Carpal tunnel syndrome: prevalence in the general population

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

PURPOSE

This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes.

METHODS

The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens.

RESULTS

There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05).

CONCLUSION

Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.

Application of ultrasound elastography for determining carpal tunnel syndrome severity

OBJECTIVE

To evaluate grey-scale and elastography ultrasound imaging findings in patients with CTS compared to nerve conductive studies.

METHOD

Sixty median nerves of 31 cases with confirmed CTS and 44 median nerves in 22 controls (healthy volunteers) who had no clinical evidence of CTS were evaluated. An expert radiologist performed all US evaluations. The RGB image is a three-dimensional matrix. A colour image RGB is an M × N × 3 array of colour pixels. The total pixels, total blue and red pixels, and blue and red indexes were compared between cases and controls.

RESULTS

Of the 60 nerves in the cases, 17 (16.3%) were mildly affected, 30 (28.8%) were moderately affected, and 13 (12.5%) were severely affected. Mean CSA, total blue pixels and blue indexes were significantly different between controls and cases with different levels of disease severity. The best cut-off point in the blue index to differentiate patients from controls was 0.1486, with a sensitivity and specificity of 80 and 70% (AUC = 0.79, P < 0.001), respectively. The best cut-off point for the red index to differentiate patients from controls was 0.1896, with a sensitivity and specificity of 70 and 55% (AUC = 0.64, P = 0.01), respectively.

CONCLUSION

Sono-elastography could be a useful diagnostic method for evaluating CTS severity in affected cases.

'Cuff Sign' a new maneuver for decision-making in patients with carpal tunnel syndrome

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that results from compression of the median nerve within the carpal tunnel. In most patients, the diagnosis can be proposed based on patient history and clinical symptoms, with physical findings being attributed only in more severely affected patients. The purpose of this study is to introduce a reliable and accurate method for the proper selection of patients with mild carpal tunnel syndrome (CTS), for surgery.

MATERIALS AND METHODS

Electerodiagnostic studies are performed before and after placement of the cuff of the sphygmomanometer at the arm (Cuff sign), at a mean arterial pressure, for three minutes. Thirty symptomatic patients with mild findings on electrodiagnostic studies and 49 asymptomatic control hands have been included.

RESULTS

Fifteen patients reported good pain relief on the first postoperative day (50%), which increased to 21 on the fouteenth postoperative day (70%). The sensory latency changes were significantly higher in the pain relief group, both on the first and fourteenth postoperative days.

CONCLUSION

Considering the fact that cooperation of the patients is not necessary and the double effects of direct pressure and ischemia over the proximal parts of the median nerve leads to prolonged latencies, this test is a useful method for decision-making in patients with severe symptoms of CTS, despite the mild electrodiagnostic findings.

Comparison of automated versus traditional nerve conduction study methods for median nerve testing in a general worker population

OBJECTIVE

To investigate the validity of automated nerve conduction studies compared to traditional electrodiagnostic studies (EDS) for testing median nerve abnormalities in a working population.

DESIGN

Agreement study and sensitivity investigation from 2 devices.

SETTING

Field research testing laboratory.

PARTICIPANTS

Active workers from several industries participating in a longitudinal study of carpal tunnel syndrome.

METHODS

Sixty-two subjects received bilateral median and ulnar nerve conduction testing across the wrist with a traditional device and the NC-stat automated device. We compared the intermethod agreement of analogous measurements.

MAIN OUTCOME MEASUREMENT

Nerve conduction study parameters.

RESULTS

Median motor and sensory latency comparisons showed excellent agreement (intraclass correlation coefficients 0.85 and 0.80, respectively). Areas under the receiver operating characteristic curves were 0.97 and 0.96, respectively, using the optimal thresholds of 4.4-millisecond median motor latency (sensitivity 100%, specificity 86%) and 3.9-millisecond median sensory latency (sensitivity 100%, specificity 87%). Ulnar nerve testing results were less favorable.

CONCLUSION

The automated NC-stat device showed excellent agreement with traditional EDS for detecting median nerve conduction abnormalities in a general population of workers, suggesting that this automated nerve conduction device can be used to ascertain research case definitions of carpal tunnel syndrome in population health studies. Further study is needed to determine optimal thresholds for defining median conduction abnormalities in populations that are not seeking clinical care.

Personal and workplace factors and median nerve function in a pooled study of 2396 US workers

OBJECTIVE

Evaluate associations between personal and workplace factors and median nerve conduction latency at the wrist.

METHODS

Baseline data on workplace psychosocial and physical exposures were pooled from four prospective studies of production and service workers (N = 2396). During the follow-up period, electrophysiologic measures of median nerve function were collected at regular intervals.

RESULTS

Significant adjusted associations were observed between age, body mass index, sex, peak hand force, duration of forceful hand exertions, Threshold Limit Value for Hand Activity Limit, forceful repetition rate, wrist extension, and decision latitude on median nerve latencies.

CONCLUSIONS

Occupational and nonoccupational factors have adverse effects on median nerve function. Measuring median nerve function eliminates possible reporting bias that may affect symptom-based carpal tunnel syndrome case definitions. These results suggest that previously observed associations between carpal tunnel syndrome and occupational factors are not the result of such reporting bias.

