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Ogura Y, Miyoshi H, Yoshida S, Arakawa F, Takeuchi M, Nakama K, Matsuura M, Takada H, Yamanaka Y, Hiraoka K, Ohshima K. Comprehensive gene expression analysis using RNA sequencing between male and female patients with idiopathic carpal tunnel syndrome. J Orthop Res 2024. [PMID: 38855962 DOI: 10.1002/jor.25914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/25/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
Idiopathic carpal tunnel syndrome is the most common entrapment neuropathy in hand surgery, and it is characterized by Noninflammatory fibrosis of subsynovial connective tissues. The prevalence and incidence differ between male and female individuals, and the mechanism underlying this difference remains largely unclear. In the present study, we collected subsynovial connective tissues from six male and six female patients diagnosed with idiopathic carpal tunnel syndrome during surgery. We performed a comprehensive gene expression analysis using RNA sequencing to compare the gene expression profiles between male and female patients with idiopathic carpal tunnel syndrome. We identified 26 genes with significantly different expressions between male and female patients, in which POSTN, COL1A1, and COL3A1, which are involved in extracellular matrix organization, and IGF1, an important fibrotic factor, were significantly upregulated in male patients. Immunohistochemistry confirmed the expression of proteins encoded by these genes in tissues, and male patients tended to show increased POSTN expression. Our results indicate that fibrosis of subsynovial connective tissues is induced by different mechanisms in male and female patients, and genes involved in extracellular matrix organization, especially POSTN, might be important factors in male patients. This study provides insight into the pathogenesis of idiopathic carpal syndrome and might contribute to the development of new treatment strategies.
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Affiliation(s)
- Yusuke Ogura
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Shiro Yoshida
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Fumiko Arakawa
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Mai Takeuchi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Kenjiro Nakama
- Department of Orthopaedic Surgery, Kawasaki Hospital, Yame, Japan
| | - Mitsuhiro Matsuura
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hirofumi Takada
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Hiraoka
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
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Nakamichi R, Saito T, Shimamura Y, Hamada M, Nishida K, Ozaki T. Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision. BMC Musculoskelet Disord 2024; 25:251. [PMID: 38561698 PMCID: PMC10983724 DOI: 10.1186/s12891-023-07151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/23/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy. METHODS Sixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient's satisfaction with the surgery. RESULTS In the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7). CONCLUSIONS ECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.
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Affiliation(s)
- Ryo Nakamichi
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Taichi Saito
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan.
| | - Yasunori Shimamura
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Keiichiro Nishida
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
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Singh RP, Maurya AP, Rout AK, Singh S. Carpal tunnel syndrome secondary to a giant lipoma of the wrist and distal forearm. BMJ Case Rep 2024; 17:e256971. [PMID: 38373813 PMCID: PMC10882456 DOI: 10.1136/bcr-2023-256971] [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] [Indexed: 02/21/2024] Open
Abstract
In up to 2% of the population, benign tumours called lipomas can develop. When they are more than 5 cm, they are considered giant lipomas. Giant lipomas of the distal forearm and hand may cause compression to the underlying tissues, nerves and muscles, even though they are typically asymptomatic. An older woman with soft tissue swelling in her right wrist and forearm, and numbness and pain in her right hand presented to the general surgery outpatient clinic. Her numb fingers indicated that the median nerve was compressed, and an MRI scan of her wrist and forearm revealed median nerve compression due to a giant lipoma with a dimension of about 9.2×3.4×4 cm. A surgical excision was done with an intraoperative nerve stimulator, and the specimen sent for histopathology confirmed the diagnosis of lipoma. Pain, numbness and motor power improved within 1 week postoperatively, and the patient was discharged.
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Affiliation(s)
| | | | | | - Sourabh Singh
- General Surgery, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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Huang CY, Lai CY, Reeves KD, Lam KHS, Li TY, Cheng CI, Wu YT. Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome: A Prospective, Randomized, and Single-Blind Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:161-169. [PMID: 37873682 DOI: 10.1002/jum.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES This study compared ultrasound-guided nerve hydrodissection (HD) outcomes using two commonly used injectate volumes (10 and 5 mL) of normal saline to explore if there is a volume effect of HD for patients with moderate carpal tunnel syndrome (CTS). METHODS Twenty-four participants were randomly assigned to treatment with HD using ultrasound-guidance and either 10 mL or 5 mL of normal saline (HD-10 and HD-5 groups respectively). Our primary outcome measures were the change scores of the two subscales of the Boston Carpal Tunnel Syndrome Questionnaire: The Symptom Severity Scale (SSS) and Functional Status Scale (FSS). We conducted a one-way repeated analysis of variance for 3 time points (4, 12, and 24 weeks) for both SSS and FSS, respectively, for change scores from time 0, and percentage change from time 0. RESULTS All participants (n = 12 per group) completed the study. From 0 to 24 weeks the HD-10 group outperformed the HD-5 group for improvement in SSS (median ± IQR; -0.8 ± 0.4 versus -0.5 ± 0.5; P = .024) and FSS scores (mean ± SD; -0.8 ± 0.2 versus -0.5 ± 0.5; P = .011). The HD-10 group improvement in FSS subtest significantly exceeded the MCID percentage-change-based threshold of 27% (34%; P = .039). CONCLUSIONS Despite the limitations of small study size, a largely inert injectate, and a single injection approach, these findings in favor of the 10 mL group suggest that the volume used for ultrasound-guided HD in moderate CTS matters, and a higher volume is more effective.
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Affiliation(s)
- Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | - Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Chaudhary R, Khanna J, Bansal S, Bansal N. Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment. Curr Drug Targets 2024; 25:221-240. [PMID: 38385490 DOI: 10.2174/0113894501280331240213063333] [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: 10/17/2023] [Revised: 01/01/2024] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand. OBJECTIVES The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage. METHODS Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome. RESULTS The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments. CONCLUSION We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.
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Affiliation(s)
- Rishabh Chaudhary
- Department of Pharmacology, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana-133207, India
| | - Janvi Khanna
- Department of Pharmacology, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana-133207, India
| | - Seema Bansal
- Department of Pharmacology, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana-133207, India
| | - Nitin Bansal
- Department of Pharmacy, Chaudhary Bansilal University, Bhiwani, India
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Murciano Casas MP, Rodríguez-Piñero Durán M, Delgado Mendilivar JM, Expósito Tirado JA, Jiménez Sarmiento AS. [Analysis of the echographic parameters described in the study of carpal tunnel syndrome: A systematic review]. Rehabilitacion (Madr) 2024; 58:100822. [PMID: 37864963 DOI: 10.1016/j.rh.2023.100822] [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: 08/21/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 10/23/2023]
Abstract
Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy; the diagnosis is established by electrodiagnostic tests with until 34% of false positives/negatives. We present the following systematic review which objective is to analyze the most recent literature related to the ultrasound parameters described to study CTS. We selected studies that evaluated ultrasound parameters in patients with clinical suspicion following the Cochrane manual's recommendations. We include systematic reviews, meta-analyses, case-control studies and diagnostic tests, evaluating retrospective studies and bibliographic reviews with proper methodological quality. Articles published between 2005 and 2019. We included eight articles (two systematic reviews/meta-analyses, two case-control studies, one diagnostic test study, two literature reviews, and one retrospective). The parameters analyzed were cross-sectional area, wrist-forearm index, entry-exit index, thinning range, palmar bowing of the flexor retinaculum, and vascularity/mobility. Current evidence allows us to affirm that ultrasound is useful in screening for CTS.
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Affiliation(s)
- M P Murciano Casas
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | | | - J A Expósito Tirado
- Servicio de Rehabilitación y Medicina Física, Hospital Virgen de Valme, Sevilla, España
| | - A S Jiménez Sarmiento
- Servicio de Rehabilitación y Medicina Física, Hospital Virgen de Valme, Sevilla, España
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Lo YC, Lin CH, Huang SW, Chen YP, Kuo YJ. High incidence of trigger finger after carpal tunnel release: a systematic review and meta-analysis. Int J Surg 2023; 109:2427-2434. [PMID: 37161585 PMCID: PMC10442144 DOI: 10.1097/js9.0000000000000450] [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: 12/09/2022] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Trigger finger (TF) often occurs after carpal tunnel release (CTR), but the mechanism and outcomes remain inconsistent. This study evaluated the incidence of TF after CTR and its related risk factors. MATERIALS AND METHODS PubMed, Embase, and Scopus databases were searched up to 27 August 2022, with the following keywords: "carpal tunnel release" and "trigger finger". Studies with complete data on the incidence of TF after CTR and published full text. The primary outcome was the association between CTR and the subsequent occurrence of the TF and to calculate the pooled incidence of post-CTR TF. The secondary outcomes included the potential risk factors among patients with and without post-CTR TF as well as the prevalence of the post-CTR TF on the affected digits. RESULTS Ten studies with total 10,399 participants in 9 studies and 875 operated hands in one article were included for meta-analysis. CTR significantly increases the risk of following TF occurrence (odds ratio=2.67; 95% CI 2.344-3.043; P <0.001). The pooled incidence of TF development after CTR was 7.7%. Women were more likely to develop a TF after CTR surgery (odds ratio=2.02; 95% CI 1.054-3.873; P =0.034). Finally, the thumb was the most susceptible fingers, followed by middle and ring fingers. CONCLUSIONS High incidence of TF comes after CTR, and women were more susceptible than man. Clinicians were suggested to notice the potential risk of TF after CTR in clinical practice. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Yu-Chieh Lo
- Department of Primary Care Medicine, Shuang Ho Hospital
| | | | | | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Mamipour H, Negahban H, Aval SB, Zaferanieh M, Moradi A, Kachooei AR. Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial. J Bodyw Mov Ther 2023; 35:378-384. [PMID: 37330796 DOI: 10.1016/j.jbmt.2023.04.033] [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: 10/05/2021] [Revised: 10/09/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome in the upper extremities. Acupuncture is often used as a treatment method in CTS and numerous studies consider it effective. However, no study has yet compared the efficacy of physical therapy including bone and neural mobilization, exercise and electrotherapy with and without acupuncture in CTS patients. PURPOSE comparing the effect of physiotherapy plus acupuncture with physiotherapy alone on pain, disability and grip strength in CTS patients. METHOD Forty patients with mild to moderate CTS were randomly divided into two equal groups. Both groups received exercise and manual techniques for 10 sessions. Patients in the physiotherapy plus acupuncture group also received 30 min of acupuncture in every session. The visual analog scale (VAS) score, the score on the Boston carpal tunnel questionnaire for functional status and symptom severity, shortened disability of arm, shoulder, hand (Quick-DASH) score and grip strength were evaluated at pre-test and post-test. RESULTS According to ANOVA results, there is a significant interaction between group and time for VAS, BCTQ and Quick-DASH parameters. At the post-test, while the parameters of VAS, BCTQ and Quick-DASH in the physiotherapy plus acupuncture group had a statistically significant difference compared to the physiotherapy group, no significant difference was observed between the two groups in the pre-test. Moreover, there is no significant difference between groups in grip strength improvement. CONCLUSION This study shows preliminary evidence that physiotherapy plus acupuncture, was more effective than physiotherapy alone in pain relief and improving disability of patients suffering from CTS.
