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Affiliation(s)
- Inge Petter Kleggetveit
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital-Rikshospitalet, P.b. 4950 Nydalen, 0424 Oslo, Norway
| | - Ellen Jørum
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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102
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Izadi S, Kardeh B, Hooshiar SSH, Neydavoodi M, Borhani-Haghighi A. Correlation of clinical grading, physical tests and nerve conduction study in carpal tunnel syndrome. Scand J Pain 2018; 18:345-350. [PMID: 29794262 DOI: 10.1515/sjpain-2017-0164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022]
Abstract
Background and aims Carpal tunnel syndrome (CTS) is a common debilitating condition. As the reliability of CTS-specific physical tests and its clinical grading remain a matter of debate, we determined the correlations between these assessments with nerve conduction study (NCS). Methods In this cross-sectional study, patients with uni or bilateral CTS, which was confirmed in electrodiagnosis, were enrolled. Clinical grading was based on the modified criteria of the Italian CTS Study Group. Numeric Pain Rating Scale (NPRS) and Boston Questionnaire (BQ) were used. Physical tests [Phalen's, reverse Phalen's, Tinel's and manual carpal compression test (mCCT)] were performed by a single blinded neurologist. A p-value<0.05 was considered statistically significant. Results A total of 100 patients (age=47.48±11.44 years; 85% female) with 181 involved hands were studied. The majority of hands (59.7%) were classified as grade 2 of clinical grading. On NCS, hands with mild (64%), moderate (27%) and severe (9%) CTS were identified. Sensory (velocity, latency and amplitude) and motor parameters (latency and amplitude) were significantly correlated with clinical grades (p-value<0.001). The correlation of NPRS (p-value=0.009) and BQ (p-value<0.001) scores with NCS was significant. None of the physical tests were significantly correlated with NCS in terms of result or duration (p-value>0.05). Conclusions We found that physical tests are not a reliable screening method for evaluation of CTS severity. However, the BQ and clinical grading can be more valuable due to their significant correlation with NCS. Implications Physicians might benefit from employing clinical grading and BQ in practice for better assessment of CTS severity.
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Affiliation(s)
- Sadegh Izadi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neurology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahareh Kardeh
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seied Saeed Hosini Hooshiar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neurology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Neydavoodi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Neurology, Medical School, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran, Phone/Fax: +98-711-627-2287
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103
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Coraci D, Giovannini S, Loreti C, Pecchioli C, Piccinini G, Padua L. The past encounters the future: "old" diagnostic methods to check innovative treatments for carpal tunnel syndrome. Comment on: "Treatment of carpal tunnel syndrome: from ultrasonography to ultrasound surgery" by Petrover and Richette. Joint Bone Spine 2017 https://doi.org/10.1016/j.jbspin.2017.11.003. Joint Bone Spine 2018; 85:783-784. [PMID: 30053611 DOI: 10.1016/j.jbspin.2018.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Silvia Giovannini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | | | - Giulia Piccinini
- IRCCS Fondazione Don Carlo Gnocchi, 20121 Milan, Italy; Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, 00180 Rome, Italy
| | - Luca Padua
- IRCCS Fondazione Don Carlo Gnocchi, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
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104
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Motomiya M, Funakoshi T, Ishizaka K, Nishida M, Matsui Y, Iwasaki N. Blood Flow Changes in Subsynovial Connective Tissue on Contrast-Enhanced Ultrasonography in Patients With Carpal Tunnel Syndrome Before and After Surgical Decompression. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1597-1604. [PMID: 29171083 DOI: 10.1002/jum.14500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/20/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Although qualitative alteration of the subsynovial connective tissue in the carpal tunnel is considered to be one of the most important factors in the pathophysiologic mechanisms of carpal tunnel syndrome (CTS), little information is available about the microcirculation in the subsynovial connective tissue in patients with CTS. The aims of this study were to use contrast-enhanced ultrasonography (US) to evaluate blood flow in the subsynovial connective tissue proximal to the carpal tunnel in patients with CTS before and after carpal tunnel release. METHODS The study included 15 volunteers and 12 patients with CTS. The blood flow in the subsynovial connective tissue and the median nerve was evaluated preoperatively and at 1, 2, and 3 months postoperatively using contrast-enhanced US. RESULTS The blood flow in the subsynovial connective tissue was higher in the patients with CTS than in the volunteers. In the patients with CTS, there was a significant correlation between the blood flow in the subsynovial connective tissue and the median nerve (P = .01). The blood flow in both the subsynovial connective tissue and the median nerve increased markedly after carpal tunnel release. CONCLUSIONS Our results suggest that increased blood flow in the subsynovial connective tissue may play a role in the alteration of the microcirculation within the median nerve related to the pathophysiologic mechanisms of CTS. The increase in the blood flow in the subsynovial connective tissue during the early postoperative period may contribute to the changes in intraneural circulation, and these changes may lead to neural recovery.
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Affiliation(s)
- Makoto Motomiya
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Orthopedic Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Tadanao Funakoshi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiologic Technology, Hokkaido University Hospital, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine , Hokkaido University Hospital, Sapporo, Japan
| | - Yuichiro Matsui
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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105
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Carpal tunnel syndrome treatment with palmitoylethanolamide: neurophysiology and ultrasound show small changes in the median nerve. Rheumatol Int 2018; 38:1307-1309. [DOI: 10.1007/s00296-018-4064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022]
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106
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Nehete SR, Raut BB, Hiremath AS, Thatte RM. A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery. Indian J Plast Surg 2018; 50:260-265. [PMID: 29618860 PMCID: PMC5868104 DOI: 10.4103/ijps.ijps_41_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery. Patients and Methods A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively. Results Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05). Conclusions Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.
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Affiliation(s)
- Sushil Ramesh Nehete
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Binita B Raut
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Amita S Hiremath
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - R Mukund Thatte
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
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107
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Sonoo M, Menkes DL, Bland JD, Burke D. Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value? Clin Neurophysiol Pract 2018; 3:78-88. [PMID: 30215013 PMCID: PMC6133914 DOI: 10.1016/j.cnp.2018.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/28/2018] [Accepted: 02/03/2018] [Indexed: 12/31/2022] Open
Abstract
This paper summarises the views of four experts on the place of neurophysiological testing (EDX) in patients presenting with possible carpal tunnel syndrome, in guiding their treatment, and in reevaluations. This is not meant to be a position paper or a literature review, and heterogeneous viewpoints are presented. Nerve conduction studies should be performed in patients presenting with possible carpal tunnel syndrome to assist diagnosis, and may need to be repeated at intervals in those managed conservatively. There is evidence that local corticosteroid injection is safe and effective for many patients, thereby avoiding or deferring surgical decompression. All patients should undergo EDX studies before any invasive procedure for CTS (injection or surgery). Needle EMG studies are not obligatory, but may be needed in those with severe disease and those in whom an alternate or concomitant diagnosis is suspected.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 1738605, Japan
| | - Daniel L. Menkes
- Department of Neurology, Beaumont Health, Beaumont Neuroscience Building, Royal Oak, MI 48073, United States
| | - Jeremy D.P. Bland
- East Kent Hospitals University NHS Foundation Trust, Ethelbert Road, Canterbury, Kent, UK
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
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108
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Ažman D, Hrabač P, Demarin V. Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:879-889. [PMID: 28960430 DOI: 10.1002/jum.14417] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasonography (US) of the median nerve has been increasingly studied and used for confirmation of carpal tunnel syndrome (CTS). However, a consensus on the choice of parameters to be evaluated is still not established. The aim of this diagnostic accuracy study was to assess the diagnostic value of multiple parameters individually, as well as in different combinations of variable complexity, and to find an optimal approach for US-based confirmation of a CTS diagnosis. METHODS All participants completed clinical and electrophysiologic evaluations, and their hands were scanned with a 5-13-MHz linear US transducer. Eighty-six patients with CTS (135 symptomatic hands) and 50 control participants (93 asymptomatic hands) were analyzed. The median nerve was recorded transversely at the forearm, at the carpal tunnel inlet, in the mid tunnel, and at the carpal tunnel outlet. For determining the parameters' diagnostic value, sensitivities, specificities, and area under the curve (AUC) values were calculated. RESULTS The inlet cross-sectional area, inlet circumference, and outlet cross-sectional area of the median nerve had the highest AUCs (0.962, 0.920, and 0.913, respectively), sensitivities (87.4%, 80.0%, and 74.1%), and specificities (94.6%, 91.4%, and 92.5%) among single-measurement parameters. An analysis of 2-level parameters (wrist-to-forearm-ratio, inlet-to-outlet-ratio, outlet-to-forearm-ratio, and inlet-outlet mean) yielded the highest AUC (0.974) for the mean cross-sectional area of the median nerve [(inlet + outlet cross-sectional area)/2], with high sensitivity (93.5%) and specificity (91.1%). A compound regression-based index yielded a marginally higher AUC (0.989) than the previously mentioned parameters. CONCLUSIONS Results of the study show that the mean cross-sectional area and inlet cross-sectional area may be valid and easy-to-acquire parameters for routine clinical use in confirming CTS.