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

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

The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: a new paradigm

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, affecting 9% of women, and it is responsible for significant morbidity and occupational absence. Clinical assessment is used for initial diagnosis and nerve conduction (NC) studies are currently the principal test used to confirm the diagnosis. Sensitivity of NC studies is >85% and specificity is >95%. There is now good evidence that US can be used as an alternative to NC studies to diagnose CTS. US can assess the anatomy of the median nerve and also identify pathology of the surrounding structures that may compress the nerve. Median nerve enlargement (cross-sectional area ≥10 mm(2) at the level of the pisiform bone or tunnel inlet) is the most commonly used parameter to diagnose CTS on US, and sensitivity has been reported to be as high as 97.9% using this parameter. US may also be used to guide therapeutic corticosteroid injection into the carpal tunnel--thus avoiding median nerve injury--and to objectively monitor the response to treatment. There is now sufficient evidence to propose a new paradigm for the diagnosis of CTS that incorporates US. US is proposed as the initial diagnostic test in CTS based on similar sensitivity and specificity to NC studies but higher patient acceptability, lower cost and additional capability to assess carpal tunnel anatomy and guide injection.

Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome

AIMS/HYPOTHESIS

We sought to establish the molecular and pathological changes predisposing diabetic and non-diabetic patients to the development of carpal tunnel syndrome (CTS).

METHODS

The posterior interosseous nerve (PIN) was biopsied in 25 diabetic and 19 non-diabetic patients undergoing carpal tunnel decompression for CTS. Detailed morphometric and immunohistological analyses were performed in the nerve biopsy.

RESULTS

In diabetic patients median nerve distal motor latency was prolonged (p < 0.05 vs non-diabetic patients), PIN myelinated fibre density (p < 0.05), fibre area (p < 0.0001) and axon area (p < 0.0001) were reduced, the percentage of unassociated Schwann cell profiles (p < 0.0001) and unmyelinated axon density (p < 0.0001) were increased and the axon diameter was reduced (p < 0.0001). Endoneurial capillary basement membrane area was increased (p < 0.0001) in diabetic patients, but endothelial cell number was increased (p < 0.01) and luminal area was reduced (p < 0.05) in non-diabetic patients with CTS. There was no difference in the expression of hypoxia-inducible factor 1α between diabetic and non-diabetic patients with CTS. However, the expression of vascular endothelial growth factor A (VEGF) (p < 0.05) and its receptors VEGFR-1 (p < 0.01) and VEGFR-2 (p < 0.05) was significantly increased in diabetic patients, particularly those with type 1 diabetes, and related to the severity of nerve fibre pathology.

CONCLUSIONS/INTERPRETATION

This study demonstrates increased nerve fibre and microvascular pathology in relation to enhanced expression of VEGF and its receptors in a non-compressed nerve in diabetic compared with non-diabetic patients with CTS. It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS.

Treatment outcome in carpal tunnel syndrome: does distribution of sensory symptoms matter?

BACKGROUND

Patients with complaints of carpal tunnel syndrome (CTS) with signs and symptoms not exclusively confined to the median nerve territory, but otherwise fulfilling the clinical criteria may erroneously be withheld from therapy.

METHODS

One hundred and twenty one patients who fulfilled the clinical criteria for the diagnosis of CTS with signs and symptoms restricted to the median nerve territory (group A) and 91 patients without this restriction (group B) were included in a prospective cohort study. All patients fulfilled electrodiagnostic criteria of CTS. Outcome was determined after 7 to 9 months by means of Symptom Severity Score (SSS) and Functional Status Score (FSS) according to Levine and a patient satisfaction questionnaire.

RESULTS

Response rates were 81.8% (group A) and 82.4% (group B). All patients in group B had sensory symptoms involving digit 5. There were no significant differences in improvement of SSS, FSS and patient satisfaction scores between groups after treatment.

CONCLUSION

CTS patients with characteristic sensory signs and symptoms not exclusively restricted to the median nerve innervated area should be treated in the same manner as patients with CTS symptoms restricted to the median nerve innervated area and should therefore not be withheld from surgical treatment.

A comparison between ultrasonographic, surgical and histological assessment of tenosynovits in a cohort of idiopathic carpal tunnel syndrome patients

Carpal tunnel syndrome (CTS) may be caused by subclinical tenosynovitis which may be detected by ultrasonography (US). The objective of this study is to investigate whether ultrasonography has a place in the workup of idiopathic CTS patients. Therefore, we investigated the prevalence of tenosynovitis and its association with the clinical outcome of surgery. A cohort of 31 consecutive idiopathic CTS patients (33 wrists) who were a candidate for carpal tunnel release (CTR) surgery was assessed using greyscale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS). Peroperatively, tenosynovitis was evaluated macroscopically by the surgeon. Tissue samples from areas macroscopically suspected for tenosynovitis were taken for histological evaluation. The clinical outcome of the operation was assessed after 6 months and if applicable alternative diagnoses for the CTS were proposed. US tenosynovitis (OMERACT) was detected preoperatively in 58 % of the wrists. Peroperatively, macroscopic tenosynovitis was detected visually in 88 % of the wrists. Histological evaluation demonstrated a limited influx of lymphocytes indicative of a mild chronic inflammatory response in 19 %. Non-specific reactive changes were observed in 78 % of the cases. Ultrasonographically defined tenosynovitis was associated with an OR of 2.81 (95 % CI 0.61-13) for responding well to surgery. Most cases of ultrasonographic and peroperatively defined tenosynovitis were classified by histology as reactive changes. The presence of ultrasonographic tenosynovitis might be associated with a better clinical outcome of surgery.

