1
|
Lyu S, Zhang M, Yu J, Zhu J, Zhang B, Gao L, Jin D, Chen Q. Application of radiomics model based on ultrasound image features in the prediction of carpal tunnel syndrome severity. Skeletal Radiol 2024; 53:1389-1397. [PMID: 38289532 DOI: 10.1007/s00256-024-04594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE The aim of our study is to develop and validate a radiomics model based on ultrasound image features for predicting carpal tunnel syndrome (CTS) severity. METHODS This retrospective study included 237 CTS hands (106 for mild symptom, 68 for moderate symptom and 63 for severe symptom). There were no statistically significant differences among the three groups in terms of age, gender, race, etc. The data set was randomly divided into a training set and a test set in a ratio of 7:3. Firstly, a senior musculoskeletal ultrasound expert measures the cross-sectional area of median nerve (MN) at the scaphoid-pisiform level. Subsequently, a recursive feature elimination (RFE) method was used to identify the most discriminative radiomic features of each MN at the entrance of the carpal tunnel. Eventually, a random forest model was employed to classify the selected features for prediction. To evaluate the performance of the model, the confusion matrix, receiver operating characteristic (ROC) curves, and F1 values were calculated and plotted correspondingly. RESULTS The prediction capability of the radiomics model was significantly better than that of ultrasound measurements when 10 robust features were selected. The training set performed perfect classification with 100% accuracy for all participants, while the testing set performed accurate classification of severity for 76.39% of participants with F1 values of 80.00, 63.40, and 84.80 for predicting mild, moderate, and severe CTS, respectively. Comparably, the F1 values for mild, moderate, and severe CTS predicted based on the MN cross-sectional area were 76.46, 57.78, and 64.00, respectively.. CONCLUSION This radiomics model based on ultrasound images has certain value in distinguishing the severity of CTS, and was slightly superior to using only MN cross-sectional area for judgment. Although its diagnostic efficacy was still inferior to that of neuroelectrophysiology. However, this method was non-invasive and did not require additional costs, and could provide additional information for clinical physicians to develop diagnosis and treatment plans.
Collapse
Affiliation(s)
- Shuyi Lyu
- Department of Ultrasound, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
- Department of Ultrasound, Zhenhai Hospital of Traditional Chinese Medicine, No.51, Huancheng W Rd, Zhenhai District, Ningbo, 315200, Zhejiang, People's Republic of China
| | - Meiwu Zhang
- Department of Ultrasound, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Jianjun Yu
- Department of Neuroelectrophysiology, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Jiazhen Zhu
- Department of Radiology, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Baisong Zhang
- Department of Ultrasound, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Libo Gao
- Department of Ultrasound, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Dingkelei Jin
- Department of Ultrasound, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China
- Hangzhou Medical College, Binjiang District, Hangzhou, 310051, People's Republic of China
| | - Qiaojie Chen
- Department of Orthopaedics, Haishu District, Ningbo NO.2 Hospital, No. 41, Northwest Street, Ningbo, Zhejiang, 315010, People's Republic of China.
| |
Collapse
|
2
|
Aversano FJ, Goldfarb CA, Gelberman RH, Calfee RP. The Utility of the Carpal Tunnel Syndrome-6 for Predicting the Outcomes of Carpal Tunnel Release. J Hand Surg Am 2022; 47:944-952. [PMID: 35941000 DOI: 10.1016/j.jhsa.2022.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Considering the cost of, discomfort with, and time required for nerve conduction testing, the Carpal Tunnel Syndrome-6 (CTS-6) is often used to determine the likelihood of the presence of carpal tunnel syndrome. We sought to determine whether the CTS-6, designed as a diagnostic instrument, could serve a dual purpose and predict the outcome of carpal tunnel release (CTR) based on postoperative changes in the Boston Carpal Tunnel Questionnaire (BCTQ) score. METHODS This prospective observational study enrolled 118 adults before they underwent open CTR at a tertiary center. A primary regression analysis was used to determine the association between preoperative CTS-6 scores and changes in the BCTQ score at ≥6 months after surgery. Additional demographic, social, electrodiagnostic, and mental health variables were assessed for associations with changes in the BCTQ score. The secondary outcomes included single questions rating satisfaction with the result of CTR as well as symptom changes and the Decision Regret Scale. Noneffective CTR was defined as a BCTQ score change of <1.0 point or reported dissatisfaction. RESULTS Postoperatively, the BCTQ score improvement averaged 1.38 ± 0.77. Although 102 of 109 patients (94%) noted symptom improvement, 94 of 109 (86%) were satisfied with the result of CTR, and 78 of 109 patients (72%) demonstrated a meaningful change in the BCTQ score. Preoperative CTS-6 scores were not correlated with changes in BCTQ scores. CTS-6 scores were not associated with Decision Regret Scale scores, reported satisfaction, or the single-question assessment of symptom changes. Satisfaction, decision regret, and the single symptom change question were correlated with changes in the BCTQ score and each other. Dissatisfied patients were distinguished by a differential improvement in the BCTQ score (1.5 vs 0.7), but no preoperative variable consistently predicted noneffective CTR. CONCLUSIONS The CTS-6 score does not predict changes in BCTQ scores after CTR. Patient satisfaction with surgical results is associated with postoperative changes in carpal tunnel symptoms but is not predictable using preoperative information. A single question of symptom change may offer an efficient assessment of CTR outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Francis J Aversano
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Charles A Goldfarb
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Richard H Gelberman
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Ryan P Calfee
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, St. Louis, MO.