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Affiliation(s)
- Hamed Mamipour
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Shapour Badiee Aval
- Department of Complementary and Chinese Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahsa Zaferanieh
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Reza Kachooei
- Rothman Orthopaedic Institute, AdventHealth, Orlando, FL, USA; Department of Orthopaedics, University of Central Florida, FL, USA.
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Fattah SA, Selim MS, Abdel Fattah MA, Abo-Elmatty DM, Mesbah NM, Abdel-Hamed AR. Serum Transforming Growth Factor β1 and Its Genetic Variants Are Associated with Increased Macrophage Inflammatory Protein 1β and Susceptibility to Idiopathic Carpal Tunnel Syndrome. J Pers Med 2023; 13:jpm13050715. [PMID: 37240885 DOI: 10.3390/jpm13050715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy in which one of the body's peripheral nerves becomes pinched or crushed. Transforming growth factor beta 1 (TGF-β1) plays an important role in the pathogenesis of CTS. An association between TGF-β1 polymorphisms and the susceptibility or progression of a number of diseases has been reported. In this study, three TGF-β1 single nucleotide polymorphisms (SNPs), serum TGF-β1, and macrophage inflammatory protein 1 beta (MIP-1β) were investigated as potential diagnostic markers for the progression of CTS in Egyptian patients. One hundred CTS patients and 100 healthy controls were recruited for the study. TGF-β1 SNPs +915G/C, -509C/T and -800G/A were determined by TaqMan genotyping assay. Serum TGF-β1 and MIP-1β levels were measured by ELISA. Serum TGF-β1 and MIP-1β levels increased significantly and were strongly correlated with the occurrence of CTS. The C allele of +915G/C, the T allele of -509C/T, and the G allele of -800G/A occurred more frequently in patients from CTS than in controls. The serum levels of TGF-β1 and MIP-1β in the group of carriers of the genotypes +915G/C GC and CC, the genotype -509C/T TT and the genotype -800G/A GA and AA were significantly higher in CTS patients. TGF-β1 and its +915G/C, -509C/T, and -800G/A SNPs and MIP-1β could be useful prognostic markers for the occurrence of CTS.
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Affiliation(s)
- Shaimaa A Fattah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Mohamed S Selim
- Cardiovascular Therapy Department, Novartis Company, Riyadh 12271, Saudi Arabia
| | - Maha A Abdel Fattah
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Dina M Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Noha M Mesbah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
| | - Asmaa R Abdel-Hamed
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt
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Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AES, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel) 2023; 13:diagnostics13061138. [PMID: 36980446 PMCID: PMC10046938 DOI: 10.3390/diagnostics13061138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.
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Affiliation(s)
- King Hei Stanley Lam
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Faculty of Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: ; Tel.: +852-23720888
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Kenneth Dean Reeves
- Private Practice PM&R and Pain Management, 4840 El Monte, Roeland Park, KS 66205, USA
| | - Felice Galluccio
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Fisiotech Lab. Studio, Rheumatology and Pain Management, 50136 Firenze, Italy
- Morphological Madrid Research Center (MoMaRC), 10107 Madrid, Spain
| | - Abdallah El-Sayed Allam
- Morphological Madrid Research Center (MoMaRC), 10107 Madrid, Spain
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Clinical Neurophysiology Fellowship, Arab Board of Health Specializations, Ministry of Health, Baghdad 61298, Iraq
| | - Philip W. H. Peng
- Department of Anesthesiology and Pain Medicine, The University of Toronto, Toronto, ON M5T 2S8, Canada
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Liu Y, Yang J, Dong W, Liu W, Chen L, Li J, Chen J, Zhou X, Yin H, Li J. Comparison of acupotomy release combined with glucocorticoid intrathecal injection versus isolated glucocorticoid intrathecal injection for carpal tunnel syndrome: A protocol for a meta-analysis of comparative studies. Medicine (Baltimore) 2023; 102:e32940. [PMID: 36862892 PMCID: PMC9981390 DOI: 10.1097/md.0000000000032940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is more common in people who need to engage in repetitive wrist work. Once it has occurred, localized pain and numbness of the fingers will develop, in severe cases, muscle atrophy will even arise, and after rest and physical therapy, many patients will still be unable to relieve or recur. In this case, the patient can receive intrathecal glucocorticoid injections, but the hormone injections alone can only provide short-term relief, and because the mechanical factors of median nerve compression are not fundamentally removed. Therefore, combined acupotomy release can help to release the compression of the transverse carpal ligament on the nerve and increase the volume within the carpal tunnel to achieve more satisfactory long-term results. Hence, a meta-analysis is necessary to provide evidence whether there is a significant difference in the treatment of CTS with acupotomy release combined with glucocorticoid intrathecal injection (ARGI) compared with isolated glucocorticoid intrathecal injection (GI). METHODS We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed, Cochrane central register of controlled trials, Web of Science, Chinese national knowledge infrastructure, Wanfang data, Chinese scientific journals database, Chinese databases SinoMed, and electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for nonrandomized studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS This systematic review will evaluate the difference in efficacy of ARGI versus isolated GI in the treatment of CTS. CONCLUSION The conclusion of this study will provide evidence for judging whether ARGI is superior to GI for treatment of CTS.
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Affiliation(s)
- Yukun Liu
- Anning Municipal Hospital of Traditional Chinese Medicine, Anning City, China
| | - Jingfan Yang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Wei Dong
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Weitong Liu
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Li Chen
- Anning Municipal Hospital of Traditional Chinese Medicine, Anning City, China
| | - Jiao Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Jiankun Chen
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Xing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang, China
| | - Hong Yin
- Kunming University of Science and Technology Hospital, Kunming City, Yunnan Province, China
| | - Jinlei Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
- * Correspondence: Jinlei Li, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, No.25, Dongfeng East Road, Panlong District, Kunming City, Yunnan Province, P.R. China (e-mail: )
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El-Hady AO. The sensitivity of median versus ulnar palmar mixed nerve study in the early diagnosis of carpal tunnel syndrome. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-022-00163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Abstract
Background
Electrodiagnostic tests (EDX) are the most frequent and applicable studies in early diagnosis of carpal tunnel syndrome (CTS), but the definitive sensitive and specific tests are still under study. We aimed to evaluate the role of the median versus ulnar palmar mixed nerve study (Mix M-U), and its sensitivity in comparison to other provocative comparison studies, in supporting the early diagnosis of CTS. This cross-sectional study included 142 idiopathic early CTS hands from 100 patients and 71 hands from 50 healthy subjects as a control group. We did routine median motor and sensory studies and 4 comparative tests namely median versus radial sensory study (MVR), Mix M-U, median versus ulnar sensory study (MVU), and median versus ulnar lumbrical-interossei motor study (LU-IN).
Results
The routine median motor and sensory latency and amplitude showed a statistically significant difference between CTS and control groups as (p< 0.05) and a highly statistically significant difference between the 2 groups as regards the 4 comparative tests as (p< 0.0001). The specificities of all the 4 comparative tests were higher than 90%. MVR test had the highest sensitivity (92.2%) and followed by Mix M-U study (82.2%) and MVU (78.7%), and the least sensitive test was the LM-IN (66.9%).
Conclusions
Although the patients’ results fall within the normal range according to the reference range in the literature, it showed a statistically significant difference when compared to controls. A high percentage of those symptomatic patients showed results of typical CTS when tested with the comparative studies so there is a need to use these sensitive tests to diagnose cases with early CTS. According to sensitivity studies, the selection of which tests to do in order is a challenging choice. For the diagnosis of cases with early CTS with a normal ordinary motor and sensory studies, MVR comparative technique appeared as the best sensitive and specific provocative electrophysiological test followed by the Mix M-U test. We recommend the use of a combination of both tests first in the diagnosis of early CTS and if one of them was negative we can use the other comparative studies MVU and then LM-IN studies.