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Affiliation(s)
- Dražen Ažman
- Department of Neurology, Dr J. Benčević General Hospital, Medical School of University of Osijek Education Base, Slavonski Brod, Croatia
| | - Pero Hrabač
- Department of Croatian Institute for Brain Research, Medical School of University of Zagreb, Zagreb, Croatia
| | - Vida Demarin
- Department of International Institute for Brain Health, Medical School of University of Zagreb, Zagreb, Croatia
- Department of Croatian Academy of Sciences and Arts, Medical School of University of Zagreb, Zagreb, Croatia
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109
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Cingoz M, Kandemirli SG, Alis DC, Samanci C, Kandemirli GC, Adatepe NU. Evaluation of median nerve by shear wave elastography and diffusion tensor imaging in carpal tunnel syndrome. Eur J Radiol 2018; 101:59-64. [PMID: 29571802 DOI: 10.1016/j.ejrad.2018.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of the current study is to investigate the diagnostic role of shear-wave elastography and diffusion tensor imaging in patients with carpal tunnel syndrome. MATERIAL AND METHODS The study included a total of 77 wrists; 18 normal, 35 wrists with mild, 9 wrists with moderate and 15 wrists with severe carpal tunnel syndrome. Elastography of the median nerve was performed by defining the boundaries of a segment of the nerve at sagittal plane at the level of proximal carpal row. Additionally, the cross-sectional area of the median nerve was evaluated. Fractional anisotropy and apparent diffusion coefficient measurements were carried out by placing region-of-interest at three levels: at pisiform bone (carpal tunnel inlet), mid carpal tunnel, and hook of hamate (carpal tunnel outlet). RESULTS Patients with carpal tunnel syndrome had higher elasticity values of median nerve (53.0 kPa; IQR 40.8-77.0 kPa) compared to control subjects. (36.8 kPa; IQR 31.0-39.9 kPa) Patients with moderate-severe carpal tunnel syndrome had higher elasticity values (82 kPa; IQR 64.0-95.5 kPa) compared to patients with mild carpal tunnel syndrome. (44 kPa; IQR 32.5-59.5 kPa) Patients with carpal tunnel syndrome had lower fractional anisotropy at mid-carpal level (0.382; IQR 0.330-0.495) compared to the control group. (0.494; IQR 0.434-0.537) Patients with moderate-severe carpal tunnel syndrome had lower fractional anisotropy values (0.366; IQR 0.331-0.407) and higher apparent diffusion coefficient values (1.509 mm2/s; IQR 1.374-1.733 mm2/s) compared to patients with mild carpal tunnel syndrome. (0,423; IQR 0.324-0.526 and 1.293 mm2/s; IQR 0.967-1.514 mm2/s) CONCLUSION: Shear-wave elastography and diffusion tensor imaging are helpful imaging modalities in diagnosing carpal tunnel syndrome and assessing its severity.
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Affiliation(s)
- Mehmet Cingoz
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Turkey
| | | | - Deniz Can Alis
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Turkey
| | - Cesur Samanci
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Turkey
| | - Guzin Cakir Kandemirli
- Taksim Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Turkey
| | - Nurten Uzun Adatepe
- Istanbul University, Cerrahpasa Medical Faculty, Department of Neurology, Turkey
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Trachani E, Rigopoulou A, Veltsista D, Gavanozi E, Chrysanthopoulou A, Chroni E. Occurrence of bifid median nerve in healthy and carpal tunnel syndrome patients. J Electromyogr Kinesiol 2018; 39:77-80. [PMID: 29413456 DOI: 10.1016/j.jelekin.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022] Open
Abstract
We investigated the possible association between median nerve morphology and carpal tunnel size, hand side and nerve conduction measurements. The study included a patient group (n = 58; 44 women) with idiopathic carpal tunnel syndrome (CTS) in 100 hands and a control group of healthy volunteers (n = 56, 112 hands; 44 women). The following data were recorded: (1) median and ulnar motor and sensory nerve conduction parameters (2) ultrasonographic dimensions of the carpal tunnel inlet area (CTAin) and inlet area of the median nerve. The prevalence of bifid median nerve was 19% in the CTS hands and 13.3% in the control group. Bilateral bifid nerve was detected in 7 subjects and unilateral in 23, with no side or sex preponderance. The median nerve area was larger in the participants with single than those with bifid median nerve. No correlation was found between CTAin and median nerve area for single or bifid nerves in controls or patients. It was concluded that bifid median nerve was not a rare variation. We could not, however, support its etiological relation to CTS. Ultrasonographic examination of the carpal tunnel region supplementing neurophysiology provided a reliable means to detect median nerve size and morphology. CLINICAL TRIAL REGISTRATION NUMBER 84; 5/3/15.
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Affiliation(s)
- Eftychia Trachani
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Aspasia Rigopoulou
- Department of Radiology, School of Medicine, University of Patras, Patras, Greece
| | - Dimitra Veltsista
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Evangelia Gavanozi
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | | | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece.
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Sartorio F, Vercelli S, Bravini E, Zanetta A, Bargeri S, Pisano F, Ferriero G. Assessment of dexterity and diagnostic accuracy of the Functional Dexterity Test in patients with carpal tunnel syndrome. LA MEDICINA DEL LAVORO 2018; 109:31-39. [PMID: 29405175 PMCID: PMC7682158 DOI: 10.23749/mdl.v109i1.6036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The diagnosis of carpal tunnel syndrome (STC) is centered on the symptoms. However, patients also show an impairment of sensorimotor functions, but the relationship between STC and manual dexterity has never been investigated. OBJECTIVES To analyze the correlation between manual dexterity and severity of the STC. Another objective was the diagnostic accuracy of the clinical battery including provocative tests (Phalen, Tinel) and Functional Dexterity Test (FDT). METHODS A sample of 80 subjects with suspected STC was subdivided into 4 groups based on EMG (severe/extreme-GrA, moderate-GrB, mild/minimal-GrC, negative-GrD) and evaluated in blind by Phalen, Tinel and FDT. The relationship between the FDT and the allocation of subjects was investigated by Spearman's rho, while the groups were compared with univariate ANOVA and Tukey's post hoc analysis. Diagnostic accuracy of the clinical battery was expressed by sensitivity, specificity, and likelihood ratios (LR). RESULTS A moderate (r=0.48, p minor of 0.001) correlation was found between FDT and the 4 groups. ANOVA has returned a significant difference between GrA vs. all others and between GrB vs. GrD. The battery showed a sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of 70%, 94%, 11.98 and 0.31 respectively. CONCLUSIONS The results of this study supported the hypothesis that STC patients also have a dexterity impairment. The FDT was able to discriminate between three levels of severity (negative, mild to moderate, severe to extreme), maintaining a good level of diagnostic accuracy in addition to provocative tests.