| |
Collapse
|
3
|
Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2155765. [PMID: 35782066 PMCID: PMC9242805 DOI: 10.1155/2022/2155765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/31/2022] [Accepted: 06/11/2022] [Indexed: 11/18/2022]
Abstract
Background Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.
Collapse
|
4
|
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.
Collapse
|
5
|
Liu CT, Liu DH, Chen CJ, Wang YW, Wu PS, Horng YS. Effects of wrist extension on median nerve and flexor tendon excursions in patients with carpal tunnel syndrome: a case control study. BMC Musculoskelet Disord 2021; 22:477. [PMID: 34030693 PMCID: PMC8146623 DOI: 10.1186/s12891-021-04349-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Reduced gliding ability of the median nerve in the carpal tunnel has been observed in patients with carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the gliding abilities of the median nerve and flexor tendon in patients with CTS and healthy participants in the neutral and 30° extended positions of the wrist and to compare the gliding between the finger flexion and extension phases. Methods Patients with CTS and healthy participants were consecutively recruited in a community hospital. All the subjects received the Boston CTS questionnaire, physical examinations, nerve conduction study (NCS), and ultrasonography of the upper extremities. Duplex Doppler ultrasonography was performed to evaluate the gliding abilities of the median nerve and flexor tendon when the subjects continuously moved their index finger in the neutral and 30° extension positions of the wrist. Results Forty-nine patients with CTS and 48 healthy volunteers were consecutively recruited. Significant differences in the Boston CTS questionnaire, physical examination and NCS results and the cross-sectional area of the median nerve were found between the patients and the healthy controls. The degree of median nerve gliding and the ratio of median nerve excursion to flexor tendon excursion in the CTS group were significantly lower than those in the healthy control group in both the neutral and 30° wrist extension positions. Significantly increased excursion of both the median nerve and flexor tendon from the neutral to the extended positions were found in the CTS group. The ratio of median nerve excursion to flexor tendon excursion was significantly higher in the finger flexion phase than in the extended phase in both groups, and this ratio had mild to moderate correlations with answers on the Boston CTS Questionnaire and with the NCS results. Conclusions Reduced excursion of the median nerve was found in the patients with CTS. The ratio of median nerve excursion to flexor tendon excursion was significantly lower in the patients with CTS than in the healthy volunteers. The median nerve excursion was increased while the wrist joint was extended to 30° in the patients with CTS. Wrist extension may be applied as part of the gliding exercise regimen for patients with CTS to improve median nerve mobilization. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04349-8.
Collapse
Affiliation(s)
- Chien-Ting Liu
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231, Taiwan.,Department of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Dung-Huan Liu
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.,Doctoral Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan
| | - Chii-Jen Chen
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - You-Wei Wang
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Pao-Sheng Wu
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231, Taiwan
| | - Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231, Taiwan. .,Department of Medicine, Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
6
|
Mathews H, Middleton A, Boan L, Jacks M, Riddick L, Shepherd J, Patel J, McNeal A, Fritz S. Intrarater and interrater reliability of a hand-held dynamometric technique to quantify palmar thumb abduction strength in individuals with and without carpal tunnel syndrome. J Hand Ther 2019; 31:554-561. [PMID: 28943237 DOI: 10.1016/j.jht.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical measurement. INTRODUCTION Individuals with carpal tunnel syndrome (CTS) sometimes exhibit weakness of palmar abduction strength (TAS). Reliable assessment of this strength in both subjects with and without CTS with the commonly available Microfet 2 is not known. PURPOSE OF THE STUDY The purpose of this study was to determine the intrarater and interrater reliabilities of a handheld dynamometric (HHD) method to assess TAS in individuals with and without CTS using the commercially available MicroFET2 and to examine the association between TAS in individuals with CTS and the Carpal Tunnel Symptom Questionnaire (CTSQ) scores. METHODS In 2 different study phases, individuals with and without CTS were assessed for TAS by 2 different examiners. The CTSQ was administered to the individuals with CTS. RESULTS Intrarater and interrater reliability coefficients (0.89-0.93 and 0.82-0.90, respectively) were excellent in individuals with and without CTS. Weak negative correlations were found between TAS and overall CTSQ and symptom severity subscale scores, and a moderate negative correlation was found between TAS and functional Status Subscale score. DISCUSSION This HHD method of reliably assessing TAS better quantifies deficits and progress than traditional manual muscle testing for muscle grades greater than 3/5. CONCLUSION This method of HHD reliably quantifies TAS but is more reliable with the same than different raters.