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Vo NQ, Nguyen DD, Hoang NT, Ngo DHA, Nguyen THD, Trong BL, Le NTN, Thanh TN. Magnetic resonance imaging as a first-choice imaging modality in carpal tunnel syndrome: new evidence. Acta Radiol 2023; 64:675-683. [PMID: 35437022 DOI: 10.1177/02841851221094227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common type of peripheral nerve compression. Magnetic resonance imaging (MRI) is becoming more popular in practice in the evaluation of CTS. PURPOSE To evaluate the diagnostic value of MRI in CTS. MATERIAL AND METHODS A cross-sectional study of 39 wrists was conducted. Clinical and nerve conduction study findings were evaluated and graded according to the Boston Carpal Tunnel Questionnaire (BCTQ) and the American Association of Neuromuscular and Electrodiagnostic Medicine. MRI was performed using a 1.5-T scanner. MRI parameters included cross-sectional area (CSA) of the median nerve and the ratio change in CSA at four levels: distal radioulnar joint (DRUJ-CSA); pisiform (p-CSA); middle of the carpal tunnel (i-CSA); and hook of hamate. The ratio change in CSA was expressed as p-CSA/DRUJ-CSA and ΔCSA (difference between iCSA and DRUJ-CSA), the flattening ratio of the median nerve, the thickness of the flexor retinaculum, flexor retinaculum bowing ratio, signal intensity ratio of the median, nerve and hypothenar muscle signal intensity. RESULTS With a cutoff point of 10.9 mm2 of the p-CSA, MRI had a sensitivity and specificity of 97.4% and 80% for diagnosis of CTS, respectively. There was a significant association between the clinical and electrophysiological stage with MRI findings (P < 0.001). There was a positive correlation between the BCTQ score and MRI parameters (0.5 < r < 0.7, P < 0.01). CONCLUSION MRI has good diagnostic value in evaluating CTS. We recommend using p-CSA ≥10.9 mm2 and ΔCSA ≥2.3 mm2 as MRI diagnostic criteria of CTS.
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Affiliation(s)
- Nhu Quynh Vo
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Duy Duan Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Ngoc Thanh Hoang
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Dac Hong An Ngo
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Thi Hieu Dung Nguyen
- Department of Physiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Binh Le Trong
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Nghi Thanh Nhan Le
- Department of Surgery, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Thao Nguyen Thanh
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
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Hou P, Yu W, Wang C, Qiu S, Sun L, Zhang W. The position of the median nerve in relation to the palmaris longus tendon at the wrist: a study of 784 MR images. J Hand Surg Eur Vol 2023:17531934221148124. [PMID: 36708212 DOI: 10.1177/17531934221148124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Iatrogenic injury of the median nerve has been reported after endoscopic carpal tunnel release and corticoid injection. In 784 MR images of the wrist, the position of the median nerve in relation to the palmaris longus tendon was analysed. The ulnar edge of the median nerve was found medial to the palmaris longus tendon in 14% and 36% of patients at the proximal wrist crease and entrance of the carpal tunnel, respectively, compared with 23% and 40% of patients with carpal tunnel syndrome (88 patients). The position of the median nerve in relation to the palmaris longus tendon varies widely. It is suggested that the palmaris longus tendon may not be considered a safe landmark to locate the position of the median nerve and care should be taken when introducing an endoscopic instrument or during steroid injection for carpal tunnel syndrome.Level of evidence: IV.
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Affiliation(s)
- Peng Hou
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weibin Yu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chunyang Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shuo Qiu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Luyuan Sun
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wen Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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15
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Zhou Q, Shen Y, Zhu X, Sun X, Qiu Z, Li S, Zhang W. Ultrasound-guided percutaneous release procedures in the transverse carpal ligament by acupotomy: A cadaveric study. Front Surg 2023; 9:906109. [PMID: 36684210 PMCID: PMC9852730 DOI: 10.3389/fsurg.2022.906109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to determine the safety and accuracy of ultrasound-guided acupotomy percutaneous loosening of the transverse carpal ligament. Methods The 100 upper limb specimens were equally divided into the ultrasound-guided acupotomy group (U) and the nonultrasound-guided acupotomy group (N). For the U group, we simulated ultrasound-guided acupotomy loosening of the transverse carpal ligament in a human specimen, and for the N group, we performed the loosening of the transverse carpal ligament through the same approach under nonultrasound-guided conditions. The safety and accuracy of the two methods were compared through measurement. Results In the ultrasound-guided group, the injury rate of nerves, blood vessels and tendons caused by needle-knife release was 0%. In the non-ultrasound-guided group, the rate of nerve, blood vessel and tendon damage was 6 percent, 12 percent and 20 percent, respectively. χ 2 test (Fisher exact test) was performed for the nerve and blood vessel damage rates in the two groups (PN > 0.05, PA < 0.05), the difference in nerve damage rates was not statistically significant, but the difference in blood vessel damage rates was statistically significant. Pearson's χ 2 test was performed on the tendon injury rates of the two groups (PF < 0.05), and the difference was statistically significant. In the ultrasound-guided group, the proportion of acupotomy marks greater than or equal to half of the width of the transverse carpal ligament was 86%, and the non-ultrasound-guided group was 36%. The accuracy of the two surgical methods was tested by Pearson's χ 2 test (PL < 0.05), and the difference was statistically significant. According to the measurement, the ultrasound-guided acupotomy technology had high safety and accuracy. Conclusion In this study, we designed a new method for cutting the transverse carpal ligament under ultrasound guidance, which is different from surgery. These results indicate that this is a safe and accurate method of interventional treatment of carpal tunnel syndrome.
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Affiliation(s)
- Qiaoyin Zhou
- College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (FuJian University of TCM), Ministry of Education, Fuzhou, China,Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, China
| | - Yifeng Shen
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, China,Department of Urology, Hospital of Chengdu University of Chinese Medicine, Chengdu, China
| | - Xinyue Zhu
- Department of Acupuncture and Moxibustion, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Xiaojie Sun
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Zuyun Qiu
- Traditional Chinese Medicine Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Shiliang Li
- College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, China,Correspondence: Shiliang Li Weiguang Zhang
| | - Weiguang Zhang
- Health Science Center, Peking University, Beijing, China,Correspondence: Shiliang Li Weiguang Zhang
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16
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Elzinga K, Khayambashi S, Hahn C, Mahe E, Fine NM. Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4757. [PMID: 36699235 PMCID: PMC9872973 DOI: 10.1097/gox.0000000000004757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED Carpal tunnel syndrome (CTS) is common in patients with transthyretin amyloidosis (ATTR), and many experience residual symptoms and/or develop recurrent disease following routine carpal tunnel release (CTR). An extended CTR with median nerve neurolysis is recommended for thorough nerve decompression. Tissue confirmation of amyloidosis can be performed at the time of CTR with biopsies of the transverse carpal ligament and/or tenosynovium. METHODS We describe a retrospective, single-center experience performing an extended CTR technique including unilateral and bilateral cases for 13 consecutive patients (18 wrists) with ATTR and symptomatic median neuropathy at the wrist. RESULTS The mean patient age was 83 (range 67-90) years and 11 (85%) were men. Notable intraoperative findings in all cases included thickened tenosynovium and median nerve epineurium, and adherence of the median nerve to the deep surface of transverse carpal ligament. Pathology findings were positive for amyloidosis from both the transverse carpal ligament and the tenosynovium biopsies in all patients. CONCLUSIONS Extended CTR with simultaneous wrist tissue biopsy can be safely performed for ATTR patients with CTS. Characteristic intraoperative findings should increase clinical suspicion for undiagnosed ATTR and prompt performance of biopsy for diagnostic confirmation. Volar wrist tenosynovial biopsy is our preferred tissue for confirmation of ATTR, for patients with and without CTS, given its safety profile and 100% pathological yield in our series.
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Affiliation(s)
- Kate Elzinga
- Section of Plastic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Shahin Khayambashi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Hahn
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Etienne Mahe
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Kang BH, Woo SR, Park HJ, Chung SY, Kang S, Jeong SH, Yoon JS. Ultrasonographic Assessment of the Safe Zone for Carpal Tunnel Intervention: A Comparison Between Healthy Individuals and Patients With Carpal Tunnel Syndrome. Ann Rehabil Med 2022; 46:284-291. [PMID: 36588443 PMCID: PMC9810651 DOI: 10.5535/arm.22123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To compare transverse and longitudinal safe zones using ultrasonography between healthy individuals and patients with carpal tunnel syndrome (CTS). METHODS This was a prospective observational case-control study. Forty wrists from 20 healthy individuals and 40 wrists from 24 patients with CTS were examined. Patients with CTS were classified into three groups (mild, moderate, and severe CTS) based on electrodiagnostic findings. Using ultrasonography, we measured the distance between the median nerve and ulnar vessels to identify the transverse safe zone, and between the distal flexor retinaculum and superficial palmar artery arch to identify the longitudinal safe zone. RESULTS The transverse and longitudinal safe zones were significantly different between participants with CTS and those without CTS. The transverse safe zone significantly differed between the mild and severe CTS groups, while the longitudinal safe zone was not significantly different between the groups. The cross-sectional area of the median nerve negatively correlated with the transverse and longitudinal safe zones. CONCLUSION Transverse and longitudinal safe zones were narrower in patients with CTS than in the healthy group. A significant difference was observed between patients with mild CTS and those with severe CTS. Furthermore, the cross-sectional area of the median nerve was directly proportional to the degree of narrowing of the transverse and longitudinal safe zones.
