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Hernández-Secorún M, Abenia-Benedí H, Lucha-López MO, Durán-Serrano M, Hamam-Alcober JS, Krauss J, Booth-Smith C, Hidalgo-García C. Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study. Brain Sci 2024; 14:615. [PMID: 38928615 PMCID: PMC11201705 DOI: 10.3390/brainsci14060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon's visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman's rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman's rho = -0.353) and moderately with SF-36 subscale, Social Functioning (Spearman's rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.
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Affiliation(s)
- Mar Hernández-Secorún
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
| | - Hugo Abenia-Benedí
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
| | - María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
| | - María Durán-Serrano
- Unit of Reconstructive Surgery of the Locomotor System, Hand-Microsurgery, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.D.-S.); (J.S.H.-A.)
| | - Javier Sami Hamam-Alcober
- Unit of Reconstructive Surgery of the Locomotor System, Hand-Microsurgery, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain; (M.D.-S.); (J.S.H.-A.)
| | - John Krauss
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (J.K.); (C.B.-S.)
| | - Christie Booth-Smith
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA; (J.K.); (C.B.-S.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Faculty of Health Science, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (H.A.-B.); (C.H.-G.)
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2
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Rezaee M, Roshandel H, Rahimibarghani S, Rihani TSS, Mohammadyahya E. Predictors of pain intensity in carpal tunnel syndrome: Development and validation of a model. Clin Neurol Neurosurg 2024; 243:108395. [PMID: 38936177 DOI: 10.1016/j.clineuro.2024.108395] [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: 04/04/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Pain often accompanies carpal tunnel syndrome and affects patients' health-related quality of life. The aim was to develop and validate a predictive model for the pain intensity of carpal tunnel syndrome using demographic, clinical, electrophysiological, and ultrasound findings. METHODS We conducted a secondary analysis of data from a large sample of patients (May 2017 to December 2022) with carpal tunnel syndrome. A total of 520 (53.0 %) mild, 276 (28.1 %) moderate, and 186 (18.9 %) severe syndromes were included in the complete data set of 982 hands (61.1 % female). The mean age was 57.8 (10.7) years and the median duration [interquartile range] of the symptoms was 4 [2,10] months. A regression model was developed and validated to predict pain intensity on a numerical rating scale using a tree-based machine learning algorithm. RESULTS The validation of the regression model showed good performance with a root mean squared error, R-squared, and mean absolute error of 1.35, 0.42, and 1.05, respectively. Overall, the top significant predictors of pain intensity were compound motor nerve action potential latency, nocturnal pain, and thenar weakness. These were followed by the cross-sectional area of the median nerve, sensory nerve action potential, bowing of the flexor retinaculum, disease duration, and body mass index. We did not find strong associations between the median nerve transcarpal latency, age, sex, and diabetes with the pain intensity of carpal tunnel syndrome. CONCLUSION Our model showed good performance in predicting the subjective pain intensity of carpal tunnel syndrome, even in the context of non-linear relations.
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Affiliation(s)
- Mehdi Rezaee
- Department of Anesthesiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Islamic Republic of Iran
| | - Hamid Roshandel
- Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Sarvenaz Rahimibarghani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Tayebeh Sadat Salehi Rihani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Elham Mohammadyahya
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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Hannaford A, Paling E, Silsby M, Vincenten S, van Alfen N, Simon NG. Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders. Muscle Nerve 2024; 69:653-669. [PMID: 38433118 DOI: 10.1002/mus.28068] [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: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.
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Affiliation(s)
- Andrew Hannaford
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Elijah Paling
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Matthew Silsby
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sanne Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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van der Heijden B, Dailiana ZH, Giele HP. State of the art review. Upper extremity revision nerve compression surgery. J Hand Surg Eur Vol 2024; 49:687-697. [PMID: 38488612 DOI: 10.1177/17531934241238533] [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] [Indexed: 06/01/2024]
Abstract
Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome.Level of evidence: V.
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Affiliation(s)
- Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Hospital's-Hertogenbosch, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Henk P Giele
- Department of Plastic, Reconstructive and Hand Surgery, John Radcliffe Hospital, Oxford, UK
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Savage NJ, McKell JS. Median Nerve Cross-Sectional Area and Carpal Tunnel Syndrome in Specific Populations: Sonographic Analysis of Patients with Type 2 Diabetes or Bifid Anatomy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38813705 DOI: 10.1002/jum.16491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/01/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Evaluate diagnostic accuracy of median nerve cross-sectional area (CSA) to determine severity versus presence of carpal tunnel syndrome (CTS) across existing electrodiagnostic-based (EDX) classification systems in patients with type 2 diabetes or bifid anatomy. METHODS Retrospective analysis of cross-sectional patient data. Receiver operating characteristic analysis used to determine median nerve CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX-based classifications of CTS in patients with type 2 diabetes or bifid anatomy. Determine shifts in diagnostic probability based on established cutoff values and associated likelihood ratios. Distal CSA measured at or near carpal tunnel inlet, proximal CSA at level of pronator quadratus muscle, and delta CSA by subtracting proximal from distal. RESULTS Binary categorizations of CTS were statistically superior to consolidated categorizations of CTS severity in patients with type 2 diabetes or bifid anatomy. Binary categorizations established reasonably consistent median nerve CSA cutoff values across all EDX-based classifications examined resulting in the following for distal CSA or delta CSA: ≤10 or ≤4 mm2 to rule out and ≥11 or ≥5 mm2 to rule in CTS, respectively. These cutoff values resulted in small shifts in diagnostic probability in patients with type 2 diabetes and small to conclusive shifts in diagnostic probability in patients with bifid anatomy. CONCLUSIONS Binary categorizations to rule out or rule in CTS based on the proposed cutoff values provide the most meaningful information about shifts in diagnostic probability across all EDX-based classifications examined. The use of median nerve CSA to categorize severity of CTS is not recommended in patients with type 2 diabetes or bifid anatomy.
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Affiliation(s)
- Nathan J Savage
- Department of Physical Therapy, Winston-Salem State University, Winston-Salem, North Carolina, USA
| | - John S McKell
- Department of Physical Therapy, McKell Therapy Group, LLC, Provo, Utah, USA
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6
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Savage NJ, McKell JS. Sonographic Measurement of Median Nerve Cross-Sectional Area to Determine Severity of Carpal Tunnel Syndrome: A Cautionary Tale. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38778784 DOI: 10.1002/jum.16486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Evaluate the diagnostic accuracy of median nerve cross-sectional area (CSA) to determine the severity of carpal tunnel syndrome (CTS) vs the presence of CTS across existing electrodiagnostic-based (EDX) classification systems. METHODS Retrospective analysis of cross-sectional patient data. Receiver operating characteristic (ROC) analysis was used to determine CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX-based classifications of CTS severity. Identification of CSA cutoff values associated with likelihood ratios capable of achieving conclusive (but at least moderate) shifts in diagnostic probability. RESULTS Binary categorizations of CTS (ie, "Normal" vs "Absent") were statistically superior to consolidated categorizations of CTS severity (ie, "Normal," "Mild," "Moderate," or "Severe"). Binary categorizations established consistent CSA cutoff values across all EDX-based classifications examined and achieved conclusive shifts in diagnostic probability based on the following values of distal CSA or delta CSA: <7 or <1 mm2 to rule out and >13 or >7 mm2 to rule in CTS, respectively. Additionally, the following values of distal CSA and delta CSA may be used in certain circumstances because they produce only small shifts in diagnostic probability: ≤10 or ≤3 mm2 to rule out and ≥11 or ≥4 mm2 to rule in CTS, respectively. CONCLUSIONS Using median nerve CSA to categorize the severity of CTS is not recommended based on lack of consistent and meaningful shifts in diagnostic probability. Rather, binary categorizations to rule out or rule in CTS based on the proposed CSA cutoff values consistently provided conclusive shifts in diagnostic probability across all EDX-based classifications examined.
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Affiliation(s)
- Nathan J Savage
- Department of Physical Therapy, Winston-Salem State University, Winston-Salem, North Carolina, USA
| | - John S McKell
- Department of Physical Therapy, McKell Therapy Group, LLC, Orem, Utah, USA
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7
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Rotaru-Zavaleanu AD, Lungulescu CV, Bunescu MG, Vasile RC, Gheorman V, Gresita A, Dinescu VC. Occupational Carpal Tunnel Syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies. Front Public Health 2024; 12:1407302. [PMID: 38841666 PMCID: PMC11150592 DOI: 10.3389/fpubh.2024.1407302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
Carpal Tunnel Syndrome (CTS) has traditionally been viewed as a specialized medical condition. However, its escalating prevalence among professionals across a multitude of industries has sparked substantial interest in recent years. This review aims to delve into CTS as an occupational disease, focusing on its epidemiological patterns, risk factors, symptoms, and management options, particularly emphasizing its relevance in professional environments. The complex interaction of anatomical, biomechanical, and pathophysiological factors that contribute to the development of CTS in different work settings underlines the critical role of ergonomic measures, prompt clinical identification, and tailored treatment plans in reducing its effects. Nevertheless, the challenges presented by existing research, including diverse methodologies and definitions, highlight the need for more unified protocols to thoroughly understand and tackle this issue. There's a pressing demand for more in-depth research into the epidemiology of CTS, its injury mechanisms, and the potential role of targeted medicine. Moreover, recognizing CTS's wider ramifications beyond personal health is essential. The economic burden associated with CTS-related healthcare costs, productivity losses, and compensation claims can significantly impact both businesses and the broader society. Therefore, initiatives aimed at preventing CTS through workplace interventions, education, and early intervention programs not only benefit the affected individuals but also contribute to the overall well-being of the workforce and economic productivity. By fostering a collaborative approach among healthcare professionals, employers, policymakers, and other stakeholders, we can strive towards creating safer and healthier work environments while effectively managing the challenges posed by CTS in occupational settings.