Collapse
Affiliation(s)
- Harvey Mathews
- Department of Exercise Science, Program of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Addie Middleton
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Lindsey Boan
- Department of Exercise Science, Program of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Madison Jacks
- Department of Exercise Science, Program of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Lindsey Riddick
- Department of Exercise Science, Program of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jessica Shepherd
- Department of Exercise Science, Program of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jay Patel
- Palmetto Health USC Medical Center, Palmetto Health USC Orthopedic Rehabilitation, Columbia, SC
| | - Antonia McNeal
- Palmetto Health USC Medical Center, Palmetto Health USC Orthopedic Rehabilitation, Columbia, SC
| | - Stacy Fritz
- Department of Exercise Science, Program of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia, SC
| |
Collapse
|
7
|
Abstract
The Academy of Orthopaedic Physical Therapy and the Academy of Hand and Upper Extremity Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on hand pain and sensory deficits in carpal tunnel syndrome. J Orthop Sports Phys Ther 2019;49(5):CPG1-CPG85. doi:10.2519/jospt.2019.0301.
Collapse
|
8
|
Jung HY, Kong MS, Lee SH, Lee CH, Oh MK, Lee ES, Shin H, Yoon CH. Prevalence and Related Characteristics of Carpal Tunnel Syndrome Among Orchardists in the Gyeongsangnam-do Region. Ann Rehabil Med 2016; 40:902-914. [PMID: 27847721 PMCID: PMC5108718 DOI: 10.5535/arm.2016.40.5.902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/15/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the prevalence and related characteristics of carpal tunnel syndrome (CTS) in orchardists and to investigate the association between electrodiagnostic severity and physical examinations. Methods Between July 2013 and September 2014, 377 subjects (174 men and 203 women) visited the Gyeongsang National University Hospital's Center for Farmer's Safety and Health. All the subjects underwent electrodiagnostic tests and physical examination, including Phalen's test, Tinel's sign, and Durkan's carpal compression test (CCT). The subjects were classified into 2 groups, the normal group and the CTS group, according to electrodiagnostic test results. To determine the related characteristics of CTS, potential variables, including age, sex, drinking, smoking, body mass index, waist circumference, and total work time, were compared between the 2 groups. The association between electrodiagnostic severity and physical examinations was analyzed. Results CTS was diagnosed in 194 subjects based only on electrodiagnostic test results, corresponding to a prevalence of 51.5%. Among the variables, mean age (p=0.001) and total work time (p=0.007) were significantly correlated with CTS. With respect to the physical examinations, low specificities were observed for Tinel's sign, Phalen's test, and Durkan's CCT (38.4%, 36.1%, and 40.9%, respectively) in the subjects aged ≥65 years. In addition, Phalen's test (p=0.003) and Tinel's sign (p=0.032) in men and Durkan's CCT (p=0.047) in women showed statistically significant differences with increasing CTS severity. The odds ratio was 2.066 for Durkan's CCT in women according to the multivariate logistic regression analysis. Conclusion CTS prevalence among orchardists was high, and Durkan's CCT result was significantly quantitatively correlated with the electrodiagnostic test results. Therefore, Durkan's CCT is another reliable examination method for CTS.