Temporal trend of carpal tunnel release surgery: a population-based time series analysis

BACKGROUND

Carpal tunnel release (CTR) is among the most common hand surgeries, although little is known about its pattern. In this study, we aimed to investigate temporal trends, age and gender variation and current practice patterns in CTR surgeries.

METHODS

We conducted a population-based time series analysis among over 13 million residents of Ontario, who underwent operative management for carpal tunnel syndrome (CTS) from April 1, 1992 to March 31, 2010 using administrative claims data.

RESULTS

The primary analysis revealed a fairly stable procedure rate of approximately 10 patients per 10,000 population per year receiving CTRs without any significant, consistent temporal trend (p = 0.94). Secondary analyses revealed different trends in procedure rates according to age. The annual procedure rate among those age >75 years increased from 22 per 10,000 population at the beginning of the study period to over 26 patients per 10,000 population (p<0.01) by the end of the study period. CTR surgical procedures were approximately two-fold more common among females relative to males (64.9% vs. 35.1 respectively; p<0.01). Lastly, CTR procedures are increasingly being conducted in the outpatient setting while procedures in the inpatient setting have been declining steadily - the proportion of procedures performed in the outpatient setting increased from 13% to over 30% by 2010 (p<0.01).

CONCLUSION

Overall, CTR surgical-procedures are conducted at a rate of approximately 10 patients per 10,000 population annually with significant variation with respect to age and gender. CTR surgical procedures in ambulatory-care facilities may soon outpace procedure rates in the in-hospital setting.

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

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

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

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

Carpal tunnel release in patients with diabetes result in poorer outcome in long-term study

BACKGROUND

The aim of this prospective study was to compare the results of surgical decompression of carpal tunnel syndrome (CTS) in patients with diabetes mellitus with those with idiopathic CTS.

METHODS

The results of surgical decompression of CTS in 27 patients with diabetes mellitus were compared with 42 patients with idiopathic CTS. All patients underwent surgical release of transverse carpal ligament by the mini-incision of palm technique. Patient self-administered Boston Questionnaire (BQ) for the assessment of severity of CTS symptoms and hand functional status was evaluated before and 6 months and 10 years after surgery.

RESULTS

After surgical release, all the patients of both groups reported an absence of pain, disappearance or reduction of paresthesia, and improvement in hand function. Six months after surgery, there was a significant improvement of symptomatic and functional BQ scores compared with preoperative state in both groups. Ten years after surgery, there was statistical difference in preoperative and postoperative 10th year functional BQ score between DM (-) and DM (+) (p < 0.01). DM status affected statistically functional BQ score between preoperative and postoperative 10th year.

CONCLUSION

Diabetes mellitus was a risk factor for poor outcome of surgical decompression of CTS. Patients with diabetes had worse surgical outcome compared with patients with idiopathic CTS in long-term follow-up.

Tumors and tumor-like lesions mimicking carpal tunnel syndrome

INTRODUCTION

Tumors and tumor-like lesions in or around the median nerve are uncommon causes of carpal tunnel syndrome (CTS). The purpose of the present study is to highlight the diagnostic approach and point out the profile of patients with CTS and potential underlying pathology.

MATERIALS AND METHODS

Twenty-eight patients with 32 affected hands had CTS correlated to a mass in or around the nerve. In 20 hands a palpable mass was present. Diagnostic workup included nerve conduction studies, ultrasound and/or MRI. Pre- and postoperative examination included two-point discrimination (2PD), grip strength, visual analogue scale (for pain) (VAS) and disabilities of the arm, shoulder and hand (DASH) scores.

RESULTS

Twelve of 28 patients were young (range 9-38 years) and 10 were male. Nerve compression was due to 27 extraneural lesions (8 abnormal muscles, 5 lipomas, 7 tenosynovitis, 4 vascular tumors, 2 ganglia, 1 Dupuytren's fibromatosis) and five intraneural tumors (three schwannomas, one neurofibroma, one sarcoma). Nerve decompression and excision of extraneural lesions were performed in all cases whereas in intraneural tumors, decompression was followed by excision in most cases and nerve grafting in one. Mean follow-up was 22 months (12-105 months). Extraneural masses were associated with a better outcome than nerve tumors. The mean postoperative VAS/DASH scores were 0.3/16.2 in extraneural lesions and 2.5/22 in intraneural lesions. The 2PD improved gradually in all patients (mean pre- and postoperative 12 and 5 mm). The mean grip strength increased from 28 to 31.3 kg postoperatively.

CONCLUSIONS

Although rare, the surgeon should include in the differential diagnosis of CTS the unusual cause of tumors and tumor-like lesions, especially when the patients' profile is not typical (young, male, no repetitive stress or manual labor). In addition, the presence of a palpable mass at the distal forearm or palm dictates the need for imaging studies. The extent, location and aggressiveness of the mass will determine the approach and type of procedure.

