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Lazaro RP, Eagan TS. Concurrent musculoskeletal and soft tissue pain in the upper extremity can affect the treatment and prognosis of carpal tunnel syndrome: redefining a common condition. J Pain Res 2017; 10:2497-2502. [PMID: 29123420 PMCID: PMC5661462 DOI: 10.2147/jpr.s142153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To demonstrate the importance of recognizing and separating nonmedian nerve-related symptoms from those related to median nerve compression at the carpal tunnel. Methods The records of 80 patients, aged 31–82 years (39 males and 41 females), who had undergone median nerve decompression using open and endoscopic release surgery, were reviewed. Peripheral electrodiagnostic studies were performed in all patients prior to surgery. Those whose nonmedian nerve-related symptoms, also known as musculoskeletal and soft tissue pain and tenderness, persisted postoperatively, were referred to another electrodiagnostic study to reassess the median nerve function at the carpal tunnel. Peripheral electrodiagnostic studies were deemed unnecessary for patients with exclusively median nerve-related symptoms who improved dramatically following surgery. Included from the study were cases whose presenting symptoms were primarily referrable to median nerve dysfunction with or without associated musculoskeletal pain. Cases that were excluded were those whose symptoms were related to various primary conditions. Outcome of surgery was reviewed and correlated with symptoms related to median nerve compression and musculoskeletal irritation, and with electrodiagnostic abnormalities. Results Complete resolution of symptoms, following surgery, occurred in patients with clinical and electrophysiologic signs of median nerve compression but without significant symptoms of musculoskeletal irritation. Those with concurrent and prominent musculoskeletal and soft tissue pain had variable results, both favorable and unfavorable, including three who developed signs and symptoms of complex regional pain syndrome. Conclusion The symptoms related to median nerve compression at the carpal tunnel and the symptoms related to musculoskeletal and soft tissue irritation are two different symptom complexes that have important diagnostic and therapeutic considerations. We would like to propose that “true carpal tunnel syndrome” symptoms, those that are exclusively median nerve related, should be considered a distinct entity. When musculoskeletal and soft tissue pain is more prominent and dominates the overall clinical presentation, the term “mechanical stress syndrome” is more appropriate.
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Affiliation(s)
| | - Thomas S Eagan
- Department of Orthopedic Surgery, Orthopedic and Hand Surgery and Wellness Center, Nathan Littauer Hospital, Gloversville, NY, USA
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Nazari G, Shah N, MacDermid JC, Woodhouse L. The Impact of Sensory, Motor and Pain Impairments on Patient- Reported and Performance Based Function in Carpal Tunnel Syndrome. Open Orthop J 2017; 11:1258-1267. [PMID: 29290864 PMCID: PMC5721305 DOI: 10.2174/1874325001711011258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background: Research has suggested that persistent sensory and motor impairments predominate the symptoms experienced by patients with carpal tunnel syndrome (CTS); with intermittent pain symptoms, being less predominant. Objective: The study aims to determine the relative contribution of sensory, motor and pain impairments as contributors to patient-report or performance-based hand function. Methods: Fifty participants with a diagnosis of CTS confirmed by a hand surgeon and electrodiagnosis were evaluated on a single occasion. Impairments were measured for sensibility, pain and motor performance. A staged regression analysis was performed. In the first step, variables with each of the 3 impairment categories were regressed on the Symptom Severity Scale (SSS) to identify the key variables from this domain. Models were created for both self report (Quick Disabilities of arm, shoulder and hand- Quick DASH) and performance based (Dexterity) functional outcomes. Backward regression modelling was performed for SSS and then, to allow comparability of the importance of different impairments across models, the 7 significant variables from the SSS model were forced into the models.
Results: Variables: age, touch threshold and vibration threshold of the little finger of unaffected hand, median-ulnar vibration threshold ratio of affected hand, mean pain tolerance of unaffected hand, grip strength and pinch strength of affected hand, explained 31%, 36% and 63% of the variance in SSS, Quick DASH and dexterity scores, respectively.
Conclusion: Hand function in patients with CTS is described by variables that reflect sensory status of the median and ulnar nerves, the persons pain threshold, grip and pinch strength impairments and age.
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Affiliation(s)
- Goris Nazari
- Physiotherapy, Health & Rehabilitation Science, London, Ontario, Canada
| | - Niyati Shah
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- Physiotherapy, Health & Rehabilitation Science, London, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Linda Woodhouse
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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Raducha JE, Gil JA, DeFroda SF, Wawrzynski J, Weiss APC. An Evidence-Based Approach to the Differentiation of Compressive Neuropathy from Polysensory Neuropathy in the Upper Extremity. JBJS Rev 2017; 5:e9. [DOI: 10.2106/jbjs.rvw.17.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Meems M, Spek V, Kop WJ, Meems BJ, Visser LH, Pop VJM. Mechanical wrist traction as a non-invasive treatment for carpal tunnel syndrome: a randomized controlled trial. Trials 2017; 18:464. [PMID: 29017511 PMCID: PMC5634882 DOI: 10.1186/s13063-017-2208-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain. Carpal tunnel release surgery is the only known long-term effective treatment. However, surgery is invasive and up to 30% of patients report recurrence or persistence of symptoms or suffer from post-surgical complications. A promising non-surgical treatment for CTS is mechanical wrist traction. The purpose of this study was to evaluate clinical outcomes following mechanical traction in patients with CTS compared to care as usual. METHODS Adult patients (N = 181, mean age 58.1 (13.0) years, 67% women) with electrodiagnostically confirmed CTS were recruited from an outpatient neurology clinic in the Netherlands between October 2013 and April 2015. After baseline assessments, patients were randomized to either the intervention group (12 treatments with mechanical traction, twice a week for a period of 6 weeks) or "care as usual". The main clinical outcome measure was surgery during 6 months' follow-up. In addition, symptom severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline, 3, and 6 months' follow-up. Baseline characteristics and severity of CTS symptoms at follow-up were compared between the intervention and care-as-usual groups using a t test and χ 2 tests. Time to event (surgery) between the groups was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS The intervention group had fewer surgeries (28%) compared to the care-as-usual group (43%) during follow-up (χ21 = 4.40, p = .036). Analyses of the survival curves revealed a statistically significant difference between the groups over time (log-rank test χ 21 = 6.94, p = .008). At 6 months' follow-up, symptom severity and functional status scores had significantly decreased from baseline in both groups (p < .001) and the improvements did not differ between the two groups. CONCLUSIONS Mechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months' follow-up was similar in both groups. The long-term effects of mechanical traction require further evaluation. TRIAL REGISTRATION ClinicalTrials.gov, ID: NL44692.008.13 . Registered on 19 September 2013.
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Affiliation(s)
- Margreet Meems
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Viola Spek
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Berend-Jan Meems
- Division of Neurology, VieCuri Medical Center, PO Box 1926, 5900 BX Venlo, The Netherlands
| | - Leo H. Visser
- Division of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, 5000 LC Tilburg, The Netherlands
| | - Victor J. M. Pop
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study. Musculoskelet Sci Pract 2017; 31:45-51. [PMID: 28734168 DOI: 10.1016/j.msksp.2017.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/11/2017] [Accepted: 07/15/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES 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. DESIGN 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. RESULTS 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. CONCLUSION 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.