Collapse
Affiliation(s)
- Ho-Yeon Jung
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Min Sik Kong
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Hun Lee
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Eun Shin Lee
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Heesuk Shin
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Chul Ho Yoon
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Korea
| |
Collapse
|
9
|
Samanci Y, Karagöz Y, Yaman M, Atçı İB, Emre U, Kılıçkesmez NÖ, Çelik SE. Evaluation of median nerve T2 signal changes in patients with surgically treated carpal tunnel syndrome. Clin Neurol Neurosurg 2016; 150:152-158. [PMID: 27668859 DOI: 10.1016/j.clineuro.2016.09.011] [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: 06/15/2016] [Revised: 08/24/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the accuracy of median nerve T2 evaluation and its relation with Boston Questionnaire (BQ) and nerve conduction studies (NCSs) in pre-operative and post-operative carpal tunnel syndrome (CTS) patients in comparison with healthy volunteers. METHODS Twenty-three CTS patients and 24 healthy volunteers underwent NCSs, median nerve T2 evaluation and self-administered BQ. Pre-operative and 1st year post-operative median nerve T2 values and cross-sectional areas (CSAs) were compared both within pre-operative and post-operative CTS groups, and with healthy volunteers. The relationship between MRI findings and BQ and NCSs was analyzed. The ROC curve analysis was used for determining the accuracy. RESULTS The comparison of pre-operative and post-operative T2 values and CSAs revealed statistically significant improvements in the post-operative patient group (p<0.001 for all parameters). There were positive correlations between T2 values at all levels and BQ values, and positive and negative correlations were also found regarding T2 values and NCS findings in CTS patients. The receiver operating characteristic curve analysis for defined cut-off levels of median nerve T2 values in hands with severe CTS yielded excellent accuracy at all levels. However, this accuracy could not be demonstrated in hands with mild CTS. CONCLUSION This study is the first to analyze T2 values in both pre-operative and post-operative CTS patients. The presence of increased T2 values in CTS patients compared to controls and excellent accuracy in hands with severe CTS indicates T2 signal changes related to CTS pathophysiology and possible utilization of T2 signal evaluation in hands with severe CTS.
Collapse
Affiliation(s)
- Yavuz Samanci
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Yeşim Karagöz
- Diagnostic and Interventional Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Burak Atçı
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Emre
- Neurology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nuri Özgür Kılıçkesmez
- Diagnostic and Interventional Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Suat Erol Çelik
- Neurosurgery Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
Nourbakhsh MR, Bell TJ, Martin JB, Arab AM. The Effects of Oscillatory Biofield Therapy on Pain and Functional Limitations Associated with Carpal Tunnel Syndrome: Randomized, Placebo-Controlled, Double-Blind Study. J Altern Complement Med 2016; 22:911-920. [PMID: 27487406 DOI: 10.1089/acm.2016.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Biofield treatments have been used for pain control in patients with cancer and chronic pain. However, research on the effect of biofield treatment on specific somatic disorders is lacking. This study intends to investigate the effect of oscillating biofield therapy (OBFT) on symptoms of carpal tunnel syndrome. DESIGN Randomized, placebo-controlled, double-blind study. PARTICIPANTS Thirty patients with chronic carpal tunnel syndrome participated in the study. INTERVENTION Patients were randomly assigned to active or placebo treatment groups. Those in the treatment group received six sessions of OBFT with intention to treat during a period of 2 weeks. Patients in the placebo group had the same number of treatment sessions with mock OBFT treatment. OUTCOME MEASURE The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; Symptom Severity Scale (SSS); and Functional Status Scale (FSS) were used for outcome assessment. RESULTS Both clinically and statistically significant changes in intensity of pain with activity (95% confidence interval [CI], 2.5-4.2; p = 0.000), night pain (p = 0.000, 95% CI, 3.2-5.7), DASH questionnaire (95% CI, 12.0-21.9; p = 0.000), SSS (95% CI, 0.64-1.15; p = 0.003), and FSS (95% CI, 0.41-0.97; p = 0.029) were found between the treatment and placebo groups. Statistically significant reduction in number of patients with positive results on the Phalen test (87%; p = 0.000), Tinel sign (73%; p = 0.000), and hand paresthesia (80%; p = 0.000) was noted in the treatment group. During 6-month follow-up, 86% of patients in the treatment group remained pain free and had no functional limitations. CONCLUSION OBFT can be a viable and effective treatment for improving symptoms and functional limitations associated with chronic carpal tunnel syndrome.
Collapse
Affiliation(s)
| | | | | | - Amir Massoud Arab
- 4 Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences , Tehran, Iran
| |
Collapse
|
11
|
Horng YS, Hsieh SF, Lin MC, Chang YW, Lee KC, Liang HW. Ultrasonographic median nerve changes under tendon gliding exercise in patients with carpal tunnel syndrome and healthy controls. J Hand Ther 2015; 27:317-23; quiz 324. [PMID: 25240682 DOI: 10.1016/j.jht.2014.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case control study. PURPOSE OF THE STUDY To evaluate the ultrasonographic median nerve changes under tendon gliding exercise in patients with carpal tunnel syndrome (CTS) and healthy controls. METHODS Seventy-three patients with CTS and 53 healthy volunteers were consecutively recruited. Each subject underwent a physical examination, nerve conduction studies and ultrasonographic examinations of the median nerve during tendon gliding exercises. RESULTS Significant changes in the cross-sectional area of the median nerve were found while moving from the straight position to the hook position and from the hook position to the fist position. There were also significant changes in the flattening ratio when moving from the hook position to the fist position. CONCLUSIONS Ultrasonography revealed that the median nerve was compressed in the fist position in both CTS patients and healthy volunteers. Thus, forceful grasping should be avoided during tendon gliding exercises performed in the fist position. LEVEL OF EVIDENCE 3b.
