kevin; Maupin, Kent; Andary, Michael; Amadio, Peter C.; Barth, Richard W.; Watters, William C.; Goldberg, Michael J.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.

    2016-01-01

    This clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decision-making processes involved in managing the diagnosis of carpal tunnel syndrome. The methods used to develop this clinical practice guideline were designed to combat bias, enhance transparency, and promote reproducibility. The guideline’s recommendations are as follows: The physician should obtain an accurate patient history. The physician should perform a physical examination of the patient that may include personal characteristics as well as performing a sensory examination, manual muscle testing of the upper extremity, and provocative and/or discriminatory tests for alternative diagnoses. The physician may obtain electrodiagnostic tests to differentiate among diagnoses. This may be done in the presence of thenar atrophy and/or persistent numbness. The physician should obtain electrodiagnostic tests when clinical and/or provocative tests are positive and surgical management is being considered. If the physician orders electrodiagnostic tests, the testing protocol should follow the American Academy of Neurology/American Association of Neuromuscular and Electrodiagnostic Medicine/American Academy of Physical Medicine and Rehabilitation guidelines for diagnosis of carpal tunnel syndrome. In addition, the physician should not routinely evaluate patients suspected of having carpal tunnel syndrome with new technology, such as magnetic resonance imaging, computed tomography, and pressure-specified sensorimotor devices in the wrist and hand. This decision was based on an additional nonsystematic literature review following the face-to-face meeting of the work group. PMID:19474448

  16. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... make CTS better and help relieve symptoms. Massage, yoga, ultrasound, chiropractic manipulation, and acupuncture are just a ... tunnel syndrome > A-Z Health Topics Related information Menopause Pregnancy The javascript used in this widget is ...

  17. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... is not confined to people in a single industry or job, but is especially common in those ... tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide ...

  18. Management and employee agreement on reports of organizational policies and practices important in return to work following carpal tunnel surgery.

    Science.gov (United States)

    Ossmann, Janet; Amick, Benjamin C; Habeck, Rochelle V; Hunt, Allan; Ramamurthy, Gopika; Soucie, Valerie; Katz, Jeffrey N

    2005-03-01

    This study's purpose was to assess the agreement between management and employee ratings of organizational policies and practices (OPP) involved in the return to work process following carpal tunnel surgery. As a part of the prospective community-based Maine Carpal Tunnel II Study, 65 manager and employee pairs completed a questionnaire tapping four OPP dimensions. people oriented culture, safety climate, ergonomic practices, and disability management. It was hypothesized that managers and employees would agree on their assessment of the four OPPs and a composite organizational support index. Agreement was assessed using Lin's concordance correlation coefficient. Employee and manager ratings were similar for the organizational support index (rho(c) = 0.14, p = 0.08), and people oriented culture (rho(c) = 0.25, p = 0.01) but not the other three OPPs. In larger companies (>450 employees), ratings were also similar for safety climate (rho(c) = 0.24, p = 0.09), disability management (rho(c) = 0.22, p = 0.07) and ergonomic practices (rho(c) = 0.35, p = 0.02). In unionized companies there was agreement for safety climate (rho = 0.44, p = 0.02), disability management (rho(c) = 0.41, p = 0.01) and ergonomic practices (rho(c) = 0.40, p = 0.06). These preliminary results suggest employees can report on certain OPPs and that an employee questionnaire can be used to assess organizational support. Given recent evidence that employee ratings of OPPs are predictive of injury/illness incidence, work disability and return-to-work outcomes, further research is needed to confirm these findings.

  19. ENDOSCOPIC TREATMENT OF CARPAL TUNNEL SYNDROME

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    Samo K. Fokter

    2001-12-01

    Full Text Available Background. Carpal tunnel syndrome (CTS is a frequent cause of hand pain, numbness and paresthesias. Clinical outcome studies have been shown that endoscopic transverse carpal ligament release is an effective operation for treating idiopathic CTS. This retrospective study was designed to determine the one- to five-year outcome of endoscopic surgery for this disease.Methods. Single portal endoscopic carpal tunnel release (ECTR was performed on 68 hands in 48 patients who had clinical signs and symptoms consistent with CTS confirmed with electrodiagnostic studies. Charts were reviewed and the following data were obtained: age, duration of symptoms, time of hospitalization and complications. 57 cases (40 patients responded to a questionnaire and follow-up nerve conduction studies were available in 44 cases (65% of the entire cohort. The data of electrodiagnostic studies before treatment and at follow-up were statistically compared.Results. In two cases symptoms persisted and open surgery was performed two months after endoscopic procedure. Majority of hands (49 out of 57; 86% were pain-free at the final follow-up. Electrodiagnostic studies confirmed significant difference in nerve conduction latencies, action potentials (p < 0.01 and sensory conduction velocities (p < 0.05.Conclusions. ECTR offers safe decompression of the median nerve. The resumption of activities of daily living is short and many patients are allowed to return to work soon.

  20. 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

  1. Morphological Analysis of the Carpal Tunnel

    Science.gov (United States)

    Pacek, Corey A.; Tang, Jie; Goitz, Robert J.; Kaufmann, Robert A.

    2009-01-01

    Although carpal tunnel release is one of the most commonly performed procedures in the USA, the morphology of the carpal tunnel as determined previously in the literature has been questioned. Previous methodology has been questioned for accuracy by recent studies. The purpose of this study was to perform a morphological analysis of the carpal tunnel and correlate carpal tunnel and hand dimensions. The carpal tunnels of ten cadaveric specimens were emptied of their contents and a silicone cast of the carpal tunnel was then created. This cast was then digitized, and the dimensions of the carpal tunnel were calculated. These dimensions were compared with the measured hand dimensions of the specimens. The width, depth, tilt angle, length, cross-sectional area, and volume of the carpal tunnel were 19.2 ± 1.7 mm, 8.3 ± 0.9 mm, 14.8 ± 7.8°, 12.7 ± 2.5 mm, 134.9 ± 23.6 mm2, and 1,737 ± 542 mm3, respectively. Width, depth, and cross-sectional area did not change significantly along the length of the carpal tunnel, but tilt angle did. The width of the palm strongly correlates with the width of the carpal tunnel. Other dimensional correlations did not reach statistical significance. The carpal tunnel is of uniform dimension along its length. The long axis of the carpal tunnel in cross-section rotates volarly from the radial side of the hand increasingly with distal progression along the carpal tunnel. Based on our analysis of ten cadaveric specimens, the width of the carpal tunnel may be estimated by the width of the palm using the equation: \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ {\\text{Widt}}{{\\text{h}}_{\\text{CT}}} = 1.285 + 0.236 \\times {\\text{Widt}}{{\\text{h}}_{\\text{palm}}} $$\\end{document}. PMID:19760464

  2. Aberrant Radial Artery Causing Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Zinon T. Kokkalis

    2016-07-01

    Full Text Available Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.

  3. Aberrant Radial Artery Causing Carpal Tunnel Syndrome.

    Science.gov (United States)

    Kokkalis, Zinon T; Tolis, Konstantinos E; Megaloikonomos, Panayiotis D; Panagopoulos, Georgios N; Igoumenou, Vasilios G; Mavrogenis, Andreas F

    2016-06-01

    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic.

  4. Rehabilitation following carpal tunnel release.

    Science.gov (United States)

    Peters, Susan; Page, Matthew J; Coppieters, Michel W; Ross, Mark; Johnston, Venerina

    2016-02-17

    Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. This is the first update of a review first published in 2013. To review the effectiveness and safety of rehabilitation interventions following CTS surgery compared with no treatment, placebo, or another intervention. On 29 September 2015, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, AMED, LILACS, and PsycINFO. We also searched PEDro (3 December 2015) and clinical trials registers (3 December 2015). Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo, or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery. Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and assessed the quality of the body of evidence for primary outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach according to standard Cochrane methodology. In this review we included 22 trials with a total of 1521 participants. Two of the trials were newly identified at this update. We studied different rehabilitation treatments including immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multi-modal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo, four compared rehabilitation to a no treatment control, three compared rehabilitation to standard care, and 15 compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Thirteen trials explicitly reported random sequence generation; of these, five adequately concealed the

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

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    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.

  6. 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.

  7. Restoration of hand function and ability to perform activities of daily living following surgery for carpal tunnel syndrome.

    Science.gov (United States)

    Szczechowicz, Jakub; Pieniazek, Marek; Pelczar-Pieniazek, Maria

    2008-01-01

    The aim of the study was to assess treatment efficacy in patients following surgery for carpal tunnel syndrome and compare hand function with patients' subjective evaluation and their ability to carry out activities of daily living. The study involved patients undergoing rehabilitation at the Małopolska Region Hand Rehabilitation Centre at L. Rydygier Specialized Hospital in Cracow and at the Hand Rehabilitation Unit at the Scanmed Medical Centre in Cracow. The patients were admitted to the Centre after surgical release of the transverse ligament of the wrist. Fifty hands (40 patients) were evaluated and treated. The rehabilitation programme was customised for each patient, and included patient education, a programme of home-based exercises and physiotherapeutic treatment in our centres. The patients were evaluated twice: before starting rehabilitation and at the end of the treatment. Hand function was evaluated using Swanson's method, the Alderson-McGall Hand Function Questionnaire and the Nine Hole Peg Test. Patients were also asked to provide a subjective evaluation of the typical signs and symptoms of CTS. The study showed improvement in all tests and a high level of correlation between various evaluations of hand function and patients' subjective feelings. The time at which post-operative rehabilitation was started significantly affected the outcomes of rehabilitation in the study group. There was a significant correlation between hand function impairment and subjective feelings of the patients vs. their quality of daily living.

  8. Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients

    Science.gov (United States)

    Marquardt, Tamara L.; Evans, Peter J.; Seitz, William H.; Li, Zong-Ming

    2015-01-01

    The purpose of this study was to investigate the morphological changes of the carpal arch and median nerve during the application of radiounlarly directed compressive force across the wrist in patients with carpal tunnel syndrome. Radioulnar compressive forces of 10 N and 20 N were applied at the distal level of the carpal tunnel in 10 female patients diagnosed with carpal tunnel syndrome. Immediately prior to force application and after 3 minutes of application, ultrasound images of the distal carpal tunnel were obtained. It was found that applying force across the wrist decreased the carpal arch width (p carpal arch height (p carpal arch curvature (p carpal arch area (p carpal arch can be non-invasively augmented by applying compressive force across the wrist, and that this strategy may decompress the median nerve providing symptom relief to patients with carpal tunnel syndrome. PMID:26662276

  9. Anatomic variant of the median nerve in the carpal tunnel.

    Science.gov (United States)

    Steinberg, E L; Luger, E; Taitz, C; Arensburg, B

    1998-07-01

    Forty-six hands of 23 cadavers (15 female and 8 male) were dissected to observe the patterns of distribution of the median nerve. The findings showed that in 33 hands the median nerve had a normal distribution of its branches. Also identified was the commonly recognized transligamentous variant, where the recurrent branch pierces the carpal ligament 2 to 4 mm proximal to the distal end of the carpal tunel. This latter variant occurred in 13 hands. The current study focused on the presence of an additional variant, not previously identified, that occurred in 10 hands. This branch, considered sensory, was approximately 1 mm wide and pierced the lateral carpal ligament 3 to 6 mm distal to the proximal edge of the tunnel. The importance of recognition of variants of median nerve distribution in surgery of the carpal tunnel is emphasized.

  10. Neuropraxia of the palmar cutaneous branch of the ulnar nerve during carpal tunnel decompression.

    Science.gov (United States)

    Akhtar, S; Arenas Prat, J; Sinha, S

    2005-05-01

    Carpal tunnel syndrome is one of the most commonly encountered conditions in the hand clinic and carpal tunnel decompression is the most frequently performed procedure in hand surgery. It is an effective procedure for patients with carpal tunnel syndrome. However, there is a high risk of complications that can be avoided with an understanding of wrist anatomy, appropriate planning and execution. We highlight one such complication, a case of neuropraxia of the palmar cutaneous branch of the ulnar nerve that followed carpal tunnel decompression.

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

    Directory of Open Access Journals (Sweden)

    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

  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. Acute carpal tunnel syndrome in a patient with haemophilia

    Science.gov (United States)

    Mayne, Alistair Ivan William; Howard, Anthony; Kent, Matthew; Banks, Joanne

    2012-01-01

    Acute carpal tunnel syndrome (CTS) is a rare surgical condition usually resulting from wrist trauma. We present the case of a young haemophilic man who developed acute CTS following trivial injury. The patient was initially managed conservatively but symptom progression resulted in carpal tunnel decompression. A literature review and management approach are presented. This is an important complication of haemophilia to be aware of as prompt conservative management can obviate the need for surgery. This case is useful in (a) highlighting the importance of considering a patient's medical history when formulating differential diagnoses and (b) outlining a management approach to this condition. PMID:22761230

  14. Segmental carpal canal pressure in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Ikeda, Kazuo; Osamura, Naoki; Tomita, Katsuro

    2006-01-01

    To clarify which part of the median nerve is the most compressed and to compare carpal canal pressure with the latency of the sensory nerve potential and the duration of symptoms. Fifteen patients with idiopathic carpal tunnel syndrome were studied using a pressure guidewire system to record canal pressure. The wire was introduced from the distal end of the carpal canal to 2 cm proximal to the distal wrist crease (DWC) and then retracted in 5-mm increments using an image intensifier to guide the progress. A nerve conduction study was performed, and all patients were asked how long the symptoms lasted. Carpal canal pressure was significantly higher 5 to 15 mm distal to the DWC. The most compressed point was 10 mm distal to the DWC, with a pressure of 44.9 +/- 26.4 mm Hg. The correlation coefficient between the highest canal pressure and the latency was 0.393 and between highest canal pressure and duration of symptoms was 0.402. Our study showed that the most compressed part of the median nerve in the carpal canal is 10 mm distal to the DWC. The carpal canal pressure was related to the latency and to the duration of symptoms.

  15. Quantitative MRI analysis of idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Oge, Halil Kamil; Acu, Berat; Gucer, Tacettin; Yanik, Tugra; Savlarli, Safak; Firat, Mehmet Murat

    2012-01-01

    The aim of this study was to try to find parametric ratios for the diagnosis and pathophysiology of carpal tunnel syndrome using MR. Dominant side wrist MRI examinations of 27 female carpal tunnel patients and 21 normal females were compared. The carpal tunnel contents area / carpal tunnel cross section area ratio was defined, analysed and discussed with the literature. Carpal tunnel contents / wrist area ratios of the carpal tunnel patients were measured and compared with the control group. This comparison revealed that the proportion of the contents of the carpal tunnel is increased in the carpal tunnel syndrome patients. Palmar bowing was found to be increased and median nerve cross section area was found to be increased at the proximal entrance of the carpal tunnel. As Phalen has postulated, the volume of the contents of the carpal tunnel were found to be increased in the carpal tunnel syndrome patients. Carpal tunnel cross section areas remained the same with the control group. This increase can be demonstrated by MRI imaging which can provide an evidence for the pathophysiology of carpal tunnel syndrome.

  16. Optimal management of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Shimpei Ono

    2010-08-01

    Full Text Available Shimpei Ono, Philip J Clapham, Kevin C ChungSection of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USAAbstract: In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS published a guideline for treatment of carpal tunnel syndrome (CTS in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen randomized, controlled trials and 12 systematic reviews, including three Cochrane database systematic reviews, were retrieved. Our review revealed that most of the recent studies support the AAOS guideline. However, the recent literature demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation, although the AAOS guideline recommends early surgical treatment only for cases with denervation. The usefulness of splinting and steroids as initial treatments for improving patients’ symptoms are also supported by the recent literature, but these effects are temporary. The evidence level for ultrasound treatment is still low, and further studies are needed to determine the effectiveness of this treatment. Finally, our review revealed a paucity of articles comparing the costs of CTS diagnosis and treatment. With the recent focus on health care reform and rising costs, attention to the direct and indirect costs of health care is important for all conditions. Future well designed studies

  17. Treatment for carpal tunnel syndrome by coronal Z-type lengthening of the transverse carpal ligament.

    Science.gov (United States)

    Xu, Lin; Huang, Fei; Hou, Chunlin

    2011-11-01

    To compare the effects of coronal Z-type lengthening of transverse carpal ligament with conventional open approach for carpal tunnel syndrome. A double-blinded study was conducted from January 2005 to August 2008 on 68 patients with a mean age of 41 years (range 27-55 years) diagnosed as severe carpal tunnel syndrome. They were randomized into two groups(A and B). Patients in group A underwent coronal Z-type lengthening of transverse carpal ligament; and patients in group B had conventional open approach surgery. Postoperative evaluation was scheduled at 1, 3, 6 and 12 months after the surgery and incidence rate of bowstring of the flexor tendons, improvement of grip strength and ADL activities of daily living) score were recorded. Fifty-eight patients had been followed up successfully, 30 and 28 for group A and B respectively. The Scar Tissue Formation of the flexor tendons in group B was observed more than that in group A at 6 and 12 month after operation. Improvement of grip strength were observed in two groups, which was statistically different between 6 and 12 months after operation and no significant difference was seen between 1 and 3 months after operation. According to ADL, the satisfaction rates documented on form for patients were statistically different in the two groups at 6 and 12 months after operation and no difference was noted at 1 and 3 months after operation. Excellent improvement of function and satisfaction were achieved by Coronal Z-type reconstruction of the flexor retinaculum for severe carpal tunnel syndrome. Our method offers a more effective alternative method for conventional carpal tunnel open decompression surgery.

  18. Objectification of surgical treatment of carpal tunnel syndrome

    OpenAIRE

    Dvořáková, Marie

    2011-01-01

    Title: Objectification of surgical treatment of carpal tunnel syndrome Objectives: The main aim of this work is to evaluate the effectiveness of surgical treatment of carpal tunnel syndrome. Methods: In this work was used a two-point discrimination test, that evaluated tactile sensory of the hand with carpal tunnel syndrome. It evaluated the change of discriminatory sensation after surgical treatment of carpal tunnel syndrome. The results of testing were evaluated by using the SigmaPlot stati...

  19. 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.

  20. 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. Copyright 2012, SLACK Incorporated.

  1. Effect of Carpal Tunnel Syndrome on the Ulnar Nerve at the Wrist: Sonographic and Electrophysiologic Studies.

    Science.gov (United States)

    Kang, Seok; Yang, Seung Nam; Yoon, Joon Shik; Kang, Hyo Jeong; Won, Sun Jae

    2016-01-01

    The aim of this study was to compare the ulnar nerve at the wrist by sonographic and electrophysiologic studies between patients with carpal tunnel syndrome and control participants and to verify the effect of carpal tunnel syndrome of the ulnar nerve at the wrist. Forty-two hands of patients with carpal tunnel syndrome and 37 hands of control participants were examined. Electrophysiologic studies of the ulnar nerve were done in all participants. The cross-sectional areas of the median and ulnar nerves at the wrist were evaluated by sonography. Fifteen hands of patients with carpal tunnel syndrome who underwent carpal tunnel release were also evaluated by sonography after the operation. The ulnar nerve cross-sectional area of the patients with carpal tunnel syndrome (mean ± SD, 5.16 ± 1.04 mm(2)) was significantly larger than that of the controls (3.56 ± 0.52 mm(2); P carpal ligament, the cross-sectional area of the ulnar nerve was significantly smaller than the size measured prior to surgery (P carpal tunnel syndrome and controls in ulnar nerve conduction. There were no statistically significant differences in nerve conduction study results or cross-sectional area of the ulnar nerve between patients with carpal tunnel syndrome with and without extramedian symptoms. The cross-sectional areas of the ulnar and median nerves at the wrist are increased in patients with carpal tunnel syndrome. Also, the cross-sectional area of the ulnar nerve is decreased after carpal tunnel release. © 2016 by the American Institute of Ultrasound in Medicine.

  2. 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…

  3. 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…

  4. Endoscopic release for carpal tunnel syndrome.

    Science.gov (United States)

    Vasiliadis, Haris S; Georgoulas, Petros; Shrier, Ian; Salanti, Georgia; Scholten, Rob J P M

    2014-01-31

    (95% CI 62% to 19%). ECTR more frequently resulted in transient nerve problems (ie, neurapraxia, numbness, and paraesthesiae), while OCTR had more wound problems (ie, infection, hypertrophic scarring, and scar tenderness). ECTR was safer than OCTR when the total number of complications were assessed (20 studies, RR 0.60, 95% CI 0.40 to 90) representing a relative drop in the probability by 40% (95% CI 60% to 10%).Rates of recurrence of symptoms and the need for repeated surgery were comparable between ECTR and OCTR groups.The overall risk of bias in studies that contribute data to these results is rather high; fewer than 25% of the included studies had adequate allocation concealment, generation of allocation sequence or blinding of the outcome assessor.The quality of evidence in this review may be considered as generally low. Five of the studies were presented only as abstracts, with insufficient information to judge their risk of bias. In selection bias, attrition bias or other bias (baseline differences and financial conflict of interest) we could not reach a safe judgement regarding a high or low risk of bias. Blinding of participants is impossible due to the nature of interventions.We identified three further potentially eligible studies upon updating searches just prior to publication. These compared ECTR with OCTR (two studies) or mini-open carpal tunnel release (one study) and will be fully assessed when we update the review. In this review, with support from low quality evidence only, OCTR and ECTR for carpal tunnel release are about as effective as each other in relieving symptoms and improving functional status, although there may be a functionally significant benefit of ECTR over OCTR in improvement in grip strength. ECTR appears to be associated with fewer minor complications compared to OCTR, but we found no difference in the rates of major complications. Return to work is faster after endoscopic release, by eight days on average. Conclusions from this

  5. Tensile properties of the transverse carpal ligament and carpal tunnel complex.

    Science.gov (United States)

    Ugbolue, Ukadike C; Gislason, Magnus K; Carter, Mark; Fogg, Quentin A; Riches, Philip E; Rowe, Philip J

    2015-08-01

    A new sophisticated method that uses video analysis techniques together with a Maillon Rapide Delta to determine the tensile properties of the transverse carpal ligament-carpal tunnel complex has been developed. Six embalmed cadaveric specimens amputated at the mid-forearm and aged (mean (SD)): 82 (6.29) years were tested. The six hands were from three males (four hands) and one female (two hands). Using trigonometry and geometry the elongation and strain of the transverse carpal ligament and carpal arch were calculated. The cross-sectional area of the transverse carpal ligament was determined. Tensile properties of the transverse carpal ligament-carpal tunnel complex and Load-Displacement data were also obtained. Descriptive statistics, one-way ANOVA together with a post-hoc analysis (Tukey) and t-tests were incorporated. A transverse carpal ligament-carpal tunnel complex novel testing method has been developed. The results suggest that there were no significant differences between the original transverse carpal ligament width and transverse carpal ligament at peak elongation (P=0.108). There were significant differences between the original carpal arch width and carpal arch width at peak elongation (P=0.002). The transverse carpal ligament failed either at the mid-substance or at their bony attachments. At maximum deformation the peak load and maximum transverse carpal ligament displacements ranged from 285.74N to 1369.66N and 7.09mm to 18.55mm respectively. The transverse carpal ligament cross-sectional area mean (SD) was 27.21 (3.41)mm(2). Using this method the results provide useful biomechanical information and data about the tensile properties of the transverse carpal ligament-carpal tunnel complex. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. 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.

  7. Comparing the results of limited incision technique and standard longitudinal incision technique for carpal tunnel decompression by numerical grading system.

    Science.gov (United States)

    Uygur, Fatih; Sever, Celalettin; Yüksel, Fuat

    2009-01-01

    The carpal tunnel syndrome is the most common nerve entrapment syndrome. Many different methods have been described for treatment. We performed a novel method to release the carpal tunnel. Subsequently, we compared the surgery results of this novel limited incision technique and the standard longitudinal incision technique by using a 'Numerical Grading System'. There is no reported study about the use of 'Numerical Grading System' for assessment of carpal tunnel syndrome in the literature. The novel technique is simple and effective, employs inexpensive instruments, and has a low complication rate. The aim of this paper is to record a novel limited incision technique and a new assessment method for the carpal tunnel syndrome.

  8. Minimally invasive carpal tunnel decompression using the KnifeLight.

    Science.gov (United States)

    Hwang, Peter Y K; Ho, Chi Long

    2007-02-01

    Carpal tunnel syndrome is a common condition causing hand pain, dysfunction, and paresthesia. Endoscopic carpal tunnel decompression offers many advantages compared with conventional open surgical decompression. However, it is equipment intensive and requires familiarity with endoscopic surgery. We review a minimally invasive technique to divide the flexor retinaculum by using a new instrument, the KnifeLight (Stryker, Kalamazoo, Michigan), which combines the advantages of the open and endoscopic methods, without the need for endoscopic set-up. Between July 2003 and April 2005, 44 consecutive patients (26 women [59%] and 18 men [36%]), with clinical signs and symptoms, as well as electrodiagnostic findings consistent with carpal tunnel syndrome, who did not respond to non-surgical treatment, underwent the new procedure. All patients were asked about scar hypertrophy, scar tenderness, and pillar pain. The Michigan Hand Outcomes Questionnaire (MHQ) was used to determine overall hand function, activities of daily living, work performance, pain, aesthetics, and satisfaction with hand function. Other preoperative testing included grip strength and lateral pinch strength. Grip strength was measured using the Jamar hand dynamometer (Asimov Engineering Co., Los Angeles, CA); lateral key pinch was measured using the Jamar hydraulic pinch gauge. Postoperative evaluations were scheduled at 2 weeks, 3 months, and 6 months after the procedure. A small 10-mm incision was made in the wrist crease and a small opening was made at the transverse carpal ligament. The KnifeLight tool was inserted, and the ligament was incised completely. Follow-up evaluations with use of quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at 2 weeks, 3 months, and 6 months after surgery. Fifty procedures were performed on 22 left hands (44%) and 28 right hands (56%). There were no complications related to the approach. All patients were able to use their hands

  9. Kinesiotherapy and physical therapy for carpal tunnel syndrome

    OpenAIRE

    Sochová, Jitka

    2013-01-01

    Author: Jitka Sochová Institution: Department of Rehabilitation Medicine The Faculty of Medicine in Hradec Králové Title: Kinesiotherapy and physical therapy for carpal tunnel syndrome Supervisor: Mgr. Zuzana Hamarová Pages: 128 Inserts: 7 The year of presentation: 2013 Keywords: Carpal tunnel, rehabilitation therapy, entrapment syndromes, electromyography This Bachelor Diploma deals with carpal tunnel syndrome. In theoretical part I focus on anatomy, lead and innervation of the median nerve,...

  10. Wrist immobilization after carpal tunnel release: a prospective study

    OpenAIRE

    Martins Roberto S.; Siqueira Mario G.; Simplício Hougelli

    2006-01-01

    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...

  11. Alternative diagnostic technique for carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, Katsuhiko; Nakane, Takashi [Aiko Orthopaedic Hospital, Nagoya (Japan); Kobayashi, Shigeru; Shibata, Kunio [Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine

    2002-10-01

    Compressive and entrapment neuropathies are common clinical syndromes characterized by neurologic deficits due to mechanical or dynamic compression of peripheral nerves. However, the definitive diagnosis based on clinical symptoms alone is difficult in many cases, and the electrophysiological diagnostic method is solely used as a supplementary diagnostic method at present. As a new diagnostic method for entrapment neuropathy, the present study investigated the usefulness of gadolinium-enhanced MRI in carpal tunnel syndrome. On enhanced MRI of idiopathic carpal tunnel syndrome, contrast-enhancement in the median nerve was found in 30 of 34 hands (88.2%). Enhanced MRI allows to visualize intraneural edema in the nerve easily on the naked eye. Therefore, this technique supplied useful information for making definitive diagnosis and is promising as a non-invasive diagnostic method for entrapment neuropathy. (author)

  12. Carpal tunnel syndrome in spinal patients

    OpenAIRE

    Zmeškalová, Petra

    2007-01-01

    The aim of this work is confirming of incidence carpal tunnel syndrom in patients with spinal cord lesion. This ailment stem from repetitive loading of hands on propulsion of mechanical wheelchair. Work contains the causes of biginning, risk factors for patients, prevention, conservative and operation therapy. Thesis involves characteristic of patient after spinal cord injury, seat and wheelchair propulsion. The practice task contains case report of patient and suggestion of therapy for her. ...

  13. Rehabilitation of the carpal tunnel syndrome

    OpenAIRE

    Chorvátová, Magdaléna

    2010-01-01

    In the theoretical part the thesis gathers basic information on carpal tunnel syndrome (CTS) - its etiology, pathophysiology and clinical picture. The thesis further describes the anatomy and function of hand following the CTS, the diagnosis of disease and treatment options. The thesis also presents possibilities of prevention when working with computers. In the practical part the thesis describes a case of a patient with the CTS disease and suggests using an appropriate treatment methods to ...

  14. 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.

  15. Hyperventilation provokes symptoms of carpal tunnel syndrome.

    Science.gov (United States)

    Aslam, U; Afzal, S; Syed, Shakir

    2012-01-01

    Hyperventilation causes respiratory alkalosis. The nervous system is more excitable in alkalosis. This phenomenon can be observed as paraesthesia in fingers and toes as well as around the lips in anxious patients breathing rapidly. We wanted to test this phenomenon on already irritable nerves like the median nerve in carpal tunnel syndrome (CTS). We deployed 50 patients who came in to the day case unit for carpal tunnel decompression with electro-physiologically proven diagnosis. We devised a test whereby patients were made to hyperventilate under prescribed conditions and repeated Phalen's test and Tinel's sign for comparison. These were compared with a control group chosen randomly among hospital staff. 86% patients had a positive result which was just behind Phalen's test in sensitivity. It was also 100% specific as there were no false positives. Hyperventilation is a phenomenon which provokes carpal tunnel syndrome. Its clinical value remains to be seen due to cumbersome method and probable patient non-compliance but it is a new discovery. It may be useful in other irritable-nerve-syndromes as a test to add to our available armament. It may be an additional factor or a primary reason for nocturnal paraesthesias in CTS patients.

  16. Is one-stop surgery for carpal tunnel syndrome safe? A retrospective long-term follow-up study in a neurosurgical unit in Copenhagen.

    Science.gov (United States)

    Jørgensen, Louise Møller; Piil, Karin; Bashir, Asma; Larsen, Morten Bo; Poggenborg, Pamela Santiago; Bjørck, Sebastian; Fugleholm, Kåre

    2017-09-25

    The aim of this study was to evaluate one-stop surgery (OSS) for carpal tunnel syndrome (CTS) regarding symptom relief and patient satisfaction. OSS in our setting means only one visit to the hospital for surgery and no hospital appointments for preassessment or follow-up. We hypothesised that relief of symptoms with OSS is comparable with that in non-OSS patients reported in the literature. This is a long-term retrospective follow-up study (56.5 months) of 1003 patients referred for CTS and discharged with or without surgery from an OSS clinic. Of the original cohort, 671 patients completed the long-term follow-up telephone interview. Two-thirds of the patients were free of even minor symptoms following surgery. The symptom relief and patient satisfaction in this study were comparable with results in non-OSS patients reported in the literature. The implementation of a clinical pathway and OSS for the management of CTS was safe with good long-term symptom relief and high patient satisfaction. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Carpal and cubital tunnel and other, rarer nerve compression syndromes.

    Science.gov (United States)

    Assmus, Hans; Antoniadis, Gregor; Bischoff, Christian

    2015-01-05

    Carpal tunnel syndrome is by far the most common peripheral nerve compression syndrome, affecting approximately one in every six adults to a greater or lesser extent. Splitting the flexor retinaculum to treat carpal tunnel syndrome is the second most common specialized surgical procedure in Germany. Cubital tunnel syndrome is rarer by a factor of 13, and the other compression syndromes are rarer still. This review is based on publications retrieved by a selective literature search of PubMed and the Cochrane Library, along with current guidelines and the authors' clinical and scientific experience. Randomized controlled trials have shown, with a high level of evidence, that the surgical treatment of carpal tunnel syndrome yields very good results regardless of the particular technique used, as long as the diagnosis and the indication for surgery are well established by the electrophysiologic and radiological findings and the operation is properly performed. The success rates of open surgery, and the single-portal and dual-portal endoscopic methods are 91.6%, 93.4% and 92.5%, respectively. When performed by experienced hands, all these procedures have complication rates below 1%. The surgical treatment of cubital tunnel syndrome has a comparably low complication rate, but worse results overall. Neuro-ultrasonography and magnetic resonance imaging (neuro-MRI) are increasingly being used to complement the diagnostic findings of electrophysiologic studies. Evidence-based diagnostic methods and treatment recommendations are now available for the two most common peripheral nerve compression syndromes. Further controlled trials are needed for most of the rarer syndromes, especially the controversial ones.

  18. Expected and Actual Improvement of Symptoms With Carpal Tunnel Release

    NARCIS (Netherlands)

    Becker, Stéphanie J. E.; Makanji, Heeren S.; Ring, David

    2012-01-01

    Purpose This study tested the null hypothesis that there is no difference between expected improvement and actual improvement of symptoms with carpal tunnel release (CTR). Secondary analyses addressed factors associated with both expected relief and actual relief of symptoms with carpal tunnel

  19. Carpal Tunnel Syndrome in Patient on long Term Hemodialysis - a ...

    African Journals Online (AJOL)

    Pain in hands is a common complaint in patients of end-stage renal disease on long term hemodialysis. This pain can arise from various different etiological factors. We present one such case of 56 years old lady who suffered from pain in the hand due to carpal tunnel syndrome on the side with angioaccess. Carpal tunnel ...

  20. Carpal tunnel syndrome caused by lipoma: a case report | Sbai ...

    African Journals Online (AJOL)

    . A lipoma of the hand causing a carpal tunnel syndrome by compression of the median nerve is exceptional. We report the case of a 70-year-old female presenting with a carpal tunnel syndrome. A compression of the median nerve by a ...

  1. Muscle intrusion as a potential cause of carpal tunnel syndrome.

    Science.gov (United States)

    Cartwright, Michael S; Walker, Francis O; Newman, Jill C; Arcury, Thomas A; Mora, Dana C; Haiying, Chen; Quandt, Sara A

    2014-10-01

    The aim of this study was to determine whether there is an association between flexor digitorum and lumbrical muscle intrusion into the carpal tunnel and carpal tunnel syndrome (CTS). Five hundred thirteen manual laborers (1026 wrists) were evaluated with ultrasound to determine whether those with CTS had more muscle intrusion into the carpal tunnel than those without CTS. One hundred ninety of the participants without CTS at baseline (363 wrists) were followed over 1 year to determine whether muscle intrusion at baseline predicted the development of CTS. Participants with CTS had more muscle within the carpal tunnel with the wrist in the neutral (P=0.026) and flexed (P=0.018) positions than those without CTS. Baseline muscle intrusion did not predict development of CTS at 1 year. Muscle intrusion into the carpal tunnel is associated with CTS, but muscle intrusion alone does not predict the development of CTS over the course of a year. © 2014 Wiley Periodicals, Inc.

  2. Dextrose-induced subsynovial connective tissue fibrosis in the rabbit carpal tunnel: A potential model to study carpal tunnel syndrome?

    NARCIS (Netherlands)

    Oh, S.; Ettema, A.M.; Zhao, C.; Zobitz, M.E.; Wold, L.E.; An, K.N.; Amadio, P.C.

    2008-01-01

    In this pilot study, hypertonic dextrose solution was used to induce fibrosis of the subsynovial connective tissue (SSCT) and create an animal model of potential use in the study of carpal tunnel syndrome (CTS). The SSCT of the carpal tunnel in 15 New Zealand white rabbits were injected with 0.05 ml

  3. Gender differences in carpal tunnel relative cross-sectional area: a possible causative factor in idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Sassi, S A; Giddins, G

    2016-07-01

    Previous research has not established a consistent difference in hand size or carpal tunnel cross-sectional area between patients with and without carpal tunnel syndrome. We tested the hypothesis that there would be no difference in relative carpal tunnel sizes between men and women. We defined relative carpal tunnel size as the cross-sectional areas at the inlet (level of the pisiform) and outlet (level of the hook of the hamate) of the carpal tunnel divided by the length of the capitate (as a measure of hand size). We made the measurements on the magnetic resonance imaging scans of 50 men and 50 women taken for symptoms unrelated to carpal tunnel syndrome. The mean relative cross-sectional area was appreciably smaller in women than men (p carpal tunnel cross-sectional area relative to the size of the hand is constitutionally smaller in women than in men. This could in theory be a significant factor in patients developing carpal tunnel syndrome. V. © The Author(s) 2016.

  4. 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.

  5. Occupational health hazard: carpal tunnel syndrome.

    Science.gov (United States)

    Lewis, L C; Mireles, D Z

    1997-04-01

    A significant portion of the American population today is exposed to computer-related illnesses. One of the most common injuries is carpal tunnel syndrome (CTS). Perioperative nurses will become increasingly exposed to computer-related illnesses with the advent of computerized patient record systems. Economic loss, physical disability, and emotional distress are frequent outcomes of computer-related illnesses. Federal legislation addressing preventive measures is currently nonexistent. Clinicians, as both employers and consumers of computer technology, must address computer-related illnesses, such as CTS, through identification of related risk factors, early symptoms, implementation of ergonomic measures, and support of federal and industrial safety standards.

  6. PA01.49.Carpal tunnel syndrome: A case report

    Science.gov (United States)

    Gandhi, Rahul S; Manoj Kumar, A K

    2012-01-01

    Purpose: Carpal tunnel syndrome is an entrapment neuropathy of median nerve causing paraesthesia, pain, numbness and other symptoms in the distribution of median nerve due to its compression at wrist in carpal tunnel. Modern medicine prescribes surgery for its treatment. We report a case that was treated completely without any recurrence. Method: Case presentation: A female patient aged 23 years presented with numbness in the middle finger of left hand associated with paraesthesia, morning stiffness, loss of delicate movements of middle finger and dropping of small objects since 4 days. She consulted an allopathic doctor and was diagnosed as having Carpal tunnel syndrome (CTS). She was advised surgery. The patient was reluctant for undergoing surgery and took the medicines for 1 day, but had no relief. Next day she came to the OPD. On examination, Tinel™s percussion test and hand diagram were positive. On assessment, symptom severity scale (SSS) and functional status scale (FSS) were found to be 1.5 and 3.5 respectively, before treatment. Treatment given was varanadi kashaya, sahacharadi and supti taila, yogaraja guggulu, cap chelnar, dhanyamla dhara, shunthibaladi choorna etc, for a period of 1 month. The medicines were changed as per the condition of patient and the disease, at every follow up of 1 week, during the 1 month of treatment. Result: At the end of 1 month patient got complete relief from her complaints, and the scales SSS and FSS scored 0. Conclusion: The treatment given here aimed at release of compression by considering the involvement of doshas. The state of the disease was acute due to which complete relief was achieved. Thus if patients come to Ayurveda in early stages of the disease, prognosis will be better.

  7. Idiopathic carpal tunnel syndrome in children and adolescents.

    Science.gov (United States)

    Batdorf, Niles J; Cantwell, Sean R; Moran, Steven L

    2015-04-01

    A retrospective review of a single institution's experience with idiopathic carpal tunnel syndrome (CTS) in children and adolescents was performed to evaluate management and outcomes in an effort to establish a treatment protocol. All patients diagnosed with idiopathic CTS from ages 1 to 16 years of age between 1983 and 2013 were reviewed. The results of diagnostic testing and efficacy of therapeutic interventions were analyzed. The Boston Carpal Tunnel Questionnaire was sent to all patients following medical or surgical management. A total of 20 patients with 31 involved wrists met criteria for entrance into the study. The mean age at diagnosis was 14.4 years. Orthosis fabrication was used as the initial treatment in 30 of 31 wrists and was successful in completely alleviating symptoms in 9 of 30 wrists. A steroid injection was performed in 11 of 31 wrists, completely relieving symptoms in 5 of 11 wrists. Carpal tunnel release was performed in 10 of 31 wrists. Following surgery, patients had complete relief of symptoms in 5 of 10 wrists and partial relief of symptoms in 5 of 10 wrists. Questionnaire response incidence was 55% (11 of 20), with an average long-term follow-up of 17.6 years. Eight questionnaire respondents continued to have mild to moderate symptoms while performing activities of daily living. Once metabolic, anatomical, and hereditary causes of pediatric CTS are ruled out, a reasonable treatment course should follow that of adults with orthosis fabrication, followed by injection, and then surgery for those that are refractory to nonsurgical treatment. Prognostic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Carpal tunnel syndrome impairs thumb opposition and circumduction motion.