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Kho JY, Gaspar MP, Kane PM, Jacoby SM, Shin EK. Prognostic Variables for Patient Return-to-Work Interval Following Carpal Tunnel Release in a Workers' Compensation Population. Hand (N Y) 2017; 12:246-251. [PMID: 28453350 PMCID: PMC5480659 DOI: 10.1177/1558944716661991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We hypothesize that depressive and anxiety disorders, chronic pain conditions, and work-related factors are significant determinants of the time interval for return to work (RTW) in the workers' compensation (WC) population following carpal tunnel release (CTR) surgery. METHODS We retrospectively reviewed records of all WC patients who underwent open CTR surgery over a 5-year period by 1 of 3 fellowship-trained hand surgeons. One hundred fifty-two wrists in 108 patients (64 unilateral, 44 bilateral) met the inclusion criteria. Demographic, medical, and surgical data were obtained from patient records. Bivariate and multivariate analyses were performed to assess predictors of RTW. RESULTS Eighty-nine percent of all patients returned to work full-duty. Average RTW duration in all wrists was 12.5 ± 11.3 weeks. Predictors of delayed RTW in bivariate and multivariate analyses were depression with or without anxiety, chronic pain disorders including fibromyalgia, preoperative opioid use, and modified preoperative work status. Job type, motor nerve conduction velocity, and bilateral surgery were not predictive of delayed RTW interval. CONCLUSIONS WC patients with depression, anxiety, or fibromyalgia and other chronic pain disorders were significantly more likely to have delayed RTW following CTR than were WC patients without these conditions. In addition, those who use opioid medications preoperatively and those with preoperative work restrictions were also found to have a significantly delayed RTW after CTR. Knowledge of these risk factors may help care providers and employers identify those WC patients who are most likely to have a protracted postoperative recovery period.
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Affiliation(s)
- Jenniefer Y. Kho
- Sutter Gould Medical Foundation, Modesto, CA, USA,The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael P. Gaspar
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA,Michael P. Gaspar, The Philadelphia Hand Center, P.C., The Franklin Building, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Patrick M. Kane
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Sidney M. Jacoby
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Eon K. Shin
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
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Hutchison RL, Hutchison AL, Hirthler MA. An Experimental Survey on the Effect of Using the CTS-6 Tool on the Diagnosis of Carpal Tunnel Syndrome by Hand Surgeons. J Hand Surg Asian Pac Vol 2017; 22:88-92. [PMID: 28205476 DOI: 10.1142/s0218810417500150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND This controlled randomized experiment tested the research hypothesis that providing the CTS-6 quantitative diagnostic information to hand surgeons affects the diagnosis of carpal tunnel syndrome. METHODS Surgeon members of American Association for Hand Surgery participated in an online survey. Demographic and practice pattern information was collected. Few surgeons routinely use diagnostic questionnaires or algorithms. Each member was given four clinical scenarios. The respondents were randomized, The experimental group was given the same scenarios as the control group plus the quantitative results of the CTS-6 diagnostic tool. RESULTS There were statistically significant differences between the groups in the diagnostic decisions. Using the CTS-6 quantitative diagnostic tool affected the diagnosis of carpal tunnel syndrome, especially for patients with the lowest number of findings associated with carpal tunnel syndrome. CONCLUSIONS While accurate diagnostic decisions are dependent on the incorporation of all of the pertinent information gathered during the history and physical exams, the results of the CTS-6 may help the clinician focus their thinking and revise their diagnostic probabilities.
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Affiliation(s)
- Richard L Hutchison
- * Section of Hand Surgery, Division of Orthopaedic Surgery, Children's Mercy Hospitals and Clinics, University of Missouri, Kansas City, MO, USA
| | - Alan L Hutchison
- † Medical Scientist Training Program, Graduate Program in the Biophysical Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Kwon YE, Gong HS, Shin HS, Lee HR, Kim KH, Baek GH. Evaluation of Carpal Arch Widening and Outcomes After Carpal Tunnel Release. J Hand Surg Am 2017; 42:113-117. [PMID: 28160901 DOI: 10.1016/j.jhsa.2016.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/18/2016] [Accepted: 11/23/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the carpal arch widths between baseline and 6 months after open carpal tunnel release, and to determine whether any increase in the carpal arch width was associated with clinical outcomes of surgery. METHODS We measured carpal arch widths in standardized carpal tunnel radiographs before, and 6 months after, open carpal tunnel release in 76 patients with carpal tunnel syndrome. Clinical outcomes were assessed for grip strength change and perceived disability using the Disabilities of the Arm, Shoulder, and Hand questionnaire at 6-month follow-up. We correlated the clinical outcomes with carpal arch width changes. RESULTS The mean change of the carpal arch width was 1.8 mm (standard deviation, 1.4 mm; range, -0.3 to 5.2 mm). There was no significant correlation between the amount of carpal arch width widening and the clinical outcomes in terms of grip strength change and the Disabilities of the Arm, Shoulder, and Hand scores. CONCLUSIONS This study found that the change of carpal arch width was minimal at 6 months after open carpal tunnel release, and that the increase, if any, was not associated with clinical outcomes such as grip strength change or the Disabilities of the Arm, Shoulder, and Hand scores. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Yong Eok Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Han Sol Shin
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung Rae Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ka Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Glener AD, Gandolfi B, Desai MJ, Ruch DS. Median Nerve Compression by Radial Head Osteophyte. J Hand Surg Am 2016; 41:e481-e483. [PMID: 27663050 DOI: 10.1016/j.jhsa.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 02/02/2023]
Abstract
Congenital radial head dislocations are rare, and presentation with late complications is even less common. We present a case of a patient who presented with symptoms and findings of proximal median nerve compression secondary to large osteophytes associated with untreated congenital radial head dislocations.
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Affiliation(s)
- Adam D Glener
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, NC
| | - Brad Gandolfi
- Division of Plastic, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, NC
| | - Mihir J Desai
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
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Samanci Y, Karagöz Y, Yaman M, Atçı İB, Emre U, Kılıçkesmez NÖ, Çelik SE. Evaluation of median nerve T2 signal changes in patients with surgically treated carpal tunnel syndrome. Clin Neurol Neurosurg 2016; 150:152-158. [PMID: 27668859 DOI: 10.1016/j.clineuro.2016.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/24/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the accuracy of median nerve T2 evaluation and its relation with Boston Questionnaire (BQ) and nerve conduction studies (NCSs) in pre-operative and post-operative carpal tunnel syndrome (CTS) patients in comparison with healthy volunteers. METHODS Twenty-three CTS patients and 24 healthy volunteers underwent NCSs, median nerve T2 evaluation and self-administered BQ. Pre-operative and 1st year post-operative median nerve T2 values and cross-sectional areas (CSAs) were compared both within pre-operative and post-operative CTS groups, and with healthy volunteers. The relationship between MRI findings and BQ and NCSs was analyzed. The ROC curve analysis was used for determining the accuracy. RESULTS The comparison of pre-operative and post-operative T2 values and CSAs revealed statistically significant improvements in the post-operative patient group (p<0.001 for all parameters). There were positive correlations between T2 values at all levels and BQ values, and positive and negative correlations were also found regarding T2 values and NCS findings in CTS patients. The receiver operating characteristic curve analysis for defined cut-off levels of median nerve T2 values in hands with severe CTS yielded excellent accuracy at all levels. However, this accuracy could not be demonstrated in hands with mild CTS. CONCLUSION This study is the first to analyze T2 values in both pre-operative and post-operative CTS patients. The presence of increased T2 values in CTS patients compared to controls and excellent accuracy in hands with severe CTS indicates T2 signal changes related to CTS pathophysiology and possible utilization of T2 signal evaluation in hands with severe CTS.