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Affiliation(s)
| | | | - Marius Gabriel Bunescu
- Department of Occupational Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Andrei Gresita
- College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY, United States
| | - Venera Cristina Dinescu
- Department of Health Promotion and Occupational Medicine, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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8
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Kodama A, Kurumadani H, Tanaka T, Shinomiya R, Sunagawa T, Adachi N. Association between three-dimensional motion analysis of the thumb and clinical parameters in patients with carpal tunnel syndrome. J Hand Surg Eur Vol 2024; 49:452-457. [PMID: 37873759 DOI: 10.1177/17531934231203163] [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: 10/25/2023]
Abstract
We analysed the relationship between motor dysfunction of the thumb and the clinical parameters of carpal tunnel syndrome using three-dimensional motion analysis. This single-centred, prospective study included 65 hands in 51 patients with idiopathic carpal tunnel syndrome and 30 healthy hands. Three-dimensional thumb kinematics were acquired using a motion capture system with a retroreflective surface-based marker method. The trajectory area of thumb tip, adduction and abduction of the trapeziometacarpal joints and metacarpophalangeal joints were correlated with the clinical parameters. There was no significant correlation between the results of motion analysis values and patient-reported outcomes measures. Thumb movement disorder associated with carpal tunnel syndrome affected specific activities of daily living based on the pinching movements, such as 'writing' and 'buttoning clothes' among the patient-reported outcome measure items.Level of evidence: III.
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Affiliation(s)
- Akira Kodama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Kurumadani
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Teruyasu Tanaka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rikuo Shinomiya
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Sunagawa
- Laboratory of Analysis and Control of Upper Extremity Function, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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9
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Abuharb AI, Almughira AI, Alghamdi HK, Hashem M, Bin Ahmed I, Aloriney A. Prevalence, Awareness, and Management of Carpal Tunnel Syndrome Among Diabetic Patients. Cureus 2024; 16:e53683. [PMID: 38455796 PMCID: PMC10918440 DOI: 10.7759/cureus.53683] [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] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common condition that can significantly affect the quality of life for individuals, particularly those with diabetes. This study aims to examine the severity of CTS symptoms among diabetic patients and explore the associations between demographic factors, diabetic characteristics, knowledge, and management approaches. METHODOLOGY A cross-sectional study was conducted among diabetic patients, and data were collected using standardized questionnaires. The incidence and severity of CTS were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Demographic information, diabetic characteristics, knowledge of CTS, and management approaches were also recorded. Descriptive statistics and inferential analysis were performed to analyze the data. RESULTS The study included 303 participants. The majority of the participants were aged 50 or older (44.9%) (N=136), followed by those aged 39-49 (24.4%) (N=74). In terms of gender, there were more female participants (61.4%) (N=186) than male participants (38.6%) (N=117). Older age groups exhibited higher mean BCTQ scores, suggesting increased severity. Females had significantly higher severity scores compared to males (mean BCTQ score of 17.52 vs 15.56). Regarding diabetic characteristics, complications in the eye and pain/numbness in the legs or feet were significantly associated with higher severity scores of CTS (P=0.0001). The study revealed a knowledge gap among diabetic patients about CTS, with inadequate knowledge about its causes, symptoms, consequences, and treatment options among 68.6% of the patients. The use of medical interventions such as splints, injections, and surgery was associated with higher severity scores. CONCLUSION This study highlights the incidence and severity of CTS symptoms among diabetic patients and its associations with demographic factors, diabetic characteristics, knowledge, and management approaches. Older age, female gender, widowed, diabetic complications in the eye, and pain/numbness in the legs or feet were found to be related to increased severity of CTS. Additionally, inadequate knowledge about CTS was observed among diabetic patients.
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Affiliation(s)
- Abdullah I Abuharb
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Hatan K Alghamdi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Majdi Hashem
- Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Ibrahim Bin Ahmed
- Family Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulmalik Aloriney
- Family Medicine/Diabetes, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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10
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Kimura H, Furuhata R, Matsuo T, Suzuki T, Matsumura N, Sato K, Iwamoto T. Point of care ultrasound combined with CTS-6 to diagnose idiopathic carpal tunnel syndrome. J Orthop Sci 2024:S0949-2658(24)00008-3. [PMID: 38302310 DOI: 10.1016/j.jos.2024.01.007] [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: 11/02/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND This study aimed to demonstrate the effectiveness of our new diagnostic chart using point of care ultrasound combined with CTS-6 for diagnosing idiopathic carpal tunnel syndrome. METHODS We conducted a retrospective analysis of the data of patients who visited our department and received point of care ultrasound combined with CTS-6 from 2020 to 2023. Data regarding age, sex, initial and final diagnosis, cross-sectional area of the median nerve, CTS-6 score, and electrodiagnostic severity were obtained and statistically analyzed. RESULTS Of the 177 wrists included in our study, 138 (78 %) were diagnosed with carpal tunnel syndrome, while 39 (22 %) were not (non-carpal tunnel syndrome). With our diagnostic method, 127 wrists (72 %) were diagnosed initially with carpal tunnel syndrome, 23 wrists (13 %) with non-carpal tunnel syndrome, and the rest 27 wrists (15 %) as borderline. Our initial diagnoses of carpal tunnel syndrome and non-carpal tunnel syndrome were maintained in all cases except for two. Cross-sectional area, CTS-6 score, and electrodiagnostic severity showed a positive correlation. A post hoc analysis showed that the new scoring system (CTS-6 score + 2 × cross-sectional area) with a cutoff value of 31.25 points showed a sensitivity as high as 95 % and a specificity of 100 %. CONCLUSIONS Our findings suggest that most suspected idiopathic carpal tunnel syndrome cases can be diagnosed correctly using the diagnostic chart. Although additional tools, including electrodiagnostic studies, may be needed for borderline cases, the use of point of care ultrasound combined with CTS-6 may be a recommendable first-line confirmatory test because point of care ultrasound and CTS-6 could be complementary tools, and this chart may be especially beneficial for atypical or outlier cases. LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Kitasato Institute Hospital, Tokyo, Japan.
| | - Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Tomoki Matsuo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
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11
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Kim IJ, Kim JM. Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study. J Clin Med 2024; 13:262. [PMID: 38202268 PMCID: PMC10779930 DOI: 10.3390/jcm13010262] [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: 12/09/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
Ultrasound-guided thread carpal tunnel release (TCTR) was proposed as an effective and safe surgical technique with faster recovery and fewer complications. This study was conducted to confirm the long-term outcomes after TCTR and verify its clinical effectiveness in severe carpal tunnel syndrome (CTS) for more insights into TCTR procedure. A total of 168 TCTR procedures were performed in 152 individual patients by two physiatrists during 36-month period. In an assessment of 82 hands, surgical outcomes of 2 years after TCTR could be obtained, and the grade 6 CTS group of 21 hands, classified as extremely severe grade by Bland's classification, was compared with other severity groups (grade 1-5). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to assess surgical outcomes. No adverse events occurred in all cases including the case of severe CTS and anatomical variants. TCTR showed significant improvement in BCTQ scale within 1-2 weeks, which continued up to 2 years with no recurrence (p < 0.01). Although slower and more progressive than the other severity group, there was also significant improvement relative to the BCTQ scale around 4 weeks after procedure in the grade 6 CTS group (p < 0.05). With the familiarity of ultrasound, ultrasound-guided TCTR is an effective and reliable surgical treatment for CTS in long-term outcomes and in severe CTS.
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Affiliation(s)
- In Jong Kim
- Department of Rehabilitation Medicine, Howareyou Rehabilitation Clinic, Seoul 06134, Republic of Korea;
| | - Jae Min Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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12
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Bland JDP. Use of nerve conduction studies in carpal tunnel syndrome. J Hand Surg Eur Vol 2023; 48:976-985. [PMID: 37812524 DOI: 10.1177/17531934231191685] [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] [Indexed: 10/11/2023]
Abstract
This review article examines the use of nerve conduction studies in the management of carpal tunnel syndrome. These studies should be understood not as a test that determines the diagnosis but as a measure of impaired nerve function. They are sensitive indicators of local demyelination and axonal loss that can detect and quantify these changes before the appearance of clinical signs, providing information that cannot be obtained with the unaided senses of the physician, nor by any other investigation. They are the best available indicator of overall disease severity, correlating with symptoms and anatomical change in the median nerve. They have some prognostic value for surgical outcome and are sufficiently sensitive to change for the evaluation of treatment response. When surgery does not yield the expected improvement in symptoms, they can help to establish whether decompression has been achieved provided preoperative results are available for comparison.
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Affiliation(s)
- Jeremy D P Bland
- Department of Clinical Neurophysiology, East Kent Hospitals University Foundation NHS Trust, Canterbury, Kent, UK
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13
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Fargaly SN, Bland JDP. Do nerve conduction studies or ultrasound imaging correlate more closely with subjective symptom severity in carpal tunnel syndrome? Muscle Nerve 2023; 68:264-268. [PMID: 37392186 DOI: 10.1002/mus.27924] [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: 11/13/2022] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION/AIMS Previous studies have reported weak correlations between neurophysiological measurements and subjective severity of symptoms in carpal tunnel syndrome, with Pearson r ≤ 0.26. We hypothesize that this resulted in part from patient-to-patient variability in the assessment of subjective severity using tools such as the Boston Carpal Tunnel Questionnaire. To compensate for this, we aimed to assess within-patient differences in symptom and test result severity. METHODS In our study we used retrospective data from 13 005 patients with bilateral electrophysiological results and 790 patients with bilateral ultrasound imaging drawn from the Canterbury CTS database. Measures of neurophysiological (nerve conduction studies [NCS] grade) and anatomical (cross-sectional area on ultrasound) severity within individual patients were compared between the right and left hands, eliminating individual variation in the way in which patients interpret the questionnaire. RESULTS There was a correlation found between right-hand NCS grade and symptom severity score (Pearson r = -0.302, P < .001, n = 13,005), but not between right-hand cross-sectional area and symptom severity (Pearson r = 0.058, P = .10, n = 790). In the within-subject analyses, there were significant correlations between symptoms and NCS grade (Pearson r = 0.6, P < .001, n = 6521) and between symptoms and cross-sectional area (Pearson r = 0.3. P < .001, n = 433). DISCUSSION The simple correlation between symptomatic and electrophysiological severity was comparable with previous studies, but within-patient analysis revealed that the relationship was stronger than previously reported and strong enough to be clinically useful. The relationship between symptoms and cross-sectional area measurement on ultrasound imaging was weaker.