    Science.gov (United States)

    Marquardt, Tamara L; Nataraj, Raviraj; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2014-08-01

    Carpal tunnel syndrome is associated with sensory and motor impairments resulting from the compressed and malfunctioning median nerve. The thumb is critical to hand function, yet the pathokinematics of the thumb associated with carpal tunnel syndrome are not well understood. The purpose of this study was to evaluate thumb motion abnormalities associated with carpal tunnel syndrome. We hypothesized that the ranges of translational and angular motion of the thumb would be reduced as a result of carpal tunnel syndrome. Eleven patients with carpal tunnel syndrome and 11 healthy control subjects voluntarily participated in this study. Translational and angular kinematics of the thumb were obtained using marker-based video motion analysis during thumb opposition and circumduction movements. Motion deficits were observed for patients with carpal tunnel syndrome even though maximum pinch strength was similar. The path length, normalized by palm width of the thumb tip for the patients with carpal tunnel syndrome was less than for control participants (opposition: 2.2 palm width [95% CI, 1.8-2.6 palm width] versus 3.1 palm width [95% CI, 2.8-3.4 palm width], p thumb tip ulnarly across the palm during opposition relative to control participants. The angular ROM also was reduced for the patients with carpal tunnel syndrome compared with the control participants in extension/flexion for the metacarpophalangeal (opposition: 34° versus 58°, p = .004; circumduction: 33° versus 58°, p thumb during opposition and circumduction despite normal pinch strength. Improving understanding of thumb pathokinematics associated with carpal tunnel syndrome may help clarify hand function impairment associated with the syndrome given the critical role of the thumb in dexterous manipulation.

  10. 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). Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  11. Histopathological Confirmation Etiopathology in the Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Bordeianu I.

    2016-11-01

    Full Text Available The authors present a retrospective clinical study on a total of 39 patients of both sexes aged between 38 and 76 years with idiopathic carpal tunnel compressive syndrome that surgically excised the anterior carpal ligament by a process custom classic which they examined histologically.

  12. Utilization of Preoperative Electrodiagnostic Studies for Carpal Tunnel Syndrome: An Analysis of National Practice Patterns.

    Science.gov (United States)

    Sears, Erika D; Swiatek, Peter R; Hou, Hechuan; Chung, Kevin C

    2016-06-01

    Given the lack of a reference standard diagnostic tool for carpal tunnel syndrome (CTS), we conducted a population-level analysis of patients undergoing carpal tunnel release to characterize the utilization of preoperative electrodiagnostic studies (EDS). Secondarily, we sought to determine the impact of EDS utilization on timeliness of surgery, number of preoperative physician visits, and costs. The 2009-2013 Truven MarketScan databases were used to identify a national cohort of adult patients undergoing carpal tunnel release. Three multivariable regression models were designed to evaluate the relationship between preoperative EDS use and timing of surgical release, the number of preoperative physician visits, and total costs for CTS-related visits, while controlling for sociodemographic variables, insurance type, comorbid conditions, and treatment characteristics. The final study cohort included 62,894 patients who underwent carpal tunnel release, of whom 58% had preoperative EDS. Patients undergoing EDS waited 36% longer for surgical release than patients without EDS. The mean time between diagnosis and surgery was predicted to be 183 days for patients who underwent preoperative EDS and 135 days for patients who did not. Patients having EDS experienced 1 additional visit, $996 greater total costs, and $112 additional out-of-pocket costs on average. Occupational therapy consultation and steroid injection were also associated with increased time to surgery, but with one-fourth and one-third the added cost of EDS, respectively. On the basis of national practice trends, providers do not consistently agree with the practice of performing EDS before carpal tunnel release. Given the uncertain utility of routine EDS before carpal tunnel release and its association with delays to surgery and increased costs, further evaluation of EDS in relation to patient preferences and value of care is warranted. Prognostic II. Copyright © 2016 American Society for Surgery of the

  13. [Socio professional impact of surgical release of carpal tunnel syndrome].

    Science.gov (United States)

    Kraiem, Aouatef Mahfoudh; Hnia, Hajer; Bouzgarrou, Lamia; Henchi, Mohamed Adnène; Khalfallah, Taoufik

    2016-01-01

    The objective was studying the socio-professional impact of release surgery for carpal tunnel syndrom (CTS). We conducted a cross-sectional study of patients operated for work-related CTS; data were collected in the Occupational Health Department at the University Hospital Tahar Sfar in Mahdia, Tunisia over a period of 8 years, from 1 January 2006 to December 2013. Data collection was performed using a survey form focusing on participants' socio-professional and medical characteristics and on their professional future. We used Karasek's questionnaire to study psychosocial constraints at work. The duration of a work stoppage following release surgery for CTS was significantly related to the existence of musculoskeletal disorders other than CTS, to a statement that the carpal tunnel syndrome was work related and to job seniority. As regards the professional future of operated employees, 50.7% remained in the same position, 15.3% were given customized workstation and 33.8% were offered a different position within the same company. The professional future of these employees was related to their occupational qualifications and to the type of sensory and/or motor impairment of median nerve detected during EMG test. A number of nonlesional factors determines the duration of the work stoppage, while the professional future of patients operated for CTS essentially depends on their professional qualifications and on EMG data. Certainly much broader studies would allow to refine these results.

  14. 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.

  15. [Principal causes for recurrent carpal tunnel syndrome].

    Science.gov (United States)

    Vázquez-Alonso, M F; Abdala-Dergal, C

    2016-01-01

    The frequent causes of relapsing carpal tunnel syndrome were analyzed. Nine patients were followed-up from January 1st to December 31st, 2011. They underwent a physical exam and imaging tests. Pain was measured in all of them with the VAS, and the Brigham and Womens Hospital questionnaire was used to assess disability. Patients included seven females and two males; mean age was 52 years. Major causes for relapse included postoperative fibrosis with incomplete release in seven patients and incomplete release in two patients in whom minimally invasive approaches were used. Three of the nine patients had retractile scars. The main cause of relapse was postoperative fibrosis associated with the minima-lly invasive approach.

  16. Clinical Study on Five Cases of Carpal tunnel syndrome

    National Research Council Canada - National Science Library

    Kim Il Hwan

    2001-01-01

    Objections : The purpose of the study was to evaluate the effectiveness of treating the carpal tunnel syndrome by using both the Herbal Acupuncture and herbal medicine therapy on five cases. Methods...

  17. Can Smartphone Use Bring on Carpal Tunnel Syndrome?

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_166847.html Can Smartphone Use Bring on Carpal Tunnel Syndrome? Maybe, especially ... People who spend lots of time on their smartphones may be scrolling, tapping and swiping their way ...

  18. 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)

  19. Acute carpal tunnel syndrome in a patient with haemophilia

    OpenAIRE

    Mayne, Alistair Ivan William; Howard, Anthony; Kent, Matthew; Banks, Joanne

    2012-01-01

    Acute carpal tunnel syndrome (CTS) is a rare surgical condition usually resulting from wrist trauma. We present the case of a young haemophilic man who developed acute CTS following trivial injury. The patient was initially managed conservatively but symptom progression resulted in carpal tunnel decompression. A literature review and management approach are presented. This is an important complication of haemophilia to be aware of as prompt conservative management can obviate the need for sur...

  20. 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.

  1. 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

  2. [Results of the treatment of carpal tunnel syndrome--a review].

    Science.gov (United States)

    Zyluk, Andrzej; Strychar, Jarosław

    2005-01-01

    Based on review of the literature, a comprehensive information on the methods and outcomes of the treatment of carpal tunnel syndrome is provided. Conservative treatment of the syndrome includes immobilization of the wrist, physiotherapy, drug therapy and steroid injections into carpal tunnel. Effectiveness of the conservative measures is acceptable in short perspective, but not in long term follow-up. The most common treatment in the carpal tunnel syndrome is surgery, which consists in division of the transverse carpal ligament. The advantages and drawbacks of various operative techniques are presented including classical open, endoscopic and limited open techniques with general conclusion that only operative carpal tunnel release warrants permanent recovery. A chronology and sequence of the withdrawal of symptoms of the disease was described: nocturnal pain disappears usually within first week after decompression, sensation improves within 3 months, and grip strength, after immediate post-operative deterioration, improves gradually even up to 2 years after operation. It was outlined that some patients may complain of pain and discomfort relating to the post-operative scar in the wrist, and that may be secondary morbidity, complications and recurrence after surgery. It was concluded that method of operative technique has not significant effect on long-term outcome, but in short perspective mini-invasive measures are favoured by the patients.

  3. A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States.

    Science.gov (United States)

    Chatterjee, Abhishek; McCarthy, James E; Montagne, Shirley A; Leong, Kenneth; Kerrigan, Carolyn L

    2011-03-01

    Carpal tunnel surgery (CTS) can be performed in the clinic or operating room with similar outcomes. Our goals were to perform a total cost comparison, profit analysis, and assess efficiency of CTS in each setting. A detailed cost analysis for all CTSs at a tertiary care academic center was done for the year 2007. We calculated the net revenues and profit margins for single endoscopic port and open CTS performed in each setting in the year 2007. For efficiency analysis, we assumed that the time saved by performing a procedure in the more efficient setting could accumulate and permit additional CTSs. This would be the opportunity cost of performing CTS in the less efficient setting. In general, the operating room was a costlier setting than the clinic. The total cost per case when performing single-port endoscopic CTS was more than double ($2273 vs. $985) when performed in the operating room versus the clinic. For open CTS, the operating room was more than 4 times as expensive than the clinic ($3469 vs. $670). For single endoscopic port cases, profits gained were greater than double in the clinic versus the operating room ($2710 vs. $1139). For open CTS, clinic cases had a profit margin per case of $1186; however, procedures in the operating room incurred a loss of $650 per case. The block time allowed for CTS in the clinic was 30 and 60 minutes in the operating room. To value this efficiency, we used the profit margin of CTS performed in the clinic ($2710) and divided it by the 30 minutes it took to perform. This provided us with a multiplier of $90/min. We multiplied the 30 minutes saved when operating in the clinic by the $90/min to give us an opportunity cost of $2700. Performing either single endoscopic port or open CTS in the operating room is more expensive and less efficient than in the clinic setting.

  4. 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…

  5. Determinants of return to work after carpal tunnel release.

    Science.gov (United States)

    Cowan, James; Makanji, Heeren; Mudgal, Chaitanya; Jupiter, Jesse; Ring, David

    2012-01-01

    The determinants of time to return to work-a common measure of treatment effectiveness-are incompletely defined. Our primary hypothesis was that employment circumstances are the strongest determinant of earlier return to work. Our secondary hypothesis was that return to work in patients with desk-based jobs is predicted by patient expectations and other psychosocial factors. We enrolled 65 employed patients with limited incision open carpal tunnel release in a prospective cohort study. Patients completed validated measures of depression, coping strategies, pain anxiety, and job burnout. Heavy lifting was not allowed for 1 month after surgery. Return to modified and full work duty was recorded in days. Although not specifically an exclusion criterion, none of the patients had a workers' compensation claim or other source of secondary gain. Patients returned to modified duty an average of 11.8 days and full duty at an average of 18.9 days after surgery. Predictors of earlier return to modified duty in multivariate analyses included desk-based work and both the number of days patients expected to take off and the numbers of days they wanted to take off for the entire cohort, with an additional influence from catastrophic thinking in desk-based workers. Predictors of earlier return to full duty in multivariate analyses included desk-based work and number of days patients expected to take off before for the entire cohort, fewer days off desired in non-desk-based workers, fewer days off desired and change in work role in desk-based workers, and lower pain anxiety in part-time workers. The most important determinant of return to full duty work after limited incision open carpal tunnel release is job type, but psychological factors such as patient expectations, catastrophic thinking, and anxiety in response to pain also have a role. Prognostic II. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. 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. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Carpal tunnel syndrome among grocery store workers.

    Science.gov (United States)

    Osorio, A M; Ames, R G; Jones, J; Castorina, J; Rempel, D; Estrin, W; Thompson, D

    1994-02-01

    The California Department of Health Services evaluated carpal tunnel syndrome (CTS), a median nerve entrapment condition associated with forceful and repetitive wrist motion, among grocery store workers at a large California supermarket where a CTS cluster had been reported. Forceful and repetitive wrist motion was measured, in three exposure levels, through a job classification scheme based upon type of work tasks and average time per week spent performing these tasks. A medical questionnaire and measurements of median sensory nerve conduction were used to measure CTS. CTS prevalence was 23% based upon a sample of 56 participants drawn from a workforce of 69 employees. A relative risk of 8.3 (95% confidence interval 2.6-26.4) for a history of CTS-like symptoms between the high and low exposure level groups held up after adjustment for the potential confounders of age, sex, alcohol consumption, and high-risk medical history. It was concluded that the basic principles of good ergonomic design should be used to prevent or diminish the risk of musculoskeletal injury in the workplace.

  8. Current options for nonsurgical management of carpal tunnel syndrome

    Science.gov (United States)

    Carlson, Hans; Colbert, Agatha; Frydl, Jennifer; Arnall, Elizabeth; Elliot, Molly; Carlson, Nels

    2010-01-01

    Carpal tunnel syndrome (CTS) is the most common of the entrapment neuropathies. Surgical decompression is commonly performed and has traditionally been considered the defnitive treatment for CTS. Conservative treatment options include physical therapy, bracing, steroid injections and alternative medicine. While CTS is often progressive, patients may get better without formal treatment. The resolution of symptoms is not necessarily related to the severity of the clinical findings and self-limited activity is common. The current literature suggests that bracing and corticosteroid injections may be useful in the nonsurgical treatment of CTS, although the benefits may be short term. There is limited evidence regarding the efficacy of other treatments, such as therapy, exercise, yoga, acupuncture, lasers and magnets, and further studies are needed. Surgery is recommended for progressive functional deficits and significant pain. PMID:20490348

  9. Endoscopic Carpal Tunnel Release with and without Sedation.

    Science.gov (United States)

    Tulipan, Jacob E; Kim, Nayoung; Ilyas, Asif M; Matzon, Jonas L

    2017-11-11

    This study evaluates outcomes and complications with endoscopic carpal tunnel release (eCTR) performed with local anesthesia (LOCAL) only versus local anesthesia with sedation (SEDATION). We hypothesize that patient outcomes and satisfaction will be equivalent in both groups irrespective of anesthesia type. One hundred fifty-four consecutive patients undergoing eCTR with either LOCAL or SEDATION protocols were prospectively enrolled in a study of satisfaction and outcomes. The patients were surveyed preoperatively and at 2-weeks and 3-months postoperatively to evaluate satisfaction, symptoms, complications, and disability using the QuickDASH survey, the Levine-Katz carpal tunnel survey, and a customized LIKERT scale. The hypothesis was upheld. Both groups of patients reported high levels of satisfaction (96% in LOCAL and 93% in SEDATION groups at 3 weeks). Disability, pain, and symptom scores did not differ significantly between groups at either postoperative time point. Following surgery, patients in the SEDATION group recalled more mean preoperative anxiety (4/10 versus 2.03/10 at 3 months). If they were to undergo the surgery again, patients in the SEDATION group were likely to desire either sedation (68%) or general anesthesia (29%) while patients in the LOCAL group were likely to wish for similar local-only anesthesia (78%). There were no reoperations or epinephrine-related complications in either group. Patients undergoing eCTR experience similar levels of satisfaction and outcomes with LOCAL and SEDATION protocols. The findings of this study confirm that both methods of anesthesia provide excellent results and allow for surgeons and patients to choose freely between the two anesthetic techniques.

  10. 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.)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  13. 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

  14. [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.

  15. Concomitant endoscopic carpal and cubital tunnel release: safety and efficacy.

    Science.gov (United States)

    Cross, Danielle; Matullo, Kristofer S

    2014-03-01

    When performed alone, endoscopic carpal tunnel release and endoscopic cubital tunnel release are safe and effective surgical options for the treatment of carpal and cubital tunnel syndromes, respectively. However, there is currently no literature that describes the performance of both procedures concomitantly. We describe the results of 17 cases in which dual endoscopic carpal and cubital tunnel releases were performed for the treatment of concurrent carpal and cubital tunnel syndromes. A retrospective review of all patients in a single surgeon practice that presented with concomitant ipsilateral carpal and cubital tunnel syndromes was performed. Within an 8-month period, 17 patients had undergone 19 concomitant ipsilateral endoscopic carpal and cubital tunnel releases after failing conservative treatment. Pre- and postoperative measurements included subjective numbness/tingling; subjective pain; manual muscle testing of the abductor pollicis brevis (APB), intrinsics, and flexor digitorum profundus (FDP); static two-point discrimination; quick-DASH (Disabilities of the Arm, Shoulder and Hand) scores; grip strength; chuck pinch strength; and key pinch strength. Complete data are available for 15 patients and 17 total procedures. Thirteen male and four female patients (average age of 50.5) underwent dual endoscopic cubital and carpal tunnel release. Two patients were lost to follow-up and eliminated from data analysis. Pre- and postoperative comparisons were completed for median DASH scores, grip strength, chuck pinch strength, and key pinch strength at their preoperative visit and at 12 weeks. DASH scores improved significantly from a median of 67.5 to 16 (p = 0.002), grip strengths improved from 42 to 55.0 lbs (p = 0.30), chuck pinch strengths improved significantly from 11 to 15.5 lbs (p = 0.02), and key pinch strengths increased significantly from 13 to 18 lbs (p = 0.003). Average static two-point discrimination decreased from 5.9 to 4.8

  16. 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…

  17. Wrist immobilization after carpal tunnel release: a prospective study.

    Science.gov (United States)

    Martins, Roberto S; Siqueira, Mario G; Simplício, Hougelli

    2006-09-01

    This prospective study evaluates the possible advantages of wrist immobilization 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 continuously 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.

  18. [Ultrasound examination of median nerve in carpal tunnel syndrome].

    Science.gov (United States)

    Kapuścińska, Katarzyna; Urbanik, Andrzej

    2013-01-01

    Carpal tunnel syndrome (CTS) is the most frequent compressive neuropathy, which give us characteristic features in ultrasound exam using high frequency probe. This article presents ultrasound features in patients with CTS and after surgical release of median nerve at the wrist level.

  19. Autosomal dominant carpal tunnel syndrome in a Karaite family.

    Science.gov (United States)

    Golik, A; Modai, D; Pervin, R; Marcus, E L; Fried, K

    1988-06-01

    A clinical examination and a history of 64 members belonging to four generations of a Karaite kindred revealed 11 patients with carpal tunnel syndrome (CTS). Bilateral involvement and early age of onset are salient features. The mutation may be traced in four generations. Hereditary primary CTS may be more prevalent than hitherto suspected.

  20. The second lumbrical-interossei latency difference in carpal tunnel ...

    African Journals Online (AJOL)

    Objective: To assess the value of the 2L-INT latency difference in the electrodiagnosis of the carpal tunnel syndrome (CTS) and evaluate its sensitivity in comparison to other routine median motor and sensory studies. Methods: The study was conducted on 100 hands with symptoms and signs suggestive of CTS and 100 ...

  1. Giant lipoma: an unusual cause of carpal tunnel syndrome | Jalan ...

    African Journals Online (AJOL)

    Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in the clinical practice however secondary compressive causes are rare. Among secondary causes, tumors are even rarer. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the ...

  2. The second lumbrical-interossei latency difference in carpal tunnel ...

    African Journals Online (AJOL)

    Eman A. Tawfik

    2012-12-06

    Dec 6, 2012 ... the 2LINT test and that both were correlated suggesting that the motor fibers of the median nerve can be compressed as early as ... Abbreviations: 2L-INT, second lumbrical interossei; APB, abductor pollicus brevis; CMAP, compound muscle action potential; CTS, carpal tunnel syndrome; DML, distal motor ...

  3. Retractor-endoscopic nerve decompression in carpal and cubital tunnel syndromes: outcomes in a small series.

    Science.gov (United States)

    Martin, K-Daniel; Dützmann, Stephan; Sobottka, Stephan B; Rambow, Stefanie; Mellerowicz, Helene A; Pinzer, Thomas; Schackert, Gabriele; Krishnan, Kartik G

    2014-01-01

    To present midterm to long-term results obtained in carpal tunnel release, in situ decompression, and anterior transposition of the ulnar nerve using the retractor integrated endoscope. During the period 2000-2010, 145 patients underwent endoscopic carpal tunnel releases (n = 47), endoscopic in situ decompression of the ulnar nerve (n = 55), and endoscopic anterior transposition of the ulnar nerve (n = 52). Bilateral surgery was performed in 9 patients. Independent examinations at 24 months after surgery were used for objective results (Bishop score). Subjective results were procured using a questionnaire. After endoscopic carpal tunnel release, 59.6% of patients showed excellent results, 21.2% showed good results, 12.8% showed fair results, and 6.4% showed poor results according to objective scoring. In 85% of patients, subjective improvement was noted after surgery; symptoms were the same as before surgery in 12.8% of patients and were worse in 2.1% of patients after surgery. After endoscopic in situ decompression, 56.4% of patients showed excellent results on objective scoring, 32.7% showed good results, 9.1% showed fair results, and 1.8% showed poor results. On subjective questioning, 72.7% of patients reported improvement, 20% reported no change in symptoms, and 7.3% reported worse symptoms. After endoscopic anterior transposition of the ulnar nerve, 48.1% of patients showed excellent results on objective scoring, 26.9% showed good results, 23.1% showed fair results, and 1.9% showed poor results. Subjectively, 65.4% of patients reported improvement, 26.9% reported no change in symptoms, and 7.7% reported worse symptoms. Patients with symptom duration of 9 months. The retractor-endoscopic technique provides good long-term results after carpal tunnel release, in situ decompression, and anterior subcutaneous transposition of the ulnar nerve. Outcomes showed some correlation to the duration of preoperative symptoms. Copyright © 2014 Elsevier Inc. All rights

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Percutaneous Ultrasound-Guided Carpal Tunnel Release: Study Upon Clinical Efficacy and Safety

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    Petrover, David, E-mail: dpetrover@yahoo.fr; Silvera, Jonathan, E-mail: silvera.jonathan@gmail.com [Imagerie Médicale Paris Centre Bachaumont-clinique Blomet RamsayGDS, Department of Interventional Radiology (France); Baere, Thierry De, E-mail: Debaere@igr.fr [Gustave Roussy Institute (France); Vigan, Marie, E-mail: marie.vigan@gmail.com [Association pour la recherche en chirurgie de l’épaule et du coude, clinique Drouot (France); Hakimé, Antoine, E-mail: thakime@yahoo.com [Imagerie Médicale Paris Centre Bachaumont-clinique Blomet RamsayGDS, Department of Interventional Radiology (France)

    2017-04-15

    ObjectivesTo evaluate the feasibility and 6 months clinical result of sectioning of the transverse carpal ligament (TCL) and median nerve decompression after ultra-minimally invasive, ultrasound-guided percutaneous carpal tunnel release (PCTR) surgery.MethodsConsecutive patients with carpal tunnel syndrome were enrolled in this descriptive, open-label study. The procedure was performed in the interventional radiology room. Magnetic resonance imaging was performed at baseline and 1 month. The Boston Carpal Tunnel Questionnaire was administered at baseline, 1, and 6 months.Results129 patients were enrolled. Significant decreases in mean symptom severity scores (3.3 ± 0.7 at baseline, 1.7 ± 0.4 at Month 1, 1.3 ± 0.3 at Month 6) and mean functional status scores (2.6 ± 1.1 at baseline, 1.6 ± 0.4 at Month 1, 1.3 ± 0.5 at Month 6) were noted. Magnetic resonance imaging showed a complete section of all TCL and nerve decompression in 100% of patients. No complications were identified.ConclusionsUltrasound-guided PCTR was used successfully to section the TCL, decompress the median nerve, and reduce self-reported symptoms.

  6. 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.

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

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    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.

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

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    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.

  9. A cost-utility analysis of open and endoscopic carpal tunnel release

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    Thoma, Achilleas; Wong, Vanessa H; Sprague, Sheila; Duku, Eric

    2006-01-01

    BACKGROUND Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced. OBJECTIVE To use a decision analytical model to compare ECTR with OCTR in an economic evaluation. METHODS Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature. RESULTS The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the ‘win-win’ quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR. CONCLUSIONS There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively. PMID:19554224

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

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    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.

  11. Surgical Demographics of Carpal Tunnel Syndrome and Cubital Tunnel Syndrome Over 5 Years at a Single Institution.

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    Zhang, Dafang; Collins, Jamie E; Earp, Brandon E; Blazar, Philip

    2017-08-12

    Carpal tunnel and cubital tunnel syndrome are the 2 most common upper-limb compressive neuropathies. However, whether the characteristics of patient populations undergoing surgery for these conditions are similar is unclear in terms of demographics and concomitant pathologies. Our null hypothesis was that there are no identifiable differences between these patient populations. A retrospective cohort study was performed by billing system query using Common Procedural Terminology (CPT) codes for all patients who underwent open carpal tunnel release (CTR) (CPT code 64721) and/or open cubital tunnel surgery (CPT code 64718) by 1 of 4 hand surgeons from August 2008 to July 2013. Application of exclusion criteria of acute trauma, revision surgery, neoplasm, age less than 18 years, and inaccurate or insufficient records resulted in identification of 1,114 patients who underwent CTR, 264 patients who underwent cubital tunnel surgery, and 76 patients who underwent both. Computerized medical records were analyzed for demographic variables, medical comorbidities, and other procedures performed under the same anesthetic. In the multivariable analysis, older age, female sex, higher body mass index, trigger finger, and de Quervain tenosynovitis were associated with CTR. Prior trauma to the anatomic site was more common in the cubital tunnel group. Diabetes mellitus was associated with patients who had both procedures. The populations of patients who undergo surgery for different upper-extremity compressive neuropathies are not homogenous: CTR is associated with older age, female sex, higher body mass index, and hand tendinopathies. Cubital tunnel decompression is associated with prior trauma to the anatomic site. Diabetic patients are more likely to have both procedures. Diabetic patients undergoing either procedure should be evaluated for other peripheral nerve compression pathologies. Diagnostic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by

  12. Subsynovial Connective Tissue is Sensitive to Surgical Interventions in a Rabbit Model of Carpal Tunnel Syndrome

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    Sun, Yu-Long; Moriya, Tamami; Zhao, Chunfeng; Kirk, Ramona L.; Chikenji, Takako; Passe, Sandra M.; An, Kai-Nan; Amadio, Peter C.

    2011-01-01

    The most common histological finding in carpal tunnel syndrome (CTS) is non-inflammatory fibrosis and thickening of the subsynovial connective tissue (SSCT) in the tunnel. While the cause of SSCT fibrosis and the relationship of SSCT fibrosis and CTS are unknown, one hypothesis is that SSCT injury causes fibrosis, and that the fibrosis then leads to CTS. We investigated the sensitivity of the SSCT to injuries. Two types of surgical intervention were performed in a rabbit model: a skin incision with tendon laceration and SSCT stretching sufficient to damage the SSCT, and skin incision alone,. Twelve weeks after surgery, the rabbit carpal tunnel tissues were studied with immunochemistry for TGF-β receptors 1, 2, and 3, collagen III, and collagen VI. All TGF-β receptors were expressed. The percentages of the TGF-β receptors’ expressions were less in the control SSCT fibroblasts than in the fibroblasts from rabbits with surgical interventions. The surgical interventions did not result in any alteration of collagen III expression. However, both surgical interventions resulted in a significant decrease in collagen VI expression compared to the control group. The two surgical interventions achieved similar expression of TGF-β receptors and collagens. Our results provide evidence that the SSCT is sensitive to surgical interventions, even when these are modest. Since SSCT fibrosis is a hallmark of carpal tunnel syndrome, these data also suggest that such fibrosis could result from relatively minor trauma. PMID:22009518

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

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    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.

  14. 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

  15. Can we use thermal imaging to evaluate the effects of carpal tunnel syndrome surgical decompression?

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    Baic, Agnieszka; Kasprzyk, Teresa; Rżany, Michał; Stanek, Agata; Sieroń, Karolina; Suszyński, Krzysztof; Marcol, Wiesław; Cholewka, Armand

    2017-01-01

    Abstract Research is intended to verify if thermal imaging can be used in diagnosing and monitoring the carpal tunnel syndrome (CTS). This disease is not easy to diagnose using traditional methods. Also, the difficulties in monitoring carpal tunnel surgery effects necessitate new, noninvasive method, which gives more information. The research group consists of 15 patients with CTS and control group of healthy people. All patients who were examined before surgery were also tested 4 weeks after surgery, to check the effects of treatment. In addition a lot of our patients had or will have open carpel tunnel release surgery. Diagnosis of CTS was performed by thermal imaging in both hands from phalanges to the area of the wrist on the external and palmar side of the palm. Using infrared (IR) camera one can observe high temperature gradient on hand-tested areas and these differences prove the diagnosis. Moreover patients after surgery have better temperature distribution and it was closer to control group. Results prove that surgery is the best, and currently, the only method to treat CTS. Thermal imaging may be helpful in diagnosing CTS. PMID:28953619

  16. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis,

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    Michel Chammas

    2014-10-01

    Full Text Available Carpal tunnel syndrome (CTS is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Elec-troneuromyographic examination may be recommended before the operation or in cases of occupational illnesses.

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

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    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.

  18. CARPAL TUNNEL SYNDROME PADA PEKERJA GARMEN DI JAKARTA

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    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%.

  19. Evaluation of thenar muscles by MRI in carpal tunnel syndrome

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    Dilokhuttakarn, Thitinut; Naito, Kiyohito; Kinoshita, Mayuko; Sugiyama, Yoichi; Goto, Kenji; Iwase, Yoshiyuki; Kaneko, Kazuo

    2017-01-01

    In the present study, the thenar muscles were evaluated using magnetic resonance imaging (MRI), in addition, the correlations between thenar muscle changes, clinical findings and electrodiagnostic results from patients with carpal tunnel syndrome were investigated. The subjects were 13 patients (17 wrists) who were clinically diagnosed with carpal tunnel syndrome. In all patients, a medical history was obtained and physical examination was performed, in addition to assessment using the Kapandji scoring system, visual analogue scale (VAS), quick-disabilities of the arm, shoulder and hand (Q-DASH) score, electrodiagnostic results of the median nerve, and MRI of the thenar muscles. Thenar muscle volume was not significantly correlated with clinical data or the electrodiagnostic results. The thenar muscle major axis was significantly correlated with grasp power (PKapandji score (PKapandji score were correlated with thenar muscle thickness. Furthermore, it was demonstrated that thenar muscle thinness was significantly correlated with the severity of electrodiagnostic changes; in addition, there was a significant correlation between the thenar muscle major axis and the grasp power or Kapandji score. Taken together, these results revealed that thenar muscle atrophy did not affect patient-based assessments, including VAS and Q-DASH, but reflected electrodiagnostic results, particularly DML and severity. The results of the present study suggest that thenar muscle atrophy can be used to estimate the severity of carpal tunnel syndrome. PMID:28962120

  20. Effects of taping therapy for carpal space expansion on electrophysiological change in patients with carpal tunnel syndrome.

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    Park, Yeong-Dong; Park, Yun-Jin; Park, Sang-Seo; Lee, Hae-Lim; Moon, Hyeong-Hun; Kim, Myung-Ki

    2017-06-01

    Taping therapy is one of the most conservative treatments for carpal tunnel syndrome (CTS). Preceding research studied on pain control, grip strength, and wrist function but no studies have been reported on electrophysiolgical changes after taping therapy. The aim of this study is to evaluate the effects of taping therapy for carpal space expansion on electrophysiological in 20 female patients aged from 40s to 60s with CTS. Experimental group applied taping therapy for carpal space expansion twice a week for 4 weeks and control group did not. There were significant differences between distal motor latency (DML) and sensory nerve conduction velocity (SNCV), but no difference between compound muscle action potential and sensory nerve action potential (SNAP) after 4 weeks taping treatment. Also, there was a significant difference in DML, SNCV, and SNAP in between groups. In conclusion, taping therapy for carpal space expansion can help to reduce the pressure of the carpal tunnel in CTS patients with mild symptoms.

  1. Carpal Tunnel Syndrome with Wrist Trigger Caused by Hypertrophied Lumbrical Muscle and Tenosynovitis

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    Ayuko Shimizu

    2015-01-01

    Full Text Available We present a case of carpal tunnel syndrome involving wrist trigger caused by a hypertrophied lumbrical muscle with flexor synovitis. The case was a 40-year-old male heavy manual worker complaining of numbness and pain in the median nerve area. On active flexion of the fingers, snapping was observed at the carpal area, and forceful full grip was impossible. Tinel’s sign was positive and an electromyographic study revealed conduction disturbance of the median nerve at the carpal tunnel. Magnetic resonance imaging revealed edematous lumbrical muscle with synovial proliferation around the flexor tendons. Open carpal tunnel release was performed under local anesthesia. Synovial proliferation of the flexor tendons was found and when flexing the index and middle fingers, the lumbrical muscle was drawn into the carpal tunnel with a triggering phenomenon. After releasing the carpal tunnel, the triggering phenomenon and painful numbness improved.

  2. Intraoperative dynamic pressure measurements in carpal tunnel syndrome: Correlations with clinical signs.

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    Lee, Ho Jin; Kim, Il Sup; Sung, Jae Hoon; Lee, Sang Won; Hong, Jae Taek

    2016-01-01

    This study was designed to evaluate the correlations between dynamic carpal tunnel pressure and clinical signs. From December 2008 to May 2010, open carpal tunnel release (OCTR) was performed on a total of 90 hands (83 patients). All patients completed neurological and provocation tests (two-point discrimination, Tinel test, Phalen test, reverse-Phalen test and assessment of thenar muscle atrophy). Carpal tunnel pressure (CTP) was measured in two parts of carpal tunnel (proximal and distal carpal tunnel) and in three different postures (neutral, wrist flexion and wrist extension). There were 74 females and nine males aged 36 to 86 years (mean age 54). CTP values were more elevated in the wrist extension than wrist flexion in the proximal carpal tunnel but not at the distal carpal tunnel. There was no statistically significant correlation among CTP, provocation testing, and clinical signs. However, two-point discrimination (2-PD) showed a statistically significant correlation with CTP, especially in the proximal area in the wrist extension posture (Pcarpal tunnel in the neutral posture (Pcarpal tunnel lesion since CTP values appear to vary within the carpal tunnel space and according to hand posture. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Missed childhood-onset carpal tunnel syndrome diagnosed as chronic pain: case report.

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    Wong, Anselm Harry; Horowitz, Michael I; Watson, Steven B; Watson, H Kirk

    2012-10-01

    We report the case of a 15-year-old girl with a red, swollen, and painful right hand. She first developed symptoms when she was 7 years old. Numerous physicians evaluated her at various institutions but were able to classify her only with chronic pain syndrome. She continued with regular occupational therapy and had to use special aids to compensate throughout school. After 8 years of treatment with no improvement, she presented to our office, where we diagnosed carpal tunnel syndrome. Intraoperative findings revealed a large proximal muscle belly of the index lumbrical, a thickened transverse carpal ligament, and marked compression of the median nerve. Two weeks after the surgery, her symptoms cleared; at 5 months, she remained symptom free. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. 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.

  5. [Value of neurophysiological studies in diagnostic verification of carpal tunnel syndrome].

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    Patsalis, T; Gravill, N

    1998-07-01

    The success of surgical treatment of carpal tunnel syndrome depends largely on correct diagnosis. Nerve conduction studies are usually recommended, especially in cases where history and clinical signs are not very clear. The aim of this study is to show whether nerve conduction studies are helpful in confirming the diagnosis. Fifty-two cases of carpal tunnel decompression (39 patients, 13 male, 26 female, mean age 54 years) were included in the study. Prior to surgery, all patients underwent standardized nerve conduction studies. One patient who developed RSD was excluded. In 33 cases the history was typical for carpal tunnel syndrome (Phalen 1966). The surgical result was classified excellent in 67% and good in 33%. Nerve conduction studies had failed to confirm the diagnosis in five cases, although duration as well as severity of symptoms did not differ from the other cases. In 18 cases the patients' history was considered atypical. Nerve conduction studies indicated carpal tunnel syndrome in 89%. The result of median nerve decompression was satisfactory in 78% (excellent in 45% and good in 33%) and unsatisfactory in 22% of the cases. Notably patients with unsatisfactory results had positive nerve conduction studies. The Phalen and Hoffmann-Tinel testing produced no false-positive results in these cases. General analysis showed that age, severity and duration of symptoms did not significantly influence the result. However, patients with atypical symptoms had a higher incidence of radiological evidence of cervical spondyloarthritis (50 versus 30% in patients with typical symptoms). The results of our nerve conduction studies indicated a sensitivity of 85% and a specificity of 92%, comparable favourably with other reports. We conclude that in patients with classical symptoms nerve conduction studies are not absolutely necessary. However, when symptoms are atypical the diagnosis cannot be based on nerve conduction studies alone. The false-positive results delivered

  6. Dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome: results of 411 procedures with special reference to technique, efficacy, and complications.

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    Oertel, Joachim; Schroeder, Henry W S; Gaab, Michael R

    2006-08-01

    Endoscopic release of carpal tunnel syndrome is still under debate. The main advantages of the technique are considered to be minor postoperative pain and a more rapid postoperative recovery. Disadvantages are thought to be the impossibility of a direct median nerve neurolysis and a higher surgical complication rate, including injury to the median nerve. The results of 411 consecutive endoscopic carpal tunnel procedures performed between March 1995 and September 2004 are presented. All patients were prospectively followed. In the present series, a success rate of 98.05% was observed. There was no permanent morbidity and, in particular, there was no injury of the median nerve. In four (0.97%) patients, the preoperative symptoms did not improve. In two (0.49%) of these patients, an incomplete release of the carpal ligament occurred. In another four patients (0.97%), a switch to open surgery was required. The present data prove that the endoscopic technique is a safe and reliable technique for carpal tunnel surgery. The data do not support the current discussion of a higher risk of median nerve injury with endoscopic carpal tunnel surgery. Thus, for our group, the endoscopic technique represents the therapy of choice for the primary idiopathic carpal tunnel syndrome.

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

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    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.

  8. Dupuytren Contracture in a Patient with Congenital Camptodactyly and Incidental Carpal Tunnel Syndrome

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    S Mahendran

    2008-11-01

    Full Text Available Dupuytren contracture is commonly seen in northern European populations but not in Asians. Even more rare is a presentation of flexion deformity of fingers involving two different pathologies with incidental carpal tunnel syndrome in the same patient. We report herein a case of Dupuytren contracture with congenital camptodactyly and unilateral carpal tunnel syndrome.

  9. Bilateral carpal tunnel syndrome and multiple trigger fingers in a child with mucolipidosis Type III disease

    Directory of Open Access Journals (Sweden)

    Ahmadreza Afshar

    2011-01-01

    Full Text Available This report presents a five-year-old girl with mucolipidosis Type III disease who had bilateral carpal tunnel syndrome and eight trigger fingers. Bilateral open carpal tunnel release was performed. The trigger fingers were treated with A1 and A3 pulleys release and the ulnar slips of the flexor digitorum superficialis tendons were removed.

  10. 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....

  11. Does wrist immobilization following open carpal tunnel release improve functional outcome? A literature review.

    Science.gov (United States)

    Isaac, S M; Okoro, T; Danial, I; Wildin, C

    2010-07-11

    Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the median nerve in the carpal tunnel. It is the most common peripheral entrapment neuropathy. The surgical management includes dividing the flexor retinaculum to decompress the median nerve. Post-operative mobilization of the wrist is controversial. Some surgeons splint the wrist for 2-4 weeks whilst others encourage early mobilization. The literature has been inconclusive as to which method is most beneficial. The purpose of this study is to review the literature regarding the effectiveness of wrist immobilization following open carpal tunnel decompression. We reviewed all published clinical trials claiming to evaluate the mobility status following open carpal tunnel release. Studies not in the English language as well as those with small number of patients (n immobilization after open carpal tunnel decompression when compared to early mobilization.

  12. 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. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  13. Effect of sonotherapy on symptoms of carpal tunnel syndrome

    OpenAIRE

    Ciechanowska, Katarzyna; Łukowicz, Małgorzata

    2017-01-01

    Ciechanowska Katarzyna, Łukowicz Małgorzata. Effect of sonotherapy on symptoms of carpal tunnel syndrome. Journal of Education, Health and Sport. 2017;7(4):610-621. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.556821 http://ojs.ukw.edu.pl/index.php/johs/article/view/4417 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26.01.2017). 1223 Journal of Education, Health and Sport eISSN 239...

  14. Carpal Tunnel Syndrome: A Review of the Recent Literature

    Science.gov (United States)

    Ibrahim, I; Khan, W.S; Goddard, N; Smitham, P

    2012-01-01

    Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging. PMID:22470412

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

    Directory of Open Access Journals (Sweden)

    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

  16. Which surgery should be offered for carpal tunnel syndrome in a patient who was previously treated for recurrence on the contralateral side? Preliminary study of 13 patients with the Canaletto(®) implant.

    Science.gov (United States)

    Illuminati, I; Seigle-Murandi, F; Gouzou, S; Fabacher, T; Facca, S; Hidalgo Diaz, J J; Liverneaux, P

    2017-10-16

    There are no published studies on the management of carpal tunnel syndrome (CTS) patients who have already been operated for recurrent CTS on the contralateral side. The aim of this study was to evaluate 13 patients with CTS who underwent primary release using a Canaletto(®) implant. The 13 patients had all been operated for recurrent CTS previously. On the contralateral side, they all had subjective signs, and two of them already had complications. All were operated with the Canaletto(®) implant according to Duché's technique, in a mean of 20minutes. After a mean 19.3-month follow-up, paresthesia, pain, and QuickDASH scores were significantly improved, even in one patient who underwent revision at another facility. This preliminary study suggests that use of a Canaletto(®) implant as first-line treatment for CTS in patients who already underwent revision surgery on the other side is a simple and safe technique, without worsening of symptoms. These findings should be assessed with a prospective randomized controlled trial. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  17. The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome.