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Affiliation(s)
- Yavuz Samanci
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Yeşim Karagöz
- Diagnostic and Interventional Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Burak Atçı
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Emre
- Neurology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nuri Özgür Kılıçkesmez
- Diagnostic and Interventional Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Suat Erol Çelik
- Neurosurgery Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Peters S, Johnston V, Hines S, Ross M, Coppieters M. Prognostic factors for return-to-work following surgery for carpal tunnel syndrome. ACTA ACUST UNITED AC 2016; 14:135-216. [DOI: 10.11124/jbisrir-2016-003099] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Matsuo RP, Fernandes CH, Meirelles LM, Raduan Neto J, dos Santos JBG, Fallopa F. Translation and Cross-Cultural Adaptation of the 6-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale Questionnaire Into Brazilian Portuguese. Hand (N Y) 2016; 11:168-72. [PMID: 27390557 PMCID: PMC4920532 DOI: 10.1177/1558944715627271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are several medical questionnaires to evaluate the quality of life of carpal tunnel syndrome patients. However, most measures are only available in English. We chose to translate and culturally adapt to Portuguese the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire because it provides objective assessment using a small number of questions. METHODS The translation and cultural adaptation were carried out according to the medical literature and consisted of five steps: (1) initial translation by two translators fluent in both languages, (2) association of initial translations, (3) back translation to Portuguese by two native speakers of English, (4) association of back translation and (5) comparison with the original version. RESULTS The Portuguese version was administered to patients with carpal tunnel syndrome and difficulties were noted concerning the comprehension and completion of the translated questionnaire. Patients had difficulty in understanding the horizontal layout of the response choices. Without altering the content, we changed the response choices to a vertical layout and re-administered the questionnaire to a new sample of patients followed up in the same ambulatory care service. We noted a substantial improvement in comprehension and completion of the questionnaire after the modifications. CONCLUSIONS Availability of a Portuguese version of the Six-Item Carpal Tunnel Syndrome Symptoms Scale and Palmar Pain Scale (CTS-6) questionnaire will allow an objective evaluation of the treatment of a syndrome that is very prominent in medical practice.
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Affiliation(s)
- Rodrigo Pires Matsuo
- Hand Surgery Unit, Department of Orthopedic Surgery, Universidade Federal de São Paulo, Brazil
| | - Carlos Henrique Fernandes
- Hand Surgery Unit, Department of Orthopedic Surgery, Universidade Federal de São Paulo, Brazil,Carlos Henrique Fernandes, Hand Surgery Group, Department of Orthopedic Surgery, Universidade Federal de São Paulo, Rua Borges Lagoa 1065, cj 68/69 São Paulo, SP CEP 04038-032, Brazil.
| | - Lia Miyamoto Meirelles
- Hand Surgery Unit, Department of Orthopedic Surgery, Universidade Federal de São Paulo, Brazil
| | - Jorge Raduan Neto
- Hand Surgery Unit, Department of Orthopedic Surgery, Universidade Federal de São Paulo, Brazil
| | | | - Flávio Fallopa
- Hand Surgery Unit, Department of Orthopedic Surgery, Universidade Federal de São Paulo, Brazil
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Fowler JR, Munsch M, Huang Y, Hagberg WC, Imbriglia JE. Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release. J Hand Surg Eur Vol 2016; 41:137-42. [PMID: 25770901 DOI: 10.1177/1753193415576248] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/31/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to determine if nerve conduction studies predict time to resolution of symptoms after carpal tunnel release. A total of 56 patients undergoing open carpal tunnel release were prospectively enrolled. Pre-operative presence of nocturnal symptoms and daytime numbness/tingling were documented. Pre-operative nerve conduction studies were reviewed and classified as mild, moderate, or severe. After open carpal tunnel release, patients were contacted by phone within 48 hours, at 1 week, and then at 2-week intervals for up to 9 months or until both nocturnal and daytime symptoms had resolved. This study found that patients with mild or moderate carpal tunnel syndrome experience a faster time to resolution of daytime numbness and tingling when compared with patients with severe carpal tunnel syndrome. Nocturnal symptoms resolved quickly in both groups. The results of this study are in contrast to previous studies that found little to no value of nerve conduction studies in predicting post-operative functional and subjective outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J R Fowler
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Munsch
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Huang
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - W C Hagberg
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - J E Imbriglia
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
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Barros MFFH, da Rocha Luz Júnior A, Roncaglio B, Queiróz Júnior CP, Tribst MF. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia. Rev Bras Ortop 2016; 51:36-9. [PMID: 26962490 PMCID: PMC4767833 DOI: 10.1016/j.rboe.2015.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 11/17/2022] Open
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.
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Barros MFFH, Luz Júnior ADR, Roncaglio B, Queiróz Júnior CP, Tribst MF. Avaliação do tratamento cirúrgico da síndrome do túnel do carpo com anestesia local. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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English JHJ, Gwynne-Jones DP. Incidence of Carpal Tunnel Syndrome Requiring Surgical Decompression: A 10.5-Year Review of 2,309 Patients. J Hand Surg Am 2015; 40:2427-34. [PMID: 26460063 DOI: 10.1016/j.jhsa.2015.07.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the demographics, neurophysiological grading, and incidence of patients undergoing carpal tunnel decompression (CTD) for carpal tunnel syndrome (CTS) in a single region. METHODS A retrospective review of 2,313 patients aged greater than 16 years who underwent 3,073 CTDs between January 2000 and August 2010. Crude annual and age- and sex-specific incidences were calculated for the study period. Nerve conduction study grades were recorded and compared with age and sex. RESULTS Of the 2,313 patients 1,419 (61%) were female and 890 (39%) were male. Mean age at surgery was 56 years (range, 16-93 years). Females had a significantly higher CTD incidence compared with males (161 vs 108/100,000 person-years, respectively). The highest rates of CTD were seen in the 70- to 79-year age group for both men and women (307/100,000 person-years). Neurophysiological grade increased in severity with increasing age despite using an age-adjusted grading system, with higher grades in patients aged greater than 65 years. CONCLUSIONS This study suggests that carpal tunnel syndrome has the highest incidence in older people who tend to have more severe neurophysiological changes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- John H J English
- Department of Orthopaedic Surgery, Dunedin Hospital, Dunedin, New Zealand.
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Shende VS, Sharma RD, Pawar SM, Waghmare SN. A study of median nerve entrapment neuropathy at wrist in uremic patients. Indian J Nephrol 2015. [PMID: 26199474 PMCID: PMC4495477 DOI: 10.4103/0971-4065.144425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy seen in uremic patients. The study was undertaken to estimate the frequency of CTS in uremic patients and to identify the most sensitive electrodiagnostic test. Study was conducted on 80 subjects of age 30–60 years. End-stage kidney disease patients were recruited for the clinical evaluation, motor nerve conduction studies (NCS), sensory NCS, F wave study and median-versus-ulnar comparison studies (palm-to-wrist mixed comparison study, digit 4 sensory latencies study and lumbrical-interossei comparison study). Among three different diagnostic modalities, frequency of CTS was found to be 17.5% with clinical evaluation, 15% with routine NCS studies and 25% with median-versus-ulnar comparison studies. Among the median-versus-ulnar comparison studies, lumbrical-interossei comparison study was found to be most sensitive (90%). The comparative tests for CTS are more sensitive compared to routine NCS and clinical examination. Among the comparative tests, lumbrical-interossei comparison study is the most sensitive. Early diagnosis of CTS may help patients of uremia to seek proper treatment at an appropriate time.