Collapse
Affiliation(s)
- Yi-Shiung Horng
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; Department of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
| | - Shih-Fu Hsieh
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC
| | - Ming-Chuan Lin
- Department of Physical Medicine and Rehabilitation, Min-Sheng Hospital, Taoyuan, Taiwan, ROC
| | - Yi-Wei Chang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC
| | - Kun-Chang Lee
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC.
| |
Collapse
|
12
|
Oskouei AE, Talebi GA, Shakouri SK, Ghabili K. Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome. J Phys Ther Sci 2014; 26:1017-22. [PMID: 25140086 PMCID: PMC4135187 DOI: 10.1589/jpts.26.1017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/08/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the efficacy of neuromobilization
combined with routine physiotherapy in patients with carpal tunnel syndrome through
subjective, physical, and electrophysiological studies. [Subjects and Methods] Twenty
patients with carpal tunnel syndrome (totally 32 hands) were assigned two groups:
treatment and control groups. In both groups, patients received the routine physiotherapy.
In addition to the routine physiotherapy, patients in the treatment group received
neuromobilization. The symptoms severity scale, visual analogue scale, functional status
scale, Phalen’s sign, median nerve tension test, and median nerve distal sensory and motor
latency were assessed. [Results] There were significant improvements in the symptoms
severity scale, visual analogue scale, median nerve tension test, and Phalen’s sign in
both groups. However, the functional status scale and median nerve distal motor latency
were significantly improved only in the treatment group. [Conclusion] Neuromobilization in
combination with routine physiotherapy improves some clinical findings more effectively
than routine physiotherapy. Therefore, this combination can be used as an alternative
effective non-invasive treatment for patients with carpal tunnel syndrome.
Collapse
Affiliation(s)
- Ali E Oskouei
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Iran
| | - Ghadam Ali Talebi
- Department of Physiotherapy, School of Medicine, Babol University of Medical Sciences, Iran
| | - Seyed Kazem Shakouri
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Iran
| | - Kamyar Ghabili
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Iran
| |
Collapse
|
13
|
Noszczyk BH, Nowak M, Krześniak N. Use of the Accordion Severity Grading System for negative outcomes of carpal tunnel syndrome. J Plast Reconstr Aesthet Surg 2013; 66:1123-30. [PMID: 23668952 DOI: 10.1016/j.bjps.2013.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 03/10/2013] [Accepted: 04/06/2013] [Indexed: 12/31/2022]
Abstract
A universal classification of the negative outcomes of carpal tunnel release surgery does not, as yet, exist. In order to avoid the use of arbitrary factors we have applied the Accordion Severity Grading System, which uses rigorously defined qualitative terms to classify complications. It also provides a uniform manner for grading the severity of complications, enabling outcome comparisons between centres. We analysed the negative outcomes of 500 device-assisted carpal tunnel releases performed over a 2-year period in the author's department. In order to establish a standardised list of complications we used the terms employed within the guidelines of the American Academy of Orthopaedic Surgeons. Most of these terms were subsequently defined using the data variables and definitions taken from the American College of Surgeons National Surgical Quality Improvement Program or the Medical Subject Headings of the National Library of Medicine. We also adopted the quantitative severity weighting, as proposed by the Accordion system, in order to determine the postoperative morbidity index for our assisted carpal tunnel releases. The most common complications were pain and reversible damage to peripheral nerves. Other common negative events, other than complications, included hand weakness, which we classified as a sequela of the procedure, and incomplete retinaculum release, which we classified as failure to cure. The overall postoperative morbidity index for complications was 0.014. Although the Accordion system was developed for more complex procedures, it may also be adopted for carpal tunnel release surgery where it provides an objective and universal method for the classification of complications.
Collapse
Affiliation(s)
- B H Noszczyk
- Department of Plastic Surgery, Medical Centre for Postgraduate Education, Warsaw, Poland.