    Science.gov (United States)

    Baker, Nancy A; Moehling, Krissy K; Rubinstein, Elaine N; Wollstein, Ronit; Gustafson, Norman P; Baratz, Mark

    2012-01-01

    To compare the effectiveness of an intensive lumbrical splint/stretch combination with 3 less intensive lumbrical splint/stretch combinations on carpal tunnel symptoms and function. Randomized Clinical Trial. Outpatient hand therapy clinics. Volunteers (N=124) with mild to moderate carpal tunnel syndrome. A 4-week home regimen of nocturnal splints (lumbrical splints or cock-up splints) combined with stretches (lumbrical intensive or general) performed 6 times daily. The effect of the intervention on carpal tunnel symptoms and function was examined with the Carpal Tunnel Symptom Severity and Function Questionnaire (CTQ) and Disabilities of the Arm, Shoulder, and Hand (DASH). We also evaluated whether subjects obtained surgery at 24 weeks. There were significant main effects over time for all outcome measures at 4, 12, and 24 weeks. There was a significant interaction effect for the CTQ-Function and DASH at 12 weeks. Post hoc analyses indicated significant differences between the lumbrical splint/general stretch and general splint/lumbrical stretch groups and the other 2 groups. At 24 weeks, a significantly greater percentage of subjects in the general splint/lumbrical stretch group achieved a clinically important improvement on the CTQ-Function. By 24 weeks, only 25.5% of subjects had elected to undergo surgery. A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline. Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Clinical Study on Five Cases of Carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Kim Il Hwan

    2001-12-01

    Full Text Available Objections : The purpose of the study was to evaluate the effectiveness of treating the carpal tunnel syndrome by using both the Herbal Acupuncture and herbal medicine therapy on five cases. Methods : For the Herbal Acupuncture, Jungseonguhhyl No. 1 and Hwanglyunhaedoktang were used. For the herbal medicine, Dangguihwalhyul-tang was used. The patients were treated once in every two days; the result was evaluated after ten treatments. Patients' conditions were monitored through their testimony, phalen's test, nerve conduction study and electromyography. Results : In all five cases, the patients showed improvement; in four cases, the patients no longer had most of the clinical symptoms. Based on the result of the nerve conduction study, for the four cases in which the patients no longer displayed most of the clinical symptoms, their nerve conduction rate improved; for the remaining one case, the patient's nerve conduction rate deteriorated. Conclusions : The results of this study demonstrate that combining the Herbal Acupuncture and herbal medicine therapy can have noticeable effects in treating the carpal tunnel syndrome; developing more variety of the herbal acupuncture would lead to even better treatment results.

  19. Occupational carpal tunnel syndrome in Washington State, 1984-1988.

    Science.gov (United States)

    Franklin, G M; Haug, J; Heyer, N; Checkoway, H; Peck, N

    1991-06-01

    There are no published population-based studies of occupational carpal tunnel syndrome (OCTS) using a strict case definition. Most studies are either industry specific or present patient self-report of symptoms. We conducted a population-based incidence study of OCTS using the Washington State Workers' Compensation database. Incident OCTS claims were identified with paid bills for physician reported ICD codes 354.0 and 354.1. There were 7,926 incident OCTS claims identified for the years 1984-1988, which yields an industry-wide incidence rate of 1.74 claims/1,000 FTEs. The mean age (37.4 years) and female/male ratio (1.2:1) in this population differ from those reported in nonoccupational carpal tunnel studies (mean age, 51 years; female/male ratio, 3:1). The female-specific OCTS incidence rate increased significantly during the study period. The highest industry specific OCTS rates were found in the food processing, carpentry, egg production, wood products, and logging industries. Demographic differences and industry-specific rates consistent with workplace exposures suggest that OCTS is distinct from CTS occurring in nonoccupational settings. Workers' compensation data proved useful in identifying high risk industries.

  20. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Yesildag, A. E-mail: ahmetysd@hotmail.com; Kutluhan, S.; Sengul, N.; Koyuncuoglu, H.R.; Oyar, O.; Guler, K.; Gulsoy, U.K

    2004-10-01

    AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm{sup 2} at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome.

  1. Does ultrasonography contribute significantly to the diagnosis of carpal tunnel syndrome?

    Science.gov (United States)

    Zyluk, A; Walaszek, I; Szlosser, Z

    2014-02-01

    Recent studies have demonstrated ultrasonography as a valuable tool for confirming the diagnosis of carpal tunnel syndrome. The objective of this study was to investigate sonographic parameters of the median nerve in patients diagnosed clinically with carpal tunnel syndrome. 185 wrists in 185 patients, 149 women (81%) and 36 men (19%), with a mean age of 59 years, with the clinical diagnosis of carpal tunnel syndrome were examined sonographically. We measured cross-sectional area (CSA) of the median nerve at the forearm and at the carpal tunnel inlet, as well as the height (a-p dimension) of the nerve at the tunnel inlet and in the narrowest site in the carpal tunnel. Moreover, in all patients the severity of the disease was assessed by the Levine questionnaire. A significant variability of sonographic data characterizing the median nerve was found: the mean CSA at the tunnel inlet was 17.6 mm2 (range: 7-36) and height of the nerve at the tunnel inlet was a mean of 2.7 mm (range: 1.3-4.5). No correlation was found between sonographic data and severity of the syndrome as expressed by the Levine scores. Sonography of the median nerve contributes little to the diagnosis of a clinically relevant carpal tunnel syndrome and its routine use is not justified. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Short-Term Outcomes after Median Nerve Release for Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Andrea Dominguez,

    2017-06-01

    Full Text Available AIM: To study the short-term (considered as a 1-month period after surgery outcomes experienced by patients following median nerve release due to carpal tunnel syndrome. MATERIAL AND METHODS: A longitudinal cohort study was performed between September 2013 and October 2014. Inclusion criteria included suffering from CTS for at least six months confirmed by clinical and electromyographyc criteria and undergoing median nerve release. Exclusion criteria were pregnancy, patients with acute CTS and patients who were not able to read or non-Spanish speakers. All participants completed the questionnaires DASH, SF-36 and a Visual Analogue Scale for Pain, preoperatively and one month after surgery. RESULTS: Thirty patients were included, 22 women and 8 men. DASH and VAS showed statistical significant differences before and after surgery (p < 0.05 whereas SF-36 did not show significant differences. CONCLUSION: This study shows that median nerve surgical release for CTS has satisfying outcomes in only one month from surgery.

  3. An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome.

    Science.gov (United States)

    Tal-Akabi, A; Rushton, A

    2000-11-01

    Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. There is little literature available that addresses the management of this condition, which may partly explain why physiotherapy is often overlooked as a treatment approach in its management. This study investigated the effects of two manual therapy techniques in the treatment of patients experiencing carpal tunnel syndrome. An experimental different subject design compared three groups of subjects in three different conditions (two treatment interventions and one control group). Each group consisted of seven patients. The objectives of the study were: (1) to investigate differences between treated and untreated groups; (2) to investigate differences in the effectiveness of treatment I (median nerve mobilization) compared with treatment II (carpal bone mobilization). Measurements were taken applying several measurement tools, including active range of wrist movement (ROM flexion and extension), upper limb tension test with a median nerve bias (ULTT2a), three different scales to evaluate pain perception and function, and lastly numbers of patients continuing to surgery in each group were compared. In visual terms a clear trend was demonstrated between subjects who received treatment compared to those who were not treated, in particular the descriptive analysis of results for ULTT2a and numbers of patients continuing to surgery. When analysed statistically, less could be concluded. Only scores on a Pain Relief Scale (Pmobilization and median nerve mobilization. Copyright 2000 Harcourt Publishers Ltd.

  4. High-resolution US findings of carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Hyuk Won; Lee, Jin Hee; Rhee, Chang Soo; Lee, Sung Moon; Woo, Seong Ku [Keimyung University School of Medicine, Taegu (Korea, Republic of)

    2002-06-15

    To describe US findings of carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of US in CTS by measuring the cross-sectional area of the median nerve. Thirty one wrists from 21 patients with CTS diagnosed clinically and by electromyography and thirty two wrists from 16 normal control patients were included. The age of the patients with CTS ranged 36 to 65 years (mean=51 years); the age of the normal control group, 31 to 62 years (mean=43 years). Axial images of the wrists at the levels of the radiocarpal joint (RCJ), mid-level of the lunate and the capitate in the neutral position were obtained. The cross sectional area (CSA) of the median nerve was calculated at three levels using a indirect method by employing a ellipse tool programmed built in sonographic machine. In patients with CTS, CSA measured at the radiocarpal joint, mid-level of the lunate and capitate were 12.35 {+-} 3.90 mm{sup 2}, 14.68 {+-} 3.83 mm{sup 2} and 8.48 {+-} 1.88 mm'2, respectively. On the other hand, CSA of the control group, 8.44 {+-} 1.41 mm{sup 2}, 8.75 {+-} 1.46 mm{sup 2}, and 8.19 {+-} 1.47 mm{sup 2}, respectively. CSA at the radiocarpal joint and the mid lunate was bigger (or larger) in patients with CTS than in that of the controls with a statistical significance (P<0.05) while CSA at the mid capitate was slightly bigger in patients with CTS than that of the controls but without a statistical significance. CSA of the median nerve over 12 mm{sup 2} at the mid lunate level was highly predictive of carpal tunnel syndrome (sensitivity=80.6%, specificity=93.8%, positive predictive value=92.6%, negative predictive value=83.3%, and likelihood ratio=13). High resolution US can be useful in diagnosis of CTS, and CSA of the median nerve over 12 mm{sup 2} at the mid lunate level is highly predictive of carpal tunnel syndrome.

  5. Identification of the variables relevant to the recovery from post-surgical carpal tunnel syndrome.

    Science.gov (United States)

    Smail, K E

    1995-01-01

    The purpose of this paper is to determine what variables have been found to predict successful outcome for patients who have undergone carpal tunnel release surgery. In this case, 'successful' is defined as long-term relief of symptoms, pain free functional performance, or return to work. The variables have been divided into three major groups. The first group is the variables that relate to the individual. The second group is those variables that relate to the person's employment. The last group of variables to be discussed are those that relate to society. From this literature review, it appears that there are a significant number of variables that are 'relevant' to the recovery from carpal tunnel release surgery. However, the research conducted thus far has produced few results that identify any consistently reliable 'predictors' of surgical outcome. Future studies will require that a greater degree of reliability and validity be established for these variables. In addition, a clear and consistent definition of success with specific criteria for recovery will be necessary.

  6. Exercise and mobilisation interventions for carpal tunnel syndrome.

    Science.gov (United States)

    Page, Matthew J; O'Connor, Denise; Pitt, Veronica; Massy-Westropp, Nicola

    2012-06-13

    Non-surgical treatment, including exercises and mobilisation, has been offered to people experiencing mild to moderate symptoms arising from carpal tunnel syndrome (CTS). However, the effectiveness and duration of benefit from exercises and mobilisation for this condition remain unknown. To review the efficacy and safety of exercise and mobilisation interventions compared with no treatment, a placebo or another non-surgical intervention in people with CTS. We searched the Cochrane Neuromuscular Disease Group Specialised Register (10 January 2012), CENTRAL (2011, Issue 4), MEDLINE (January 1966 to December 2011), EMBASE (January 1980 to January 2012), CINAHL Plus (January 1937 to January 2012), and AMED (January 1985 to January 2012). Randomised or quasi-randomised controlled trials comparing exercise or mobilisation interventions with no treatment, placebo or another non-surgical intervention in people with CTS. Two review authors independently assessed searches and selected trials for inclusion, extracted data and assessed risk of bias of the included studies. We calculated risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs) for primary and secondary outcomes of the review. We collected data on adverse events from included studies. Sixteen studies randomising 741 participants with CTS were included in the review. Two compared a mobilisation regimen to a no treatment control, three compared one mobilisation intervention (for example carpal bone mobilisation) to another (for example soft tissue mobilisation), nine compared nerve mobilisation delivered as part of a multi-component intervention to another non-surgical intervention (for example splint or therapeutic ultrasound), and three compared a mobilisation intervention other than nerve mobilisation (for example yoga or chiropractic treatment) to another non-surgical intervention. The risk of bias of the included studies was low in some studies and unclear or high in other studies, with

  7. Carpal tunnel syndrome following an electrical injury in a child

    Science.gov (United States)

    Anand, Sambandam; Findlay, Alice Rima; Anand, Geetha

    2015-01-01

    Carpal tunnel syndrome (CTS) is very rare in children and has been reported very infrequently in the literature. We present an unusual case of CTS in a 14-year-old girl who developed this following an accidental electrical shock. As far as we are aware, this is the first case report of CTS in a child following electrical injury. This rare complication of electrical injury can easily be disregarded or misdiagnosed as neuropraxia, and this can delay appropriate treatment, as evidenced by this case. We propose that CTS should be considered when instigating initial medical care after an electrical injury, and that a referral to a hand surgeon should not be delayed, as these children need urgent surgical intervention to preserve hand function. PMID:25733087

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

  9. 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.

  10. Acute Carpal Tunnel Syndrome Caused by Diffuse Giant Cell Tumor of Tendon Sheath: A Case Report

    Science.gov (United States)

    Ward, Christina M; Lueck, Nathan E; Steyers, Curtis M

    2007-01-01

    A 46 year old male developed spontaneous acute carpal tunnel syndrome of the right wrist without any antecedent trauma. Surgical exploration revealed hemorrhage secondary to diffuse giant cell tumor of tendon sheath as the underlying cause. PMID:17907439

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Postures of upper extremity correlated with carpal tunnel syndrome (CTS).

    Science.gov (United States)

    Chiang, Chia-Liang; Liao, Chu-Yung; Kuo, Hsien-Wen

    2017-03-30

    Non-medical hospital staff members are in frequent contact with patients and therefore are required to perform a wide variety of repetitive and high-frequency activities. The objective of this study was to assess the relationships between upper extremity activity and carpal tunnel syndrome (CTS) among non-medical hospital staff members. Carpal tunnel syndrome in 144 non-medical hospital staff members was diagnosed using the Nordic Musculoskeletal Questionnaire (NMQ), a physician's diagnosis, physical examination (Tinel's signs and Phalen test) and a nerve conduction velocity (NCV) test. In addition, an ergonomic assessment was performed and a video camera was used to record the physical activities at work. The prevalence rate of CTS was highest for the NMQ (51.9%), followed by physician's diagnosis (49.5% for the right hand, 29.9% for the left hand), physical examination (54.7%), and nerve conduction test (motor nerve 27.5% and 25%, sensory nerve 21.7% and 15%, for right and left hands, respectively). Based on logistic regression models for the NMQ and physician's diagnoses, there was a dose-dependently higher risk of CTS with the upper extremity index among participants, but this was non-significant based on the physical examination and nerve conduction tests. Nerve conduction velocity is the gold standard in diagnosis of CTS, but use of NMQ and physician's diagnosis may overestimate the incidence of CTS in workers who have been engaging in repetitive stress activities for a relatively short time. Int J Occup Med Environ Health 2017;30(2):281-290.

  13. Confirmatory Factor Analysis of the Boston Carpal Tunnel Questionnaire.

    Science.gov (United States)

    Lue, Yi-Jing; Wu, Yuh-Yih; Liu, Ya-Fen; Lin, Gau-Tyan; Lu, Yen-Mou

    2015-12-01

    Carpal tunnel syndrome (CTS) is one of the most common hand problems and a major cause of work disability. The purpose of this study was to use confirmatory factor analysis (CFA) to assess the factor structure of the Boston Carpal Tunnel Questionnaire (BCTQ) in patients with CTS. One hundred and twenty-three patients with CTS were recruited from two hospitals. Each patient completed the functional status scale and the symptom severity scale of the BCTQ. CFA was used to assess the model fit between the data and pre-established theoretical measurement models. CFA showed that all three-factor models were better than the original two-factor model. Among the three-factor models, the simplified model, with 11 items assessing daytime pain, nocturnal numbness/tingling, and hand function was the best, for the model fit the data better than did the other models. Specifically, the Comparative Indices were larger than 0.95 (Tucker-Lewis Index and Comparative Fit Index values), and the Absolute Fit Indices and information-theoretic measures were the smallest. Moreover, all factor loadings were significant and high in magnitude (ranging from 0.66 to 0.99), the composite reliabilities exceeded 0.60 (ranging from 0.78 to 0.94), and the average variance extracted exceeded 0.50 (ranging from 0.61 to 0.89). The simplified model showed the highest reliability and validity, and the factor structure was the simplest/clearest one. The simplified model is recommended for clinical use due to its convenience and precision for assessing the problems of patients with CTS.

  14. [Case-control study on transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after distal radius fracture].

    Science.gov (United States)

    Wang, Yan-jie; Wang, Shi-gang; Miao, Shu-juan; Su, Xia

    2011-06-01

    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. 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. 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 carpal ligament resection can effectively prevent the delayed carpal tunnel syndrome occurrence for the distal radius fracture with open reduction by palm side.

  15. 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. PMID:25802819

  16. 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.

  17. Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project.

    Science.gov (United States)

    Burnham, Taylor; Higgins, Derek C; Burnham, Robert S; Heath, Deborah M

    2015-03-01

    Osteopathic manipulative treatment (OMT) has been recognized as a management option for carpal tunnel syndrome (CTS), although limited research exists to substantiate its effectiveness. To evaluate the effectiveness of OMT in the management of CTS. This single-blinded quasi-controlled trial was conducted at an academic institution. Participants with CTS underwent weekly OMT sessions for 6 consecutive weeks. The main outcome measures were the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a sensory symptom diagram (SSD), patient estimate of overall change, electrophysiologic testing of the median nerve (trans-carpal tunnel motor and sensory nerve conduction velocity and amplitude ratio), and carpal tunnel ultrasound imaging of the cross-sectional area of the median nerve and transverse carpal ligament length and bowing. All outcome measures were administered to participants before the first OMT session. Immediately after the first session, electrophysiologic testing of the median nerve and ultrasound imaging of the carpal tunnel were repeated. After 6 weeks of OMT, all outcome measures were readministered. Results of the BCTQ revealed statistically significant improvements in symptoms and function after 6 weeks of OMT (F=11.0; P=.004), and the improvements tended to be more pronounced on the treated side. The drop in SSD scores after 6 weeks of treatment was statistically significant (F=4.19; P=.0002). Patient estimate of overall improvement of symptoms was statistically significant for the treated side. No statistically significant changes in electrophysiologic function of the median nerve, cross-sectional area of the median nerve, or transverse carpal ligament bowing were observed. After treatment, the increase in transverse carpal ligament length was statistically significant, but no side-to-side difference was detected. Osteopathic manipulative treatment resulted in patient-perceived improvement in symptoms and function associated with CTS. However, median

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

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    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.

  20. Carpal tunnel syndrome – Part II (treatment)☆☆☆

    Science.gov (United States)

    Chammas, Michel; Boretto, Jorge; Burmann, Lauren Marquardt; Ramos, Renato Matta; Neto, Francisco Santos; Silva, Jefferson Braga

    2014-01-01

    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%. PMID:26229842

  1. Does routine carpal tunnel release during fixation of distal radius fractures improve outcomes?

    Science.gov (United States)

    Medici, Antonio; Meccariello, Luigi; Rollo, Giuseppe; De Nigris, Giancarlo; Mccabe, Steven James; Grubor, Pedrag; Falzarano, Gabriele

    2017-10-01

    This case-control study was designed to test the hypothesis whether carpal tunnel release (CTR) during fixation of distal radius 23-C2 AO fractures improves outcomes. Thirty-five consecutive patients who sustained distal radius fractures of the dominant hand participated in this study. Patients were allocated into two groups: (a) The ORIF + CTR (16 patients (11 males and 5 females)); (b) the ORIF and NOT CTR 19 patients (12 males and 7 females). Patient assessment included visual analogic scale of pain (VAS), the subjective Mayo Wrist Score (MWS), electromyograms (EMG) at 3 month and 6 months from the day of injury and complications. All patients had the same physiotherapy treatment algorithm following surgery. Patient follow up took place at 1 month, 3, 6, and 12 months. A the T12 month follow up point the VAS average was 0.8 (range 0-3) in ORIF + CTR group compared to 1.2 (range 0-3) in the ORIF and NOT CTR. The MWS average was 98.7 (range 95-100) in ORIF + CTR group versus 97.6 (range 95-100) in ORIF no CTR group. There was no statistical significance (p > 0.5) between the two groups during the follow up period. Patients in the sixth month of ORIF + CTR had no suffering of the median nerve, while 31.58% of patients in ORIF and no CTR found to have carpal tunnel syndrome. Routine release of the transverse carpal ligament at the time of fracture fixation may reduce the incidence of postoperative median nerve dysfunction. © 2017 Elsevier Ltd. All rights reserved.

  2. Persistent median artery and bifid median nerve that cause carpal tunnel syndrome: A case report

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    Hikmet ihsan Eren

    2013-12-01

    Full Text Available Carpal tunnel syndrome can be secondary in some patients, vascular anomalies (usually a persistent median artery, median nerve variations, or both are among the etiologic factors. High division of the median nerve proximal to the carpal tunnel (known as a bifid median nerve is a median nerve anomaly that has an incidence rate of 2.8%. This rare entity is often associated with various abnormalities that are clinically relevant, such as vascular malformations (persistent median artery, aberrant muscles, and carpal tunnel syndrome. Bifid median nerve and median artery association can be seen in %2.8 of population. This anomaly has asymptomatic findings, but in some cases acute and chronic findings can be seen as well. In this article, we present intraoperatively diagnosed median nerve and median artery assosicated carpal tunel sydrome. [Hand Microsurg 2013; 2(3.000: 115-118

  3. Effects of Metabolic Syndrome on the Outcome of Carpal Tunnel Release: A Matched Case-Control Study.

    Science.gov (United States)

    Roh, Young Hak; Lee, Beom Koo; Noh, Jung Ho; Oh, Joo Han; Gong, Hyun Sik; Baek, Goo Hyun

    2015-07-01

    To compare outcomes of carpal tunnel release in patients with or without metabolic syndrome. In a prospective consecutive series, 35 patients with metabolic syndrome and surgically treated carpal tunnel syndrome (CTS) were age- and sex- matched with 37 control patients without metabolic syndrome. Grip, pinch strength, perception of touch with Semmes-Weinstein monofilament, and Boston Carpal Tunnel Questionnaires (BCTQ) were assessed preoperatively and at 3, 6, and 12 months postoperatively. Patients with metabolic syndrome had more severe electrophysiologic grade of CTS than those without metabolic syndrome, but the 2 groups had similar preoperative grip/pinch strength and BCTQ scores. The BCTQ symptom score for the metabolic syndrome group was significantly greater than that of the control group at 3 months, and the BCTQ function score of the metabolic syndrome group was significantly greater than that of the control group at 3 and 6 months' follow-up. However, there was no significant difference in BCTQ symptom or functional scores between groups at 12 months' follow-up. There was no significant difference in grip strength between groups through 12 months' follow-up whereas the pinch strength of the control group was significantly greater than that of the metabolic syndrome group at 12 months' follow-up. Semmes-Weinstein monofilament test results were significantly greater in the control group than in the metabolic syndrome group at 3 and 6 months' follow-up but were similar at 12 months. Patients with CTS and metabolic syndrome have delayed functional recovery after carpal tunnel release, but noteworthy improvements in symptom severity and hand function are similar to those in patients without metabolic syndrome 1 year after surgery. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. The nerve/tunnel index: a new diagnostic standard for carpal tunnel syndrome using sonography: a pilot study.

    Science.gov (United States)

    Kim, Hyoung Seop; Joo, Seung Ho; Han, Zee-A; Kim, Yong Wook

    2012-01-01

    To define the relationship between body indices of healthy adults and cross-sectional areas of the carpal tunnel and median nerve and to obtain the nerve/tunnel index, which represents a new standard for diagnosing carpal tunnel syndrome using sonography. Body indices (height, weight, and body mass index) were analyzed in 60 healthy adults, and electromyography and sonography were also performed. The cross-sectional areas of the proximal and distal median nerve and carpal tunnel were obtained by sonography. The proximal and distal nerve/tunnel indices were obtained by calculating the ratio between the proximal and distal cross-sectional areas of the median nerve to those of the carpal tunnel and multiplying the value by 100. Although the proximal cross-sectional areas of the median nerve and body indices showed statistically significant relationships with weak positive correlations, the proximal and distal areas of the carpal tunnel showed relatively stronger correlations with body indices. Between sexes, there were significant differences in the proximal median nerve cross-sectional area (mean ± SD: male, 10.48 ± 3.21 mm(2); female, 8.81 ± 3.21 mm(2); P carpal tunnel area (male, 182.50 ± 21.15 mm(2); female, 151.23 ± 21.14 mm(2); P tunnel index (male, 5.80% ± 1.72%; female, 5.91% ± 1.63%). There was a statistically significant difference in the distal carpal tunnel cross-sectional area (male, 138.90 ± 20.95 mm(2); female, 121.50 ± 18.99 mm(2); P tunnel index (male, 7.15% ± 2.00%; female, 7.01% ± 1.38%) showed no significant differences. The proximal index was significantly higher than the distal index (proximal, 5.85% ± 1.66%; distal, 7.08% ± 1.71%). The nerve/tunnel index is unaffected by body indices or sex and thus may be a useful and objective standard for diagnosing carpal tunnel syndrome.

  5. 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.)

  6. Cost-Minimization Analysis of Open and Endoscopic Carpal Tunnel Release.

    Science.gov (United States)

    Zhang, Steven; Vora, Molly; Harris, Alex H S; Baker, Laurence; Curtin, Catherine; Kamal, Robin N

    2016-12-07

    Carpal tunnel release is the most common upper-limb surgical procedure performed annually in the U.S. There are 2 surgical methods of carpal tunnel release: open or endoscopic. Currently, there is no clear clinical or economic evidence supporting the use of one procedure over the other. We completed a cost-minimization analysis of open and endoscopic carpal tunnel release, testing the null hypothesis that there is no difference between the procedures in terms of cost. We conducted a retrospective review using a private-payer and Medicare Advantage database composed of 16 million patient records from 2007 to 2014. The cohort consisted of records with an ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis of carpal tunnel syndrome and a CPT (Current Procedural Terminology) code for carpal tunnel release. Payer fees were used to define cost. We also assessed other associated costs of care, including those of electrodiagnostic studies and occupational therapy. Bivariate comparisons were performed using the chi-square test and the Student t test. Data showed that 86% of the patients underwent open carpal tunnel release. Reimbursement fees for endoscopic release were significantly higher than for open release. Facility fees were responsible for most of the difference between the procedures in reimbursement: facility fees averaged $1,884 for endoscopic release compared with $1,080 for open release (p Occupational therapy fees associated with endoscopic release were less than those associated with open release (an average of $237 per session compared with $272; p = 0.07). The total average annual reimbursement per patient for endoscopic release (facility, surgeon, and occupational therapy fees) was significantly higher than for open release ($2,602 compared with $1,751; p carpal tunnel release.

  7. Ergonomic positioning or equipment for treating carpal tunnel syndrome.

    Science.gov (United States)

    O'Connor, Denise; Page, Matthew J; Marshall, Shawn C; Massy-Westropp, Nicola

    2012-01-18

    Non-surgical treatment, including ergonomic positioning or equipment, are sometimes offered to people experiencing mild to moderate symptoms from carpal tunnel syndrome (CTS). The effectiveness and duration of benefit from ergonomic positioning or equipment interventions for treating CTS are unknown. To assess the effects of ergonomic positioning or equipment compared with no treatment, a placebo or another non-surgical intervention in people with CTS. We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 2, in The Cochrane Library), MEDLINE (1966 to June 2011), EMBASE (1980 to June 2011), CINAHL Plus (1937 to June 2011), and AMED (1985 to June 2011). We also reviewed the reference lists of randomised or quasi-randomised trials identified from the electronic search. Randomised or quasi-randomised controlled trials comparing ergonomic positioning or equipment with no treatment, placebo or another non-surgical intervention in people with CTS. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of included studies. We calculated risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for the primary and secondary outcomes. We pooled results of clinically and statistically homogeneous trials, where possible, to provide estimates of the effect of ergonomic positioning or equipment. We included two trials (105 participants) comparing ergonomic versus placebo keyboards. Neither trial assessed the primary outcome (short-term overall improvement) or adverse effects of interventions. In one small trial (25 participants) an ergonomic keyboard significantly reduced pain after 12 weeks (MD -2.40; 95% CI -4.45 to -0.35) but not six weeks (MD -0.20; 95% CI -1.51 to 1.11). In this same study, there was no difference between ergonomic and standard keyboards in hand function at six or 12 weeks or palm

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

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    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.

  9. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome.

    Science.gov (United States)

    Geler Külcü, Duygu; Bursali, Canan; Aktaş, İlknur; Bozkurt Alp, Selin; Ünlü Özkan, Feyza; Akpinar, Pınar

    2016-06-23

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment choices are not always satisfactory. The aim of this study was to investigate the effect of kinesiotaping (KT) on pain level, grip strength, and functional status compared with that of placebo KT and orthotic device (OD) in patients with CTS. In this randomized, placebo-controlled study, participants were allocated into one of three groups: an experimental KT group (Group 1), a placebo KT group (Group 2), and an OD group (Group 3). Visual analogue scale (VAS) and Douleur Neuropathique 4 (DN4) scores, dynamometric grip strength measures, and the Boston CTS questionnaire (BQ) were the outcome measures. All groups significantly improved in terms of VAS scores (P < 0.05), DN4 scores (P < 0.05), and BQ scores (P < 0.05). Grip strength improved in Group 3 (P = 0.001). There was a significant difference among the groups with respect to BQ scores (P < 0.05). KT application for the treatment of CTS should be an alternative treatment choice.

  10. [Carpal tunnel in complex regional pain syndrome: a case report].

    Science.gov (United States)

    Raspopović, Emilija Dubljanin; Matanović, Dragana; Lesić, Aleksandar; Sudjić, Vojo; Zivković, Kristina; Bumbasirević, Marko

    2011-01-01

    When treating complex regional pain syndrome (CRPS) a positive outcome can be expected when the condition is identified and therapy is begun in the first six months. Nevertheless, symptoms may not improve by standard treatment as expected. One of the possible reasons for this is the coexistence of associated compressive neuropathies in the affected hand. A 50-year old female patient with history of CRPS on the left hand which developed as a complication of lateral epicondilytis treated with immobilization is presented. She continued to suffer from intensive pain in her hand despite pharmacological pain relief and initiation of a complex rehabilitation program. Electrophysiologic testing revealed the coexistence of conjoined severe carpal tunnel syndrome. After she underwent surgical decompression pain relief occurred and overall functional results improved. Failure of therapy response in CRPS should alert the clinican to check for associated compressive neuropathy. Detection of this complication can prevent further damage of the nerve, hasten recovery of CRPS, and prevent eventual permanent disability of the hand.

  11. 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.

  12. 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.

  13. The mini incision technique for carpal tunnel decompression using nasal instruments.

    Science.gov (United States)

    Sever, Celalettin; Kulahci, Yalcin; Oksuz, Sinan; Sahin, Cihan

    2010-07-01

    Mini incision techniques for carpal tunnel release have become increasingly popular for the treatment of carpal tunnel syndrome. The main advantages of mini incision techniques are shorter recovery and return-to-work time. However, the risk of neurovascular injury still remains worrisome. We present a novel method to release the carpal tunnel by using nasal instruments. This novel technique combines the advantages of endoscopic and open techniques while utilizing standard instruments. The advantages, disadvantages and results of this technique are discussed. Forty-five patients (15 male, 30 female, age 28-62; mean 48) with isolated carpal tunnel syndrome were enrolled to the study. Atotal of 55 wrists (bilateral in 7 cases, the right wrist in 41 and the left wrist in 14) underwent carpal tunnel decompression with a mini longitudinal incision technique. Grip strength--key pinch and sensorial evaluations were performed in all patients by one examiner using the Pressure-Specified Sensory Device. Significant differences between the pre- and postoperative periods were observed in either grip strength or pinch strength (p<0.05). No recurrence or injury to the neurovascular structures was noted in the follow-up period. The technique is simple and effective, employs inexpensive instruments, and has a low complication rate.

  14. Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation.

    Science.gov (United States)

    Tulipan, Jacob E; Kim, Nayoung; Abboudi, Jack; Jones, Christopher; Liss, Frederic; Kirkpatrick, William; Rivlin, Michael; Wang, Mark L; Matzon, Jonas; Ilyas, Asif M

    2017-08-01

    Background  Carpal tunnel release (CTR) is the most common surgery of the hand, and interest is growing in performing it under local anesthesia without tourniquet. To better understand differences, we hypothesized that patients undergoing CTR under wide-awake local anesthesia with no tourniquet (WALANT) versus sedation (monitored anesthesia care [MAC]) would not result in a difference in outcome. Methods  Consecutive cases of electrodiagnostically confirmed open CTR across multiple surgeons at a single center were prospectively enrolled. Data included demographic data, visual analog scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, customized Likert questionnaire, and complications. Results  There were 81 patients enrolled in the WALANT group and 149 patients in the MAC group. There were no reoperations in either group or any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at 2 weeks or 3 months. Average postoperative QuickDASH, Levine-Katz, and VAS pain scales were the same in both groups. Both groups of patients reported high levels of satisfaction at 91 versus 96% for the WALANT versus MAC groups, respectively ( p  > 0.05). Patients in each group were likely to request similar anesthesia if they were to undergo surgery again. Conclusion  Patients undergoing open CTR experienced similar levels of satisfaction and outcomes with either the WALANT or MAC techniques. There was no statistically significant difference between either group relative to the tested outcome measures. These data should facilitate surgeons and patients' choosing freely between WALANT and MAC techniques relative to complications and outcomes.

  15. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    NARCIS (Netherlands)

    A. Filius (Anika); M. Scheltens-De Boer (Marjan); H.G. Bosch (Hans); P.A. van Doorn (Pieter); H.J. Stam (Henk); S.E.R. Hovius (Steven); P.C. Amadio (Peter ); R.W. Selles (Ruud)

    2015-01-01

    textabstractDynamics 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

  17. 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

  18. 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

    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

  19. [Clinical auxiliary diagnosis value of high frequency ultrasonographic measurements of the thickness of transverse carpal ligaments in carpal tunnel syndrome patients].

    Science.gov (United States)

    Xu, L; Chen, F M; Wang, L; Zhang, P X; Jiang, X R

    2016-04-18

    To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS). 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-frequency 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 direct 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 hamate 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) analyzed. 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-index finger sensory nerve conduction velocity (SCV), wrist-middle finger SCV showed a negative correlation. High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.

  20. 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

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

    Science.gov (United States)

    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

    2016-09-06

    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. 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. 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). 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. Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch/Trial2.aspx

  2. Clinical outcome of carpal tunnel release with and without opposition transfer.

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    Uemura, T; Hidaka, N; Nakamura, H

    2010-10-01

    We studied the clinical outcome in 24 patients (25 hands) with carpal tunnel syndrome characterized by severe thenar muscle atrophy, who were treated by open carpal tunnel release alone (10 hands) or with simultaneous opposition transfer (15 hands). We also compared the surgical results in patients younger or older than 65 years. Pain and numbness improved after open carpal tunnel release but more so in younger patients. Activities of daily living also improved with and without opposition transfer; however, certain activities such as fastening hooks or buttons, using chopsticks and turning a key in a lock improved more with opposition transfer. Grip strength did not improve, with or without opposition transfer, regardless of the patients' ages. Pinch strength improved more with opposition transfer.

  3. Role of Wrist Immobilization in the Work EnvironmentErgonomics and Carpal Tunnel Syndrome.

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    Perez-Balke, G; Buchholz, B

    1994-01-01

    Commercial wrist splints do not constitute an ergonomic control for stressors associated with carpal tunnel syndrome. The science of ergonomics seeks to change the environment, not the human, in an effort to fit the work requirements to the capabilities of the individual. In contrast, immobilization of the wrist seeks to change the worker while the work environment exposures remain unchanged. Given this caveat, do wrist splints play a preventive role in the work environment with respect to the control of physical stressors that are likely to cause or exacerbate carpal tunnel syndrome? In an effort to provide an answer to this question, this article will provide a short synopsis of carpal tunnel syndrome as it relates to its diagnosis, occurrence in industry, and conservative treatment; a brief review of splinting as conservative treatment and an overview of the effect of wrist immobilization on physical stressors.

  4. Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome.

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    Tekin, Fatih; Sürmeli, Mehmet; Şimşek, Hülya; Ceran, Candemir; Tezcan, Soner; Taner, Ömer Faruk; Şimşek, Gülçin

    2015-12-01

    This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes. The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens. There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.

  5. Computer use and carpal tunnel syndrome: A meta-analysis.

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    Shiri, Rahman; Falah-Hassani, Kobra

    2015-02-15

    Studies have reported contradictory results on the role of keyboard or mouse use in carpal tunnel syndrome (CTS). This meta-analysis aimed to assess whether computer use causes CTS. Literature searches were conducted in several databases until May 2014. Twelve studies qualified for a random-effects meta-analysis. Heterogeneity and publication bias were assessed. In a meta-analysis of six studies (N=4964) that compared computer workers with the general population or other occupational populations, computer/typewriter use (pooled odds ratio (OR)=0.72, 95% confidence interval (CI) 0.58-0.90), computer/typewriter use ≥1 vs. computer/typewriter use ≥4 vs. computer/typewriter use (pooled OR=1.34, 95% CI 1.08-1.65), mouse use (OR=1.93, 95% CI 1.43-2.61), frequent computer use (OR=1.89, 95% CI 1.15-3.09), frequent mouse use (OR=1.84, 95% CI 1.18-2.87) and with years of computer work (OR=1.92, 95% CI 1.17-3.17 for long vs. short). There was no evidence of publication bias for both types of studies. Studies that compared computer workers with the general population or several occupational groups did not control their estimates for occupational risk factors. Thus, office workers with no or little computer use are a more appropriate comparison group than the general population or several occupational groups. This meta-analysis suggests that excessive computer use, particularly mouse usage might be a minor occupational risk factor for CTS. Further prospective studies among office workers with objectively assessed keyboard and mouse use, and CTS symptoms or signs confirmed by a nerve conduction study are needed. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Experiences with preventing carpal tunnel syndrome in an automotive plant.

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    Žídková, Věra; Nakládalová, Marie; Zapletalová, Jana; Nakládal, Zdeněk; Kollárová, Helena

    2017-02-21

    Carpal tunnel syndrome (CTS) is a common occupational disease. The aim was to assess the effect of preventive measures in automotive assembly workers. The analysis summarizes data from annual crosssectional studies. The 7-year analysis of data was based on medical records obtained from an occupational physician and inspections carried out at the workplace where targeted preventive measures were introduced, including better ergonomic arrangement of the workplace, technical adjustments facilitating the work, preventive nerve conduction studies (NCS) testing of the median nerve once a year, switching of workers and their targeted rotation within the workplace. The NCS testing of median nerve conduction at the wrist was the basic objective method for assessment of the prevalence and severity of CTS. Over the study period, the sample comprised 1804 workers at risk for repetitive overuse of the upper extremities, of whom 281 were females with a mean age of 38.5 years and 1523 were males with a mean age of 31.4 years. Over the study period, a total of 13 cases of CTS were recognized as an occupational disease in the plant, 8 of which occurred within the first 2 years from the initiation of production. Introduction of preventive measures decreased the prevalence of median neuropathy from 18.3% of examined extremities in 2011 to 10.5% in 2013 (p = 0.003). In early 2014, the production pace increased and this was accompanied by a rise in abnormal NCS findings to 16.9%. Over the study period, the rate of sensorimotor neuropathy decreased in favor of merely sensory neuropathies, which have been most frequent since 2013. The percentage of employees whose contracts were terminated due to median neuropathy decreased steadily from 5.5% to 0.4%. Targeted prevention of work-related CTS is effective as evidenced by the decrease in the prevalence of median neuropathy detected by NCS. Int J Occup Med Environ Health 2017;30(1):45-54.

  7. 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.