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112
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Arslan H, Yavuz A, İlgen F, Aycan A, Ozgokce M, Akdeniz H, Batur A. The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome. J Med Ultrason (2001) 2018; 45:453-459. [PMID: 29330689 DOI: 10.1007/s10396-017-0857-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/07/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS). METHODS Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n = 21), (II) mild (n = 39), (III) moderate (n = 38), and (IV) severe (n = 19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups. RESULTS Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic "idiopathic CTS" patients (48 women, 2 men; mean age 45.9 years, range 23-73 years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P < 0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P < 0.001). A 3.250 m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively. CONCLUSION The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.
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Affiliation(s)
- Harun Arslan
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey.
| | - Alpaslan Yavuz
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Ferda İlgen
- Department of Neurology, Van Training and Research Hospital, Van, Turkey
| | - Abdurrahman Aycan
- Department of Neurosurgery, Medical Faculty, Van Yuzuncu Yil University, Van, Turkey
| | - Mesut Ozgokce
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Hüseyin Akdeniz
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
| | - Abdussamet Batur
- Department of Radiology, Medical Faculty, Van Yuzuncu Yil University, 65100, Van, Turkey
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113
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Triki L, Zouari HG, Kammoun R, Kammoun F, Kammoun I, Masmoudi K, Lefaucheur JP. A reappraisal of small- and large-fiber damage in carpal tunnel syndrome: New insights into the value of the EMLA test for improving diagnostic sensitivity. Neurophysiol Clin 2017; 47:427-436. [DOI: 10.1016/j.neucli.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
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114
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Jemaa SB, Zouari HG, Sakka S, Kammoun I, Masmoudi. K. Physiopathologie des paresthésies extramédiannes lors du syndrome du canal carpien. Neurophysiol Clin 2017. [DOI: 10.1016/j.neucli.2017.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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115
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Hupalo M, Smigielski J, Fortuniak J, Jaskolski DJ. Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies. Clin Neurophysiol 2017; 129:327-332. [PMID: 29183658 DOI: 10.1016/j.clinph.2017.10.034] [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] [Received: 06/29/2017] [Revised: 10/02/2017] [Accepted: 10/22/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Evaluation of the diagnostic utility of the oxyneurography (ONG) in diagnosing carpal tunnel syndrome (CTS). METHODS ONG examination of the median nerve was performed in 260 patients. The results were compared with nerve conduction studies and clinical provocative tests. RESULTS ONG index greater than or equal to 62% was found in 95.18% of the patients with no or minimal Nerve Conduction Study (NCS) changes (1-2 according to the Padua classification) but only in 1.69% of the patients with advanced NCS changes (Padua 3-6). The sensitivity and specificity of the ONG study i.e. 95.18% and 98.31%, respectively, were compared with standard clinical tests: Tinel sign (61.45% and 14.69%), Phalen test (34.94% and 45.20%), reverse Phalen test (81.93% and 34.46%) and carpal compression test (91.57% and 72.32%). CONCLUSIONS ONG index lower than 62% was indicative of CTS. ONG has higher sensitivity and specificity then other clinical tests and it is an accurate and reliable method for the diagnosis of CTS. SIGNIFICANCE Oxyneurography is a non-invasive, fast and safe study which may play role in the diagnosis of carpal tunnel syndrome.
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Affiliation(s)
- Marlena Hupalo
- Department of Neurosurgery and Oncology of Central Nervous System, Barlicki University Hospital, Medical University of Lodz, Kopcinskiego 22, Lodz, Poland
| | - Janusz Smigielski
- Department of Geriatrics, Medical University of Lodz, Pieniny 30, Lodz, Poland
| | - Jan Fortuniak
- Department of Neurosurgery and Oncology of Central Nervous System, Barlicki University Hospital, Medical University of Lodz, Kopcinskiego 22, Lodz, Poland.
| | - Dariusz J Jaskolski
- Department of Neurosurgery and Oncology of Central Nervous System, Barlicki University Hospital, Medical University of Lodz, Kopcinskiego 22, Lodz, Poland
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Ultrasonographic changes after steroid injection in carpal tunnel syndrome. Skeletal Radiol 2017; 46:1521-1530. [PMID: 28770310 DOI: 10.1007/s00256-017-2738-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/29/2017] [Accepted: 07/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the ultrasonographic changes after steroid injection in carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of ultrasound in post-treatment examination with clinical correlation. MATERIALS AND METHODS Twenty-seven wrists with idiopathic CTS after a single injection of 40 mg of prednisolone hydrochloride were prospectively studied using a high-resolution ultrasound. Axial images of the wrists were obtained at the level of the distal radius, pisiform and hamate prior to and 1, 4 and 8 weeks after steroid injection. The cross-sectional area (CSA, mm2) and flattening ratio (FR) of the median nerve were measured. The bowing of the flexor retinaculum (palmar displacement: PD, mm) and the transverse sliding distance of the median nerve (TSD, mm) during flexion-extension of the index finger were computed. Pre- and post-injection ultrasonographic findings were analyzed in relation to clinical parameters such as pain score. RESULTS At all levels of the wrist, the CSA decreased significantly at 1 week after the injection, which continued to 8 weeks post-injection. The PD also diminished significantly 1 week after the injection. Furthermore, the TSD significantly increased from 1 week after injection, which lasted to the end of this study. The CSA, PD and TSD showed significant correlation with improvement of pain scores. CONCLUSION Ultrasound is useful in follow-up examinations of CTS. Significant ultrasound findings after steroid injections in CTS include decreased swelling of the median nerve, decreased bowing of the flexor retinaculum and increased mobility of the median nerve. All of them significantly correlate with clinical symptoms.
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117
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Considerations About "Carpal Tunnel Syndrome Grading Using High-Resolution Ultrasonography". J Clin Neurophysiol 2017; 34:553. [PMID: 29023308 DOI: 10.1097/wnp.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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118
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Klauser AS, Abd Ellah M, Kremser C, Taljanovic M, Schmidle G, Gabl M, Cartes-Zumelzu F, Steiger R, Gizewski ER. Carpal tunnel syndrome assessment with diffusion tensor imaging: Value of fractional anisotropy and apparent diffusion coefficient. Eur Radiol 2017; 28:1111-1117. [PMID: 28956129 DOI: 10.1007/s00330-017-5046-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/15/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To quantitatively assess carpal tunnel syndrome (CTS) with DTI by evaluating two approaches to determine cut-off values. METHODS In forty patients with CTS diagnosis confirmed by nerve conduction studies (NCs) and 14 healthy subjects (mean age 58.54 and 57.8 years), cross-sectional area (CSA), apparent diffusion coefficient (ADC) and fractional anisotropy (FA) at single and multiple levels with intraobserver agreement were evaluated. RESULTS Maximum and mean CSA and FA showed significant differences between healthy subjects and patients (12.85 mm2 vs. 28.18 mm2, p < 0.001, and 0.613 vs. 0.524, p=0.007, respectively) (10.12 mm2 vs. 19.9 mm2, p<0.001 and 0.617 vs. 0.54, p=0.003, respectively), but not maximum and mean ADC (p > 0.05). For cut-off values, mean and maximum CSA showed the same sensitivity and specificity (93.3 %). However, mean FA showed better sensitivity than maximum FA (82.6 % vs. 73.9 %), but lower specificity (66.7 % vs. 80 %), and significant correlation for maximum CSA, 97 % (p < 0.01), with good correlation for maximum ADC and FA, 84.5 % (p < 0.01) and 62 % (p=0.056), respectively. CONCLUSIONS CSA and FA showed significant differences between healthy subjects and patients. Single measurement at maximum CSA is suitable for FA determination. Key Points • DTI showed that FA is stronger than ADC for CTS diagnosis. • Single- and multiple-level approaches were compared to determine FA and ADC. • Single-level evaluation at the thickest MN cross-sectional area is sufficient.