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

Background

The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy).

Methods

In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence.

Results

The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment.

Conclusions

With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS.

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

The reliability of the scratch-collapse test for diagnosis of carpal tunnel syndrome (CTS) has not been tested by independent investigators. This study measured the reliability of the scratch-collapse test comparing the treating hand surgeon and blinded evaluators. We performed a prospective observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing. The treating hand surgeon performed the scratch-collapse test. Next, the test was administered by one of the six observers, unaware of the patient's symptoms and the diagnosis made by treating hand surgeon. The kappa statistic (κ) was used to calculate the interrater reliability between the treating hand surgeons and blinded scratchers. The agreement between the blinded observers and the hand surgeons on the scratch-collapse test was substantial 0.63 (95 % CI, 0.34-0.87; p < 0.001). The sensitivity of the blinded scratch test in our sample was 32 %. In a small study with a spectrum bias favoring electrophysiologically confirmed CTS the reliability was lower than that reported by the inventors of the test, but was still substantial. We propose a larger study of patients with a greater variety of electrodiagnostic test results using fewer observers with more experience.

A community-based epidemiological study of peripheral neuropathies in Assiut, Egypt

BACKGROUND

There is very little published information about the prevalence, patterns, and predictors of peripheral neuropathies. The current study is a community-based survey was conducted in the Assiut Governorate to estimate their prevalence and clinical profile.

MATERIAL AND METHODS

A door-to-door study was carried out on 42,223 persons from rural and urban communities in the Assiut Governorate, Egypt. There were 13,288 (31.5%) subjects from the urban and 28,935 (68·5%) from the rural area. All subjects filled in a questionnaire designed specifically for diagnosis of peripheral neuropathy. Positive cases were then given a complete medical and neurological examination, routine laboratory tests, neurophysiology, and neuroimaging (magnetic resonance).

RESULTS

The crude prevalence rate (CPR) of peripheral neuropathy was 3181/100,000 inhabitants. There was a significantly higher prevalence in the rural compared with the urban population (3795 versus 1844/100,000) and in females than males (4473 versus 1943/100,000; P<0.001 for both). The most common type reported was entrapment neuropathy (736 cases with CPR of 1743/100,000), particularly carpal tunnel syndrome (1686/100,000). Diabetic neuropathy was the most common non-compressive neuropathy with a CPR of 649/100,000. Type II diabetes was recorded in 241 patients with a CPR of 571/100,000. Compressive radiculopathy had a crude prevalence of 358/100,000; traumatic and iatrogenic radiculopathy had a prevalence rate of 149/100,000. Less common conditions were: uremic neuropathy (21/100,000) hepatic neuropathy (14/100,000), Bell's palsy (28/100,000), Guillian-Barre' syndrome (12/100,000), chronic inflammatory demyelinating polyneuropathy (12/100,000), hereditary sensory motor neuropathy (12/100,000), and idiopathic neuropathy (92/100,000).

CONCLUSION

The overall prevalence of peripheral neuropathies was high in comparison to other studies. Entrapment neuropathy, diabetic neuropathy, and spondylotic radiculopathy were the most common. Overall, the prevalence of peripheral neuropathy was higher in the rural than in the urban population.

The value of provocative tests for the wrist and elbow: a literature review

To describe and determine the usefulness of provocative tests for the wrist and elbow a literature search was performed. A total of 31 diagnostic studies were identified, assessed, and ranked. The highest ranking tests had a mean positive likelihood ratio of ≥2.0, or a mean negative likelihood ratio of ≤0.5, from more than one study. The highly recommended tests were found to be the Phalen's, Tinel's test for carpal tunnel and cubital tunnel, and modified compression test, scaphoid shift test, and elbow flexion test. A total of 14 tests met our requirements to be considered a recommended test. A greater number of provocative tests either do not have adequate data to support their usefulness or their clinical utility has not been assessed. This information may assist hand therapists in choosing which provocative tests are considered clinically useful in improving the probability of the presence or absence of pathology in the hand, wrist, and elbow.

LEVEL OF EVIDENCE

NA.

Ulnar sensory-motor amplitude ratio: a new tool to differentiate ganglionopathy from polyneuropathy

The objective of this study was to evaluate if the ratio of ulnar sensory nerve action potential (SNAP) over compound muscle action potential (CMAP) amplitudes (USMAR) would help in the distinction between ganglionopathy (GNP) and polyneuropathy (PNP).MethodsWe reviewed the nerve conductions studies and electromyography (EMG) of 18 GNP patients, 33 diabetic PNP patients and 56 controls. GNP was defined by simultaneous nerve conduction studies (NCS) and magnetic resonance imaging (MRI) abnormalities. PNP was defined by usual clinical and NCS criteria. We used ANOVA with post-hoc Tukey test and ROC curve analysis to compare ulnar SNAP and CMAP, as well as USMAR in the groups.ResultsUlnar CMAP amplitudes were similar between GNP x PNP x Controls (p=0.253), but ulnar SNAP amplitudes (1.6±3.2 x 11.9±9.1 × 45.7±24.7) and USMAR values (0.3±0.3 × 1.5±0.9 × 4.6±2.2) were significantly different. A USMAR threshold of 0.71 was able to differentiate GNP and PNP (94.4% sensitivity and 90.9% specificity).ConclusionsUSMAR is a practical and reliable tool for the differentiation between GNP and PNP.