  8. Ultrasonographic changes after steroid injection in carpal tunnel syndrome.

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    Lee, Yeon Soo; Choi, Eunseok

    2017-11-01

    To determine the ultrasonographic changes after steroid injection in carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of ultrasound in post-treatment examination with clinical correlation. Twenty-seven wrists with idiopathic CTS after a single injection of 40 mg of prednisolone hydrochloride were prospectively studied using a high-resolution ultrasound. Axial images of the wrists were obtained at the level of the distal radius, pisiform and hamate prior to and 1, 4 and 8 weeks after steroid injection. The cross-sectional area (CSA, mm2) and flattening ratio (FR) of the median nerve were measured. The bowing of the flexor retinaculum (palmar displacement: PD, mm) and the transverse sliding distance of the median nerve (TSD, mm) during flexion-extension of the index finger were computed. Pre- and post-injection ultrasonographic findings were analyzed in relation to clinical parameters such as pain score. At all levels of the wrist, the CSA decreased significantly at 1 week after the injection, which continued to 8 weeks post-injection. The PD also diminished significantly 1 week after the injection. Furthermore, the TSD significantly increased from 1 week after injection, which lasted to the end of this study. The CSA, PD and TSD showed significant correlation with improvement of pain scores. Ultrasound is useful in follow-up examinations of CTS. Significant ultrasound findings after steroid injections in CTS include decreased swelling of the median nerve, decreased bowing of the flexor retinaculum and increased mobility of the median nerve. All of them significantly correlate with clinical symptoms.

  9. Carpal tunnel syndrome impairs index finger responses to unpredictable perturbations.

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    Grandy, Emily L; Xiu, Kaihua; Marquardt, Tamara L; Li, Chengliu; Evans, Peter J; Li, Zong-Ming

    2017-03-16

    The fine-tuning of digit forces to object properties can be disrupted by carpal tunnel syndrome (CTS). CTS' effects on hand function have mainly been investigated using predictable manipulation tasks; however, unpredictable perturbations are commonly encountered during manual tasks, presenting situations which may be more challenging to CTS patients given their hand impairments. The purpose of this study was to investigate muscle and force responses of the index finger to unpredictable perturbations in patients with CTS. Nine CTS patients and nine asymptomatic controls were instructed to stop the movement of a sliding plate by increasing index finger force following an unexpected perturbation. The electrical activity of the first dorsal interosseous muscle and forces exerted by the index finger were recorded. CTS patients demonstrated 20.9% greater muscle response latency and 12.0% greater force response latency compared to controls (psliding was significantly different between groups (p<0.05); the CTS group's duration was 142.2±5.8ms compared to the control group's duration of 133.1±8.4ms. Although CTS patients had increased muscle and force response durations comparatively, these differences were not statistically significant. Findings from this study suggest CTS-induced sensorimotor deficits interfere with accurate detection, processing and response to unpredictable perturbations. These deficits could be accounted for at multiple levels of the peripheral and central nervous systems. Delayed and decreased responses may indicate inefficient object manipulation by CTS patients and may help to explain why CTS patients tend to drop objects. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

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    Katarzyna Kapuścińska

    2015-09-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2 with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2 , max. 31 mm2 . Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%. Increased nerve vascularity on the transverse section was present in 50 patients (80.65%. Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

  11. Outcomes Following Carpal Tunnel Release in Patients Receiving Workers' Compensation: A Systematic Review.

    Science.gov (United States)

    Dunn, John C; Kusnezov, Nicholas A; Koehler, Logan R; Vanden Berge, Dennis; Genco, Ben; Mitchell, Justin; Orr, Justin D; Pallis, Mark

    2017-04-01

    Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers' compensation (WC) claims. The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria. A systematic review was generated; patient demographics, outcomes, and complications were recorded. Weighted averages were calculated for the demographic and outcome data. Categorical data such as complications were pooled from the studies and used to determine the overall complication rate. Statistical significance was determined between WC and non-WC cohorts when applicable with the chi-square statistic. The WC cohort included 1586 wrists, and the non-WC cohort included 2781 wrists. The WC cohort was younger and more often involved the dominant extremity. The WC cohort was less likely to have appropriate physical exam findings confirming diagnosis and electrodiagnostic studies. WC patients took almost 5 weeks longer to return to work, were 16% less likely to return to preinjury vocation, and had lower Standard Form (SF)-36 scores. Finally, WC patients had nearly 3 times the number of complications and nearly twice the rate of persistent pain. WC patients undergoing carpal tunnel release (CTR) fare poorly as compared with non-WC patients in nearly every metric. Higher rates of postoperative pain with delayed return to work can be anticipated in a WC cohort. In addition, WC patients receive suboptimal preoperative workup, and it is possible that unnecessary surgery is being completed in these cases. These findings are important to consider when treating the WC patient with CTS.

  12. 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.

  13. The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome.

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    Vanni, Daniele; Sirabella, Francesco Saverio; Galzio, Renato; Salini, Vincenzo; Magliani, Vincenzo

    2015-11-01

    The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6±0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

  14. 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

    Full Text Available Abstract Background Carpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare the efficacy of surgical treatment of carpal tunnel syndrome with conservative treatment Methods We included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010, MEDLINE (1980 to June 2010, EMBASE (1980 to June 2010, PEDro (searched in June 2010, international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR and 95% confidence intervals for electrophysiological studies and complication were also calculated. Results We assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47 and symptom severity 0.43 (95% CI 0.29, 0.57. There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months ( 0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56. The RR for secondary outcomes of normal

  15. A Clinical Scoring System for Distinguishing Patients With Coincident Cubital Tunnel Syndrome Among Patients With Carpal Tunnel Syndrome.

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    Koh, Justin; Azari, Kodi K; Benhaim, Prosper

    2017-01-01

    Background: Coincident carpal and cubital tunnel syndromes present a diagnostic challenge, exacerbated by the limitations of nerve conduction study (NCS) for confirming cubital tunnel syndrome. This study develops a diagnostic scoring system, the Koh-Benhaim (KB) score, to identify patients with coincident compression neuropathies. Methods: A retrospective review of 515 patients was performed from patients surgically treated for carpal and/or cubital tunnel release. These patients were divided as patients with isolated carpal tunnel syndrome (n = 337) or coincident carpal and cubital tunnel syndromes (n = 178), then characterized according to demographics, medical history, physical examination, and NCS results. Univariate and multivariate logistic regression identified predictors of coincident neuropathy. A clinical score was constructed by integerizing regression coefficients of predictive factors. Receiver operating characteristic (ROC) curves were generated for each iteration of the score. Sensitivities, specificities, and positive and negative predictive values were calculated to identify the best cutoff value. Results: Decreased intrinsic muscle strength, decreased ulnar sensation, positive elbow flexion test, positive cubital tunnel Tinel's sign, and abnormal NCS result were selected. The cutoff value for high risk of coincident compression was 3 points: positive predictive value, 82.9% and specificity, 93.4%. Model performance was very good-ROC area under the curve of 0.917. Conclusions: A KB score of 3 or greater represents high risk of coincident cubital tunnel compression. The variables involved are routinely used to assess the cubital tunnel, and all component factors of the KB score were of equivalent clinical weight in assessing patients with potential coincident compression neuropathy.

  16. THIRD TRIMESTER OF PREGNANCY: CARPAL TUNNEL SYNDROME, ANXIETY AND DEPRESSION

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    Tupković Emir

    2013-01-01

    Full Text Available This study measured the frequency of carpal tunnel syndrome (CTS and the levels of anxietyand 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 higherwhen compared to the control group (p = 0.037. The subjective assessment of pain in the group of womenwith CTSwas 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 shouldmake 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.

  17. Increased pain sensitivity is not associated with electrodiagnostic findings in women with carpal tunnel syndrome.

    Science.gov (United States)

    de la Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César; Laguarta-Val, Sofia; Alonso-Blanco, Cristina; Martínez-Perez, Almudena; Arendt-Nielsen, Lars; Pareja, Juan A

    2011-01-01

    To determine the differences in widespread pressure pain and thermal hypersensitivity in women with minimal, moderate, and severe carpal tunnel syndrome (CTS) and healthy controls. A total of 72 women with CTS (19 with minimal, 18 with moderate, and 35 with severe) and 19 healthy age-matched women participated. Pressure pain thresholds were bilaterally assessed over the median, ulnar, and radial nerves, the C5 to C6 zygapophyseal joint, the carpal tunnel, and the tibialis anterior muscle. In addition, warm and cold detection thresholds and heat and cold pain thresholds were bilaterally assessed over the carpal tunnel and the thenar eminence. All outcome parameters were assessed by an assessor blinded to the participant's condition. No significant differences in pain parameters among patients with minimal, moderate, and severe CTS were found. The results showed that PPT were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, C5 to C6 zygapophyseal joint, and the tibialis anterior muscle in patients with minimal, moderate, or severe CTS as compared with healthy controls (all, P<0.001). In addition, patients with CTS also showed lower heat pain threshold and reduced cold pain threshold compared with controls (P<0.001). No significant sensory differences between minimal, moderate, or severe CTS were found. The similar widespread pressure and thermal hypersensitivity in patients with minimal, moderate, or severe CTS and pain intensity suggests that increased pain sensitivity is not related to electrodiagnostic findings.

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

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    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. Functional deficits in carpal tunnel syndrome reflect reorganization of primary somatosensory cortex

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    Maeda, Yumi; Kettner, Norman; Holden, Jameson; Lee, Jeungchan; Kim, Jieun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Im, Jaehyun; Libby, Alexandra; Mezzacappa, Pia; Morse, Leslie R.; Park, Kyungmo; Audette, Joseph

    2014-01-01

    The functional significance of brain plasticity seen in carpal tunnel syndrome is unclear. Using functional MRI and bio-behavioural testing, Maeda et al. link blurred primary somatosensory cortical representations of median nerve innervated fingers with symptomatology and impaired psychomotor performance and discrimination accuracy. Neuroplasticity in these patients is thus indeed maladaptive.

  20. Reliability and Validation of the Greek Version of the Boston Carpal Tunnel Questionnaire.

    Science.gov (United States)

    Bougea, Anastasia; Zambelis, Thomas; Voskou, Panagiota; Katsika, Paraskevi Zacharoula; Tzavara, Chara; Kokotis, Panagiotis; Karandreas, Nikolaos

    2017-08-01

    The Boston Carpal Tunnel Questionnaire (BCTQ) is an easy, brief, self-administered questionnaire developed by Levine et al for the assessment of severity of symptoms and functional status of patients with carpal tunnel syndrome. The aim of our study was to develop and validate the Greek version of BCTQ. We conducted a cross-sectional study of 90 patients with idiopathic carpal tunnel syndrome. The original English version of BCTQ was adapted into Greek using forward and backward translation. Reliability was assessed by internal consistency (Cronbach α and item-total correlation) and reproducibility. Validity was examined by correlating the Boston Questionnaire scores to Canterbury severity scale for electrodiagnostic severity grading. The Greek version showed high reliability (Cronbach α 0.89 for Symptom Severity Scale and 0.93 for Functional Status Scale) and construct validity (Pearson correlation coefficient 0.53 for Symptom Severity Scale and 0.68 for Functional Status Scale). Test-retest were 0.75 for Symptom Severity Scale and 0.79 for Functional Status Scale ( P Greek version of the BCTQ is a valid, reliable screening tool for assessment in daily practice of symptoms and functional status in patients with carpal tunnel syndrome.

  1. Immediate and long-term effects of selected physiotherapy methods in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Kwolek, Andrzej; Zwolińska, Jolanta

    2011-01-01

    Carpal tunnel syndrome is a serious therapeutic problem and it considerably impairs the patients' quality of life. Despite many studies, the effectiveness of conservative treatment is still debatable. This study aimed to evaluate the immediate and long-term effects of conservative treatment involving ultrasound therapy combined with massage and kinesiotherapy for carpal tunnel syndrome. A total of 61 patients with carpal tunnel syndrome were assessed with regard to such symptoms as pain, numbness, tingling sensation, morning stiffness, and self-care difficulties. We used provocation tests and investigated sensory impairments, autonomic disturbances, and Lüthy's sign. Conduction in the median nerve fibres was assessed during a nerve conduction study. We performed computer-aided measurement of the hand joint range of motion and global grip strength. The tests were conducted before and on completion of a rehabilitation programme. The hands were re-examined one year later. The treatment involved ultrasound therapy, massage, and kinesiotherapy. The treatment outcomes confirmed the effectiveness of the therapeutic programme. Significant improvements concerning the majority of the symptoms were observed between the first and second examination as well for the entire follow-up period. We observed significant improvement in the quality of sensation, the hand range of motion and muscle strength. Ultrasound therapy combined with massage and kinesiotherapy brings the expected, long-term effects in patients with carpal tunnel syndrome.

  2. Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome

    Science.gov (United States)

    Miyamoto, Hideaki; Morizaki, Yutaka; Kashiyama, Takahiro; Tanaka, Sakae

    2016-01-01

    Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Grey-scale sonography and sonoelastography (SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area (CSA). Several authors have assessed additional parameters. “Delta CSA” is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The “CSA ratio” is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS. PMID:27027498

  3. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Pourmemari, M H; Shiri, R

    2016-01-01

    To assess whether diabetes increases the risk of carpal tunnel syndrome and to estimate the magnitude of the association with Type 1 and Type 2 diabetes. We conducted a systematic search of PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate for articles published between 1950 and January 2015. A total of 36 studies (eight cross-sectional, 21 case-control and seven cohort studies) qualified for meta-analysis. We used a random-effects meta-analysis and assessed heterogeneity and publication bias. The pooled odds ratio of 25 studies (including a total of 92 564 individuals) that reported unadjusted estimates for the association between diabetes and carpal tunnel syndrome or carpal tunnel release was 1.97 (95% CI 1.56-2.49). The pooled odds ratio of 18 case-control or cohort studies consisting of >37 million individuals that reported estimates after controlling for potential confounders was 1.69 (95% CI 1.45-1.96). The association did not differ for Type 1 and Type 2 diabetes. Furthermore, there was no publication bias. This meta-analysis suggests that both Type 1 and Type 2 diabetes are risk factors for carpal tunnel syndrome. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

  4. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy : A prospective study

    NARCIS (Netherlands)

    Meems, M.; Truijens, S. E. M.; Spek, V.; Visser, L. H.; Pop, V. J. M.

    2015-01-01

    Objective To investigate the prevalence, severity and relation to fluid retention of self-reported pregnancy-related carpal tunnel syndrome (CTS) symptoms in a large sample of pregnant women. Design A prospective longitudinal cohort study. Setting Dutch women who became pregnant between January 2013

  5. Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature.

    Science.gov (United States)

    Natsis, K; Iordache, G; Gigis, I; Kyriazidou, A; Lazaridis, N; Noussios, G; Paraskevas, G

    2009-11-01

    The median artery usually regresses after the eighth week of intrauterine life, but in some cases it persists into adulthood. The persistent median artery (PMA) passes through the carpal tunnel of the wrist, accompanying the median nerve. During anatomical dissection in our department, we found two unilateral cases of PMA originating from the ulnar artery. In both cases the PMA passed through the carpal tunnel, reached the palm, and anastomosed with the ulnar artery, forming a medio-ulnar type of superficial palmar arch. In addition, in both cases we observed a high division of the median nerve before entering the carpal tunnel. Such an artery may result in several complications such as carpal tunnel syndrome, pronator syndrome, or compression of the anterior interosseous nerve. Therefore, the presence of a PMA should be taken into consideration in clinical practice. This study presents two cases of PMA along with an embryological explanation, analysis of its clinical significance, and a review of the literature. The review of the literature includes cases observed during surgical procedures or anatomical dissections. Cases observed by means of imaging techniques were not included in the study.

  6. Functional deficits in carpal tunnel syndrome reflect reorganization of primary somatosensory cortex.

    Science.gov (United States)

    Maeda, Yumi; Kettner, Norman; Holden, Jameson; Lee, Jeungchan; Kim, Jieun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Im, Jaehyun; Libby, Alexandra; Mezzacappa, Pia; Morse, Leslie R; Park, Kyungmo; Audette, Joseph; Tommerdahl, Mark; Napadow, Vitaly

    2014-06-01

    Carpal tunnel syndrome, a median nerve entrapment neuropathy, is characterized by sensorimotor deficits. Recent reports have shown that this syndrome is also characterized by functional and structural neuroplasticity in the primary somatosensory cortex of the brain. However, the linkage between this neuroplasticity and the functional deficits in carpal tunnel syndrome is unknown. Sixty-three subjects with carpal tunnel syndrome aged 20-60 years and 28 age- and sex-matched healthy control subjects were evaluated with event-related functional magnetic resonance imaging at 3 T while vibrotactile stimulation was delivered to median nerve innervated (second and third) and ulnar nerve innervated (fifth) digits. For each subject, the interdigit cortical separation distance for each digit's contralateral primary somatosensory cortex representation was assessed. We also evaluated fine motor skill performance using a previously validated psychomotor performance test (maximum voluntary contraction and visuomotor pinch/release testing) and tactile discrimination capacity using a four-finger forced choice response test. These biobehavioural and clinical metrics were evaluated and correlated with the second/third interdigit cortical separation distance. Compared with healthy control subjects, subjects with carpal tunnel syndrome demonstrated reduced second/third interdigit cortical separation distance (P < 0.05) in contralateral primary somatosensory cortex, corroborating our previous preliminary multi-modal neuroimaging findings. For psychomotor performance testing, subjects with carpal tunnel syndrome demonstrated reduced maximum voluntary contraction pinch strength (P < 0.01) and a reduced number of pinch/release cycles per second (P < 0.05). Additionally, for four-finger forced-choice testing, subjects with carpal tunnel syndrome demonstrated greater response time (P < 0.05), and reduced sensory discrimination accuracy (P < 0.001) for median nerve, but not ulnar nerve

  7. 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.

  8. Carpal Tunnel Syndrome Associated with Oral Bisphosphonates. A Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Alfonso Carvajal

    Full Text Available Bisphosphonates are widely used to prevent osteoporotic fractures. Some severe musculoskeletal reactions have been described with this medication; among them, some cases of carpal tunnel syndrome. Thus, the aim of this study was to explore whether bisphosphonates may be associated with this syndrome.A cohort study was conducted to compare exposed to unexposed women; the exposed group was that composed of women having received at least one prescription of an oral bisphosphonate. For the purpose, we used information from The Health Improvement Network (THIN database. The outcome of interest was defined as those women diagnosed with carpal tunnel syndrome. A survival analysis was performed; the Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals, and to adjust for identified confounding variables.Out of a sample of 59,475 women older than 51 years, 19,825 were treated with bisphosphonates during the period studied. No differences in age distribution or mean follow-up time were observed between the two groups in comparison. Overall, there were 572 women diagnosed with carpal tunnel syndrome, 242 (1.2% in the group exposed to bisphosphonates, and 330 (0.8% in the unexposed. An adjusted hazard ratio of developing carpal tunnel syndrome of 1.38 (95%CI, 1.15-1.64 was found for women exposed to bisphosphonates; no significant changes in the hazard ratios were found when considering different levels of bisphosphonate exposure.An increased risk of carpal tunnel syndrome is associated with the use of bisphosphonates in postmenopausal women.

  9. Quality of information on the Internet about carpal tunnel syndrome: an update.

    Science.gov (United States)

    Lutsky, Kevin; Bernstein, Joseph; Beredjiklian, Pedro

    2013-08-01

    The use of the Internet for health-related information has increased significantly. In 2000, the current authors examined the source and content of orthopedic information on the Internet. At that time, Internet information regarding carpal tunnel syndrome was found to be of limited quality and poor informational value. The purposes of the current study were to reevaluate the type and quality of information on the Internet regarding carpal tunnel syndrome and to determine whether the quality of information available has improved compared with 1 decade ago. The phrase carpal tunnel syndrome was entered into the 5 most commonly used Internet search engines. The top 50 nonsponsored and the top 5 sponsored universal resource locators identified by each search engine were collected. Each unique Web site was evaluated for authorship and content, and an informational score ranging from 0 to 100 points was assigned. Approximately one-third of nonsponsored Web sites were commercial sites or selling commercial products. Seventy-six percent of sponsored sites were selling a product for the treatment of carpal tunnel syndrome. Thirty-eight percent of nonsponsored sites provided unconventional information, and 48% of sponsored sites provided misleading information. Just more than half of nonsponsored sites were authored by a physician or academic institution. The informational mean score was 53.8 points for nonsponsored sites and 14.5 points for sponsored sites. The informational quality on the Internet on carpal tunnel syndrome has improved over the past decade. Despite this progress, significant room exists for improvement in the quality and completeness of the information available. Copyright 2013, SLACK Incorporated.

  10. Carpal tunnel syndrome in the Clínica Universitaria San Juan de Dios de Cartagena, Colombia. Epidemiological, clinical profile and therapeutic evolution

    OpenAIRE

    Bedoya-Mosquera Jaddy Sandrey; Vergara-Bonnet Julio; Araujo-Orozco Marco Antonio; Ramos-Clason Enrique Carlos

    2012-01-01

    Introduction: carpal tunnel syndrome (CTS) is one of the major health problems ofworkers who carry out tasks related to intense manual effort and repetitive movementsof the upper limb.Objectives: to determine the epidemiological and clinical profile of patientsattending a pain unit, identify job, clinical and therapeutic characteristicsto compare the clinical course of patients before and after surgery.Methods: a prospective descriptive study. The study population consisted of allworkers who ...

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Prediction of Outcome in Women With Carpal Tunnel Syndrome Who Receive Manual Physical Therapy Interventions: A Validation Study.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Cleland, Joshua A; Salom-Moreno, Jaime; Palacios-Ceña, María; Martínez-Perez, Almudena; Pareja, Juan A; Ortega-Santiago, Ricardo

    2016-06-01

    Study Design Secondary analysis of a randomized trial. Background A clinical prediction rule to identify patients with carpal tunnel syndrome (CTS) most likely to respond to manual physical therapy has been published but requires further testing to determine its validity. Objective To assess the validity of a clinical prediction rule proposed for the management of patients with CTS in a different group of patients with a variety of treating clinicians. Methods A preplanned secondary analysis of a randomized controlled trial investigating the efficacy of manual physical therapies, including desensitization maneuvers of the central nervous system, in 120 women suffering from CTS was performed. Patients were randomized to receive 3 sessions of manual physical therapy (n = 60) or surgical release/decompression of the carpal tunnel (n = 60). Self-perceived improvement with a global rating of change was recorded at 6- and 12-month follow-ups. Pain intensity (mean pain and worst pain on a 0-to-10 numeric pain-rating scale) and scores on the Boston Carpal Tunnel Questionnaire (functional status and symptom severity subscales) were assessed at baseline and at 1, 3, 6, and 12 months. A baseline assessment of status on the clinical prediction rule was performed (positive status on the clinical prediction rule was defined as meeting at least 2 of the following criteria: pressure pain threshold of less than 137 kPa over the affected C5-6 joint; heat pain threshold of less than 39.6°C over the affected carpal tunnel; and general health score [Medical Outcomes Study 36-Item Short-Form Health Survey] of greater than 66 points). Linear mixed models with repeated measures were used to examine the validity of the rule. Results Participants with a positive status on the rule who received manual physical therapy did not experience greater improvements compared to those with a negative status on the rule for mean pain (P = .65), worst pain (P = .86), function (P = .99), or symptom

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. MÚSCULO LUMBRICAL COMO CAUSA DE SÍNDROME DEL TÚNEL CARPIANO. Lumbrical muscle within the carpal tunnel as a cause of carpal tunnel syndrome.

    OpenAIRE

    Fernando Martinez

    2017-01-01

    El síndrome del túnel carpiano es la neuropatía por atrapamiento mas frecuente. La causa mas frecuente es el disbalance entre contenido y continente del canal carpiano. En este sentido, la presencia de músculos anormales o supernumerarios es una causa poco común pero conocida, de compresión del nervio mediano en el canal carpiano. Se presenta un caso de músculo lumbrical intracanal como posible causa de un síndrome del túnel carpiano.  Carpal tunnel syndrome is the most common entrapment neur...

  16. Z-Elongation of the transverse carpal ligament vs. complete resection for the treatment of carpal tunnel syndrome.

    Science.gov (United States)

    Castro-Menéndez, M; Pagazaurtundúa-Gómez, S; Pena-Paz, S; Huici-Izco, R; Rodríguez-Casas, N; Montero-Viéites, A

    Carpal tunnel syndrome is treated successfully by surgical release of the transverse carpal ligament (TCL). However, persistent weakness of grip and pain over the thenar and hypothenar ends of this ligament, and "pillar pain", are reported to be common complications. In order to reduce these complications, different ligament reconstruction or lengthening techniques have been proposed. The purpose of this study is compare effectiveness and complications of TCL z-lengthening technique with complete TCL section. A prospective, randomised, intervention trial was conducted on 80 patients. The patients were divided into 2 groups: 1) complete release of TCL; 2) z-lengthening of TCL according to a modified Simonetta technique. Grip strength, pillar pain and clinical and functional assessment were carried out using the Levine et al. questionnaire. No significant differences were observed (p>.05) in the postoperative reviews between the two groups as regards grip strength loss and pillar pain. There were significant differences between preoperative and postoperative mean Levine scores, but there was no difference in the mean scores of the two procedures at any time. In conclusion, according to the results, TCL z-lengthening is more effective than simple division, but there is no identifiable benefit in z-lengthening for avoiding complications. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. The role of self-efficiency toward pain following surgical treatment of carpal tunnel syndrome.

    Science.gov (United States)

    Hidalgo Diaz, J J; Botero, S S; Vernet, P; Aguerre, C; Facca, S; Liverneaux, P

    2016-12-01

    Some very poor results after carpal tunnel syndrome (CTS) surgery are difficult to explain. The main hypothesis of this study was that a relationship exists between self-efficiency toward pain and the difference between pre-operative and post-operative pain. The secondary hypothesis was that a relationship exists between self-efficiency toward pain and the pre-operative and post-operative QuickDASH score. The records of 64 patients operated for purely subjective CTS were reviewed. The evaluation consisted in determining self-efficacy beliefs from two PSEQ2 questions (1: I can still accomplish most of my goals in life, despite the pain; 2: I can live a normal lifestyle, despite the pain), pain levels and the QuickDASH score. There was an inversely proportional relationship between the pre-operative PSEQ2 and pain on one hand, and post-operative pain and the pre-operative QuickDASH score on the other hand. We found no correlation between the pre-operative PSEQ2 and post-operative QuickDASH score. Self-efficiency beliefs as measured by PSEQ2 help to predict pain levels after surgical CTS treatment in the absence of sensory and/or motor deficits and/or associated morbidity. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  18. The Role of Wrist Magnetic Resonance Imaging in the Differential Diagnosis of the Carpal Tunnel Syndrome.

    Science.gov (United States)

    Onen, Mehmet Resid; Kayalar, Ali Erhan; Ilbas, Elif Nurbegum; Gokcan, Recai; Gulec, Ilker; Naderi, Sait

    2015-01-01

    The carpal tunnel syndrome (CTS) is the commonest compressive neuropathy. Electromyography (EMG) is accepted as gold standard in diagnosis of CTS. However, pathologies and variations that are associated with a various findings may lead to failure. Magnetic resonance Imaging (MRI) was applied to 69 wrists of 55 patients, who received a diagnosis of CTS by means of clinical and electrodiagnostic testing (EDT) during the years 2011 and 2013. We detected a total of 71 additional pathologies in MRI analyses: 29 degenerative bone cysts, 28 ganglion cysts, 8 tenosynovitis, and 6 avascular necroses. While the MRI detected 44 (59.5%) additional radiological pathologies in 39 wrists diagnosed with mid-level CTS by means of EMG, the number of detected additional pathologies was 27 (36.5%) in 30 wrists diagnosed with advanced-level CTS. Wrist MRI is an effective means to reveal associated pathologies in patients diagnosed with CTS by means of clinical testing and EDT. Additional pathologies may not only change the applicable type of surgery, but also decrease the number of postoperative failures. Wrist MRI is recommended, especially for young cases with unilateral CTS history accompanied by dubious clinical symptoms and lacking any pronounced predisposing factors.

  19. Dynamic Ultrasound—A Useful Tool to Demonstrate Adhesions Postcarpal Tunnel Surgery

    Directory of Open Access Journals (Sweden)

    Mei-Ting Wang

    2016-09-01

    Full Text Available Carpal tunnel syndrome is common, and open carpal tunnel release remains the treatment of choice for cases refractive to conservative treatment. However, up to 25% of postrelease patients remain symptomatic. Our case illustrates how ultrasound examination can visualize the movements of the contents of the carpal tunnel and reveal additional pathologies. A 42-year-old patient with previous bilateral open carpal tunnel release surgeries presented with recurrent symptoms of bilateral hand tingling sensation starting months after the first operation. Under real-time sonographic exam, the median nerve (MN changed shape and migrated inferiorly when the patient extended her third finger, suggesting that the perineurium of the MN was adherent to the tendon sheath of the third flexor digitorum superficialis tendon. The patient opted to continue conservative treatment but unfortunately did not improve. Recurrent inflammation and fibrosis may have led to the adhesion of the flexor tendons to the MN which was only apparent on real-time evaluation of the displacement of the MN on ultrasound examination. We suggest that the observation of the displacement of the MN during active finger movement can be integrated into the examination of carpal tunnel syndrome patients both before and after surgical intervention and herein include an easy to follow protocol for such examinations.

  20. [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. Copyright © 2014. Published by Elsevier SAS.

  1. Limited longitudinal sliding of the median nerve in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Valls-Solé, J; Alvarez, R; Nuñez, M

    1995-07-01

    During normal movements or changes in position of the limbs, nerve structures must accommodate the resulting changes in length of the nerve path. In patients with carpal tunnel syndrome, we monitored electrophysiologically the longitudinal adjustment of the median nerve to positions of extreme flexion and extreme extension of the wrist and elbow, by measuring the differences induced in the latency of the sensory nerve action potential (SNAP) recorded in the forearm and upper arm. In patients, the latency difference was significantly shorter than in normal subjects (0.196 +/- 0.084 ms vs. 0.088 +/- 0.059 ms in the forearm, and 0.485 +/- 0.122 ms vs. 0.129 +/- 0.086 ms in the upper arm). These results indicate that the displacement of the source of the median nerve SNAP with movements of flexion and extension is limited in patients with carpal tunnel syndrome. Such an abnormality may partly underlie the pathophysiology of entrapment syndromes.

  2. Longitudinal sliding of the median nerve in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Erel, E; Dilley, A; Greening, J; Morris, V; Cohen, B; Lynn, B

    2003-10-01

    In nerve compression syndromes restricted nerve sliding may lead to increased strain, possibly contributing to symptoms. Ultrasound was used to examine longitudinal median nerve sliding in 17 carpal tunnel syndrome patients and 19 controls during metacarpophalangeal joint movement. Longitudinal movement in the forearm averaged 2.62 mm in controls and was not significantly reduced in carpal tunnel syndrome (CTS) patients (mean=2.20 mm). In contrast, CTS patients had a 40% reduction in transverse nerve movement at the wrist on the most, compared to least, affected side and nerve areas were enlarged by 34%. Normal longitudinal sliding in the patients indicates that nerve strain is not increased and will not contribute to symptoms.

  3. The Prevalence of Pronator Teres among Patients with Carpal Tunnel Syndrome: Cross-sectional Study

    OpenAIRE

    Asheghan, Mahsa; Hollisaz, Mohammad Taghi; Aghdam, Abbas Shahabi; Khatibiaghda, Amidoddin

    2016-01-01

    The aim of conducting this study was to determine the prevalence of PTS among patients with carpal tunnel syndrome. The study was conducted from March 2014 to April 2015 in the EDX ward and clinic of physical medicine and rehabilitation at the university hospital; Baqiytallah, a large referral practice and research center in Tehran. We included patients with clinical symptoms and signs of CTS. Clinical assessments were aimed to the diagnosis of CTS and PTS. At the next stage, ultrasound study...

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

    Directory of Open Access Journals (Sweden)

    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

  5. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment

    Science.gov (United States)

    Ghasemi-rad, Mohammad; Nosair, Emad; Vegh, Andrea; Mohammadi, Afshin; Akkad, Adam; Lesha, Emal; Mohammadi, Mohammad Hossein; Sayed, Doaa; Davarian, Ali; Maleki-Miyandoab, Tooraj; Hasan, Anwarul

    2014-01-01

    Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anatomy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation. PMID:24976931

  6. Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis)☆☆☆

    Science.gov (United States)

    Chammas, Michel; Boretto, Jorge; Burmann, Lauren Marquardt; Ramos, Renato Matta; dos Santos Neto, Francisco Carlos; Silva, Jefferson Braga

    2014-01-01

    Carpal tunnel syndrome (CTS) is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Electroneuromyographic examination may be recommended before the operation or in cases of occupational illnesses. PMID:26229841

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

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    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.

  8. 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.

  9. [Etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype wrist movements].

    Science.gov (United States)

    Lewańska, Magdalena; Walusiak-Skorupa, Jolanta

    2014-01-01

    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. 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. 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. 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.

  10. Median nerve deformation and displacement in the carpal tunnel during finger motion.

    Science.gov (United States)

    Yoshii, Yuichi; Ishii, Tomoo; Tung, Wen-Lin; Sakai, Shinsuke; Amadio, Peter C

    2013-12-01

    The objective of this study was to evaluate the correlations between deformation and displacement of median nerve and flexor tendons during finger motion in the carpal tunnel for both carpal tunnel syndrome (CTS) patients and healthy controls. Sixty-two wrists of 31 asymptomatic volunteers and fifty-one wrists of 28 idiopathic CTS patients were evaluated by ultrasound. The displacement of the median nerve and the middle finger flexor digitorum superficialis (FDS) tendon, as well as area, perimeter, aspect ratio of a minimum enclosing rectangle, and circularity of the median nerve were measured in finger extension and flexion positions. Deformation indices were defined as the ratios of indices in finger extension and flexion positions. The correlations between displacement and deformation indices were evaluated. There were significant correlations between nerve palmar-dorsal displacement and deformation indices (p deformation index showed the strongest correlation to palmar-dorsal displacement of the nerve (-0.572, p deformation indices and nerve palmar-dorsal displacement in the carpal tunnel. Since the highest correlations were between palmar-dorsal nerve displacement direction and aspect ratio deformation index, these parameters may be helpful to understand the pathophysiology of CTS. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  11. The Prevalence of Pronator Teres among Patients with Carpal Tunnel Syndrome: Cross-sectional Study.

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    Asheghan, Mahsa; Hollisaz, Mohammad Taghi; Aghdam, Abbas Shahabi; Khatibiaghda, Amidoddin

    2016-09-01

    The aim of conducting this study was to determine the prevalence of PTS among patients with carpal tunnel syndrome. The study was conducted from March 2014 to April 2015 in the EDX ward and clinic of physical medicine and rehabilitation at the university hospital; Baqiytallah, a large referral practice and research center in Tehran. We included patients with clinical symptoms and signs of CTS. Clinical assessments were aimed to the diagnosis of CTS and PTS. At the next stage, ultrasound study was performed for the participants with suspected CTS. Sample size calculations were based on the formula: [Formula: see text]. Results showed that 13 (8.8%) patients presented electrodiagnostic, and 27 (18.2%) had clinical manifestations of pronator teres syndrome of which, 17 showed ultrasonic signs of the syndrome. In addition, 2, 7, and 8 out of the 17 patients had mild, moderate, and sever carpal tunnel syndrome, respectively. Age was not significantly different between the patients with, and without pronator teres syndrome ( p -value=0.179). Nine participants with pronator teres syndrome were male and there was a significant difference concerning sex ( p -value=0.013). There was a good agreement between electrodiagnostic and ultrasound findings (Cohen's kappa coefficient=0.71, p -valuesyndrome should be considered as a possibility among patients with carpal tunnel syndrome especially in sever forms. Both electrodiagnostic and sonographic studies are efficient for diagnosing pronator teres syndrome. Men are more prone to develop pronator teres syndrome.

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

    Science.gov (United States)

    Kanikannan, Meena Angamuthu; Boddu, Demudu Babu; Umamahesh; Sarva, Sailaja; Durga, Padmaja; Borgohain, Rupam

    2015-01-01

    The diagnostic accuracy of high-resolution ultrasonography (HRUS) in comparison to electro-diagnostic testing (EDX) in carpal tunnel syndrome (CTS) is debatable. 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). 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. 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. 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. 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.

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

    Science.gov (United States)

    Chen, Yan; Zhao, Cheng-Qiang; Ye, Gang; Liu, Can-Dong; Xu, Wen-Dong

    2016-07-01

    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 optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside reflection 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 significantly among cases, with the measured laser reflection coefficient ranging from 1.8% to 54%. The reflection coefficient 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.

  15. Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome.

    Science.gov (United States)

    Lee, Michael J; LaStayo, Paul C

    2004-10-01

    The purpose of this clinical commentary is to provide a comprehensive review of compressive neuropathies that may mimic carpal tunnel syndrome, provide the clinician with information to differentially diagnose these median nerve compression sites, and provide an evidence-based opinion regarding conservative intervention techniques for the various compression syndromes. While rare in comparison to carpal tunnel syndrome, pronator syndrome and anterior interosseous nerve syndrome are proximal median nerve compressions that may be suspected if a patient with carpal tunnel syndrome fails to respond to conservative or surgical intervention. Differential diagnosis is based largely on the symptoms, patterns of paresthesia, and specific patterns of muscle weakness. Due to the relative rarity of pronator syndrome and anterior interosseous nerve syndrome, few controlled studies exist to determine the most effective treatment techniques. Based on sound anatomical and biomechanical considerations, anecdotal experience, and available research, however, treatment strategies for pronator syndrome and anterior interosseous nerve syndrome compression neuropathies can be divided into 4 major categories: (1) rest/immobilization, (2) modalities, (3) nerve gliding, and (4) nonconservative treatment.

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

    Science.gov (United States)

    Aoki, Takatoshi; Oshige, Takahisa; Matsuyama, Atsushi; Oki, Hodaka; Kinoshita, Shunsuke; Yamashita, Yoshiko; Takahashi, Hiroyuki; Hayashida, Yoshiko; Sakai, Akinori; Hisaoka, Masanori; Korogi, Yukunori

    2014-03-01

    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 × 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 carpal tunnel syndrome. • MRI helps in therapeutic decision-making whenever steroid injection is considered. • T2 signal decrease of the median nerve correlates with poor outcome. • T2 signal decrease of median nerve may reflect fibrosis and amyloid deposition.

  17. 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.)

  18. 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.)

  19. Risk factors for operated carpal tunnel syndrome: a multicenter population-based case-control study

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    Mandes Anna

    2009-09-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a socially and economically relevant disease caused by compression or entrapment of the median nerve within the carpal tunnel. This population-based case-control study aims to investigate occupational/non-occupational risk factors for surgically treated CTS. Methods Cases (n = 220 aged 18-65 years were randomly drawn from 13 administrative databases of citizens who were surgically treated with carpal tunnel release during 2001. Controls (n = 356 were randomly sampled from National Health Service registry records and were frequency matched by age-gender-specific CTS hospitalization rates. Results At multivariate analysis, risk factors were blue-collar/housewife status, BMI ≥ 30 kg/m2, sibling history of CTS and coexistence of trigger finger. Being relatively tall (cut-offs based on tertiles: women ≥165 cm; men ≥175 cm was associated with lower risk. Blue-collar work was a moderate/strong risk factor in both sexes. Raised risks were apparent for combinations of biomechanical risk factors that included frequent repetitivity and sustained force. Conclusion This study strongly underlines the relevance of biomechanical exposures in both non-industrial and industrial work as risk factors for surgically treated CTS.

  20. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial.

    Science.gov (United States)

    Michalsen, Andreas; Bock, Silke; Lüdtke, Rainer; Rampp, Thomas; Baecker, Marcus; Bachmann, Jürgen; Langhorst, Jost; Musial, Frauke; Dobos, Gustav J

    2009-06-01

    We investigated the effectiveness of cupping, a traditional method of treating musculoskeletal pain, in patients with carpal tunnel syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0 years) with neurologically confirmed CTS were randomly assigned to either a verum (n = 26) or a control group (n = 26). Verum patients were treated with a single application of wet cupping, and control patients with a single local application of heat within the region overlying the trapezius muscle. Patients were followed up on day 7 after treatment. The primary outcome, severity of CTS symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control group [group difference -24.5mm (95%CI -36.1; -2.9, P cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified. The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.

  1. 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

  2. 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

  3. [Magnetic resonance in the tunnel carpal syndrome. Possibilities and perspectives of an etiopathogenetic study].

    Science.gov (United States)

    Giovagnoni, A; Ercolani, P; Soccetti, A; Misericordia, M; De Nigris, E

    1991-01-01

    Thirty-four selected patients were evaluated in order to define MRI capabilities in the preoperative evaluation and characterization of the pathogenetic patterns of carpal tunnel syndrome (CTS). MRI examinations were performed by means of a superconductive unit (1.0 T, Magnetom): SE T1 (500/17) and T2 (2000/90) axial images of the carpal region were obtained with a round surface coil. In 8 patients 3D GE (FLASH) pulse sequences were used to obtain 32 images of the hand; 3D reconstruction was also applied. Six patients with rheumatoid arthritis and amyloidosis were also studied after i.v. injection of Gd-DTPA (0.2 mM/kg). MRI findings were compared with both clinico-electrophysiologic and surgical results. High agreement was observed only between MRI and surgical findings. MRI allowed the direct demonstration of carpal tunnel abnormalities in 8 cases, while abnormal findings in the median nerve were observed in 18 patients. The possibility of depicting medial nerve lesions on T2-weighted images when no direct demonstration of the cause of compression is possible, could represent a guideline for the etiopathogenetic investigation of CTS. However, further experience in selected patients is necessary to define all the aspects relative to this very common syndrome.