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Affiliation(s)
- Byung Heon Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Sang Rok Woo
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Hyun Jin Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seong Yun Chung
- Goodbone Physical Medicine and Rehabilitation Clinic, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seong-Ho Jeong
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea,Corresponding author: Joon Shik Yoon Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea. Tel: +82-2-2626- 1500, Fax: +82-2-859-5422, E-mail:
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18
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Hong J, Wang X, Xue J, Li J, Zhang M, Mao W. Clinical Characteristics and Treatment of Adult Idiopathic Carpal Tunnel Syndrome Accompanied with Trigger Digit. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8104345. [PMID: 36267317 PMCID: PMC9578891 DOI: 10.1155/2022/8104345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
Purpose To investigate the clinical characteristics and treatment of adult idiopathic carpal tunnel syndrome (CTS) accompanied with trigger digit. Materials and Methods A retrospective analysis was performed on a total of 74 patients with adult idiopathic CTS accompanied with trigger digit admitted to and treated at the Hand Surgery Department of Ningbo No. 6 Hospital from January 1, 2017 to December 31, 2019. Data on patients' gender, age, occupation, course of the disease, menstruation, surgeries, examination-related information, complications, treatment methods, and prognoses during follow-up were recorded and subsequently used to analyze the pathogeneses, clinical characteristics, and treatment. Results A total of 74 patients (72 females and 2 males) were included. Among female patients, 51 were postmenopausal and 18 were non-postmenopausal. There were 101 fingers with trigger digit, including 14 patients with trigger digit in both hands, and 115 wrists affected by the CTS. The average course of CTS was 34.5 ± 49.3 months, and that of trigger digit was 10.5 ± 22.4 months. Seventy had both trigger digit and CTS in one hand, while among patients with both hands involved, only 4 had trigger digit or CTS in one hand. Eighty-nine fingers underwent A1 pulley release, and 104 hands underwent carpal tunnel surgery, with steroids being injected under the adventitia of the median nerve during the surgery. All patients who underwent surgeries had I/A-healed incisions, and 14 of them had obvious synovial hyperplasia observed in the carpal tunnel and flexor tendon sheath during surgeries. Follow-up visits, which lasted 3 to 35 months, had an average duration of 1.34 years and included 72 patients. In 63 patients (63/72), the syndrome of tenosynovitis and numbness disappeared and normal hand functions were restored; in 6 patients, the numbness in hands greatly improved and normal hand functions were almost completely restored, while no improvement in numbness of hands and limited hand functions were still observed in 3 patients. Conclusion CTS accompanied with trigger digit was more common in postmenopausal females, and the course of CTS was longer than that of trigger digit. CTS and trigger digit were more likely to simultaneously occur in the same hand, while some patients might not have obvious synovial hyperplasia in the carpal tunnel. Surgeries were effective in severe cases.
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Affiliation(s)
- Jinjiong Hong
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, China
| | - Xiaofeng Wang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, China
| | - Jianbo Xue
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, China
| | - Jimin Li
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, China
| | - Minghua Zhang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, China
| | - Weisheng Mao
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, China
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Ultrasonographical Evaluation of the Median Nerve Mobility in Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12102349. [PMID: 36292039 PMCID: PMC9600711 DOI: 10.3390/diagnostics12102349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022] Open
Abstract
Diagnostic ultrasound is widely used for evaluating carpal tunnel syndrome (CTS), an entrapment neuropathy of the median nerve (MN). Decreased mobility of the MN inside the carpal tunnel has been reported in CTS, and various methods have been used to evaluate MN mobility; however, there is still no conclusive understanding of its connection with CTS. The purpose of this study is to conduct a systematic review and meta-analysis of the current published literature on ultrasonographic evaluations of transverse and longitudinal MN displacement and to identify the relationship between MN mobility and CTS. This study was conducted in accordance with the 2020 PRISMA statement and the Cochrane Collaboration Handbook. Comparative studies that investigated differences in MN displacement between CTS patients and healthy controls were retrieved by searching the Cochrane Library, Embase and PubMed. A total of 15 case–control studies were included. Nine of 12 studies evaluating transverse MN displacement and 4 of 5 studies evaluating longitudinal MN gliding showed that the MN was less mobile in CTS patients than in healthy subjects. Despite the large heterogeneity among the 15 included studies, this systematic review and meta-analysis provide evidence that the mobility of the MN is significantly reduced in both transverse and longitudinal planes in CTS patients compared to healthy controls. Five of the 15 included studies reported that a decrease in transverse or longitudinal MN displacement in CTS was correlated with clinical symptoms or with severity as measured by a nerve conduction study (NCS).
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Yamamoto M, Curley J, Hirata H. Trends in Open vs. Endoscopic Carpal Tunnel Release: A Comprehensive Survey in Japan. J Clin Med 2022; 11:jcm11174966. [PMID: 36078895 PMCID: PMC9456605 DOI: 10.3390/jcm11174966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 01/17/2023] Open
Abstract
We analyzed trends in open and endoscopic carpal tunnel release (CTR) from 2014 to 2019 using the National Database of Health Insurance Claims and Specific Health Checkups in Japan (NDB). Japan has a universal health insurance system and more than 95% of all claims are searchable in the NDB open data repository. The results revealed that nearly 40,000 CTRs were performed annually in Japan, and open CTR was performed almost 4 times more often than endoscopic CTR. The crude annual incidence of CTR in the general population among people 20 years of age or older was 32.2 per 100,000. The incidence of open CTR peaked in the 80–84 age range for both males and females. The incidence of endoscopic CTR peaked at 80–84 years in females and at 75–79 years in males. There was a mild correlation coefficient between the endoscopic CTRs and the number of hand surgery specialists by prefecture per population (r = 0.32, p = 0.04). However, the number of hand surgeons per capita by region and open CTR per capita was not correlated (r = 0.06, p = 0.67). There were about twice as many outpatient as inpatient surgeries, reflecting a trend toward ambulatory treatment.
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The Radiographic Risk Factors Predicting Occurrence of Idiopathic Carpal Tunnel Syndrome in Simple Wrist X-ray. J Clin Med 2022; 11:jcm11144031. [PMID: 35887794 PMCID: PMC9324589 DOI: 10.3390/jcm11144031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
The causes of carpal tunnel syndrome are complex. However, little is known about the risk factors for carpal tunnel syndrome occurrence on simple radiographic images. To determine the X-ray imaging factors that can predict idiopathic carpal tunnel syndrome occurrence, we compared a group diagnosed with idiopathic carpal tunnel syndrome who received carpal tunnel release with a control group that had no symptoms. The simple wrist X-ray findings of 75 patients diagnosed with idiopathic carpal tunnel syndrome and 87 patients selected for the control group were evaluated. All the carpal tunnel syndrome patients were diagnosed based on clinical symptoms and nerve conduction studies. Anteroposterior and lateral radiographs of the wrists were taken in all the groups. The radial inclination, volar tilt, ulnar variance, radiolunate angle, and lunate-to-axis-of-radius distance were measured. Data were measured using two independent raters. After calculating the average of each value, the two groups were statistically compared. The diagnostic performance of statistically different figures was confirmed by drawing receiver operator characteristic curves. There was a significant difference in the radiolunate angle and lunate-to-axis-of-radius distance between the two groups (p < 0.01 and p = 0.028, respectively). The odd ratios for each parameter were 1.052 and 1.319, respectively. The area under the receiver operator characteristic curves were 0.715 and 0.601, respectively. In this study, radiolunate angle and lunate-to-axis-of-radius distance were useful as radiographic diagnostic tools. In other words, excessive dorsiflexion and volar displacement of the lunate can be considered as risk factors that may cause idiopathic carpal tunnel syndrome in the future.
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22
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Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med 2022; 11:jcm11133705. [PMID: 35806998 PMCID: PMC9267718 DOI: 10.3390/jcm11133705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with failure of primary surgery for carpal tunnel syndrome (CTS) present a frustrating clinical problem because there are no relevant treatment guidelines, and the effect of current conservative management or revision surgery is unsatisfactory. Hydrodissection with 5% dextrose is emerging as an effective treatment for primary CTS and may be an effective alternative treatment method for persistent or recurrent post-surgical CTS. We retrospectively investigated the long-term effectiveness of hydrodissection with 5% dextrose for persistent or recurrent CTS. Thirty-six of forty consecutively-treated patients with either persistent or recurrent symptoms of CTS after surgery, who were treated with ultrasound-guided hydrodissection of the median nerve using 10 mL of 5% dextrose, were available to provide outcome data by a structured phone interview at least six months after treatment completion. Symptom relief ≥ 50% represented an effective outcome, while symptom relief < 50% was rated as a poor outcome. Nearly 2/3 (61.1%) of patients reported an effective outcome after a mean of 3.1 injections, with a post-injection follow-up mean of 33 (6−67) months. A non-significant trend toward a more frequently-effective outcome was observed in those with recurrent versus persistent symptoms following CTS (76.9% vs. 52.2%, p = 0.165). However, a significantly higher percentage of those with recurrent symptoms reported an excellent outcome, defined as a greater than 70% improvement (8/13 [61.6%] vs. 3/23 [13%], p = 0.006). The percentage of patients achieving an effective outcome was not significantly different between <2, 2−4, and >4 years of post-treatment follow-up (36.4% vs. 77.8% vs. 57.1%; p = 0.077). Hydrodissection with 5% dextrose may result in a clinically important and durable benefit in those experiencing persistent or recurrent CTS after surgery.
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Affiliation(s)
- Ta-Chung Chao
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong;
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (T.-C.C.); (T.-Y.L.)
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87923311 (ext. 13342)
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Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2155765. [PMID: 35782066 PMCID: PMC9242805 DOI: 10.1155/2022/2155765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/31/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022]
Abstract
Background Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.
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Lee JH, Lee JK, Park JS, Kim DH, Baek JH, Yoon BN, Kim S, Ha C, Cho WM, Han SH. Characteristics of surgically treated Guyon canal syndrome: A multicenter retrospective study. J Plast Reconstr Aesthet Surg 2022; 75:3269-3278. [PMID: 35654688 DOI: 10.1016/j.bjps.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Guyon canal (GC) syndrome is a rare peripheral neuropathy involving the distal part of the ulnar nerve. Several causes are associated with GC syndrome, including anatomic variations, space-occupying tumors, and trauma. Because of disease rarity, the only reported studies of GC syndrome are case series with small sample size. We conducted a multicenter study to identify the basic characteristics of patients with surgically treated GC syndrome and the risk factors for the disease. This retrospective multicenter study was conducted between January 2001 and December 2020. We screened 70 patients who underwent GC release surgery by seven hand surgeons at six institutes. A total of 56 patients were included in this study, including 38 patients (67.9%) who underwent isolated GC decompression and 18 (32.1%) who underwent combined peripheral nerve decompression. The mean patient age was 48.4 years (range: 20-89 years), and 40 patients (71.4%) were male. The average preoperative symptom duration was 18.5 months, and most patients were office workers. Ultrasound was positive for GC syndrome in 7/10 patients evaluated, CT in 2/5, MRI in 17/23, and electrodiagnostic studies in 35/44. The most common cause of GC syndrome was tumor (n = 23), followed by idiopathic (n = 17), trauma (n = 12), anatomic variants (n = 3), and inflammation (n = 3). In conclusion, most patients with GC syndrome in this study were male and had symptoms in one wrist. The most common cause of GC syndrome in this study was a tumor, including a ganglion cyst. Level of Evidence: Level IV case series.
