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Wall JC, Wall HP, Osemwengie BO, MacKay BJ. The Impact of Obesity on Orthopedic Upper Extremity Surgery. Orthop Clin North Am 2018; 49:345-351. [PMID: 29929716 DOI: 10.1016/j.ocl.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Obese patients have increased rates of upper extremity injury, carpal tunnel syndrome, and upper extremity osteoarthritis. Preoperative considerations include cardiovascular disease, pulmonary disease, and diabetes mellitus. Intraoperative and anesthetic considerations include specialized equipment, patient positioning, and the physiology of obese patients. Postoperative considerations should include increased risk of cardiovascular complications as well as surgical site infections and malunion. Surgery of the hand and upper extremity may be less prone to the postoperative complications seen in other regions of the body. There are currently no direct contraindications for obese patients to undergo orthopedic procedures if the appropriate considerations have been made.
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Holt PA, Ozyurekoglu T, Deveshwar S, Maclaughlin EJ, Khlopas A, Mont MA, Pang SW, Tuber JS, Schechtman J, Zizic TM. A Pulsed Electrical Joint Stimulator for the Treatment of Osteoarthritis of the Hand and Wrist. Orthopedics 2018; 41:e550-e556. [PMID: 29813168 DOI: 10.3928/01477447-20180524-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/01/2018] [Indexed: 02/03/2023]
Abstract
The hand is commonly affected by osteoarthritis (OA). The development and progression of OA are believed to involve inflammation, even in the early stages of the disease. Inflammatory and proinflammatory cytokines have also been shown to be elevated in the flexor tenosynovium of idiopathic carpal tunnel syndrome (CTS). A large percentage of patients with hand OA also have a concomitant CTS. This study evaluated the results of a pulsed electrical joint stimulator in patients who had hand OA with or without CTS. Pain, tenderness, and swelling; grip strength and pinch force; and Patient and Physician Global Assessment and Disabilities of the Arm, Shoulder and Hand (DASH) results were evaluated. The primary efficacy outcome was pain due to OA in the study hand in the past 48 hours. Secondary outcomes consisted of OA pain in the study thumb in the past 48 hours, grip strength, pinch force, and Patient and Physician Global Assessment and DASH results. All 7 outcome parameters improved in OA patients. On physical examination, individual finger and wrist joints had also improved regarding pain, swelling, and tenderness. In the subset of patients with CTS, CTS pain, paresthesia, weakness, and all CTS symptoms had significantly improved. Patient and Physician Global Assessment and DASH results and pinch force were also significantly improved. This pulsed electrical joint stimulator is effective in providing clinically relevant and statistically significant reductions in the signs and symptoms of OA of the hand and CTS. It could be a useful modality for the treatment of patients who have one of these conditions or both. [Orthopedics. 2018; 41(4):e550-e556.].
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Takase F, Mifune Y, Inui A, Ueda Y, Kataoka T, Kokubu T, Kuroda R. Association of advanced glycation end products in Dupuytren disease. J Orthop Surg Res 2018; 13:143. [PMID: 29880057 PMCID: PMC5992766 DOI: 10.1186/s13018-018-0848-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/28/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Advanced glycation end products are associated with aging, hyperglycemia, and oxidative stress. Accumulation of advanced glycation end products can cause various pathological conditions; however, the association of Dupuytren's disease with advanced glycation end products has not been demonstrated yet. The aim of this study is to investigate the association of Dupuytren's disease with advanced glycation end products. METHODS Normal palmar fascia from five patients with carpal tunnel syndrome (control group) and Dupuytren's cords from five patients (Dupuytren's disease group) were harvested. The tissues were stained using an anti-advanced glycation end products antibody, anti-receptor for advanced glycation end products antibody, and an anti-reactive oxygen species modulator 1 antibody. The expression of nicotinamide adenine dinucleotide phosphate oxidase-1 and nicotinamide adenine dinucleotide phosphate oxidase-4 genes was also assessed using real-time PCR. For in vitro analysis, the cells harvested from the control and Dupuytren's disease groups were used. After 3 days of exposure to four types of media (control group, control + advanced glycation end products group, Dupuytren's disease group, Dupuytren's disease + advanced glycation end products group), superoxide detection reagent was detected using a total reactive oxygen species/superoxide detection kit. RESULTS Immunostaining of the palmar fasciae of the Dupuytren's disease group showed higher expressions of advanced glycation end products and receptor for advanced glycation end products than that in the control group. The expression of nicotinamide adenine dinucleotide phosphate oxidase oxidase-1 and nicotinamide adenine dinucleotide phosphate oxidase-4 as well as reactive oxygen species modulator 1, an oxidatively damaged protein, was also higher in the Dupuytren's disease group than in the control group. In an in vitro cell culture, the addition of advanced glycation end products to the Dupuytren's disease-derived cells produced more superoxide free radicals. CONCLUSIONS These data suggest that the advanced glycation end products receptor for advanced glycation end products interaction produced free radicals via nicotinamide adenine dinucleotide phosphate oxidase activation in Dupuytren's disease patients. Further studies are required to confirm these results.