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Affiliation(s)
- V S Shende
- Department of Physiology, MGIMS, Sevagram, Wardha, Maharashtra, India
| | - R D Sharma
- Department of Physiology, MGIMS, Sevagram, Wardha, Maharashtra, India
| | - S M Pawar
- Department of Physiology, MGIMS, Sevagram, Wardha, Maharashtra, India
| | - S N Waghmare
- Department of Physiology, MGIMS, Sevagram, Wardha, Maharashtra, India
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Kim JH, Gong HS, Kim YH, Rhee SH, Kim J, Baek GH. Evaluation of Radiographic Instability of the Trapeziometacarpal Joint in Women With Carpal Tunnel Syndrome. J Hand Surg Am 2015; 40:1298-302. [PMID: 26050203 DOI: 10.1016/j.jhsa.2015.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether median nerve dysfunction measured by electrophysiologic studies in carpal tunnel syndrome (CTS) is associated with thumb trapeziometacarpal (TMC) joint instability. METHODS We evaluated 71 women with CTS and 31 asymptomatic control women. Patients with generalized laxity or TMC joint osteoarthritis were excluded. We classified the electrophysiologic severity of CTS based on nerve conduction time and amplitude and assessed radiographic instability of the TMC joint based on TMC joint stress radiographs. We compared subluxation ratio between patients with CTS and controls and performed correlation analysis of the relationship between the electrophysiologic grade and subluxation ratio. RESULTS Thirty-one patients were categorized into the mild CTS subgroup and 41 into the severe CTS subgroup. There was no significant difference in subluxation ratio between the control group and CTS patients or between the control group and CTS subgroup patients. Furthermore, there was no significant correlation between electrophysiologic grade and subluxation ratio. CONCLUSIONS This study demonstrated that patients with CTS did not have greater radiographic TMC joint instability compared with controls, and suggests that TMC joint stability is not affected by impaired median nerve function. Further studies could investigate how to better evaluate proprioceptive function of TMC joint and whether other nerves have effects on TMC joint motor/proprioceptive function, to elucidate the relationship between neuromuscular control of the TMC joint, its stability, and its progression to osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Youn Ho Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hwan Rhee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jihyoung Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Frueh F, Palma A, Raptis D, Graf C, Giovanoli P, Calcagni M. Carpal tunnel syndrome: Analysis of online patient information with the EQIP tool. ACTA ACUST UNITED AC 2015; 34:113-21. [DOI: 10.1016/j.main.2015.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 04/19/2015] [Accepted: 04/29/2015] [Indexed: 12/17/2022]
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Yucel H. Factors affecting symptoms and functionality of patients with carpal tunnel syndrome: a retrospective study. J Phys Ther Sci 2015; 27:1097-101. [PMID: 25995565 PMCID: PMC4433986 DOI: 10.1589/jpts.27.1097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/04/2014] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The aim of this retrospective study was to determine the associations between
clinical, physical, and neurophysiological outcomes and self-reported symptoms and
functions of patients after surgical carpal tunnel release. [Subjects and Methods] Among
261 patients who had undergone open surgical carpal tunnel release within the last three
years, 83 (mean age 50.27 ± 11.13 years) participated in this study. Their
socio-demographics and comorbidities were recorded. The intensity of pain, paresthesia,
and fatigue symptoms in the hand were assessed by means of a Visual Analogue Scale, the
Semmes-Weinstein Monofilaments test of light touch pressure sensation, and Jamar
dynamometry for measurement of grip and pinch strengths. The Boston Carpal Tunnel
Questionnaire evaluated the severity of symptoms and hand functional status, and the
variables were analyzed by multivariate linear regression. [Results] The severity of the
symptoms and functional status of release surgery patients was associated with diabetes
mellitus, migraine, night pain, paresthesia and fatigue symptoms, impaired light touch
pressure, and lack of medical treatment. [Conclusion] Appropriate post-surgery treatment
programs for these factors should be taken into consideration to help patients obtain
optimal functionality and health in their daily lives.
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Affiliation(s)
- Hulya Yucel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Turkey
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An Association between Carpal Tunnel Syndrome and Migraine Headaches-National Health Interview Survey, 2010. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e333. [PMID: 25878944 PMCID: PMC4387155 DOI: 10.1097/gox.0000000000000257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 11/13/2014] [Indexed: 12/31/2022]
Abstract
Background: Migraine headaches have not historically been considered a compression neuropathy. Recent studies suggest that some migraines are successfully treated by targeted peripheral nerve decompression. Other compression neuropathies have previously been associated with one another. The goal of this study is to evaluate whether an association exists between migraines and carpal tunnel syndrome (CTS), the most common compression neuropathy. Methods: Data from 25,880 respondents of the cross-sectional 2010 National Health Interview Survey were used to calculate nationally representative prevalence estimates and 95% confidence intervals (95% CIs) of CTS and migraine headaches. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% CI for the degree of association between migraines and CTS after controlling for known demographic and health-related factors. Results: CTS was associated with older age, female gender, obesity, diabetes, and smoking. CTS was less common in Hispanics and Asians. Migraine was associated with younger age, female gender, obesity, diabetes, and current smoking. Migraine was less common in Asians. Migraine prevalence was 34% in those with CTS compared with 16% in those without CTS (aOR, 2.60; 95% CI, 2.16–3.13). CTS prevalence in patients with migraine headache was 8% compared with 3% in those without migraine headache (aOR, 2.67; 95% CI, 2.22–3.22). Conclusions: This study is the first to demonstrate an association between CTS and migraine headache. Longitudinal and genetic studies with physician verification of migraine headaches and CTS are needed to further define this association.
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Abstract
This review discusses key diagnostic points and treatment guidelines for compression neuropathies of the wrist, forearm, and elbow. Recent treatment progress is reviewed, controversies are highlighted, and consensus is summarized. Limited or mini-open releases and endoscopic carpal tunnel releases are considered equally safe and efficient. Both methods are currently mainstays of surgical treatment.
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Miranda GVD, Fernandes CH, Raduan Neto J, Meirelles LM, Santos JBGD, Faloppa F. Corticoid injection as a predictive factor of results of carpal tunnel release. ACTA ORTOPEDICA BRASILEIRA 2015; 23:76-80. [PMID: 26405432 PMCID: PMC4562971 DOI: 10.1590/1413-78522015230200943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/10/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment. Level of Evidence II, Prognostic Study.