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Affiliation(s)
- A S Klauser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Abd Ellah
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
- Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Taljanovic
- Department of Medical Imaging, University of Arizona, College of Medicine, Banner- University Medical Center, Tucson, USA
| | - G Schmidle
- Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M Gabl
- Department for Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Cartes-Zumelzu
- Department of Neuroradiology, Neuroimaging core facility, Medical University of Innsbruck, Innsbruck, Austria
| | - R Steiger
- Department of Neuroradiology, Neuroimaging core facility, Medical University of Innsbruck, Innsbruck, Austria
| | - E R Gizewski
- Department of Neuroradiology, Neuroimaging core facility, Medical University of Innsbruck, Innsbruck, Austria
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Zhang C, Li M, Jiang J, Zhou Q, Xiang L, Huang Y, Ban W, Peng W. Diagnostic Value of Virtual Touch Tissue Imaging Quantification for Evaluating Median Nerve Stiffness in Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1783-1791. [PMID: 28436592 DOI: 10.1002/jum.14213] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the shear wave velocity (SWV) of the median nerve by Virtual Touch tissue imaging quantification (VTIQ; Siemens AG, Erlangen, Germany) through the beginning of the carpal tunnel and to determine whether VTIQ could be used to diagnose carpal tunnel syndrome. METHODS This study recruited 49 consecutive patients (72 wrists) with a definitive diagnosis of carpal tunnel syndrome and 23 healthy volunteers (46 wrists). We measured the median nerve diameter and cross-sectional area by 2-dimensional sonography and the SWV by VTIQ. The interobserver variability was analyzed, and diagnostic values were evaluated by drawing a receiver operating characteristic curve. RESULTS The median nerve SWV was significantly higher in the carpal tunnel syndrome group (3.857 m/s) than the control group (2.542 m/s; P < .05). A 3.0-m/s SWV cutoff value revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 83.3%, 91.3%, 93.8%, 77.8%, and 86.4%, respectively. The interobserver agreement was excellent for the SWV measurements. CONCLUSIONS The median nerve SWV at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom VTIQ appears to be a highly reproducible diagnostic technique.
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Affiliation(s)
- Chen Zhang
- Departments of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Miao Li
- Medical Ultrasound, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jue Jiang
- Medical Ultrasound, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Zhou
- Medical Ultrasound, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Xiang
- Neurology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajuan Huang
- Departments of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenrui Ban
- Departments of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Peng
- Departments of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Tang QY, Lai WH, Tay SC. The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome. J Hand Surg Asian Pac Vol 2017; 22:303-308. [PMID: 28774240 DOI: 10.1142/s0218810417500344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. METHODS Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). RESULTS In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. CONCLUSIONS Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome.
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Affiliation(s)
- Qian Ying Tang
- * Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Hong Lai
- * Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shian Chao Tay
- † Department of Hand Surgery, Singapore General Hospital, Singapore
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Metin Ökmen B, Kasapoğlu Aksoy M, Güneş A, Eröksüz R, Altan L. Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1403-1410. [PMID: 28210859 DOI: 10.1007/s00484-017-1317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/09/2017] [Accepted: 01/26/2017] [Indexed: 06/06/2023]
Abstract
Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)(n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)(n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0(p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2(p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.
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Affiliation(s)
- Burcu Metin Ökmen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Aygül Güneş
- Department of Neurology, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Riza Eröksüz
- Department of Medical Ecology and Hydroclimatology, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
- Department of Physical Medicine and Rehabilitation, Uludag University Faculty of Medicine, Bursa, Turkey
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Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen LC. Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial. Mayo Clin Proc 2017; 92:1179-1189. [PMID: 28778254 DOI: 10.1016/j.mayocp.2017.05.025] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS). PATIENTS AND METHODS A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection. RESULTS All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. CONCLUSION Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS. TRIAL REGISTRATION www.ClinicalTrials.gov: NCT02809261.
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Affiliation(s)
- Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China; Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
| | - Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ming-Jen Ke
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China; Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Science, School of Medicine, Taipei, Taiwan, Republic of China
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, Taipei, Taiwan, Republic of China.
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Nanno M, Kodera N, Tomori Y, Hagiwara Y, Takai S. Electrophysiological Assessment for Splinting in the Treatment of Carpal Tunnel Syndrome. Neurol Med Chir (Tokyo) 2017; 57:472-480. [PMID: 28757539 PMCID: PMC5638791 DOI: 10.2176/nmc.oa.2017-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An electrophysiological study is commonly used to decide a therapeutic strategy for carpal tunnel syndrome (CTS). In this study, the electrophysiological parameter measurement as a prognostic indicator for CTS after wrist splinting was assessed to identify appropriate candidates for wrist splinting for CTS. One hundred and six hands in 78 patients with CTS were treated by wrist splinting, and three electrophysiological parameters; median distal motor latency (DML) of the abductor pollicis brevis (APB) muscle, median distal sensory latency (DSL) of the index finger, and second lumbrical-interossei latency difference (2L-INT LD); were statistically analyzed to compare with clinical results by Kelly’s evaluation respectively. Clinical results were excellent in 15 hands, good in 51 hands, fair in 19 hands, and poor in 21 hands. The recordable rate in 2L-INT LD (99.1%) was higher than DML (96.2%) and DSL (79.2%). Patients with DML less than 6.5 ms, DSL less than 5.7 ms, or 2L-INT LD less than 2.5 ms had significantly excellent or good clinical results. The odds ratios of the DML, DSL, and the 2L-INT LD were 7.93, 8.81, and 12.8, respectively. This study demonstrated that CTS patients with DML less than 6.5 ms, DSL less than 5.7 ms, or 2L-INT less than 2.5 ms were good candidates for wrist splinting. Especially, the 2L-INT LD could be the most reliable indicator to predict clinical results for all grades of CTS. This electrophysiological information could be useful in further improvement of accurate diagnosis of CTS, and may help in the assessment of appropriate treatment for CTS with wrist splinting.
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Affiliation(s)
| | - Norie Kodera
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School
| | | | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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Distal pain and carpal tunnel syndrome diagnosis among cashiers: a longitudinal study. Int Arch Occup Environ Health 2017. [PMID: 28634858 DOI: 10.1007/s00420-017-1237-8] [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: 10/19/2022]
Abstract
OBJECTIVE To estimate in a longitudinal study the yearly incidence of carpal tunnel syndrome (CTS) in a cohort of women working as cashiers. METHOD A total of 198 cashiers, belonging to a cohort investigated in 2011-2012 for arm pain, were screened for re-assessment in 2015 (at least 40 months from the first examination), and 156 women had complete demographic, personal and working data allowing to be included in this study. On the basis of self- and clinician-administered questionnaires investigating the presence of CTS, all symptomatic patients underwent clinical and neurophysiological [nerve conduction studies (NCS) of median and ulnar nerves] assessments. RESULTS NCS confirmed the presence of CTS in 17 out of 149 workers; however, seven of them already received the diagnosis of CTS at the previous assessment in 2011-2012, leading to an overall incidence of new cases equal to 7.0%. Cumulative working time at the cashier of the women with CTS in the period 2012-2015 was highly variable (1744-4479 h) without an evident association with the severity of CTS. No differences in general demographic data were found in the women with vs. without CTS. Comorbidities potentially associated with increased risk of CTS were present in 21 women in the entire cohort (14.0% of the population, 40.0% in the subgroup of women with newly assessed CTS). Overweight/obesity and hypothyroidism were the most frequent comorbidities. CONCLUSION The results of this prospective study showed that the annualized incidence of CTS in our population of cashier was 2.0%; 40% of the new CTS cases had comorbidities.