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Velázquez-Rueda ML, Hernández-Méndez-Villamil E, Mendoza-Muñoz M, Rivas-Montero JA, Espinosa-Gutiérrez A. [Strength and function of hand before and after release of carpal tunnel in patients with type 2 diabetes mellitus by open and endoscopic approach. Case-control study]. ACTA ORTOPEDICA MEXICANA 2018; 32:22-27. [PMID: 30182542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the upper extremity neuropathy more frequent. Treatments led to the entrapment of the median nerve in the carpal tunnel are more complicated and the results less promising and unsatisfactory in diabetic patients. The objective of this study is to compare the results of strength and hand function in healthy patients against patients with diabetes mellitus type 2 (DM2) with a diagnosis of CTS before and after the open and endoscopic release of the carpal tunnel. MATERIAL AND METHODS This is an observational, retrospective and descriptive study for a period of five years where we evaluated the results in healthy patients and with DM2, with diagnosis of CTS who underwent surgical treatment by open or endoscopic approach; we applied the DASH questionnaire, force grip and clamp fine measurements, presence of infection, pain and complications. RESULTS The results of 86 patients evaluated, showed a statistical association in the decrease in scores on the functional scale DASH with both approaches, association between remission of hypoesthesias in healthy patients with either of the two approaches as opposed to diabetic patients and association between developing DM2 and complications in the short term. CONCLUSION Both approaches improve symptoms and function of the hand in healthy and diabetic patients, but the fi rst group will present cases of complete remission in contrast to the group of diabetic patients.
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Datema M, Tannemaat MR, Hoitsma E, van Zwet EW, Smits F, van Dijk JG, Malessy MJA. Outcome of Carpal Tunnel Release and the Relation With Depression. J Hand Surg Am 2018; 43:16-23. [PMID: 28951099 DOI: 10.1016/j.jhsa.2017.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/15/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the relation between depressive symptoms and outcome of carpal tunnel release (CTR). METHODS Prospective study in a general hospital with data collection at baseline and 3 and 12 months after CTR. We quantified depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) scale and performed multivariable analyses on 2 outcome measures: (1) carpal tunnel syndrome (CTS) symptoms (Boston Carpal Tunnel Questionnaire [BCTQ]) and (2) palmar pain, focusing on preoperative CES-D and BCTQ score, sex, age, alcohol use, diabetes, and severity of nerve conduction abnormalities. RESULTS We included 227 patients. Before surgery, patients with depression had a higher BCTQ score than patients without depression. After 1 year, depressed patients had a higher BCTQ score and more palmar pain. The CES-D decreased by a median of 2 points from baseline to 1 year. This correlated with the decrease in BCTQ score. Multivariable analyses showed that preoperative depression had a small but statistically significant influence on palmar pain, but not on postoperative BCTQ score. CONCLUSIONS Depression is not an independent predictor of residual CTS symptoms 1 year after CTR. Depressive symptoms in patients with CTS decrease after CTR, along with a decrease in CTS symptoms. The nature of this relationship is unknown. Patients with CTS and depression may expect a somewhat higher degree of palmar pain after CTR, the clinical relevance of which is small. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Jørgensen LM, Piil K, Bashir A, Larsen MB, Poggenborg PS, Bjørck S, Fugleholm K. Is one-stop surgery for carpal tunnel syndrome safe? A retrospective long-term follow-up study in a neurosurgical unit in Copenhagen. BMJ Open 2017; 7:e016103. [PMID: 28951406 PMCID: PMC5623482 DOI: 10.1136/bmjopen-2017-016103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 11/04/2022] Open
Abstract
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 hypothesised that relief of symptoms with OSS is comparable with that in non-OSS patients reported in the literature. DESIGN 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. RESULTS 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. CONCLUSION 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.