| | | | | |
Collapse
|
14
|
Horng YS, Chang HC, Lin KE, Guo YL, Liu DH, Wang JD. Accuracy of ultrasonography and magnetic resonance imaging in diagnosing carpal tunnel syndrome using rest and grasp positions of the hands. J Hand Surg Am 2012; 37:1591-8. [PMID: 22770417 DOI: 10.1016/j.jhsa.2012.04.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/30/2012] [Accepted: 04/30/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the accuracy of ultrasonography and magnetic resonance imaging (MRI) in diagnosing carpal tunnel syndrome (CTS) in both the rest and grasp positions. We postulated that the diagnostic accuracy could be improved by imaging hands in the grasp position rather than in the rest position. METHODS Fifty patients with CTS and 45 healthy volunteers received a package of questionnaires and had a physical examination and a nerve conduction study. Ultrasonography and MRI images were recorded in both the rest and grasp positions for each participant. RESULTS There were significant differences between the patients and the healthy volunteers regarding patient-reported outcomes, the results of physical examinations, the nerve conduction studies, and the ultrasonography and MRI imaging. The area under the receiver operating characteristic curve of ultrasonography was significantly improved by measuring the bowing of the flexor retinaculum in the grasp position than by measuring that in the rest position. The diagnostic accuracy of ultrasonography was similar to that of MRI when we used a combination of the measurements of the cross-sectional area of the median nerve in the rest position and the bowing of the flexor retinaculum in the grasp position. CONCLUSIONS The accuracies of MRI and ultrasonography for diagnosing CTS were improved by measuring the bowing of the flexor retinaculum in the grasp position. Ultrasonography can be an adequate screening method for CTS if clinicians combine the cross-sectional area of the median nerve in the rest position and the bowing of the flexor retinaculum in the grasp position. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic I.
Collapse
Affiliation(s)
- Yi-Shiung Horng
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
| | | | | | | | | | | |
Collapse
|
15
|
Qerama E, Kasch H, Fuglsang-Frederiksen A. Occurrence of myofascial pain in patients with possible carpal tunnel syndrome - A single-blinded study. Eur J Pain 2012; 13:588-91. [DOI: 10.1016/j.ejpain.2008.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 06/30/2008] [Accepted: 07/27/2008] [Indexed: 10/21/2022]
|
16
|
Amirfeyz R, Mehendale S, Tyrrell S, Bhatia R, Leslie I, Bannister G. KATZ AND STIRRAT HAND DIAGRAM REVISITED. ACTA ACUST UNITED AC 2011; 15:71-3. [DOI: 10.1142/s0218810410004667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/12/2010] [Accepted: 04/06/2010] [Indexed: 11/18/2022]
Abstract
Katz and Stirrat devised a hand diagram, which uses subjective information from the patient for the diagnosis of carpal tunnel syndrome (CTS). They reported a good result. We tested the inter-observer and intra-observer reliability of this hand diagram. Twenty five consecutive patients with a diagnosis of CTS, 25 with other common hand and wrist problems but CTS and 25 healthy individuals were prospectively recruited. Each patient filled in a hand diagram. Two experienced hand surgeon scored the diagrams blindly on two different sittings four-week apart. The intra-class correlation coefficient (ICC) and Cohen's Kappa were used for intra and inter-observer reliability respectively. The intra-observer agreement was poor (ICC 95% 0.33–0.65) and inter-observer was fair (Kappa = 0.241). This study does not support the use of Katz and Stirrat Hand Diagram for the diagnosis of carpal tunnel syndrome in place if a thorough clinical examination.
Collapse
Affiliation(s)
- Rouin Amirfeyz
- Trauma and Orthopaedic Department, British Royal Infirmary, Bristol, UK
| | | | | | - Raj Bhatia
- Trauma and Orthopaedic Department, British Royal Infirmary, Bristol, UK
| | - Ian Leslie
- Trauma and Orthopaedic Department, British Royal Infirmary, Bristol, UK
| | | |
Collapse
|
17
|
The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. Am J Phys Med Rehabil 2011; 90:435-42. [PMID: 21430512 DOI: 10.1097/phm.0b013e318214eaaf] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : The aim of this study was to investigate the effectiveness of tendon and nerve gliding exercises as a part of combined treatments for carpal tunnel syndrome. DESIGN : Patients with carpal tunnel syndrome were randomized into three groups. All patients received conventional treatments (splint and paraffin therapy, as in group 3), but group 1 underwent additional tendon gliding exercises and group 2 underwent additional nerve gliding exercises. Each patient received a package of questionnaires and underwent physical examinations and nerve conduction study of the upper limbs before and after treatment for 2 mos. RESULTS : Sixty patients were recruited, and 53 completed the study. There were significant improvements in symptom severity and pain scale scores in all groups. However, only group 1 showed significant improvements in their scores on functional status; the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the physical domain of the World Health Organization Quality of Life Questionnaire Brief Version. After adjusting for baseline data, we found significant differences in the functional status scores among the groups. Post hoc analyses detected a significant difference in functional status scores between groups 1 and 2. CONCLUSIONS : The combination of tendon gliding exercises with conventional treatments may be more effective than that of nerve gliding exercises with conventional treatments.