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Zeidman LA, Pandey DK. A carpal tunnel grading system including combined sensory index-diagnosed mild cases: Relation to presenting features and outcomes. Muscle Nerve 2017; 57:45-48. [PMID: 28224654 DOI: 10.1002/mus.25632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/09/2017] [Accepted: 02/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Prior studies have demonstrated superiority of the combined sensory index (CSI) algorithm in diagnosing mild carpal tunnel syndrome (CTS) and have compared presenting symptoms to CTS grade. However, CTS symptoms, signs, and outcomes, including CSI-diagnosed cases, have not been compared with CTS grade. METHODS We retrospectively studied 294 CTS hands from 2010 to 2013; stratified them into mild, moderate, and severe grades; and analyzed the association between CTS grade and presenting symptoms/signs and outcomes. RESULTS Sensorimotor symptoms (P = 0.017) and signs (P < 0.001) were significantly associated with CTS grade. Regardless of CTS grade, 94% of hands improved with surgery compared with 42% with conservative treatment (P < 0.001). Even in mild CTS, 100% improved with surgery vs. 33% with conservative management (P = 0.011). DISCUSSION These results corroborate prior studies that compared symptoms to CTS grade and suggest that more objective signs associate even better. CTS grades associate with outcomes, but additional studies are required. Muscle Nerve 57: 45-48, 2018.
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Affiliation(s)
- Lawrence A Zeidman
- Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center Neuropsychiatric Institute (M/C 796), 912 S. Wood Street, Chicago, Illinois, 60612-7330, USA
| | - Dilip K Pandey
- Department of Neurology and Rehabilitation, University of Illinois at Chicago Medical Center Neuropsychiatric Institute (M/C 796), 912 S. Wood Street, Chicago, Illinois, 60612-7330, USA
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Hara Y, Nishiura Y, Ochiai N, Murai S, Yamazaki M. The relationship between preoperative needle electromyography findings and muscle power restoration after surgery in severe carpal tunnel syndrome patients. J Orthop Sci 2017; 22:430-433. [PMID: 28325700 DOI: 10.1016/j.jos.2017.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 09/18/2016] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Needle electromyography provides essential information about the functional aspects of the muscle. But little attention has been given in the literature to needle electromyography examinations in carpal tunnel syndrome. We examined the relationship between preoperative needle electromyography findings and functional recovery of the abductor pollicis brevis (APB) muscle in severe carpal tunnel syndrome patients. METHODS The subjects of this study were 49 patients, 58 hands, who fit the following 5 criteria: (1) idiopathic carpal tunnel syndrome; (2) pre-op MMT grade of the APB muscle was M0 or M1; (3) APB-CMAP (compound muscle action potential) was not evoked in a median nerve conduction study; (4) needle electromyography of the APB muscle had been done; (5) underwent carpal tunnel release only. The patients were divided into two groups according to the results of pre-op needle electromyography: voluntary motor unit potential of the APB muscle was evoked [MUP(+) group]or not [MUP(-) group]. We evaluated APB muscle strength at one year after surgery, and patient satisfaction and functional evaluations (CTSI-FS) at more than one year after. RESULTS The APB muscle recovery rate to M3 or higher was 100% in the MUP(+) group, and 57% in the MUP(-) group. Patient satisfaction was also high and functional recovery was sufficient in the MUP(+) group. No patients requested a second opponensplasty. CONCLUSION Our findings suggest that post-op restoration of thumb function relates to whether or not the MUP ofthe APB muscle is evoked. Single-stage opponensplasty may be unnecessary if the MUP of the APB muscle is; evoked. Needle electromyography is therefore useful in consideration for opponensplasty. LEVEL OF EVIDENCE Level Ⅲ, case-control study.
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Affiliation(s)
- Yuki Hara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1Tennoudai, Tsukuba, Ibaraki, Japan.
| | - Yasumasa Nishiura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1Tennoudai, Tsukuba, Ibaraki, Japan
| | - Naoyuki Ochiai
- Department of Orthopaedic Surgery, Kikkoman General Hospital, 100 Miyazaki, Noda, Chiba, Japan
| | - Shinji Murai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1Tennoudai, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1Tennoudai, Tsukuba, Ibaraki, Japan
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Ginanneschi F, Mondelli M, Aretini A, Rossi A. Reappraisal of the F/M amplitude ratio in carpal tunnel syndrome. FUNCTIONAL NEUROLOGY 2017; 32:23-27. [PMID: 28380320 DOI: 10.11138/fneur/2017.32.1.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The F-wave/M-wave amplitude (F/M-amp) ratio has been shown to be increased in peripheral neuropathies, provided the maximum M-wave is relatively preserved. Reduced M-wave amplitudes and central facilitation of antidromically-induced reactivation of the anterior horn cells' axon hillocks (F-wave) are believed to contribute to higher F/M-amp ratios. The present study was undertaken to re-evaluate mechanisms responsible for higher F/M-amp ratios in carpal tunnel syndrome (CTS). We enrolled 232 cases affected by CTS and 108 controls. Fand M-wave amplitudes and F-wave chronodispersion were analyzed for the median and ulnar nerves. The F/M-amp ratio of the median nerve in CTS subjects with moderate-severe nerve damage was significantly higher than that of mild CTS subjects and controls. Chronodispersion of the median nerve F-wave increased with increasing CTS severity. We conclude that the relative preservation of the median nerve F-wave is due to damage to the large diameter muscle afferent fibers responsible for the monosynaptic response. Absence of the monosynaptic response makes the small motoneurons, usually inaccessible to the antidromic volley because of its collision with the orthodromic reflex volley, able to fire in the F-wave.
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Coraci D, Santilli V, Coco S, Giovannini S, Padua L. Nerve ultrasound in carpal tunnel syndrome. Usefulness of an evaluation along a long tract. J Clin Neurosci 2017; 42:217-218. [PMID: 28343915 DOI: 10.1016/j.jocn.2017.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Daniele Coraci
- Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy; Don Carlo Gnocchi ONLUS Foundation, Milan, Italy.
| | - Valter Santilli
- Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy; Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
| | - Salvatore Coco
- Board of Physical Medicine and Rehabilitation, Department of Orthopaedic Science, "Sapienza" University, Rome, Italy
| | - Silvia Giovannini
- Rehabilitation Units, Policlinico Universitario Agostino Gemelli Foundation, Rome, Italy
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
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Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Huang GS, Chen LC. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial. Sci Rep 2017; 7:94. [PMID: 28273894 PMCID: PMC5427966 DOI: 10.1038/s41598-017-00224-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/14/2017] [Indexed: 12/24/2022] Open
Abstract
Recently, a few small reports with short follow-up period have shown clinical benefits of platelet-rich plasma (PRP) for peripheral neuropathy including one pilot study and one small, non-randomized trial in patients with carpal tunnel syndrome (CTS). Therefore, we conducted a randomized, single-blind, controlled trial to assess the 6-month effect of PRP in patients with CTS. Sixty patients with unilateral mild-to-moderate CTS were randomized into two groups of 30, namely the PRP and control groups. In the PRP group, patients were injected with one dose of 3 mL of PRP using ultrasound guidance and the control group received a night splint through the study period. The primary outcome measure was the visual analog scale (VAS) and secondary outcome measures included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score, the cross-sectional area (CSA) of the median nerve (MN), electrophysiological findings of the MN, and finger pinch strength. The evaluation was performed before treatment and at 1, 3, and 6 months post-injection. The PRP group exhibited a significant reduction in the VAS score, BCTQ score, and CSA of MN compared to the those of control group 6 months post-treatment (p < 0.05). Our study demonstrates that PRP is a safe modality that effectively relieves pain and improves disability in the patients with CTS.