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Lin FY, Manrique OJ, Lin CL, Cheng HT. Incidence of trigger digits following carpal tunnel release: A nationwide, population-based retrospective cohort study. Medicine (Baltimore) 2017; 96:e7355. [PMID: 28682885 PMCID: PMC5502158 DOI: 10.1097/md.0000000000007355] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
The onset of trigger digits after carpal tunnel release (CTR) have been reported inconsistently across different studies. The aim of this study is to assess the incidence of trigger digits after CTR using nationwide population cohort data.We conducted a retrospective cohort study using the Longitudinal Health Insurance Database 2000 (LHID2000) from the National Health Insurance Database (NHIRD) in Taiwan. The LHID2000 contained 1 million beneficiaries randomly selected from the year 2000 Registry for Beneficiaries in NHIRD. We identified 2605 carpal tunnel syndrome (CTS) patients received CTR from 2000 to 2010 (CTR cohort, n = 2605). For each CTR patient, 4 CTS patients without CTR were randomly selected in the control cohort from the general population frequency matched by age, sex, and diagnosed year (non-CTR cohort, n = 10,420). Both cohorts were followed up until the end of 2011 to investigate the occurrence of trigger digits. Adjusted hazard ratios (aHRs) with 95% confidence interval (CI) of trigger digits were estimated using the Cox proportional hazards model after controlling for age, sex, and comorbidities.The CTR cohort had a mean follow-up period of 5.58 ± 3.18 years and the non-CTR cohort had a mean follow-up period of 5.90 ± 3.10 years. The overall risk of trigger digits was 3.63-fold greater in the CTR cohort than in the non-CTR cohort (incidence rate: 12.6 vs 3.38/1000 person-years, aHR: 3.63, 95% CI, 2.97-4.44). The incidence of postoperative trigger digits was highest in the 1st 6 months (incidence rate: 27.9/1000 person-years, aHR: 9.65, 95% CI, 5.27-17.7) and then significantly decreased over time.CTR was significantly associated with the subsequent development of trigger digits, especially in the postoperative 6 months.
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Puchalski P, Zyluk A, Zyluk-Gadowska P. An analysis of the course of carpal tunnel syndrome before operation. Acta Orthop Belg 2017; 83:22-29. [PMID: 29322890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED This work reports the results of an analysis into the course of carpal tunnel syndrome before operation in 479 patients, predominantly women, aged a mean of 58 years, who were scheduled for carpal tunnel operation. The patients were asked to characterise in detail the course of the disease and what determined the decision to undergo surgery. RESULTS We identified two specific patterns of CTS course: progressive and preservative/mild. Patients with short-lasting disease suffer first of all from symptoms, but the longer the duration, the more pronounced the functional impairment. In a proportion of patients with longer-lasting disease, spontaneous resolution may occur, for up to a year or more. Bilateral involvement is more common than unilateral and the interval between involvement of the other hand is a mean of 10 months. For most patients the primary motivation to undergo surgery is troublesome symptoms (pain and paraesthesia). Functional impairment is of secondary importance, however, its prominence increases in older patients and in those with longer-lasting disease.
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Dua K, Osterman AL, Abzug JM. Carpal Tunnel Syndrome: Initial Management and the Treatment of Recalcitrant Patients. Instr Course Lect 2017; 66:141-152. [PMID: 28594494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Carpal tunnel syndrome (CTS) is a focal compressive neuropathy of the median nerve at the level of the wrist. CTS is the most common type of compressive neuropathy that occurs in the upper extremity. Typically, patients with CTS have paresthesia, pain, and numbness in the radial three and one-half digits. Nighttime symptoms are more common earlier in the disease process, with daytime symptoms becoming more frequent as CTS progresses. Electrodiagnostic studies may be performed to confirm a diagnosis of CTS or to obtain a baseline before surgical treatment; however, electrodiagnostic studies may be normal in a subset of patients who have CTS. Patients who have mild CTS should undergo an initial trial of nonsurgical treatment that includes lifestyle modifications, nighttime splinting, and corticosteroid injections. Carpal tunnel release should be performed in patients in whom nonsurgical treatment fails and patients who have acute CTS secondary to infection or trauma or have advanced symptoms. Recalcitrant CTS, which may occur in as many as 25% of patients who undergo carpal tunnel release, most commonly results from an incomplete transverse carpal ligament release or an incorrect initial diagnosis. Patients with recurrent symptoms often have perineural fibrosis that tethers the median nerve.