The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

The objective of this prospective study was to investigate the long-term effect of one or more local corticosteroid injections in patients with carpal tunnel syndrome and whether a good response can be predicted. Follow-up visits took place at 3 weeks, 6 months, and 1 year after the first corticosteroid injection. Thirty of the 120 patients (25%) had a good outcome with a single injection, 11 additional patients (9%) needed a second injection, and five patients (4%) needed a third injection to reach a good outcome after 1 year. Of patients with an initial good treatment response, 28 (52%) had a good outcome after 1 year compared with 18 (27 %) who had an initially moderate or no response to treatment. One-third of patients with carpal tunnel syndrome had a long-term beneficial effect from corticosteroid injection, especially when they had a good initial response.

Pilot randomised controlled trial comparing C-Trac splints with Beta Wrist Braces for the management of carpal tunnel syndrome

Introduction

The C-Trac splint has been designed to mechanically stretch the transverse carpal ligament and is advertised as an alternative to surgical Carpal Tunnel Decompression. The purpose of the study is to compare the effectiveness of the C-Trac splint with standard splinting in mild to moderate idiopathic carpal tunnel syndrome.

Methods

This is a pilot parallel randomised controlled trial. Forty-nine patients with clinically and neurophysiologically proven carpal tunnel syndrome were randomised into the two treatment groups, C-Trac and Beta Wrist Brace, and reassessed clinically for one year.

Results

Patients were generally satisfied with both splints, but two out of the 24 C-Trac patients developed problematic side effects possibly due to using the splint: De Quervains tenosynovitis and basal joint arthritic pain. There was no clinically relevant or statistically significant difference in the success and failure rates of the two splints by eight weeks, six months or at one year. Three of the 25 C-Trac splints (costing £130 each) used during the one-year study required replacement, compared with eight of the Beta Wrist Braces (costing approximately £10 each).

Conclusions

These results suggest that C-Trac splint is not dissimilar in efficacy to a resting Beta Wrist Brace. The reported side effects raise questions as to the wisdom of its unregulated use.

Comparison of proximal and distal cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index in subjects with carpal tunnel syndrome

OBJECTIVES

To provide a quantitative analysis of ultrasonographic measurements and possible pathophysiology of carpal tunnel syndrome by comparing cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index and the difference in ultrasonographic findings between affected and nonaffected hands and between sexes.

DESIGN

Blinded comparison study.

SETTING

Secondary referral and training hospital of institutional practice.

PARTICIPANTS

Patients (N=51; 42 women, 9 men) with suspected carpal tunnel syndrome who underwent sonography within 1 week after the electrodiagnostic study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Electrodiagnostic and ultrasonographic studies were conducted on both upper extremities. Cross-sectional areas of the median nerve and carpal tunnel were measured at 2 separate levels; proximal and distal cross-sectional areas of the carpal tunnel were each measured at the scaphoid-pisiform and trapezium-hamate levels, respectively.

RESULTS

Comparison between normative (n=24) and abnormal hands (n=78) revealed the following: the mean proximal cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index of electrodiagnostically normative hands were 10.941mm(2), 192.43mm(2), and 5.635%, respectively, whereas those of abnormal hands were 13.74mm(2), 208.87mm(2), and 6.693%, respectively, showing statistically significant differences for all (P<.05). Distal measurements of the cross-sectional area of the median nerve, carpal tunnel, and nerve/tunnel index were 10.088mm(2), 150.4mm(2), and 6.762%, respectively, in normative hands, and 11.178mm(2), 149.6mm(2), and 7.493%, respectively, in abnormal hands, showing no statistically significant differences (P>.05). In women, proximal cross-sectional areas of the median nerve and nerve/tunnel index of abnormal hands showed statistically significant differences, but no ultrasonographic measurement with a statistically significant difference was observed in men.

CONCLUSIONS

Compared with nonaffected hands, the proximal cross-sectional areas of the median nerve and carpal tunnel were greater, but the distal ultrasonographic measurements were not in affected hands. Ultrasonographic findings of carpal tunnel syndrome were different according to sex.

Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome

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

Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies

OBJECTIVES

Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology.

METHODS

Six research groups collected prospective data at > 50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies.

RESULTS

At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years.

CONCLUSIONS

Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure-response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference.

[Neurography for diagnosing carpal tunnel syndrome]

BACKGROUND

A number of evidence-based guidelines now recommend that a nerve conduction study should be used to confirm the existence of carpal tunnel syndrome before any surgery takes place.

METHOD

The article is based on a search in PubMed, a personal literature archive (1980-2011) and long clinical experience of neurological and neurophysiological diagnostics.

RESULTS

Both motor and sensory nerve fascicles must be tested after adequate warming up. An extended nerve conduction study with supplementary tests to compare velocities and latencies in median and ulnar nerves, increases the diagnostic precision. Given normal or mild findings, surgery can usually be avoided as the first choice of treatment, because many patients with mild carpal tunnel syndrome recover spontaneously.