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Affiliation(s)
- Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, No. 161, Sec. 6, Minquan East Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Ming-Jen Ke
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.
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130
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Kutlar N, Bayrak AO, Bayrak İK, Canbaz S, Türker H. Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity. Neurol Res 2017; 39:126-132. [PMID: 28050946 DOI: 10.1080/01616412.2016.1275455] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography. PATIENTS AND METHODS The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization. RESULTS A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages. CONCLUSION Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.
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Affiliation(s)
- Nihal Kutlar
- a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey
| | - Ayse Oytun Bayrak
- a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey
| | - İlkay Koray Bayrak
- b Faculty of Medicine, Department of Radiology , Ondokuz Mayis University , Samsun , Turkey
| | - Sevgi Canbaz
- c Faculty of Medicine, Department of Public Health , Ondokuz Mayis University , Samsun , Turkey
| | - Hande Türker
- a Faculty of Medicine, Department of Neurology , Ondokuz Mayis University , Samsun , Turkey
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131
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Lee H, Jee S, Park SH, Ahn SC, Im J, Sohn MK. Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome. Ann Rehabil Med 2016; 40:1048-1056. [PMID: 28119835 PMCID: PMC5256332 DOI: 10.5535/arm.2016.40.6.1048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. Methods Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. Results Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). Conclusion These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.
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Affiliation(s)
- Hyewon Lee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Soo Ho Park
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Chan Ahn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Juneho Im
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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132
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The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial. Sci Rep 2016; 6:38344. [PMID: 27910920 PMCID: PMC5133546 DOI: 10.1038/srep38344] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/02/2016] [Indexed: 12/20/2022] Open
Abstract
Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.
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133
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Chatterjee S, Sanyal D, Das Choudhury S, Bandyopadhyay M, Chakraborty S, Mukherjee A. Effect of pioglitazone on nerve conduction velocity of the median nerve in the carpal tunnel in type 2 diabetes patients. World J Diabetes 2016; 7:547-553. [PMID: 27895823 PMCID: PMC5107714 DOI: 10.4239/wjd.v7.i19.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/08/2016] [Accepted: 08/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the impact of pioglitazone pharmacotherapy in median nerve electrophysiology in the carpal tunnel among type 2 diabetes patients. METHODS The study was executed in patients with type 2 diabetes, treated with oral drugs, categorized under pioglitazone or non-pioglitazone group (14 in each group), and who received electrophysiological evaluation by nerve conduction velocity at baseline and 3 mo. RESULTS At 3 mo, pioglitazone-category had inferior amplitude in sensory median nerve [8.5 interquartile range (IQR) = 6.5 to 11.5) vs non-pioglitazone 14.5 (IQR 10.5 to 18.75)] (P = 0.002). Non-pioglitazone category displayed amelioration in amplitude in the sensory median nerve [baseline 13 (IQR = 9 to 16.25) vs 3 mo 8.5 (IQR = 6.5 to 11.5)] (P = 0.01) and amplitude in motor median nerve [baseline 9 (IQR = 4.75 to 11) vs 3 mo 6.75 (IQR = 4.75 to 10.25)] (P = 0.049); and deterioration of terminal latency of in motor ulnar nerve [baseline 2.07 (IQR = 1.92 to 2.25) vs 3 mo 2.16 (IQR = 1.97 to 2.325)] (P = 0.043). There was amelioration of terminal latency in sensory ulnar nerve [baseline 2.45 (IQR = 2.315 to 2.88) vs 3 mo 2.37 (IQR = 2.275 to 2.445) for pioglitazone group (P = 0.038). CONCLUSION Treatment with pioglitazone accentuates probability of compressive neuropathy. In spite of comparable glycemic control over 3 mo, patients treated with pioglitazone showed superior electrophysiological parameters for the ulnar nerve. Pioglitazone has favourable outcome in nerve electrophysiology which was repealed when the nerve was subjected to compressive neuropathy.
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134
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Mondelli M, Farioli A, Mattioli S, Aretini A, Ginanneschi F, Greco G, Curti S. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures. PLoS One 2016; 11:e0164715. [PMID: 27768728 PMCID: PMC5074522 DOI: 10.1371/journal.pone.0164715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/29/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales. Methods We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender. Results We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar. Conclusions Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study.
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Affiliation(s)
- Mauro Mondelli
- EMG Service, Local Health Unit no.7, Siena, Italy
- * E-mail:
| | - Andrea Farioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Federica Ginanneschi
- Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Giuseppe Greco
- EMG Service, Local Health Unit no.7, “Nottola” Hospital, Montepulciano, Siena, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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135
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Electrodiagnosis of Lesions of Median and Ulnar Nerve Hand Sensory Branches. J Clin Neurophysiol 2016; 33:454-457. [DOI: 10.1097/wnp.0000000000000266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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136
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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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137
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Toia F, Gagliardo A, D'Arpa S, Gagliardo C, Gagliardo G, Cordova A. Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound? J Neurosurg 2016; 125:603-14. [DOI: 10.3171/2015.6.jns151001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described.
METHODS
The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study.
Ultrasound was used to explore the nerve fascicular echotexture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded.
The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed.
RESULTS
Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative (“nonconfirming”) in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for entrapment neuropathies (43.8%).
CONCLUSIONS
Ultrasound is a powerful, noninvasive tool for the examination of peripheral nerve injuries, and can guide diagnosis of and surgical strategy for focal peripheral nerve injuries. It allows direct visualization of the cause and extent of nerve lesions and finds its place between electrodiagnostic tests and exploratory surgery. It can provide invaluable information, such as the presence and extent of a mass, scar compression, or neuromas. The authors recommend it as a complement to routine clinical and neurophysiological evaluation and as the first-line imaging modality for masses of suspected nerve origin.
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Affiliation(s)
- Francesca Toia
- 1Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, and
| | | | - Salvatore D'Arpa
- 1Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, and
| | - Cesare Gagliardo
- 3Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo; and
| | | | - Adriana Cordova
- 1Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, and
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138
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Associations Between Body Anthropometric Measures and Severity of Carpal Tunnel Syndrome. Arch Phys Med Rehabil 2016; 97:1456-1464. [DOI: 10.1016/j.apmr.2016.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/21/2022]
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139
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Funaba M, Kanchiku T, Imajo Y, Yamamoto H, Hiura Y, Fujimoto K, Taguchi T, Kido K. Relation between distal motor latency delay and sensory action potential absence of the median nerve in carpal tunnel syndrome. Clin Neurol Neurosurg 2016; 148:45-8. [PMID: 27391975 DOI: 10.1016/j.clineuro.2016.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/12/2016] [Accepted: 06/22/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To elucidate the cutoff value for distal motor latency (DML) at which sensory nerve action potentials (SNAPs) are absent in carpal tunnel syndrome (CTS) patients. METHOD We examined 157 hands in 129 patients with CTS retrospectively. We classified the patients according to whether SNAPs were successfully obtained. Group A consisted of hands with SNAPs, while Group B consisted of hands without SNAPs. The cutoff value for DML was determined by receiver-operating characteristic curve analysis. We enrolled 130 hands with CTS for the analysis, because measurements were successful in 130 hands for compound muscle action potentials and in 82 hands for SNAPs from a total of 157 hands investigated. RESULTS A significant correlation was observed between DML and SCV (P<0.0001, R*2=0.40). The most discriminative cutoff value for DML was 7.7ms, resulting in a sensitivity of 79.6% and specificity of 79.3%. CONCLUSION Cases in which SNAPs are evoked despite a DML longer than 7.7ms should raise suspicion.
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Affiliation(s)
- Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan; Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan.
