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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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Ergen Hİ, Keskinbıçkı MV, Öksüz Ç. The Effect of Proprioceptive Training on Hand Function and Activity Limitation After Open Carpal Tunnel Release Surgery: A Randomized Controlled Study. Arch Phys Med Rehabil 2024; 105:664-672. [PMID: 38142026 DOI: 10.1016/j.apmr.2023.12.004] [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: 03/20/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To investigate the effect of proprioceptive training on hand function and activity limitation in patients undergoing open carpal tunnel release surgery. DESIGN Randomized controlled study. SETTING A university hospital. PARTICIPANTS Thirty patients were included in the study and randomized to proprioceptive training (PT) and conventional rehabilitation (CR) groups. INTERVENTION One week after surgery, both groups received CR for 6 weeks. All participants were asked to perform home-based exercises daily in 3 sets with 10 repetitions. For the PT group, a 6-step PT program was conducted starting from Week 6. Both groups received face-to-face interventions twice a week for 12 weeks. MAIN OUTCOME MEASURES The outcome measures included the Purdue Pegboard Test (PPT), the joint position sense test (JPST), the Boston Carpal Tunnel Questionnaire, and the Patient-Specific Functional Scale. In total, 3 assessments were performed (at 1, 6 and 12 weeks postoperatively). RESULTS In the PT group, the results for PPT were statistically significant (P<.05). Although there was a greater decrease in the absolute angular error value (JPST) of the PT group compared to the CR group, the difference was nonsignificant (P>.05). Similar reductions in activity limitation were seen in both groups (PT: 176%, CR: 175%). Symptom severity decreased by 40% in the PT group vs 32% in the CR group. The effect sizes were larger for the changes between the second and third assessments in the PT group compared to the CR group in all parameters tested. CONCLUSION When applied after carpal tunnel release surgery, PT may potentially to improve hand functions, reduce activity limitation, increase participation in activities of daily living, and thus improve quality of life.
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Affiliation(s)
- Halil İbrahim Ergen
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Gaziantep University, Gaziantep.
| | | | - Çiğdem Öksüz
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara
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Sanders HM, Tong Y, Hooper RC, Wang L, Chung KC. Decision for Carpal Tunnel Surgery: High-deductible Health Plans versus Traditional Health Plans. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5659. [PMID: 38435458 PMCID: PMC10906623 DOI: 10.1097/gox.0000000000005659] [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: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
Background Delay in surgical treatment for carpal tunnel syndrome (CTS) may result in long-term decreased functional outcomes. Few investigators have examined the relationship between type of health insurance plan and time to definitive treatment of CTS following diagnosis. We investigated the relationship between insurance type, treatment decision, and the time between diagnosis and surgery across groups. Methods This was a retrospective cohort study using the MarketScan Commercial Claims and Encounters Database 2011-2020. We used χ2 tests, linear regression, and logistic regression models to analyze demographic data and the time lag interval between CTS diagnosis and treatment. Results Overall, 28% of high-deductible health plan (HDHP) patients underwent carpal tunnel release, compared with 20% of traditional insurance patients (P < 0.001). HDHPs are defined by the internal revenue service as a deductible of $1400 for an individual or $2800 for a family per year. The odds of undergoing surgery versus no treatment for HDHP patients were 47% higher than traditional patients (P < 0.001). Among the patients who underwent surgery, HDHP patients underwent surgery 65 days earlier on average following diagnosis compared with traditional patients (P < 0.001). Conclusions Patients with HDHPs who receive a diagnosis of CTS are more likely to undergo surgery, with a shorter time lag between diagnosis and surgery. The results from this study call attention to differences in surgical decision-making between patients enrolled in different insurance plans.
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Affiliation(s)
- Hayley M. Sanders
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
| | - Yanlin Tong
- Department of Biostatistics, University of Michigan, Ann Arbor, Mich
| | - Rachel C. Hooper
- Division of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Mich
| | - Kevin C. Chung
- Division of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Mich
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Kayastha A, Lakshmanan K, Valentine MJ, Kramer HD, Kim J, Pettinelli N, Kramer RC. A Readability Study of Carpal Tunnel Release in 2023. Hand (N Y) 2024:15589447241232095. [PMID: 38414220 DOI: 10.1177/15589447241232095] [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: 02/29/2024]
Abstract
BACKGROUND The National Institutes of Health (NIH) and the American Medical Association (AMA) recommend a sixth-grade reading level for patient-directed content. This study aims to quantitatively evaluate the readability of online information sources related to carpal tunnel surgery using established readability indices. METHODS Web searches for "carpal tunnel release" and "carpal tunnel decompression surgery" queries were performed using Google, and the first 20 websites were identified per query. WebFX online software tools were utilized to determine readability. Indices included Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, Coleman Liau Index, Automated Readability Index, Gunning Fog Score, and the Simple Measure of Gobbledygook Index. Health-specific clickthrough rate (CTR) data were used in order to select the first 20 search engine results page from each query. RESULTS "Carpal tunnel release" had a mean readability of 8.46, and "carpal tunnel decompression surgery" had a mean readability of 8.70. The range of mean readability scores among the indices used for both search queries was 6.17 to 14.0. The total mean readability for carpal tunnel surgery information was found to be 8.58. This corresponds to approximately a ninth-grade reading level in the United States. CONCLUSION The average readability of carpal tunnel surgery online content is three grade levels above the recommended sixth-grade level for patient-directed materials. This discrepancy indicates that existing online materials related to carpal tunnel surgery are more difficult to understand than the standards set by NIH and AMA.
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Morrell NT, Dahlberg RK, Scott KL. Electrical Stimulation Use in Upper Extremity Peripheral Nerve Injuries. J Am Acad Orthop Surg 2024; 32:156-161. [PMID: 38109725 DOI: 10.5435/jaaos-d-23-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/08/2023] [Indexed: 12/20/2023] Open
Abstract
Peripheral nerve injuries can be debilitating and often have a variable course of recovery. Electrical stimulation (ES) has been used as an intervention to attempt to overcome the limits of peripheral nerve surgery and improve patient outcomes after peripheral nerve injury. Little has been written in the orthopaedic literature regarding the use of this technology. The purpose of this review was to provide a focused analysis of past and current literature surrounding the utilization of ES in the treatment of various upper extremity peripheral nerve pathologies including compression neuropathies and nerve transection. We aimed to provide clarity on the clinical benefits, appropriate timing for its employment, risks and limitations, and the need for future studies of ES.
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Affiliation(s)
- Nathan T Morrell
- Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM (Morrell and Dahlberg), Banner University Medical Center, Glendale, AZ (Scott)
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Pimentel IS, Pimentel VS, Faloppa F, Belloti JC, Tamaoki MJS, Pimentel BFR. Usefulness of the Phalen Test and the Tinel Sign in the Prognosis and the Impact on Quality of Life of Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release. Rev Bras Ortop 2024; 59:e54-e59. [PMID: 38524717 PMCID: PMC10957282 DOI: 10.1055/s-0044-1779318] [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: 11/30/2022] [Accepted: 06/26/2023] [Indexed: 03/26/2024] Open
Abstract
Objective: To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach. Methods: The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment. Results: The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95%CI]: 1.16%-8.17%), 0.88% (95%CI: 0.08%-4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%-19.18% ), 4.42% (95%CI : 1.65%-9.36%) and 2.65% (95%CI : 0.70%-6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity ( p < 0.001) and of 1.6 points for functional status ( p < 0.001). Conclusion: Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life.
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Affiliation(s)
| | - Victor Spirandelli Pimentel
- Departamento de Ortopedia e Traumatologia, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
| | - Flavio Faloppa
- Departamento de Ortopedia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - João Carlos Belloti
- Departamento de Ortopedia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Benedito Felipe Rabay Pimentel
- Serviço de Ortopedia e Traumatologia, Hospital Municipal Universitário de Taubaté (HMUT), Taubaté, SP, Brasil
- Hospital Regional do Vale do Paraíba (HRVP), Complexo Hospitalar do Vale do Paraíba, Faculdade de Medicina, Universidade de Taubaté (Unitau), Taubaté, SP, Brasil
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Boretto JG. CORR Insights®: Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clin Orthop Relat Res 2024; 482:141-142. [PMID: 37610714 PMCID: PMC10723884 DOI: 10.1097/corr.0000000000002822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Jorge G. Boretto
- Head of the Hand and Upper Extremity Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Kong G, Brutus JP, Vo TT, Hagert E. The prevalence of double- and multiple crush syndromes in patients surgically treated for peripheral nerve compression in the upper limb. HAND SURGERY & REHABILITATION 2023; 42:475-481. [PMID: 37714514 DOI: 10.1016/j.hansur.2023.09.002] [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: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE The double crush syndrome describes a condition characterized by multifocal entrapment of a nerve. In the upper limb, the high prevalence of carpal tunnel syndrome makes it a common diagnosis of assumption in the setting of median neuropathy. More proximal compressions may tend to be overlooked, under-diagnosed and under-treated in the population. This study aims to map the prevalence of peripheral upper limb nerve compressions among patients undergoing peripheral nerve decompression. METHODS A prospective case series was conducted on 183 patients undergoing peripheral nerve decompression in a private hand surgery clinic. Level(s) of nerve compression in the median, ulnar and radial nerves were determined by history and physical examination. The prevalence of each nerve compression syndrome or combination of syndromes was analyzed. RESULTS A total of 320 upper limbs in 183 patients were analyzed. A double crush of the median nerve at the levels of the lacertus fibrosus and carpal tunnel was identified in 78% of upper limbs with median neuropathy, whereas isolated lacertus syndrome and carpal tunnel syndrome were present in only 5% and 17% of affected limbs respectively. Cubital tunnel syndrome affected 12.5% of upper limbs, and 80% of these had concomitant lacertus and carpal tunnel syndromes, compared to only 7.5% with isolated cubital tunnel syndrome. CONCLUSION A high prevalence should prompt clinicians towards more routine assessment for double crush syndrome to avoid misdiagnosis, inadequate treatment, recurrence, and revision surgeries.