Collapse
|
18
|
Amirjani N, Ashworth NL, Olson JL, Morhart M, Ming Chan K. Discriminative validity and test-retest reliability of the Dellon-modified Moberg pick-up test in carpal tunnel syndrome patients. J Peripher Nerv Syst 2011; 16:51-8. [DOI: 10.1111/j.1529-8027.2011.00312.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
19
|
Functional outcomes post carpal tunnel release: a modified replication of a previous study. J Hand Ther 2009; 22:240-8; quiz 249. [PMID: 19457636 DOI: 10.1016/j.jht.2009.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 03/23/2009] [Accepted: 03/25/2009] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Exploratory cohort study. INTRODUCTION To compares the outcome of self-administered questionnaires and physical measures in assessing change in function for participants after carpal tunnel surgery. METHODS The self-administered questionnaires were the Carpal Tunnel Questionnaire (CTQ), the Disabilities of the Arm, Shoulder, and Hand (DASH), and Short Form-36. The physical measures were grip, pinch, range of motion, sensibility, and dexterity. Twenty-nine participants from five hand clinics were enrolled in the study. RESULTS The results revealed that self-administered questionnaires were sensitive to change in function and three of ten physical measures showed a change in function. CONCLUSIONS The authors concluded that select physical measures coupled with a disease-specific assessment, such as the CTQ and a region-specific questionnaire, such as the DASH would result in a comprehensive assessment of outcomes. This combination of assessments provides both physical measures of recovery and measures of perceived level of function. LEVEL OF EVIDENCE 4.
Collapse
|
20
|
Abstract
The authors performed nerve conduction studies on 54 hands in patients referred with the clinical diagnosis of carpal tunnel syndrome. The authors studied the motor and sensory latencies of the median and ulnar nerves and compared them with each other. The authors divided the results into hands with no, mild, moderate, or severe carpal tunnel syndrome. The authors correlated these results with the presences or absence of the Phalen's sign. The authors concluded that the Phalen's sign is present mostly in the moderate to severe median nerve entrapment, but still can sometimes be present as a false positivity in normal hands.
Collapse
|
21
|
Evaluation of the clinical efficacy of conservative treatment in the management of carpal tunnel syndrome. Adv Ther 2009; 26:107-16. [PMID: 19165436 DOI: 10.1007/s12325-008-0134-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is impingement of the median nerve at the wrist. The aim of this study was to compare the effectiveness of tendon and nerve gliding exercises with standard conservative treatment (SCT), which consists of splinting and local steroid injections, in the treatment of CTS. METHODS This study was a prospective, randomized, single-blind trial. Patients were randomized into three groups: treatment with SCT (Group 1); SCT and tendon and nerve gliding exercises (Group 2); tendon and nerve gliding exercises only (Group 3). A symptom total point score was obtained from five symptoms: hand pain, tingling, numbness, nocturnal numbness, and interrupted sleep. The functional status of the hand was determined by assessing seven daily living activities: writing, buttoning clothes, gripping a telephone receiver, opening jars, doing housework, carrying grocery bags, and bathing. Standard physical examinations (Tinel's test, Phalen's test, reverse Phalen's test, and the compression test) were also performed. RESULTS A total of 111 patients who were diagnosed with intermediate-stage CTS were included in the study. At the end of treatment, significant improvements in symptoms and functionality were detected in all groups. However, the recovery of patients in Groups 1 (n=41) and 2 (n=35) were found to be significantly greater than that of patients in Group 3 (n=35; P<0.001). Patient satisfaction was investigated a mean of 11 months after treatment. Percentages of asymptomatic patients in Group 1 and Group 2 were significantly higher than in Group 3 (P=0.02 and P=0.04, respectively). CONCLUSION In the intermediate stage of CTS, SCT was an effective treatment to improve symptoms and functional status. Tendon and nerve gliding exercises alone were inferior to either SCT alone or SCT in combination with gliding exercises.
Collapse
|
22
|
Jarvik JG, Comstock BA, Heagerty PJ, Haynor DR, Fulton-Kehoe D, Kliot M, Franklin GM. Magnetic resonance imaging compared with electrodiagnostic studies in patients with suspected carpal tunnel syndrome: predicting symptoms, function, and surgical benefit at 1 year. J Neurosurg 2008; 108:541-50. [DOI: 10.3171/jns/2008/108/3/0541] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal in this study of patients with clinical carpal tunnel syndrome (CTS) was to compare the usefulness of magnetic resonance (MR) imaging with that of electrodiagnostic studies (EDSs) for the following purposes: 1) prediction of 1-year outcomes and 2) identification of patients who are likely to benefit from surgical treatment.