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Prospective comparison of the six-item carpal tunnel symptoms scale and portable nerve conduction testing in measuring the outcomes of treatment of carpal tunnel syndrome with steroid injection. Hand (N Y) 2015; 10:49-53. [PMID: 25767421 PMCID: PMC4349851 DOI: 10.1007/s11552-014-9672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We prospectively studied patients clinically diagnosed with carpal tunnel syndrome (CTS) and treated with the injection of corticosteroid into their carpal tunnel in order to compare changes in the six-item CTS symptoms scale and portable nerve conduction study (NCS) parameters as outcome tools. Our pilot study was the first to assess the utility of the six-item CTS symptom scale (CTS-6) with steroid injections as a patient-directed outcome measure for the treatment of CTS. METHODS We enrolled patients who presented to our county hospital orthopedic surgery clinic from August 2012 through August 2013. The patients were clinically diagnosed with CTS. After completing the six-item CTS symptoms scale questionnaire, portable NCS was obtained. Each patient then received an injection of 1 ml of triamcinolone acetonide 40 mg/ml mixed with 1 ml of 1 % lidocaine into the carpal tunnel. Six weeks postinjection, each patient repeated a CTS-6 questionnaire and underwent a repeat portable NCS. The CTS-6 and NCS results were analyzed using the paired samples t test. A Pearson correlation was used to assess the correlation between the changes in the CTS-6 and the NCS measurements. Statistical significance was set at P < 0.05. RESULTS Thirty-two wrists in 20 patients were evaluated. There was a statistically significant difference between the CTS-6 scores before and after injection. There were also statistically significant changes in the five of the NCS parameters. None of the correlations between the CTS-6 and the NCS parameters were statistically significant. CONCLUSIONS The six-item CTS symptoms scale and portable NCS are both useful measures for evaluating the results of steroid injections. The CTS-6 is an effective tool because of its ease of use, low cost, correspondence with changes in NCS, and ability to monitor the outcome of steroid treatment for carpal tunnel syndrome.
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Kanatani T, Nagura I, Kurosaka M, Kokubu T, Sumi M. Electrophysiological assessment of carpal tunnel syndrome in elderly patients: one-year follow-up study. J Hand Surg Am 2014; 39:2188-91. [PMID: 25240431 DOI: 10.1016/j.jhsa.2014.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/09/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To objectively assess elderly patients with carpal tunnel syndrome to characterize their preoperative severity and prognosis after carpal tunnel release using a electrophysiological severity scale. METHODS Electrophysiologic assessment was performed preoperatively and 1 year postoperatively following carpal tunnel release in 112 hands in patients over 70 years of age prospectively by the use of the following electrophysiological severity scale: stage 1, normal distal motor latency (DML) and normal sensory conduction velocity (SCV); stage 2, DML ≥ 4.5 milliseconds and normal SCV; stage 3, DML ≥ 4.5 milliseconds and SCV < 40.0 m/s; stage 4, DML ≥ 4.5 milliseconds and non-measurable SCV; stage 5; non-measurable DML and non-measurable SCV. Additionally, the outcomes of clinical symptoms of pain, nocturnal symptoms, numbness, loss of 2-point discrimination in the median nerve territory, and thenar atrophy were assessed. RESULTS The mean age of patients was 77 years at the time of the operation. Preoperatively, the most common severity was stage 5 (70 of 112 hands, 63%), and clustering stage 4 and 5 together as severe resulted in 103 hands (92%). One year postoperatively, 97 hands (87%) demonstrated at least one stage improvement, and the numbers of mild (stage 1 or 2) increased from 3 (3%) to 45 hands (40%). Parallel with the electrophysiological improvement, pain and nocturnal symptoms resolved in 17 of 17 hands and 11 of 11 hands, respectively, in whom they were present preoperatively. Numbness, loss of 2-point discrimination, and thenar atrophy demonstrated the improvement in 96 of 112 (86%) hands, in 58 of 112 (52%) hands, and in 80 of 96 (83%) hands. CONCLUSIONS We observed electrophysiologic improvement in 86% of elderly patients following carpal tunnel release. Electrophysiologic outcomes correlated with improvement in clinical variables. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Takako Kanatani
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
| | - Issei Nagura
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan
| | - Masatoshi Sumi
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan; Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan
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Mojaddidi MA, Ahmed MS, Ali R, Jeziorska M, Al-Sunni A, Thomsen NOB, Dahlin LB, Malik RA. Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. Diabetologia 2014; 57:1711-9. [PMID: 24865616 DOI: 10.1007/s00125-014-3271-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/22/2014] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS We sought to establish the molecular and pathological changes predisposing diabetic and non-diabetic patients to the development of carpal tunnel syndrome (CTS). METHODS The posterior interosseous nerve (PIN) was biopsied in 25 diabetic and 19 non-diabetic patients undergoing carpal tunnel decompression for CTS. Detailed morphometric and immunohistological analyses were performed in the nerve biopsy. RESULTS In diabetic patients median nerve distal motor latency was prolonged (p < 0.05 vs non-diabetic patients), PIN myelinated fibre density (p < 0.05), fibre area (p < 0.0001) and axon area (p < 0.0001) were reduced, the percentage of unassociated Schwann cell profiles (p < 0.0001) and unmyelinated axon density (p < 0.0001) were increased and the axon diameter was reduced (p < 0.0001). Endoneurial capillary basement membrane area was increased (p < 0.0001) in diabetic patients, but endothelial cell number was increased (p < 0.01) and luminal area was reduced (p < 0.05) in non-diabetic patients with CTS. There was no difference in the expression of hypoxia-inducible factor 1α between diabetic and non-diabetic patients with CTS. However, the expression of vascular endothelial growth factor A (VEGF) (p < 0.05) and its receptors VEGFR-1 (p < 0.01) and VEGFR-2 (p < 0.05) was significantly increased in diabetic patients, particularly those with type 1 diabetes, and related to the severity of nerve fibre pathology. CONCLUSIONS/INTERPRETATION This study demonstrates increased nerve fibre and microvascular pathology in relation to enhanced expression of VEGF and its receptors in a non-compressed nerve in diabetic compared with non-diabetic patients with CTS. It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS.
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Affiliation(s)
- Moaz A Mojaddidi
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, The University of Manchester, AV Hill Building, Oxford Road, Manchester, M13 9PT, UK
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77
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Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am 2014; 39:1403-7. [PMID: 24818965 DOI: 10.1016/j.jhsa.2014.03.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/30/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew D Duckworth
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Fife, United Kingdom; Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
| | - Paul J Jenkins
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Fife, United Kingdom; Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jane E McEachan
- Department of Orthopaedic Surgery, Queen Margaret Hospital, Fife, United Kingdom; Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Claes F, Kasius KM, Meulstee J, Grotenhuis JA, Verhagen WIM. Treatment outcome in carpal tunnel syndrome: does distribution of sensory symptoms matter? J Neurol Sci 2014; 344:143-8. [PMID: 25060420 DOI: 10.1016/j.jns.2014.06.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 06/10/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with complaints of carpal tunnel syndrome (CTS) with signs and symptoms not exclusively confined to the median nerve territory, but otherwise fulfilling the clinical criteria may erroneously be withheld from therapy. METHODS One hundred and twenty one patients who fulfilled the clinical criteria for the diagnosis of CTS with signs and symptoms restricted to the median nerve territory (group A) and 91 patients without this restriction (group B) were included in a prospective cohort study. All patients fulfilled electrodiagnostic criteria of CTS. Outcome was determined after 7 to 9 months by means of Symptom Severity Score (SSS) and Functional Status Score (FSS) according to Levine and a patient satisfaction questionnaire. RESULTS Response rates were 81.8% (group A) and 82.4% (group B). All patients in group B had sensory symptoms involving digit 5. There were no significant differences in improvement of SSS, FSS and patient satisfaction scores between groups after treatment. CONCLUSION CTS patients with characteristic sensory signs and symptoms not exclusively restricted to the median nerve innervated area should be treated in the same manner as patients with CTS symptoms restricted to the median nerve innervated area and should therefore not be withheld from surgical treatment.