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Affiliation(s)
- Geraldine Kong
- Hamad Medical Corporation, Dept. of Orthopedic Surgery, Doha, Qatar
| | | | | | - Elisabet Hagert
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; Karolinska Institutet, Dept. of Clinical Science and Education, Sodersjukhuset, Stockholm, Sweden
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Roe AK, Eppler SL, Kakar S, Akelman E, Got CJ, Blazar PE, Ruch DS, Richard MJ, Yao J, Kamal RN. Do Patients Want to Be Involved in Their Carpal Tunnel Surgery Decisions? A Multicenter Study. J Hand Surg Am 2023; 48:1162.e1-1162.e8. [PMID: 35672175 DOI: 10.1016/j.jhsa.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 02/13/2022] [Accepted: 03/30/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Carpal tunnel syndrome requires multiple decisions during its management, including regarding preoperative studies, surgical technique, and postoperative wound management. Whether patients have varying preferences for the degree to which they share in decisions during different phases of care has not been explored. The goal of our study was to evaluate the degree to which patients want to be involved along the care pathway in the management of carpal tunnel syndrome. METHODS We performed a prospective, multicenter study of patients undergoing carpal tunnel surgery at 5 academic medical centers. Patients received a 27-item questionnaire to rate their preferred level of involvement for decisions made during 3 phases of care for carpal tunnel surgery: preoperative, intraoperative, and postoperative. Preferences for participation were quantified using the Control Preferences Scale. These questions were scored on a scale of 0 to 4, with patient-only decisions scoring 0, semiactive decisions scoring 1, equally collaborative decisions scoring 2, semipassive decisions scoring 3, and physician-only decisions scoring 4. Descriptive statistics were calculated. RESULTS Seventy-one patients completed the survey between November 2018 and April 2019. Overall, patients preferred semipassive decisions in all phases of care (median score, 3). Patients preferred equally collaborative decisions for preoperative decisions (median score, 2). Patients preferred a semipassive decision-making role for intraoperative and postoperative decisions (median score, 3), suggesting these did not need to be equally shared. CONCLUSIONS Patients with carpal tunnel syndrome prefer varying degrees of involvement in the decision-making process of their care and prefer a semipassive role in intraoperative and postoperative decisions. CLINICAL RELEVANCE Strategies to engage patients to varying degrees for all decisions during the management of carpal tunnel syndrome, such as decision aids for preoperative surgical decisions and educational handouts for intraoperative decisions, may facilitate aligning decisions with patient preferences for shared decision-making.
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Affiliation(s)
- Allison K Roe
- Department of Orthopaedic Surgery, Value in Orthopaedics, Innovation and Choices Health Policy Research Center, Stanford University, Redwood City, CA
| | - Sara L Eppler
- Department of Orthopaedic Surgery, Value in Orthopaedics, Innovation and Choices Health Policy Research Center, Stanford University, Redwood City, CA
| | - Sanjeev Kakar
- Hand Surgery Quality Consortium; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | - Edward Akelman
- Hand Surgery Quality Consortium; Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Christopher J Got
- Hand Surgery Quality Consortium; Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Philip E Blazar
- Hand Surgery Quality Consortium; Department of Orthopaedic Surgery, Harvard University, Boston, MA
| | - David S Ruch
- Hand Surgery Quality Consortium; Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Marc J Richard
- Hand Surgery Quality Consortium; Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Value in Orthopaedics, Innovation and Choices Health Policy Research Center, Stanford University, Redwood City, CA; Hand Surgery Quality Consortium
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Value in Orthopaedics, Innovation and Choices Health Policy Research Center, Stanford University, Redwood City, CA; Hand Surgery Quality Consortium.
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Mubin NF, Mubin AN, Fogel J, Morrison E. Progression From Steroid Injection to Surgery in Carpal Tunnel Syndrome Patients With Concurrent Ulnar Nerve Compression: A Retrospective Analysis. Hand (N Y) 2023:15589447231198270. [PMID: 37746706 DOI: 10.1177/15589447231198270] [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: 09/26/2023]
Abstract
BACKGROUND Steroid injections are a common treatment option in the management of carpal tunnel syndrome (CTS). This study assesses various prognostic factors for progression to carpal tunnel release (CTR) after a first-time steroid injection for CTS with specific focus on concomitant ulnar nerve compression (UNC). METHODS This is a retrospective study of 426 hands with CTS treated with a first-time steroid injection in the Long Island region of New York. The main predictor variable was UNC measured in two analytical models of positive UNC and location of UNC (wrist or elbow). Multivariate logistic regression analyses adjusted for demographic, medical, and CTS-related variables for 2 study outcomes occurring within 1 year: (1) CTR; and (2) steroid reinjection. RESULTS Overall progression to CTR within 1 year of steroid injection was 23.0%. Ulnar nerve compression was present in 16.7% of patients and was significantly associated with increased odds for CTR but not with steroid reinjection. These results were further localized to be specific for UNC at the elbow. A moderate or severe result on electrodiagnostic studies was associated with increased odds for CTR. Increased age was associated with slightly increased odds of steroid reinjection while a history of distal radius fracture was associated with decreased odds of steroid reinjection. CONCLUSIONS Carpal tunnel syndrome patients with UNC may benefit from earlier definitive treatment with CTR rather than attempting steroid injections, as they are more likely to seek reintervention within 1 year of their initial injection.
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Affiliation(s)
| | | | - Joshua Fogel
- Nassau University Medical Center, East Meadow, NY, USA
- Brooklyn College, Brooklyn, NY, USA
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Klarskov VR, Ladefoged BT, Pedersen ALD, Hartig-Andreasen C, Clemmensen TS, Poulsen SH. Clinical characteristics and prognostic implications of orthopedic ligament disorders in patients with wild-type transthyretin amyloidosis cardiomyopathy. J Cardiol 2023; 82:122-127. [PMID: 37141937 DOI: 10.1016/j.jjcc.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Wild-type transthyretin amyloidosis (ATTRwt) is associated with multiple ligament disorders (LD) such as carpal tunnel syndrome (CTS), lumbar spinal stenosis (LSS), and spontaneous tendon rupture (STR). No studies have investigated the prevalence of these LD in the same cohort of ATTRwt patients. Furthermore, the clinical characteristics and prognostic implications of such disorders have not been studied. METHODS From 2017 to 2022, 206 consecutive patients with ATTRwt were diagnosed and followed prospectively to the time of death or the censoring date of September 1st, 2022. Patients with and without LD were compared, and the presence of LD was used along with the baseline clinical, biochemical, and echocardiographic characteristics to predict hospitalization with worsening heart failure and death. RESULTS CTS surgery was performed in 34 % of the patients, 8 % were treated for LSS, and 10 % had experienced an STR. The median follow-up time was 706 days (312-1067). Hospitalization with worsening heart failure occurred more frequently in patients with LD compared to patients without LD (p = 0.035). Presence of LD or surgery for CTS were found to be independent predictors of worsening heart failure with a hazard ratio of 2.0 (p = 0.01). The mortality was comparable between patients with and without LD (p = 0.10). CONCLUSION Orthopedic disorders are prevalent in ATTRwt cardiomyopathy, and presence of LD was an independent predictor of hospitalization with worsening heart failure.
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Hattori Y, Kawaguchi Y, Usami T, Waguri-Nagaya Y, Murakami H, Okamoto H. Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release. J Hand Surg Asian Pac Vol 2023; 28:197-204. [PMID: 37120302 DOI: 10.1142/s2424835523500212] [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: 05/01/2023]
Abstract
Background: This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). Methods: We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Results: Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, p < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, p < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, p < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, p < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, p < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm2, p < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm2, p = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, p < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, p < 0.01). Conclusions: Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Yusuke Hattori
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Usami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideki Okamoto
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Sugiura K, Omura T, Miyagi M, Shibata Y, Matsuyama Y. Prevalence and the Influence of Trapeziometacarpal Osteoarthritis on Patients with Carpal Tunnel Syndrome. J Hand Surg Asian Pac Vol 2023; 28:96-101. [PMID: 36803330 DOI: 10.1142/s2424835523500029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Background: The coexistence of carpal tunnel syndrome (CTS) and trapeziometacarpal (TMC) osteoarthritis have been previously described. The influence of TMC osteoarthritis in the outcomes of CTS surgery is yet to be elucidated. The purpose of this study is to examine the prevalence of TMC osteoarthritis in patients who underwent open carpal tunnel release (OCTR) and to analyse the influence of osteoarthritis on the postoperative outcomes of CTS. Methods: We retrospectively reviewed 134 procedures on 113 patients who underwent OCTR between 2002 and 2017. The presence of TMC osteoarthritis was based upon preoperative plain radiograph. For the evaluation of CTS, pre- and postoperative muscle power of abductor pollicis brevis (APB) muscle by manual muscle testing (MMT) and distal motor latency (DML) detected on the APB muscle was examined. Results: The mean follow-up period was 11.4 months. The prevalence of radiographic TMC osteoarthritis was 40% in patients who underwent OCTR. In electrophysiological study, the mean pre- and postoperative DML showed no statistical difference regardless of the coexistence of TMC osteoarthritis. However, there was a significantly higher incidence of poorer muscle strength of the APB in patients with TMC osteoarthritis. No patients complained of TMC joint pain prior to OCTR, but four cases developed TMC joint pain during the postoperative follow-up period, all of whom had full recovery of APB muscle strength. Conclusions: The presence of asymptomatic TMC osteoarthritis may affect the postoperative outcomes of OCTR, so preoperative evaluation of TMC osteoarthritis should be considered in patients undergoing OCTR. In addition, the symptoms of TMC osteoarthritis may worsen in some patients after CTS surgery and should be taken into consideration during the postoperative follow-up. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Kaori Sugiura
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takao Omura
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Michihito Miyagi
- Department of Orthopaedic Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yosuke Shibata
- Department of Community Health and Preventative Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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14
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Núñez-Cortés R, Cruz-Montecinos C, Torreblanca-Vargas S, Andersen LL, Tapia C, Ortega-Palavecinos M, López-Bueno R, Calatayud J, Pérez-Alenda S. Social determinants of health and physical activity are related to pain intensity and mental health in patients with carpal tunnel syndrome. Musculoskelet Sci Pract 2023; 63:102723. [PMID: 36740566 DOI: 10.1016/j.msksp.2023.102723] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper limb and a frequent cause of disability. OBJECTIVE To analyze the association between social determinants of health (SDH) and physical activity with pain intensity and mental health in patients with CTS. DESIGN A cross-sectional study was conducted in patients with CTS awaiting surgery in two public hospitals in Chile. METHODS The SDH collected included: employment status, educational level and monetary income. The level of physical activity was defined according to compliance with WHO recommendations. Outcome measures included: Pain intensity (Visual Analog Scale), Symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), and catastrophic thinking (Pain Catastrophizing Scale). The adjusted regression coefficient (β) for the association between SDH and physical activity with each outcome was obtained using multivariable linear regression models controlling for age, sex, body mass index and symptom duration. RESULTS Eighty-six participants were included (mean age 50.9 ± 10 years, 94% women). A high level of physical activity was associated with a 12.41 mm decrease in pain intensity (β = -12.41, 95%CI: -23.87 to -0.95) and a 3.29 point decrease in depressive symptoms (β = -3.29, 95%CI: -5.52 to -1.06). In addition, being employed was associated with a 2.30 point decrease in anxiety symptoms (β = -2.30; 95%CI: -4.41 to -0.19) and a high educational level was associated with a 7.71 point decrease in catastrophizing (β = -7.71; 95%CI: -14.06 to -1.36). CONCLUSION Multidisciplinary care teams should be aware of the association between SDH and physical activity with physical and mental health.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Section of Clinical Research, Hospital Clínico La Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | | | | | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Rubén López-Bueno
- National Research Centre for the Working Environment, Copenhagen, Denmark; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Spain; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Spain.
