1
|
Latario LD, Fowler JR. Characteristics of Patients with Clinical Signs and Symptoms of Carpal Tunnel Syndrome but Negative Diagnostic Testing. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5816. [PMID: 38752222 PMCID: PMC11095960 DOI: 10.1097/gox.0000000000005816] [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: 02/26/2024] [Accepted: 03/22/2024] [Indexed: 05/18/2024]
Abstract
Background Carpal tunnel syndrome (CTS) is a clinical diagnosis involving numerous confirmatory diagnostic tools, including patient questionnaires, ultrasound (US), and electrodiagnostic studies (EDX.) Patients may experience clinical symptoms of CTS with false negative diagnostic testing. The purpose of this study was to identify characteristics of patients with clinical symptoms of CTS with negative diagnostic testing. Methods An existing database of 295 hands containing the six-item CTS-6, US of the median nerve, and EDX was queried. Patients with symptoms of carpal tunnel scoring 12.5 or higher on CTS-6 were sorted into those with all positive testing or negative testing. Results In 60 patients, 103 hands had both positive US and EDX and a CTS-6 of 12.5 or higher. Twenty-nine hands in 25 patients had a CTS-6 of 12.5 or higher and both negative ultrasound and EDX. There was a significantly younger average age of 43 (P = 0.007) and lower average BMI of 28 (P < 0.0001) of patients in the negative diagnostic study group, compared with the average age of 53, and a body mass index (BMI) of 34 in the positive diagnostic study. Conclusions In this series, patients with symptoms of carpal tunnel syndrome and negative diagnostic studies were on average younger and had a lower BMI. These patients may warrant more careful consideration of CTS clinical diagnosis and counseling regarding a higher risk of false-negative confirmatory testing. Further studies are needed to determine possible effects of age and BMI on electrodiagnostic studies and ultrasound testing in CTS.
Collapse
Affiliation(s)
- Luke D. Latario
- From the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Penn
| | - John R. Fowler
- From the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Penn
| |
Collapse
|
2
|
Halpern RA, Huang S, Dunham K, Petchprapa C, Wollstein R. Association Between Thenar Musculature and Carpal Tunnel Syndrome. J Hand Surg Asian Pac Vol 2024; 29:43-48. [PMID: 38299240 DOI: 10.1142/s2424835524500073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Dynamic forces acting on the transverse carpal ligament (TCL) may influence the mechanics of the carpal tunnel (CT), thus affecting the occurrence of CT syndrome (CTS). Previous studies demonstrated an association between muscle overlying the CT and the diagnosis of CTS. Understanding the location of insertion/origin of the thenar musculature will allow mechanical analysis of the forces applied to the TCL during performance of individual tasks. Our purpose was to determine the location of muscle overlying the CT on magnetic resonance imaging (MRI) in CTS and controls. Methods: Case-control study of 21 normal adult wrist MRI scans. MRI measurements were performed on an axial cut at the level of the hook-of-hamate. Median nerve cross-sectional area (CSA), median nerve shape and increased signal intensity within the CT were associated with CTS. The amount and length of muscle crossing the midline and the CT on the same cut was measured and the association with the occurrence of CTS was analysed. Results: We found an inverse relationship between the amount of muscle crossing the midline and the size of the CT, and a direct relationship with occurrence of CTS p less than 0.01, but no differences regarding length of muscle crossing the midline. Conclusions: This study supports an association between the thenar musculature location relative to the CT and the predictors of CTS on MRI. Since the location of muscle origin/insertion is variable, their effect may differ accordingly, therefore, further study is needed to describe the exact location of origin/insertion and its differential dynamic or static effect on the pathogenesis of CTS. Level of Evidence: Level IV (Diagnostic).