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Oshima Y, Okutsu I, Hamanaka I, Motomura T. Carpal Tunnel Syndrome Accompanying Radial Dysplasia Due to Thalidomide Embryopathy. ACTA ACUST UNITED AC 2016; 31:342-4. [PMID: 16530898 DOI: 10.1016/j.jhsb.2006.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Revised: 01/10/2006] [Accepted: 01/19/2006] [Indexed: 11/25/2022]
Abstract
We performed endoscopic carpal tunnel release in four hands in three patients suffering from radial dysplasia due to thalidomide embryopathy. Carpal canal pressure measurements results confirmed the diagnoses. All operations were successfully performed and resulted in no complications. Tingling sensation and sensory disturbances of the hands subsided.
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Wilgis EFS, Burke FD, Dubin NH, Sinha S, Bradley MJ. A Prospective Assessment of Carpal Tunnel Surgery with Respect to Age. ACTA ACUST UNITED AC 2016; 31:401-6. [PMID: 16687196 DOI: 10.1016/j.jhsb.2006.03.165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 03/17/2006] [Indexed: 11/29/2022]
Abstract
Six hundred and thirty five carpal tunnel decompressions in 490 patients were studied prospectively in two hand surgery centres to assess the effect of increasing age on the outcome after surgery. The outcome was assessed using the Levine–Katz carpal tunnel questionnaire, Tinel’s sign, Phalen’s test, Semmes–Weinstein monofilaments and pinch and grip strengths. Assessments were made pre-operatively, at 2 weeks and 6 months postoperatively. Information was also sought concerning co-morbid conditions. Cases were divided into four groups (less than 40 years of age, 40 to 60, 61 to 80, and over 80 years of age). Patients improved significantly in all age groups after carpal tunnel surgery. Despite a relatively high number of co-morbidities, older patients had an acceptable complication rate and their improvement was comparable to all other age groups.
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Iwasaki N, Masuko T, Ishikawa J, Minami A. Surgical Efficacy of Carpal Tunnel Release for Carpal Tunnel Syndrome in Acromegaly: Report of Four Patients. ACTA ACUST UNITED AC 2016; 30:605-6. [PMID: 16095779 DOI: 10.1016/j.jhsb.2005.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 06/09/2005] [Indexed: 11/25/2022]
Abstract
Although carpal tunnel syndrome is frequent in acromegaly, few acromegalics will be encountered by most hand surgeons. This paper considers the treatment of four cases of acromegaly in whom carpal tunnel syndrome arose, to discuss aspects of management of carpal tunnel syndrome in this patient group.
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Zoicas F, Kleindienst A, Mayr B, Buchfelder M, Megele R, Schöfl C. Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP). Horm Metab Res 2016; 48:452-6. [PMID: 26849823 DOI: 10.1055/s-0042-100913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.
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Silva FJ, Kanegusuku V, Bortoncello R, Skare T. Carpal tunnel syndrome and fibromyalgia. ACTA REUMATOLOGICA PORTUGUESA 2016; 41:275-276. [PMID: 27155824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Romeo EL, Previti M, Giandalia A, Russo GT, Cucinotta D. Ulcero-osteolytic lesions in a woman with type 2 diabetes and carpal tunnel syndrome: A case report and literature review. Diabetes Res Clin Pract 2016; 113:204-7. [PMID: 26830858 DOI: 10.1016/j.diabres.2016.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Abstract
We describe the case of a 73-year-old woman with type 2 diabetes presenting with ulcers and ostelytic lesions on distal phalanges of left hand, who was diagnosed with the rare "ulcero-mutilating" variant of carpal tunnel syndrome. A review of literature on cutaneous manifestations associated with the syndrome is also presented.