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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15
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Graham JG, Plusch KJ, Hozack BA, Ilyas AM, Matzon JL. Early Revision Rate Following Primary Carpal Tunnel Release. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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16
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Pimentel VS, Artoni BB, Faloppa F, Belloti JC, Tamaoki MJS, Pimentel BFR. Prevalência de variações anatômicas encontradas em pacientes com síndrome do túnel do carpo submetidos a liberação cirúrgica por via aberta clássica. Rev Bras Ortop 2022; 57:636-641. [PMID: 35966418 PMCID: PMC9365476 DOI: 10.1055/s-0041-1731361] [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: 10/18/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective
To evaluate the prevalence of anatomical variations encountered in patients with carpal tunnel syndrome who underwent carpal tunnel classical open release.
Methods
A total of 115 patients with a high probability of clinical diagnosis for carpal tunnel syndrome and indication for surgical treatment were included. These patients underwent electroneuromyography and ultrasound for diagnostic confirmation. They underwent surgical treatment by carpal tunnel classical open release, in which a complete inventory of the surgical wound was performed in the search and visualization of anatomical variations intra- and extra-carpal tunnel.
Results
The total prevalence of anatomical variations intra- and extra-carpal tunnel found in this study was 63.5% (95% confidence interval [CI]: 54.5–72.4). The prevalence of the carpal transverse muscle was 57.4% (95% CI: 47.8–66.6%), of the bifid median nerve associated with the persistent median artery was 1.7% (95% CI: 0.0–4.2%), and the median bifid nerve associated with the persistent median artery and the transverse carpal muscle was 1.7% (95% CI: 0.0–4.2%).
Conclusion
The most prevalent extra-carpal tunnel anatomical variation was carpal transverse muscle. The most prevalent intra-carpal tunnel anatomical variation was median bifid nerve associated with the persistent median artery. The surgical finding of an extra-carpal tunnel anatomical variation, such as the transverse carpal muscle, may indicate the presence of other associated carpal intra tunnel anatomical variations, such as the bifid median nerve, persistent median artery, and anatomical variations of the recurrent median nerve branch.
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Affiliation(s)
| | - Bruna Borsari Artoni
- Curso de Medicina, Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brasil
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia, Disciplina de Cirurgia da Mão e Membro Superior, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - João Carlos Belloti
- Departamento de Ortopedia e Traumatologia, Disciplina de Cirurgia da Mão e Membro Superior, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia e Traumatologia, Disciplina de Cirurgia da Mão e Membro Superior, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Benedito Felipe Rabay Pimentel
- Faculdade de Medicina, Universidade de Taubaté (UNITAU), Taubaté, SP, Brasil
- Serviço de Ortopedia e Traumatologia, Hospital Municipal Universitário de Taubaté (H-MUT), Taubaté, SP, Brasil
- Serviço de Ortopedia e Traumatologia, Hospital Regional do Vale do Paraíba (HRVP), Complexo Hospitalar do Vale do Paraíba, Taubaté, SP, Brasil
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17
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Mujadzic T, Friedman HI, Atwez A, Botonjic H, Mujadzic MM, Chen E, Gilstrap JN, Mujadzic MM. Palmar Creases and Their Implication on Carpal Tunnel Surgery. Ann Plast Surg 2022; 88:S495-S497. [PMID: 35690945 DOI: 10.1097/sap.0000000000003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A thorough knowledge of normal and variant anatomy of the wrist and hand is fundamental to avoiding complications during carpal tunnel release. The purpose of this study was to document variations of the surface anatomy of the hand to identify a safe zone in which the initial carpal tunnel incision could be placed. The safe zone was identified as the distance between the radial side of hook of hamate and the ulnar edge of the origin of the motor branch of the median nerve (MBMN). METHODS Kaplan's cardinal line and other superficial markers were used to estimate the size of the safe zone, in accordance to prior published anatomical studies. The presence of a longitudinal palmar crease (thenar, median, or ulnar creases) within the safe zone was recorded. RESULTS Of the 150 participants (75 male, 75 female) examined, the average safe zone widths were 10.85 (right) and 10.28 (left) mm. In all the hands examined, 86.33% of the safe zones (259 of 300) contained a longitudinal palmar crease. In the White population (n = 50), the average safe zone widths were 11.49 (right) and 10.01 (left) mm; in the African American population (n = 50), the average safe zone widths were 12.27 (right) and 12.01 (left) mm; and in the Asian population (n = 50), the average safe zone widths were 8.79 (right) and 8.82 (left) mm. On overage, males had a larger safe zone width than females by 4.55 mm. CONCLUSIONS Although there seems to be variability between race and sex with regard to safe zone width, finding 86.33% of longitudinal palmar creases within the safe zone suggests that, for most patients, the initial carpal tunnel surgery incision may be hidden within the palmar crease while minimizing the risk of motor branch of the median nerve injury. Overall, the safe zone width is on average up to 10.5 mm measured from the hook of the hamate along Kaplan's cardinal line.
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Affiliation(s)
- Tarik Mujadzic
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Harold I Friedman
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Abdelaziz Atwez
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Hata Botonjic
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | | | - Elliott Chen
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Jarom N Gilstrap
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Mirsad M Mujadzic
- From the Prisma Health/University of South Carolina School of Medicine, Columbia, SC
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18
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Triolo ER, BuSha BF. Design and experimental testing of a force-augmenting exoskeleton for the human hand. J Neuroeng Rehabil 2022; 19:23. [PMID: 35189922 PMCID: PMC8862586 DOI: 10.1186/s12984-022-00997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many older Americans suffer from long-term upper limb dysfunction, decreased grip strength, and/or a reduced ability to hold objects due to injuries and a variety of age-related illnesses. The objective of this study was to design and build a five-fingered powered assistive exoskeleton for the human hand, and to validate its ability to augment the gripping and pinching efforts of the wearer and assist in performing ADLs. Methods The exoskeleton device was designed using CAD software and 3-D printed in ABS. Each finger’s movement efforts were individually monitored by a force sensing resistor at each fingertip, and proportionally augmented via the microcontroller-based control scheme, linear actuators, and rigid exoskeleton structure. The force production of the device and the force augmenting capability were assessed on ten healthy individuals with one 5-digit grasping test, three pinching tests, and two functional tests. Results Use of the device significantly decreased the forearm muscle activity necessary to maintain a grasping effort (67%, p < 0.001), the larger of two pinching efforts (30%, p < 0.05), and the palmer pinching effort (67%, p < 0.001); however, no benefit by wearing the device was identified while maintaining a minimal pinching effort or attempting one of the functional tests. Conclusion The exoskeleton device allowed subjects to maintain independent control of each digit, and while wearing the exoskeleton, in both the unpowered and powered states, subjects were able to grasp, hold, and move objects such as a water bottle, bag, smartphone, or dry-erase marker.
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Affiliation(s)
- Emily R Triolo
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Brett F BuSha
- Department of Biomedical Engineering, The College of New Jersey, 2000 Pennington Road, STEM Building, Ewing, NJ, 08628, USA.
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19
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Paiva Filho HR, Costa AC, Paiva VGN, Severino NR. Contradições diagnósticas na síndrome do túnel do carpo. Rev Bras Ortop 2022; 58:290-294. [DOI: 10.1055/s-0042-1742337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022] Open
Abstract
Resumo
Objetivo Diante da divergência sobre a necessidade de exames complementares, como ultrassonografia (US) e eletroneuromiografia (ENMG) para o diagnóstico da síndrome do túnel do carpo (STC), objetivamos elucidar qual deles apresenta maior precisão na confirmação da presença ou não desta afecção.