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Affiliation(s)
- Franka Claes
- Department of Neurology, Vlietland Hospital, Schiedam, The Netherlands.
| | - Kristel M Kasius
- Department of Neurology, St Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Jan Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J André Grotenhuis
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wim I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Cooney WP. Just Because We Can Cut, Should We? Commentary on an article by Daniel A. Osei, MD, et al.: "Simultaneous Bilateral or Unilateral Carpal Tunnel Release? A Prospective Cohort Study of Early Outcomes and Limitations". J Bone Joint Surg Am 2014; 96:e96. [PMID: 24897753 DOI: 10.2106/jbjs.n.00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- William P Cooney
- Mayo Clinic and Mayo Graduate School of Medicine Rochester, Minnesota
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80
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Zeidman LA, Singh SK, Pandey DK. Higher diagnostic yield with the combined sensory index in mild carpal tunnel syndrome. J Clin Neuromuscul Dis 2014; 15:143-146. [PMID: 24872211 DOI: 10.1097/cnd.0000000000000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The combined sensory index (CSI), a sensitive composite score of 3 median sensory comparison studies, may still be underutilized in diagnosing mild cases of carpal tunnel syndrome (CTS). Our goal was to compare the effectiveness of the "standard" median digit 2 (D2) sensory study to a CSI algorithm in diagnosing mild CTS. METHODS We retrospectively identified patients with typical CTS symptoms and signs. Electrodiagnostically normal patients and those having mild CTS diagnosed by D2 or CSI algorithm were separated into groups. RESULTS Seventy-four patients were included, and 51 (68.9%) were diagnosed with mild CTS. Of the 51, 31 (60.8%) were diagnosed using the CSI algorithm, and 20 (39.2%) were diagnosed using D2 (P < 0.001). CONCLUSIONS Our data suggest that the CSI algorithm is significantly more effective than the D2 to diagnose mild CTS. If mild CTS is diagnosed earlier, treatment can be initiated sooner and morbidity can likely prevented.
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Affiliation(s)
- Lawrence A Zeidman
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL
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81
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Okamura A, Meirelles LM, Fernandes CH, Raduan Neto J, Santos JBGD, Faloppa F. Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique. ACTA ORTOPEDICA BRASILEIRA 2014; 22:29-33. [PMID: 24644417 PMCID: PMC3952868 DOI: 10.1590/s1413-78522014000100005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the postoperative results of patients with carpal tunnel syndrome by the endoscopic release technique with single portal. Methods: 78 patients (80 wrists) were evaluated preoperatively and postoperatively at 1, 3 and 6 months by the Boston questionnaire, the visual analogue scale (VAS) for pain, monofilament test sensitivity, grip strength, lateral pinch, pulp to pulp pinch and tripod pinch. Results: Statistical analysis was significant (p <0.05) in the progressive decline of pain and improved function (Boston) during follow-up. The sensitivity significantly improved comparing the data pre and postoperatively. The grip strength, lateral pinch, pulp to pulp pinch and tripod pinch decreased in the first month after surgery, returning to preoperative values around the third month postoperatively. Conclusion: The technique proved to be safe and effective in improving pain, function, and return sensitivity and strength. Level of Evidence II, Prospective study
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82
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Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-Resolution Magnetic Resonance Neurography in Upper Extremity Neuropathy. Neuroimaging Clin N Am 2014; 24:109-25. [DOI: 10.1016/j.nic.2013.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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83
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Clinical usefulness of oral supplementation with alpha-lipoic Acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:891310. [PMID: 24563654 PMCID: PMC3915925 DOI: 10.1155/2014/891310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 12/29/2022]
Abstract
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.
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Talebi M, Andalib S, Bakhti S, Ayromlou H, Aghili A, Talebi A. Effect of vitamin b6 on clinical symptoms and electrodiagnostic results of patients with carpal tunnel syndrome. Adv Pharm Bull 2013; 3:283-8. [PMID: 24312849 DOI: 10.5681/apb.2013.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Carpal tunnel syndrome (CTS) refers to a cluster of signs and symptoms that stems from compression of the median nerve traveling through carpal tunnel. Surgery is a definite treatment for CTS; however, many conservative therapies have been proposed. The present study set out to assess the effect of vitamin B6 in patients with CTS. METHODS Forty patients (67 hands) with mild-moderate CTS were initially selected and randomly assigned into two groups as follows: 1) Case group with 20 subjects (32 affected hands) receiving vitamin B6 (120 mg/day for 3 months) and splinting. 2) Control group with 19 subjects (35 affected hands) only received splinting. One subject from the control group dispensed with continuing participation in the research. Daily symptoms and electrodiagnostic (NCV-EMG) results were assessed at baseline and after 3 months. RESULTS Nocturnal awakening frequency due to pain, daily pain, daily pain frequency, daily pain persistence, hand numbness, hand weakness, hand tingling, severity of nocturnal numbness and tingling, nocturnal awakening frequency owing to hand numbness and tingling, and clumsiness in handling objects improved significantly in the vitamin B6-treated patients; even so, only problem with opening a jam bottle and handling phone significantly reduced in the control group. The median nerve sensory latency mean decreased following the treatment; and the median nerve sensory amplitude mean and sensory conduction velocity mean increased. CONCLUSION The present study suggests that vitamin B6 treatment improves clinical symptoms and sensory electrodiagnostic results in CTS patients, and thus is recommended for CTS treatment.
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Affiliation(s)
- Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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85
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Esenwein P, Sonderegger J, Gruenert J, Ellenrieder B, Tawfik J, Jakubietz M. Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 2013; 133:1155-62. [PMID: 23660964 DOI: 10.1007/s00402-013-1766-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Palmar plate fixation of unstable distal radial fractures is quickly becoming the standard treatment for this common injury. The literature reporting complications consists mainly of isolated case reports or small case series. METHOD Between February 2004 and December 2009 palmar plate fixation was performed in 665 cases. The overall complication rate was 11.3 % (75 complications). Revision surgery was necessary in 10 % (65 procedures). RESULTS The reasons for revision surgery were: postoperative median nerve compression (22 patients) and secondary dislocation (9 patients). An ulna shortening osteotomy for ulnar impingement syndrome was necessary in eight cases. Intraarticular screw placement occurred in three patients. There were two flexor pollicis longus, one finger flexor and three extensor pollicis longus tendon ruptures. Posttraumatic compartment syndrome of the forearm requiring fasciotomy occurred in four cases. There were three cases of infection. Nonoperative treatment was necessary in nine patients, who developed a complex regional pain syndrome. Hardware failure occurred in three cases. Hardware removal was performed in 232 (34 %) cases. CONCLUSION Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.
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Affiliation(s)
- P Esenwein
- Department of Hand, Plastic and Reconstructive Surgery, Cantonal Hospital, 9007, St. Gallen, Switzerland.