INTERPRETATION

The gold standard for diagnosis of carpal tunnel syndrome should be a combination of a clinical examination and a nerve conduction study.

Relationship between electrodiagnostic severity and neuropathic pain assessed by the LANSS pain scale in carpal tunnel syndrome

OBJECTIVE

The aim of the study was to investigate the relationship between the presence of neuropathic pain assessed by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale and electrophysiological findings in patients with carpal tunnel syndrome (CTS).

METHODS

We studied 124 hands with idiopathic CTS with pain complaints involving hand and wrist. All hands were assessed by the LANSS with which a score of 12 or more is defined as pain dominated by neuropathic mechanisms. These hands were assigned to minimal, mild, moderate, severe, or extreme severe groups according to the results of the median nerve conduction studies.

RESULTS

A LANSS score ≥ 12, suggestive of pain dominated by neuropathic mechanisms, was defined in 59 (47.6%) CTS hands. Pain intensity was significantly higher in CTS hands with a LANSS score ≥ 12 (P < 0.001). Among electrophysiological findings, compound muscle action potential amplitude was significantly lower in hands with a LANSS score ≥ 12 compared with hands with a LANSS score < 12 (P = 0.020). Severity of CTS was not significantly different between LANSS ≥ 12 and LANSS < 12 groups. Electrophysiological severity was significantly higher in CTS hands with evoked pain (P = 0.005) and allodynia (P < 0.001) in LANSS subscore analysis.

CONCLUSION

We suggest that the presence of pain dominated by neuropathic mechanisms in CTS is not related to electrophysiological CTS severity. Neuropathic pain should be assessed carefully in patients with CTS, and an appropriate treatment plan should be chosen, taking into account the clinical and electrophysiological findings together with the true pain classification.

The diagnostic assessment of hand elevation test in carpal tunnel syndrome

Objective

The aim of this study is to establish the value of hand elevation test as a reproducible provocative test for the diagnosis of carpal tunnel syndrome (CTS).

Methods

We had a prospective study of 45 hands of 38 patients diagnosed with CTS between April 2005 and February 2009. The diagnosis of CTS was based on the American Academy of Neurology clinical diagnostic criteria. Experimental and control group patients underwent Tinel's test, Phalen's test, carpal compression test and hand elevation test as provocative tests for CTS.

Results

We used chi-square analysis to compare Tinel's test and Phalen's test, carpal compression test with hand elevation test. The sensitivity and specificity of the hand elevation test is 86.7% and 88.9% each. Tinel's test had 82.2% sensitivity and 88.9% specificity. Phalen's test had 84.4% sensitivity and 86.7% specificity. Carpal compression test had 84.4% sensitivity 82.2% specificity. Comparisons of sensitivity and specificity between hand elevation test and Tinel's test, Phalen's test, and carpal compression test had no statistically significant differences. To compare the diagnostic accuracies of four tests, the area under the non-parametric receiver operating character curve was applied.

Conclusion

The hand elevation test has higher sensitivity and specificity than Tinel's test, Phalen's test, and carpal compression test. Chi-square statistical analysis confirms the hand elevation test is not ineffective campared with Tinel's test, Phalen's test, and carpal compression test.

Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and a reliable method for its calculation

INTRODUCTION

The aim of this study was to investigate factors affecting median nerve cross-sectional area (CSA) and determine a dependable swelling ratio (SR) calculation method.

METHODS

Using ultrasonography, median nerve CSAs were measured at the tunnel inlet, midtunnel, and outlet, and at 4 cm and 12 cm proximal to the wrist. We used CSAmax as the largest of the tunnel measurements and calculated swelling ratios (SRs) by using the CSAmax. Sonographic measurements were correlated with electrophysiologic findings. We evaluated the effects of gender, weight, and height on median nerve thickness.

RESULTS

We studied 95 wrists of 55 CTS patients and 48 wrists of 27 volunteers. Gender, weight, and height had effects on certain median nerve CSA measurements. CSAmax, SRmax4, and SRmax12 had superior correlations with electrophysiologic findings. The correlation between 4-cm and 12-cm median nerve CSAs was statistically significant (r = 0.879 and P < 0,001).

CONCLUSION

We have developed a reliable SR method considering factors affecting median nerve CSA.

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

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

Technical considerations for measurement of median nerve conduction velocity at wrist

Nerve conduction velocity (NCV) testing for the median nerve is the gold standard for diagnosing carpal tunnel syndrome (CTS), which affects about 6% of the general population. However, NCV equipment is relatively expensive and not always available at outpatient clinics. This study investigated the effects of different sampling rates and electrode placements on the NCV values of the median nerve to establish the practical significance of those specifications. The NCV of the median nerve at the wrist was measured in 30 healthy subjects with sampling rates of 2 kHz or 10 kHz and wide or narrow spacing of the electrode; Paired t-tests were used to compare the NCV values acquired by the different testing protocols. We found that the sampling rate had a statistically significant effect on the NCV values (P < 0.01), while the electrode placements did not significantly affect the NCV values (P > 0.05). The findings of this study have implications for improving the cost-effectiveness and technical applicability of NCV instruments.

