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Mete Cavus F, Maden C, Turhan B. Comparison of the Effects of Volar-Assisted and Elastic Wrist Splints on Edema, Pain, Grip Strength, and Functionality in Pregnant Women With Carpal Tunnel Syndrome. Hand (N Y) 2024:15589447241257647. [PMID: 38869069 DOI: 10.1177/15589447241257647] [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: 06/14/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common musculoskeletal problem in pregnancy. The aim of this study is to compare the effects of rigid and elastic wrist splints on edema, pain levels, grip strength, and upper-extremity functionality in pregnant women with CTS. METHODS Forty-one pregnant women in the last trimester of pregnancy who were diagnosed with CTS were included in the study. The grip strength was evaluated with the Jamar hand dynamometer, functionality with the Quick Disabilities of the Arm, Shoulder, and Hand and Boston Carpal Tunnel Syndrome Questionnaire, pain with the Visual Analog Scale (VAS), and edema with the water overflow method. RESULTS The mean age of the participants was 31.71 ± 5.78 years, body mass index was 28.85 ± 3.63 kg/m2, duration of pain was 2.24 ± 0.79 months, and their pain intensity was 6.63 ± 1.69 according to the VAS. As a result of the study, reductions in pain (P = .001), increases in functionality values (P = .001), increases in grip strength (P = .001), and decreases in edema (P = .001) were observed in both groups after the treatment. However, there was no significant difference in pain, functionality, or grip strength values between the groups after the treatment (P > .05). CONCLUSION In this study comparing the effects of a wrist splint to those of an elastic splint, both treatment methods for pregnant women with CTS decreased pain and edema, increased grip strength, and improved upper-extremity functionality. Considering individual needs, characteristics, and living conditions, both splints can be recommended for pregnant women with CTS.
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Affiliation(s)
| | - Cagtay Maden
- Gaziantep Islamic Science and Technology University, Turkey
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Arshad MS, Mattoo B, Alam I. Exploring pathogenic pathways in carpal tunnel syndrome: sterile inflammation and oxidative stress. J Basic Clin Physiol Pharmacol 2024; 0:jbcpp-2024-0004. [PMID: 38804046 DOI: 10.1515/jbcpp-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The main objective of the current study was to find the association between oxidative stress, inflammatory markers, and electrophysiological profile with symptom severity in patients of carpal tunnel syndrome (CTS). METHODS Thirty-two carpal tunnel syndrome patients and 32 controls were included in the study. Boston CTS questionnaire along with plasma oxidative stress markers including superoxide dismutase, malondialdehyde, and nitric oxide and inflammatory markers including IL-6 and TNF-α were compared with the electrophysiological parameters derived from nerve conduction studies. Statistical significance of the levels between groups was calculated using unpaired-t test after checking for normality with D'Agostino & Pearson omnibus normality test. RESULTS We found that the median nerve conduction velocity was prolonged, amplitude was decreased, while the levels of oxidative stress markers like malondialdehyde (MDA), superoxidase dismutase (SOD), and nitric oxide (NO) were increased in CTS patients compared to controls. Inflammatory markers like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were also increased in CTS patients. We found that plasma SOD and TNF-α correlated well with the median motor amplitude. There was no other significant correlation between oxidative stress markers and inflammatory markers with nerve conduction studies or disease severity. Patients with mild disease also showed lesser levels of SOD, NO, IL-6, and TNF-α markers than patients with severe disease. CONCLUSIONS CTS is probably a disease of sterile inflammation and disbalance of oxidative stress, with higher inflammatory and oxidative stress markers pointing to a more severe disease.