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Affiliation(s)
| | - Jeremy D P Bland
- East Kent Hospitals University Foundation NHS Trust, Canterbury, UK
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14
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O'Donnell M, Eadie P, Dorairaj J, Stapleton T. Advanced practice occupational therapy led triage and treatment clinic for patients with carpal tunnel syndrome in an Irish public hospital. Musculoskeletal Care 2023; 21:633-643. [PMID: 36760197 DOI: 10.1002/msc.1733] [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: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION A pilot CTS Triage and Treat clinic led by an Advanced Practice Occupational Therapist was established to address the CTS wait list at a large urban hospital. The aims of this pilot were to develop a clinical triage and screening protocol to inform the stratification of patients for suitable treatment options and to reduce waiting time. METHODS A cross sectional study with follow up was conducted, patients on the wait list at time of commencement of the pilot and subsequent referrals over a 1-year period were recruited. Triage consisted of tests of sensibility, self-rating measures, provocative tests and detailed patient to inform the subsequent treatment stratification, conservative, injection, surgery, or further investigation. Nonparametric analyses were used to test relationships between the test scores and to complete subgroup comparisons. RESULTS Eighty-nine patients were triaged over the pilot period, 62 (70%) had a positive Phalen's at triage. Following triage 48 (54%) patients were stratified for conservative management, injection (n = 23, 26%) and surgery/differential diagnosis (n = 18, 20%). Statistically significant differences in BCTQ (SSS and FSS) and Q-DASH scores were noted across the three outcome groups, with lower scores among those commenced on conservative management. BCTQ (SSS) scores were aligned with the Semmes Weinstein Monofilaments sensibility thresholds. Wait times showed a marked decrease from 10 to 2 months over the period of the pilot. DISCUSSION Findings highlight the positive impact of occupational therapy led triage and treat approach in the reduction of wait time for assessment and treatment for patients with CTS.
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Affiliation(s)
- Michelle O'Donnell
- Department of Occupational Therapy, St James's Hospital, Dublin, Ireland
| | | | | | - Tadhg Stapleton
- Discipline of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
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Benli Küçük E. Temporal Changes in Electrophysiological Parameters in Untreated Patients With Carpal Tunnel Syndrome. Cureus 2023; 15:e46039. [PMID: 37900432 PMCID: PMC10603599 DOI: 10.7759/cureus.46039] [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] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is a common entrapment neuropathy worldwide. This study aimed to investigate the temporal changes in electrophysiological parameters in untreated patients with CTS. METHODS Patients were recruited among those with the symptoms of CTS who were referred to the electrophysiology laboratory of Niğde Ömer Halisdemir University Bor Physical Therapy and Rehabilitation Hospital in Niğde, Turkey. Forty-nine patients (78 hands) who had not received any sort of treatment for CTS and had prior electrophysiological examination postive for CTS were included. Laboratory records were reviewed retrospectively. Recent electrophysiological parameters of the patients were compared to their prior examinations using Wilcoxon signed-rank test and sign test was used to compare the change in the electrophysiological severity of the study hands between two examinations. One-way analysis of variance (ANOVA) was used to compare individual parameters of the median NCS among electrophysiological change groups (improved, deteriorated, and same). RESULTS The mean age was 50 ± 11 years, and 43 (88%) patients were female. The mean duration of time between the two electrophysiological examinations was 37 ± 20 months. Median sensory peak latency and median motor distal latency increased significantly in the second evaluation (p=0.005 and p=0.004, respectively). Median sensory conduction velocity decreased in the second examination (p=0.002). However, CTS severity determined electrophysiologically did not differ significantly in the two examinations (p=0.286). CONCLUSION Although there was a deterioration in electrophysiological parameters during a mean follow-up period of 37 months, the electrophysiological severity of the patients did not worsen.
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Affiliation(s)
- Esin Benli Küçük
- Physical Medicine and Rehabilitation, Niğde Ömer Halisdemir University School of Medicine, Niğde, TUR
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16
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Kimura H, Matsuo T, Suzuki T, Matsumura N, Sato K, Iwamoto T. Influence of Electrodiagnostic Studies on Surgery for Carpal Tunnel Syndrome: A Retrospective Analysis of Data from a Single Urban Institution. J Hand Surg Asian Pac Vol 2023; 28:453-460. [PMID: 37758495 DOI: 10.1142/s2424835523500510] [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: 10/03/2023]
Abstract
Background: This study aimed to clarify the influence of preoperative electrodiagnostic (EDX) utilisation and its severity on surgically treated patients with carpal tunnel syndrome (CTS). Methods: This retrospective study analysed the data of patients who underwent CTS surgery at our facility from 2012 to 2022. Data regarding age, sex, affected side, diabetes mellitus, rheumatoid arthritis, haemodialysis and insurance type were collected, along with the following clinical information: utilisation of EDX, steroid injection, number of items of preoperative physical examination and history taking, intervals between symptom onset and the initial visit and between the initial visit and surgery, type of surgical procedure and surgery categorisation (primary or revision). EDX data (EDX severity, interval between EDX and surgery and concomitant nerve lesions) were also investigated. Univariate and multivariate analyses were conducted to assess the influence of EDX utilisation and severity on clinical parameters. Results: Of the 343 hands enrolled in our study, 304 (89%) underwent preoperative EDX assessment. EDX severity was classified as normal, mild, moderate or severe in 6 (2%), 18 (6%), 102 (34%) and 178 hands (58%), respectively. After the univariate and multivariable analyses, more items of preoperative physical examination and history taking were associated with non-EDX utilisation, whereas younger age, female sex and steroid injection were associated with milder EDX. Conclusions: Increased number of items of preoperative physical examination and history taking or steroid injection were independently associated with non-EDX utilisation or milder EDX, respectively, suggesting that when thorough clinical evaluation is conducted, hand surgeons may be less likely to request for EDX before surgery. Moreover, their treatment recommendation may be influenced by EDX severity. Level of Evidence: Level III (Diagnostic).
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Affiliation(s)
- Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoki Matsuo
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Twardowska M, Czarnecki P, Jokiel M, Bręborowicz E, Huber J, Romanowski L. Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1404. [PMID: 37629694 PMCID: PMC10456912 DOI: 10.3390/medicina59081404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.
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Affiliation(s)
- Marta Twardowska
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Marta Jokiel
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Ewa Bręborowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland;
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135/147, 61-545 Poznan, Poland; (P.C.); (M.J.); (E.B.); (L.R.)
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Bejarano MC, Clearfield DA. Platelet Releasate Injection as a Novel Treatment for Ulnar Neuritis at the Elbow: A Case Report. Cureus 2023; 15:e42223. [PMID: 37605660 PMCID: PMC10440148 DOI: 10.7759/cureus.42223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
This report examines the efficacy of platelet releasate injection as a treatment method for ulnar neuritis. Platelet-rich plasma (PRP), an autologous product of concentrated platelets, has the potential to accelerate healing in injured peripheral nerves by releasing growth factors that promote nerve repair. Platelet releasate, the supernatant of thrombin-activated PRP, has yet to be thoroughly investigated as a treatment option for ulnar neuritis. In this report, a 42-year-old female patient presented with right-sided elbow and neck pain that was subsequently diagnosed as ulnar neuritis and neurogenic thoracic outlet syndrome. Initial imaging at the right elbow demonstrated ulnar nerve entrapment within the arcade of Struthers. The patient's symptoms were first managed with home exercise and ulnar nerve hydrodissection at the elbow, which decreased but did not resolve her pain. Platelet releasate injection of the ulnar nerve at the elbow was subsequently performed. Six weeks post-procedure, the patient reported additional pain improvement. Provocative tests at the elbow were negative and imaging demonstrated a normal-appearing ulnar nerve. Despite these results, the patient was not completely symptom-free; persistent symptoms were attributed to her concomitant neurogenic thoracic outlet syndrome. While platelet releasate injection has not previously been explored as a treatment option for ulnar neuritis, this case demonstrates how platelet releasate injection may facilitate healing in an ulnar nerve injured by entrapment. Further investigation could support platelet releasate injection as an effective monotherapy or as an adjunct treatment for ulnar neuritis and similar peripheral neuropathies.
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Affiliation(s)
- Michael C Bejarano
- Medicine, Texas College of Osteopathic Medicine at University of North Texas Health Science Center, Fort Worth, USA
| | - Daniel A Clearfield
- Sports Medicine, Motion Is Medicine Sports Medicine, North Richland Hills, USA
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Sousa RL, Moraes VYD, Zobiole AF, Nakachima LR, Belloti JC. Diagnostic criteria and outcome measures in randomized clinical trials on carpal tunnel syndrome: a systematic review. SAO PAULO MED J 2023; 141:e2022086. [PMID: 37075455 PMCID: PMC10109546 DOI: 10.1590/1516-3180.2022.0086.07022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/07/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The diagnostic criteria for carpal tunnel syndrome (CTS) lack uniformity. Moreover, because CTS is a syndrome, there is no consensus as to which signs, symptoms, clinical and complementary tests are more reproducible and accurate for use in clinical research. This heterogeneity is reflected in clinical practice. Thus, establishing effective and comparable care protocols is difficult. OBJECTIVE To identify the diagnostic criteria and outcome measures used in randomized clinical trials (RCTs) on CTS. DESING AND SETTING Systematic review of randomized clinical trials carried out at the Federal University of São Paulo, São Paulo, Brazil. METHODS We searched the Cochrane Library, PubMed, and Embase databases for RCTs with surgical intervention for CTS published between 2006 and 2019. Two investigators independently extracted relevant data on diagnosis and outcomes used in these studies. RESULTS We identified 582 studies and 35 were systematically reviewed. The symptoms, paresthesia in the median nerve territory, nocturnal paresthesia, and special tests were the most widely used clinical diagnostic criteria. The most frequently assessed outcomes were symptoms of paresthesia in the median nerve territory and nocturnal paresthesia. CONCLUSION The diagnostic criteria and outcome measures used in RCTs about CTS are heterogeneous, rendering comparison of studies difficult. Most studies use unstructured clinical criteria associated with ENMG for diagnosis. The Boston Questionnaire is the most frequently used main instrument to measure outcomes. REGISTRATION PROSPERO (CRD42020150965- https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=150965).