  4. Can Impairment Interfere with Performance by Women with Carpal Tunnel Syndrome According to International Classification of Function?

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    Somayeh Kavousipor

    2015-03-01

    Full Text Available Background: Carpal tunnel syndrome is the most prevalent compression neuropathy of upper extremity which, two of the most important risk factors of that are the female sex and manual works. In the model of international classification of function, disability and health, disease is an impairment, results in functional limitation. The goal of this study is to compare hand function of participants between various severities of carpal tunnel syndrome. Methods: In a cross-sectional study, during 6 months period of time, 30 housekeeper women with carpal tunnel syndrome, with the mean age of 47.03 years, were selected through simple sampling. They were assessed for hand function, by Purdue peg board test and Boston questionnaire, after that a professional practitioner had performed Nerve Conductive Velocity (NCV test and identified the severity of their diseases. Then the data were analyzed with SPSS software, by Kruskal-Wallis test. Results: The mean of Purdue peg board test and Boston questionnaire scores in various clusters of carpal tunnel syndrome severity, were not different (P>0.05. Conclusion: In this research, severity of electrodiagnostic findings of participants, with carpal tunnel syndrome, is not related to their performance and functional limitations.

  5. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review.

    Science.gov (United States)

    Muller, Monique; Tsui, Deborah; Schnurr, Ronda; Biddulph-Deisroth, Lori; Hard, Julie; MacDermid, Joy C

    2004-01-01

    The purpose of this study was to determine the effectiveness of hand therapy interventions for carpal tunnel syndrome (CTS) based on the best available evidence. A qualitative systematic review was conducted. A literature search using 40 key terms was conducted from the earliest available date to January 2003 using seven databases. Articles were randomly assigned to two of five reviewers and evaluated according to predetermined criteria for inclusion at each of the title, abstract, and article levels. Included studies were independently scored by two reviewers using a structured effectiveness quality evaluation scale and also graded according to Sackett's Levels of Evidence. There were 2027 articles identified from the literature search, of which 345 met the inclusion criteria. Twenty-four studies were used to formulate 30 recommendations. Current evidence demonstrates a significant benefit (grade B recommendations) from splinting, ultrasound, nerve gliding exercises, carpal bone mobilization, magnetic therapy, and yoga for people with CTS.

  6. [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. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  7. The Correlation Between Electrodiagnostic Results and Ultrasonographic Findings in the Severity of Carpal Tunnel Syndrome in Females

    Science.gov (United States)

    2017-01-01

    Objective To determine which ultrasonographic measurement can be used as an indicator reflecting the severity of carpal tunnel syndrome (CTS), by comparing electrodiagnostic results with ultrasonographic measurements in females. Many previous studies have tried to reveal that the ultrasonography (US) can possibility be used for diagnosis and severity of CTS. However, the criteria are different by gender. Thus far, there have been many efforts towards providing patients with a CTS diagnosis and severity prediction using US, but studies' results are still unclear due to lack of data on gender differences. Methods We collected data from 54 female patients. We classified the severity of CTS according to electrodiagnostic results. Ultrasonographic measurements included proximal and distal cross-sectional areas of the median nerve and carpal tunnel. Results The severity by electrodiagnostic results statistically correlated to the proximal cross-sectional area (CSA) of the median nerve and carpal tunnel. However, there was no relationship between the proximal and distal nerve/tunnel indexes and the severity by electrodiagnostic results. Conclusion In female patients with CTS, the proximal CSAs of the median nerve and carpal tunnel increase. They correlate with the severity by electrodiagnostic findings. The CSA of the proximal median nerve could be particularly used as a predictor of the severity of CTS in female patients. However, the nerve/tunnel index is constant, irrespective of the severity of CTS. PMID:28971044

  8. Identification of Subgroups of Women with Carpal Tunnel Syndrome with Central Sensitization.

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    Fernández-de-Las-Peñas, César; Fernández-Muñoz, Juan J; Navarro-Pardo, Esperanza; da-Silva-Pocinho, Ricardo F; Ambite-Quesada, Silvia; Pareja, Juan A

    2016-09-01

    Identification of subjects with different sensitization mechanisms can help to identify better therapeutic strategies for carpal tunnel syndrome (CTS). The aim of the current study was to identify subgroups of women with CTS with different levels of sensitization. A total of 223 women with CTS were recruited. Self-reported variables included pain intensity, function, disability, and depression. Pressure pain thresholds (PPT) were assessed bilaterally over median, ulnar, and radial nerves, C5-C6 joint, carpal tunnel, and tibialis anterior to assess widespread pressure pain hyperalgesia. Heat (HPT) and cold (CPT) pain thresholds were also bilaterally assessed over the carpal tunnel and the thenar eminence to determine thermal pain hyperalgesia. Pinch grip force between the thumb and the remaining fingers was calculated to determine motor assessment. Subgroups were determined according to the status on a previous clinical prediction rule: PPT over the affected C5-C6 joint 66 points. The ANOVA showed that women within group 1 (positive rule, n = 60) exhibited bilateral widespread pressure hyperalgesia (P < 0.001) and bilateral thermal thresholds (P < 0.001) than those within group 2 (negative rule, n = 162). Women in group 1 also exhibited higher depression than those in group 2 (P = 0.023). No differences in self-reported variables were observed. This study showed that a clinical prediction rule originally developed for identifying women with CTS who are likely to respond favorably to manual physical therapy was able to identify women exhibiting higher widespread pressure hyper-sensitivity and thermal hyperalgesia. This subgroup of women with CTS exhibiting higher sensitization may need specific therapeutic programs. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Computer keyboarding biomechanics and acute changes in median nerve indicative of carpal tunnel syndrome.

    Science.gov (United States)

    Toosi, Kevin K; Hogaboom, Nathan S; Oyster, Michelle L; Boninger, Michael L

    2015-07-01

    Carpal tunnel syndrome is a common and costly peripheral neuropathy. Occupations requiring repetitive, forceful motions of the hand and wrist may play a role in the development of carpal tunnel syndrome. Computer keyboarding is one such task, and has been associated with upper-extremity musculoskeletal disorder development. The purpose of this study was to determine whether continuous keyboarding can cause acute changes in the median nerve and whether these changes correlate with wrist biomechanics during keyboarding. A convenience sample of 37 healthy individuals performed a 60-minute typing task. Ultrasound images were collected at baseline, after 30 and 60 min of typing, then after 30 min of rest. Kinematic data were collected during the typing task. Variables of interest were median nerve cross-sectional area, flattening ratio, and swelling ratio at the pisiform; subject characteristics (age, gender, BMI, wrist circumference, typing speed) and wrist joint angles. Cross-sectional area and swelling ratio increased after 30 and 60 min of typing, and then decreased to baseline after 30 min of rest. Peak ulnar deviation contributed to changes in cross-sectional area after 30 min of typing. Results from this study confirmed a typing task causes changes in the median nerve, and changes are influenced by level of ulnar deviation. Furthermore, changes in the median nerve are present until cessation of the activity. While it is unclear if these changes lead to long-term symptoms or nerve injury, their existence adds to the evidence of a possible link between carpal tunnel syndrome and keyboarding. Published by Elsevier Ltd.

  10. A program plan addressing carpal tunnel syndrome: the utility of King's goal attainment theory.

    Science.gov (United States)

    Norgan, G H; Ettipio, A M; Lasome, C E

    1995-08-01

    1. Today's nurse is prepared to address the needs of groups of individuals who share common characteristics or risks (aggregates). Program planning skills and ability to use nursing theory can enhance the nurse's effectiveness in addressing the needs of such aggregates. 2. Carpal tunnel syndrome and other repetitive stress injuries are very costly to industry, both in terms of monetary loss and lost work hours. Such injuries can be reduced in the workplace through careful observation and communication of trends by the nurse. 3. The systems perspective of King's goal attainment theory guided the nurse in problem solving and facilitating the development of a workplace capable of responding to trends as they occur.

  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. 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.

  13. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome.

    Science.gov (United States)

    O'Connor, D; Marshall, S; Massy-Westropp, N

    2003-01-01

    Non-surgical treatment for carpal tunnel syndrome is frequently offered to those with mild to moderate symptoms. The effectiveness and duration of benefit from non-surgical treatment for carpal tunnel syndrome remain unknown. To evaluate the effectiveness of non-surgical treatment (other than steroid injection) for carpal tunnel syndrome versus a placebo or other non-surgical, control interventions in improving clinical outcome. We searched the Cochrane Neuromuscular Disease Group specialised register (searched March 2002), MEDLINE (searched January 1966 to February 7 2001), EMBASE (searched January 1980 to March 2002), CINAHL (searched January 1983 to December 2001), AMED (searched 1984 to January 2002), Current Contents (January 1993 to March 2002), PEDro and reference lists of articles. Randomised or quasi-randomised studies in any language of participants with the diagnosis of carpal tunnel syndrome who had not previously undergone surgical release. We considered all non-surgical treatments apart from local steroid injection. The primary outcome measure was improvement in clinical symptoms after at least three months following the end of treatment. Three reviewers independently selected the trials to be included. Two reviewers independently extracted data. Studies were rated for their overall quality. Relative risks and weighted mean differences with 95% confidence intervals were calculated for the primary and secondary outcomes in each trial. Results of clinically and statistically homogeneous trials were pooled to provide estimates of the efficacy of non-surgical treatments. Twenty-one trials involving 884 people were included. A hand brace significantly improved symptoms after four weeks (weighted mean difference (WMD) -1.07; 95% confidence interval (CI) -1.29 to -0.85) and function (WMD -0.55; 95% CI -0.82 to -0.28). In an analysis of pooled data from two trials (63 participants) ultrasound treatment for two weeks was not significantly beneficial. However

  14. 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.

  15. Motor Unit Number Estimation and Motor Unit Action Potential Analysis in Carpal Tunnel Syndrome

    Science.gov (United States)

    Sohn, Min Kyun; Jee, Sung Ju; Kim, Young-Jae; Shin, Hyun-Dae

    2011-01-01

    Objective To evaluate the clinical significance of motor unit number estimation (MUNE) and quantitative analysis of motor unit action potential (MUAP) in carpal tunnel syndrome (CTS) according to electrophysiologic severity, ultrasonographic measurement and clinical symptoms. Method We evaluated 78 wrists of 45 patients, who had been diagnosed with CTS and 42 wrists of 21 healthy controls. Median nerve conduction studies, amplitude and duration of MUAP, and the MUNE of the abductor pollicis brevis were measured. The cross sectional area (CSA) of the median nerve at the pisiform and distal radioulnar joint level was determined by high resolution ultrasonography. Clinical symptom of CTS was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Results The MUNE, the amplitude and the duration of MUAP of the CTS group were significantly different from those found in the control group. The area under the ROC curve was 0.944 for MUNE, 0.923 for MUAP amplitude and 0.953 for MUAP duration. MUNE had a negative correlation with electrophysiologic stage of CTS, amplitude and duration of MUAP, CSA at pisiform level, and the score of BCTQ. The amplitude and duration of MUAP had a positive correlation with the score of BCTQ. The electrophysiologic stage was correlated with amplitude but not with the duration of MUAP. Conclusion MUNE, amplitude and duration of MUAP are useful tests for diagnosis of CTS. In addition, the MUNE serves as a good indicator of CTS severity. PMID:22506210

  16. Work-related carpal tunnel syndrome treatment: a cross-sectional study among 106 patients

    Directory of Open Access Journals (Sweden)

    M. Aouatef

    2017-08-01

    Full Text Available The objective is to assess the influence of sociodemographic, professional and clinical variables on the choice of treatment of work-related carpal tunnel syndrome (CTS. An exhaustive and trans-sectional study was conducted over a period of eight years, from 1st January 2006 to 31 December 2013 in the Department of Occupational Medicine at University Hospital of Mahdia, Tunisia. The study population was represented by patients with work-related carpal tunnel syndrome. Data collection was based on a questionnaire sheet, describing social, occupational and medical characteristics of patients. The study population was characterized by a large female dominance, representing 95.3% with an average age of 42±7.8 years. Patients medically treated represented 38.7% and 61.3% had had surgical treatment. After binary logistic regression, surgical indication of CTS was significantly correlated to diabetes (p=0.017, other musculoskeletal disorders (p=0.02, functional signs of CTS (acrocyanosis p=0.05; muscle weakness p=0.015; radiating pain p=0.01; painful discomfort of the hand, the forearm or arm p=0.027 and to the atrophy of thenar muscles (p=0.018. According to this study, the choice of therapy for occupational CTS depends only on clinical data. More detailed studies will be needed to refine these results.

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

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    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.

  18. Effects of Carpal Tunnel Syndrome on Force Coordination and Muscle Coherence during Precision Pinch.

    Science.gov (United States)

    Lu, Szu-Ching; Xiu, Kaihua; Li, Ke; Marquardt, Tamara L; Evans, Peter J; Li, Zong-Ming

    2017-06-01

    Carpal tunnel syndrome (CTS), caused by entrapment of the median nerve in the carpal tunnel, impairs hand function including dexterous manipulation. The purpose of this study was to investigate the effects of CTS on force coordination and muscle coherence during low-intensity sustained precision pinch while the wrist assumed different postures. Twenty subjects (10 CTS patients and 10 asymptomatic controls) participated in this study. An instrumented pinch device was used to measure the thumb and index finger forces while simultaneously collecting surface electromyographic activities of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles. Subjects performed a sustained precision pinch at 10% maximum pinch force for 15 sec with the wrist stabilized at 30° extension, neutral, or 30° flexion using customized splints. The force discrepancy and the force coordination angle between the thumb and index finger forces were calculated, as well as the β-band (15-30 Hz) coherence between APB and FDI. The index finger applied greater force than the thumb (p force discrepancy was increased with wrist flexion (p 0.05). The directional force coordination was not significantly affected by wrist posture or CTS (p > 0.05). In general, digit force coordination during precision pinch seems to be sensitive to wrist flexion, but is not affected by CTS. The β-band muscular coherence was increased by wrist flexion for CTS patients (p force coordination in CTS patients supporting the avoidance of flexion posture for symptom exacerbation and functional performance.

  19. Efficacy of high frequency ultrasound in postoperative evaluation of carpal tunnel syndrome treatment

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    Katarzyna Kapuścińska

    2016-03-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leave because of work-related hand overload. The main treatment is operation. Aim: The aim of the study is to assess the usefulness of high frequency ultrasound in the postoperative evaluation of CTS treatment efficacy. Material and methods: Sixty-two patients (50 women and 12 men aged 28–70, mean age 55.2 underwent surgical treatment of CTS. Ultrasound examinations of the wrist in all carpal tunnel sufferers were performed 3 months after the procedure with the use of a high frequency broadband linear array transducer (6–18 MHz, using 18 MHz band of MyLab 70/Esaote. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging for postoperative evaluation of CTS treatment efficacy. Results: Among all 62 patients, 3 months after surgical median nerve decompression: in 40 patients, CTS symptoms subsided completely, and sonographic evaluation did not show median nerve entrapment signs; in 9 patients, CTS symptoms persisted or exacerbated, and ultrasound proved nerve compression revealing preserved flexor retinaculum fibers; in 13 patients, scar tissue symptoms occurred, and in 5 of them CTS did not subside completely (although ultrasound showed no signs of compression. Conclusions: Ultrasound imaging with the use of a high frequency transducer is a valuable diagnostic tool for postoperative assessment of CTS treatment efficacy.

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

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    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.

  1. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

    Science.gov (United States)

    Ordahan, Banu; Karahan, Ali Yavuz

    2017-08-01

    Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3 weeks) alone and splint (during the night and day time as much as possible for 3 weeks) + paraffin treatment (five consecutive days a week for 3 weeks). Clinical and electrophysiological assessments were performed before and 3 weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values (p 0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group (p 0.05), and the difference in these parameters between the groups was statistically significant (p < 0.05). In conclusion, using splinting alone in patients with CTS is an effective treatment for reducing symptoms in the early stages. Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

  3. 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.)

  4. 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.)

  5. Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

    Science.gov (United States)

    Ordahan, Banu; Karahan, Ali Yavuz

    2017-12-01

    Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3 weeks) alone and splint (during the night and day time as much as possible for 3 weeks) + paraffin treatment (five consecutive days a week for 3 weeks). Clinical and electrophysiological assessments were performed before and 3 weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values ( p 0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group ( p 0.05), and the difference in these parameters between the groups was statistically significant ( p Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Work-related carpal tunnel syndrome treatment: a cross-sectional study among 106 patients.

    Science.gov (United States)

    Aouatef, M; Asma, B; Hajer, H; Charfeddine, A; Lamia, B; Taoufik, K

    2017-08-03

    The objective is to assess the influence of sociodemographic, professional and clinical variables on the choice of treatment of work-related carpal tunnel syndrome (CTS). An exhaustive and trans-sectional study was conducted over a period of eight years, from 1st January 2006 to 31 December 2013 in the Department of Occupational Medicine at University Hospital of Mahdia, Tunisia. The study population was represented by patients with work-related carpal tunnel syndrome. Data collection was based on a questionnaire sheet, describing social, occupational and medical characteristics of patients. The study population was characterized by a large female dominance, representing 95.3% with an average age of 42±7.8 years. Patients medically treated represented 38.7% and 61.3% had had surgical treatment. After binary logistic regression, surgical indication of CTS was significantly correlated to diabetes (p=0.017), other musculoskeletal disorders (p=0.02), functional signs of CTS (acrocyanosis p=0.05; muscle weakness p=0.015; radiating pain p=0.01; painful discomfort of the hand, the forearm or arm p=0.027) and to the atrophy of thenar muscles (p=0.018). According to this study, the choice of therapy for occupational CTS depends only on clinical data. More detailed studies will be needed to refine these results.

  8. 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…

  9. Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions.

    Science.gov (United States)

    Chimenti, Peter C; McIntyre, Allison W; Childs, Sean M; Hammert, Warren C; Elfar, John C

    2016-01-01

    Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.

  10. 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

  11. Median nerve T2 assessment in the wrist joints: preliminary study in patients with carpal tunnel syndrome and healthy volunteers.

    Science.gov (United States)

    Cha, Jang Gyu; Han, Jong Kyu; Im, Soo Bin; Kang, Sung Jin

    2014-10-01

    To perform a prospective quantitative analysis of median nerve T2 values and cross-sectional area (CSA) in patients with carpal tunnel syndrome (CTS) as compared to asymptomatic volunteers. Twelve CTS patients with positive nerve conduction results and 12 healthy volunteers (controls) were enrolled and underwent axial T2 mapping of the wrist joints. Median nerve T2 values and CSAs at the distal radioulnar joint, pisiform, and hook of hamate levels were compared between the groups. The T2 values at the proximal and distal carpal tunnel were higher in the CTS patients than in the controls (P carpal tunnel were significantly larger in the CTS patients than in the controls (P carpal tunnel and has the potential to be a promising complementary method for evaluation of CTS patients. A future study with larger sample sizes is necessary to investigate the potential effect of median nerve T2 assessment to a reliable tool in the diagnosis of CTS. © 2013 Wiley Periodicals, Inc.

  12. 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

  13. An Anechoic Space at the Carpal Tunnel Inlet is a Consistent Ultrasonographic Entity which Accommodates Tendon Displacement during Finger Flexion.

    Science.gov (United States)

    Lee, Bing Howe; Goh, Chin Hock; Lahiri, Amitabha

    2016-06-01

    We consistently observed the presence of anechoic spaces on standard ultrasonographic imaging of the carpal tunnel inlet in normal subjects. These spaces change in size during finger flexion and have not been characterized in a large sample of normal individuals. Ultrasonographic quantification of these spaces may indicate the available space in the region of the carpal tunnel, which allows the normal motion of tendons and the median nerve. Transverse ultrasonographic images of the carpal tunnel inlet from 33 asymptomatic volunteers were obtained at Position A (fingers in extension) and B (fingers in flexion). Cross-sectional area (CSA), perimeter and position of anechoic space relative to median nerve were recorded. Analysis showed a 75.4% prevalence rate of a single anechoic space. Two discrete patterns were observed. 89.1% had a decrease in CSA and perimeter of anechoic space from Position A to B while 10.9% exhibited an increase. Mean position of the anechoic space is ulnar (7.49 ± 3.57 mm) and dorsal (2.18 ± 1.28 mm) to the median nerve. A consistent anechoic space at the carpal tunnel inlet is seen in 75.4% of normal hands and can be quantified (cross sectional area 11.75 ± 7.36 mm(2)). It allows for the accommodation of flexor tendons during finger flexion.

  14. 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

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    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.

  15. Cost-Utility of Interventions in Patients with Carpal Tunnel Syndrome in a Universitary Hospital in Cali, Colombia

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    César Augusto Guevara

    2015-05-01

    Full Text Available Introduction: Although there are several treatments for carpal tunnel syndrome (CTS, the efficiency of these has not evaluated in Colombia. Objective: Determine the incremental cost-utility ratio (ICUR of medical and surgical treatment in patients with CTS. Material and methods: A cost utility analysis was conducted from the societal perspective with patients older than 18 years diagnosed with CTS who received medical or surgical treatment. Quality-adjusted life-years (QALYs were calculated using the EQ-5D. Costs were obtained from the ISS national tariff 2001+30 %. The results were extrapolated to long term through a Markov model with a discount rate of 3,5 %. A probabilistic sensitivity analysis using Monte Carlo simulation was performed. Results: Fifty- three patients participated, women (71,7 %; mean age: 55,5 years. 79 % of patients received medical treatment. The most frequent treatment was medical observation (66,7 % and NSAIDs (16,6 %. Medical treatment provided 0,33 QALYs (± 0,11 and surgery 0,37 (± 0,10. The average total cost of medical treatment at 6 months and 20 years was COP 132 006 (95 % CI: COP 70 255 - 425 341 and COP 483 440 (95 % CI: COP 104 310 - 862 570 respectively. The cost of surgery was COP 1 972 644 (95 % CI: COP 981 204 - 8 517 065 and COP 979 585 (95 %: COP 684 912 - 1 274 258. The surgery was dominated by 6 months. The ICUR at 20 years was COP 1 033 635/QALY additional (95 % CI: COP 840 179 - 1 235 323/additional QALY with a 80 % of probability that surgery be cost-utility when there is a willingness to pay COP 5 000 000. Conclusion: The medical treatment is cost-effective with regard to the surgery in short term. However, in the long term the surgery is cost effective with respect to the medical treatment.

  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.

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    Alexander Marschall

    Full Text Available 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.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.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.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.

  17. Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

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    Hye Mi Yoo

    2015-05-01

    Full Text Available BackgroundAn anatomical analysis of the transverse carpal ligament (TCL and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings.MethodsUsing 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months.ResultsIn the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were 35.30±2.59 mm and 9.50±2.13 mm, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm. The 13 surgeries performed in the clinical settings yielded satisfactory results.ConclusionsThis peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

  18. Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

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    Eduardo Jun Sadatsune

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period, incidence of postoperative neuropathic pain (over a six-month period, need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4 questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

  19. Intradermal therapy (mesotherapy) for the treatment of acute pain in carpal tunnel syndrome: a preliminary study.

    Science.gov (United States)

    Conforti, Giorgio; Capone, Loredana; Corra, Stefano

    2014-01-01

    The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy). In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence. The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment. With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS.

  20. Risk Factors of Carpal Tunnel Syndrome in Food-Packing Workers Karanganyar

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    Haris Setyawan

    2017-02-01

    Carpal tunnel syndrome (CTS terjadi ketika saraf median, yang membentang dari lengan bawah ke tangan, mengalami tekanan atau terpuntir di pergelangan tangan. Hasilnya mungkin sakit, kelemahan atau mati rasa di tangan dan pergelangan tangan, yang memancar ke lengan tangan. Penelitian ini bertujuan untuk mengkaji faktor risiko usia, jenis kelamin, masa kerja dan gerakan repetitif terhadap keluhan CTS pada pekerja pengepakan makanan di Karanganyar. Penelitian ini dilaksanakan pada bulan Oktober – Desember 2014 menggunakan desain observational analitik dengan penelitian potong lintang. Sampel terdiri dari 50 orang dari total 67 pekerja pengepak makanan di kawasan industri Jaten Karanganyar yang diambil dengan menggunakan teknik simple random sampling. Data penelitian diolah menggunakan uji kai kuadrat dan regresi logistik multivariat. Hasil penelitian menunjukkan bahwa usia dan jenis kelamin signifikan berhubungan dengan keluhan CTS, dan usia merupakan faktor yang paling berpengaruh 24 kali lipat untuk meningkatkan risiko terjadinya CTS (nilai p = 0.057, Exp. B = 24.965.

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

    Science.gov (United States)

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2015-01-01

    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. PMID:25856042

  4. Comparison of range-of-motion constraints provided by prefabricated splints used in the treatment of carpal tunnel syndrome: a pilot study.

    Science.gov (United States)

    Apfel, Eileen; Johnson, Merry; Abrams, Reid

    2002-01-01

    Nocturnal splinting of the wrist is commonly used to treat carpal tunnel syndrome. Rationales for overnight wrist splinting are based on several research studies, which suggest that passively and actively sustained positions of the wrist and digits during sleep contribute to elevated carpal tunnel pressures. The types of splints used for carpal tunnel syndrome include custom and prefabricated orthoses of many variations. The purpose of this paper is to assess the resting and passive range-of-motion position restrictions and parameters provided by four prefabricated orthoses commonly prescribed for or used by patients at the authors' treatment facility. A literature review provides information that supports optimal wrist and finger positioning to minimize resting carpal tunnel pressures. This information may be useful in determining the most effective splint design choices.

  5. Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study

    Science.gov (United States)

    Metin Ökmen, Burcu; Kasapoğlu Aksoy, Meliha; Güneş, Aygül; Eröksüz, Riza; Altan, Lale

    2017-08-01

    Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)( n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)( n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0( p study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

  6. Electrophysiologic and Ultrasonographic Assessment of Carpal Tunnel Syndrome in Wheelchair Basketball Athletes.

    Science.gov (United States)

    Kim, Do Kyun; Kim, Beom Suk; Kim, Min Je; Kim, Ki Hoon; Park, Byung Kyu; Kim, Dong Hwee

    2017-02-01

    To investigate the contributing factors of carpal tunnel syndrome (CTS), electrodiagnostic and ultrasonographic findings of median nerve, and median nerve change after exercise in wheelchair basketball (WCB) players. Fifteen WCB players with manual wheelchairs were enrolled in the study. Medical history of the subjects was taken. Electrodiagnosis and ultrasonography of both median nerves were performed to assess CTS in WCB players. Ultrasonographic median nerves evaluation was conducted after wheelchair propulsion for 20 minutes. Average body mass index (BMI) and period of wheelchair use of CTS subjects were greater than those of normal subjects. Electrodiagnosis revealed CTS in 14 of 30 hands (47%). Cross-sectional area (CSA) of median nerve was greater in CTS subjects than in normal subjects at 0.5 cm and 1 cm proximal to distal wrist crease (DWC), DWC, 1 cm, 2 cm, 3 cm, and 3.5 cm distal to DWC. After exercising, median nerve CSAs at 0.5 cm and 1 cm proximal to DWC, DWC, and 3 cm and 3.5 cm distal to DWC were greater than baseline CSAs in CTS subjects; and median nerve CSAs at 1 cm proximal to DWC and DWC were greater than baseline CSAs in normal subjects. The changes in median nerve CSA after exercise in CTS subjects were greater than in normal subjects at 0.5 cm proximal to DWC and 3 cm and 3.5 cm distal to DWC. BMI and total period of wheelchair use contributed to developing CTS in WCB players. The experimental exercise might be related to the median nerve swelling around the inlet and outlet of carpal tunnel in WCB athletes with CTS.

  7. 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.

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

    Science.gov (United States)

    Kuo, Tai-Tzung; Lee, Ming-Ru; Liao, Yin-Yin; Chen, Jiann-Perng; Hsu, Yen-Wei; Yeh, Chih-Kuang

    2016-01-01

    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 quantitatively estimating

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

    Science.gov (United States)

    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. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  10. Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review.

    Science.gov (United States)

    Ballestero-Pérez, Ruth; Plaza-Manzano, Gustavo; Urraca-Gesto, Alicia; Romo-Romo, Flor; Atín-Arratibel, María de Los Ángeles; Pecos-Martín, Daniel; Gallego-Izquierdo, Tomás; Romero-Franco, Natalia

    2017-01-01

    The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale. Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment. Copyright © 2016. Published by Elsevier Inc.

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

    Science.gov (United States)

    Kuo, Tai-Tzung; Lee, Ming-Ru; Liao, Yin-Yin; Chen, Jiann-Perng; Hsu, Yen-Wei; Yeh, Chih-Kuang

    2016-01-01

    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 quantitatively estimating

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

    Directory of Open Access Journals (Sweden)

    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

  13. Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review.

    Science.gov (United States)

    Jiménez Del Barrio, S; Bueno Gracia, E; Hidalgo García, C; Estébanez de Miguel, E; Tricás Moreno, J M; Rodríguez Marco, S; Ceballos Laita, L

    2016-07-22

    Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S

  14. Prevalence of Mucopolysaccharidosis Types I, II, and VI in the Pediatric and Adult Population with Carpal Tunnel Syndrome (CTS). Retrospective and Prospective Analysis of Patients Treated for CTS

    DEFF Research Database (Denmark)

    Nørmark, Mette Borch; Kjaer, Nanna; Lund, Allan Meldgaard

    2017-01-01

    BACKGROUND: We wanted to investigate whether the prevalence of mucopolysaccharidoses (MPS) I, II, and VI was higher than expected in a selected cohort of patients with carpal tunnel syndrome (CTS). CTS is a common finding in patients with MPS, and therefore we screened patients who had undergone...... surgery for CTS for undiagnosed MPS. PATIENTS AND METHODS: Patients who had been operated for CTS were found in databases from two hospitals. Furthermore, patients who had undergone surgery for CTS when under the age of 18 were retrieved from the National Patient Registry. All included patients had...... a filter paper blood spot sample taken that was subsequently analyzed enzymatically for MPS I, II, and VI. RESULTS: 425 patients were included. 402 patients tested negative in the first test. 23 had inconclusive result whereof 18 was negative in a second test. The remaining five patients had two...

  15. The effects of neural mobilization in addition to standard care in persons with carpal tunnel syndrome from a community hospital.

    Science.gov (United States)

    Heebner, Michelle L; Roddey, Toni S

    2008-01-01

    The purpose of this study was to determine whether neural mobilization in addition to standard care is more effective than standard care alone in the treatment of Carpal Tunnel Syndrome (CTS). Sixty participants were randomly assigned to one of two groups. Group 1 received standard care, and Group 2 performed a neurodynamic mobilization exercise in addition to standard care. Outcomes were assessed at baseline and at one and six months using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Brigham and Woman's Hospital Carpal Tunnel Specific Questionnaire (CTSQ), and elbow extension range of motion during an upper limb median nerve tension test. There were no significant differences in the outcome measures between groups, except Group 1 had improved scores on the function status scale of the CTSQ compared to Group 2 at six months. The addition of neural mobilization to standard care did not result in improved outcomes in patients with CTS.

  16. 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.

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

    OpenAIRE

    Oliaiy Gh; Akbari M.; Bagheri H; Abolfazli R; Talebian S; Fattahi F

    1997-01-01

    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 ca...

  18. 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. Copyright 2011, SLACK Incorporated.

  19. 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.

  20. Carpal Tunnel Syndrome Prevalence and Characteristics among Administrative Staff at Dr.Hasan Sadikin General Hospital Bandung

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    Andrian Andrian

    2017-06-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a neurologic disease affecting hands, which is closely related to work, and is the most prevalent nerve compression disease. The incidence of CTS quite often occur in people working with their hands, for instance the administrative staff, especially in a busy workplace such as Dr.Hasan Sadikin General Hospital Bandung. CTS causes reduction in work productivity, and consequently degrading family welfare and the quality of public service. For that very reason, the prevalence and characteristics of CTS among administrative staff at Dr.HasanSadikin General Hospital Bandung needed to be revealed. Methods: This quantitative descriptive study involved 94 administrative staff in the Medical record department of Dr. Hasan Sadikin General Hospital using the Carpal-tunnel.net questionnaire and further examinations by neurologists. Variables involved in this study were the subject characteristics. Results: Out of the 90 subjects, 22 stated having symptoms related to CTS (prevalence, 24.4%. On further clinical examination, 3 were diagnosed of suffering from CTS (prevalence, 3.3%. Conclusions: Carpal tunnel syndrome is found among the administrative staff at Dr. Hasan Sadikin General Hospital Bandung  and the prevalence is lower than in the general population. A further study is required to reveal ther specific division in the hospital with the most prevalent CTS case. DOI: 10.15850/amj.v4n2.1077

  1. A comparison of wrist function, range of motion and pain between sports and non sports wheelchair-dependent persons with carpal tunnel syndrome

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    Farshad Okhovatian

    2012-04-01

    Full Text Available Background and Aim: Carpal tunnel syndrome is common among handicapped people using wheelchair, and repeated wrist movements increase the risk of incidence of this syndrome. In present study, performance, pain and range of motion of wrist were compared between the athletes and non-athlete handicapped people suffering from carpal tunnel syndrome. Materials and Methods : In this descriptive study, all members of handicapped basketball team in Tehran (35 persons and 33 wheelchair-bound non-athlete handicapped persons residing in Tehran sanitariums were studied (similar with respect to age, weight, height, years of using wheelchair and level of disability.In this study, Clinical Questionnaire and Nerve Conduction Study were used for diagnosing carpal tunnel syndrome, VAS Scale for measuring pain, Goniometer for measuring range of motion of wrist, and Self-Administered Questionnaire for investigating severity of symptoms and performance.Results: The finings of this study indicated that there was no significant difference between two athlete and non-athlete handicapped groups with carpal tunnel syndrome in prevalence of carpal tunnel syndrome, severity of pain, performance and range of motion of wrist (p>0.05. Among 35 athletes, 6 persons (mean age: 36±3.11, mean weight: 68±4.74 and mean height: 172±7 and among 33 non-athletes, 5 persons (mean age: 41±7.1, mean weight: 73±3 and mean height: 173±5 had carpal tunnel syndrome.Conclusion : Unlike what is supposed, repeated movements of wrist is not the only factor predisposing the athlete handicapped people to carpal tunnel syndrome, So other influencing factors should be considered.

  2. 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

  3. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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.

  7. Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial.

    Science.gov (United States)

    Wolny, Tomasz; Saulicz, Edward; Linek, Paweł; Shacklock, Michael; Myśliwiec, Andrzej

    2017-05-01

    The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS). The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions. A baseline assessment revealed group differences in sensory conduction of the median nerve (P therapy, analysis of variance revealed group differences in pain severity (P therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in individuals with CTS. However, the results regarding pain reduction, subjective symptoms, and functional status were better in the MT group. Copyright © 2017. Published by Elsevier Inc.

  8. Effect of hand volume and other anthropometric measurements on carpal tunnel syndrome.

    Science.gov (United States)

    Arslan, Yıldız; Bülbül, İsmail; Öcek, Levent; Şener, Ufuk; Zorlu, Yaşar

    2017-04-01

    Carpal tunnel syndrome (CTS), majority of cases are considered to be idiopathic, is the most commonly encountered peripheral neuropathy causing disability. We asserted that thick and big hands may more prone to idiopathic CTS (ICTS) than others. The study included 165 subjects admitted to our electrophysiology lab with pre-diagnosis of CTS between May 2014 and April 2015. Eighty-five of the subjects were diagnosed as ICTS. The parameters analyzed were: age, gender, occupation, BMI, hand dominance, grade of ICTS, wrist circumference, proximal/distal width of palm, hand/palm length, hand volume and palm length/proximal palm width. Female gender was significantly higher in both groups. The mean age of study group was 44.02 ± 9.11 years, and control group was 41.25 ± 9.94 years. BMI, wrist circumference and hand volume were significantly higher in the study group (p hand volume, wrist circumference and lower palm length/prox. palm width ratio can also be anthropometric risk factors. Large hand volumes, big and coarse hands are more prone to ICTS.

  9. [Etiological factors for developing carpal tunnel syndrome in people who work with computers].

    Science.gov (United States)

    Lewańska, Magdalena; Wagrowska-Koski, Ewa; Walusiak-Skorupa, Jolanta

    2013-01-01

    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. 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. The patients worked with use of computer for 6.43 +/- 1.71 h 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. The results of our study show that CTS is usually generated by different causes not related with using computers at work.

  10. Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review.

    Science.gov (United States)

    Mansfield, Michael; Thacker, Michael; Sandford, Fiona

    2017-10-01

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Research has shown that associative factors for CTS include occupational and biomechanical elements, gender, and age. To date, no systematic review has been undertaken to determine specifically whether there are any psychosocial risk factors in developing CTS. The objective is to determine whether psychosocial factors are associated with and/or predict the development of CTS. A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE, and CINAHL from inception to May 30, 2017. Quantitative studies must have investigated a minimum of 1 or more psychosocial factors-cognitive, affective, behavioral, vocational, or interpersonal processes (eg, social support)-and include a point or risk estimate. One reviewer conducted the search and 2 reviewers independently assessed eligibility and completed methodological quality assessment using a modified Downs and Black checklist. Data were analyzed narratively. Six moderate- to high-quality studies were included in the final review. Five studies reported a positive association between psychosocial factors and CTS, where psychosocial factors were more in those who reported CTS. One study reported no positive or negative association with CTS development. Four studies reported a negative association between psychosocial factors and CTS, where psychosocial factors were less in those who reported CTS. There is limited evidence for a positive association between psychosocial factors and CTS. However, this was not a consistent finding across all included studies. Further research is indicated in standardizing CTS diagnostic criteria and investigating other working environments.

  11. Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome.

    Science.gov (United States)

    Tulipan, Jacob E; Lutsky, Kevin F; Maltenfort, Mitchell G; Freedman, Mitchell K; Beredjiklian, Pedro K

    2017-08-01

    Electrophysiologic studies including electromyography and nerve conduction studies play a role in the evaluation of carpal tunnel syndrome (CTS), despite evidence that these studies do not correlate with CTS-specific symptom scores. There is a lack of evidence comparing electrophysiologic data with general measures of function. Fifty patients presenting for CTS treatment over an 8-month period were analyzed retrospectively. All patients completed surveys including the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Medical Outcomes Study 12-Item Short-Form Survey [(physical component summary 12, mental component summary (MCS-12)]. Electromyography and nerve conduction studies were performed on all patients and compared with outcome scores. Analysis demonstrated no relationship between DASH or MCS-12 and electrodiagnostic severity. No significant correlations were noted between DASH or MCS-12 and median motor or sensory latency. There was a moderate-weak correlation (rho = 0.34) between more severe electrophysiologic grade and better function based on physical component summary 12. Electrodiagnostic severity grades do not correlate with patient-reported disability, including the DASH and MCS-12 surveys. There is a counterintuitive correlation between more-severe electrodiagnostic findings and decreased physical disability. These findings indicate that disability may not correlate with electrodiagnostic severity of median neuropathy in CTS.

  12. Carpal tunnel syndrome and HIV infection. A case report and literature review

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    Andrés Reyes-Corcho

    2009-11-01

    Full Text Available The first clinical case of carpal tunnel syndrome (CTS in Cuban HIV-infected patient was described, and the scientific literature indexed in: PUBMED/MEDLINE, LILACS and BIREME were revised. The case presented was a male with HIV infection without preceding opportunistic illnesses, CD4+ T cell count over 200 cells/mm3 and clinical symptoms of pain, tingling and numbness in the right hand and wrist for three months. The electrophysiological study was compatible with CTS. The pharmacological treatment did not modify the symptoms and the patient received specific surgical treatment with absolute resolution of symptoms. CTS is a compressive neuropathy that can occur in HIV-positive individuals with as similar frequency as in the general population. The association between HIV infection and CTS is scarcely described in the medical scientific literature and probably does not represent a different phenomenon from what happens in the HIV-negative population. Nevertheless, its clinical recognition among other neurological and muscle-skeletal manifestations in HIV-infected patients is important.

  13. Body mass index as predictor of carpal tunnel syndrome among garment workers

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    Lie T Merijanti S.

    2009-12-01

    Full Text Available Of the nerve entrapment syndromes the most well-known is the carpal tunnel syndrome (CTS involving the median nerve. In the field of occupational medicine this condition is categorized as an occupational disease, for which industrial workers may claim compensation if the CTS occurs as a consequence of their job. However, although several occupational risk factors have been suggested as causing the development of CTS, a definitive role of work activities as the central cause of CTS is unclear. The aim of the present study was to evaluate both non-occupational and occupational factors associated with CTS in garment home-industry workers. A cross-sectional study was performed from April to June 2008 in the garment home industry in North Jakarta. A total of 99 workers, consisting of 45 males and 54 females were included in this study. Historical data were obtained from a self-administered detailed questionnaire, while anthropometric and provocative median nerve test variables were measured directly. The results showed that body mass index (BMI was a significant predictor of CTS in male workers (p=0.031, while the risk of CTS was three-fold higher in female workers using hormonal contraceptives (Prevalence Ratio/PR = 3.3 ; 95% Confidence of Interval/CI = 1.0 – 10.5. In conclusion it appears that BMI and hormonal contraceptive use were CTS predictors.