Methods
The authors prospectively enrolled 120 patients with clinically suspected CTS. The participants were tested using standardized EDSs, MR imaging, and a battery of questionnaires, including the Carpal Tunnel Syndrome Assessment Questionnaire, a well-validated 5-point score of symptoms and function. The EDSs and MR images were each interpreted independently. Patients were reevaluated after 1 year. The decision to treat patients conservatively or by carpal tunnel release was made by the individual surgeon, who had access to the initial EDS but not MR imaging results. Univariate and multivariate analyses were used to determine associations between 1-year outcomes and baseline diagnostic tests.
Results
The authors recontacted 105 of 120 participants at 12 months. Of these, 30 patients had had surgery and 75 had not. Patients who had undergone surgery showed greater improvement at 1 year than those who had not had surgery. The length of the abnormal T2-weighted nerve signal on MR imaging and median–ulnar sensory latency difference were the strongest predictors of surgical benefit. There was a clear patient preference for the MR imaging over EDSs.
Conclusions
The findings obtained with MR imaging of the carpal tunnel predict surgical benefit independently of nerve conduction studies.
Collapse
Affiliation(s)
- Jeffrey G. Jarvik
- 1Departments of Radiology,
- 2Neurological Surgery,
- 3Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Bryan A. Comstock
- 3Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
| | - Patrick J. Heagerty
- 3Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
- 4Departments of Biostatistics and
| | | | | | | | - Gary M. Franklin
- 5Environmental Health, School of Public Health; and
- 6Neurology, and
- 7Rehabilitation Medicine, School of Medicine
| |
Collapse
|
23
|
Abstract
PURPOSE To provide a comprehensive review of the management of carpal tunnel syndrome. METHODS AND RESULTS A systematic literature review is provided of the history, anatomy, pathophysiology, epidemiology, diagnostic criteria, investigative surgical techniques, results and complications for carpal tunnel syndrome. CONCLUSION Surgery for carpal tunnel syndrome requires meticulous attention to history-taking, investigation, counseling, training and surgical technique if unsatisfactory results and complications are to be avoided.
Collapse
Affiliation(s)
- J Haase
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
24
|
|
25
|
Abstract
UNLABELLED We examined the effects of carpal tunnel syndrome on thumb strength in multiple directions to test the hypothesis that a force deficit would be most severe in directions associated with abduction. Twelve right-handed women with carpal tunnel syndrome in the right hand, and 12 age-matched, gender-matched, right-handed control subjects were included. Thumb strength was measured in all directions in the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes, the boundary of maximal force magnitude, were constructed using the directional forces. The force envelope or envelope area did not differ between the control subjects and the patients with carpal tunnel syndrome. The percentage contributions of force quadrant to the envelope area did not differ between the patients and the control subjects. Our results support the concept that thumb strength is relatively preserved with carpal tunnel syndrome, and failed to support the traditional belief that carpal tunnel syndrome preferentially impairs thumb abduction strength. The data suggest the commonly used testing of thumb abduction strength may not be an effective means to evaluate the existence or severity of carpal tunnel syndrome. LEVEL OF EVIDENCE Diagnostic study, Level III (study of nonconsecutive patients; without consistently applied "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Zong-Ming Li
- Hand Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | | | | |
Collapse
|
26
|
Zalaffi A, Mariottini A, Carangelo B, Buric J, Muzii VF, Alexandre A, Palma L, Rovere A. Wrist median nerve motor conduction after end range repeated flexion and extension passive movements in Carpal Tunnel Syndrome. Pilot study. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 92:47-52. [PMID: 15830967 DOI: 10.1007/3-211-27458-8_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Carpal Tunnel Syndrome (CTS) can be due to a variety of different pathological conditions. These etiological and epidemiological differences may explain the non-homogeneous response to ordinary conservative therapeutical options observed in this syndrome. The aim of our study was to investigate on the possibility of identifying different sub-groups of patients among conservatively treatable CTS with different susceptibility to physiotherapeutic treatments. We decided to utilize an objective approach measuring some median motor nerve function parameters. Short term variations of Compound Motor Action Potential (CMAP) from the thenar eminence were compared in two groups of 55 hands (CTS patients and normal controls) after performance of two different types of end range passive movement. We found a different distribution of CMAP amplitude modifications within a sub-group of patients that suddenly improved more than the controls after two series of 10 end range passive flexions or after two series of ten end range passive extensions. Amplitude changes proved to be much more useful than latency variation studies in the provocative test neurophysiological approach. The method we propose appears to be useful for better surgical indication and/or for improvement of conservative therapeutic choice.
Collapse
Affiliation(s)
- A Zalaffi
- Departement of Ophthalmological and Neurosurgical Science, Siena University, Siena, Italy
| | | | | | | | | | | | | | | |
Collapse
|