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Affiliation(s)
- Rafael Luz Sousa
- MD. Hand Surgeon and Master's Student, Discipline of Hand and Upper Limb Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Vinicius Ynoe de Moraes
- MD, PhD. Hand Surgeon, Discipline of Hand and Upper Limb Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Hand Surgeon, Hand Surgery Service, Hospital Alvorada Moema, United Health, São Paulo (SP), Brazil
| | - Alexandre Figueiredo Zobiole
- MD. Orthopedist and Fellow of shoulder and elbow at the Sports Traumatology Center, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Luis Renato Nakachima
- MD, MSc, PhD. Adjunct Professor, Department of Orthopedics and Traumatology. Discipline of Hand and Upper Limb Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - João Carlos Belloti
- MD, MSc, PhD. Adjunct Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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20
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Clinical Utility of Boston-CTS and Six-Item CTS Questionnaires in Carpal Tunnel Syndrome Associated with Diabetic Polyneuropathy. Diagnostics (Basel) 2022; 13:diagnostics13010004. [PMID: 36611296 PMCID: PMC9818529 DOI: 10.3390/diagnostics13010004] [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: 10/18/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Diabetic polyneuropathy (DPN) is the most frequent complication of diabetes. Carpal tunnel syndrome (CTS), one of the most common neuropathies, is a chronic compression of the median nerve at the wrist. In our prospective cross-sectional study, we enrolled patients with type 2 diabetes presenting with signs and symptoms suggestive of DPN (n = 53). We aimed to compare two clinical scales: the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and the six-item CTS symptoms scale (CTS-6), with nerve conduction studies (NCS) for detecting CTS in patients with DPN. Carpal tunnel syndrome and DPN were clinically evaluated, and the diagnosis was confirmed by NCS. Depending on the NCS parameters, the study group was divided into patients with and without DPN. For each group, we selected patients with CTS confirmed through NCS, and the results were compared with the BCTQ and CTS-6 scales. The clinical evaluation of CTS performed through BCTQ and CTS-6 was statistically significantly different between patients with and without CTS. When comparing the BCTQ questionnaire with the NCS tests, we found area under the curve (AUC) = 0.76 (95% CI 0.65-0.86) in patients with neuropathy and AUC = 0.72 (95% CI 0.55-0.88) in patients without neuropathy. At the same time, the AUC values of the CTS-6 scale were 0.76 (95% CI 0.61-0.88) in patients with neuropathy and 0.70 (95% CI 0.51-0.86) in patients without neuropathy. Using multiple logistic regression, we demonstrated that DPN increased the chances of detecting CTS using the two questionnaires. The Boston Carpal Tunnel Syndrome and CTS-6 questionnaires can be used in the diagnosis of CTS in diabetic patients with and without DPN but with moderate AUC. The presence of DPN increased the chances of detecting CTS using the BCTQ questionnaire and the CTS-6 scale.
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Kang DH, Lee KC, Kim JY, Seo H, Kim JW, Kim JD. Repair of severed recurrent thenar branch of median nerve after open carpal tunnel release. Trauma Case Rep 2022; 42:100690. [PMID: 36148020 PMCID: PMC9485210 DOI: 10.1016/j.tcr.2022.100690] [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] [Accepted: 07/30/2022] [Indexed: 11/22/2022] Open
Abstract
An anatomical understanding of median nerve variation is essential for successful decompression of carpal tunnel syndrome (CTS). Although iatrogenic injury of the thenar branch after carpal tunnel release (CTR) has not been reported in many cases, it can cause serious damage to the patient. In case of rapidly progressing thenar atrophy after CTS surgery, thenar branch of median nerve injury should be suspected. Nerve conduction examination and ultrasound before surgery can be a useful tool for diagnosis.
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Affiliation(s)
- Dong Hee Kang
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Ki Chul Lee
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Joo Yong Kim
- Department of Orthopaedics, Busan Korea Hospital, Busan, Republic of Korea
| | - Han Seo
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Ji WooK Kim
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Ju Deok Kim
- Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
- Corresponding author at: Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea.
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22
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Kudo T, Yoshii Y, Hara Y, Ogawa T, Ishii T. Clinical Relevance of Ultrasonographic and Electrophysiological Findings of the Median Nerve in Unilateral Carpal Tunnel Syndrome Patients. Diagnostics (Basel) 2022; 12:diagnostics12112799. [PMID: 36428858 PMCID: PMC9689393 DOI: 10.3390/diagnostics12112799] [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: 10/19/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Few studies have compared the unaffected and affected sides in the same carpal tunnel syndrome (CTS) patients using ultrasonography and electrophysiological tests. We focused on unilateral idiopathic CTS patients to investigate whether clinical test results differ between the unaffected and affected sides. The bilateral wrist joints of 61 unilateral idiopathic CTS patients were evaluated. The median nerve cross-sectional area of ultrasound image, and latencies of the compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) were measured. The values obtained were compared between the affected and unaffected sides. The diagnostic accuracies of each parameter were assessed, and cut-off values were defined. Significant differences were observed in all parameters between the affected and unaffected sides (p < 0.01). Area under the curve (AUC) values were 0.74, 0.88, and 0.73 for the cross-sectional area, CMAP distal latency, and SNAP distal latency, respectively. Cut-off values were 11.9 mm2, 5.1 ms, and 3.1 ms for the cross-sectional area, CMAP distal latency, and SNAP distal latency, respectively. The most reliable parameter that reflected clinical symptoms was the distal latency of CMAP. Cut-off values for each parameter are considered to be an index for the onset of the clinical symptoms of CTS.
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Affiliation(s)
- Takamasa Kudo
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
- Correspondence: ; Tel.: +81-29-887-1161
| | - Yuki Hara
- Department of Orthopedic Surgery, University of Tsukuba Hospital, Tsukuba 305-8577, Ibaraki, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, Mito Medical Center, Mito 311-3193, Ibaraki, Japan
| | - Tomoo Ishii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Ibaraki, Japan
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Kuroiwa T, Jagtap J, Starlinger J, Lui H, Akkus Z, Erickson B, Amadio P. Deep Learning Estimation of Median Nerve Volume Using Ultrasound Imaging in a Human Cadaver Model. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2237-2248. [PMID: 35961866 DOI: 10.1016/j.ultrasmedbio.2022.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
Median nerve swelling is one of the features of carpal tunnel syndrome (CTS), and ultrasound measurement of maximum median nerve cross-sectional area is commonly used to diagnose CTS. We hypothesized that volume might be a more sensitive measure than cross-sectional area for CTS diagnosis. We therefore assessed the accuracy and reliability of 3-D volume measurements of the median nerve in human cadavers, comparing direct measurements with ultrasound images interpreted using deep learning algorithms. Ultrasound images of a 10-cm segment of the median nerve were used to train the U-Net model, which achieved an average volume similarity of 0.89 and area under the curve of 0.90 from the threefold cross-validation. Correlation coefficients were calculated using the areas measured by each method. The intraclass correlation coefficient was 0.86. Pearson's correlation coefficient R between the estimated volume from the manually measured cross-sectional area and the estimated volume of deep learning was 0.85. In this study using deep learning to segment the median nerve longitudinally, estimated volume had high reliability. We plan to assess its clinical usefulness in future clinical studies. The volume of the median nerve may provide useful additional information on disease severity, beyond maximum cross-sectional area.
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Affiliation(s)
- Tomoyuki Kuroiwa
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaidip Jagtap
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Starlinger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department for Orthopedics and Trauma Surgery, Medical University Vienna, Vienna, Austria
| | - Hayman Lui
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zeynettin Akkus
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Peter Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Bayat M, Bagheri Z, Raeissadat SA, Rayegani SM, Ahmadzadeh A, Shirani F. Diagnostic Value of Ultrasound for Detecting Carpal Tunnel Syndrome in Patients With Rheumatoid Arthritis: A Three-Arm Cross-Sectional Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221092982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study was conducted to assess the diagnostic value of sonography in detecting carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and to compare the results with a normal control group. Materials and Methods: In this three-arm cross-sectional study, the sonographically measured median nerve cross-sectional area (MNCSA) was compared in three groups: RA patients with CTS, RA patients without CTS, and normal subjects (no RA, no CTS). A nerve conduction study (NCS) was performed for all enrolled participants, across the three study arms. Results: In this study, 38 RA patients (17 in CTS group and 21 in no CTS group) and 19 healthy subjects were recruited. The MNCSAs were 11.86 (±1.87) mm2 in RA patients with CTS, 10.16 (±1.71) mm2 in RA patients without CTS, and 9.42 (±1.46) mm² in healthy control patients. The accuracy of sonography in detecting CTS was 0.79 (95% confidence interval, 0.67–0.91), with a sensitivity and specificity of 88% and 57%, respectively. The MNCSA in CTS group was significantly higher than the control group ( P = .02). Conclusion: In this cohort, the sonographic measurement of MNCSA was an accurate and sensitive method for the diagnosis of CTS, especially in its early stages. In addition, in this cohort, RA without CTS did not increase the MNCSA.
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Affiliation(s)
- Masume Bayat
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Physical Medicine and Rehabilitation Research Center, Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Bagheri
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Ahmadzadeh
- Department of Rheumatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shirani
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ratasvuori M, Sormaala M, Kinnunen A, Lindfors N. Ultrasonography for the diagnosis of carpal tunnel syndrome: correlation of clinical symptoms, cross-sectional areas and electroneuromyography. J Hand Surg Eur Vol 2022; 47:369-374. [PMID: 34812067 DOI: 10.1177/17531934211059808] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study evaluates the usefulness of ultrasonography in diagnosing carpal tunnel syndrome (CTS). The cross-sectional area of the median nerve was measured at the forearm and its entry into the carpal tunnel and compared with clinical symptoms and electroneuromyography. A total of 124 patients were examined, 77 patients with clinically confirmed CTS and 47 controls. A significant correlation was found between the ultrasonography cross-sectional area values at entry points into the carpal tunnel and electroneuromyography. The highest sensitivity (87%) and specificity (91%) for different cut-off values (8.5-12.5 mm2) of the cross-sectional area was for 11.5 mm2. The use of ultrasonography may provide a quick and reliable differential diagnostic tool for the primary diagnosis of CTS in patients with classical symptoms.Level of evidence: II.