  14. The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study

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    Fatma Gülçin Ural

    2017-01-01

    Full Text Available Introduction. The aim of this study was to explore the acupuncture effect on the cross-sectional area (CSA of the median nerve at the wrist in patients with carpal tunnel syndrome (CTS and, additionally, to identify whether clinical, electrophysiological, and ultrasonographic changes show any association. Methods. Forty-five limbs of 27 female patients were randomly divided into two groups (acupuncture and control. All patients used night wrist splint. The patients in the acupuncture group received additional acupuncture therapy. Visual analog scale (VAS, Duruöz Hand Index (DHI, Quick Disabilities of the Arm, Shoulder and Hand (DASH questionnaire scores, electrophysiologic measurements, and median nerve CSAs were noted before and after the treatment in both groups. Results. VAS, DHI, Quick DASH scores, and electrophysiological measurements were improved in both groups. The median nerve CSA significantly decreased in the acupuncture group, whereas there was no change in the control group. Conclusion. After acupuncture therapy, the patients with CTS might have both clinical and morphological improvement.

  15. Effect of wrist angle on median nerve appearance at the proximal carpal tunnel.

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    Loh, Ping Yeap; Muraki, Satoshi

    2015-01-01

    This study investigated the effects of wrist angle, sex, and handedness on the changes in the median nerve cross-sectional area (MNCSA) and median nerve diameters, namely longitudinal diameter (D1) and vertical diameter (D2). Ultrasound examination was conducted to examine the median nerve at the proximal carpal tunnel in both dominant and nondominant hands of men (n = 27) and women (n = 26). A total of seven wrist angles were examined: neutral; 15°, 30°, and 45° extension; and 15°, 30°, and 45° flexion. Our results indicated sexual dimorphism and bilateral asymmetry of MNCSA, D1 and D2 measurements. MNCSA was significantly reduced when the wrist angle changed from neutral to flexion or extension positions. At flexion positions, D1 was significantly smaller than that at neutral. In contrast, at extension positions, D2 was significantly smaller than that at neutral. In conclusion, this study showed that MNCSA decreased as the wrist angle changed from neutral to flexion or extension positions in both dominant and nondominant hands of both sexes, whereas deformation of the median nerve differed between wrist flexion and extension.

  16. Altered Median Nerve Deformation and Transverse Displacement during Wrist Movement in Patients with Carpal Tunnel Syndrome

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

    2014-01-01

    Rationale and Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in CTS patients. The purpose of this study was to evaluate the deformability and mobility of the median nerve in CTS patients compared to healthy subjects. Materials and Methods: Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Initial and final median nerve shape and position were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. Results: The deformation ratio for circularity was significant less in CTS patients compared to healthy subjects during wrist flexion (Pwrist flexion was significantly different between CTS patients and healthy subjects (Pwrist extension with fingers extended. Conclusions: CTS Patients differ from normal subjects with regard to mobility and deformability of the median nerve. PMID:24594417

  17. A prospective study of carpal tunnel syndrome: workplace and individual risk factors

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    Burt, Susan; Deddens, James A; Crombie, Ken; Jin, Yan; Wurzelbacher, Steve; Ramsey, Jessica

    2015-01-01

    Objectives To quantify the risk for carpal tunnel syndrome (CTS) from workplace physical factors, particularly hand activity level and forceful exertion, while taking into account individual factors including age, gender, body mass index (BMI), and pre-existing medical conditions. Methods Three healthcare and manufacturing workplaces were selected for inclusion on the basis of range of exposure to hand activity level and forceful exertion represented by their jobs. Each study participants job tasks were observed and evaluated ’ onsite and videotaped for further analysis, including frequency and duration of exertion and postural deviation. Individual health assessment entailed electrodiagnostic testing of median and ulnar nerves, physical examination and questionnaires at baseline with annual follow-up for 2 years. Results The incidence of dominant hand CTS during the study was 5.11 per 100 person-years (29 cases). Adjusted HRs for dominant hand CTS were as follows: working with forceful exertion ≥20% but job strain. Conclusions Workplace and individual risk factors both contribute to the risk for CTS. Time spent in forceful exertion can be a greater risk for CTS than obesity if the job exposure is high. Preventive workplace efforts should target forceful exertions. PMID:23788614

  18. Comparison of static wrist splint with static wrist and metacarpophalangeal splint in carpal tunnel syndrome.

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    Bulut, Gul Tugba; Caglar, Nil Sayiner; Aytekin, Ebru; Ozgonenel, Levent; Tutun, Sule; Demir, Saliha Eroglu

    2015-01-01

    The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS). The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS. Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later. At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance. The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS.

  19. A square-shaped wrist as a predictor of carpal tunnel syndrome: A meta-analysis.

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    Shiri, Rahman

    2015-11-01

    This meta-analysis aims to assess an association between wrist ratio (wrist thickness/wrist width) and carpal tunnel syndrome (CTS). Sixteen studies qualified for a random-effects meta-analysis. Mean wrist ratio was higher in individuals with CTS compared with those without CTS [pooled mean difference 0.036, 95% confidence interval (CI) 0.025-0.046]. Pooled odds ratio (OR) of CTS for mean wrist ratio was 4.56 (95% CI 2.97-6.99), and for wrist ratio ≥0.70 vs. <0.70 it was 2.73 (95% CI 1.49-5.01). In addition, the pooled OR for a 1-unit (0.01) increase in wrist ratio was 1.12 (CI 1.09-1.16). The association between wrist ratio and CTS did not differ between men and women. Moreover, there was no evidence of publication bias. This meta-analysis suggests that a square-shaped wrist is a predictor for CTS in both men and women. Future studies should explore whether a square-shaped wrist can potentiate the adverse effects of obesity and occupational workloads on CTS. © 2015 Wiley Periodicals, Inc.

  20. Insulin resistance increases risk of carpal tunnel syndrome: a case-control study.

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    Plastino, Massimiliano; Fava, Antonietta; Carmela, Colica; De Bartolo, Matteo; Ermio, Caterina; Cristiano, Dario; Ettore, Maria; Abenavoli, Ludovico; Bosco, Domenico

    2011-09-01

    Carpal tunnel syndrome (CTS) is one of the most common upper limb compression neuropathies. In only 50% of cases it is possible to identify a cause. Our objective was to determine the role of glucose metabolism abnormalities in idiopathic CTS. We identified 117 patients with idiopathic moderate or severe CTS and 128 controls. In all we evaluated glucose and insulin levels at fasting and after 2-h oral glucose tolerance test (2h-OGTT). In addition we determined insulin resistance (IR). Following OGTT the prevalence of glucose metabolism abnormalities was significantly higher in the CTS group (p = 0.001). IR was documented in 80% of patients, of whom 45% had impaired glucose tolerance, 14% newly diagnosed diabetes mellitus, and 20% IR only. Waist circumference and body mass index were also significantly increased in the CTS group. In this study, we focused on evidence that pre-diabetes may represent a risk factor for CTS. We proposed to determine IR as a rule in all patients with idiopathic CTS. © 2011 Peripheral Nerve Society.

  1. 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.

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

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    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.

  3. 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

  4. Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome.

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    Benjamin Soon

    Full Text Available Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms. Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047, intensity (p = 0.044 and area (p = 0.012 of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006. Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.

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

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    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. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. 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.

  7. 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.

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

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    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.

  9. 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.

  10. 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

  11. 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.

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

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    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. © 2015 World Obesity.

  13. Isokinetic evaluation of wrist muscle strength in patients of carpal tunnel syndrome.

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    Ağırman, Mehmet; Kara, Adnan; Durmuş, Oğuz; Saral, İlknur; Çakar, Engin

    2017-04-01

    This study aims to investigate the isokinetic characteristics of wrist strength in flexion, extension, supination, pronation, radial, and ulnar deviation in patients with moderate or severe carpal tunnel syndrome (CTS). Thirteen patients (23 hands) (2 males, 11 females; mean age 45 years; range 29 to 60 years) with moderate or severe CTS were compared to six healthy control subjects (12 hands) (2 males, 4 females; mean age 41 years; range 27 to 63 years) in this study, which was conducted between January 2016 and April 2016. Wrist flexion, extension, supination, pronation, radial, and ulnar deviation muscle strengths were measured at 30°/second (5 sets) angular velocity with isokinetic dynamometer. Grip strength was measured with hand dynamometer (kilograms). Boston Questionnaire was used for clinical assessment. Grip strength (p=0.003); wrist flexion 30°/second (p=0.014); extension 30°/second (p=0.016); and ulnar deviation 30°/second (p=0.017) muscle strengths were lower in CTS patients compared with the control group. An evaluation according to symptom duration did not reveal any significant relationship in any of the isokinetic tests with the exception of pronation 30°/second (p=0.039, r= -0.432) and ulnar deviation 30°/second (p=0.034, r=0.443) in CTS patients. No significant relationship was found between Boston Questionnaire, grip strength, and isokinetic test results. Quantitative wrist strength measurements with isokinetic dynamometers are beneficial in conservative exercise treatments and motor assessments of CTS patients.

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

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    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. © 2011 European Federation of International Association for the Study of Pain Chapters.

  15. Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity

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    Firosh Khan

    2017-01-01

    Full Text Available Aim: Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and is one of the most common requests for electrodiagnosis. We aimed to note the relationship of subjective symptom severity of CTS, with objective electrophysiological severity and psychological status of patients. Patients and Methods: One hundred and forty-four consecutive patients of CTS referred to neurophysiology laboratory of a tertiary care hospital over 1 year were prospectively studied. Boston CTS Assessment Questionnaire (BCTSAQ and visual analog scale (VAS were used to assess subjective symptom severity. Psychological status was assessed by Hospital Anxiety and Depression Scale (HADS. Electrophysiological severity of CTS was estimated by median motor distal latency and median to ulnar peak sensory latency difference across the wrist. Each parameter in both hands was scored from 0 to 3 depending on the severity grade, and a composite electrophysiological severity score (CEPSS was calculated for each patient by summing up the scores in both hands. Statistical analysis was done by Spearman's rank correlation test. Results: There was significant correlation of BCTSAQ with VAS (P = 0.001, HADS anxiety score (P < 0.001, and HADS depression score (P = 0.01. CEPSS had no significant correlation with VAS (P = 0.103, HADS anxiety score (P = 0.211, or HADS depression score (P = 0.55. CEPSS had a borderline correlation with BCTSAQ (P = 0.048. Conclusions: While the subjective symptoms of CTS are well correlated with psychological factors, their correlation with objective electrophysiological severity is weak. Hence, prompt treatment of psychological comorbidity is important in symptomatic management of CTS; decision about surgical intervention should be based on electrophysiological severity rather than symptom severity.

  16. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review.

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    Huisstede, Bionka M; Hoogvliet, Peter; Randsdorp, Manon S; Glerum, Suzanne; van Middelkoop, Marienke; Koes, Bart W

    2010-07-01

    To review literature systematically concerning effectiveness of nonsurgical interventions for treating carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Two reviewers independently applied the inclusion criteria to select potential studies. Two reviewers independently extracted the data and assessed the methodologic quality. A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 20 RCTs were included. Strong and moderate evidence was found for the effectiveness of oral steroids, steroid injections, ultrasound, electromagnetic field therapy, nocturnal splinting, and the use of ergonomic keyboards compared with a standard keyboard, and traditional cupping versus heat pads in the short term. Also, moderate evidence was found for ultrasound in the midterm. With the exception of oral and steroid injections, no long-term results were reported for any of these treatments. No evidence was found for the effectiveness of oral steroids in long term. Moreover, although higher doses of steroid injections seem to be more effective in the midterm, the benefits of steroids injections were not maintained in the long term. For all other nonsurgical interventions studied, only limited or no evidence was found. The reviewed evidence supports that a number of nonsurgical interventions benefit CTS in the short term, but there is sparse evidence on the midterm and long-term effectiveness of these interventions. Therefore, future studies should concentrate not only on short-term but also on midterm and long-term results. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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

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    Koh, Sung Hye; Kwon, Bong Cheol; Park, Chanyeong; Hwang, Su Yeon; Lee, Joon Woo; Kim, Sam Soo

    2014-11-01

    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). 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 1cm 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. 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. The individual performances of both scans were not significantly different in diagnosing CTS. Measuring both CSA and FA at P1 may be useful and efficient to utilize the merits of both scans and to increase the CTS diagnostic performance. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome.

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

    2014-04-01

    Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in patients with CTS. The purpose of this study was to evaluate the deformability and mobility of the median nerve in patients with CTS compared to healthy subjects. Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Shape and position of initial and final median nerve were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter, and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. The deformation ratio for circularity was significantly less in patients with CTS compared to healthy subjects during wrist flexion (P < .05). The mean vector of median nerve displacement during wrist flexion was significantly different between patients with CTS and healthy subjects (P < .05). The displacement magnitude of the median nerve was found to be less in patients with CTS compared to healthy subjects during most movements, with the exception of wrist extension with fingers extended. Patients with CTS differ from normal subjects with regard to mobility and deformability of the median nerve. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. The Effects of Steroid Phonophoresis on Clinical Parameters and Nerve Conduction Velocities in Carpal Tunnel Syndrome

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    Filiz Dogan-Akcam

    2012-02-01

    Full Text Available Objective: This study was aimed to investigate the effects of steroid phonophoresis on electroneurophysiological and clinical parameters and to compare these effects with ultrasound (US and sham US in carpal tunnel syndrome (CTS. Material-Method: 39 patients with CTS (69 hands were included in the study. Patients were randomized to phonophoresis (n=13 patients, 21 hands, US (n=13 patients, 24 hands and sham US (n=13 patients, 24 hands groups. Steroid phonophoresis, using dexamethasone as conductive agent, was applied at 1.0 W/cm2 to the phonophoresis group. Ultrasound at 1.0 W/cm2 and imitative US at 0.0 W/cm2 were applied to the US and sham US groups respectively. All groups were asked to perform tendon and nerve gliding exercises. Distal motor latency (mMDL and sensory nerve conduction velocity (mSNCV of median nerve, visual analogue scale (VAS and Boston Scale were assessed at the beginning, 2nd week and in the 12th week. Results: All of the variables were significantly improved in the 12th week in steroid phonophoresis group, whereas VAS, symptom severity and functional capacity of Boston scale were improved in US and sham US groups. mSNCV was also improved in sham US group. The differences between 12th week-pre treatment values (delta were used for group comparisons. Delta values of electroneurophysiological parameters of phonophoresis group were found to be significantly different, whereas no significant differences were found between the groups for the other variables. Conclusion: Steroid phonophoresis has favorable effects on electroneurophysiological studies and these effects last longer. Favorable effects on clinical findings and patient based assessments were observed in all groups. The improvements seen in sham US group may suggest the effectiveness of tendon and nerve gliding exercises. [Cukurova Med J 2012; 37(1.000: 17-26

  1. Prevalence of clinical findings of carpal tunnel syndrome in Isfahanian dentists

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    Haghighat, Abbas; Khosrawi, Saeid; Kelishadi, Abdolmajid; Sajadieh, Sepideh; Badrian, Hamid

    2012-01-01

    Background: Carpal tunnel Syndrome (CTS) is the most common compression neuropathy. Jobs with frequent and repetitive hand movements are one of the risk factors for this syndrome. The aim of this study was to determine the prevalence of CTS in Isfahanian dentists. Materials and Methods: In this cross-sectional descriptive study, 240 dentists were evaluated for CTS. Diagnosis was made according to both questionnaire and clinical tests of Phalen and Tinel. Age, sex, years of experience, working hours per week and the type of procedure were considered as dependent variables. All data were analyzed by Chi-square and T-test using SPSS software 11.5 (α=0.05). Results: Among the dentists who were studied, 173 (72%) were male and 67 (28%) were female. 16.2% of males and 17.9% of females had symptoms of CTS and there wasn’t any significant difference between them (P>0.05%). the prevalence increased with advancing age. In a way that it reached to 22.2% in ages more than 55 in contrast to 6% among individuals between 25–34 years old. With increasing of experience to 15 years the risk of CTS increased but an unexpected reduction was observed with more than 15 years of experience. Conclusion: This study showed the prevalence of CTS was 16.7% among dentists and was more common in older dentists. CTS prevalence was increased with age. The dentist population with more working hours per week and more experience years were more susceptible for this syndrome. Using suitable gloves, wrist splints and short periods of resting during vigorous continuous working can decrease the symptoms of this disease. PMID:23210072

  2. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies.

    Science.gov (United States)

    Ooi, Chin Chin; Wong, Siew Kune; Tan, Agnes B H; Chin, Andrew Y H; Abu Bakar, Rafidah; Goh, Shy Yunn; Mohan, P Chandra; Yap, Robert T J; Png, Meng Ai

    2014-10-01

    The aim of this work was to evaluate the diagnostic performance of grey-scale, color Doppler, and dynamic ultrasound (US) for diagnosing carpal tunnel syndrome (CTS) using the medical diagnostic test called nerve conduction study (NCS) as the reference standard, and to correlate the increase in median nerve (MN) cross-sectional area (CSA) with severity of CTS. Fifty-one patients (95 wrists) with clinical symptoms of idiopathic CTS were recruited. The CSA and flattening ratio of the MN were measured at the distal radio-ulnar joint, pisiform, and hamate levels; bowing of the flexor retinaculum was determined at the hamate level. The hypervascularity of the MN was evaluated. The transverse sliding of the MN was observed dynamically and recorded as being either normal or restricted/absent. Another 15 healthy volunteers (30 wrists) were recruited as controls. Interoperator reliability was established for all criteria. CTS was confirmed in 75 wrists (75/95: 79%; 14 minimal, 21 mild, 23 moderate, 17 severe). CSA at the pisiform level was found to be the most reliable and accurate grey-scale criterion to diagnose CTS (optimum threshold: 9.8 mm(2)). There was a good correlation between the severity of NCS and CSA (r = 0.78, p < 0.001). The sensitivity and specificity of color-Doppler and dynamic US in detecting CTS was 69, 95, 58, and 86%, respectively. Combination of these subjective criteria with CSA increases the sensitivity to 98.3%. US measurement of CSA provides additional information about the severity of MN involvement. Color-Doppler and dynamic US are useful supporting criteria that may expand the utility of US as a screening tool for CTS.

  3. Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort

    Science.gov (United States)

    Harris-Adamson, Carisa; Eisen, Ellen A; Dale, Ann Marie; Evanoff, Bradley; Hegmann, Kurt T; Thiese, Matthew S; Kapellusch, Jay M; Garg, Arun; Burt, Susan; Bao, Stephen; Silverstein, Barbara; Gerr, Fred; Merlino, Linda; Rempel, David

    2015-01-01

    Background Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes. Objective This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors. Methods 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis. Results Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12). Conclusions Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort. PMID:23645610

  4. Personal risk factors for carpal tunnel syndrome in female visual display unit workers

    Directory of Open Access Journals (Sweden)

    Matteo Riccò

    2016-12-01

    Full Text Available Objectives: Carpal tunnel syndrome (CTS is the most common nerve entrapment syndrome, which since the beginning of the seventies has been linked to the keyboard and visual display unit (VDU. The objective of this study was to investigate the prevalence and personal factors associated with CTS in female VDU workers in Italy. Material and Methods: Participants in this study were female adult subjects, working ≥ 20 h/week (N = 631, mean age 38.14±7.81 years, mean working age 12.9±7.24 years. Signs and symptoms were collected during compulsory occupational medical surveillance. The binary logistic regression was used to estimate adjusted odds ratios for the factors of interest. Results: Diagnosis of CTS was reported in 48 cases (7.6%, 11 of them or 1.7% after a surgical correction for the incidence of 5.94/1000 person-years. In general, signs and symptoms of CTS were associated with the following demographic factors: previous trauma of upper limb (adjusted odds ratio (ORa = 8.093, 95% confidence interval (CI: 2.347–27.904, history (> 5 years of oral contraceptives therapy/hormone replacement therapy (ORa = 3.77, 95% CI: 1.701–8.354 and cervical spine signs/symptoms (ORa = 4.565, 95% CI: 2.281–9.136. Conclusions: The prevalence of CTS was similar to the estimates for the general population of Italy. Among personal risk factors, hormone therapy, previous trauma of the upper limb and signs/symptoms of the cervical spine appeared to be associated with a higher risk of CTS syndrome. Eventually, the results reinforce interpretation of CTS in VDU workers as a work-related musculoskeletal disorder rather than a classical occupational disease. Int J Occup Med Environ Health 2016;29(6:927–936

  5. Personal risk factors for carpal tunnel syndrome in female visual display unit workers.

    Science.gov (United States)

    Riccò, Matteo; Cattani, Silvia; Signorelli, Carlo

    2016-11-18

    Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome, which since the beginning of the seventies has been linked to the keyboard and visual display unit (VDU). The objective of this study was to investigate the prevalence and personal factors associated with CTS in female VDU workers in Italy. Participants in this study were female adult subjects, working ≥ 20 h/week (N = 631, mean age 38.14±7.81 years, mean working age 12.9±7.24 years). Signs and symptoms were collected during compulsory occupational medical surveillance. The binary logistic regression was used to estimate adjusted odds ratios for the factors of interest. Diagnosis of CTS was reported in 48 cases (7.6%, 11 of them or 1.7% after a surgical correction) for the incidence of 5.94/1000 person-years. In general, signs and symptoms of CTS were associated with the following demographic factors: previous trauma of upper limb (adjusted odds ratio (ORa) = 8.093, 95% confidence interval (CI): 2.347-27.904), history (> 5 years) of oral contraceptives therapy/hormone replacement therapy (ORa = 3.77, 95% CI: 1.701-8.354) and cervical spine signs/symptoms (ORa = 4.565, 95% CI: 2.281-9.136). The prevalence of CTS was similar to the estimates for the general population of Italy. Among personal risk factors, hormone therapy, previous trauma of the upper limb and signs/symptoms of the cervical spine appeared to be associated with a higher risk of CTS syndrome. Eventually, the results reinforce interpretation of CTS in VDU workers as a work-related musculoskeletal disorder rather than a classical occupational disease. Int J Occup Med Environ Health 2016;29(6):927-936.

  6. Short-term effectiveness of short-wave diathermy treatment on pain, clinical symptoms, and hand function in patients with mild or moderate idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Incebiyik, Serap; Boyaci, Ahmet; Tutoglu, Ahmet

    2015-01-01

    We determined the effects of short-wave diathermy (SWD) treatment on mild and moderate idiopathic carpal tunnel syndrome (CTS). This was a prospective, randomized, controlled, double-blind clinical trial. The study involved 58 wrists in 31 patients diagnosed clinically and electrophysiologically with mild and moderate CTS. They were assigned randomly to one of two groups. Group 1 received a hot pack, SWD, and nerve and tendon gliding exercises and Group 2 received a hot pack, placebo SWD, and nerve and tendon gliding exercises. The treatment was applied five times weekly for a total of 15 sessions. Patients were evaluated using the Tinel test, Phalen test, carpal compression test, reverse Phalen test, carpal tunnel compression test, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), and a visual analog scale (VAS). Clinical tests and scales were evaluated at the beginning and end of therapy. In the SWD group, in the Tinel test, Phalen test, reverse Phalen test, carpal compression test, VAS, BCTQ-FSS, and BCTQ-SSS, statistically significant improvements were detected (p 0.05) from baseline. All parameters improved significantly in the SWD group versus the controls (p < 0.05). SWD provided short-term improvements in pain, clinical symptoms, and hand function in patients with mild and moderate CTS.

  7. Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study.

    Science.gov (United States)

    Boudier-Revéret, M; Gilbert, K K; Allégue, D R; Moussadyk, M; Brismée, J M; Sizer, P S; Feipel, V; Dugailly, P M; Sobczak, S

    2017-10-01

    To evaluate the effect of neurodynamics mobilization (NDM) on an artificially induced edema in the median nerve at the level of the carpal tunnel in unembalmed cadavers and to assess whether NDM tensioning techniques (TT) and NDM sliding techniques (SLT) induce similar effects on intraneural fluid dispersion. Fourteen upper extremities of seven unembalmed cadavers were used in this study. A biomimetic solution was injected directly under the epineurium of the median nerve at the level of the proximal transverse carpal ligament. The initial dye spread was allowed to stabilize and measured with a digital caliper. Tensioning and sliding techniques were applied following a randomized crossover design to each upper extremity and were performed for a total of 5 min each. Post-intervention dye spread measurements were taken after each technique. After the first mobilization, the mean longitudinal dye spread (7.5 ± 6.6 mm) was significantly greater (p = 0.024) compared to the stabilized dye spread. There was a significant longitudinal diffusion effect with both, TT (p = 0.018) and SLT (p = 0.016), with no statistically significant difference between techniques (p = 0.976). The order in which techniques were administered did not influence the diffusion. Five minute of passive NDM in the form of tensioning or sliding technique induced significant fluid dispersion in the median nerve at the carpal tunnel of unembalmed human cadavers. This study provides support for clinical mechanism of NDM in reducing intraneural edema. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Do Patients With Carpal Tunnel Syndrome Benefit From Low-Level Laser Therapy? A Systematic Review of Randomized Controlled Trials.

    Science.gov (United States)

    Franke, Thierry P; Koes, Bart W; Geelen, Sven J; Huisstede, Bionka M

    2017-06-16

    To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome. The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. Two reviewers independently applied the inclusion criteria to select potential studies. Two reviewers independently extracted the data and assessed the methodologic quality. A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively). In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  9. Single parameter wrist ultrasonography as a first-line screening examination in suspected carpal tunnel syndrome patients.

    Science.gov (United States)

    Kurca, E; Nosal, V; Grofik, M; Sivak, S; Turcanova-Koprusakova, M; Kucera, P

    2008-01-01

    Carpal tunnel syndrome (CTS) is the most common form of peripheral nerve entrapment. Electromyography with selected nerve conduction studies (NCS) is an accepted diagnostic tool in CTS patients. Ultrasonography presents a widely available and low cost investigation method and its position in CTS diagnostics needs further clarification with concrete recommendations for clinical practice. A prospective study of 37 patients with 74 wrists (59 wrists with suspected CTS) was done. Normative data were obtained from a control group of 25 healthy persons (50 wrists) age and sex matched. All persons underwent ultrasonographic examination (median nerve cross-sectional area at carpal tunnel entrance measurement--CSA) and median NCS studies (distal motor and sensory latency measurement--DML and DSL). CSA has a sensitivity of 93% (CI 84-97%) and specificity of 96% (CI 87-99%) in our patients group. Conventional first-line NCS studies results in our patients groupare as follows: DML sensitivity 58% (CI 45-69%) and specificity 100% (CI 93-100%); DSL sensitivity 88% (CI 78-94%) and specificity 94% (CI 84-98%). We recommend the use of single-parameter wrist ultrasonography as a first-line screening laboratory method in suspected CTS diagnosis (Ref. 14). Full Text (Free, PDF) www.bmj.sk.

  10. Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome.

    Science.gov (United States)

    Coppieters, Michel W; Alshami, Ali M

    2007-07-01

    Nerve and tendon gliding exercises are advocated in the conservative and postoperative management of carpal tunnel syndrome (CTS). However, traditionally advocated exercises elongate the nerve bedding substantially, which may induce a potentially deleterious strain in the median nerve with the risk of symptom exacerbation in some patients and reduced benefits from nerve gliding. This study aimed to evaluate various nerve gliding exercises, including novel techniques that aim to slide the nerve through the carpal tunnel while minimizing strain ("sliding techniques"). With these sliding techniques, it is assumed that an increase in nerve strain due to nerve bed elongation at one joint (e.g., wrist extension) is simultaneously counterbalanced by a decrease in nerve bed length at an adjacent joint (e.g., elbow flexion). Excursion and strain in the median nerve at the wrist were measured with a digital calliper and miniature strain gauge in six human cadavers during six mobilization techniques. The sliding technique resulted in an excursion of 12.4 mm, which was 30% larger than any other technique (psliding technique. Nerve gliding associated with wrist movements can be considerably increased and nerve strain substantially reduced by simultaneously moving neighboring joints. These novel nerve sliding techniques are biologically plausible exercises for CTS that deserve further clinical evaluation. Copyright (c) 2007 Orthopaedic Research Society.

  11. The importance of the recovery treatment in increasing the quality of the lives of the patients with the carpal tunnel syndrome

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    Sinziana Calina Silisteanu

    2016-09-01

    Full Text Available The hand is a very important segment in gestures, functionality and the achievement of ADL. The Carpal tunnel syndrome was described for the first time by Paget in 1854 , being a very frequent health condition of the extremity in the upper limb caused by the compression of the median nerve at the level of the fibre bone tunnel at the level of the hand wrist. The incidence of the Carpal tunnel syndrome is approximately 0.125% - 1% /year, having a prevalence of 5-15%. Among the patients diagnosed with the Carpal tunnel syndrome, 80% are over 40 years old, the women being more affected than the men. The Carpal tunnel syndrome is a disability issue with social and economic consequences, being a burden for the society. The recovery is conservative and it consists of immobilisation by orthesis at the hand level, crio-therapy, kinetic therapy, electric therapy (laser, ultrasound, low and average frequency electrical power or by surgical intervention. This study tries to point out if it is possible to influence the quality of life and the individuals' level of functional independence by applying therapeutic protocols specific to this health condition. The patients diagnosed with the Carpal tunnel syndrome received a complex treatment which included electric therapy (of low and average frequency, TENS, laser and ultrasound, massage for the upper limb and kinetic therapy, with a length of 15 days, then the patients were called for the checkup 30 days later. It is important to set clear objectives for the recovery programmes and to create optimised treatment schemes. They confirm the hypothesis based on which the research was conducted. Therefore, any health condition for this segment may influence the quality of patients' life, with involvement in the achievement of the daily activities and the social professional insertion.

  12. 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.

  13. Arthritis as a risk factor for carpal tunnel syndrome: a meta-analysis.

    Science.gov (United States)

    Shiri, R

    2016-10-01

    The effects of inflammatory and degenerative arthritis on carpal tunnel syndrome (CTS) are not well known. This systematic review and meta-analysis aimed to assess whether rheumatoid arthritis (RA) and osteoarthritis (OA) increase the risk of CTS. Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar, and ResearchGate until January 2015. Twenty-three (five cohort, 10 case control, and eight cross sectional) studies qualified for the meta-analyses. A random-effects meta-analysis was used and heterogeneity and publication bias were assessed. Both RA and OA were associated with CTS. Pooled unadjusted odds ratios (ORs) were 1.91 [95% confidence interval (CI) 1.33-2.75, I(2) = 55.2%, nine studies, n = 10 688] for arthritis (either inflammatory or degenerative), 2.91 (95% CI 2.33-3.62, I(2) = 22.3%, 11 studies, n = 74 730) for RA, and 2.13 (95% CI 1.65-2.76, I(2) = 39.2%, five studies, n = 20 574) for OA of any joint. Pooled confounder-adjusted ORs were 1.96 (95% CI 1.21-3.18, I(2) = 73.1%, six studies, n = 11 542) for arthritis, 1.96 (95% CI 1.57-2.44, I(2) = 32.2%, eight studies, n = 72 212) for RA, and 1.87 (95% CI 1.64-2.13, I(2) = 0%, two studies, n = 19 480) for OA. There was no evidence of publication bias, and excluding cross-sectional studies or studies appraised as having a high risk of selection bias did not change the magnitude of the associations. The findings of this systematic review and meta-analysis suggest that both RA and OA increase the risk of CTS. Further prospective studies on the effect of wrist OA on CTS are needed.

  14. Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts.

    Science.gov (United States)

    Mediouni, Z; Bodin, J; Dale, A M; Herquelot, E; Carton, M; Leclerc, A; Fouquet, N; Dumontier, C; Roquelaure, Y; Evanoff, B A; Descatha, A

    2015-09-09

    The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work. The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix. During a follow-up of 3-5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders. In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort. Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. 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.

  16. Carpal tunnel syndrome diagnosis by a self-normalization process and ultrasound compound imaging.

    Science.gov (United States)

    Liao, Yin-Yin; Wu, Chin-Chou; Kuo, Tai-Tzung; Chen, Jiann-Perng; Hsu, Yen-Wei; Yeh, Chih-Kuang

    2012-12-01

    Carpal tunnel syndrome (CTS) is the common entrapment neuropathy that occurs due to compression of the median nerve at the wrist. Ultrasound images have been used to highlight anatomical variants of the median nerve, and CTS is thought to be associated to enlargement of the cross-sectional area (CSA) of the median nerve. However, there remains controversy regarding the most appropriate cutoff values of the computer measurements including the CSA, flattening ratio, and palmar bowing of median nerve, especially given that they can be influenced by image artifacts and factors that differ between individual patients. This study proposed a modified ultrasound compound imaging technique by moving fingers to reduce image artifacts, and the estimates of the normalized CSA [i.e., CSA at the wrist (CSAw) to CSA at the midforearm] with the aim of reducing discrepancies in CSA estimates and improving the ability of CTS discrimination. The subjects were examined with their arms supine and while they were making repetitive movements of their fingers (from an open palm into a clenched fist) within 3 s. By a commercial ultrasound scanner with a 10-MHz linear array transducer, a total of 70 images were acquired in each subject. The frame rate of ultrasound system was 25 fps. Nine frames in the acquisition sequence that had produced partial speckle decorrelation were incoherently added to form a compound image, and the inplane motion of them was corrected using the multilevel block-sum pyramid algorithm. The manual contours outlined by ten experimenters and three physicians were used to test the performance in determining the boundary of the median nerve. The receiver operating characteristic (ROC) curve was used to evaluate the usefulness of the estimates in distinguishing healthy volunteers from CTS patients. The manual contours of the median nerve in the compound images had an average area overlap exceeding 90% and relatively small area errors. The areas under the ROC curve

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Activation in the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system in women with carpal tunnel syndrome.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Díaz-Rodríguez, Lourdes; Salom-Moreno, Jaime; Galiano-Castillo, Noelia; Valverde-Herreros, Lis; Martínez-Martín, Javier; Pareja, Juan A

    2014-08-01

    The aim of this study is to investigate the differences in salivary cortisol (hypothalamic-pituitary-adrenocortical [HPA] axis), α-amylase activity (sympathetic nervous system [SNS]), and immunoglobulin A (IgA; immune system) concentrations between women with carpal tunnel syndrome (CTS) and healthy women. A cross-sectional study. Activation of HPA, SNS, and immune system in CTS has not been clearly determined. One hundred two women (age: 45 ± 7 years) with electrodiagnostic and clinical diagnosis of CTS and 102 matched healthy women. The intensity of the pain was assessed with a Numerical Pain Rating Scale (0-10), and disability was determined with Boston Carpal Tunnel Questionnaire. Salivary cortisol concentration, α-amylase activity, salivary flow rate, and IgA concentration were collected from nonstimulated saliva. Women with CTS exhibited lower salivary flow rate (P  0.2) were found between groups as a total. Women with severe CTS exhibited lower salivary flow rate (P < 0.001), higher α-amylase activity (P = 0.002), and higher cortisol concentration (P = 0.03) than healthy women and than those with minimal/moderate CTS (P < 0.05). Within women with CTS, significant positive associations between α-amylase activity and the intensity of pain were found: the highest the level of pain, the higher the α-amylase activity, i.e., higher SNS activation. These results suggest that women with severe CTS exhibit changes in activation in the HPA axis and SNS but not in the humoral immune system. Activation of the SNS was associated with the intensity of pain. Future studies are needed to elucidate the direction of this relationship. Wiley Periodicals, Inc.

  20. 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.

    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 during different wrist movements, in order to have a baseline for comparison with abnormal movements. Dynamic ultrasound images were obtained in both wrists of 10 asymptomatic volunteers during wrist maximal flexion, extension and ulnar deviation. In order 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 to that in the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (pwrist flexion with finger extension and wrist ulnar deviation with finger extension (all pwrist flexion with finger extension (2.36±0.79 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) (pwrist flexion and ulnar deviation could induce significant transverse displacement and deformation of the median nerve. PMID:24210862

  1. Epidemiological survey of patients with a carpal tunnel syndrome referred to Sina Hospital in Hamedan during 2014-2016

    Directory of Open Access Journals (Sweden)

    Masoud Ghiasian

    2017-11-01

    Full Text Available Background: Carpal tunnel syndrome is a common mono-neuropathy with various causes. This study aimed at evaluating the epidemiology of patients with the carpal tunnel syndrome referred to Sina Hospital in Hamedan City, Iran. Materials and Methods: In this descriptive-cross sectional study, 300 patients (600 hands suffering from paresthesia, pain and weakness of the first to third finger were studied. Diagnosis and severity of the disease was evaluated according to history, examination and electro-diagnostic studies. Afterall the data were collected. Results: This study was conducted on 230 (76.7% females and 70 (23.3% males with the mean ages of 47.3±17.4 and 49.1±20.2 years, respectively (P=0.224. Sixteen of them were left-handed and the rest were right-handed. Also, 113 of the patients had risk factors such as diabetes with the prevalence of 18.1% and hypothyroidism with 6.4% as the most common ones. The most common occupations were carpet weaving and milking with prevalence rates of 19.4% and 13.3%, respectively. In electro-diagnostic findings, 57% of the patients had moderate involvement and 16.6% had severe involvement. The Phalen and Tinel test was positive in 32.2% of the patients and negative in 32.2% of the cases. There was a relationship between the severity of involvement and probability of a positive Phalen and Tinel test. Conclusion: Considering that 76% of the cases were women and among jobs, after housekeeping, carpet weaving and milking are the most common ones, paying more attention to these people and designing the proper work tools (especially carpet weaving and milking tools as well as training of the housewives are recommended to prevent this syndrome.

  2. The Use of Neurodynamic Techniques in the Conservative Treatment of Carpal Tunnel Syndrome - a Critical Appraisal of the Literature.

    Science.gov (United States)

    Wolny, Tomasz

    2017-10-31

    Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, characterized by the presence of many sensory and motor abnormalities. In the physiotherapy of patients with CTS, neurodynamic tech-niques are very common, while the scientific literature does not show clear evidence of beneficial effects obtained by using these techniques. Therefore, the aim of this work was to critically evaluate the use of neurodynamic techniques in the conservative treatment of CTS. Three electronic databases (MEDLINE, SCOPUS and POL-index) and Google Scholar were queried to find articles. The search terms were combinations of words (in Polish, English and German) contain-ing abbreviated and full versions of the following expressions: carpal tunnel syndrome, CTS, neuromobilization, neurodynamic techniques and manual therapy. Sixteen research papers met the conditions for inclusion in this review. Most of them used different methodologies of therapeutic intervention, making it difficult to interpret the results of individual works. Fourteen studies were randomized trials, one a case-control retrospective study and one was a clinical study without a control group. The most common evaluation variables were pain, nerve conduction, subjective symptoms and function, grip strength, sensation and range of motion. The therapy used neurodynamic techniques carried out by the patient or passive mobilization by the physiotherapist. 1. A review of existing studies evaluating the effec-tiveness of neurodynamic techniques in the treat-ment of CTS shows that most of them produced beneficial therapeutic effects. 2. Due to a considerable heteroge-n-ei--ty of the parti-cipants, study design and metho-do-logy of thera-peutic interventions, it is difficult to for-mulate a general conclusion. 3. Hence the need arises for further research to assess the effectiveness of neu-ro-dynamic techniques in conservative therapy of CTS based on a similar therapeutic methodology.

  3. Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinnervation without affecting the functional measures in carpal tunnel syndrome patients.

    Science.gov (United States)

    Gordon, Tessa; Amirjani, Nasim; Edwards, David C; Chan, K Ming

    2010-05-01

    Electrical stimulation (ES) of injured peripheral nerves accelerates axonal regeneration in laboratory animals. However, clinical applicability of this intervention has never been investigated in human subjects. The aim of this pilot study was to determine the effect of ES on axonal regeneration after surgery in patients with median nerve compression in the carpal tunnel causing marked motor axonal loss. A randomized control trial was conducted to provide proof of principle for ES-induced acceleration of axon regeneration in human patients. Carpel tunnel release surgery (CTRS) was performed and in the stimulation group of patients, stainless steel electrode wires placed alongside the median nerve proximal to the surgical decompression site for immediate 1 h 20 Hz bipolar ES. Subjects were followed for a year at regular intervals. Axonal regeneration was quantified using motor unit number estimation (MUNE) and sensory and motor nerve conduction studies. Purdue Pegboard Test, Semmes Weinstein Monofilaments, and Levine's Self-Assessment Questionnaire were used to assess functional recovery. The stimulation group had significant axonal regeneration 6-8 months after the CTRS when the MUNE increased to 290+/-140 (mean+/-SD) motor units (MU) from 150+/-62 MU at baseline (p0.2). Terminal motor latency significantly accelerated in the stimulation group but not the control group (p>0.1). Sensory nerve conduction values significantly improved in the stimulation group earlier than the controls. Other outcome measures showed a significant improvement in both patient groups. We conclude that brief low frequency ES accelerates axonal regeneration and target reinnervation in humans. Copyright 2009 Elsevier Inc. All rights reserved.