Métodos Um total de 175 pacientes de um ambulatório de cirurgia da mão foram avaliados clinicamente, e os resultados dos testes clínicos (Tinel, Phalen e Durkan), da US (normal ou alterada) e da ENMG (normal, leve, moderada e grave) foram anotados, cruzados, e submetidos a análise estatística para verificar a concordância entre eles.
Resultados A idade média da amostra era de 53 anos, sendo prevalente o sexo feminino (159 casos). Dos pacientes com teste clínico positivo, 43,7% apresentavam US normal, e 41,7%, ENMG sem alterações. Foram encontrados resultados negativos no Tinel em 46,9% no Phalen em 47,4%, e no Durkan em 39,7%. No cruzamento entre a ENMG e os demais métodos diagnósticos, houve pouca concordância estatística.
Conclusão Não houve concordância entre os resultados dos exames clínicos, da US e da ENMG no diagnóstico da STC, e não há exame clínico ou complementar para STC que determine a conduta terapêutica com precisão.
Nível de Evidência IV, Série de Casos.
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20
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Abstract
During the past 2 decades, increased powerful and quality ultrasound devices have contributed to developing ultrasound surgery more specifically for the hand. Carpal tunnel release under ultrasound now is available as a safe technique. The procedure uses a specific device. A detailed surgical technique is presented. The role of sonography is emphasized. This article discusses the results of the 150 first cases. The author's experience is compared with other ultrasound-guided carpal tunnel release procedures. Outcome quality optimized by the ultra-mini-invasive approach and ultrasound should increase its use.
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Affiliation(s)
- Isabelle David
- Department of Hand Surgery, Belledonne Private Hospital, 83 Avenue Gabriel Péri, Saint-Martin d'Hères 38400.
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21
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Lee SH, Gong HS. Grip Strength Measurement for Outcome Assessment in Common Hand Surgeries. Clin Orthop Surg 2022; 14:1-12. [PMID: 35251535 PMCID: PMC8858903 DOI: 10.4055/cios21090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Grip strength has been used to evaluate the upper extremity functional status and clinical outcomes following upper extremity trauma or surgery. Understanding general recovery patterns of grip strengthening can be helpful in assessing the patients’ recovery status and in assisting in preoperative consultations regarding expectations for recovery. We summarize related studies on grip strength measurement and recovery patterns in common hand conditions, including carpal tunnel syndrome, cubital tunnel syndrome, triangular fibrocartilage complex injury, and distal radius fractures.
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Affiliation(s)
- Seung Hoo Lee
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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22
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Yang C, Chen HH, Lee MC, Kao HK, Lin YT, Chen CT, Chang CJ, Tsai CH. Risk Factors of Carpal Tunnel Syndrome in Taiwan: A Population-Based Cohort Study. Ann Plast Surg 2022; 88:74-78. [PMID: 34270471 DOI: 10.1097/sap.0000000000002950] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), 1 of the most common peripheral neuropathies of the upper extremity, has been studied for decades regarding its epidemiology and associated medical conditions. We conducted a large-scale, age- and gender-matched study from an Asian population database to investigate the relationship between the incidence and the demographic characteristics. METHODS A retrospective cohort study using data of National Health Insurance Research Database was conducted. One million enrollees in Taiwan was used to identify 9442 patients with CTS and 37,768 randomly selected controls, in a control-case ratio of 4:1. Diagnoses of CTS were ascertained from January 1, 2003, to December 31, 2012. Sociodemographic and medical characteristics were evaluated to assess the correlation with CTS. RESULTS Annual incidence of CTS was approximately 0.4% during the 10-year-period in Taiwan, with higher incidence rate in female sex and middle age of group (50-59 years). Among the medical conditions, previous wrist injuries, obesity, gout, and rheumatoid arthritis were associated with CTS most significantly. CONCLUSIONS Carpal tunnel syndrome has presented a relatively constant incidence in Taiwan. Female gender with middle age seemed to have the highest incident rate during a 10-year period from 2003 to 2012. Among the risk factors of CTS, previous wrist injuries, obesity, gout, and rheumatoid arthritis were demonstrated to be the most significantly correlated comorbidities.
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Affiliation(s)
- Cristhiam Yang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Hung Chen
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Min-Chao Lee
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Tzung Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Sciences and Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsuan Tsai
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
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23
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Núñez-Cortés R, Cruz-Montecinos C, Torres-Castro R, Tapia C, Püschel TA, Pérez-Alenda S. Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:1615-1627. [PMID: 34861234 DOI: 10.1016/j.apmr.2021.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR). DATA SOURCES Embase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021. STUDY SELECTION Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR. DATA EXTRACTION Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis. DATA SYNTHESIS A total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low. CONCLUSIONS This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom; Primate Models for Behavioural Evolution Lab, Institute of Cognitive and Evolutionary Anthropology, School of Anthropology, University of Oxford, Oxford, United Kingdom
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.
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24
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Li YL, Wu JJ, Ma J, Li SS, Xue X, Wei D, Shan CL, Zheng MX, Hua XY, Xu JG. Brain Structural Changes in Carpal Tunnel Syndrome Patients: From the Perspectives of Structural Connectivity and Structural Covariance Network. Neurosurgery 2021; 89:978-986. [PMID: 34634107 DOI: 10.1093/neuros/nyab335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy. However, CTS-related changes of brain structural covariance and structural covariance networks (SCNs) patterns have not been clearly studied. OBJECTIVE To explore CTS-related brain changes from perspectives of structural connectivity and SCNs. METHODS Brain structural magnetic resonance images were acquired from 27 CTS patients and 19 healthy controls (HCs). Structural covariance and SCNs were constructed based on gray matter volume. The global network properties including clustering coefficient (Cp), characteristic path length (Lp), small-worldness index, global efficiency (Eglob), and local efficiency (Eloc) and regional network properties including degree, betweenness centrality (BC), and Eloc of a given node were calculated with graph theoretical analysis. RESULTS Compared with HCs, the strength of structural connectivity between the dorsal anterior insula and medial prefrontal thalamus decreased (P < .001) in CTS patients. There was no intergroup difference of area under the curve for Cp, Lp¸ Eglob, and Eloc (all P > .05). The real-world SCN of CTS patients showed a small-world topology ranging from 2% to 32%. CTS patients showed lower nodal degrees of the dorsal anterior insula and medial prefrontal thalamus, and higher Eloc of a given node and BC in the lateral occipital cortex (P < .001) and the dorsolateral middle temporal gyrus (P < .001) than HCs, respectively. CONCLUSION CTS had a profound impact on brain structures from perspectives of structural connectivity and SCNs.
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Affiliation(s)
- Yu-Lin Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Si-Si Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Xue
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dong Wei
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Lei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Engineering Research Center, Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Wahl EP, Huber J, Richard MJ, Ruch DS, Mithani SK, Pidgeon TS. Patient Perspectives on the Cost of Hand Surgery. J Bone Joint Surg Am 2021; 103:2133-2140. [PMID: 34424868 DOI: 10.2106/jbjs.20.02195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Health-care expenditures in the U.S. are continually rising, prompting providers, patients, and payers to search for solutions to reduce costs while maintaining quality. The present study seeks to define the out-of-pocket price that patients undergoing hand surgery are willing to pay, and also queries the potential cost-cutting measures that patients are most and least comfortable with. We hypothesized that respondents would be less accepting of higher out-of-pocket costs. METHODS A survey was developed and distributed to paid, anonymous respondents through Amazon Mechanical Turk. The survey introduced 3 procedures: carpal tunnel release, cubital tunnel release, and open reduction and internal fixation of a distal radial fracture. Respondents were randomized to 1 of 5 out-of-pocket price options for each procedure and asked if they would pay that price. Respondents were then presented with various cost-saving methods and asked to select the options that made them most uncomfortable, even if those would save them out-of-pocket costs. RESULTS There were 1,408 respondents with a mean age of 37 years (range, 18 to 74 years). Nearly 80% of respondents were willing to pay for all 3 of the procedures regardless of which price they were presented. Carpal tunnel release was the most price-sensitive, with rejection rates of 17% at the highest price ($3,000) and 6% at the lowest ($250). Open reduction and internal fixation was the least price-sensitive, with rejection rates of 11% and 6% at the highest and lowest price, respectively. The use of older-generation implants was the least acceptable cost-cutting measure, at 50% of respondents. CONCLUSIONS The present study showed that most patients are willing to pay a considerable amount of money out of pocket for hand surgery after the condition, treatment, and outcomes are explained to them. Furthermore, respondents are hesitant to sacrifice advanced technology despite increased costs.
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Affiliation(s)
- Elizabeth P Wahl
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Joel Huber
- The Fuqua School of Business, Duke University, Durham, North Carolina
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Suhail K Mithani
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Tyler S Pidgeon
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Demographical, Anatomical, Disease-Related, and Occupational Risk Factors for Carpal Tunnel Syndrome. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.117607] [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
Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy. It causes characteristic symptoms, including numbness and paresthesia in hand due to median nerve compression at the wrist. Objectives: We aimed to investigate CTS prevalence and personal, psychosocial, biomedical, and occupational factors related to it comprehensively, according to scattered publications, without the simultaneous evaluation of all CTS risk factors. Methods: A total of 345 patients referred to a hand clinic with a complaint of paresthesia in upper extremities and suspected CTS. The patients underwent neurological assessment and electrodiagnostic (EDX) tests to confirm the diagnosis. The demographic information, past medical history, past trauma history, and occupational history of all the patients were recorded and finally analyzed with SPSS software. Results: Of the patients, 213 (67.1%) met the criteria for CTS, of whom 160 (75%) were female. Females were significantly more affected by CTS than males (P < 0.05). The mean age was higher in the CTS patients (53.80 ± 11.57 years) than in non-patients (42.39 ± 12.31 years, P < 0.001). No statistical relevance was found between CTS prevalence with occupational history, underlying medical conditions, positive Tinel’s and Phalen's tests, and muscle atrophy. Conclusions: We recognized age and gender as main determinants in developing CTS. We also found that older age was related to higher CTS intensity.