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hisashi Yamamoto
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
| | - Yasuhiro Hiura
- Department of Orthopedic Surgery, Ube Kosan Central Hospital, Yamaguchi, Japan
| | - Kazuhiro Fujimoto
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kenji Kido
- Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan
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Simultaneous Median-Radial Nerve Electrical Stimulation Revisited: An Accurate Approach to Carpal Tunnel Syndrome Diagnosis and Severity. J Clin Neurophysiol 2016; 33:554-559. [PMID: 27258600 DOI: 10.1097/wnp.0000000000000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To assess the accuracy of an unusual test for CTS investigation and correlate it with clinical symptoms. METHODS Initially, we applied a visual analog scale for CTS discomfort (CTS-VAS) and performed a standard electrophysiologic test for CTS diagnosis (median-ulnar velocity comparison). Posteriorly, a blinded neurophysiologist performed the orthodromic simultaneous median-radial nerve stimulation (SMRS) at the thumb, with recording of both action potentials over the lateral aspect of the wrist. RESULTS All hands (106) showed median-radial action potential splitting using the SMRS technique, in which was possible to measure the interpeak latencies (IPLs) between action potentials. The IPL and median nerve conduction velocity were different according to CTS intensity (Bonferroni; P < 0.001). There was significant correlation between IPL and median nerve conduction velocity (Spearman; r = -0.51; P < 0.01). In the same way, there was a significant correlation between IPL and median nerve conduction velocity with CTS-VAS (r = 0.6 and r = -0.3, respectively). The duration and unpleasantness of the SMRS procedure were lower when compared with standard approach (t Student < 0.001 for both comparisons). Twenty-nine symptomatic patients (39 hands) who did not fulfill criteria for CTS based on standard approach showed abnormal IPLs. CONCLUSIONS The SMRS technique is a simple, sensitive, and tolerable approach for CTS diagnosis. Apart from that, the data from SMRS correlated better with clinical impact of CTS in comparison with the standard approach. Therefore, this method might be useful as adjunct to standard electrophysiologic approaches in clinical practice.
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Yilmaz O, Sunter G, Salcini C, Koytak PK, Tanridag T, Us O, Uluc K. Motor-Unit Number Estimation Is Sensitive in Detecting Motor Nerve Involvement in Patients with Carpal Tunnel Syndrome. J Clin Neurol 2016; 12:166-71. [PMID: 26790466 PMCID: PMC4828562 DOI: 10.3988/jcn.2016.12.2.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/19/2015] [Accepted: 09/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE We compared the motor-unit number estimation (MUNE) findings in patients who presented with signs and/or findings associated with carpal tunnel syndrome (CTS) and healthy controls, with the aim of determining if motor-unit loss occurs during the clinically silent period and if there is a correlation between clinical and MUNE findings in CTS patients. METHODS The study investigated 60 hands of 35 patients with clinical CTS and 60 hands of 34 healthy controls. Routine median and ulnar nerve conduction studies and MUNE analysis according to the multipoint stimulation method were performed. RESULTS The most common electrophysiological abnormality was reduced conduction velocity in the median sensory nerve (100% of the hands). The MUNE value was significantly lower for the patient group than for the control group (p=0.0001). ROC analysis showed that a MUNE value of 121 was the optimal cutoff for differentiating between patients and controls, with a sensitivity of 63.3% and a specificity of 68.3%. MUNE values were lower in patients with complaints of numbness, pain, and weakness in the median nerve territory (p<0.05, for all comparisons), and lower in patients with hypoesthesia than in patients with normal neurological findings (p=0.023). CONCLUSIONS The MUNE technique is sensitive in detecting motor nerve involvement in CTS patients who present with sensorial findings, and it may be useful in detecting the loss of motor units during the early stages of CTS. Larger-scale prospective clinical trials assessing the effect of early intervention on the outcome of these patients would help in confirming the possible benefit of detecting subclinical motor-unit loss in CTS.
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Affiliation(s)
- Orhan Yilmaz
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Gulin Sunter
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Celal Salcini
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
- Department of Neurology, Uskudar University, NPIstanbul Neuropsychiatry Hospital, Istanbul, Turkey
| | - Pınar Kahraman Koytak
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Tulin Tanridag
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Onder Us
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey.
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142
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Vergara Amador E, Viveros Carreño JM, Ahumada Graubard F. Evolución electrofisiológica en pacientes con síndrome del túnel del carpo tratados con cirugía. REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.51311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
<p>Antecedentes. En la liberación del síndrome de túnel del carpo (STC) los estudios electrodiagnósticos pueden cuantificar la gravedad de la enfermedad. Hasta la fecha, los reportes de estudios que evalúan la evolución electrofisiológica como resultado objetivo de la cirugía de descompresión son controvertidos, de hecho la correlación entre estas pruebas y la percepción clínica de mejoría ha sido descrita como modesta. Objetivos. Evaluar el comportamiento de los parámetros electrofisiológicos en una serie de pacientes operados del síndrome de túnel del carpo y determinar las variables electrofisiológicas de mejor rendimiento. Materiales y métodos. Estudio observacional analítico retrospectivo de pacientes operados ambulatoriamente por síndrome de túnel del carpo y evaluados con estudios electrodiagnósticos antes y después de la cirugía. Resultados. Se analizaron 48 pacientes con edad promedio de 48 años. El 52% de pacientes mejoraron según la escala de Padua. Las latencias distales motoras y sensitivas y el delta sensitivo del nervio mediano mejoraron después de cirugía con resultados estadísticamente significativos. Las latencias del nervio cubital no variaron. Conclusiones. La mejoría de los parámetros electrofisiológicos después de una liberación de síndrome de túnel del carpo es controversial: algunos reportes muestran mejoría desde el primer mes, especialmente en la velocidad de conducción sensitiva. Otros estudios muestran mejoría significativa entre las semanas 18 y 42 postoperatorias, siendo la recuperación motora más rápida que la sensitiva. En el presente estudio el 52% de los pacientes mejoraron en las escalas por disminución del grado de severidad. Las latencias distales motoras y sensitivas y el delta sensitivo del nervio mediano evidenciaron una mejoría. Estos resultados sugieren que los estudios electrodiagnóstico son efectivos en la evaluación objetiva de pacientes con síndrome de túnel del carpo y es el único examen que puede demostrar mejoría luego de una liberación del STC.</p>
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143
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Gürsoy AE, Bilgen HR, Dürüyen H, Altıntaş Ö, Kolukisa M, Asil T. The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci 2016; 37:1055-61. [PMID: 26939675 DOI: 10.1007/s10072-016-2530-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/22/2016] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP- group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP- group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP- groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP- group was lower than EP+ group, statistically difference was not significant between EP+ and EP- groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP- groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results.