  4. Quantitative Evaluation of Median Nerve Motor Function in Carpal Tunnel Syndrome Using Load Cell : Correlation with Clinical, Electrodiagnostic, and Ultrasonographic Findings

    OpenAIRE

    Kim, Dong Hwan; Park, Sung Bae; Lee, Sang Hyung; Son, Young-Je; Chung, Gih Sung; Yang, Hee-Jin

    2013-01-01

    Objective Major complaints of carpal tunnel syndrome (CTS) are sensory components. However, motor deficit also impedes functional status of hand. Contrary to evaluation of sensory function, the objective, quantitative evaluation of median nerve motor function is not easy. The motor function of median was evaluated quantitatively using load cell and its correlation with findings of electrodiagnostic study (EDS) was evaluated. Methods Objective motor function of median nerve was evaluated by lo...

  5. Comparison of Median Nerve Cross-sectional Area on 3-T MRI in Patients With Carpal Tunnel Syndrome.

    Science.gov (United States)

    Ikeda, Mikinori; Okada, Mitsuhiro; Toyama, Masahiko; Uemura, Takuya; Takamatsu, Kiyohito; Nakamura, Hiroaki

    2017-01-01

    This study correlated morphologic abnormalities of idiopathic carpal tunnel syndrome (CTS) with the severity of CTS using 3-T magnetic resonance imaging (MRI). The relationship of the severity of CTS and the cross-sectional area of the median nerve (CSA) was assessed at several levels. Seventy wrists of 35 patients (27 women and 8 men) with unilateral idiopathic CTS underwent nerve conduction study and 3-T MRI of the wrist. The CSA at 4 levels (distal radioulnar joint, body of scaphoid, tubercule of scaphoid, and hook of hamate) and the thickness of the transverse carpal ligament at 3 levels in both affected and unaffected hands were measured using 3-T MRI and correlated with the severity of CTS assessed with distal motor latency. The CSA in the affected hand at the scaphoid body level was significantly higher than in the unaffected hand. The CSA at the scaphoid body level was positively correlated with distal motor latency in the affected hand. The CSA in the affected hand at the scaphoid tubercule level was significantly lower than in the unaffected hand. The CSA had a negative correlation with distal motor latency at the scaphoid tubercule level. The CSA at the distal radioulnar joint and the hamate hook was not significantly different between the affected hand and the unaffected hand. The CSA at the distal radioulnar joint level and hook level were not correlated significantly with distal motor latency in the affected hand. The mean CSA of the affected hand at the scaphoid body level was highest in 4 levels. [Orthopedics. 2017; 40(1):e77-e81.]. Copyright 2016, SLACK Incorporated.

  6. Establishing and validating the fluorescent amyloid ligand h-FTAA (heptamer formyl thiophene acetic acid) to identify transthyretin amyloid deposits in carpal tunnel syndrome.

    Science.gov (United States)

    Hahn, Katharina; Nilsson, K Peter R; Hammarström, Per; Urban, Peter; Meliss, Rolf Rüdiger; Behrens, Hans-Michael; Krüger, Sandra; Röcken, Christoph

    2017-06-01

    Transthyretin-derived (ATTR) amyloidosis is a frequent finding in carpal tunnel syndrome. We tested the following hypotheses: the novel fluorescent amyloid ligand heptameric formic thiophene acetic acid (h-FTAA) has a superior sensitivity for the detection of amyloid compared with Congo red-staining; Amyloid load correlates with patient gender and/or patient age. We retrieved 208 resection specimens obtained from 184 patients with ATTR amyloid in the carpal tunnel. Serial sections were stained with Congo red, h-FTAA and an antibody directed against transthyretin (TTR). Stained sections were digitalized and forwarded to computational analyses. The amount of amyloid was correlated with patient demographics. Amyloid stained intensely with h-FTAA and an anti-TTR-antibody. Congo red-staining combined with fluorescence microscopy was significantly less sensitive than h-FTAA-fluorescence and TTR-immunostaining: the highest percentage area was found in TTR-immunostained sections, followed by h-FTAA and Congo red. The Pearson correlation coefficient was .8 (Congo red vs. h-FTAA) and .9 (TTR vs. h-FTAA). Amyloid load correlated with patient gender, anatomical site and patient age. h-FTAA is a highly sensitive method to detect even small amounts of ATTR amyloid in the carpal tunnel. The staining protocol is easy and h-FTAA may be a much more sensitive procedure to detect amyloid at an earlier stage.

  7. A pilot randomized double-blind placebo-controlled trial on topical chamomile (Matricaria chamomilla L.) oil for severe carpal tunnel syndrome.

    Science.gov (United States)

    Hashempur, Mohammad Hashem; Lari, Zeinab Nasiri; Ghoreishi, Parissa Sadat; Daneshfard, Babak; Ghasemi, Mohammad Sadegh; Homayouni, Kaynoosh; Zargaran, Arman

    2015-11-01

    To assess the effectiveness of standardized topical Chamomile (Matricaria chamomilla L.) oil in patients with severe carpal tunnel syndrome, as a complementary treatment. A pilot randomized double-blind placebo-controlled trial was conducted. Twenty six patients with documented severe carpal tunnel syndrome were treated in two parallel groups with a night splint plus topical chamomile oil or placebo. They were instructed to use their prescribed oil for 4 weeks, twice daily. Symptomatic and functional status of the patients and their electrodiagnostic parameters were evaluated when enrolled and after the trial period, as our outcome measures. A significant improvement of symptomatic and functional status of patients in the chamomile oil group was observed (p = 0.019 and 0.016, respectively) compared with those in the placebo group. However, electrodiagnostic parameters showed no significant changes between the two groups. Chamomile oil improved symptomatic and functional status of patients with severe carpal tunnel syndrome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Personal and occupational risk factors for carpal tunnel syndrome in meat processing industry workers in Northern Italy

    Directory of Open Access Journals (Sweden)

    Matteo Riccò

    2017-04-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a musculoskeletal condition that often impairs the fitness to work. Our aim is to retrospectively evaluate the association between physical exposures in meat processing industry in Northern Italy and the CTS, taking into account non-occupational factors. Material and Methods: A cross-sectional study was performed to include 434 workers (236 males, 198 females, 37.0±10.6 years old, working age: 12.6±10.8 years from meat processing industries. Signs and symptoms were collected at the compulsory occupational medical surveillance. Occupational risk factors were assessed through a questionnaire and direct assessment by investigators. Adjusted odds ratios (ORadj for factors of interest were estimated through binary logistic regression. Results: Diagnosis of the CTS was reported for 61 out of 434 subjects (14.1% for an incidence of 11.3/1000 person- years. In general, signs and symptoms for the CTS were associated with the following demographic factors: smoking history (OR = 1.909, 95% confidence interval (CI: 1.107–3.293, previous traumas of the upper limb (OR = 3.533, 95% CI: 1.743–7.165, hypothyroidism status (OR = 7.897, 95% CI: 2.917–21.38 and, in the case of female participants only, previous pregnancies (OR = 2.807, 95% CI: 1.200–6.566 as well as a personal history of oral contraceptive therapy and/or steroidal replacement therapy (OR = 11.57, 95% CI: 4.689–28.56. The carpal tunnel syndrome cases were associated with the following occupational factors (> 4 h/day: forceful hand exertion (ORadj = 3.548, 95% CI: 1.379–9.131, repeated trauma of the hand (ORadj = 3.602, 95% CI: 1.248– 10.395, repeated movements of the wrist (ORadj = 2.561, 95% CI: 1.100–5.960. Conclusions: Increasing levels of hand activity and force were associated with the increased CTS prevalence among participants. Recommendations have to be provided in order to reduce occupational exposure to these risk factors and

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Personal and occupational risk factors for carpal tunnel syndrome in meat processing industry workers in Northern Italy.

    Science.gov (United States)

    Riccò, Matteo; Signorelli, Carlo

    2017-03-24

    Carpal tunnel syndrome (CTS) is a musculoskeletal condition that often impairs the fitness to work. Our aim is to retrospectively evaluate the association between physical exposures in meat processing industry in Northern Italy and the CTS, taking into account non-occupational factors. A cross-sectional study was performed to include 434 workers (236 males, 198 females, 37.0±10.6 years old, working age: 12.6±10.8 years) from meat processing industries. Signs and symptoms were collected at the compulsory occupational medical surveillance. Occupational risk factors were assessed through a questionnaire and direct assessment by investigators. Adjusted odds ratios (ORadj) for factors of interest were estimated through binary logistic regression. Diagnosis of the CTS was reported for 61 out of 434 subjects (14.1%) for an incidence of 11.3/1000 person- years. In general, signs and symptoms for the CTS were associated with the following demographic factors: smoking history (OR = 1.909, 95% confidence interval (CI): 1.107-3.293), previous traumas of the upper limb (OR = 3.533, 95% CI: 1.743-7.165), hypothyroidism status (OR = 7.897, 95% CI: 2.917-21.38) and, in the case of female participants only, previous pregnancies (OR = 2.807, 95% CI: 1.200-6.566) as well as a personal history of oral contraceptive therapy and/or steroidal replacement therapy (OR = 11.57, 95% CI: 4.689-28.56). The carpal tunnel syndrome cases were associated with the following occupational factors (> 4 h/day): forceful hand exertion (ORadj = 3.548, 95% CI: 1.379-9.131), repeated trauma of the hand (ORadj = 3.602, 95% CI: 1.248- 10.395), repeated movements of the wrist (ORadj = 2.561, 95% CI: 1.100-5.960). Increasing levels of hand activity and force were associated with the increased CTS prevalence among participants. Recommendations have to be provided in order to reduce occupational exposure to these risk factors and improve medical surveillance. Med Pr 2017;68(2):199-209.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. The usefulness of the Phalen test and the Hoffmann-Tinel sign in the diagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Brüske, J; Bednarski, M; Grzelec, H; Zyluk, A

    2002-04-01

    Both the Phalen test and the percussion (Hoffmann-Tinel) test are considered to be the classic diagnostic tests for Carpal Tunnel Syndrome (CTS). Sensitivity of these tests, as given in the literature, ranges from 42 to 85% (Phalen) and from 38 to 100% (Hoffmann-Tinel), and specificity from 54 to 98% and from 55 to 100% respectively. The objective of this study was to evaluate sensitivity and specificity of both tests and to analyse the influence of such selected factors, such as patient's age and duration of symptoms. The clinical group consisted of 112 patients (147 hands) with CTS confirmed clinically and on nerve conduction studies. The control group of 50 patients (100 hands) was selected from hospital volunteers, who did not complain of any hand symptoms. Sensitivity and specificity of the Phalen test turned out to be respectively 85 and 89% and for the percussion test, 67 and 68%. There was no significant influence of patients' age upon the test results. Seventeen patients showed negative results for both tests, but in these individuals, the duration of symptoms was significantly longer than in the remaining group. These findings indicated essential diagnostic value for the Phalen test, but considerably smaller for the percussion test. In the diagnosis of long lasting syndromes, the usefulness of both tests is limited.

  13. 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.

  14. Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome.

    Science.gov (United States)

    Evanoff, Bradley; Zeringue, Angelique; Franzblau, Alfred; Dale, Ann Marie

    2014-02-01

    We studied associations between job-title-based measures of force and repetition and incident carpal tunnel syndrome (CTS). Job exposure matrices (JEMs) are not commonly used in studies of work-related upper-extremity disorders. We enrolled newly hired workers in a prospective cohort study. We assigned a Standard Occupational Classification (SOC) code to each job held and extracted physical work exposure variables from the Occupational Information Network (O*NET). CTS case definition required both characteristic symptoms and abnormal median nerve conduction. Of 1,107 workers, 751 (67.8%) completed follow-up evaluations. A total of 31 respondents (4.4%) developed CTS during an average of 3.3 years of follow-up. Repetitive motion, static strength, and dynamic strength from the most recent job held were all significant predictors of CTS when included individually as physical exposures in models adjusting for age, gender, and BMI. Similar results were found using time-weighted exposure across all jobs held during the study. Repetitive motion, static strength, and dynamic strength were correlated, precluding meaningful analysis of their independent effects. This study found strong relationships between workplace physical exposures assessed via a JEM and CTS, after adjusting for age, gender, and BMI. Though job-title-based exposures are likely to result in significant exposure misclassification, they can be useful for large population studies where more precise exposure data are not available. JEMs can be used as a measure of workplace physical exposures for some studies of musculoskeletal disorders.

  15. An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal, India

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    Gangopadhyay, Somnath; Chakrabarty, Sabarni; Sarkar, Krishnendu; Dev, Samrat; Das, Tamal; Banerjee, Sunetra

    2015-01-01

    Background: Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery. Objectives: The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS). Methods: The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS. Results: Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group. Conclusions: Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS. PMID:25658674

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

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    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.

  17. Value of F-wave inversion in diagnosis of carpal tunnel syndrome and it's relation with anthropometric measurements.

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

    2015-01-01

    The clinical importance of F-wave inversion in the diagnosis of Carpal Tunnel Syndrome (CTS) is not yet well known. This study aims to investigate the value of F-wave inversion in diagnosing CTS, and to evaluate the relationship of F-wave inversion with age, gender, diabetes mellitus, body mass index (BMI), wrist or waist circumferences. Patients (n=744) who were considered to have CTS with clinical findings were included in the study. In order to confirm the diagnosis of CTS, standard electrophysiological parameters were studied with electroneuromyography. In addition, median nerve F-wave measurements were done and we determined if F-wave inversion was present or not. Sensitivity and specificity of F-wave inversion were investigated for its value in showing CTS diagnosed by electrophysiological examination. CTS diagnosis was confirmed by routine electrophysiological parameters in 307 (41.3%) patients. The number of the patients with the presence of F-wave inversion was 243 (32.7%). Sensitivity of F-wave inversion was found as 56% and specificity as 83.8%. BMI and wrist circumference values were significantly higher in patients with F-wave inversion present than those with F-wave inversion absent (p=0.0033, p=0.025 respectively). F-wave inversion can be considered as a valuable electrophysiological measurement for screening of CTS.

  18. Modeling the cost-benefit of nerve conduction studies in pre-employment screening for carpal tunnel syndrome.

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    Evanoff, Bradley; Kymes, Steve

    2010-06-01

    The aim of this study was to evaluate the costs associated with pre-employment nerve conduction testing as a screening tool for carpal tunnel syndrome (CTS) in the workplace. We used a Markov decision analysis model to compare the costs associated with a strategy of screening all prospective employees for CTS and not hiring those with abnormal nerve conduction, versus a strategy of not screening for CTS. The variables included in our model included employee turnover rate, the incidence of CTS, the prevalence of median nerve conduction abnormalities, the relative risk of developing CTS conferred by abnormal nerve conduction screening, the costs of pre-employment screening, and the worker's compensation costs to the employer for each case of CTS. In our base case, total employer costs for CTS from the perspective of the employer (cost of screening plus costs for workers' compensation associated with CTS) were higher when screening was used. Median costs per employee position over five years were US$503 for the screening strategy versus US$200 for a no-screening strategy. A sensitivity analysis showed that a strategy of screening was cost-beneficial from the perspective of the employer only under a few circumstances. Using Monte Carlo simulation varying all parameters, we found a 30% probability that screening would be cost-beneficial. A strategy of pre-employment screening for CTS should be carefully evaluated for yield and social consequences before being implemented. Our model suggests such screening is not appropriate for most employers.

  19. Prevalence of low back pain and carpal tunnel syndrome among dental practitioners in Dakshina Kannada and Coorg District

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    D Anupama Prasad

    2017-01-01

    Full Text Available Context: Dental practitioners who usually have to work for long durations in a particular fixed posture are more prone to musculoskeletal disorders (MSDs, particularly those involving the hand and wrist and also of the lower back. Aims: To study the prevalence of carpal tunnel syndrome (CTS and low back pain (LBP among dental practitioners and to correlate the symptoms with the duration of practice. Subjects and Methods: A closed-end questionnaire was distributed to 100 dental practitioners from Dakshina Kannada and Coorg districts of Karnataka, India. Statistical Analysis Used: Analyses were carried out using Chi-square test and Fisher's exact test. Results: The study found that 86% of the total population of dentists practicing for more than 5 years showed symptoms of CTS and 54.0% experienced LBP. Conclusion: Symptoms of MSDs related to hands, wrists, and low back is widely prevalent among the dentists, which severely impact their work efficiency. Precautionary measures early in the clinical practice such as proper ergonomics in the operating field and few strengthening exercises as described in this study can reduce the onset and progression of the symptoms.

  20. 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.

  1. An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal, India.

    Science.gov (United States)

    Gangopadhyay, Somnath; Chakrabarty, Sabarni; Sarkar, Krishnendu; Dev, Samrat; Das, Tamal; Banerjee, Sunetra

    2015-01-01

    Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery. The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS). The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS. Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group. Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS.

  2. Score reliability and construct validity of the Flinn Performance Screening Tool for adults with symptoms of carpal tunnel syndrome.

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    Flinn, Sharon R; Pease, William S; Freimer, Miriam L

    2012-01-01

    We investigated the psychometric properties of the Flinn Performance Screening Tool (FPST) for people referred with symptoms of carpal tunnel syndrome (CTS). An occupational therapist collected data from 46 participants who completed the Functional Status Scale (FSS) and FPST after the participants' nerve conduction velocity study to test convergent and contrasted-group validity. Seventy-four percent of the participants had abnormal nerve conduction studies. Cronbach's α coefficients for subscale and total scores of the FPST ranged from .96 to .98. Intrarater reliability for six shared items of the FSS and the FPST was supported by high agreement (71%) and a fair κ statistic (.36). Strong to moderate positive relationships were found between the FSS and FPST scores. Functional status differed significantly among severe, mild, and negative CTS severity groups. The FPST shows adequate psychometric properties as a client-centered screening tool for occupational performance of people referred for symptoms of CTS. Copyright © 2012 by the American Occupational Therapy Association, Inc.

  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

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

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    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

  5. The Effects of Oscillatory Biofield Therapy on Pain and Functional Limitations Associated with Carpal Tunnel Syndrome: Randomized, Placebo-Controlled, Double-Blind Study.

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    Nourbakhsh, Mohammad Reza; Bell, Thomas J; Martin, Jason Benson; Arab, Amir Massoud

    2016-11-01

    Biofield treatments have been used for pain control in patients with cancer and chronic pain. However, research on the effect of biofield treatment on specific somatic disorders is lacking. This study intends to investigate the effect of oscillating biofield therapy (OBFT) on symptoms of carpal tunnel syndrome. Randomized, placebo-controlled, double-blind study. Thirty patients with chronic carpal tunnel syndrome participated in the study. Patients were randomly assigned to active or placebo treatment groups. Those in the treatment group received six sessions of OBFT with intention to treat during a period of 2 weeks. Patients in the placebo group had the same number of treatment sessions with mock OBFT treatment. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; Symptom Severity Scale (SSS); and Functional Status Scale (FSS) were used for outcome assessment. Both clinically and statistically significant changes in intensity of pain with activity (95% confidence interval [CI], 2.5-4.2; p = 0.000), night pain (p = 0.000, 95% CI, 3.2-5.7), DASH questionnaire (95% CI, 12.0-21.9; p = 0.000), SSS (95% CI, 0.64-1.15; p = 0.003), and FSS (95% CI, 0.41-0.97; p = 0.029) were found between the treatment and placebo groups. Statistically significant reduction in number of patients with positive results on the Phalen test (87%; p = 0.000), Tinel sign (73%; p = 0.000), and hand paresthesia (80%; p = 0.000) was noted in the treatment group. During 6-month follow-up, 86% of patients in the treatment group remained pain free and had no functional limitations. OBFT can be a viable and effective treatment for improving symptoms and functional limitations associated with chronic carpal tunnel syndrome.

  6. Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome.

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    Fernández-de-Las-Peñas, César; Madeleine, Pascal; Martínez-Perez, Almudena; Arendt-Nielsen, Lars; Jiménez-García, Rodrigo; Pareja, Juan A

    2010-08-01

    To assess topographical pressure pain sensitivity maps of the hand in patients with unilateral carpal tunnel syndrome (CTS) as compared with healthy subjects. A total of 20 women with CTS (ages 32-52 years) and 20 healthy matched women (ages 32-51 years) were recruited. Pressure pain thresholds (PPTs) were measured bilaterally over 30 locations of the palm of each hand by an assessor blinded to the subjects' conditions. Patients showed lower PPTs in both hands in all of the measurement points as compared with controls (P < 0.001 for all). PPTs were lower in those points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers (P < 0.001). CTS patients showed lower PPT levels in dermatomes C6, C7, and C8 when compared with healthy controls (P < 0.001 for all), but without differences between dermatomes (P = 0.4). PPT was negatively correlated with both hand pain intensity and duration of symptoms (P < 0.001 for all). Our findings revealed bilateral generalized pressure pain hyperalgesia in unilateral CTS because lower PPT levels were found in all of the points. The pressure pain hyperalgesia was not uniformly distributed since PPTs were lower in points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers. The decrease in PPT levels was associated with the intensity and the duration of the pain symptoms, supporting a role of both peripheral and central sensitization mechanisms in this pain condition.

  7. Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials.

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    Huisstede, Bionka M; Hoogvliet, Peter; Franke, Thierry P; Randsdorp, Manon S; Koes, Bart W

    2017-09-20

    To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database. Two reviewers independently applied the inclusion criteria to select potential eligible studies. Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool. A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified. Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm

  8. Effects of Carpal Tunnel Syndrome on Adaptation of Multi-Digit Forces to Object Weight for Whole-Hand Manipulation

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    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. PMID:22110738

  9. The investigation of association between IL-1Ra and ACE I/D polymorphisms in carpal tunnel syndrome.

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    Cevik, Betul; Tekcan, Akin; Inanir, Ahmet; Kurt, Semiha Gulsum; Yigit, Serbulent

    2017-03-29

    Carpal tunnel syndrome (CTS) is a common neurologic impairment caused by injury on the median nerve in the wrist, characterized by pain and loss of sensory. CTS usually occurs through three factors, such as a mechanical pressure on median nerve, immunologic changes, and oxidative stress. The aim of this study was to evaluate the influence of interleukin-1 receptor antagonist (IL-1Ra) and angiotensin-converting enzyme (ACE) I/D polymorphisms on the susceptibility of patients to the CTS. One hundred fifty-eight patients with CTS and 151 healthy controls were enrolled in this study. Each patient was analyzed according to diseases symptoms, such as gender, a positive Tinel's sign, a positive Phalen maneuver, disease sides, EMG findings, and clinical stage. We applied the polymerase chain reaction (PCR) to determine the polymorphisms of IL-1Ra and ACE I/D. The statistically significant relation was not found between IL-1Ra, ACE I/D polymorphisms and CTS (respectively, P>.05; P>.05, OR: 1.51, CI: 0.82-1.61). Additionally, in the result of the statistical analysis compared with gene polymorphisms and clinical characteristics, we did not find any correlation (P>.05). Our findings showed that there are no associations of IL-1Ra and ACE I/D polymorphisms with susceptibility of a person for the development of CTS. So, it means that these polymorphisms do not create a risk for the development of CTS. Further studies with larger populations will be required to confirm these findings in different study populations. © 2017 Wiley Periodicals, Inc.

  10. Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers.

    Science.gov (United States)

    Walker, Francis O; Cartwright, Michael S; Blocker, Jill N; Arcury, Thomas A; Suk, Jung I M; Chen, Haiying; Schulz, Mark R; Schultz, Mark R; Grzywacz, Joseph G; Mora, Dana C; Quandt, Sara A

    2013-10-01

    The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS. Copyright © 2013 Wiley Periodicals, Inc.

  11. [Observation on therapeutic effects of acupuncture combined with TDP irradiation and chinese herbal steaming and washing therapy for treatment of carpal tunnel syndrome in early stage].

    Science.gov (United States)

    Zhang, Cui-yan; Wang, Yan-xiang

    2009-09-01

    To search for an effective therapy for carpal tunnel syndrome in early stage. Sixty cases were randomly divided into an observation group 1 (21 cases), an observation group 2 (22 cases) and a basic treatment group (17 cases). The patients in three groups were treated with oral administration of Vitamin B1, Vitamin B12, compound Vitamin B and small splint for wrist protection as basic treatment, and the observation group 1 was also treated with acupuncture on local points as Laogong (PC 8), Yuji (LU 10), Hegu (LI 4) and Waiguan (TE 5) etc. combined with TDP irradiation, and the observation group 2 was treated with herbal steaming and washing on the affected part using Safflower and Lopseed etc. Electromyography, visual analogue scale (VAS) and clinical effect of three groups were observed before and after treatment. The changes of electromyogra phy had no significant difference before and after treatment in all groups (all P > 0.05), the VAS scores in two ob servation groups were superior to that in basic treatment group (both P Acupunture combined with TDP irradiation and Chinese herbal steaming and washing therapy both have significant therapeutic effects for treatment of carpal tunnel syndrome in early stage.

  12. Response of pain intensity to soft tissue mobilization and neurodynamic technique: a series of 18 patients with chronic carpal tunnel syndrome.

    Science.gov (United States)

    De-la-Llave-Rincon, Ana I; Ortega-Santiago, Ricardo; Ambite-Quesada, Silvia; Gil-Crujera, Antonio; Puentedura, Emilio J; Valenza, Marie C; Fernández-de-las-Peñas, César

    2012-07-01

    The purpose of this prospective case series was to examine the combined effects of soft tissue mobilization and nerve slider neurodynamic technique on pain and pressure sensitivity in women with chronic carpal tunnel syndrome (CTS). Eighteen women with a clinical and electromyographic diagnosis of CTS participated. Patients completed the numerical pain rating scale (NPRS) for current, worst, and lowest pain intensity and underwent pain pressure threshold (PPT) testing over the median, radial, and ulnar nerves; the C5-C6 zygapophyseal joint; the carpal tunnel; and the tibialis anterior muscle. Pain was assessed at baseline and 1-week follow-up, whereas PPT were assessed at baseline and immediately after and 1-week after intervention. Each received soft tissue mobilization and nerve slider neurodynamic technique directed at different anatomical sites of potential entrapment of the median nerve. A decrease in the mean current intensity and worst level of hand pain (P.195). The application of soft tissue mobilization and neurodynamic technique decreased the intensity of pain but did not change pressure pain sensitivity in this group of women with chronic CTS. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  13. Pain on administration of non-alkalinised lidocaine for carpal tunnel decompression: A comparison between the Gale and the "advancing wheal" techniques.

    Science.gov (United States)

    Kattan, Abdullah E; Al-Shomer, Feras; Al-Jerian, Albaraa; Al-Qattan, Mohammad M

    2016-01-01

    This study compares two methods of administration of non-alkalinised lidocaine for carpal tunnel decompression in volunteers as well as in patients undergoing carpal tunnel release: The Gale subcutaneous injection technique and another subcutaneous injection technique known as the "advancing wheal" technique. The comparison was done in nine male volunteers and in 20 patients. In the volunteer part of the study, both hands were injected and, hence, each volunteer acted as his own control. In the clinical part of the study, the 20 patients were randomised, with 10 patients receiving the Gale technique and the other 10 receiving the wheal technique. In volunteers, the advancing wheal technique was associated with less pain; but with a longer duration of injection and a higher number of needle pricks when compared with the Gale technique. Eight volunteers preferred the advancing wheal technique because the overall pain experience was less. One volunteer preferred the Gale technique because it took less time to complete the injection procedure. Clinically, the wheal technique also had a significantly lower mean pain score than the Gale technique. It was concluded that the advancing wheal technique is associated with less pain than the Gale technique.

  14. Outcomes Following Cubital Tunnel Surgery in Young Patients: The Importance of Nerve Mobility.

    Science.gov (United States)

    Henn, Curtis M; Patel, Aalok; Wall, Lindley B; Goldfarb, Charles A

    2016-04-01

    To investigate the outcomes following surgical management of unstable and stable ulnar nerves at the elbow in young patients. We retrospectively reviewed the charts of 67 patients who were 30 years old or younger when they underwent primary cubital tunnel surgery at our institution over a 10-year period. In 34 (45%) of these patients, the ulnar nerve either subluxated or perched on the medial epicondyle with elbow flexion and made up the "unstable" cohort. The remaining 42 patients made up the "stable" cohort. Preoperative, intraoperative, and postoperative data were obtained from the patients' charts. Thirty-nine patients completed the following outcome measures: Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), visual analog scale (VAS) for pain and treatment satisfaction, return to sport or full activities, and the presence of persistent symptoms. At an average of 5.6 years following surgery, the unstable cohort had a significantly lower QuickDASH score (6.4 vs 18.6) and a significantly higher VAS for treatment satisfaction (8.7 vs 5.9) compared with the stable cohort. The unstable cohort was also significantly less likely to experience residual symptoms (43% vs 94%), persistent numbness (39% vs 44%), or persistent tingling (22% vs 56%) compared with the stable cohort. Within the stable cohort, patients who underwent simultaneous carpal tunnel release exhibited improved VAS and QuickDASH scores compared with patients who did not. There were no differences in time to return to sports or full activities or pain VAS between the two groups. Surgical management of young patients with symptomatic, unstable ulnar nerves results in superior subjective outcomes compared with surgery in young patients with stable ulnar nerves. Therapeutic III. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. A rare cause of carpal tunnel syndrome: intraneural lipofibroma of median nerve

    Directory of Open Access Journals (Sweden)

    Necdet Saglam

    2012-08-01

    Full Text Available We determined fusiform expansion of the median nerve by a mass in a patient who admitted to our clinic with the complaints of swelling in the wrist, weakness of the fingers, and aggravating pain and tingling sensation at night. Surgical decompression revealed a fusiform expansion of the median nerve by the mass and an intact epineurium. The mass was completely removed by dissection. Pathologic examination revealed a lipofibroma surrounded by a thin fibrous capsule. The patient was symptom-free and complete remission of neurologic findings was noted on the last clinical examination at 20 months postoperatively. In conclusion, we think that intramural lipofibromas in the median nerve can be successfully treated with a precise surgery and respecting the nerve fibers. [Hand Microsurg 2012; 1(2.000: 72-76

  16. [Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation].

    Science.gov (United States)

    Neubrech, F; Gentzsch, T; Kotsougiani, D; Bickert, B; Kneser, U; Harhaus, L

    2016-06-01

    In the current literature, there are reports of associations between complex regional pain syndromes (CRPS) and carpal tunnel syndromes (CTS). The aim of this study was to determine the prevalence of both disease patterns in hand rehabilitation patients and to investigate whether there is a correlation between CTS and CRPS. Furthermore, differences in the healing process of patients with and without additional CTS, and the effectiveness of the rehabilitative therapy for both diseases, were investigated. The computerised medical records of 791 patients in the years 2009-2015 who had been in hand rehabilitation were retrospectively analysed. At the beginning and end of rehabilitation, measurements were made of pain by visual analogue scales (VAS, 0-10), grip strength and finger mobility (mean distance from finger pulp to palmar D2-D5). The clinical course was statistically analysed. CRPS diagnosis was confirmed clinically by a pain therapist, CTS diagnosis was confirmed by neurological and neurophysiological examination. Surgical therapy was performed despite CRPS diagnosis. The prevalence of CRPS was 161/1000 and of CTS 62/1000; the co-prevalence of the 2 diagnoses was 24/1000 (pCRPS group, after a mean of 8 (1-21) weeks of rehabilitative therapy, mean pain was reduced from 5 (1-10) to 3 (0-9), grip strength improved from 10 (0-39)kg to 18.5 (2.5-45.5)kg and finger mobility increased from 2.9 (0-7.6)cm to 1.8 (0-7.8)cm. In the CRPS+CTS group, after a mean of 6.8 (3-23) weeks of rehabilitative therapy, mean pain was reduced from 5 (0-8) to 2.6 (0-5), grip strength improved from 9.7 (2.4-25.5)kg to 17.4 (0.9-47.4)kg and finger mobility increased from 2.7 (0-5.3)cm to 1.7 (0-5.3)cm. Improvement over the period of rehabilitation was significant in both groups, though the period of therapy was significantly shorter in the CRPS+CTS group. CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients. © Georg Thieme Verlag KG

  17. Clinical and electrophysiological comparison of different methods of soft tissue coverage of the median nerve in recurrent carpal tunnel syndrome.

    Science.gov (United States)

    Stütz, Nicolas M; Gohritz, Andreas; Novotny, Alexander; Falkenberg, Udo; Lanz, Ulrich; van Schoonhoven, Jörg

    2008-03-01

    To evaluate the clinical and electrophysiological results of 26 patients treated with either a hypothenar fat flap or a synovial flap to prevent recurrent scar compression of the median nerve after previously failed carpal tunnel decompression. A total of 26 patients underwent flap coverage as a result of a nerve tethering attributable to a position within scar; 15 were covered by a synovial flap and 11 by a hypothenar fat flap. Only patients in whom the median nerve was significantly enveloped in scar tissue were included. All candidates underwent a thorough clinical examination and nerve conduction test. The pre- and postoperative nerve conduction tests and the results of the two groups were statistically compared. The reduction rates of brachial nocturnal pain and pillar pain were 25 and 25%, respectively, in the synovial flap group and 64 and 37%, respectively, in the hypothenar fat flap group. The reduction rates of a positive Tinel's sign (25%) and a positive Phalen's test (13%) were lower in the synovial flap group compared with hypothenar fat flap coverage (55% Tinel's sign, 46% Phalen's test). Thenar atrophy and paresthesia were reduced in 44 and 62%, respectively, in the synovial flap group and in 46 and 64%, respectively, in the hypothenar fat flap group. The overall patient satisfaction (73%) and the Disabilities of the Arm, Shoulder and Hand score (31 points) appeared superior in the hypothenar fat flap group compared with the synovial flap group (56%; 37 points). Nerve conduction tests demonstrated a significant improvement when comparing the pre- and postoperative measurements in both groups. Distal motor latency decreased in the hypothenar fat flap group from 6.81 ms to 4.92 msec (P = 0.01; mean value) and in the synovial flap group from 6.04 ms to 4.43 msec (P < 0.001; mean value). Coverage by an ulnar-based hypothenar fat flap appeared to produce superior clinical results compared with coverage with synovial tissue from adjacent flexor tendons

  18. Carpal tunnel syndrome and musculoskeletal symptoms in postmenopausal women with early breast cancer treated with exemestane or tamoxifen after 2-3 years of tamoxifen: a retrospective analysis of the Intergroup Exemestane Study

    NARCIS (Netherlands)

    Mieog, J. Sven D.; Morden, James P.; Bliss, Judith M.; Coombes, R. Charles; van de Velde, Cornelis J. H.; Delozier, T.; Veronesi, A.; Vrdoljak, E.; Monnier, A.; Coombes, C.; Nagykalnai, T.; Roumen, R. M. H.; Utracka-Hutka, B.; Pluzanska, A.; Porpiglia, M.; Genta, F.; Benedetto, C.; Sozzani, P.; Steiner, M.; Rubinov, R.; Leviov, M.; Semiglazov, V.; Fox, J.; Mayordomo, J. I.; Cervek, J.; Sleeboom, H. P.; Jassem, J.; Hinton, C. P.; Paulsen, T. H.; Guleng, R. J.; Fein, L.; Gutulescu, N.; Florián, J.; Rosso, R.; Rutgers, E. J.; Krzakowski, M.; Pienkowski, T.; Krajina, Z.; Siffnerova, H.; Pawlicki, M.; Drosik, K.; Wagnerowa, M.; Brunt, M.; Vukelja, S.; Mitrowic, L.; Cataliotti, L.; Karnicka-Mlodkowska, H.; Bonnefoi, H.; Tilch, G.; Chollet, P.; Patel, A.; Kamby, C.; Giustini, L.; Acito, L.; Mouridsen, H.; Roche, H.; de Lafontan, B.; Tomczak, P.; Petruzelka, L.; Lortholary, A.; Pacquola, M. G.; Skene, A.; Rici, S.; Michelotti, A.; Ghilezan, N.; Stewart, A.; Beauduin, M.; Andersen, J.; Vassilaros, S.; Celio, Luigi; Bajetta, E.; Bastús, R.; Marsland, T.; Paridaens, R.; Tzekova, V.; Lichtenegger, W.; Piersma, H.; Jones, S.; Holmberg, S.; Verhoeven, D.; Hill, A.; Porcile, G.; Bruno, M. F.; Chernozemski, I.; Coleman, R.; Jadeja, J.; Cohn, A.; Merlano, M.; Perroni, D.; Di Costanzo, F.; van Bochove, A.; Gerrits, M. A. N.; Malec, V.; Balil, A.; Mendiola, C.; Dodwell, D.; Knox, R.; Horgan, K.; Joannides, T.; Leonard, R. C. F.; Cawthorn, S. J.; Ghosh, C.; Cantrell, J.; Campos, D.; Orti, R.; Diedrich, K.; Aas, H.; Barnadas, A.; Vila, M. M.; Makris, A.; Anderson, T.; Chittor, S.; Michel, J.; Philip, P.; Redmond, P.; Mastboom, W. J. B.; Nordenskjöld, B.; Simmonds, P.; Grieve, R. J.; Tomova, A.; Piot, G.; Borea, G.; Ucci, G.; Einarsson, E.; Nicholson, S.; Gardiol, E. A.; Kerger, J.; Schlosser, J.; Namer, M.; Pinotti, G.; Rutten, H. T. J.; Iversen, T.; Nejim, A.; Dudov, A.; Grundtvig, P.; Lang, I.; Massidda, B.; van de Velde, C. H. J.; Gervasio, M. H.; Tengrup, I.; Tennvall, L.; Goodman, S.; Modgill, V. K.; Vorobiof, D. A.; Mickiewicz, E.; Chirgwin, J.; Focan, C.; Albin, N.; Contu, A. A.; Svensson, J. H.; Borghede, G.; Källström, A.-C.; Forbes, J. F.; Hurtz, H. J.; Tubiana-Hulin, M.; Viens, P.; Scanni, A.; Arnoldi, E.; Nastasi, G.; Bottini, A.; Alquati, P.; Muscat, V.; Brincat, S.; Holmen, K.; Amaral, N.; Moreno, I.; Trask, C.; Robinson, A.; Mcintyre, K.; Otsuka, A.; Hohaus, B.; Hoefig, G.; Georgoulias, V.; Salvagni, S.; Bidin, L.; Artioli, F.; Engan, T.; Benedikstsson, K. P.; Campbell, I.; Harvey, V.; Zimbler, H.; Mrsic-Krmpotic, Z.; Canon, J. L.; Tchilingirov, P. V.; Buser, K.; Bolanca, A.; Reztke, U.; Rhein, U.; Jouve, M.; Mullins, G.; Vesentini, L.; Gallo, L.; Merlini, L.; Decensi, A.; Carreca, I.; van Tienhoven, G.; Börjesson, B.; Hansen, J.; Koza, I.; Arcusa, A.; Inoriza, A.; Pelegri, A.; Eremin, O.; Modiano, M. R.; Anthony, S.; Donat, D.; Richardet, E.; Kochli, O.; Zeißig, P.; Gauch, G.; Aabo, K.; Fumoleau, P.; Erdkamp, F. L. G.; Lovén, L.; Jönsson, P.-E.; Perren, T.; Stuart, N.; Galindo, E.; Marek, B. J.; Salmon, J. P.; Dohollou, N.; Thompson, R.; Folco, U.; Rosa, A.; Tonato, M.; Heijmans, G. J.; Koralewski, P.; Bång, H.; Lescure, A. R.; Carrato, A.; Martin, M.; Neave, F.; Howell, T.; Savin, M.; Loesch, D.; Hannois, A.; Mohr, A.; Laube, T.; Omar, S.; Bonneterre, J.; Servent, V.; Danese, S.; Sertoli, M. R.; Butzelaar, R. M. J. M.; Steller, E. Ph; Gomez, H.; Skoog, P.; Alvarez, I.; Aguilar, E. Aranda; Giner, J. Lizón; Yosef, H. M. A.; Barrett- Lee, P.; Buzdar, A. U.; George, T.; Olivaires, J.; Vsianska, M.; Köhler, U.; Lindeløv, B.; Toftdahl, D. B.; Nielsen, E. B.; Veyret, C.; Castera, D.; Kerbrat, P.; Vassilaros, P.; Yeo, W.; Boni, C.; Aitini, E.; Luporini, G.; Herben, M. G.; Espelid, H.; Dahl, S.; Ingvar, C.; Meana, A.; Pico, C.; Garcia, A. M.; Agrawal, R. K.; Gruenberg, D.; Nunez de Pierro, A.; Gill, G.; Nogaret, J. M.; Honhon, B.; Wassenaar, H.; Nielander, Rik; Warnier, Ph; Sessa, C.; Padrik, P.; Guastalla, J. P.; Serin, D.; Jaubert, D.; Dank, M.; Given, F. H.; Mascia, V.; de Fraia, E.; Silingardi, V.; Conte, P. F.; Labianca, R.; Tondini, C.; Bagnulo, A.; Gardani, G.; Wils, J.; Liem, G. S.; Nuytinck, J. K. S.; Formoe, E.; Ambré, T.; Alés, J.; Aramburo, P.; Mansi, J.; Graham, J.; Joffe, J.; Sainsbury, J.; Stone, J.; Good, R. H.; Cartwright, T.; Werner, I. D.; Murray, E.; Beith, J.; Tigges, F. J.; Bojko, P.; Sandberg, E.; Jensen, B.; Lotz, J. P.; Carney, D.; Shapira, J.; Neumann, A.; Goldhirsch, A.; Dicato, M.; de Graaf, H.; Maartense, E.; Burghouts, J.; Cassinello, J.; Jones, A.; Gaffney, C.; Blum, R.; Abdi, E.; Becquart, D.; Dirix, L.; Janssens, J.; NMarschner, N.; Blaska-Jaulerry, B.; Prevot, G.; Mirah Lev, L.; Shani, A.; Baruch, N. B.; Peretz, T.; Gips, M.; Cognetti, F.; Carlini, P.; Nortier, J. W. R.; ten B Huinink, D.; Roussel, J. G. J.; Unneberg, K.; Kylberg, F.; Hovind, H.; Nestvold, T.; Fogelkvist, R.; Due, J.; Muller, S.; Gilligan, D.; Russel, S.; Mcaleer, J.; Yiangou, C.; Foote, L.; Schottstaedt, M.; Holmes, F. A.; Wainstein, R.; Contreras, O.; Martinez, J.; Della-Fiorentina, S.; Beslija, S.; Vermorken, J. B.; Thirion, M.; Fraikin, J.; Castiglione, M.; Jäger, W.; Fasching, P.; Fabriz, H.; Neis, K.; Kirschbaum, M.; Labat, J. P.; Dupuis, O.; Bernard, Jean; Datchary, J.; Provencal, J.; Allain, P.; Clerico, M.; Lopez, M.; Nalli, G.; Aspevik, R.; Fràguas, A.; Curescu, S.; Cuevas, J. M.; Oltra, A.; Bradley, C.; Kapoor, R.; Akbain, S.; Croghan, M. K.; Modiano, M.; Taetle, R.; Beale, P.; Gobert, P.; Bondue, H.; Böhm, R.; Møller, K. A.; Brettes, J. P.; Netter, G.; Grogan, L.; Klein, B.; Botta, M.; Barni, S.; van Meerwijk, I.; Kåresen, R.; Godes, J.; Aramburo, A.; Jara, C.; Zanger, B.; Fleagle, J. T.; Greenspan, A.; Marschke, R.; Medgyesy, D. C.; Garbo, L.