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Affiliation(s)
- Jae Hoon Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
| | - Jun-Ku Lee
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea.
| | - Jin Sung Park
- Department of Orthopedic Surgery, Yeson Hospital, 206 Bucheon-ro, Bucheon-si, Gyeonggi-do, 14555, Republic of Korea
| | - Dong Hee Kim
- Departments of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Jong Hun Baek
- Department of Orthopaedic surgery. College of medicine. Kyung Hee university. Seoul. Republic of Korea, Republic of Korea.
| | - Byung-Nam Yoon
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Segi Kim
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Cheungsoo Ha
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Weong Min Cho
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
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Vihlborg P, Pettersson H, Makdoumi K, Wikström S, Bryngelsson IL, Selander J, Graff P. Carpal Tunnel Syndrome and Hand-Arm Vibration: A Swedish National Registry Case-Control Study. J Occup Environ Med 2022; 64:197-201. [PMID: 34873137 PMCID: PMC8887848 DOI: 10.1097/jom.0000000000002451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the increased risk for carpal tunnel syndrome (CTS) in men and women with hand-arm vibration (HAV) exposure. DESIGN Case-control study of CTS where 4396 cases was obtained from National Outpatient Register between 2005 through 2016. Cases were matched to controls and exposure was estimated using a job exposure matrix. RESULTS Exposure to HAV increased the risk of CTS with an OR of 1.61 (95% CI 1.46-1.77). The risk was highest in men <30 years of age and among women <30 years no increased risk was observed. The risk increased with a mean year exposure above 2.5 m/s2 to OR 1.84 (95% CI 1.38-2.46). CONCLUSIONS HAV exposure increase the risk of CTS in both genders, with highest risk increase in younger men. This emphasize identification of HAV exposure in patients with CTS.
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Affiliation(s)
- Per Vihlborg
- Department of Geriatrics and Odensbackens Health Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Dr Vihlborg); School of Medical Sciences, Örebro University, Örebro, Sweden (Dr Wikström); Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (Dr Pettersson); Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Dr Makdoumi); Center for Clinical Research and Education, County Council of Värmland, Sweden (Dr Wikström); Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Mr Bryngelsson); Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Selander); National Institute of Occupational Health (STAMI), Oslo, Norway (Dr Graff)
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Venkataraman S, Benny R, Chanu A, Singh U, Kandasamy D, Lingaiah R. A randomized controlled trial to compare the effect of ultrasound-guided, single-dose platelet-rich plasma and corticosteroid injection in patients with carpal tunnel syndrome. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Efficacy of 5% Dextrose Water Injection for Peripheral Entrapment Neuropathy: A Narrative Review. Int J Mol Sci 2021; 22:ijms222212358. [PMID: 34830240 PMCID: PMC8621462 DOI: 10.3390/ijms222212358] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/19/2022] Open
Abstract
Current non-surgical treatment for peripheral entrapment neuropathy is considered insignificant and unsustainable; thus, it is essential to find an alternative novel treatment. The technique of perineural injection therapy using 5% dextrose water has been progressively used to treat many peripheral entrapment neuropathies and has been proven to have outstanding effects in a few high-quality studies. Currently, the twentieth edition of Harrison’s Principles of Internal Medicine textbook recommends this novel injection therapy as an alternative local treatment for carpal tunnel syndrome (CTS). Hence, this novel approach has become the mainstream method for treating CTS, and other studies have revealed its clinical benefit for other peripheral entrapment neuropathies. In this narrative review, we aimed to provide an insight into this treatment method and summarize the current studies on cases of peripheral entrapment neuropathy treated by this method.
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Effects of a preoperative neuromobilization program offered to individuals with carpal tunnel syndrome awaiting carpal tunnel decompression surgery: A pilot randomized controlled study. J Hand Ther 2021; 34:37-46. [PMID: 32151500 DOI: 10.1016/j.jht.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/31/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Pilot randomized controlled trial with parallel groups. INTRODUCTION Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. PURPOSE OF THE STUDY To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). METHODS Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. RESULTS Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. DISCUSSION Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program's content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. CONCLUSION A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.
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Saba EKA. Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done.
Results
Regarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%).
Conclusions
The concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.
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Meems M, Boekhorst MGBM, Pop VJM. Long-Term Follow-Up Results of Mechanical Wrist Traction as Non-Invasive Treatment for Carpal Tunnel Syndrome. Front Neurol 2021; 12:668549. [PMID: 34552548 PMCID: PMC8450522 DOI: 10.3389/fneur.2021.668549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: For patients with carpal tunnel syndrome (CTS), the only long-term effective treatment option is carpal tunnel release surgery. Up to one-third report recurrent symptoms, and 12% needs repeated surgery. This study aimed to evaluate the long-term effects of mechanical traction as a non-invasive treatment option for CTS compared to care as usual. Methods: Patients with electrodiagnostically confirmed CTS [N = 181; mean age, 58.1 (13.0) years; 67% women] were recruited from an outpatient neurology clinic in the Netherlands. Patients completed baseline questionnaires and randomized to the intervention group (12 treatments with mechanical traction, twice a week for 6 weeks) or care as usual. The primary clinical outcome measure was surgery during the 12-month follow-up. Secondly, we assessed symptom severity with the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline and at the 12-month follow-up. Changes in CTS symptom severity between baseline and the 12-month follow-up were analyzed between groups using t-tests and a multiple linear regression analyses, adjusting for duration of complaints, age, gender, and symptom severity at baseline. Results: At the 12-month follow-up, 35 of 94 (37%) patients in the intervention group had surgery, compared to 38 of 87 (44%) in the care-as-usual group (χ12 = 0.78, p = 0.377). Symptom severity and functional status scores did not significantly differ between the intervention (n = 81) and care-as-usual group (n = 55) at follow-up. For patients who did not have surgery, BCTQ scores decreased significantly more from baseline to the 12-month follow-up in the intervention group (n = 53) compared to patients in the care-as-usual group (n = 25). For patients who did not have surgery, belonging to the intervention group and a higher BCTQ score at baseline were related to a greater decrease in BCTQ scores from baseline to the 12-month follow-up, as well as symptom severity and functional status. Conclusions: Mechanical traction is effective in reducing symptom severity compared to current conservative treatment options in standard care and can therefore benefit the large number of patients that prefer conservative treatment for CTS. Clinical Trial Registration: Clinical Trials NL44692.008.13. Registered 19 September 2013, https://clinicaltrials.gov/ct2/show/NCT01949493
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Affiliation(s)
- Margreet Meems
- Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, Netherlands
| | - Myrthe G B M Boekhorst
- Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, Netherlands
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Hsiao MY, Wu YW, Chen WS, Lin YL, Kuo PL, Wu CH. Pathogenic Hydrogel? A Novel-Entrapment Neuropathy Model Induced by Ultrasound-Guided Perineural Injections. Int J Mol Sci 2021; 22:ijms22073494. [PMID: 33800600 PMCID: PMC8036453 DOI: 10.3390/ijms22073494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022] Open
Abstract
Entrapment neuropathy (EN) is a prevalent and debilitative condition caused by a complex pathogenesis that involves a chronic compression–edema–ischemia cascade and perineural adhesion that results in excessive shear stress during motion. Despite decades of research, an easily accessible and surgery-free animal model mimicking the mixed etiology is currently lacking, thus limiting our understanding of the disease and the development of effective therapies. In this proof-of-concept study, we used ultrasound-guided perineural injection of a methoxy poly(ethylene glycol)-b-Poly(lactide-co-glycoilide) carboxylic acid (mPEG-PLGA-BOX) hydrogel near the rat’s sciatic nerve to induce EN, as confirmed sonographically, electrophysiologically, and histologically. The nerve that was injected with hydrogel appeared unevenly contoured and swollen proximally with slowed nerve conduction velocities across the injected segments, thus showing the compressive features of EN. Histology showed perineural cellular infiltration, deposition of irregular collagen fibers, and a possible early demyelination process, thus indicating the existence of adhesions. The novel method provides a surgery-free and cost-effective way to establish a small-animal model of EN that has mixed compression and adhesion features, thus facilitating the additional elucidation of the pathophysiology of EN and the search for promising treatments.
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Affiliation(s)
- Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan; (M.-Y.H.); (W.-S.C.); (Y.-L.L.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan; (Y.-W.W.); (P.L.-K.)
| | - Ya-Wen Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan; (Y.-W.W.); (P.L.-K.)
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan; (M.-Y.H.); (W.-S.C.); (Y.-L.L.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan; (Y.-W.W.); (P.L.-K.)
| | - Yu-Ling Lin
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan; (M.-Y.H.); (W.-S.C.); (Y.-L.L.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan; (Y.-W.W.); (P.L.-K.)
| | - Po-Ling Kuo
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan; (Y.-W.W.); (P.L.-K.)
- Department of Electrical Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan; (M.-Y.H.); (W.-S.C.); (Y.-L.L.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 10048, Taiwan; (Y.-W.W.); (P.L.-K.)