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86
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Gancarczyk SM, Strauch RJ. Carpal tunnel syndrome and trigger digit: common diagnoses that occur "hand in hand". J Hand Surg Am 2013; 38:1635-7. [PMID: 23849736 DOI: 10.1016/j.jhsa.2013.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/20/2013] [Accepted: 04/21/2013] [Indexed: 02/08/2023]
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87
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Delayed electrophysiological recovery after carpal tunnel release for advanced carpal tunnel syndrome: a two-year follow-up study. J Clin Neurophysiol 2013; 30:95-7. [PMID: 23377449 DOI: 10.1097/wnp.0b013e31827ed839] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Advanced carpal tunnel syndrome presents severe thenar atrophy with the absence of electrophysiological motor and sensory responses. Because of severity of these conditions, a substantial period of recovery after surgery is required before improvement becomes evident. In this electrophysiological-based study, the reappearance of distal motor latency (DML) at the abductor pollicis brevis and/or sensory nerve conduction velocity (SCV) after wrist stimulation were evaluated 1 year and 2 years after carpal tunnel release . To categorize outcomes, the following grading scale was used: stage I, normal DML and SCV; stage II, DML ≥ 4.5 ms and normal SCV; stage III, DML ≥ 4.5 ms and SCV < 40.0 ms; stage IV, DML ≥ 4.5 ms and nonmeasurable SCV; stage V: nonmeasurable DML and SCV. The authors found measurable DML and/or SCV and significant improvement both 1 year and 2 years postoperatively. Furthermore, the percentage of patients who recovered to the extent that they presented as mild carpal tunnel syndrome (stage I or II) increased significantly. They conclude that electrophysiological assessment of DML and SCV of advanced carpal tunnel syndrome using the above grading scale was effective as an objective evaluation tool of recovery after carpal tunnel release.
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88
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Berger M, Vermeulen M, Koelman JHTM, van Schaik IN, Roos YBWEM. The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated? J Hand Surg Eur Vol 2013; 38:634-9. [PMID: 23221180 DOI: 10.1177/1753193412469580] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this prospective study was to investigate the long-term effect of one or more local corticosteroid injections in patients with carpal tunnel syndrome and whether a good response can be predicted. Follow-up visits took place at 3 weeks, 6 months, and 1 year after the first corticosteroid injection. Thirty of the 120 patients (25%) had a good outcome with a single injection, 11 additional patients (9%) needed a second injection, and five patients (4%) needed a third injection to reach a good outcome after 1 year. Of patients with an initial good treatment response, 28 (52%) had a good outcome after 1 year compared with 18 (27 %) who had an initially moderate or no response to treatment. One-third of patients with carpal tunnel syndrome had a long-term beneficial effect from corticosteroid injection, especially when they had a good initial response.
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Affiliation(s)
- M Berger
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
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89
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Abstract
This study evaluates the diagnostic value of ultrasound as a first-line exam in carpal tunnel syndrome. In 16 patients with carpal tunnel syndrome and 32 matched controls, evaluation of the median nerve was performed by the cross-sectional area at wrist level and wrist-forearm ratio. This study found statistically significant differences between patients and controls by both methods, and both showed high specificity and positive predictive values. Optimal cut-off values were identified at a 14 mm(2) cross-sectional area and a 1.6 wrist-forearm ratio. This study implies that ultrasound evaluation of the median nerve is a valuable tool as a first-line diagnostic test used by the surgeon for examination of patients with presumed carpal tunnel syndrome. Owing to the high positive predictive value of ultrasound, the need for referral to nerve conduction study may be limited.
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Affiliation(s)
- J Lange
- Orthopaedic Research Unit - Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
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90
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Bartels RHMA, Boogaarts H, Westert G. Incorporation of the experience of patients in the development of a patient-reported outcome measures (PROM) for carpal tunnel syndrome. Acta Neurochir (Wien) 2013; 155:1057-67. [PMID: 23605258 DOI: 10.1007/s00701-013-1708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/27/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Regularly, patients are not involved in development of evaluative tools. Investigators define outcomes according to their interests. These can be different with those of the patients. Therefore, it may be difficult for patients to choose between treatment options, because the outcomes' measurements may not reflect their problems in daily life. Most ideally, patients are involved from the beginning in the development of an outcome measurement tool. In this study, a new concept was demonstrated in which a questionnaire was developed in collaboration with patients to evaluate the quality of surgical care of a frequently encountered entity (carpal tunnel syndrome) that is meaningful for and understandable by patients. METHODS Through a patient participatory research in an academic hospital, 50 consecutive patients who recently underwent surgical decompression of carpal tunnel syndrome were asked to optimize a questionnaire. An existing questionnaire was sent to the patients with the request to grade the relevance of each question. They were also offered the possibility to add questions from their point of view. RESULTS All questions were found relevant. Finally, the questionnaire was modified by adding one question proposed by the patients. They wanted to include a question that would evaluate the effect of the treatment. Therefore, a question was introduced to evaluate the effect of the surgery on the symptoms and signs with a six-item Likert scale varying from severely worsened to free of signs and symptoms. Finally, the EQ-5D-5 L was added as a measure of quality of life. CONCLUSIONS The participation of patients is essential but until now not usual when a tool for evaluating the success of a treatment is developed. Information that is meaningful for patients but not obligate for researchers can easily be missed in the classical development of outcome measurement tools. This information will be crucial when future patients try to understand the findings of research in order to make an appropriate decision between eventual treatment options.
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Affiliation(s)
- Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein- Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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91
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Faour-Martín O, Martín-Ferrero MÁ, Vega Castrillo A, Almaraz-Gómez A, Valverde-García JA, Amigo Liñares L, Red-Gallego MÁDL. Long-term effects of preserving or splitting the carpal ligament in carpal tunnel operation. J Plast Surg Hand Surg 2013; 47:263-7. [PMID: 23547536 DOI: 10.3109/2000656x.2012.755928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Carpal tunnel syndrome is treated very successfully by surgical release of the flexor retinaculum. However, in some patients, all symptoms are not resolved. Weakness in grip strength and pain in the thenar and hypothenar areas corresponding to the end of the transverse ligament after its complete section have been described as common complications of classical neurolysis of the median nerve. This study presents here the long-term results of decompression operation of the median nerve at the wrist, conserving the transverse ligament, as well as its comparison with the classical open neurolysis with a complete section of the ligament. This is an analysis of a retrospective cohort of 114 patients, who were operated on for carpal tunnel syndrome. A clinical, electromyographic, and dynamometric evaluation of the patients studied was carried out in a comparative analysis of the surgical techniques used (flexor retinaculum lengthening according to the Simonetta technique and classical open neurolysis of the median nerve), in a period of 10 years after the operation. The ligamentoplasty technique, in the long-term, contributes to better results of manual force, with a smaller resolution of tingling sensations than the neurolysis with complete section of the transverse ligament. For those patients who do not present a severe clinical or electromyographic syndrome, and in addition require manual effort for their daily activities, the technique of ligamentoplasty, according to Simonetta, is a surgical option to be taken into account.