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Kanatani T, Harada Y, Nagura I, Takase F, Lucchina S. Evaluation of carpal tunnel release outcomes by the Japanese version of the carpal tunnel syndrome questionnaire compared to an electrophysiological severity grade. J Orthop Sci 2021; 26:1004-1007. [PMID: 33183937 DOI: 10.1016/j.jos.2020.10.007] [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: 07/14/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The outcome of carpal tunnel release (CTR) one year postoperatively was assessed by the Japanese version of Carpal tunnel syndrome questionnaire, CTSI-JSSH. Patients were further graded by the electrophysiological severity scale and the CTSI-JSSH scores were compared amongst the Stages before surgery and one-year postoperatively. METHODS This study included 247 hands and the mean age of the patients was 68 years (range:26-91). They completed the CTSI-JSSH consisting of the two subscales of the symptom scale (CTSI-JSSH-SS) and the functional scale (CTSI-JSSH-FS) both preoperatively and at the follow-up period of one year. The change of the scores of the CTSI-JSSH-SS, CTSI-JSSH-FS and total CTSI-JSSH were examined. Electrophysiological examination was performed before CTR and graded according to the electrophysiological severity scale as Stage 1-5. The scores of the CTSI-JSSH-SS, CTSI-JSSH-FS and total CTSI-JSSH were compared amongst Stage 1-5. RESULTS All CTSI-JSSH-SS, CTSI-JSSH-FS and total CTSI-JSSH scores improved significantly one-year postoperatively. Also, the standardized response mean (SRM) and effect size (ES) showed large responsiveness, i.e. 1.36/1.43, 1.12/1.08 and 1.43/1.45 respectively. There was no significant difference in the score of the CTSI-JSSH-SS, CTSI-JSSH-FS and total CTSI-JSSH amongst any of the Stages preoperatively, while the scores in Stage 5 were significantly inferior to the ones in Stages 3 and 4 one-year postoperatively. CONCLUSIONS The clinical outcomes of CTR were favorable by assessment of the CTSI-JSSH. We suggest the postoperative inferior scores in Stage 5 may be due to the potential axonal damage which could explain the disappearance of distal motor latency and sensory nerve conduction velocity in Stage 5.
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Affiliation(s)
- Takako Kanatani
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe, 651-0053, Japan
| | - Yoshifumi Harada
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe, 651-0053, Japan
| | - Issei Nagura
- Department of Orthopaedic Surgery, Ako City Hospital, 1090 Nakahiro, Ako, 678-0232, Japan
| | - Fumiaki Takase
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, 4-1-23 Kagoike-dori, Chuo-ku, Kobe, 651-0053, Japan
| | - Stefano Lucchina
- Locarno Hand Center, Via Ramogna 16, 6600, Locarno, Switzerland; Hand Unit - Locarno's Regional Hospital, Via Ospedale 1, 6600, Locarno, Switzerland.
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Sadr AH, Misky AT, Akhavani MA. What happens if you ignore carpal tunnel syndrome? QJM 2021; 114:331-332. [PMID: 32761192 DOI: 10.1093/qjmed/hcaa235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- A H Sadr
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - A T Misky
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - M A Akhavani
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
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Via GG, Esterle AR, Awan HM, Jain SA, Goyal KS. Comparison of Local-Only Anesthesia Versus Sedation in Patients Undergoing Staged Bilateral Carpal Tunnel Release: A Randomized Trial. Hand (N Y) 2020; 15:785-792. [PMID: 30880470 PMCID: PMC7850244 DOI: 10.1177/1558944719836237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Carpal tunnel syndrome is a common disease treated operatively. During the operation, the patient may be wide-awake or sedated. The current literature has only compared separate cohorts. We sought to compare patient experience with both local-only anesthesia and sedation. Methods: Staged bilateral carpal tunnel release utilizing open or endoscopic technique was scheduled and followed through to completion of per-protocol analysis in 31 patients. Patients chose initial hand laterality and were randomized regarding initial anesthesia method: local-only or sedation. Data collection via questionnaires began at consent and continued to 6 weeks postoperatively from second procedure. Primary outcome measures included patient satisfaction and patient anesthesia preference. Results: At final follow-up, 6 weeks postoperatively, high satisfaction (30 of 31 patients per method) was reported with both types of anesthesia. Among these patients, 17 (54%) preferred local-only anesthesia, 10 (34%) preferred sedation, 2 had no preference, and 2 opted out of response. Although anesthesia fees were approximately $390 lower with local-only anesthesia, total costs for carpal tunnel release were not significantly different with respect to the anesthesia cohorts. Total time in surgical facility was approximately 26 minutes quicker with local-only anesthesia, largely due to shorter time in the post-anesthesia care unit. Scaled comparison of worst postoperative pain following the 2 procedures revealed no difference between local-only anesthesia and sedation. Conclusions: Patients reported equal satisfaction scores with carpal tunnel release whether performed under local-only anesthesia or with sedation. In addition, local-only anesthesia was indicated as the preference of patients in 59% of cases.
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Affiliation(s)
- Garrhett G. Via
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Hisham M. Awan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | - Sonu A. Jain
- The Ohio State University Wexner Medical Center, Columbus, USA
| | - Kanu S. Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA,Kanu S. Goyal, Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite #3200, Columbus, OH 43212, USA.
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Li C, Wang N, Schäffer AA, Liu X, Zhao Z, Elliott G, Garrett L, Choi NT, Wang Y, Wang Y, Wang C, Wang J, Chan D, Su P, Cui S, Yang Y, Gao B. Mutations in COMP cause familial carpal tunnel syndrome. Nat Commun 2020; 11:3642. [PMID: 32686688 PMCID: PMC7371736 DOI: 10.1038/s41467-020-17378-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/21/2020] [Indexed: 02/06/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, affecting a large proportion of the general population. Genetic susceptibility has been implicated in CTS, but the causative genes remain elusive. Here, we report the identification of two mutations in cartilage oligomeric matrix protein (COMP) that segregate with CTS in two large families with or without multiple epiphyseal dysplasia (MED). Both mutations impair the secretion of COMP by tenocytes, but the mutation associated with MED also perturbs its secretion in chondrocytes. Further functional characterization of the CTS-specific mutation reveals similar histological and molecular changes of tendons/ligaments in patients’ biopsies and the mouse models. The mutant COMP fails to oligomerize properly and is trapped in the ER, resulting in ER stress-induced unfolded protein response and cell death, leading to inflammation, progressive fibrosis and cell composition change in tendons/ligaments. The extracellular matrix (ECM) organization is also altered. Our studies uncover a previously unrecognized mechanism in CTS pathogenesis. Familial carpal tunnel syndrome (CTS) is common, but causal genes are not characterized. Here the authors report two CTS-related mutations in two large families that impair secretion of COMP in tenocytes, leading to ER stress-induced unfolded protein response, inflammation and fibrosis in patients and mouse models.
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Affiliation(s)
- Chunyu Li
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ni Wang
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Alejandro A Schäffer
- National Center for Biotechnology Information and National Cancer Institute, National Institutes of Health, Bethesda, MD, US
| | - Xilin Liu
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuo Zhao
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Gene Elliott
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, US
| | - Lisa Garrett
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, US
| | - Nga Ting Choi
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yueshu Wang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yufa Wang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Cheng Wang
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jin Wang
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Danny Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peiqiang Su
- Department of Orthopaedic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shusen Cui
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Yingzi Yang
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, US. .,Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, Harvard University, Boston, MA, US.
| | - Bo Gao
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. .,National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, US.
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Chang CY, Beduschi MG, Pacheco TA, de M. Chang CC. Carpal Tunnel Syndrome: Retrospective Analysis of 60 Consecutive Cases of Ambulatory Surgical Treatment With Local Anesthesia. Hand (N Y) 2020; 15:509-513. [PMID: 30501506 PMCID: PMC7370391 DOI: 10.1177/1558944718813721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: The purpose of this study was to evaluate the safety and efficacy of ambulatory open surgical treatment for carpal tunnel syndrome with local anesthesia and without tourniquet ischemia, sedation by an anesthesiologist, or hospitalization. Methods: A retrospective analysis of 60 consecutive cases performed during 1 year was conducted, excluding other compressive or noncompressive neuropathies. The criteria for treatment efficacy were improvements in symptoms and recurrence rates, and the safety criterion was the presence of complications. Results: The mean patient age was 53.39 years, with 91.7% of women and 8.3% of men. The right side was more frequently affected (65% of the cases). The anesthetic and surgical procedures were well tolerated by patients. No complications during the procedures or postsurgical recurrences were observed. Conclusions: Consistent with previous data, the results of this study corroborate that the proposed treatment is effective, safe, and of low cost, resulting in great savings and increased productivity for the public health system.
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Affiliation(s)
- Chia Y. Chang
- Hospital Federal dos Servidores do Estado do Rio de Janeiro, Brazil,Ivo Pitanguy Institute, Rio de Janeiro, Brazil,Chang Y. Chia, Division of Reconstructive Microsurgery, Hospital Federal dos Servidores do Estado do Rio de Janeiro (HFSE-RJ), Av. das Américas, 505, Room 203, Barra da Tijuca, Rio de Janeiro, RJ, 22631-000, Brazil.