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Affiliation(s)
- Maire Ratasvuori
- Department of Musculoskeletal and Plastic Surgery, Töölö Hospital, Helsinki, Finland
| | - Markus Sormaala
- Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki, Finland
| | | | - Nina Lindfors
- Department of Musculoskeletal and Plastic Surgery, Töölö Hospital, Helsinki, Finland
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Endo T, Matsui Y, Kawamura D, Urita A, Momma D, Ota M, Shibayama H, Iwai T, Nishida M, Iwasaki N. Diagnostic Utility of Superb Microvascular Imaging and Power Doppler Ultrasonography for Visualizing Enriched Microvascular Flow in Patients With Carpal Tunnel Syndrome. Front Neurol 2022; 13:832569. [PMID: 35432160 PMCID: PMC9008197 DOI: 10.3389/fneur.2022.832569] [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: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Recent studies suggest that blood flow changes in the median nerve may help confirm a diagnosis of carpal tunnel syndrome (CTS). Herein, we examined the utility of superb microvascular imaging (SMI), a new ultrasonographic (US) technique for visualizing microvascular flow, for detecting blood flow differences between CTS patients and healthy controls. We performed a retrospective analysis of 28 hands with suspected CTS. Patients received both nerve conduction and US examinations. Ten healthy volunteers were enrolled as the control group. The nerve compression ratio and the blood flow signal area were quantified using color Doppler US (CDUS), power Doppler US (PDUS), and SMI. Correlation analyses between the blood flow signal area, the compound muscle action potential of the thenar muscle, and the nerve compression ratio were performed. As a result, the mean nerve compression ratio was found to be significantly higher in the CTS group. There were no differences in the blood flow signal area between the groups using CDUS, while PDUS and SMI showed higher blood flow signals in the CTS group. The blood flow signal area measured by SMI had stronger correlations with the compound muscle action potential amplitude and the nerve compression ratio than those for PDUS. The diagnostic utility of SMI was equivalent to PDUS, but superior to conventional CDUS. Nevertheless, the blood flow signal by SMI was more strongly correlated with the electrophysiological severity and compression ratio than for PDUS. Use of SMI in future studies may help clarify the underlying mechanisms of blood flow changes in CTS.
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Affiliation(s)
- Takeshi Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
- *Correspondence: Yuichiro Matsui
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Mitsutoshi Ota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Shibayama
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahito Iwai
- Division of Laboratory and Transfusion Medicine, Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Sasaki T, Koyama T, Kuroiwa T, Nimura A, Okawa A, Wakabayashi Y, Fujita K. Evaluation of the Existing Electrophysiological Severity Classifications in Carpal Tunnel Syndrome. J Clin Med 2022; 11:jcm11061685. [PMID: 35330012 PMCID: PMC8950957 DOI: 10.3390/jcm11061685] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 12/13/2022] Open
Abstract
Electrophysiological examination is important for the diagnosis and evaluation of nerve function in carpal tunnel syndrome (CTS). Electrophysiological severity classifications of CTS using a nerve conduction study (NCS) have been reported, and there are many reports on the relationship between severity classifications and clinical symptoms. The existing electrophysiological severity classifications have several problems, such as cases that do not fit into a classification and unclear reasons for the boundary value. The purpose of this study was to clarify the relationship between sensory nerve conduction velocity (SCV) and distal motor latency (DML) and to evaluate whether the existing severity classification method is appropriate. We created a scatter diagram between SCV and DML for our NCSs and found a negative correlation between SCV and DML (correlation coefficient, −0.786). When we applied our NCSs to the existing classifications (Padua and Bland classifications), there were many unclassifiable cases (15.2%; Padua classification), and the number of Grade 3 cases was significantly higher than that of Grade 2 or 4 cases (Bland classification). Our large dataset revealed a strong negative correlation between SCV and DML, indicating that the existing severity classifications do not always accurately reflect the severity of the disease.
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Affiliation(s)
- Toru Sasaki
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.S.); (T.K.); (T.K.); (A.O.)
- Department of Orthopaedic Surgery, Tsuchiura Kyodo General Hospital, 4-1-1, Tsuchiura 300-0028, Ibaraki, Japan
| | - Takafumi Koyama
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.S.); (T.K.); (T.K.); (A.O.)
| | - Tomoyuki Kuroiwa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.S.); (T.K.); (T.K.); (A.O.)
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.S.); (T.K.); (T.K.); (A.O.)
| | - Yoshiaki Wakabayashi
- Department of Orthopaedic Surgery, Yokohama City Minato Red Cross Hospital, 3-12-1, Shinyamashita, Naka-ku, Yokohama City 231-8682, Kanagawa, Japan;
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
- Correspondence: ; Tel.: +81-3-5803-5279
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Shin DJ, Nam KE, Song DH, Im S, Won SJ, Kim YH, Lim SH, Lee JI. Carpal tunnel syndrome and tenosynovitis in women with breast cancer associated with hormone therapy: A multi-institutional analysis using a clinical data warehouse. Medicine (Baltimore) 2022; 101:e28786. [PMID: 35119045 PMCID: PMC8812623 DOI: 10.1097/md.0000000000028786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
The study aims to evaluate the characteristics, treatments, and incidence rates of carpal tunnel syndrome (CTS) and tenosynovitis in women with breast cancer, according to the hormone therapy used. We retrospectively reviewed women with breast cancer identified from the clinical data warehouse of the six hospitals in Korea, from January 2015 to August 2020. Among them, patients with CTS or tenosynovitis were reviewed in terms of disease status and treatments. A total of 101 patients among a population of 15,504 met the study inclusion criteria, so their clinical data were analyzed. Aromatase inhibitor (AI) users frequently needed oral medication for CTS, and developed severe CTS which frequently required surgery. AI users presented with a higher incidence of CTS (1.3%) than patients without hormone therapy (0.4%), and tenosynovitis occurred at a higher rate in AI users (2.3%) compared to the tamoxifen (1.1%) and no hormone groups (0.5%). More than half of the CTS and tenosynovitis occurred within 12 months after hormone commencement. The incidence and disease characteristics of CTS and tenosynovitis differed among the groups depending on the type of hormone therapy received. Our findings will help clinicians understand clinical courses and treatments for CTS and tenosynovitis in breast cancer patients.
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Affiliation(s)
- Dong Jae Shin
- Departments of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Eun Nam
- Departments of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Heon Song
- Departments of Rehabilitation Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Im
- Departments of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Jae Won
- Departments of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeo Hyung Kim
- Departments of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Hoon Lim
- Departments of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong In Lee
- Departments of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lattré T, Claeys K, Parmentier S, VAN Holder C. A Detailed Comparison of Preoperative Complaints in Severe Carpal Tunnel Syndrome versus Recurrent Carpal Tunnel Syndrome Using the Boston Carpal Tunnel Questionnaire. J Hand Surg Asian Pac Vol 2022; 27:98-104. [PMID: 35037583 DOI: 10.1142/s2424835522500060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The Boston Carpal Tunnel Questionnaire (BCTQ) has a symptom severity scale (SSS) with 11 questions and a functional status scale (FSS) with 8 questions. The final score for each scale is the sum divided by the number of questions and ranges between 1 and 5. A score of 1 indicates they have no complaints and 5 indicates high severity and functional loss. Unfortunately, this single digit score does not permit a detailed analysis of the symptoms and functional status. The aim of this study is to conduct an in-depth comparison of preoperative complaints using the BCTQ between patients with severe carpal tunnel syndrome (SCTS) and recurrent carpal tunnel syndrome (RCTS). Methods: This is a retrospective cohort study on the preoperative status of 37 patients with SCTS and 18 patients with RCTS using the BCTQ. The questions in the SSS and FSS were classified into four groups based on the responses of patients, namely a low complaint (LC) (1-1.99), moderate complaint (MC) (2-2.99), high complaint (HC) (3-3.99), and severe complaint (SC) (4-5) groups. The patients in the SCTS and RCTS groups were compared to find differences in age, gender, hand dominance, and responses to questions in the SSS and FSS. Results: The age of patients in the SCTS group (76.06 years) was significantly higher compared to the RCTS group (51.11 years). There was no significant difference between the two groups with regard to gender or hand dominance. The top question with SC or HC response in the SCTS group was problems in grasping small objects (SSS) and fastening buttons (FSS) and in the RCTS group was tingling in the hand (SSS) and difficulty with opening a jar (FSS). Conclusions: An in-depth analysis of the BCTQ allowed us to compare and understand differences in symptoms and function between patients with SCTS and RCTS. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Tom Lattré
- Departments of Plastic Surgery and Physical Rehabilitation, Ziekenhuis Waregem, Vijfseweg 150, Waregem, Belgium
| | - Kurt Claeys
- Campus Bruges, Department of Rehabilitation Sciences, Katholic University Leuven, Spoorwegstraat 12, Bruges, Belgium
| | - Steven Parmentier
- Departments of Plastic Surgery and Physical Rehabilitation, Ziekenhuis Waregem, Vijfseweg 150, Waregem, Belgium
| | - Carlo VAN Holder
- Departments of Plastic Surgery and Physical Rehabilitation, Ziekenhuis Waregem, Vijfseweg 150, Waregem, Belgium
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30
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Qian X, Yue L, Mellor D, Robbins NM, Li W, Xiao S. Reduced Peripheral Nerve Conduction Velocity is Associated with Alzheimer's Disease: A Cross-Sectional Study from China. Neuropsychiatr Dis Treat 2022; 18:231-242. [PMID: 35177907 PMCID: PMC8846612 DOI: 10.2147/ndt.s349005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Elderly individuals with degenerative diseases of the central nervous system are more likely to develop peripheral neuropathy; however, research is limited as to whether the decline in peripheral nerve conduction can be used as a biomarker of Alzheimer's disease (AD). PATIENTS AND METHODS This study enrolled 74 patients with mild cognitive impairment (MCI), 21 with AD, and 82 healthy elderly individuals. All participants underwent a peripheral nerve conduction and neuropsychological evaluation. Nicolet EDX was used to assess peripheral nerve conduction in the limbs and comparisons were made between the three cognitive groups. Furthermore, the relationship between peripheral nerve conduction and cognitive function was investigated. RESULTS A ladder-shaped difference was found in the median (p < 0.001) and common peroneal (p < 0.001) motor nerve velocity, with the control group > MCI group > AD group, even after controlling for variables. The median motor nerve amplitude in the AD group was lower than that in the control group (P = 0.017). After controlling for age, sex, education, and height, the median motor nerve velocity was positively correlated with the Montreal Cognitive Assessment (r = 0.196, p = 0.015), and the common peroneal motor nerve velocity was positively correlated with verbal fluency task-idioms (r = 0.184, p = 0.026). The median (AUC: 0.777, p < 0.001) and common peroneal motor nerve velocities (AUC: 0.862; p < 0.001) were significantly associated with the diagnosis of AD. The accuracy rate of these two motor nerve velocities to predict AD was 51.5%. CONCLUSION Our study found that peripheral motor nerve velocity may correlate with early cognitive impairment in AD. However, the accuracy of different cognitive classifications and the value of early diagnosis are not ideal when peripheral motor nerve velocity is used alone. Whether peripheral nerve function can be used as a marker for early diagnosis of AD needs further clarification but provides a new possibility for the future of biomarker research.