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Kang S, Yang SN, Yoon JS, Kang HJ, Won SJ. Effect of Carpal Tunnel Syndrome on the Ulnar Nerve at the Wrist: Sonographic and Electrophysiologic Studies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:37-42. [PMID: 26589645 DOI: 10.7863/ultra.15.02064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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 < .0001). After release of the transverse carpal ligament, the cross-sectional area of the ulnar nerve was significantly smaller than the size measured prior to surgery (P < .0001). The cross-sectional area of the median nerve was significantly correlated with that of the ulnar nerve (P < .05). However, no statistically significant difference was found between the patients with 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. CONCLUSIONS 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.
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Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med 2016; 33:10-6. [PMID: 26173490 DOI: 10.1111/dme.12855] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
AIMS 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. METHODS 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. RESULTS 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. CONCLUSION This meta-analysis suggests that both Type 1 and Type 2 diabetes are risk factors for carpal tunnel syndrome.
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Yagci I, Akdeniz Leblebicier M, Mansiz Kaplan B, Ozturk Gokbakan D, Akyuz G. Sonographic Measurements Can Be Misleading for Diagnosing Carpal Tunnel Syndrome in Patients with Rheumatoid Arthritis. ACTA REUMATOLOGICA PORTUGUESA 2016; 41:40-44. [PMID: 27115106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To compare the nerve cross sectional areas (CSA) of patients with RA without any sign of peripheral neuropathy to healthy controls. METHODS Clinical, electrophysiological and sonographic assessments were done by three blinded researchers. The patients who had an electrodiagnostic or clinical of peripheral neuropathy were excluded from the study. Nerve CSA were measured in various levels; hamatum hook, pisiform bone, radio-ulnar joint, distal 1/3 of forearm, and elbow for median nerve; radio-ulnar joint, pisiform bone, distal 1/3 of forearm, and medial epicondyle for ulnar nerve. RESULTS The study was completed with 30 women with RA and 30 healthy women. Despite both groups had neither clinical nor electrophysiological neuropathy, the sonographic measurements showed that median nerve CSA at radioulnar joint, pisiform and hamatum levels of patients with RA were larger in rheumatoid arthritis patients than healthy controls. Ulnar nerve CSA at radioulnar joint, pisiform and distal 1/3 forearm and medial epicondyle levels of patients with RA were also increased (p<0.05). If the pisiform level median nerve CSA>10 mm2 was used as sonographic carpal tunnel syndrome (CTS) criterion, 23/60 hands of 30 patients with RA and 5/60 hands of 30 healthy controls could be diagnosed as CTS. CONCLUSION Median and ulnar nerve CSA were larger than healthy control in patients with rheumatoid arthritis without clinical and electrophysiological peripheral neuropathy. The rheumatologists should be careful to diagnose CTS in patients with RA while using US.
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Vázquez-Alonso MF, Abdala-Dergal C. [Principal causes for recurrent carpal tunnel syndrome]. ACTA ORTOPEDICA MEXICANA 2016; 30:17-20. [PMID: 27627773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Lue YJ, Wu YY, Liu YF, Lin GT, Lu YM. Confirmatory Factor Analysis of the Boston Carpal Tunnel Questionnaire. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:717-724. [PMID: 25894722 DOI: 10.1007/s10926-015-9579-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Khan AA, Ali H, Ali K, Muhammad G, Rashid B, Gul N, Zadran KK, Mushtaq M, Saboor A, Ali S, Bhatti SN. OUTCOME OF OPEN CARPAL TUNNEL RELEASE SURGERY. J Ayub Med Coll Abbottabad 2015; 27:640-642. [PMID: 26721028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Carpel tunnel syndrome is a common compression neuropathy of the median nerve causing pain, numbness and functional dysfunction of the hand. Among the available treatments, surgical release of the nerve is the most effective and acceptable treatment option. The aim of this study was to see the outcomes of surgical release of carpel tunnel using open technique. METHODS This descriptive case series was conducted at the Department of neurosurgery, Ayub Teaching Hospital Abbottabad from April 2013 to March 2014. One hundred consecutive patients with carpel tunnel syndrome were included who underwent open carpel tunnel release surgery. They were followed up at 1, 3 and 6 months. Residual pain, numbness and functional improvement of the hand were the main outcome measures. RESULTS Out of 100 patients, 19 were males. The age ranged from 32 to 50 years with a mean of 39.29±3.99 years. The duration of symptoms was from 5 to 24 months. In the entire series patient functional outcome and satisfaction was 82% at 1 month, 94% at 3 months and 97% at 6 months. 18% patient had residual pain at 1 month post-operative follow-up, 6% at 3 months and 3% at 6 month follow-up. CONCLUSION Open carpel tunnel release surgery is an effective procedure for compression neuropathy of the median nerve. It should be offered to all patients with moderate to severe pain and functional disability related to carpel tunnel syndrome.