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Szekeres M. Clinical relevance commentary in response to: Intrarater and inter-rater reliability of a handheld dynamometric technique to quantify palmar thumb abduction strength in individuals with and without carpal tunnel syndrome. J Hand Ther 2020; 31:562-563. [PMID: 30449388 DOI: 10.1016/j.jht.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
PURPOSE OF REVIEW To determine the current evidence for various non-operative therapies in the treatment of carpal tunnel syndrome RECENT FINDINGS: Multiple non-operative treatment modalities exist in the treatment of mild to moderate carpal tunnel syndrome. While certain modalities such as splinting and corticosteroid injections have moderate- to high-quality evidence to support use, other less commonly used treatments have fewer therapeutic indications in the current literature. Healthcare providers should be able to initiate the appropriate diagnostic evaluation and assess the utility of non-operative therapies in the treatment of carpal tunnel syndrome. Moreover, healthcare providers should also be able to understand the evidence behind each treatment and the indications for surgical intervention.
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Affiliation(s)
- Peter J. Ostergaard
- Division of Hand Surgery, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Maximilian A. Meyer
- Division of Hand Surgery, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Brandon E. Earp
- Division of Hand Surgery, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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Núñez-Cortés R, Cruz-Montecinos C, Antúnez-Riveros MA, Pérez-Alenda S. Does the educational level of women influence hand grip and pinch strength in carpal tunnel syndrome? Med Hypotheses 2020; 135:109474. [PMID: 31756589 DOI: 10.1016/j.mehy.2019.109474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Grip and pinch strength are relevant functional variables for various activities of daily life and are related to the quality of life of patients with carpal tunnel syndrome (CTS). OBJECTIVE The main aim was to analyze the relationship between grip and pinch strength and the educational level in women with CTS. STUDY DESIGN Cross-sectional study. METHODS Thirty-one female patients with CTS awaiting surgery were assigned to the low education group if they only had primary education level (completed or not) and the high education group for those having higher education level. The assessments included: grip strength, pinch strength, Visual Analogue Scale, Quick DASH Questionnaire, Pain Catastrophizing Scale and the Tampa scale of kinesiophobia. RESULTS A statistically significant difference was obtained for grip strength (p = 0.027), pinch strength (p = 0.002) and catastrophizing (p = 0.038) between the two groups. No significant differences were observed for the other variables studied (p < 0.05). Grip strength was not related to individual factors: type of work, age, body mass index. CONCLUSION CTS patients with a low educational level exhibited reduced grip and pinch strength and more catastrophic thinking. Future studies should investigate the mechanisms involved in the loss of strength in patients with lower educational levels.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Service of Physical Therapy, Hospital Clínico La Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Biomechanics and Kinesiology Laboratory, Service of Physical Therapy, San José Hospital, Santiago, Chile; Department of Physiotherapy, University of Valencia, Valencia, Spain.
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Abstract
Background: Corticosteroid injection into the carpal tunnel is both a diagnostic test and a therapeutic modality in the treatment of carpal tunnel syndrome. Many injection techniques are described in the literature. Improper placement of injection may result in damage to neurovascular structures in the carpal canal or decrease efficacy of the test and/or therapy. The purpose of this study is to determine if carpal tunnel injection using anatomic landmarks is reproducible and safe. A review of the senior author's injection technique is presented. Methods: Over 8 years, there were 756 attempted placements of a 25-gauge needle into the carpal tunnel in a simulated carpal tunnel injection prior to open carpal tunnel release. The needle was inserted at the wrist crease, just ulnar to palmaris longus. Open carpal tunnel release was subsequently performed, and position of the needle was recorded. Results: In 572 patients (75.7%), the needle was found to be in the carpal tunnel without penetration of contents. The needle was in the carpal tunnel but piercing the median nerve in 66 attempts (8.7%). The carpal tunnel was missed in 118 attempts (15.6%). Conclusions: This is the largest study looking at accuracy of carpal tunnel injection using anatomic landmarks. Our injection accuracy (75.7%) is less than reported in previous studies, which note 82% to 100% accuracy using the same injection technique. This may indicate that carpal tunnel injection is less reliable than previously thought. Safety of carpal tunnel injection remains an important concern. The median nerve was penetrated in 8.7% of attempts.
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Affiliation(s)
| | - Brendan J. MacKay
- Texas Tech University Health Sciences
Center, Lubbock, USA
- Brendan J. MacKay, Department of Orthopaedic
Surgery, School of Medicine, Texas Tech University Health Sciences Center, 3601
4th Street, Lubbock, TX 79430, USA.
| | - Steven J. Seiler
- Orthopaedic & Spine Center of the
Rockies, Fort Collins, CO, USA
| | - Michael T. Fry
- Texas Tech University Health Sciences
Center, Lubbock, USA
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Tsai MC, Kuo YH, Muo CH, Chou LW, Lu CY. Characteristics of Traditional Chinese Medicine Use for Carpal Tunnel Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214086. [PMID: 31652897 PMCID: PMC6862695 DOI: 10.3390/ijerph16214086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 12/31/2022]
Abstract
Carpal tunnel syndrome (CTS) is a common musculoskeletal disorder and an occupational disease caused by repeated exercise or overuse of the hand. We investigated the characteristics of traditional Chinese medicine (TCM) use by practitioners in CTS patients, including demographic variables, socioeconomic status, previous medical conditions, health care use, and hospital characteristics for TCM health care. This cross-sectional study identified 25,965 patients newly diagnosed with CTS based on the first medical diagnosis recorded between 1999 and 2013 in the nationwide representative insurance database of Taiwan. The date of initial CTS diagnosis in outpatient data was defined as the index date, and four patients were excluded because of missing gender-related information. Patients who used TCM care as the first option at their diagnosis were classified as TCM users (n = 677; 2.61%), and all others were TCM non-users (n = 25,288; 97.4%). In the all variables-adjusted model, female patients had an adjusted odds ratio (OR; 95% CI) of TCM use of 1.35 (1.11-1.66). National Health Insurance (NHI) registration was associated with higher odds ratios of TCM use in central, southern, and eastern Taiwan than in northern Taiwan (ORs = 1.43, 1.86, and 1.82, respectively). NHI registration was associated with higher odds ratios of TCM use in rural cities than in urban cities (OR (95% CI) = 1.33 (1.02-1.72)). The TCM group had a 20% less likelihood of exhibiting symptoms, signs, and ill-defined conditions and injury and poisoning. The TCM group had a 56% lower likelihood of having diseases of the musculoskeletal system and connective tissue. Multi-level model outcomes were similar to the results of the all variables-adjusted model, except for the NHI registration outcome in rural and urban cities (OR [95% CI] = 1.33 [0.98-1.81]). Significant associations between the number of TCM visits and TCM use were observed in all logistic regression models. The study presented key demographic characteristics, health care use, and medical conditions associated with TCM use for CTS. Previous experience of TCM use may affect the use of TCM for CTS treatment. This information provides a reference for the allocations of relevant medical resources and health care providers.
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Affiliation(s)
- Meng-Chuan Tsai
- Department of Sport and Health Management, Da-Yeh University, Changhua 51591, Taiwan.
| | - Yu-Hsien Kuo
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Li-Wei Chou
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 404, Taiwan.
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404, Taiwan.
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Taichung 404, Taiwan.
| | - Chung-Yen Lu
- Department of Sport and Health Management, Da-Yeh University, Changhua 51591, Taiwan.
- Department of Chinese Medicine, China Medical University Hospital, Taipei Branch, Taipei 114, Taiwan.
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Hablas SA, Nada DW, Alashkar DS, Elsharkawy AA. The effect of botulinum toxin type A injection in decreasing intratunnel tendon tension in carpal tunnel syndrome: a randomized controlled trial for efficacy and safety. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_35_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lee MH, Gong HS, Lee MH, Cho KJ, Kim J, Baek GH. The Effect of Vitamin D Deficiency Correction on the Outcomes in Women After Carpal Tunnel Release. J Hand Surg Am 2019; 44:649-654. [PMID: 31047743 DOI: 10.1016/j.jhsa.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 02/01/2019] [Accepted: 03/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies suggest that vitamin D supplementation improves myelination and recovery after nerve injuries. The purpose of this study was to evaluate whether correction of vitamin D level leads to better surgical outcomes in women with both carpal tunnel syndrome (CTS) and vitamin D deficiency. METHODS We retrospectively reviewed 84 vitamin D-deficient women with CTS who underwent carpal tunnel release and then received daily vitamin D supplementation of 1,000 IU vitamin D for 6 months. We also reviewed 35 control patients who were vitamin D-nondeficient at baseline and thus did not receive the supplementation. At baseline and 6 months after surgery, we measured serum vitamin D levels, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, motor conduction velocity, and grip and pinch strengths. We compared the outcomes of CTS related to vitamin D levels. We also correlated baseline and follow-up vitamin D levels with the assessed parameters. RESULTS At 6 months, 59 patients became vitamin D-nondeficient (≥ 20 ng/mL) and 25 were still vitamin D-deficient (< 20 ng/mL). Patients who became vitamin D-nondeficient had subtle but better DASH scores than patients who were still vitamin D-deficient or the control patients. Vitamin D levels at 6 months were found to have significant correlation with the DASH score at 6 months. Vitamin D levels at 6 months did not have significant correlation with motor conduction velocity or grip and pinch strengths. CONCLUSIONS Women with CTS and vitamin D deficiency showed subtle but better DASH scores after surgery when vitamin D deficiency was corrected by supplementation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Myung Ho Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Min Ho Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwan Jae Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Carpal tunnel syndrome and spinal canal stenosis: harbingers of transthyretin amyloid cardiomyopathy? Clin Res Cardiol 2019; 108:1324-1330. [PMID: 30953182 DOI: 10.1007/s00392-019-01467-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) and spinal canal stenosis can be frequently observed in the medical history of patients with transthyretin amyloidosis (ATTR), both in the hereditary (mt-ATTR) and wild-type (wt-ATTR) form. The aim of this retrospective single-center analysis was to determine the prevalence of these findings, delay to diagnosis of systemic amyloidosis and the prognostic value in a large cohort of patients with wt-ATTR and mt-ATTR amyloidosis. METHODS Medical records of 253 patients diagnosed with wt-ATTR, 136 patients with mt-ATTR and 77 asymptomatic gene carriers were screened for history of CTS and spinal canal stenosis and laboratory analysis, electrocardiography and echocardiographic results, respectively. Clinical follow-up was performed by phone assessment. RESULTS History of CTS was present in 77 patients (56%) with mt-ATTR, in 152 patients (60%) with wt-ATTR and even in 10 of the asymptomatic gene carriers (13%). Latency between carpal tunnel surgery and first diagnosis of systemic amyloidosis was significantly longer in wt-ATTR compared to mt-ATTR (117 ± 179 months vs. 66 ± 73 months; p = 0.02). In total, 36 patients (14%) with wt-ATTR and 7 patients (5%) with mt-ATTR had a history of clinically significant spinal canal stenosis. In the subgroup of mt-ATTR, patients with CTS had thicker IVS (19 ± 5 mm vs. 16 ± 5 mm, p < 0.05), higher LV mass index (225 ± 78 g vs. 193 ± 98 g, p < 0.05), lower Karnofsky index (78 ± 15% vs. 83 ± 17%, p < 0.05), and lower mitral annular plane systolic excursion (MAPSE; 9 ± 4 mm vs. 11 ± 5 mm, p < 0.05) compared to patients without CTS, whereas in wt-ATTR no significant differences could be observed. No significant difference in survival was observed between patients with and without CTS (wt-ATTR: 67 vs. 63 months, p = 0.45; mt-ATTR: 74 vs. 63 months, p = 0.60). A combination of CTS and spinal stenosis was present in 32 wt-ATTR patients (12%) and 3 mt-ATTR patients (2.2%). CONCLUSIONS The prevalence of CTS is high and the latency between CTS surgery and diagnosis of amyloidosis is long among patients with wt-ATTR and mt-ATTR. CTS might be predictive for future occurrence of systemic (predominantly cardiac) ATTR amyloidosis.