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92
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Emre Durakoğlugil M, Çiçek Y, Altan Kocaman S, Sabri Balik M, Kirbaş S, Çetin M, Erdoğan T, Çanga A. Increased pulse wave velocity and carotid intima-media thickness in patients with carpal tunnel syndrome. Muscle Nerve 2013; 47:872-7. [PMID: 23519786 DOI: 10.1002/mus.23672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Murtaza Emre Durakoğlugil
- Faculty of Medicine; Department of Cardiology; Rize University; Islampaşa Mahallesi 53100 Rize Turkey
| | - Yüksel Çiçek
- Faculty of Medicine; Department of Cardiology; Rize University; Islampaşa Mahallesi 53100 Rize Turkey
| | | | - Mehmet Sabri Balik
- Department of Orthopedics and Traumatology; Faculty of Medicine; Rize University; Rize Turkey
| | - Serkan Kirbaş
- Faculty of Medicine; Department of Neurology; Rize University; Rize Turkey
| | - Mustafa Çetin
- Department of Cardiology; Rize Education and Research Hospital; Rize Turkey
| | - Turan Erdoğan
- Faculty of Medicine; Department of Cardiology; Rize University; Islampaşa Mahallesi 53100 Rize Turkey
| | - Aytun Çanga
- Department of Cardiology; Rize Education and Research Hospital; Rize Turkey
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93
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[Neurolysis of the median nerve in the elderly: a long term evaluation]. Rev Esp Geriatr Gerontol 2012; 48:65-8. [PMID: 23141625 DOI: 10.1016/j.regg.2012.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/08/2012] [Accepted: 03/24/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE Carpal tunnel release by opening the flexor retinaculum is considered a satisfactory treatment. However, several factors, like ageing, may influence postoperative results. We present the long term outcomes in elderly patients. METHODS This is an historical prospective long term study of 52 patients who received surgical treatment of carpal tunnel syndrome when they were 65 or older. We have carried out a clinical-functional (with the Levine questionnaire), electromyographic and dynamometric valuation of the patients studied, up to ten years from the surgery. RESULTS The results of Levine's questionnaire, revealed favourable data for a mean follow-up of 10.35 years, with a mean improvement in the clinical score of 1.93 points (95% confidence interval [CI]: 1.72-2.17) and in the functional score of 0.83 points (95% CI: 0.68-0.99). Similarly, the electromyographic values showed a significant improvement compared to preoperative ones (mean difference of sensory velocity of 8.43m/s, 95% CI: 8.17-11.63; mean difference of motor latency of 1.65ms, 95% CI: 1.24-2.25). The data on grip strength did not reach statistical significance. CONCLUSIONS In elderly patients, complete section of the carpal transverse ligament, allows maintaining favourable differences in most of the parameters studied, ten years after surgery, making the surgical treatment a recommendable option.
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94
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Abstract
Carpal tunnel syndrome is a very common hand condition, which after a failure of conservative treatment can be treated successfully with surgical decompression in either an open or endoscopic manner. On comparing the two techniques there may be some subtle differences; however, both can provide an excellent outcome. This article provides a detailed review of each technique as well as their comparative differences in terms of technique, outcomes, and complications.
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95
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Bonfiglioli R, Botter A, Calabrese M, Mussoni P, Violante FS, Merletti R. Surface electromyography features in manual workers affected by carpal tunnel syndrome. Muscle Nerve 2012; 45:873-82. [PMID: 22581542 DOI: 10.1002/mus.23258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Alterations in surface electromyographic (sEMG) signals of the abductor pollicis brevis muscle were evaluated in 24 non-manual workers and 40 manual workers (25 asymptomatic and 15 reporting CTS symptoms). METHODS The initial value (IV) and the normalized rate of change (NRC) of average rectified value (ARV), mean frequency of the power spectrum (MNF), and muscle fiber conduction velocity (MFCV) were calculated during contractions at 20% and 50% of maximal voluntary contraction (MVC). Neuromuscular efficiency (NME) and kurtosis of the sEMG amplitude distribution were estimated. RESULTS With respect to controls, manual workers showed higher NME, lower ARV IV, and reduced myoelectric manifestations of fatigue (lower MNF NRC for both contraction levels, and lower MFCV NRC at 50% MVC). Kurtosis at 20% MVC showed higher values in symptomatic manual workers than in the other two groups. CONCLUSIONS Kurtosis seems to be a promising parameter for use in monitoring individuals who develop CTS.
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Affiliation(s)
- Roberta Bonfiglioli
- Department of Internal Medicine, Geriatrics, and Nephrology, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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96
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Vanti C, Bonfiglioli R, Calabrese M, Marinelli F, Violante FS, Pillastrini P. Relationship Between Interpretation and Accuracy of the Upper Limb Neurodynamic Test 1 in Carpal Tunnel Syndrome. J Manipulative Physiol Ther 2012; 35:54-63. [DOI: 10.1016/j.jmpt.2011.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/21/2011] [Accepted: 08/17/2011] [Indexed: 10/15/2022]
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97
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Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ, Carrino JA, Chhabra A. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 2012; 41:15-31. [PMID: 21479520 PMCID: PMC3158963 DOI: 10.1007/s00256-011-1143-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 02/02/2023]
Abstract
Peripheral nerves often traverse confined fibro-osseous and fibro-muscular tunnels in the extremities, where they are particularly vulnerable to entrapment and compressive neuropathy. This gives rise to various tunnel syndromes, characterized by distinct patterns of muscular weakness and sensory deficits. This article focuses on several upper and lower extremity tunnels, in which direct visualization of the normal and abnormal nerve in question is possible with high resolution 3T MR neurography (MRN). MRN can also serve as a useful adjunct to clinical and electrophysiologic exams by discriminating adhesive lesions (perineural scar) from compressive lesions (such as tumor, ganglion, hypertrophic callous, or anomalous muscles) responsible for symptoms, thereby guiding appropriate treatment.
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Affiliation(s)
- Ty K Subhawong
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 N. Caroline Street, Room 4214, Baltimore, MD 21287, USA.
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98
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Chochole M. Die Hand im Alter. MANUELLE MEDIZIN 2011. [DOI: 10.1007/s00337-011-0879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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99
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Hartmann P, Mohokum M, Schlattmann P. The association of Raynaud’s syndrome with carpal tunnel syndrome: a meta-analysis. Rheumatol Int 2011; 32:569-74. [DOI: 10.1007/s00296-011-2122-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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100
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Tseng CH, Liao CC, Kuo CM, Sung FC, Hsieh DPH, Tsai CH. Medical and non-medical correlates of carpal tunnel syndrome in a Taiwan cohort of one million. Eur J Neurol 2011; 19:91-7. [PMID: 21631646 DOI: 10.1111/j.1468-1331.2011.03440.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), with unclear etiology, is the most common entrapment neuropathy. Its occurrence is related to lots of medical and non-medical conditions with uncertain causality. With a large population, we characterized selected demographical and clinical factors to add more information on CTS-correlated factors and new insight into future CTS prevention. METHODS A national insurance claim dataset of one million enrollees in Taiwan was used to identify 15 802 patients with CTS and 31 604 randomly selected controls, during a period of 7 years starting 1 January 2000. Statistical association with CTS was determined for five sociodemographic and nine medical factors. RESULTS Patients were predominantly women (65.6% vs. 47.7% in the control group) and older (40 and above, 62.6% vs. 36.2%). Rheumatoid arthritis was found to be the most significant comorbidity associated with CTS, followed by gout, hypertension, diabetes, obesity, uremia, and acromegaly. For younger group age ≤39, the association of these comorbidities was stronger, and hypothyroidism and vitamin B(6) deficiency were additional comorbidities. Aging appears to reduce the relative impact of the diseases commonly associated with CTS as the possible risk factors. CONCLUSIONS Identification of the CTS correlates in younger group would be of greater value in timely detection and treatment for these diseases. Correcting these disorders may aid in removing possible causes of CTS. This is the first report on the effect of aging on probable CTS risk factors. How factors associated with aging contribute to the development of CTS remains to be determined.
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Affiliation(s)
- C-H Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
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