Collapse
Affiliation(s)
- Robert A Halpern
- Department of Orthopaedic Surgery, NYU Grossman School of Medicine, NY, USA
| | - Shengnan Huang
- Department of Orthopaedic Surgery, NYU Grossman School of Medicine, NY, USA
| | - Kevin Dunham
- Department of Radiology, NYU Grossman School of Medicine, NY, USA
| | | | - Ronit Wollstein
- Department of Orthopaedic Surgery, NYU Grossman School of Medicine, NY, USA
- Heersink School of Medicine, University of Alabama, AL, USA
| |
Collapse
|
3
|
Ikumi A, Yoshii Y, Kudo T, Kohyama S, Ogawa T, Hara Y, Ishii T. Potential Relationships between the Median Nerve Cross-Sectional Area and Physical Characteristics in Unilateral Symptomatic Carpal Tunnel Syndrome Patients. J Clin Med 2023; 12:jcm12072515. [PMID: 37048599 PMCID: PMC10095503 DOI: 10.3390/jcm12072515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The present study investigated the relationships between the median nerve cross-sectional area (CSA) and physical characteristics in patients with unilateral symptomatic carpal tunnel syndrome (CTS). Methods: Height, weight, body mass index (BMI), disease duration, results of electrodiagnostic testing (EDX), and median nerve CSA at the level of the wrist crease were recorded in 81 patients with CTS who presented with symptoms on only one side. Correlation coefficients between median nerve CSA and physical characteristics, disease duration, and results of EDX were analyzed. Results: Median nerve CSA at the wrist crease (mm2) was significantly larger on the symptomatic side (14.1 ± 3.8) than on the asymptomatic side (11.5 ± 2.9). Median nerve CSA correlated with body weight (correlation coefficient = 0.39) and BMI (correlation coefficient = 0.44) on the asymptomatic side, but not on the symptomatic side. These correlations were slightly stronger in females (correlation coefficient = 0.46) than in males (correlation coefficient = 0.40). No correlations between median nerve CSA and disease duration and the results of EDX were observed in both sides. Conclusions: In patients with unilateral symptomatic CTS, median nerve CSA correlated with BMI only on the asymptomatic side. The present results suggest that the relationship between median nerve CSA and BMI in CTS is significant until symptom onset but may be masked by edema and pseudoneuroma after its onset. A higher BMI is associated with a larger CSA of the median nerve, which may be a risk factor for the development of CTS.
Collapse
Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Tsukuba University Hospital, Tsukuba 305-8576, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
- Correspondence: ; Tel.: +81-29-8871161
| | - Takamasa Kudo
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Sho Kohyama
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, Mito Medical Center Hospital, Ibaraki 311-3193, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, National Center of Neurology and Psychiatry, Kodaira 187-8551, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
| |
Collapse
|
4
|
Vinciguerra C, Iacono S, Bevilacqua L, Landolfi A, Piscosquito G, Ginanneschi F, Schirò G, Di Stefano V, Brighina F, Barone P, Balistreri CR. Sex differences in neuromuscular disorders. Mech Ageing Dev 2023; 211:111793. [PMID: 36806604 DOI: 10.1016/j.mad.2023.111793] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
The prevalence, onset, pathophysiology, and clinical course of many neuromuscular disorders (NMDs) may significantly differ between males and females. Some NMDs are more frequently observed in females, and characterized to show a higher grade of severity during or after the pregnancy. Meanwhile, others tend to have an earlier onset in males and exhibit a more variable progression. Prevalently, sex differences in NMDs have a familiar character given from genetic inheritance. However, they may also influence clinical presentation and disease severity of acquired NMD forms, and are represented by both hormonal and genetic factors. Consequently, to shed light on the distinctive role of biological factors in the different clinical phenotypes, we summarize in this review the sex related differences and their distinctive biological roles emerging from the current literature in both acquired and inherited NMDs.
Collapse
Affiliation(s)
- Claudia Vinciguerra
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy.
| | - Salvatore Iacono
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Liliana Bevilacqua
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Annamaria Landolfi
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Giuseppe Schirò
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Paolo Barone
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo
| |
Collapse
|