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Masud M, Rashid M, Malik SA, Ibrahim Khan M, Sarwar SUR. Does the Duration and Severity of Symptoms Have an Impact on Relief of Symptoms after Carpal Tunnel Release? J Brachial Plex Peripher Nerve Inj 2019; 14:e1-e8. [PMID: 30679941 PMCID: PMC6342680 DOI: 10.1055/s-0038-1668552] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 06/16/2018] [Indexed: 10/27/2022] Open
Abstract
Rationale Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery. Method It included 45 cases of CTS, all treated with limited access open carpal tunnel release. The duration of symptoms (i.e., pain, numbness, tingling, waking up at night because of pain/numbness, difficulty in grasping small objects, and their preoperative severity) was noted using Boston CTS questionnaire. To investigate the outcome, patients were divided into three groups based on their duration of symptoms. Result Group1: The severity of symptoms was reduced to normal in a short period of time in patients who presented with duration of symptoms less than 6 months. Group 2: Patients in whom symptoms lasted for 6 to 12 months had reduced or delayed recovery of hand function as compared with first group. Group 3: Patients who had symptoms for more than 12 months had incomplete recovery of grip strength. Return to normal function took the longest time (median: 16 weeks) in this group. Conclusion This study suggests that patients who present late have delayed/incomplete relief of symptoms after carpal tunnel release.
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Affiliation(s)
- Mehreen Masud
- Department of Plastic Surgery, Shifa International Hospital, Islamabad, Pakistan
| | - Mamoon Rashid
- Department of Plastic Surgery, Shifa International Hospital, Islamabad, Pakistan
| | - Saleem Akhtar Malik
- Department of Plastic Surgery, Shifa International Hospital, Islamabad, Pakistan
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Fernandes CH, Meirelles LM, Fernandes M, Nakachima LR, Santos JBGD, Fallopa F. Intra-individual evaluation of results between open and endoscopic release in bilateral carpal tunnel syndrome. Rev Bras Ortop 2018; 53:696-702. [PMID: 30377602 PMCID: PMC6204539 DOI: 10.1016/j.rboe.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022] Open
Abstract
Objective The authors performed an intra-individual comparison of surgical results between the open and endoscopic surgical techniques in patients with bilateral carpal tunnel syndrome. Each hand was submitted to surgery using one of these techniques. Methods Fifteen patients (30 hands) were evaluated by the Boston Questionnaire, visual analogue pain scale, palmar grip strength, and for tip, key, and tripod pinch strengths. These measurements were taken before surgery and at two weeks, one month, three months, and six months after the procedure. Scores for each evaluation tool in each evaluation time period were compared. Results In comparison to the group submitted to open surgery, the group submitted to endoscopic surgery had worse scores in the evaluation of the 1st and 6th postoperative months regarding the severity of the symptoms. The authors found no differences in the functional status of the hand. Regarding the intensity of pain evaluated by the visual analogue pain scale, no difference was found between the averages in all time periods evaluated. No differences in palmar grip strength and in fingertip, key (lateral), and tripod pinch strengths were found in all time periods. There were no differences between averages in the preoperative period at two weeks, one month, and three months after surgery. After six months, the group of patients submitted to open surgery presented greater tripod force than the group of patients who underwent endoscopic surgery. Conclusion No differences were observed by using the intra-individual evaluation in the results between open and endoscopic techniques for the treatment of carpal tunnel syndrome.
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Affiliation(s)
- Carlos Henrique Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lia Miyamoto Meirelles
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcela Fernandes
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Luis Renato Nakachima
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - João Baptista Gomes Dos Santos
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Flavio Fallopa
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Avaliação intraindividual dos resultados entre as técnicas aberta e endoscópica de um portal na síndrome do túnel do carpo bilateral. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pimentel BFR, Faloppa F, Tamaoki MJS, Belloti JC. Effectiveness of ultrasonography and nerve conduction studies in the diagnosing of carpal tunnel syndrome: clinical trial on accuracy. BMC Musculoskelet Disord 2018; 19:115. [PMID: 29649998 PMCID: PMC5898048 DOI: 10.1186/s12891-018-2036-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of two diagnostic tests routinely used for diagnosing carpal tunnel syndrome (CTS)-ultrasonography (US) and nerve conduction studies (NCS)-by comparing their accuracy based on surgical results, with the remission of paresthesia as the reference standard. METHODS We enrolled 115 patients, all of the female gender with a high probability of a clinical diagnosis of CTS. All patients underwent US and NCS for a diagnosis and subsequent surgical treatment. As a primary outcome, the accuracy of the US and NCS diagnoses was measured by comparing their diagnoses compared with those determined by the surgical outcomes. Their accuracy was secondarily evaluated based on before and after scores of the Boston Carpal Tunnel Questionnaire (BCTQ). RESULTS Overall, 104 patients (90.4%) were diagnosed with CTS by the surgical reference standard, 97 (84.3%) by NCS, and 90 (78.3%) by US. The concordance of NCS and surgical treatment (p < 0.001; kappa = 0.648) was superior to that of US and surgical treatment (p < 0.001; kappa = 0.423). The sensitivity and specificity of US and NCS were similar (p = 1.000 and p = 0.152, respectively: McNemar's test). The BCTQ scores were lower after surgery in patients diagnosed by both US and NCS (p < 0.001and p < 0.001, respectively: analysis of variance). CONCLUSIONS US and NCS effectively diagnosed CTS with good sensitivity but were not effective enough to rule out a suspicion of CTS. TRIAL REGISTRATION This study was registered at September, 10 th, 2015, and the registration number was NCT02553811 .
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Affiliation(s)
- Benedito Felipe Rabay Pimentel
- Division of Hand Surgery and Upper Limb, Discipline of Orthopaedics and Traumatology, Paraiba Valley Regional Hospital and Taubaté University Hospital, University of Taubaté, 239 Francisco de Barros, Taubaté, São Paulo zip code 12020-230 Brazil
| | - Flávio Faloppa
- Division of Hand Surgery and Upper Limb, Department of Orthopedics and Traumatology, Federal University of São Paulo, Paulista School of Medicine, 786 Borges Lagoa, São Paulo, São Paulo zip code 04038-030 Brazil
| | - Marcel Jun Sugawara Tamaoki
- Division of Hand Surgery and Upper Limb, Department of Orthopedics and Traumatology, Federal University of São Paulo, Paulista School of Medicine, 786 Borges Lagoa, São Paulo, São Paulo zip code 04038-030 Brazil
| | - João Carlos Belloti
- Division of Hand Surgery and Upper Limb, Department of Orthopedics and Traumatology, Federal University of São Paulo, Paulista School of Medicine, 786 Borges Lagoa, São Paulo, São Paulo zip code 04038-030 Brazil
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Nehete SR, Raut BB, Hiremath AS, Thatte RM. A study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome, their correlation with post-operative recovery. Indian J Plast Surg 2018; 50:260-265. [PMID: 29618860 PMCID: PMC5868104 DOI: 10.4103/ijps.ijps_41_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective We aimed to study the various clinical and electrophysiological parameters of severity of carpal tunnel syndrome (CTS) and to see if the severity of CTS affects recovery after surgery. Patients and Methods A prospective study of 35 patients suffering from CTS. Clinical severity was assessed using visual analogue scale and standard questionnaires such as Levine and Disabilities of Arm, Shoulder and Hand questionnaires. All the patients underwent electrophysiological evaluation to assess electrophysiological severity of CTS. According to modified Padua classification, they were classified into three groups, namely, minimal to mild, moderate and severe to extreme. All patients underwent Carpal tunnel release in our unit. The clinical assessment was repeated 3 months post-operatively. Results Out of 33 patients, majority (65.7%) of the patients were suffering from moderately severe CTS. The clinical provocative tests were positive in majority of patients. Clinically and statistically significant (P < 0.001) improvement was seen in all clinical severity scores. However, it did not show any statistical correlation with electrophysiological severity of the disease when compared among the groups. There was no association of age, gender of the patient, body mass index, hand dominance, affected side of the patient, results of provocative tests and the presence or absence of thenar muscle atrophy when compared among the three severity groups (P > 0.05). Conclusions Although pre-operative clinical scores of severity and electrophysiology have a diagnostic role in CTS, they do not correlate with post-operative recovery and in turn fail to predict the extent of post-operative recovery before surgery.