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Han SW, Cheon KY, Kim JY, Baik JS. Carpal Tunnel Syndrome in Patients with Tremor Dominant Parkinson's Disease. PLoS One 2015; 10:e0130779. [PMID: 26091110 PMCID: PMC4474427 DOI: 10.1371/journal.pone.0130779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/22/2015] [Indexed: 11/18/2022] Open
Abstract
Background Unilateral hand tremor is one of the cardinal symptoms of Parkinson’s disease. Additionally, mechanical traumatic hand movement is one of the risk factors for carpal tunnel syndrome. Our objective in this study was to examine whether repetitive mechanical movement may be related to the development of carpal tunnel syndrome in Parkinson’s disease with unilateral hand tremor using neurophysiological methods. Methods The study participants included 33 de novo Parkinson’s disease patients with unilateral hand tremor, and we compared the tremor hand and non-tremor hand within the same patients. Results Seven (21.2%) of the 33 patients had carpal tunnel syndrome. All of carpal tunnel syndrome patients showed neurophysiological abnormalities in both the hand without tremor and the hand with tremor. In addition, in patients without carpal tunnel syndrome, the sensory nerve action potential was lower in the hand without tremor than in the hand with tremor, although there were no significant differences. Conclusions We concluded that hand tremor in de novo Parkinson’s disease patients was not directly related to the development of carpal tunnel syndrome. In contrast, more frequent use of hand without tremor may induce mechanical loading and may be associated with CTS in the hand without tremor. Early diagnosis of Parkinson’s disease and proper education in hand use may be essential for preventing carpal tunnel syndrome in Parkinson’s disease tremor patients.
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Earp BE, Han CH, Floyd WE, Rozental TD, Blazar PE. De Quervain tendinopathy: survivorship and prognostic indicators of recurrence following a single corticosteroid injection. J Hand Surg Am 2015; 40:1161-5. [PMID: 25936736 DOI: 10.1016/j.jhsa.2014.12.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine short- and long-term success rates of a single corticosteroid injection for de Quervain tendinopathy while identifying prognostic indicators for symptom recurrence and repeat intervention. METHODS Fifty consecutive patients with de Quervain tendinopathy treated with corticosteroid injections (lidocaine plus triamcinolone acetonide or dexamethasone) were prospectively enrolled. Patients with inflammatory arthritis, carpometacarpal osteoarthritis, or a previous distal radius fracture affecting the symptomatic wrist were excluded. Demographic data and information on existing comorbidities were recorded. Patients were seen in clinic at 6 weeks after injection and contacted at 3, 6, 9, and 12 months following injection to determine symptom recurrence and further intervention. Medical records were also reviewed for this purpose. Kaplan-Meier survival analysis and Cox regression modeling were used to estimate recurrence rates and identify predictors of symptom recurrence and repeat intervention. RESULTS Fifty wrists in 50 patients (average age, 49 y) were included. One patient was lost to follow-up. Eighty-two percent of patients had resolved symptoms 6 weeks after a steroid injection. Twenty-four patients had a recurrence of symptoms at a median of 84 days after the injection. Eleven patients underwent additional intervention (7 surgical releases and 4 repeat injections) at a median of 129 days (range, 42-365) after the injection. Estimated freedom from symptom recurrence was 52% at 6 and 12 months. Estimated freedom from repeat intervention was 81% at 6 months and 77% at 12 months. Two of 3 patients with a history of trigger finger required subsequent de Quervain surgery. CONCLUSIONS We demonstrated that a single cortisone injection was effective in alleviating symptoms of de Quervain tendinopathy in 82% of patients and that over half remained symptom-free for at least 12 months. All patients with recurring symptoms developed them within the first 6 months. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Heymann WR. Necrotic Carpal Tunnel Syndrome: A Standard Deviation From the Median Nerve. Skinmed 2015; 13:231-232. [PMID: 26380511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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