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 302058, Taiwan
- Correspondence:
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Ho TY, Chen SR, Li TY, Li CY, Lam KHS, Chen LC, Md YTW. Prognostic factors in carpal tunnel syndrome treated with 5% dextrose perineural injection: A retrospective study. Int J Med Sci 2021; 18:1960-1965. [PMID: 33850465 PMCID: PMC8040404 DOI: 10.7150/ijms.56142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/12/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Perineural injection therapy with 5% dextrose water (D5W) is a potential and innovative treatment with long-term efficacy for carpal tunnel syndrome (CTS). However, the prognostic factors of this management are lacking; hence, the aim of this retrospective study was to identify the prognostic factors of D5W perineural injection therapy for mild-to-moderate CTS. Methods: A total of 52 patients (52 wrists) diagnosed with mild-to-moderate CTS and treated with a single ultrasound-guided 5cc D5W perineural injection were retrospectively reviewed. Patient-reported injection outcomes (visual analog scale, VAS) at 6 months post-injection were categorized into two groups; (1) Good outcome, when symptom relief ≥50% compared to pre-injection and (2) Poor outcome, when symptom relief < 50% compared to pre-injection. Significant variables between groups were entered into a binary logistic regression with forward stepwise regression to determine the prognostic factors for these outcomes. Results: The treatment outcome was significantly related to body height and sensory nerve conduction velocity (SNCV) (159.1 ± 1.0 vs. 155.0 ± 1.8, p=0.04; 33.6 ± 0.8 vs. 28.3 ± 1.2, p=0.001, good vs. poor outcomes). However, only SNCV remained significantly correlated with the outcomes after conducting stepwise logistic regression (ORs: 1.201; 95% CI 1.05-1.38; p=0.01). Conclusions: SNCV was found to be a significant prognostic factor of treatment outcome for patients with mild-to-moderate CTS 6 months after a D5W perineural injection.
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Affiliation(s)
- 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.,Department of Physical Medicine and Rehabilitation, Taichung Armed Forces General Hospital, No. 348, Sec. 2, Chungshan Road, Taiping District, Taichung City, Taiwan, Republic of China
| | - Si-Ru 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
| | - 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
| | - Chun-Yi 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
| | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong.,Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong.,Department of Family Medicine, The University of Hong Kong, Hong Kong
| | - 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
| | - Yung-Tsan Wu Md
- 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
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Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: A double-blind, prospective, randomized, placebo-controlled study. Turk J Phys Med Rehabil 2020; 66:388-397. [PMID: 33364558 PMCID: PMC7756840 DOI: 10.5606/tftrd.2020.3956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives
This study aims to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in carpal tunnel syndrome (CTS) compared to the wrist splint treatment.
Patients and methods
Between April 2016 and March 2017, a total of 189 patients (22 males, 167 females, mean age 48.8±9.5 years, range, 24 to 70 years) with mild-to-moderate CTS were included in this double-blind, prospective, randomized, placebo-controlled study. The patients were divided into four treatment groups using stratified randomization: splint group (Group 1, n=47), splint+ESWT (Group 2, n=47), ESWT (Group 3, n=45), and splint+placebo ESWT (Group 4, n=50). All patients were evaluated at baseline, and one and three months. Pain using the Visual Analog Scale (VAS), finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and electrophysiological examination were assessed.
Results
A total of 168 patients completed the study. There was no significant difference among the four groups in terms of age, sex, comorbid diseases, symptom duration, VAS-pain, BCTQ, and LANSS scores (p>0.05). Pain and functionality significantly improved in all groups (p<0.05). In the group with ESWT and using wrist splint combined, a greater improvement of the hand function and electrophysiological measures was observed.
Conclusion
Our study results show that ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS.
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Barreira M, Marques N, Campos V, Marques G, Gonçalves S, Stefanova Alves S. A giant hand lipoma as a rare cause of secondary carpal tunnel syndrome - A case report. Int J Surg Case Rep 2020; 77:538-542. [PMID: 33395841 PMCID: PMC7701893 DOI: 10.1016/j.ijscr.2020.11.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/14/2020] [Accepted: 11/14/2020] [Indexed: 11/09/2022] Open
Abstract
Space-occupying lesions like lipoma are a rare cause of secondary compression neuropathies of the upper extremity. Atypical symptomatology should raise suspicion of local causes and regular work-up should be extended. Images studies leads to successful diagnosis and guidance of the best surgical treatment. Monobloc resection is still the best treatment to reduce the risk of iatrogenic lesions and disease recurrence.
Introduction Lipomas are a rare cause of compressive neuropathy and they lead to atypical clinical presentation that can mimic carpal tunnel syndrome. Case Presentation The authors describe a rare presentation of a carpal tunnel syndrome recurrence after a hand giant lipoma, presenting with rapidly compression neuropathy of the median nerve, 6 months after de primary surgery. Discussion Lipomas are common benign soft tumours. Their occurrence in the hand remains rare and they rarely cause secondary entrapment neuropathies. Carpal tunnel syndrome is mostly idiopathic and bilateral. Local factors should be suspected when these neuropathies present with atypical symptomatology or even when they recur after primary conventional surgical release. Investigation should consider images studies as this correct preoperative assessment leads to successful diagnosis and treatment.
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Affiliation(s)
- Mariana Barreira
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal.
| | - Nuno Marques
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Vicente Campos
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Guilherme Marques
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Sérgio Gonçalves
- Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
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Yao Y, Grandy E, Evans PJ, Seitz WH, Li ZM. Location-dependent change of median nerve mobility in the carpal tunnel of patients with carpal tunnel syndrome. Muscle Nerve 2020; 62:522-527. [PMID: 32644200 DOI: 10.1002/mus.27017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls. METHODS Eleven healthy volunteers and 11 CTS patients participated in this study. Dynamic ultrasound images captured location-dependent longitudinal median nerve mobility within the carpal tunnel during finger flexion at the metacarpophalangeal joints using a speckle cross-correlation algorithm. RESULTS Median nerve longitudinal mobility in the carpal tunnel was significantly smaller in CTS patients (0.0037 ± 0.0011 mm/degree) compared with controls (0.0082 ± 0.0026 mm/degree) (P < .05), especially in the proximal (0.0064 vs 0.0132 mm/degree on average) and middle (0.0033 vs 0.0074 mm/degree on average) carpal tunnel sections. DISCUSSION Median nerve mobility can potentially serve as a biomechanical marker when diagnosing CTS, or when assessing the effectiveness of surgical and conservative treatments.
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Affiliation(s)
- Yifei Yao
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emily Grandy
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter J Evans
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - William H Seitz
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zong-Ming Li
- Hand Research Laboratory, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
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Asgari MR, Mosaviinejad SS, Ebrahimian A, Aminianfar A, Ghorbani R, Babamohamadi H. The effects of acupressure on the symptoms severity and function status and electrodiagnostic findings in patients with carpal tunnel syndrome. Complement Ther Med 2020; 51:102420. [PMID: 32507434 DOI: 10.1016/j.ctim.2020.102420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effects of acupressure on the symptoms severity, function status and electrodiagnostic findings in patients with Carpal tunnel syndrome (CTS). DESIGN This double blind, randomized, controlled clinical trial study was conducted on 57 patients with CTS that selected through convenience sampling. The patients were randomly assigned to three groups, including (1) acupressure; (2) placebo acupressure; and (3) control. SETTING The study was conducted in the medical centers affiliated to Semnan University of Medical Sciences, Iran. INTERVENTION The intervention groups received acupressure or placebo for one month. The control group received only routine cares (splints and analgesics) with no additional intervention. PRIMARY OUTCOMES The severity of symptoms and hand function were evaluated by the Boston Carpal Tunnel Syndrome Questionnaire, and electrodiagnostic findings, including Nerve Conduction Velocity (NCV), Distal Sensory Latency (DSL), and Distal Motor Latency (DML) were measured by Electromyography device before and after the intervention. RESULTS The results showed significant differences in the mean severity of symptoms, hand function, NCV, DSL, and DML before and after the intervention in the acupressure group (P < 0.05). Significant differences were also observed between the means difference in severity of symptoms, hand function, and NCV, DSL, and DML before and after the intervention in the three groups (P < 0.05). CONCLUSION According to the results, acupressure was effective in reducing the severity of clinical symptoms, improving the hand function, and improving the electrodiagnostic findings. Therefore, the application of acupressure can be recommended for improving clinical symptoms of patients with CTS.
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Affiliation(s)
- Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Abbasali Ebrahimian
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Atefeh Aminianfar
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
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El-Shamy FF, Omar MT, Moghanm FS, El-Shamy H, El-Shamy AM. Ameliorative potential of black sand therapy on carpal tunnel syndrome during pregnancy: A case report. Complement Ther Clin Pract 2020; 39:101149. [PMID: 32379681 DOI: 10.1016/j.ctcp.2020.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/01/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
Hot sand baths are used for the treatment musculoskeletal diseases. The aim of this study was to assess beneficial effect of black sand bathing in the treatment of antenatal carpal tunnel syndrome (CTS). Study was conducted in single case with CTS of the right dominant hand. The treatment time was 20 min/day, 5 days/week for 2 weeks. CTS were evaluated using a visual analogue scale (VAS), pinch gauge dynamometer and Boston Carpal Tunnel Questionnaire (BCTQ) with electrophysiological studies at baseline and at week 2. Pain intensity (VAS) was decreased (34.2%), Tip, Key and Tripod pinch strengths were increased (14.29%), (19.23%) and (21.74%) respectively. Mean scores on the BCTQ-SSS and BCTSQ-FSS were decreased (23.69%) and (20.7%) respectively. Electrophysiological studies revealed that decreased mMDL (11.47%), increased mSNCV (9.23%) at the end of treatment. The black sand bathing is supported as a complementary therapy in antenatal CTS.