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Affiliation(s)
- Sushil Ramesh Nehete
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Binita B Raut
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Amita S Hiremath
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - R Mukund Thatte
- Department of Plastic Surgery, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India
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Kim K, Gong HS, Kim J, Baek GH. Expression of vitamin D receptor in the subsynovial connective tissue in women with carpal tunnel syndrome. J Hand Surg Eur Vol 2018; 43:290-295. [PMID: 29329504 DOI: 10.1177/1753193417749158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Studies suggest that low vitamin D levels are associated with carpal tunnel syndrome. We aimed to evaluate whether level of vitamin D receptor expression in the endothelial cells of the subsynovial connective tissue is associated with clinical features of carpal tunnel syndrome. We obtained the subsynovial connective tissue from 52 women with carpal tunnel syndrome during surgery and performed immunohistochemical analysis of vitamin D receptors in the endothelial cells of the subsynovial connective tissue. We explored correlation of vitamin D receptor expression with clinical features of carpal tunnel syndrome, such as age, symptom duration, symptom severity and electrophysiological severity. Diverse range of vitamin D receptor expression was observed. Vitamin D receptor expression was independently associated with distal motor latency. This suggests that vitamin D receptor expression may be associated with disease progression, as prolonged distal motor latency reflects severity of the disease. Further studies are necessary to explore the role of vitamin D and vitamin D receptors in patients with carpal tunnel syndrome. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kahyun Kim
- 1 Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hyun Sik Gong
- 2 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jihyeung Kim
- 2 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- 2 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Dunn JC, Kusnezov NA, Koehler LR, Vanden Berge D, Genco B, Mitchell J, Orr JD, Pallis M. Outcomes Following Carpal Tunnel Release in Patients Receiving Workers' Compensation: A Systematic Review. Hand (N Y) 2018; 13:137-142. [PMID: 28387162 PMCID: PMC5950969 DOI: 10.1177/1558944717701240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers' compensation (WC) claims. METHODS The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria. A systematic review was generated; patient demographics, outcomes, and complications were recorded. Weighted averages were calculated for the demographic and outcome data. Categorical data such as complications were pooled from the studies and used to determine the overall complication rate. Statistical significance was determined between WC and non-WC cohorts when applicable with the chi-square statistic. RESULTS The WC cohort included 1586 wrists, and the non-WC cohort included 2781 wrists. The WC cohort was younger and more often involved the dominant extremity. The WC cohort was less likely to have appropriate physical exam findings confirming diagnosis and electrodiagnostic studies. WC patients took almost 5 weeks longer to return to work, were 16% less likely to return to preinjury vocation, and had lower Standard Form (SF)-36 scores. Finally, WC patients had nearly 3 times the number of complications and nearly twice the rate of persistent pain. CONCLUSIONS WC patients undergoing carpal tunnel release (CTR) fare poorly as compared with non-WC patients in nearly every metric. Higher rates of postoperative pain with delayed return to work can be anticipated in a WC cohort. In addition, WC patients receive suboptimal preoperative workup, and it is possible that unnecessary surgery is being completed in these cases. These findings are important to consider when treating the WC patient with CTS.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
| | | | - Logan R. Koehler
- William Beaumont Army Medical Center, El Paso, TX, USA
- Logan R. Koehler, Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.
| | | | - Ben Genco
- Texas Tech University Health Sciences Center El Paso, USA
| | | | - Justin D. Orr
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Mark Pallis
- William Beaumont Army Medical Center, El Paso, TX, USA
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Bertolini GRF, Kakihata CMM, Peretti AL, Bernardino GR, Karvat J, Silva JLDC, Brancalhão RMC, Ribeiro LDFC. Effects of the platelet-rich fibrin associated with physical exercise in a model of median nerve compression. MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-6574201700040010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Wadsten MÅ, Sjödén GO, Buttazzoni GG, Buttazzoni C, Englund E, Sayed-Noor AS. The influence of late displacement in distal radius fractures on function, grip strength, range of motion and quality of life. J Hand Surg Eur Vol 2018; 43:131-136. [PMID: 28758528 DOI: 10.1177/1753193417721446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Late displacement of distal radius fractures, still in acceptable radiological position after 1-2 weeks, occurs in approximately one-third of cases. The aim of this study was to investigate the influence of late displacement on the functional outcome and quality of life at 1 year in non-operatively treated distal radius fractures. One hundred and seventy five unilateral conservatively treated distal radius fractures with minimal displacement after 10-14 days were finally evaluated in the study. Follow-up included radiographs at 3 months and clinical examination 1 year after the fracture. Final radiographic parameters, grip strength, range of motion, QuickDASH, EQ-5D and pain visual analogue scale were evaluated with multivariate analysis. Late displacement occurred in 28% of the cases and was associated with loss of grip strength and range of motion. No significant differences were seen in the outcome questionnaires. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Å Wadsten
- 1 Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Sweden
| | - G O Sjödén
- 1 Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Sweden
| | - G G Buttazzoni
- 2 Department of Surgical and Perioperative Sciences (Orthopaedics-Östersund), Umeå University, Sweden
| | - C Buttazzoni
- 2 Department of Surgical and Perioperative Sciences (Orthopaedics-Östersund), Umeå University, Sweden
| | - E Englund
- 3 Department of Research and Development, Västernorrland County, Sundsvall, Sweden
| | - A S Sayed-Noor
- 1 Department of Surgical and Perioperative Sciences (Orthopaedics-Sundsvall), Umeå University, Sweden
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Liu R, Kuang X, Deng J, Wang YC, Wang AC, Ding W, Lai YC, Chen J, Wang P, Lin Z, Qi HJ, Sun B, Wang ZL. Shape Memory Polymers for Body Motion Energy Harvesting and Self-Powered Mechanosensing. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:1705195. [PMID: 29318681 DOI: 10.1002/adma.201705195] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/29/2017] [Indexed: 06/07/2023]
Abstract
Growing demand in portable electronics raises a requirement to electronic devices being stretchable, deformable, and durable, for which functional polymers are ideal choices of materials. Here, the first transformable smart energy harvester and self-powered mechanosensation sensor using shape memory polymers is demonstrated. The device is based on the mechanism of a flexible triboelectric nanogenerator using the thermally triggered shape transformation of organic materials for effectively harvesting mechanical energy. This work paves a new direction for functional polymers, especially in the field of mechanosensation for potential applications in areas such as soft robotics, biomedical devices, and wearable electronics.
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Affiliation(s)
- Ruiyuan Liu
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- Institute of Functional Nano and Soft Materials, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Xiao Kuang
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jianan Deng
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Yi-Cheng Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Aurelia C Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Wenbo Ding
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Ying-Chih Lai
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jun Chen
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Peihong Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Zhiqun Lin
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - H Jerry Qi
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Baoquan Sun
- Institute of Functional Nano and Soft Materials, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Zhong Lin Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Science, National Center for Nanoscience and Technology, Beijing, 100083, China
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Tran TA, Williams LM, Bui D, Anthonisen C, Poltavskiy E, Szabo RM. Prospective Pilot Study Comparing Pre- and Postsurgical CTSAQ and Neuro-QoL Questionnaire with Median Nerve High-Resolution Ultrasound Cross-Sectional Areas. J Hand Surg Am 2018; 43:184.e1-184.e9. [PMID: 28951102 PMCID: PMC5805607 DOI: 10.1016/j.jhsa.2017.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were (1) to assess the utility of the Quality of Life in Neurological Disorder (Neuro-QoL) questionnaire in patients with carpal tunnel syndrome by comparing the validated patient-reported outcome (PRO) measure Neuro-QoL to the validated Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) before and following carpal tunnel release, (2) to compare the measurements of the median nerve cross-sectional area (CSA) using high-resolution ultrasound (HRUS) before and after surgery, and (3) to determine a correlation between HRUS and PRO. METHODS Individuals diagnosed with carpal tunnel syndrome were evaluated using the CTSAQ, Neuro-QoL, and HRUS before surgery and at 3 months after surgery. RESULTS Twenty patients completed the study. Overwhelmingly, there was an improvement in symptoms and function assessed by patients on both the Neuro-QoL and the CTSAQ at 3 months after surgery. The Neuro-QoL Physical Function and Upper Extremity scores had strong correlation with the CTSAQ activity score but had low to moderate correlation with the CTSAQ symptoms score, before and after surgery. The HRUS measurements of the median nerve at the carpal tunnel inlet demonstrated a decrease in CSA whereas no noticeable changes were observed at mid tunnel and at the outlet (hook of hamate). The correlations between the ultrasound findings and PRO measures ranged from weak to strong. CONCLUSIONS Patients had resolution of symptoms and higher physical function following carpal tunnel release measured by both the CTSAQ and the Neuro-QoL scores. The Neuro-QoL self-assessment questionnaire, a measurement of quality of life, correlated well with the CTSAQ. Therefore, it could be used as a self-assessment outcomes tool in patients undergoing carpal tunnel release. At 3 months after surgery, HRUS measurements of the median nerve CSA showed a noticeable decrease of CSA only at the inlet of carpal tunnel. This objective improvement correlated with the improvement in CTSAQ and Neuro-QoL scores. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnosis II.
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