The outcome of carpal tunnel decompression in patients with diabetes mellitus

Diabetes mellitus is recognised as a risk factor for carpal tunnel syndrome. The response to treatment is unclear, and may be poorer than in non-diabetic patients. Previous randomised studies of interventions for carpal tunnel syndrome have specifically excluded diabetic patients. The aim of this study was to investigate the epidemiology of carpal tunnel syndrome in diabetic patients, and compare the outcome of carpal tunnel decompression with non-diabetic patients. The primary endpoint was improvement in the QuickDASH score. The prevalence of diabetes mellitus was 11.3% (176 of 1564). Diabetic patients were more likely to have severe neurophysiological findings at presentation. Patients with diabetes had poorer QuickDASH scores at one year post-operatively (p = 0.028), although the mean difference was lower than the minimal clinically important difference for this score. After controlling for underlying differences in age and gender, there was no difference between groups in the magnitude of improvement after decompression (p = 0.481). Patients with diabetes mellitus can therefore be expected to enjoy a similar improvement in function.

Carpal tunnel syndrome: the role of occupational factors among 906 workers

Background

Carpal tunnel syndrome (CTS) is common in the industrial setting. However,there is a controversy about the sole role of occupational ergonomic hazards in CTS.

Objectives

This study was conducted among assembling workers of a detergent factory and computer users with the aims of A) determination of CTS prevalence and B) evaluation of personal risk factors and level of exposure to occupational risk factors via Quick Exposure Check (QEC).

Materials and Methods

In this descriptive cross-sectional study, 906 cases (332 assembling workers and 574 computer workers) were enrolled. CTS was assessed by symptoms on the Katz hand diagram and physical examination. QEC technique was applied to evaluate physical exposure to the risk factors.

Results

According to this study, the prevalence of probable CTS was 14% in men and 8.9% in women; the rate of probable CTS was significantly higher in assembly workers than in computer users (P < 0.001). Mean age and work duration in the probable CTS group was statistically higher than in non-CTS group. But both groups were in the same range (fewer than 30, P = 0.024, 0.004); BMI in the probable CTS group was slightly lower than in non CTS group, but BMI in both groups were in the normal range. Wrist ratio > 0.7 correlated with increased risk of probable CTS (P < 0.001) Prevalence of probable CTS was significantly higher in third and fourth levels of QEC (P < 0.001).

Conclusions

Although this article had limitations, our findings suggest that the level of occupational exposure is an indicator of CTS development.

Prevalence of clinical findings of carpal tunnel syndrome in Isfahanian dentists

BACKGROUND

Carpal tunnel Syndrome (CTS) is the most common compression neuropathy. Jobs with frequent and repetitive hand movements are one of the risk factors for this syndrome. The aim of this study was to determine the prevalence of CTS in Isfahanian dentists.

MATERIALS AND METHODS

In this cross-sectional descriptive study, 240 dentists were evaluated for CTS. Diagnosis was made according to both questionnaire and clinical tests of Phalen and Tinel. Age, sex, years of experience, working hours per week and the type of procedure were considered as dependent variables. All data were analyzed by Chi-square and T-test using SPSS software 11.5 (α=0.05).

RESULTS

Among the dentists who were studied, 173 (72%) were male and 67 (28%) were female. 16.2% of males and 17.9% of females had symptoms of CTS and there wasn't any significant difference between them (P>0.05%). the prevalence increased with advancing age. In a way that it reached to 22.2% in ages more than 55 in contrast to 6% among individuals between 25-34 years old. With increasing of experience to 15 years the risk of CTS increased but an unexpected reduction was observed with more than 15 years of experience.

CONCLUSION

This study showed the prevalence of CTS was 16.7% among dentists and was more common in older dentists. CTS prevalence was increased with age. The dentist population with more working hours per week and more experience years were more susceptible for this syndrome. Using suitable gloves, wrist splints and short periods of resting during vigorous continuous working can decrease the symptoms of this disease.

Hand-held nerve conduction device in carpal tunnel syndrome: a prospective study

INTRODUCTION

We assessed the clinical impact of replacing standard neurophysiologic testing with a hand-held device (Mediracer) for diagnosis of carpal tunnel syndrome (CTS).

METHODS

One hundred patients (200 hands) with suspected CTS were studied by blinded assessors [Hand-therapist (HT)1 and Consultant Neurophysiologist] using the Mediracer, followed by standard neurophysiologic testing. To simulate testing by personnel without neurological training, Mediracer recordings were analyzed separately by an assessor who had not seen the patients (HT2).

RESULTS

Correlation of the CTS grades was 0.94 for the results obtained by HT1, and 0.87 for HT2. The sensitivity and specificity of the Mediracer was 0.85 and 0.9, respectively, by HT1, and 0.84 and 0.89 for HT2. Nine patients had conditions other than CTS, and 35 patients were judged to require further investigation.

CONCLUSIONS

The Mediracer should only be used in patients with typical CTS symptoms and signs and no muscle wasting who have had careful neurological assessment.