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Affiliation(s)
- Fayiz F El-Shamy
- Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Kafrelsheikh University, Kafrelsheikh, Egypt.
| | - Mohammed T Omar
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - F S Moghanm
- Department of Soil and Water, Faculty of Agriculture, Kafrelsheikh University, Egypt
| | - Hany El-Shamy
- Chemistry Department, El Shaheed Ezzat El Shafei Secondary School for Girls, Kafrelsheikh, Egypt
| | - Ahmed M El-Shamy
- Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Egypt
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Kim JR, Lee YK, Lee HJ, Kim JS. Round Acupuncture for the Treatment of Recurrent Carpal Tunnel Syndrome. J Pharmacopuncture 2020; 23:37-41. [PMID: 32322434 PMCID: PMC7163388 DOI: 10.3831/kpi.2020.23.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Round Acupuncture having blunt end has developed from acupotomy. This case report is to find out that Round Acupuncture is effective in treating patients with recurrent carpal tunnel syndrome (CTS), which has not improved by steroid injection or acupotomy. Methods Round Acupuncture was inserted into the distal fibers of transverse carpal ligament and released toward the proximal fibers. Treatment was performed three times in total. T ingling, numbn ess, night pain and swelling sensation were assessed, and provocative maneuvers were also used. Results After treat ment, all symptoms completely disappeared and the patient had no recurrence until 3 months after treatment. Conclusion Round Acupuncture co uld be an effective treatment for recurrent CTS.
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Affiliation(s)
- Ju-Ran Kim
- Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea
| | - Yun Kyu Lee
- Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea
| | - Hyun-Jong Lee
- Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea
| | - Jae Soo Kim
- Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea
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Abstract
Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most frequently reported forms of median nerve compression. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation. The diagnosis of CTS is conducted through medical assessments and electrophysiological testing, although idiopathic CTS is the most typical method of diagnosis for patients suffering from these symptoms. The pathophysiology of CTS involves a combination of mechanical trauma, increased pressure, and ischemic damage to the median nerve within the carpal tunnel. The diagnosis of CTS patients requires the respective medical professional to develop a case history associated with the characteristic signs of CTS. In addition, the doctor may question whether the patients use vibratory objects for their tasks, the parts of the arm where the sensations are felt, or if the patient may already have predisposing factors for CTS incidence. During the diagnosis of CTS, it is essential to note that other conditions may also provide similar symptoms to CTS, thus requiring vigorous diagnosis to assert the medical condition of the patients. Doctors use both non-surgical and surgical treatments when addressing CTS. Non-surgical treatments include wrist splinting, change of working position, medications, and the use of alternative non-vibrating equipment at work. On the other hand, surgical methods include open release and endoscopic surgeries. This review of literature has provided an overview of CTS with an emphasis on anatomy, epidemiology, risk factors, pathophysiology, stages of CTS, diagnosis, and management options.
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Affiliation(s)
- Alessia Genova
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Olivia Dix
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Asem Saefan
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Mala Thakur
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | - Abbas Hassan
- Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
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Aggarwal P, Jirankali V, Garg SK. Accuracy of high‐resolution ultrasonography in establishing the diagnosis of carpal tunnel syndrome. ANZ J Surg 2020; 90:1057-1061. [DOI: 10.1111/ans.15704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/26/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Purnima Aggarwal
- Department of Radiodiagnosis and ImagingGovernment Medical College and Hospital Chandigarh India
| | - Vivek Jirankali
- Department of Radiodiagnosis and ImagingGovernment Medical College and Hospital Chandigarh India
| | - Sudhir K. Garg
- Department of Orthopedic SurgeryGovernment Medical College and Hospital Chandigarh India
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Chang YW, Hsieh TC, Tzeng IS, Chiu V, Huang PJ, Horng YS. Ratio and difference of the cross-sectional area of median nerve to ulnar nerve in diagnosing carpal tunnel syndrome: a case control study. BMC Med Imaging 2019; 19:52. [PMID: 31272405 PMCID: PMC6610846 DOI: 10.1186/s12880-019-0351-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background To evaluate the diagnostic accuracy of the median-to-ulnar nerve ratio (MUR) and the median-to-ulnar nerve difference (MUD) in patients with carpal tunnel syndrome (CTS). Methods In this study, 32 patients with CTS and 32 healthy volunteers were evaluated. All participants received a series of tests and ultrasound examination for the evaluation of the following criteria: cross-sectional area of the median nerve at the pisiform level (CSA-P), swelling ratio (SR), MUR, MUD, and flattening ratio (FR). Results CSA-P, SR, MUR, and MUD were all significantly larger in the patients with CTS than in the healthy volunteers. The areas under the receiver operator characteristic curves of MUD, MUR, CSA-P, and SR were 0.78, 0.75, 0.70, and 0.61 respectively. MUD had higher sensitivity (84%) than MUR, CSA-P, and SR (sensitivity: 63, 63, and 53%, respectively). Conclusions By using the ulnar nerve area at the pisiform level as an internal control parameter, the MUD and MUR methods showed higher diagnostic accuracy than SR in patients with CTS. Further application of these methods in research and clinical settings is recommended. Trial registration Clinicaltrial.gov NCT03033173. Registered 18 January 2017. Retrospectively registered.
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Affiliation(s)
- Yi-Wei Chang
- Department of Physical Medicine and Rehabilitation Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan, Republic of China
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - I-Shiang Tzeng
- Department of Research Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan, Republic of China
| | - Valeria Chiu
- Department of Physical Medicine and Rehabilitation Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan, Republic of China
| | - Pei-Jung Huang
- Department of Physical Medicine and Rehabilitation Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan, Republic of China
| | - Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, New Taipei City, 231, Taiwan, Republic of China. .,Department of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.
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Abstract
BACKGROUND Recurrent carpal tunnel syndrome is often associated with perineural scarring around the median nerve. Surgical options include relatively invasive procedures, such as fat pad grafting, ligament reconstruction, muscle transfer, and nerve wraps. All have limited success because of the possibility of repeated recurrent scarring postoperatively. METHODS We discuss a technique involving injection with external hydroneurolysis of the median nerve under ultrasound guidance for recurrent carpal tunnel. Injection enables a gentler dissection of the surrounding tissues compared with open external neurolysis, with less chance of recurrent scarring. This technique is a unique alternative to repeat operative intervention in recurrent carpal tunnel, as well as a prelude to repeat open decompression and salvage procedures. RESULTS Ultrasound-guided injection with external hydroneurolysis of the median nerve is a safer, more limited procedure compared with repeat open surgery, usually performed in an office setting. This procedure limits risk, anesthesia, and operating/recovery room expenses, offering relief in 70% to 80% of cases. Furthermore, in the 20% to 30% of patients with inadequate relief, surgery remains a viable option. US provides important information on the anatomy of the median nerve and carpal canal and can rule out covert pathology. CONCLUSIONS We offer an alternative treatment for recurrent carpal tunnel syndrome, a difficult problem for which many surgeons recommend nonoperative treatment. US provides objective data concerning residual nerve compression and allows for dynamic assessment. Theoretically, this also offers a viable solution for surgeons and their patients with recurrent carpal tunnel syndrome before being pressed to consider repeat open surgery.
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Setayesh M, Zargaran A, Sadeghifar AR, Salehi M, Rezaeizadeh H. New candidates for treatment and management of carpal tunnel syndrome based on the Persian Canon of Medicine. Integr Med Res 2018; 7:126-135. [PMID: 29984174 PMCID: PMC6026351 DOI: 10.1016/j.imr.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 12/30/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is defined as a compressing median mononeuropathy. CTS is one of the major costly debilitating diseases of the hand. Although CTS is a relatively recent concept in current medicine, some evidences show that medieval physicians in Persian medicine (PM) such as Avicenna were familiar with it. The PM textbook written by Avicenna, the Canon of Medicine, defines the anatomy of carpal tunnel and median nerve, as well as mononeuropathy; it also offers suggestions for the prevention and treatment of carpal tunnel syndrome (called as Vaja al-asab and Khadar) in the chapter of nerve diseases. The book describes not only symptoms including pain, paresthesia, hypoesthesia, tingling, and numbness, but also its etiology such as nerve compression (entrapment neuropathy); nonphysical reasons such as disturbed balance among the four body humors; alteration in the nerve's temperament (Mizaj) that prevents the transmission of nerve impulses; and the others such as nutrition, mental condition, sleep, weather condition, body movements, and proper disposal of body waste. Furthermore, the book suggests a lifestyle modification method based on six factors and 10 prescriptions composed with 85 natural products that are not actively used for CTS treatment in modern times. The medicinal suggestions for CTS in the Canon of Medicine will be good candidates for discovering new treatments besides providing historical significance to the various insights considered 1000 years ago.
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Affiliation(s)
- Mohammad Setayesh
- Department of Persian Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Arman Zargaran
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of History of Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Sadeghifar
- Department of Orthopedic Surgery, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Salehi
- Traditional and Complementary Medicine Research Center (TCMRC), Department of Traditional Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Hossein Rezaeizadeh
- Department of Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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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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Özer G. The impact of serum vitamin D concentration on median nerve conduction. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2018. [DOI: 10.5799/jcei.433800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Yamanaka Y, Menuki K, Tajima T, Okada Y, Kosugi K, Zenke Y, Sakai A. Effect of estradiol on fibroblasts from postmenopausal idiopathic carpal tunnel syndrome patients. J Cell Physiol 2018; 233:8723-8730. [PMID: 29781507 DOI: 10.1002/jcp.26752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/18/2018] [Indexed: 11/08/2022]
Abstract
Fibrosis of the subsynovial connective tissue (SSCT) is a characteristic finding in patients with idiopathic carpal tunnel syndrome (CTS). Idiopathic CTS frequently occurs in postmenopausal women; therefore, female steroid hormones, especially estrogens, may be involved in its development. In this study, we evaluated the effect of the estradiol on the expression of genes and proteins related to fibrosis of SSCT fibroblasts from patients with idiopathic CTS. This study included 10 postmenopausal women (mean age 76 years). Fibroblasts derived from SSCT were treated with estradiol (10-4 -10-12 M), and the expression levels of TGF-β-responsive genes were evaluated. The relationships between the expression of untreated estrogen receptor α (ERα) and ERβ and changes in gene expression due to estradiol treatment were examined by quantitative real-time polymerase chain reaction. The effects of 10-4 M estradiol on collagen type I (Col1) and collagen type III (Col3) protein expression levels were also evaluated by fluorescent staining. The relationships between ERα/β and Col1/3 expression were evaluated by immunohistochemical staining. The reduction in Col1A1 mRNA expression due to estradiol treatment was positively correlated with ERα expression (r = 0.903, p < 0.01). At the protein level, expression of Col1 and Col3 were down-regulated. These results indicated that ERα-mediated signaling may be involved in the regulation of Col1A1, and its regulatory effect may be dependent on the ERα expression level. The accurate evaluation of ERα expression level in the SSCT of individual patients with idiopathic CTS might guide the effective use of new estrogen replacement therapy.