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Affiliation(s)
- Xinyi Qian
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ling Yue
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, Australia
| | - Nathaniel M Robbins
- Department of Neurology (N.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Shifu Xiao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Singjam A, Charoentanyarak K, Saengsuwan J. Prevalence and predictive factors for bilateral carpal tunnel syndrome by electrodiagnosis: A retrospective study. PLoS One 2021; 16:e0260578. [PMID: 34941881 PMCID: PMC8699666 DOI: 10.1371/journal.pone.0260578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. Patients who have unilateral symptoms are frequently found to have bilateral CTS by electrodiagnostic (EDx) study. We aimed to (a) study the prevalence and identify the predictive factors for bilateral CTS diagnosed by EDx; and (b) develop a model to predict bilateral CTS. Methods The retrospective clinical and EDx data of patients with CTS were collected and analyzed using the Chi-squared test and multiple logistic regression analysis. A model was fitted, and the best cutoff point determined. Calibration and discrimination performance of the model were performed. Results A total of 327 patients with a mean age of 50.0 years were enrolled. Most were women (82.6%), and the most common presenting symptom was hand numbness (93.6%). The median duration of symptoms was 60 days. The prevalence of bilateral CTS was 80.7%. In the multivariate analysis, the predictive factors for bilateral CTS were the presence of bilateral symptoms (AOR 6.7 [95%CI 3.1–14.3]), thenar muscle weakness (AOR 3.9 [95%CI 1.3–11.6]), and age ≥ 45 years (AOR 2.5 [95%CI 1.3–4.6]). The logistic regression model was fitted, and the best cutoff point determined. The area under the receiver operating curve (AUC) was 0.76. The respective optimism-corrected C index and Somers’ D was 0.762 and 0.524. Conclusion The prevalence of bilateral CTS was 80.7%. Our findings suggest bilateral CTS was predicted with adequate diagnostic accuracy by bilateral symptoms, age ≥ 45 years, and thenar muscle weakness.
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Affiliation(s)
- Apiradee Singjam
- Rehabilitation Medicine Unit, Khon Kaen Hospital, Khon Kaen, Thailand
| | | | - Jittima Saengsuwan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- * E-mail:
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Tsamis KI, Kontogiannis P, Gourgiotis I, Ntabos S, Sarmas I, Manis G. Automatic Electrodiagnosis of Carpal Tunnel Syndrome Using Machine Learning. Bioengineering (Basel) 2021; 8:bioengineering8110181. [PMID: 34821747 PMCID: PMC8615235 DOI: 10.3390/bioengineering8110181] [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: 09/29/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 01/03/2023] Open
Abstract
Recent literature has revealed a long discussion about the importance and necessity of nerve conduction studies in carpal tunnel syndrome management. The purpose of this study was to investigate the possibility of automatic detection, based on electrodiagnostic features, for the median nerve mononeuropathy and decision making about carpal tunnel syndrome. The study included 38 volunteers, examined prospectively. The purpose was to investigate the possibility of automatically detecting the median nerve mononeuropathy based on common electrodiagnostic criteria, used in everyday clinical practice, as well as new features selected based on physiology and mathematics. Machine learning techniques were used to combine the examined characteristics for a stable and accurate diagnosis. Automatic electrodiagnosis reached an accuracy of 95% compared to the standard neurophysiological diagnosis of the physicians with nerve conduction studies and 89% compared to the clinical diagnosis. The results show that the automatic detection of carpal tunnel syndrome is possible and can be employed in decision making, excluding human error. It is also shown that the novel features investigated can be used for the detection of the syndrome, complementary to the commonly used ones, increasing the accuracy of the method.
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Affiliation(s)
- Konstantinos I. Tsamis
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Correspondence: (K.I.T.); (G.M.)
| | - Prokopis Kontogiannis
- Department of Computer Science and Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis Gourgiotis
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
| | - Stefanos Ntabos
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
| | - Ioannis Sarmas
- Department of Neurology, University Hospital of Ioannina, 45110 Ioannina, Greece; (I.G.); (S.N.); (I.S.)
| | - George Manis
- Department of Computer Science and Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece;
- Correspondence: (K.I.T.); (G.M.)
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Application of digital infrared thermography for carpal tunnel syndrome evaluation. Sci Rep 2021; 11:21963. [PMID: 34754001 PMCID: PMC8578627 DOI: 10.1038/s41598-021-01381-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/27/2021] [Indexed: 01/18/2023] Open
Abstract
We investigated the thermographic findings of carpal tunnel syndrome (CTS). We enrolled 304 hands with electrodiagnostically identified CTS and 88 control hands. CTS hands were assigned to duration groups (D1, < 3 months; D2, 3‒6 months; D3, 6‒12 months; D4, ≥ 12 months) and severity groups (S1, very mild; S2, mild; S3, moderate; S4, severe). The temperature difference between the median and ulnar nerve territories (ΔM-U territories) decreased as CTS duration and severity increased. Significant differences in ΔM-U territories between the D1 and D3, D1 and D4, D2 and D4, and S1 and S4 groups (P = 0.003, 0.001, 0.001, and < 0.001, respectively) were observed. Thermal anisometry increased as CTS duration and severity increased. Significant differences in thermal anisometry between the D1 and D4 as well as the D2 and D4 groups (P = 0.005 and 0.04, respectively) were noted. Thermal anisometry was higher in the S4 group than in the S1, S2, and S3 groups (P = 0.009, < 0.001, and 0.003, respectively). As CTS progresses, skin temperature tends to decrease and thermal variation tends to increase in the median nerve-innervated area. Thermographic findings reflect the physiological changes of the entrapped median nerve.
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Bahrami E, Parvaresh M, Fattahi A, Farzan A, Kazemi F. Clinical Presentation of Foramen Magnum Meningioma Masqueraded by Carpal Tunnel Syndrome: A Report of 2 Cases. JBJS Case Connect 2021; 11:01709767-202112000-00043. [PMID: 34735377 DOI: 10.2106/jbjs.cc.20.00374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Meningioma is the second most common intracranial tumor. We present 2 cases of foramen magnum meningioma (FMM) that was first operated on with the diagnosis of carpal tunnel syndrome (CTS). CONCLUSION During the diagnostic assessment of CTS and recalcitrant CTS, a more proximal etiology of nerve compression should be considered, including FMM. If a more proximal cause of nerve dysfunction is suspected, cervical spine magnetic resonance imaging may be beneficial to evaluate a patient for spinal etiology.
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Affiliation(s)
- Eshagh Bahrami
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Parvaresh
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Fattahi
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolnaser Farzan
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foad Kazemi
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
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Outcome of carpal tunnel release in patients with normal nerve conduction studies. J Orthop Sci 2021; 26:798-803. [PMID: 32980190 DOI: 10.1016/j.jos.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 02/09/2023]
Abstract
BACKGROUND We evaluated outcome after carpal tunnel release (CTR) in patients with clinically diagnosed carpal tunnel syndrome (CTS) but normal results in nerve conduction studies (NCS), and compared these results with those from a prospective group of patients with NCS-verified CTS. METHODS Over a 5-year period, we prospectively included 103 patients with clinical CTS. NCS were done at inclusion, with surgeon and patient being kept blind regarding the result. The patients underwent endoscopic CTR. QuickDASH and satisfaction score were recorded preoperatively and 4 months after surgery. 94 patients, 47 of whom had NCS-verified CTS, completed the study. RESULTS A significant improvement in QuickDASH score (18 and 20 points respectively, p < 0.01) was found for both groups. Satisfaction score was significantly higher in the group with NCS-verified CTS. However, the overall satisfaction rates were 87% in the normal NCS group and 95% in the group with abnormal NCS. CONCLUSIONS Clinical outcome after CTR in patients with normal NCS was favourable and similar to that obtained in patients with NCS-verified CTS. Nonetheless, patients with normal result in NCS gave a lower satisfaction score.