    2012-01-01

    Aromatase inhibitors are more effective than is tamoxifen in prevention of breast-cancer recurrence, but at the expense of increased musculoskeletal side-effects, such as carpal tunnel syndrome. The aim of this study was to assess risk factors and the prognostic value of musculoskeletal symptoms

  19. The prevalence of hand pain in Ibadan – implications for the carpal ...

    African Journals Online (AJOL)

    The prevalence of hand pain in Ibadan – implications for the carpal tunnel syndrome. ... Usually, these symptoms form the first rungs up the ladder leading up to the carpal tunnel syndrome (CTS) (Skandalakis et al 1992), and ... Article Metrics.

  20. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  1. Is the Control of Applied Digital Forces During Natural Five-digit Grasping Affected by Carpal Tunnel Syndrome?

    Science.gov (United States)

    Chen, Po-Tsun; Jou, I-Ming; Lin, Chien-Ju; Chieh, Hsiao-Feng; Kuo, Li-Chieh; Su, Fong-Chin

    2015-07-01

    The impaired sensory function of the hand induced by carpal tunnel syndrome (CTS) is known to disturb dexterous manipulations. However, force control during daily grasping configuration among the five digits has not been a prominent focus of study. Because grasping is so important to normal function and use of a hand, it is important to understand how sensory changes in CTS affect the digit force of natural grasp. We therefore examined the altered patterns of digit forces applied during natural five-digit grasping in patients with CTS and compared them with those seen in control subjects without CTS. We hypothesized that the patients with CTS will grasp by applying larger forces with lowered pair correlations and more force variability of the involved digits than the control subjects. Specifically, we asked: (1) Is there a difference between patients with CTS and control subjects in applied force by digits during lift-hold-lower task? (2) Is there a difference in force correlation coefficient of the digit pairs? (3) Are there force variability differences during the holding phase? We evaluated 15 female patients with CTS and 15 control subjects matched for age, gender, and hand dominance. The applied radial forces (Fr) of the five digits were recorded by respective force transducers on a cylinder simulator during the lift-hold-lower task with natural grasping. The movement phases of the task were determined by a video-based motion capture system. The applied forces of the thumb in patients with CTS (7 ± 0.8 N; 95% CI, 7.2-7.4 N) versus control subjects (5 ± 0.8 N; 95% CI, 5.1-5.3 N) and the index finger in patients with CTS (3 ± 0.3 N; 95% CI, 3.2-3.3 N) versus control subjects (2 ± 0.3 N; 95% CI, 2.2-2.3 N) observed throughout most of the task were larger in the CTS group (p ranges 0.035-0.050 for thumb and 0.016-0.050 for index finger). In addition, the applied force of the middle finger in patients with CTS (1 ± 0.1 N; 95% CI, 1.3-1.4

  2. Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort.

    Science.gov (United States)

    Jerosch-Herold, Christina; Houghton, Julie; Blake, Julian; Shaikh, Anum; Wilson, Edward Cf; Shepstone, Lee

    2017-11-03

    The Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel syndrome (CTS) and predictors of cost over 2 years. The aim of this paper is to explore the cross-sectional association of baseline patient-reported and clinical severity with anxiety, depression, health-related quality of life and costs of CTS in patients referred to secondary care. Prospective, multicentre cohort study initiated in 2013. We collected baseline data on patient-reported symptom severity (CTS-6), psychological status (Hospital Anxiety and Depression Scale), hand function (Michigan Hand Questionnaire) comorbidities, EQ-5D-3L (3-level version of EuroQol-5 dimension) and sociodemographic variables. Nerve conduction tests classified patients into five severity grades (mild to very severe). Data were analysed using a general linear model. 753 patients with CTS provided complete baseline data. Multivariable linear regression adjusting for age, sex, ethnicity, duration of CTS, smoking status, alcohol consumption, employment status, body mass index and comorbidities showed a highly statistically significant relationship between CTS-6 and anxiety, depression and the EQ-5D (p<0.0001 in each case). Likewise, a significant relationship was observed between electrodiagnostic severity and anxiety (p=0.027) but not with depression (p=0.986) or the EQ-5D (p=0.257). National Health Service (NHS) and societal costs in the 3 months prior to enrolment were significantly associated with self-reported severity (p<0.0001) but not with electrodiagnostic severity. Patient-reported symptom severity in CTS is significantly and positively associated with anxiety, depression, health-related quality of life, and NHS and societal costs even when adjusting for age, gender, body mass index, comorbidities, smoking, drinking and occupational status. In contrast, there

  3. Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome.

    Science.gov (United States)

    Golriz, Batol; Ahmadi Bani, Monireh; Arazpour, Mokhtar; Bahramizadeh, Mahmood; Curran, Sarah; Madani, Seyed Pezhman; Hutchins, Stephen W

    2016-10-01

    Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking. The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome. Quasi experimental design. A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test. Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength (P = 0.675) and pinch strength (P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels (P = 0.022) and the Disability of the Arm, Shoulder, and Hand score (P = 0.027) between the two types of splints from baseline to 6 weeks. The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function. A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel

  4. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... Impact Measurement Scales (AIMS) Evidence Based Practice (EBP) Fibromyalgia Impact Questionnaire (FIQ) Multidimensional Assessment of Fatigue (MAF) ... CAPS) (Juvenile) Dermatomyositis (Juvenile) Familial Mediterranean Fever (Juvenile) ... Cell Arteritis Glucocorticoid-induced Osteoperosis Gout Granulomatosis ...

  5. [Metaanalysis for the evaluation of risk factors for carpal tunnel syndrome (CTS) Part II. Occupational risk factors].

    Science.gov (United States)

    Spahn, G; Wollny, J; Hartmann, B; Schiele, R; Hofmann, G O

    2012-10-01

    The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an "occupational disease". This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part II addresses the occupational factors of CTS. A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random-effects model. The prevalence of CTS in working populations [10.9 % (95 % CI 7.9-14 : 9)] was significantly higher than in the general population [8.2 % (95 % CI 2.3-25.1), p heterogeneity of the different study designs made it impossible to detect concrete prevalence or incidence rates for specific job groups. However, "blue-collar work" was a significant risk factor for CTS [OR = 3.1 (95 % CI 1.9-5.3), p concrete hand burdens. In numerous studies, some factors were associated with CTS: repetition [OR = 2.7 (95 % CI 1.8-39), p < 0.001), chronic wrist flexion [OR = 1.7 (95 % CI 1.0-2.6), p = 0.033], powerful grip [OR = 4.4 (95 % CI 1.4-13.6), p = 0.009], and chronic vibration load [OR = 2.6 (95 % CI 1.7-4.0)]. Primarily, combined hand loadings were estimated. For this evaluation, the hand activity level threshold limit values (HAL TLVs®) of the ACGIH (American Conference of Governmental Hygienists) were useful. Manual work in the 4th quartile of this score was significantly associated with the prevalence of CTS [OR = 2.9 (95 % CI 1.5-5.7), p = 0.001]. These score values were identified as a significant risk factor for occupational

  6. Acute effect of topical menthol on chronic pain in slaughterhouse workers with carpal tunnel syndrome: triple-blind, randomized placebo-controlled trial

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus Due; Brandt, Mikkel

    2014-01-01

    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...

  7. 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.

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

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    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.

  9. Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers.

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    Tengfei Fu

    Full Text Available To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS.Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform and outlet (the level of the hook of the hamate, and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC curves were used to evaluate the diagnostic value between the inlet CSA and IOR.The study population included 16 men and 30 women (mean age, 45.3 years; range, 18-83 years. The control population included 18 men and 26 women (mean age, 50.4 years; range, 18-79 years. The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001. The mean IOR in healthy volunteers (1.0 was smaller than that in patients (1.6, P<0.001. Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01. An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS.The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used.

  10. 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

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    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.

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

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    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.

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

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    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.

  13. 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.

  14. Quantitative evaluation of median nerve motor function in carpal tunnel syndrome using load cell : correlation with clinical, electrodiagnostic, and ultrasonographic findings.

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    Kim, Dong Hwan; Park, Sung Bae; Lee, Sang Hyung; Son, Young-Je; Chung, Gih Sung; Yang, Hee-Jin

    2013-09-01

    Major complaints of carpal tunnel syndrome (CTS) are sensory components. However, motor deficit also impedes functional status of hand. Contrary to evaluation of sensory function, the objective, quantitative evaluation of median nerve motor function is not easy. The motor function of median was evaluated quantitatively using load cell and its correlation with findings of electrodiagnostic study (EDS) was evaluated. Objective motor function of median nerve was evaluated by load cell and personal computer-based measurement system. All of the measurement was done in patients diagnosed as having idiopathic CTS by clinical features and EDS findings. The strength of thumb abduction and index finger flexion was measured in each hand three times, and the average value was used to calculate thumb index ratio (TIR). The correlation of TIR with clinical, EDS, and ultrasonographic findings were evaluated. The TIR was evaluated in 67 patients (119 hands). There were 14 males and 53 females, mean age were 57.6 years (range 28 to 81). The higher preoperative nerve conductive studies grade of the patients, the lower TIR was observed [pnerve swelling in ultrasonography (p=0.042, ANOVA). Measurements of median nerve motor function using load cell is a valuable evaluation tool in CTS. It might be helpful in detecting subclinical motor dysfunction before muscle atrophy develops.

  15. Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome.

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    Notarnicola, Angela; Maccagnano, Giuseppe; Tafuri, Silvio; Fiore, Alessandra; Pesce, Vito; Moretti, Biagio

    2015-06-01

    Even though the initial treatment of carpal tunnel syndrome (CTS) is conservative, knowledge of the clinical effects of supplements and of some methods of physiotherapy is still preliminary. Many biological mechanisms can support the administration of shock wave therapy (ESWT) or of alpha lipoic acid (ALA) based nutraceutical, conjugated linoleic acid (GLA), anti-oxidants and Echinacea angustifolia for CTS. The shock waves reduce the nerve compression, produce an anti-inflammatory action, and accelerate the regeneration of neuropathy. ALA and GLA induce antioxidant protective actions, reduce inflammation, promote neuroregeneration, and decrease pain. The Echinacea modulates the endogenous cannabinoid system.The aim of study is to verify the efficiency of shock wave therapy versus nutraceutical composed of ALA, GLA, and Echinacea in CTS. Sixty patients were enrolled in this study and they were randomly assigned to one of two treatments. Both groups showed significant improvements in pain, symptoms' severity and functional scores, and electrodiagnostic results until the sixth month. We verified a trend to a better pain regression in the nutraceutical group. The presence of the medicinal Echinacea represents an added value to the antioxidant effect in ALA and GLA, which can justify this result. ESWT or the association of ALA, GLA, and Echinacea proved to be two effective treatments for controlling symptoms and improving the evolution of CTS. © The Author(s) 2015.

  16. Efficacy of topical chamomile oil for mild and moderate carpal tunnel syndrome: A randomized double-blind placebo-controlled clinical trial.

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    Hashempur, Mohammad Hashem; Ghasemi, Mohammad Sadegh; Daneshfard, Babak; Ghoreishi, Parissa Sadat; Lari, Zeinab Nasiri; Homayouni, Kaynoosh; Zargaran, Arman

    2017-02-01

    To evaluate the efficacy of topical chamomile oil in patients with mild and moderate carpal tunnel syndrome (CTS). Eighty six patients with electrodiagnostic criteria of mild and moderate CTS were enrolled in this randomized double-blind placebo-controlled clinical trial and received wrist splint plus topical chamomile oil or placebo for 4 weeks. They were evaluated at the baseline and end of the study regarding functional and symptomatic scores, dynamometry, and electrodiagnostic indexes. Dynamometry, functionality, and symptom severity scores of the patients were significantly improved in the chamomile oil group compared with the placebo group (P = 0.040, P = 0.0001, P = 0.017, respectively). Additionally, compound latency of the median nerve in the chamomile oil group significantly decreased (P = 0.035) compared to the placebo group. Other electerodiagnostic measurements did not change significantly. Complementary treatment with topical chamomile oil may have some benefits for patients with mild and moderate CTS, both subjectively and objectively. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial.

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    Hall, Barbara; Lee, Hoe C; Fitzgerald, Helen; Byrne, Brent; Barton, Annette; Lee, Andy H

    2013-01-01

    This study investigated the effects of wearing a wrist support splint for 8 wk and receiving a formal education program on patients with carpal tunnel syndrome (CTS), as well as factors associated with patients' desire to seek surgical intervention. Participants were recruited from a hospital surgical wait list and randomly assigned to an intervention group (n = 30) or a control group (n = 24). Significant improvements in measures of symptom severity and functional status over the duration of the study appeared in the intervention group but not in the control group. Logistic regression for the intervention group showed that symptom severity (odds ratio [OR] = 1.53, 95% confidence interval [CI] [1.20-1.93]), functional deficits (OR = 1.31, 95% CI [1.08-1.57]), pain score (OR = 1.25, 95% CI [1.11-1.61]), and symptom duration (OR = 1.11, 95% CI [1.01-1.24]) were positively associated with the desire to seek surgical intervention. This conservative CTS treatment program conducted by occupational therapists can improve symptoms and hand function in CTS patients. Copyright © 2013 by the American Occupational Therapy Association, Inc.

  18. Outcomes of revision surgery for cubital tunnel syndrome.

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    Aleem, Alexander W; Krogue, Justin D; Calfee, Ryan P

    2014-11-01

    To compare both validated patient-rated and objective outcomes of patients following revision cubital tunnel surgery to a similar group of patients who underwent primary surgery. This case-control investigation enrolled 56 patients treated surgically for cubital tunnel syndrome (28 revision cases, 28 primary controls) at a tertiary center. Patients with a minimum of 2 years of follow-up were eligible. All patients completed an in-office study evaluation. Revision participants represented 55% of potential patients in our practice and controls (treated only with primary surgery) were chosen at random from our practice to reach a 1:1 case to control ratio. Preoperative McGowan grading was confirmed similar between the groups. Outcome measures included validated patient outcome questionnaires (Patient-Rated Elbow Evaluation, Levine-Katz questionnaire), symptoms, and physical examination findings. Statistical analyses were conducted to compare the patient groups. Despite 79% of revision patients reporting symptomatic improvement, revision patients reported worse outcomes on all measured standardized questionnaires compared with primary patients. The Levine-Katz questionnaire indicated mild residual symptoms in the primary group (1.6) versus moderate remaining symptoms following revision surgery (2.3). The Patient-Rated Elbow Evaluation also indicated superior results for the control group (9 ± 10) compared with the revision group (32 ± 22). Revision patients had a higher frequency of constant symptoms, elevated 2-point discrimination, and diminished pinch strength. McGowan grading improved after 25% of revision surgeries versus 64% of primary surgeries, and 21% of revision patients had deterioration of their McGowan grade. Subjective and objective outcomes of revision patients in this cohort were inferior to outcomes of similar patients following primary surgery. Revision surgery can be offered in the setting of persistent or recurrent symptoms that are unexplained

  19. Exposure–response relationships for the ACGIH threshold limit value for hand-activity level: results from a pooled data study of carpal tunnel syndrome

    Science.gov (United States)

    Kapellusch, Jay M; Gerr, Frederic E; Malloy, Elizabeth J; Garg, Arun; Harris-Adamson, Carisa; Bao, Stephen S; Burt, Susan E; Dale, Ann Marie; Eisen, Ellen A; Evanoff, Bradley A; Hegmann, Kurt T; Silverstein, Barbara A; Theise, Matthew S; Rempel, David M

    2014-01-01

    Objective This paper aimed to quantify exposure–response relationships between the American Conference of Governmental Industrial Hygienists’ (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS). Methods Manufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions. Results The longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11–1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2–2.5) and 1.5 (95% CI 1.0–2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05–1.25), and 1.04 per unit (95% CI 0.93–1.15), respectively. Conclusion Those with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS. PMID:25266844

  20. Bilateral deficits in fine motor control and pinch grip force are not associated with electrodiagnostic findings in women with carpal tunnel syndrome.

    Science.gov (United States)

    de la Llave-Rincón, Ana Isabel; Fernández-de-Las-Peñas, César; Pérez-de-Heredia-Torres, Marta; Martínez-Perez, Almudena; Valenza, Marie Carmen; Pareja, Juan A

    2011-06-01

    : The aim of this study was to analyze the differences in deficits in fine motor control and pinch grip force between patients with minimal, moderate/mild, or severe carpal tunnel syndrome (CTS) and healthy age- and hand dominance-matched controls. : A case-control study was conducted. The subtests of the Purdue Pegboard Test (one-hand and bilateral pin placements and assemblies) and pinch grip force between the thumb and the remaining four fingers of the hand were bilaterally evaluated in 66 women with minimal (n = 16), moderate (n = 16), or severe (n = 34) CTS and in 20 age- and hand-matched healthy women. The differences among the groups were analyzed using different mixed models of analysis of variance. : A two-way mixed analysis of variance revealed significant differences between groups, not depending on the presence of unilateral or bilateral symptoms (side), for the one-hand pin placement subtest: patients showed bilateral lower scores compared with controls (P < 0.001), without differences among those with minimal, moderate, or severe CTS (P = 0.946). The patients also exhibited lower scores in bilateral pin placement (P < 0.001) and assembly (P < 0.001) subtests, without differences among them. The three-way analysis of variance revealed significant differences among groups (P < 0.001) and fingers (P < 0.001), not depending on the presence of unilateral/bilateral symptoms (P = 0.684), for pinch grip force: patients showed bilateral lower pinch grip force in all fingers compared with healthy controls, without differences among those with minimal, moderate, or severe CTS. : The current study revealed similar bilateral deficits in fine motor control and pinch grip force in patients with minimal, moderate, or severe CTS, supporting that fine motor control deficits are a common feature of CTS not associated with electrodiagnostic findings.

  1. Developing a pooled job physical exposure data set from multiple independent studies: an example of a consortium study of carpal tunnel syndrome.

    Science.gov (United States)

    Bao, Stephen S; Kapellusch, Jay M; Garg, Arun; Silverstein, Barbara A; Harris-Adamson, Carisa; Burt, Susan E; Dale, Ann Marie; Evanoff, Bradley A; Gerr, Frederic E; Hegmann, Kurt T; Merlino, Linda A; Thiese, Matthew S; Rempel, David M

    2015-02-01

    Six research groups independently conducted prospective studies of carpal tunnel syndrome (CTS) incidence in 54 US workplaces in 10 US States. Physical exposure variables were collected by all research groups at the individual worker level. Data from these research groups were pooled to increase the exposure spectrum and statistical power. This paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies. Physical exposure data were inspected and prepared by each of the individual research studies according to detailed instructions provided by an exposure subcommittee of the research consortium. Descriptive analyses were performed on the pooled physical exposure data set. Correlation analyses were performed among exposure variables estimating similar exposure aspects. At baseline, there were a total of 3010 participants in the pooled physical exposure data set. Overall, the pooled data meaningfully increased the spectra of most exposure variables. The increased spectra were due to the wider range in exposure data of different jobs provided by the research studies. The correlations between variables estimating similar exposure aspects showed different patterns among data provided by the research studies. The increased spectra of the physical exposure variables among the data pooled likely improved the possibility of detecting potential associations between these physical exposure variables and CTS incidence. It is also recognised that methods need to be developed for general use by all researchers for standardisation of physical exposure variable definition, data collection, processing and reduction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. An open-label pilot study evaluating the effectiveness of the heated lidocaine/tetracaine patch for the treatment of pain associated with carpal tunnel syndrome.

    Science.gov (United States)

    Nalamachu, Srinivas; Nalamasu, Rohit; Jenkins, Julie; Marriott, Thomas

    2014-09-01

    Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve at the wrist that is characterized by pain, paresthesias, weakness, and loss of dexterity. This pilot study was conducted to evaluate the heated lidocaine/tetracaine patch (HLT patch) as a conservative treatment for pain of CTS. Twenty adult patients (mean age = 44 ± 12 years) with pain secondary to unilateral CTS and electrodiagnostic evidence of mild-to-moderate CTS enrolled in this open-label study. Patients were treated with a single HLT patch placed over the junction of forearm and wrist on the palmar aspect of the wrist twice daily (morning and evening at 12-hour intervals) for 2 hours. At baseline and during the 2-week study, patients graded their pain intensity with an 11-point numerical rating scale (0 = no pain, 10 = worst imaginable pain). Pain interference with general activity, work, and sleep was evaluated with a similar 0-to-10-point scale. Fifteen patients completed the 14-day treatment period. Mean average pain intensity score decreased from 5.1 ± 1.5 at baseline to 2.5 ± 1.6 at end of study in the per-protocol population (P patch was generally well tolerated. The HLT patch resulted in clinically meaningful reduction in pain intensity in the majority of patients with mild-to-moderate CTS and may represent a targeted nonsurgical treatment for pain associated with CTS. © 2013 World Institute of Pain.

  3. Time trends in incidence and prevalence of carpal tunnel syndrome over eight years according to multiple data sources: Pays de la Loire study.

    Science.gov (United States)

    Roquelaure, Yves; Chazelle, Emilie; Gautier, Ludivine; Plaine, Julie; Descatha, Alexis; Evanoff, Bradley; Bodin, Julie; Fouquet, Natacha; Catherine, Buisson

    2017-01-01

    Objective The aim of this study was to describe time trends of incidence/prevalence of carpal tunnel syndrome (CTS), one of the most common musculoskeletal disorders, in a French region over an 8-year period. Methods Three independent data sources were analyzed for the population of the Pays de la Loire region aged 20-59 between 2004 and 2011: hospital discharge records for "surgically treated CTS" (SURG-CTS), the social insurance data on "CTS compensated for as an occupational disease" (OD-CTS), and the regional surveillance program of "work-related diseases" (WRD-CTS). Case counts were analyzed using negative binomial regression models and cubic spline curves with year as the main covariate. Results The annual incidence rates of SURG-CTS decreased from 3.35 to 2.98 per 1000 person-years over the 8-year period, with an overall declining trend [-2.00%, 95% confidence interval (95% CI) -3.07- -0.91%), P<0.001]. The annual incidence rate of OD-CTS per 1000 person-years decreased (from 1.52 to 1.01) between 2004 and 2007 and increased after 2007 (from 1.45 to 2.34), with an overall gain of 54% during the study period. The prevalence rate of WRD-CTS decreased from 5.04 (95% CI 3.90-6.13) to 3.08 (95% CI 2.11-4.06) per 1000 employed person-years, with a non-significant trend between 2004 and 2011. Conclusion The study showed declining rates of SURG-CTS and WRD-CTS in the population of working age between 2004 and 2011, contrasting with increasing rate of OD-CTS after 2007. More research and surveillance data are needed to assess whether and to what extent the declining rates of CTS are actually attributable to improvement in working conditions and/or to non-occupational factors.

  4. Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study.

    Science.gov (United States)

    Mansiz Kaplan, Basak; Akyuz, Gulseren; Kokar, Serdar; Yagci, Ilker

    2018-02-17

    The aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). A single-blind randomized controlled study. Patients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. There were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05). Adding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS. Copyright © 2018 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  5. A reappraisal of small- and large-fiber damage in carpal tunnel syndrome: New insights into the value of the EMLA test for improving diagnostic sensitivity.

    Science.gov (United States)

    Triki, Leila; Zouari, Hela G; Kammoun, Rim; Kammoun, Firas; Kammoun, Ines; Masmoudi, Kaouthar; Lefaucheur, Jean-Pascal

    2017-12-01

    To reappraise the respective involvement of small- and large-fiber damage in carpal tunnel syndrome (CTS) and to determine the diagnostic sensitivity of autonomic tests compared to conventional nerve conduction study (NCS). Thirty-two manual workers complaining of at least unilateral CTS were enrolled. They underwent clinical interview and completed the symptom severity scale of the Boston CTS Questionnaire (sssBCTQ) and the Neuropathic Pain Symptom Inventory (NPSI). In addition, transcarpal NCS was performed to investigate large sensory and motor fibers of the median nerve, while small autonomic fibers were assessed by recording sympathetic skin reflexes (SSR) at the palm and by grading skin wrinkling in response to eutectic mixture of local anesthetic (EMLA) cream application at the pulp of the index finger. For each neurophysiological variable, sensitivity and specificity values for the diagnosis of CTS were calculated and clinical correlations were studied. Among 64 hands examined, 36 were clinically symptomatic, while 22 were clinically asymptomatic and served as controls. Among all the neurophysiological variables studied, only the values of transcarpal sensory nerve conduction velocity and the EMLA test grade were found to be more altered in clinically symptomatic hands, with also a trend towards prolonged distal motor latency. Overall, for the diagnosis of clinically symptomatic CTS, NCS, SSR, and the EMLA test had a sensitivity of 66.7%, 22.2%, and 69.4%, respectively, and a specificity of 72.7%, 90.9%, and 50%, respectively. Combining NCS and the EMLA test led to a sensitivity of 88.9% and a specificity of 45.4%. The sssBCTQ (r=-0.34, P=0.009) and the total NPSI score (r=-0.41, P=0.001) correlated to a more altered EMLA test grade, but not to any NCS or SSR variables. In symptomatic hands, burning sensation was associated with more severe small-fiber lesion, while other pain and sensory symptoms were rather found to be reduced in case of large

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

    Directory of Open Access Journals (Sweden)

    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. Racing performance of Standardbred trotting horses undergoing surgery of the carpal flexor sheath and age- and sex-matched control horses.

    Science.gov (United States)

    Carmalt, James L; Johansson, Bengt C; Zetterström, Sandra M; McOnie, Rebecca C

    2017-07-01

    OBJECTIVE To determine factors affecting race speed in Swedish Standardbred horses undergoing surgery of the carpal flexor sheath (CFS), to investigate whether preoperative racing speed was associated with specific intraoperative findings and whether horses returned to racing, and to compare the performance of horses undergoing surgery of the CFS with that of age- and sex-matched control horses. ANIMALS 149 Swedish Standardbred trotters undergoing surgery of the CFS and 274 age- and sex-matched control horses. PROCEDURES Medical records of CFS horses were examined. Racing data for CFS and control horses were retrieved from official online records. Generalizing estimating equations were used to examine overall and presurgery racing speeds and the association of preoperative clinical and intraoperative findings with preoperative and postoperative speeds. Multivariable regression analysis was used to examine career earnings and number of career races. Kaplan-Meier survival analysis was used to compare career longevity between CFS and control horses. RESULTS CFS horses were significantly faster than control horses. The CFS horses that raced before surgery were slower as they approached the surgery date, but race speed increased after surgery. There were 124 of 137 (90.5%) CFS horses that raced after surgery. No intrathecal pathological findings were significantly associated with preoperative racing speed. Career longevity did not differ between CFS and control horses. CONCLUSIONS AND CLINICAL RELEVANCE Horses undergoing surgery of the CFS had a good prognosis to return to racing after surgery. Racing careers of horses undergoing surgery of the CFS were not significantly different from racing careers of control horses.

  8. Median nerve (anatomical variations) and carpal tunel syndrome - revisited.

    Science.gov (United States)

    Mizia, Ewa; Tomaszewski, Krzysztof; Depukat, Pawel; Klimek-Piotrowska, Wieslawa; Pasternak, Artur; Mroz, Izabela; Bonczar, Tomasz

    2013-01-01

    Carpal tunnel syndrome belongs to the most common causative factors of surgical interventions in the wrist region. Anatomy of carpal tunnel and median nerve is a subject of current revision. Authors paid attention to etiology of the syndrome based on review of literature and their own anatomical studies. They remind basic knowledge on the median nerve and indicate that only based on number of dissections a good orthopedic surgeon may acquire experience necessary to perform procedures in a most appropriate way.

  9. 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.

  10. 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

  11. Use of bovine carpal joints as a training model for cruciate ligament repair.

    Science.gov (United States)

    Calvert, Nicholas; Grainger, Nicholas; Hurworth, Mark

    2013-12-01

    Currently, there is a lack of cheap and effective training models to allow orthopaedic surgery trainees to learn the basics of anterior cruciate ligament reconstruction. The aim of this paper was to investigate the viability of using various animal joints as models for the training of anterior cruciate ligament reconstruction. Equine stifles, bovine stifles and carpal joints, sheep stifles and porcine stifles, were sourced from a local abattoir. Each joint was assessed for the following criteria: suitable tendons for harvesting, ease of arthroscopy access, adequacy of arthroscopy view and suitable joint surfaces. Tendon harvesting, preparation, joint arthroscopy and tendon tunnelling were performed on the most suitable joint. Equine, bovine, sheep and porcine stifles were found to be unsuitable. The bovine carpal joint was similar to a human wrist joint with two rows of carpal bones and fused metacarpal bones, but with deeper flexion - similar to a human knee joint. The distal joint space was found to provide a greater range of flexion and space than the narrower proximal joint space. The joint capsule provided sufficient integrity during saline irrigation to allow adequate visualization of joint structures. Tendons surrounding the joint were found to be of similar diameter to human hamstring tendons and easily accessible. Tendon tunnelling was successfully performed in a manner similar to human anterior cruciate ligament repair. The use of bovine carpal joints is a cost-effective, safe and easily reproducible model for education on basic anterior cruciate ligament repair skills and technique prior to patient contact. © 2013 Royal Australasian College of Surgeons.

  12. ABERRANT ABDUCTOR DIGITI MINIMI MUSCLE FOUND DURING OPEN SURGICAL DECOMPRESSION OF THE CARPAL TUNNEL: CASE REPORT. Músculo abductor digiti minimi aberrante hallado durante una cirugía abierta descompresiva del tunel carpiano: reporte de caso

    Directory of Open Access Journals (Sweden)

    Svetoslav A Slavchev

    2016-03-01

    Full Text Available En este artículo reportamos un caso interesante de músculo hipotenar aberrante encontrado durante una descompresión del túnel carpiano. La variante muscular surgía de la fascia antebraquial voloradial, y pasaba sobre la arteria y el nervio ulnar en el canal de Guyón, y se insertaba en la cara ulnar hipotenar. La tensión en el vientre muscular produjo ligera abducción de la quinta articulación metacarpofa-lángica, lo que confirmó que el músculo era abductor digiti minimi aberrante. Observamos asimismo las diferentes variaciones de este músculo y ponemos énfasis en su potencial implicancia clínica. Herein, we present an interesting case of an aberrant hypothenar muscle found during carpal tunnel decompression. The variant muscle arised from the voloradial antebrachial fascia and coursed over the ulnar artery and nerve in the Guyon canal, and inserted into the ulnar aspect of the hypothenar. Tension on the muscle belly provided slight abduction of the fifth metacarpophalangeal joint, which confirmed it to be an aberrant abductor digiti minimi muscle. We also discuss different variations of this muscle and emphasize its potential clinical implications.

  13. ABERRANT ABDUCTOR DIGITI MINIMI MUSCLE FOUND DURING OPEN SURGICAL DECOMPRESSION OF THE CARPAL TUNNEL: CASE REPORT. MÚSCULO ABDUCTOR DIGITI MINIMI ABERRANTE HALLADO DURANTE UNA CIRUGÍA ABIERTA DESCOMPRESIVA DEL TUNEL CARPIANO: REPORTE DE CASO

    Directory of Open Access Journals (Sweden)

    Svetoslav A. Slavchev

    2013-07-01

    Full Text Available Herein, we present an interesting case of an aberrant hypothenar muscle found during carpal tunnel decompression. The variant muscle arised from the voloradial antebrachial fascia and coursed over the ulnar artery and nerve in the Guyon canal, and inserted into the ulnar aspect of the hypothenar. Tension on the muscle belly provided slight abduction of the fifth metacarpophalangeal joint, which confirmed it to be an aberrant abductor digiti minimi muscle. We also discuss different variations of this muscle and emphasize its potential clinical implications.En este artículo reportamos un caso interesante de músculo hipotenar aberrante encontrado durante una descompresión del túnel carpiano. La variante muscular surgía de la fascia antebraquial voloradial, y pasaba sobre la arteria y el nervio ulnar en el canal de Guyón, y se insertaba en la cara ulnar hipotenar. La tensión en el vientre muscular produjo ligera abducción de la quinta articulación metacarpofalángica, lo que confirmó que el músculo era abductor digiti minimi aberrante. Observamos asimismo las diferentes variaciones de este músculo y ponemos énfasis en su potencial implicancia clínica.

  14. 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.

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

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    Berta Kowalska

    2012-09-01

    Full Text Available Ultrasound (US is one of the methods for imaging entrapment neuropathies, post-trau‑ matic 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 assess‑ ment 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. Entrap‑ ment 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 tun‑ nel 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 Ultrasonog‑ raphy 2012; 12 (49: 120–163 – Normal and sonographic anatomy of selected peripheral nerves. Part I: Sonohistology and general principles of examination, following the exam‑ ple 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

  16. Astigmatism outcomes of scleral tunnel and clear corneal incisions for congenital cataract surgery.

    Science.gov (United States)

    Bar-Sela, S M; Spierer, A

    2006-09-01

    To evaluate astigmatism outcomes after congenital cataract surgery with intraocular lens implantation using clear corneal or scleral tunnel incisions. We retrospectively reviewed the medical records of 46 children (67 eyes), aged 2 months to 12 years, who had undergone nontraumatic cataract extraction and intraocular lens implantation between 1996 and 2001, using a scleral tunnel incision (group 1), or a clear corneal incision (group 2). Refractive astigmatism was measured at 1 week, 3 months, and 5 months after surgery. Paired t-test was used to compare those variables, and Spearman's correlation was used to determine their relation to patient's age. Mean+/-SD astigmatism at 1 week postoperatively was 3.1+/-2.8 Diopter (D) and 2.1+/-1.7 D in groups 1 and 2, respectively. It significantly reduced to 1.1+/-1.2 D and 0.9+/-1.0 D, respectively, in the two groups at 5 months postoperatively (Pastigmatism (group 1: r=0.64; P=0.001; group 2: r=-0.58; P=0.003), and with the change in cylinder magnitude between 1 week and 3 months postoperatively (group 1: r=-0.67; P=0.001; group 2: r=0.50; P=0.013). Children who underwent congenital cataract surgery using clear corneal or scleral tunnel incisions showed high postoperative astigmatism at 1 week postoperatively, which spontaneously reduced during 5 months follow-up. Therefore, suture removal is not necessary in those cases.

  17. 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

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    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.

  18. Is epineurectomy necessary in the surgical management of carpal ...

    African Journals Online (AJOL)

    2016-04-29

    Apr 29, 2016 ... Background: In this study, it was aimed to determine whether median nerve epineurectomy is beneficial in the surgical management of carpal tunnel syndrome (CTS). Materials and Methods: The study enrolled 72 patients including 34 patients without epineurectomy (Group A) and. 38 patients with ...

  19. Is epineurectomy necessary in the surgical management of carpal ...

    African Journals Online (AJOL)

    Background: In this study, it was aimed to determine whether median nerve epineurectomy is beneficial in the surgical management of carpal tunnel syndrome (CTS). Materials and Methods: The study enrolled 72 patients including 34 patients without epineurectomy (Group A) and 38 patients with epineurectomy (Group B).

  20. Selection of Operative Procedures for Cubital Tunnel Syndrome

    Science.gov (United States)

    Novak, Christine B.

    2008-01-01

    The purpose of this study was to investigate the primary operative procedures that are performed by hand surgeons for cubital tunnel syndrome and their reported satisfaction with these procedures. The survey consisted of 22 questions regarding primary operative treatment of cubital tunnel syndrome and demographics and was sent by email to the 459 active members of the American Association for Hand Surgery. One hundred sixty-four surgeons completed the survey (36% response rate). The total sample included 154 hand surgeons (143 males, 11 females) who operated on cubital tunnel syndrome and the majority of surgeons were in private practice (n = 100) followed by academic practice (n = 50). The most prevalent factors that influence the decision to operate include evidence of muscle atrophy (84%), abnormal nerve conduction studies (51%), and failed non-operative treatment (49%). Most surgeons (n = 133) reported using more than one operative procedure for their patients with cubital tunnel syndrome. Factors that influenced the operative procedure selected included the degree of nerve compression (60%), medical comorbidities (30%), patient’s occupation (28%), and obesity (22%). Following carpal tunnel surgery, 88% of the surgeons were “very satisfied” with their patient outcome and following surgery for cubital tunnel syndrome, only 44% were “very satisfied” with their patient outcome. Most surgeons use more than one operative procedure in their treatment of patients with cubital tunnel syndrome and the selection of the operative procedure is influenced by patient factors and surgeon preference. PMID:18807093

  1. 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

    duration was assessed from yearly working proportions. Registered first-time hospital discharge CTS diagnoses and CTS surgery were collected as outcomes. The cohort was followed from 1994 to 2010. Log-linear Poisson regression was used. RESULTS: For CTS diagnoses, the adjusted incidence rate ratios (IRRs...

  2. Risk factors predicting revision surgery after medial epicondylectomy for primary cubital tunnel syndrome.

    Science.gov (United States)

    Gaspar, Michael P; Jacoby, Sidney M; Osterman, A Lee; Kane, Patrick M

    2016-04-01

    Medial epicondylectomy (ME) is one of several accepted surgical options for the treatment of cubital tunnel syndrome (CuTS). Although reported outcomes after ME are generally favorable, few data exist regarding which patients are prone to poorer outcomes requiring revision surgery. The goal of this study was to identify risk factors predicting the need for revision surgery after ME for the treatment of CuTS. We conducted a retrospective chart review of all patients treated at our institution with ME for CuTS from 2006 through 2011. We identified patients who underwent additional operations for recurrent or persistent ulnar nerve symptoms as the revision cohort. We performed bivariate analysis to determine which variables had a significant influence on the need for revision surgery. We examined qualitative factors associated with revision, including the degree of bony resection performed during the index ME, and intraoperative findings at the time of revision surgery. Revision surgery was required in 13.3% of cases (11 of 83). On bivariate analysis, younger age, associated workers' compensation claims, lesser disease severity, and preoperative opioid use were all significant predictors of the need for revision surgery. Perineural scarring and heterotopic bone formation about the elbow were the 2 most common findings at the time of revision. For patients with CuTS, the risk of revision surgery after ME is higher in younger patients, patients with less severe disease, patients taking opioid medications preoperatively, and patients with associated workers' compensation claims. Level IV; Case Series; Treatment Study. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. 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 sen