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Affiliation(s)
- Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kunitaka Menuki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Takafumi Tajima
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yasuaki Okada
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Kenji Kosugi
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yukichi Zenke
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Nageeb RS, Shehta N, Nageeb GS, Omran AA. Body mass index and vitamin D level in carpal tunnel syndrome patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:14. [PMID: 29780234 PMCID: PMC5954785 DOI: 10.1186/s41983-018-0009-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/23/2018] [Indexed: 01/03/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. The aim of this study is to evaluate the body mass index (BMI) and vitamin D levels in CTS patients. Methods The current study was conducted at Zagazig University Hospitals. It included 50 CTS patients and 50 controls. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including vitamin D levels, glycosylated hemoglobin, liver, and kidney function were carried out for every participant. All patients underwent electrodiagnostic study and completed Boston questionnaire to assess their pain sum score, symptom severity (SSS), and functional status (FSS). Results Patients had significantly higher BMI and lower vitamin D levels compared to controls (p = 0.003 and p = 0.001, respectively). Those with severe CTS had a significantly higher BMI and lower vitamin D levels than the others (p = 0.03 and p = 0.01 respectively). No significant difference was found between CTS subgroups regarding the SSS, while a higher significant FSS and pain sum score were reported in the severe CTS patients compared to the other two groups (p = 0.01 and p = 0.04 respectively). A significant negative correlation was detected between vitamin D levels and both of BMI, and Boston pain sum scores (p = 0.01 and p = 0.03 respectively). Also, an inverse correlation was detected between vitamin D levels and both of SSS and FSS (p = 0.14, p = 0.06). Furthermore, a significant positive and negative correlation between vitamin D levels and both of conduction velocity and distal motor latency respectively was observed (p = 0.02 and p = 0.01 respectively). Conclusions Carpal tunnel syndrome was significantly associated with hypovitaminosis D especially in patients with higher BMI. This highlights the importance of vitamin D supplements and weight loss regimes to minimize the severity of their pain.
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Affiliation(s)
| | - Nahed Shehta
- Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | | | - Alaa A Omran
- Faculty of Medicine, Zagazig University, Sharkia, Egypt
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Guo XY, Xiong MX, Lu M, Cheng XQ, Wu YY, Chen SY, Chen K, Zhou QD, Wang L, Tan L, Quan JR, He FD, Chen Q. Ultrasound-guided needle release of the transverse carpal ligament with and without corticosteroid injection for the treatment of carpal tunnel syndrome. J Orthop Surg Res 2018; 13:69. [PMID: 29615088 PMCID: PMC5883285 DOI: 10.1186/s13018-018-0771-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/14/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To compare the clinical effectiveness of ultrasound-guided needle release of the transverse carpal ligament (TCL) with and without corticosteroid injection in carpal tunnel syndrome (CTS). METHODS From June 2016 to June 2017, 49 CTS patients (50 wrists) were included in this study. Twenty-five wrists were treated with ultrasound-guided needle release of the TCL plus corticosteroid injection (group A), and 25 wrists were treated with single ultrasound-guided needle release of the TCL (group B). The following parameters were assessed and compared including postprocedure results according to relief of symptoms, ultrasound parameters (cross-sectional area of the median nerve at the levels of pisiform, flattening ratio of median nerve at the levels of the hamate bone, and the thicknesses of TCL on the cross-section at the level of the hamate bone), and electrophysiological parameters (distal motor latency and sensory conduction velocity). RESULTS Group A had higher overall excellent and good rate 3 months after the procedure than group B (84 vs 52%, P < 0.05). There were significant differences regarding the above ultrasonic and electrophysiological parameters between the baseline and postprocedure values in both groups (all P < 0.05). There were significant differences regarding the postprocedure values of above ultrasonic and electrophysiological parameters between the two groups (all P < 0.05). No complications such as infection or tendon rupture were noted. No procedures were converted to the open release. CONCLUSIONS Both techniques are effective in treating CTS. Ultrasound-guided needle release of the TCL with corticosteroid injection had better treatment benefits than single ultrasound-guided needle release of the TCL in treating CTS.
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Affiliation(s)
- Xuan-Yan Guo
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Mao-Xiang Xiong
- Psychiatry Department, Chengdu Mental Health Center, The Fourth People's Hospital of Chengdu, Chengdu, 610036, People's Republic of China
| | - Man Lu
- Ultrasonic Department, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, People's Republic of China
| | - Xue-Qing Cheng
- Ultrasonic Department, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, People's Republic of China
| | - Yan-Yan Wu
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Shi-Yin Chen
- Department of Chinese medicine orthopaedics, Sichuan Academy of Medical Sciences & Sichuan Provincal People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, People's Republic of China
| | - Kai Chen
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Qiao-Dan Zhou
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Lei Wang
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Li Tan
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Jie-Rong Quan
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China
| | - Fan-Ding He
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China.
| | - Qin Chen
- Ultrasonic Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32, West Section 2, Yihuan Road, Qingyang District, Chengdu, 610072, People's Republic of China.
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Chung SY, Kwak JM, Kang S, Son SH, Kim JD, Yoon JS. Predictive Variables for Sonographically Guided Corticosteroid Injection in Mild-to-Moderate Carpal Tunnel Syndrome. Ann Rehabil Med 2018; 42:213-221. [PMID: 29765874 PMCID: PMC5940597 DOI: 10.5535/arm.2018.42.2.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/01/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the predictive variables after sonographically guided corticosteroid injection in carpal tunnel syndrome. METHODS A prospective, observational study was carried out on 25 wrists of 20 consecutive patients with carpal tunnel syndrome, confirmed by the American Association of Neuromuscular and Electrodiagnostic Medicine criteria, which includes clinical history, symptoms, and evidence of slowing of distal median nerve conduction. Visual analogue scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were asked to the patients before and 4 weeks after the procedure. On a basis of VAS difference before and after the procedure, we divided the patients into two groups: more than 50% of VAS improving (good response group) and less than 50% of VAS improving (poor response group). Also, nerve conduction studies and ultrasound evaluations were performed prior to sonographically guided corticosteroid injection and at 4 weeks after the procedure. The cross-sectional area (CSA) of median nerve at maximal swelling point around wrist was measured by manual tracing using ultrasonography. With assessments mentioned above, we tried to assess predictive variables for prognosis after sonographically guided corticosteroid injection in carpal tunnel syndrome. RESULTS The CSA of median nerve at wrist measured before the procedure was significantly larger in good response group than in poor response group. Furthermore, the CSA of median nerve at wrist, symptom severity scale of BCTQ, motor/sensory latency and sensory amplitude were correlated with VAS improving. CONCLUSION The CSA of median nerve at wrist is the strongest predictive value for sonographically guided corticosteroid injection in mild-to-moderate carpal tunnel syndrome.
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Affiliation(s)
- Seong Yun Chung
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Jung Min Kwak
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seong-Ho Son
- Department of Radio Technology Research, Electronics and Telecommunications Research Institute, Daejeon, Korea
| | - Jae Do Kim
- Department of Physical Medicine and Rehabilitation, Graduate School of Korea University, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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Hypercholesterolemia Is Associated with the Subjective Evaluation of Postoperative Outcomes in Patients with Idiopathic Carpal Tunnel Syndrome Who Undergo Surgery: A Multivariate Analysis. Plast Reconstr Surg 2018; 141:941-948. [PMID: 29465486 DOI: 10.1097/prs.0000000000004228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist; its symptoms include neuropathic pain and sensory and motor disturbance distributed by the median nerve. Carpal tunnel syndrome and hypercholesterolemia have similar backgrounds, but the effect of these similarities on postoperative outcomes has not been reported. Using multivariate analysis, the authors analyzed the relationship between prognostic factors, including the presence of hypercholesterolemia, and subjective postoperative outcomes of patients with idiopathic carpal tunnel syndrome. METHODS Of 168 hands with carpal tunnel syndrome that were treated surgically, 141 that were followed up and assessed 1 year postoperatively or thereafter were included. The mean postoperative follow-up period was 40.8 months. Surgery was performed through a small palmar skin incision under local anesthesia. The outcomes were postoperative symptoms, including pain and numbness, and overall Kelly assessment. RESULTS Preoperative numbness and pain resolved and alleviated in 94 of 141 hands and was diminished in 59 of 64 hands. Univariate analysis showed that postoperative numbness and Kelly assessment were significantly associated with hypercholesterolemia. Multivariate analysis showed that postoperative numbness was significantly associated with smoking and hypercholesterolemia, and Kelly assessment was significantly associated with smoking (adjusted OR, 3.3; 95 percent CI, 1.1 to 10; p = 0.04) and hypercholesterolemia (adjusted OR, 2.9; 95 percent CI, 1.4 to 6.3; p = 0.01). CONCLUSION Hypercholesterolemia, usually a systemic condition in sites other than the hand, is associated with the subjective evaluation of postoperative symptoms in patients with idiopathic carpal tunnel syndrome. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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