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Schulze DG, Nilsen KB, Killingmo RM, Zwart JA, Grotle M. Clinical Utility of the 6-Item CTS, Boston-CTS, and Hand-Diagram for Carpal Tunnel Syndrome. Front Neurol 2021; 12:683807. [PMID: 34385969 PMCID: PMC8353366 DOI: 10.3389/fneur.2021.683807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Self-reported measures are often used in research and clinical practice to diagnose carpal tunnel syndrome (CTS) and guide therapeutic choices. We aimed to assess the clinical utility of the Norwegian versions of two self-reported outcome measures for symptom severity assessment, the 6-item CTS (CTS-6), and Boston-CTS (BCTQ), and of one diagnostic measure, the hand-diagram, by evaluating measurement properties including discriminative ability for severity assessment (CTS-6, BCTQ), and diagnosis of CTS (hand-diagram). Methods: We performed forward and backward translation and cultural adaptation of the Norwegian CTS-6 and BCTQ. Following COSMIN guidelines, we investigated internal consistency, reliability, construct validity, and discriminative ability for distinguishing between severity levels of CTS in patients with confirmed CTS for the CTS-6 and BCTQ and reliability and discriminative ability for diagnosing CTS for the hand-diagram. Results: Two hundred and fifty-one patients referred for diagnostic work-up for CTS with nerve conduction studies (NCS) participated. The CTS-6 and BCTQ had acceptable internal consistency (Crohnbach's α = 0.82 and 0.86, respectively), reliability (ICC = 0.86 and 0.90; SEM = 0.24 and 0.20; SDC95% = 0.68 and 0.55, respectively), construct validity (all eight pre-defined hypotheses confirmed) and discriminative ability to distinguish between severity levels of CTS [Area under the curve (AUC) = 0.75, 95% CI 0.64–0.85]. The hand-diagram had acceptable reliability (Cohen's kappa = 0.69) and discriminative ability to diagnose CTS (sensitivity = 0.72, specificity = 0.90). Conclusion: Our findings support the clinical utility of the CTS-6 and BCTQ for symptom severity assessment and of the hand-diagram for diagnostic screening.
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Affiliation(s)
- Daniel Gregor Schulze
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Kristian Bernhard Nilsen
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | | | - John Anker Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Margreth Grotle
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
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Osiak K, Mazurek A, Pękala P, Koziej M, Walocha JA, Pasternak A. Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome-A Systematic Review. J Clin Med 2021; 10:jcm10122691. [PMID: 34207345 PMCID: PMC8235020 DOI: 10.3390/jcm10122691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, intraoperative and postoperative data of EDX studies, time to complete or partial resolution of symptoms, and number of patients without postsurgical improvement. Our main findings revealed that that electrodiagnostic testing is still a powerful tool for diagnosis of CTS. Moreover, it can also detect other pathologies. EDX testing provides a quantitative measure of the physiological function of the median nerve, which may be used to guide surgical treatment. Thirdly, when the outcome of surgery is unsatisfactory, NCS can assist in determining the reason for failure.
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Affiliation(s)
- Katarzyna Osiak
- Medical Centre for Postgraduate Education, Department of Plastic Surgery, Professor W. Orlowski Memorial Hospital, 231st Czerniakowska Street, 00-416 Warsaw, Poland;
| | - Agata Mazurek
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Jerzy A. Walocha
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
| | - Artur Pasternak
- Medical Centre for Postgraduate Education, Department of Plastic Surgery, Professor W. Orlowski Memorial Hospital, 231st Czerniakowska Street, 00-416 Warsaw, Poland;
- Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Krakow, Poland; (A.M.); (P.P.); (M.K.); (J.A.W.)
- Correspondence: ; Tel./Fax: +48-12-422-95-11
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Patients' Perspective on Carpal Tunnel Release with WALANT or Intravenous Regional Anesthesia. Plast Reconstr Surg 2021; 147:887e-888e. [PMID: 33878083 DOI: 10.1097/prs.0000000000007823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mirzaasgari Z, Haghi-Ashtiani B, Refaiean F, Vahedifard F, Homayooni AS, Sobhkhiz M. Diagnostic value of high-frequency ultrasound in carpal tunnel syndrome during pregnancy: A case-control study. CURRENT JOURNAL OF NEUROLOGY 2021; 20:73-77. [PMID: 38011444 PMCID: PMC8743181 DOI: 10.18502/cjn.v20i2.6742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment syndrome in the upper limbs, for which pregnancy is a known risk factor. CTS diagnosis is confirmed via nerve conduction studies (NCSs), which sometimes is expensive, and the electrical stimulation makes it an unpleasant diagnostic modality, especially for pregnant subjects. Recently, high-frequency ultrasonography (HF-USG) is known as a diagnostic method. This study is concerned with determining the diagnostic value of this modality for CTS among pregnant women. Methods: This cross-sectional case-control study was conducted with 40 CTS cases and 40 matched controls. The HF-USG of wrists was performed bilaterally on all participants with a focus on the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) inlet. Results: Mean MNCSA was statistically different between the CTS group (11.71 ± 1.86 mm2, range: 8 to 18 mm2) and the control group (6.75 ± 1.38 mm2, range: 4 to 11 mm2) (P < 0.001). The receiver operating characteristic (ROC) curve was drawn, and the cross-sectional area (CSA) cut-off point of 8.5 mm2 showed sensitivity and specificity of 98% and 93%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 95% and 98%, respectively, with the mentioned point as the diagnostic threshold. Conclusion: HF-USG of the median nerve can be utilized as a preferable alternative to NCS (the current gold standard diagnostic method) in pregnant women, due to its convenience and lower cost, or at least, it can be used as a screening tool among pregnant women with suspicious symptoms.
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Affiliation(s)
- Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Haghi-Ashtiani
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Refaiean
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzan Vahedifard
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Sina Homayooni
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Sobhkhiz
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Obuchowicz R, Kruszyńska J, Strzelecki M. Classifying median nerves in carpal tunnel syndrome: Ultrasound image analysis. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Matesanz L, Hausheer AC, Baskozos G, Bennett DL, Schmid AB. Somatosensory and psychological phenotypes associated with neuropathic pain in entrapment neuropathy. Pain 2021; 162:1211-1220. [PMID: 33044393 PMCID: PMC7977619 DOI: 10.1097/j.pain.0000000000002102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT It currently remains unclear why some patients with entrapment neuropathies develop neuropathic pain (neuP), whereas others have non-neuP, presumably of nociceptive character. Studying patients with carpal tunnel syndrome (CTS), this cross-sectional cohort study investigated changes in somatosensory structure and function as well as emotional well-being specific to the presence and severity of neuP. Patients with CTS (n = 108) were subgrouped by the DN4 questionnaire into those without and with neuP. The latter group was further subdivided into mild and moderate/severe neuP using a pain visual analogue scale. N = 32 participants served as healthy controls. All participants underwent a clinical examination, quantitative sensory testing, electrodiagnostic testing (EDT), and skin biopsy to determine the structural integrity of dermal and intraepidermal nerve fibres. Patients also completed questionnaires evaluating symptom severity and functional deficits, pain distribution, sleep quality, and emotional well-being. The overall prevalence of neuP in patients with CTS was 80%, of which 63% had mild neuP. Symptom severity and functional deficits as well as somatosensory dysfunction was more pronounced with the presence and increasing severity of neuP. No difference was identified among patient groups for EDT and nerve fibre integrity on biopsies. The severity of neuP was accompanied by more pronounced deficits in emotional well-being and sleep quality. Intriguingly, extraterritorial spread of symptoms was more prevalent in patients with moderate/severe neuP, indicating the presence of central mechanisms. NeuP is common in patients with CTS, and its severity is related to the extent of somatosensory dysfunction and a compromise of emotional well-being.
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Affiliation(s)
- Luis Matesanz
- Nuffield Department for Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Andrea C Hausheer
- Nuffield Department for Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Georgios Baskozos
- Nuffield Department for Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - David L.H. Bennett
- Nuffield Department for Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Annina B. Schmid
- Nuffield Department for Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Koyama T, Sato S, Toriumi M, Watanabe T, Nimura A, Okawa A, Sugiura Y, Fujita K. A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study. JMIR Mhealth Uhealth 2021; 9:e26320. [PMID: 33714936 PMCID: PMC8005991 DOI: 10.2196/26320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 01/23/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on a CTS-screening app that uses a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. Objective To make data collection for machine learning easier and more available, we developed a screening app for CTS using a smartphone and an anomaly detection algorithm, aiming to examine our system as a useful screening tool for CTS. Methods In total, 36 participants were recruited, comprising 36 hands with CTS and 27 hands without CTS. Participants controlled the character in our app using their thumbs. We recorded the position of the thumbs and time; generated screening models that classified CTS and non-CTS using anomaly detection and an autoencoder; and calculated the sensitivity, specificity, and area under the curve (AUC). Results Participants with and without CTS were classified with 94% sensitivity, 67% specificity, and an AUC of 0.86. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92% sensitivity, and 100% specificity. Conclusions Our app could reveal the difficulty of thumb opposition for patients with CTS and screen for CTS with high sensitivity and specificity. The app is highly accessible because of the use of smartphones and can be easily enhanced by anomaly detection.
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Affiliation(s)
- Takafumi Koyama
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shusuke Sato
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Madoka Toriumi
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Takuro Watanabe
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuta Sugiura
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Olde Dubbelink TBG, De Kleermaeker FGCM, Beekman R, Wijntjes J, Bartels RHMA, Meulstee J, Verhagen WIM. Wrist Circumference-Dependent Upper Limit of Normal for the Cross-Sectional Area Is Superior Over a Fixed Cut-Off Value in Confirming the Clinical Diagnosis of Carpal Tunnel Syndrome. Front Neurol 2021; 12:625565. [PMID: 33613433 PMCID: PMC7893096 DOI: 10.3389/fneur.2021.625565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/15/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: In confirming the clinical diagnosis of carpal tunnel syndrome (CTS), ultrasonography (US) is the recommended first diagnostic test in The Netherlands. One of the most important parameters for an abnormal US result is an increase of the CSA of the median nerve at the carpal tunnel inlet. An earlier study showed that a wrist-circumference dependent cut-off for the upper limit of normal of this CSA might be superior to a fixed cut-off of 11 mm2. In this study we compared three ultrasonography (US) parameters in three large Dutch hospitals. Methods: Patients with a clinical suspicion of CTS and with reasonable exclusion of other causes of their symptoms were prospectively included. A total number of 175 patients were analysed. The primary goal was to compare the number of wrists with an abnormal US result while using a fixed cut-off of 11 mm2 (FC), a wrist circumference-dependent cut-off (y = 0.88 * x−4, where y = ULN and x = wrist circumference in centimetres; abbreviated as WDC), and an intraneural flow related cut-off (IFC). Results: The WDC considered more US examinations to be abnormal (55.4%) than the FC (50.3%) did, as well as the IFC (46.9%), with a statistically significant difference of p = 0.035 and p = 0.001, respectively. The WDC detected 12 abnormal median nerves while the FC did not, and 18 while the IFC did not. The wrist circumference of the patients of these subgroups turned out to be significantly smaller (p < 0.001) when compared with the rest of the group. Conclusion: According to these study results, the wrist-circumference dependent cut-off value for the CSA of the median nerve at the wrist appears to have a higher sensitivity than either a fixed cut-off value of 11 mm2 or cut-off values based on intraneural flow, and may add most value in patients with a smaller wrist circumference.