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Affiliation(s)
- Azize Esra Gürsoy
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey.
| | - Halide Rengin Bilgen
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Hümeyra Dürüyen
- Department of Neurology, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Özge Altıntaş
- Department of Neurology, Niğde-Bor State Hospital, Niğde, Turkey
| | - Mehmet Kolukisa
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Talip Asil
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
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144
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Yu G, Chen Q, Wang D, Wang X, Li Z, Zhao J, Song C, Wang H, Wang Z. Diagnosis of carpal tunnel syndrome assessed using high-frequency ultrasonography: cross-section areas of 8-site median nerve. Clin Rheumatol 2016; 35:2557-64. [DOI: 10.1007/s10067-016-3214-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/22/2016] [Accepted: 02/13/2016] [Indexed: 12/23/2022]
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145
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Cho YJ, Lee JH, Shin DJ, Park KH. Comparison of short wrist transverse open and limited open techniques for carpal tunnel release: a randomized controlled trial of two incisions. J Hand Surg Eur Vol 2016; 41:143-7. [PMID: 26353946 DOI: 10.1177/1753193415603968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 07/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this randomized controlled trial was to compare outcomes of limited open and short wrist transverse techniques in patients with carpal tunnel syndrome. In a single centre randomized controlled trial, 84 patients with idiopathic carpal tunnel syndrome were randomized before surgery to limited open or short wrist transverse open carpal tunnel release. The patients were evaluated at 6 weeks, 3 months, 6 months, and 1 and 2 years after surgery. At every follow-up, the Brigham and Women's Carpal Tunnel Questionnaire scores, scar discomfort, and subjective patient satisfaction were evaluated. Two years after surgery, five patients were lost to follow-up. The groups had similar Brigham and Women's Carpal Tunnel Questionnaire Symptom Severity and Functional Status scores and subjective satisfaction scores. The incidence of scar discomfort was not significantly different between the two groups on serial postoperative follow-up. Short wrist transverse open release surgery showed similar early postoperative symptoms and subjective and functional outcomes to limited open release. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Y J Cho
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - J H Lee
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - D J Shin
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
| | - K H Park
- Department of Orthopedic Surgery, Kyung Hee University, Seoul, Korea
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146
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Electrosonodiagnosis in Carpal Tunnel Syndrome: A Proposed Diagnostic Algorithm Based on an Analytic Literature Review. PM R 2016; 8:463-74. [PMID: 26804668 DOI: 10.1016/j.pmrj.2015.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Suspected carpal tunnel syndrome (CTS) remains the most common clinical scenario prompting referral for electrodiagnostic (EDx) studies to identify objective correlates of reported subjective symptoms and clinical examination findings. Despite much debate and a rapidly expanding literature, identification of an optimal algorithm for diagnosing focal median mononeuropathy at the wrist (FMMW) associated with CTS signs and symptoms remains elusive. The introduction and rapid dissemination of peripheral nerve ultrasound imaging (PN-USI) of the median nerve has raised new questions regarding the relative value of structural information from PN-USI versus physiological information from EDx in the diagnosis of FMMW, as well as the significance of various clinical signs and symptoms suggestive of CTS. The means by which PN-USI and EDx may be optimally deployed and integrated in the process of diagnosing FMMW remains to be clearly delineated. OBJECTIVE To complete an analytical literature review to guide the formulation of a clinical diagnostic algorithm (CDA) integrating the use of PN-USI and EDx for the optimal detection of FMMW in the context of making a clinical diagnosis of CTS. DATA SOURCES A structured literature review was performed on the MEDLINE medical literature database accessed through PubMed. ANALYSIS Papers with particular relevance and connection to the goal of formulating the CDA were selected from the identified studies. Studies specifically examining the correlations between systematically documented clinical symptomatology, EDx findings, and PN-USI findings were reviewed for consistent outcomes that could be incorporated into a CDA to guide the integration of these two complementary technologies in the diagnostic process. LIMITATIONS The formulation of the algorithm was limited to measures with established validity that can be readily obtained by means of widely accepted protocols using standard EDx and ultrasound equipment. The formulated algorithm assumes a consistent association between pathophysiology and anatomical deformation of the median nerve, which may not occur in certain situations. It may also not be as accurately applied to patients with CTS with significant comorbid neuromuscular conditions. CONCLUSIONS An algorithm has been developed and presented, and illustrated as a flow chart, based on findings reported in the relevant reviewed literature in which PN-USI is proposed as a painless and rapidly performed screening test for FMMW to be completed before subjecting a patient to a systematic EDx testing process.
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147
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Kang S, Yang SN, Yoon JS, Kang HJ, Won SJ. Effect of Carpal Tunnel Syndrome on the Ulnar Nerve at the Wrist: Sonographic and Electrophysiologic Studies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:37-42. [PMID: 26589645 DOI: 10.7863/ultra.15.02064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The aim of this study was to compare the ulnar nerve at the wrist by sonographic and electrophysiologic studies between patients with carpal tunnel syndrome and control participants and to verify the effect of carpal tunnel syndrome of the ulnar nerve at the wrist. METHODS Forty-two hands of patients with carpal tunnel syndrome and 37 hands of control participants were examined. Electrophysiologic studies of the ulnar nerve were done in all participants. The cross-sectional areas of the median and ulnar nerves at the wrist were evaluated by sonography. Fifteen hands of patients with carpal tunnel syndrome who underwent carpal tunnel release were also evaluated by sonography after the operation. RESULTS The ulnar nerve cross-sectional area of the patients with carpal tunnel syndrome (mean ± SD, 5.16 ± 1.04 mm(2)) was significantly larger than that of the controls (3.56 ± 0.52 mm(2); P < .0001). After release of the transverse carpal ligament, the cross-sectional area of the ulnar nerve was significantly smaller than the size measured prior to surgery (P < .0001). The cross-sectional area of the median nerve was significantly correlated with that of the ulnar nerve (P < .05). However, no statistically significant difference was found between the patients with carpal tunnel syndrome and controls in ulnar nerve conduction. There were no statistically significant differences in nerve conduction study results or cross-sectional area of the ulnar nerve between patients with carpal tunnel syndrome with and without extramedian symptoms. CONCLUSIONS The cross-sectional areas of the ulnar and median nerves at the wrist are increased in patients with carpal tunnel syndrome. Also, the cross-sectional area of the ulnar nerve is decreased after carpal tunnel release.
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Affiliation(s)
- Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.).
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
| | - Hyo Jeong Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
| | - Sun Jae Won
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (S.K., S.N.Y., J.S.Y.); Department of Physical Medicine and Rehabilitation, Seoul Veterans Hospital, Seoul, Korea (J.K.); and Department of Physical Medicine and Rehabilitation, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea (S.J.W.)
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148
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Fujimoto K, Kanchiku T, Kido K, Imajo Y, Funaba M, Taguchi T. Diagnosis of Severe Carpal Tunnel Syndrome Using Nerve Conduction Study and Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2575-2580. [PMID: 26111913 DOI: 10.1016/j.ultrasmedbio.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/14/2015] [Accepted: 05/16/2015] [Indexed: 06/04/2023]
Abstract
This study investigated the correlation between nerve conduction study and ultrasonographic findings for assessment of the usefulness of ultrasonography in determining carpal tunnel syndrome severity. Hands of adults with carpal tunnel syndrome were assessed using ultrasound and nerve conduction studies and grouped according to median nerve cross-sectional area (CSA). There were significant differences (p < 0.01) in mean median nerve CSA between controls, patients with median sensory nerve conduction velocity ≤40 m/s and patients with absent sensory nerve action potential and between controls, patients with median nerve distal motor latency ≥4.5 ms and patients with absent compound muscle action potentials of the abductor pollicis brevis. This is the first report to define median nerve CSA cutoff values (18 mm(2)) for determining carpal tunnel syndrome severity in patients with absent compound muscle action potentials of the abductor pollicis brevis. Median nerve CSA values below the cutoff values should prompt clinicians to consider other disorders, such as cervical compressive myelopathy.
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Affiliation(s)
- Kazuhiro Fujimoto
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Tsukasa Kanchiku
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kenji Kido
- Department of Orthopaedic Surgery, Ehime Rosai Hospital, Niihama, Ehime, Japan
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masahiro Funaba
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Toshihiko Taguchi
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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149
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Zanette G, Lauriola MF, Tamburin S. An electrodiagnostic technique for assessing palmar proper digital nerves of the hand: Normative data and clinical application. Muscle Nerve 2015; 52:972-80. [DOI: 10.1002/mus.24668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Stefano Tamburin
- Department of Neurological and Movement Sciences; University of Verona; Piazzale Scuro 10 I-37134 Verona Italy
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150
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Altinkaya N, Leblebici B. Prevalence of persistent median artery in carpal tunnel syndrome: sonographic assessment. Surg Radiol Anat 2015; 38:511-5. [DOI: 10.1007/s00276-015-1544-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
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