Carpal tunnel syndrome and metabolic syndrome co-occurrence

We aimed to evaluate the relation between the severity of carpal tunnel syndrome and metabolic syndrome. One hundred and fifty patients who had a clinical and electrophysiologically confirmed diagnosis of carpal tunnel syndrome (CTS), were included in this study. The patients were divided into two groups (with or without metabolic syndrome) according to the criteria of National Cholesterol Education Program. Eighty one (73.5 %) of the patients with CTS had metabolic syndrome. The patients with metabolic syndrome the severity of CTS was found 22.2 % had mild CTS, 56.8 % had moderate CTS, and 21 % had severe CTS. The patients without metabolic syndrome the severity of CTS was found 44.9 % had mild CTS, 40.6 % had moderate CTS, and 14.5 % had severe CTS. The severity of CTS between both groups was found to be statistically significant (p = 0.0009). While a correlation was found between the severity of CTS and high level of LDL with the presence of metabolic syndrome (correlation coefficient 0.209). In conclusion metabolic syndrome that appears to be a risk factor for CTS. At the same time, the presence of metabolic syndrome increases the severity of the disease.

Color Doppler ultrasound for evaluation of vasomotor activity in patients with carpal tunnel syndrome

BACKGROUND

Patients with carpal tunnel syndrome (CTS) have a variety of vasomotor symptoms. Here, we aimed to study the vasomotor activity of the radialis indicis (RI) artery (median nerve territory) and the radial palmar digital (RPD) artery of the little finger (ulnar nerve territory) before and after sympathetic stimulation in CTS patients using color Doppler ultrasound.

METHODS

We performed a cross-sectional study of 46 consecutive CTS patients plus 36 healthy controls. All patients underwent electromyography studies and were classified into mild and moderate/severe groups according to electrodiagnostic findings. Color Doppler examination of the RI artery and the RPD artery of the little finger were performed with the participants in a relaxed sitting position and after a deep breath followed by a cough (sympathetic stimulation). The pulsatility index (PI) was recorded at the point of maximal change in waveform, before and after this stimulus.

RESULTS

The PI of RI artery was significantly lower (p < 0.01) in CTS patients than healthy controls, both before and after stimulation. The changes in PI of RI artery after stimulation were significantly lower in CTS patients than healthy controls (1.18 ± 0.37 vs. 5.41 ± 0.87; p < 0.001). The same pattern was seen for PI of RI artery when comparing patients with mild vs. moderate/severe CTS. No difference was found in PI of RPD artery of the 5th finger between patients vs. controls and between patients with mild vs. moderate/severe CTS, both before and after stimulation.

CONCLUSIONS

We showed that color Doppler ultrasound can readily determine impaired vasomotor activity in CTS patients.

Prevalence of carpal tunnel syndrome among dairy workers

BACKGROUND

The purpose of this study was to determine the prevalence of carpal tunnel syndrome (CTS) among dairy workers.

METHODS

Sixty-six dairy parlor workers and 58 non-parlor workers at dairies in Texas, New Mexico, and Colorado participated in structured interviews regarding demographics, work history, and hand symptoms. All participants had nerve conduction studies performed on both hands across the carpal tunnel. A CTS case definition was based on the presence of characteristic CTS symptoms and an abnormal median mononeuropathy across the carpal tunnel.

RESULTS

The prevalence of CTS among the dairy parlor workers was 16.6% and 3.6% among non-parlor workers. The difference was found to be statistically significant (P < 0.05) with an odds ratio of 5.3, CI (1.1-25.5).

CONCLUSIONS

The results of this study indicate that CTS is a significant challenge for dairy parlor workers. The prevalence of CTS was found to be significantly higher among dairy workers performing tasks in the milking parlor as opposed to workers performing tasks in other areas of the dairy farm. The results emphasize the need for administrative and engineering controls to limit the exposure to physical risk factors that are associated with upper limb disorders such as CTS.

Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings

OBJECTIVE

Carpal tunnel syndrome (CTS) represents one of the most prevalent peripheral entrapment mononeuropathies. The purpose of our study was to assess the potential correlation between intraneural hypervascularization, flexor retinaculum bowing, and median nerve cross-sectional area and the severity of CTS in cases confirmed by nerve conduction study.

SUBJECTS AND METHODS

Sixty consecutive patients with classic or probable symptoms of CTS were enrolled in the study. A control group consisting of 27 healthy volunteers who were never diagnosed with CTS or had any symptoms of CTS was recruited among institution employees. All symptomatic patients were initially examined by a hand surgeon and subsequently referred for sonographic and electrophysiologic examinations.

RESULTS

A total of 90 wrists (in 60 patients) were included in the study. Twenty-eight (31.1%) had mild CTS, 33 had moderate disease, and 29 had severe disease. We detected significant correlation between median nerve hypervascularization and the severity of CTS (p = 0.01, logistic regression) for moderate CTS and (p = 0.04) for severe disease. We also detected a significant correlation in flexor retinaculum bowing and median nerve cross-sectional area with increase in the severity of CTS (p < 0.001 and < 0.008; chi-square test and analysis of variance, respectively).

CONCLUSION

Our study suggests that the severity of CTS strongly correlates with color Doppler sonography findings, and this technique may represent a reliable complementary tool in CTS examination.