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Affiliation(s)
| | | | - Roy Beekman
- Department of Neurology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Juerd Wijntjes
- Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jan Meulstee
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - Wim I M Verhagen
- Department of Neurology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
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Ekiz T, Karaali E, Çiloğlu O. The severity of carpal tunnel syndrome, symptom duration, and surgical technique can affect its response to treatment. HAND SURGERY & REHABILITATION 2021; 40:113. [DOI: 10.1016/j.hansur.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/02/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022]
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Walker FO, Cartwright MS. Pride and precision: Personalizing care in diagnostic neurology laboratories. Muscle Nerve 2021; 63:628-630. [PMID: 33501695 DOI: 10.1002/mus.27182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Francis O Walker
- Division of Neuromuscular Disorders, Department of Neurology, Wake Forest Medical School, Winston-Salem, North Carolina, USA
| | - Michael S Cartwright
- Division of Neuromuscular Disorders, Department of Neurology, Wake Forest Medical School, Winston-Salem, North Carolina, USA
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Lee JK, Yoon BN, Cho JW, Ryu HS, Han SH. Carpal Tunnel Release Despite Normal Nerve Conduction Studies in Carpal Tunnel Syndrome Patients. Ann Plast Surg 2021; 86:52-57. [PMID: 33141768 DOI: 10.1097/sap.0000000000002570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Carpal tunnel syndrome (CTS) is a common entrapment neuropathy, often requiring carpal tunnel release (CTR) surgery. Often, a nerve conduction study (NCS) is performed before CTR; however, there are various reports questioning the sensitivity of NCS, and some patients do undergo CTR despite normal NCS results. We had the following purposes: (1) to report clinical outcome of CTS patients who undergo CTR despite normal NCS, (2) to identify the characteristics and compare those with abnormal NCS patients in terms of basic features and risk factors, and (3) to analyze and compare normal and abnormal NCS results. MATERIALS AND METHODS Medical records of 546 CTS (30 normal NCS and 516 abnormal NCS) patients were retrospectively reviewed. Of 30 normal NCS patients, 7 were excluded, leaving 23 patients in the experimental group. We investigated the influence of age, sex, operative arm, and body mass index, as well as medical conditions known to be risk factors for CTS. In normal NCS patients, as a functional score, we investigated Boston carpal tunnel scores before and after CTR. The NCS results were compared in terms of median motor and median sensory testing. In normal NCS patients, NCS data were compared with that of the contralateral nonoperated wrists. RESULTS There were 18 women and 5 men in the normal NCS group (mean age 43.7 years). On physical examination, 22 (94.7%) patients showed a positive Tinel test, 19 (82.6%) showed a positive Phalen test, 8 (34.8%) complained of nocturnal paresthesia, and only 1 (4.3%) presented with thenar atrophy. In 19 of 23 patients, the Boston CTS scores showed significant improvement after CTR. Normal NCS patients were significantly younger and significantly heavier and more likely to be a current smoker. In NCS analysis of normal NCS patients, the operated wrists were closer to the reference values than nonoperated wrists. CONCLUSIONS Surgeons should evaluate the possibility of other combined lesions before CTR in normal NCS patients. Normal NCS can be present with a CTS diagnosis, especially in younger patients. Nevertheless, CTR after failed conservative management, despite normal NCS, could relieve subjective symptoms and function.
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Affiliation(s)
- Jun-Ku Lee
- From the Department of Orthopaedic Surgery
| | - Byung-Nam Yoon
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Jin Woo Cho
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Han-Seung Ryu
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea
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Küçük EB, Taşkıran ÖÖ. Evaluation of Duruöz Hand Index in diagnosis and staging of Carpal tunnel syndrome. J Clin Neurosci 2020; 82:111-114. [PMID: 33317717 DOI: 10.1016/j.jocn.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/27/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022]
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients' demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r: 0.306, p < 0.001) and Boston functional status scale (FSS) (r: 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR: 2.36, p: 0.01), Phalen positivity (OR: 2.22, p: 0.02), Boston symptom severity scale (SSS) scores (OR: 1.76, p: 0.024), increasing age (OR: 1.06, p < 0.001) and increased BMI (OR: 1.07, p: 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.
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Affiliation(s)
- Esin Benli Küçük
- Physical Theraphy and Rehabilitation Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey.
| | - Özden Özyemişçi Taşkıran
- Physical Theraphy and Rehabilitation Department, Koç University School of Medicine, İstanbul, Turkey
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Electrodiagnostic Testing of Entrapment Neuropathies: A Review of Existing Guidelines. J Clin Neurophysiol 2020; 37:299-305. [PMID: 33151661 DOI: 10.1097/wnp.0000000000000668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Entrapment neuropathies cover a wide range of isolated nerve injuries along the course of the upper and lower extremity nerves. Electrodiagnostic (EDX) testing is usually an essential part of the evaluation of entrapment neuropathies, and examinations for the most common entrapment neuropathies, carpal tunnel syndrome and ulnar neuropathy at the elbow, constitute a significant part of the daily work in EDX laboratories. Despite this, guidelines for EDX testing are generally sparse or do not exist for entrapment neuropathies, whereas a wide variety of different techniques are available to the clinical neurophysiologist. This study reviews the existing, more or less, detailed EDX criteria or practice parameters that are suggested by consensus groups in peer-reviewed journals for the most common entrapment neuropathies: carpal tunnel syndrome, ulnar neuropathy at the elbow, common peroneal (fibular) neuropathy at the fibular head, and tibial neuropathy at the tarsal tunnel. It is concluded that future research is needed to develop and refine EDX guidelines in entrapment neuropathies.
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Katt BM, Imbergamo C, Padua F, Leider J, Fletcher D, Nakashian M, Beredjiklian PK. Diagnostic Value of a Carpal Tunnel Corticosteroid Injection in Patients with Negative Electrodiagnostic Studies. J Hand Microsurg 2020; 14:292-297. [DOI: 10.1055/s-0040-1717830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Introduction There is a known false negative rate when using electrodiagnostic studies (EDS) to diagnose carpal tunnel syndrome (CTS). This can pose a management dilemma for patients with signs and symptoms that correlate with CTS but normal EDS. While corticosteroid injection into the carpal tunnel has been used in this setting for diagnostic purposes, there is little data in the literature supporting this practice. The purpose of this study is to evaluate the prognostic value of a carpal tunnel corticosteroid injection in patients with a normal electrodiagnostic study but exhibiting signs and symptoms suggestive of carpal tunnel, who proceed with a carpal tunnel release.
Materials and Methods The group included 34 patients presenting to an academic orthopedic practice over the years 2010 to 2019 who had negative EDS, a carpal tunnel corticosteroid injection, and a carpal tunnel release. One patient (2.9%), where the response to the corticosteroid injection was not documented, was excluded from the study, yielding a study cohort of 33 patients. Three patients had bilateral disease, yielding 36 hands for evaluation. Statistical analysis was performed using Chi-square analysis for nonparametric data.
Results Thirty-two hands (88.9%) demonstrated complete or partial relief of neuropathic symptoms after the corticosteroid injection, while four (11.1%) did not experience any improvement. Thirty-one hands (86.1%) had symptom improvement following surgery, compared with five (13.9%) which did not. Of the 32 hands that demonstrated relief following the injection, 29 hands (90.6%) improved after surgery. Of the four hands that did not demonstrate relief after the injection, two (50%) improved after surgery. This difference was statistically significant (p = 0.03).
Conclusion Patients diagnosed with a high index of suspicion for CTS do well with operative intervention despite a normal electrodiagnostic test if they have had a positive response to a preoperative injection. The injection can provide reassurance to both the patient and surgeon before proceeding to surgery. Although patients with a normal electrodiagnostic test and no response to cortisone can still do well with surgical intervention, the surgeon should carefully review both the history and physical examination as surgical success may decrease when both diagnostic tests are negative. Performing a corticosteroid injection is an additional diagnostic tool to consider in the management of patients with CTS and normal electrodiagnostic testing.
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Affiliation(s)
- Brian M. Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
| | - Casey Imbergamo
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Fortunato Padua
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
| | - Joseph Leider
- Georgetown Medical School, Washington, District of Columbia, United States
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
| | - Michael Nakashian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
| | - Pedro K. Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, United States
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Schrier VJMM, Evers S, Geske JR, Kremers WK, Villarraga HR, Selles RW, Hovius SER, Gelfman R, Amadio PC. Relative Motion of the Connective Tissue in Carpal Tunnel Syndrome: The Relation with Disease Severity and Clinical Outcome. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2236-2244. [PMID: 32600671 PMCID: PMC7429249 DOI: 10.1016/j.ultrasmedbio.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 05/07/2023]
Abstract
Excursion of the median nerve and the surrounding subsynovial connective tissue (SSCT) is diminished in patients with carpal tunnel syndrome (CTS). This study sought to determine if SSCT excursion could be utilized to predict surgical outcome. Idiopathic CTS patients were reviewed with ultrasound and electrodiagnostic tests at baseline. A speckle tracking algorithm was used to determine SSCT relative to tendon motion (shear index). Analysis of variance tests were used to compare SSCT motion with disease severity at baseline. Adjusted linear regressions were used to test the association with patient-reported outcome. A total of 90 CTS patients were analyzed and found to have an average shear index of 79% (95% confidence interval: 76.3%-81.6%). SSCT motion was lower in CTS patients with increasing electrophysiological severity (p = 0.0475). There was no significant association of pre-operative SSCT motion with symptomatic improvement (p = 0.268). Overall, SSCT motion is decreased in CTS patients, but exhibits limited correlation with clinical severity.
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Affiliation(s)
- Verena J M M Schrier
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefanie Evers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer R Geske
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Walter K Kremers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Steven E R Hovius
- Department of Plastic and Reconstructive Surgery, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - Russell Gelfman
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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