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Affiliation(s)
- Mohd Sajid Arshad
- Department of Physiology, 421037 Hamdard Institute of Medical Sciences and Research, Jamia Hamdard , New Delhi, India
| | - Bhawna Mattoo
- Department of Physiology, 421037 Hamdard Institute of Medical Sciences and Research, Jamia Hamdard , New Delhi, India
| | - Iqbal Alam
- Department of Physiology, 421037 Hamdard Institute of Medical Sciences and Research, Jamia Hamdard , New Delhi, India
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Zainab J, Manzoor N, Bashir MS, Noor R, Ikram M. Effects of kinesio taping with and without active release technique in carpal tunnel syndrome. HAND SURGERY & REHABILITATION 2024; 43:101633. [PMID: 38190964 DOI: 10.1016/j.hansur.2024.101633] [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: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Kinesio taping is used as a conservative treatment for carpal tunnel syndrome and the active release technique is also effective. OBJECTIVE The purpose of the present study was to compare the effects of kinesio taping with and without the active release technique on pain, grip strength, functional disability and range of motion in patients with carpal tunnel syndrome. METHODS It was a randomized controlled trial. Thirty-two patients with carpal tunnel syndrome were randomly allocated to two groups: Group A received kinesio taping with the active release technique for 4 weeks (3 days/week); Group B received kinesio taping alone for 4 weeks (5 days/week). Outcome measures were the Boston Carpal Tunnel Syndrome Questionnaire, a numeric pain rating scale, goniometry and hand-held dynamometry. SPSS software, version 25, was used for data analysis. RESULTS Normal distribution was assessed on the Shapiro-Wilk test and parametric tests were applied. Independent t-test results showed that patients who received kinesio taping with the active release technique showed significantly greater improvement (p < 0.05) in pain, functional status and range of motion than the group that received kinesio taping alone. Within-group analysis (paired t-test) showed that both groups significantly improved (p < 0.05) in all outcome measures. CONCLUSION Kinesio taping with the active release technique procured significantly greater improvement in pain, range of motion and functional disability than kinesio taping alone. CLINICALTRIALS gov registration number: 789.
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Affiliation(s)
- Janisar Zainab
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Nosheen Manzoor
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | | | - Rabiya Noor
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan
| | - Mehwish Ikram
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan.
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Ceylan İ, Büyükturan Ö, Aykanat Ö, Büyükturan B, Şaş S, Ceylan MF. The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study. J Hand Ther 2023; 36:773-785. [PMID: 37573157 DOI: 10.1016/j.jht.2023.02.004] [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: 06/05/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 08/14/2023]
Abstract
STUDY DESIGN Single-blinded, randomized controlled study. INTRODUCTION Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. PURPOSE OF THE STUDY This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. METHODS A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. RESULTS We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. DISCUSSION This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. CONCLUSIONS MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program.
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Affiliation(s)
- İsmail Ceylan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey.
| | - Öznur Büyükturan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Ömer Aykanat
- Department of Neurosurgery, Kirsehir Ahi Evran University School of Medicine, Kirsehir, Turkey
| | - Buket Büyükturan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Senem Şaş
- Erciyes University, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Kayseri, Turkey
| | - Mehmet Fethi Ceylan
- Department of Orthopaedics and Traumatology, İnönü University School of Medicine, Malatya, Turkey
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Matur Z, Zengin T, Bolu NE, Oge AE. Prevalence of Carpal Tunnel Syndrome Symptoms Among Young Dentists. Cureus 2023; 15:e43358. [PMID: 37700967 PMCID: PMC10493822 DOI: 10.7759/cureus.43358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Although age is a risk factor, carpal tunnel syndrome (CTS) can also affect younger individuals, particularly those involved in activities or occupations that require repetitive hand movements, forceful gripping, or prolonged wrist flexion/extension. This case-control study aimed to examine the prevalence of CTS symptoms and frequent object dropping among a group of young dentists who are exposed to CTS risk factors. Additionally, other reported risk factors for CTS, such as sex, obesity, and square wrist sign, were also investigated. Methods A total of 74 dentists (48 women, mean age 28.5 years), who are working at Istanbul Faculty of Dentistry, the largest dental school in Istanbul, which is the biggest city in Turkey, were included in the study. Additionally, 61 age- and sex-matched controls (38 women, mean age 27.9 years) were also recruited. The Edinburgh Hand Preference Questionnaire, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a questionnaire for object dropping and occupational hand usage, anthropometric measurements of the hands, clinical neurologic examination, and electromyography intended for the detection of CTS were performed. Results The dentists had a higher total weekly hand usage duration compared to the controls (66.3 vs 44.8 hours, p<0.001). BCTQ scores and the frequency of object dropping were also significantly higher in dentists compared to controls (respective p values: 0.011, 0.003). Positive correlations were found between BCTQ scores, hand usage durations, and object dropping (respective p values: 0.001, <0.001). BCTQ scores were higher in women than in men (p=0.027). Electrophysiologic evidence of CTS was found in one dentist. Conclusions Symptoms of CTS may manifest in individuals at a younger age than predicted, primarily influenced by their occupation and the duration of hand usage. Dentists, in particular, report a higher incidence of complaints related to object dropping, which can be attributed to their frequent use of specialized tools and engagement in delicate tasks, resulting in heightened awareness. However, it can also potentially serve as an indicator of CTS.
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Affiliation(s)
- Zeliha Matur
- Department of Neurology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TUR
| | - Tunahan Zengin
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TUR
- Department of Internal Medicine, Trakya University, Faculty of Medicine, Edirne, TUR
| | - Naci Emre Bolu
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TUR
- Department of Neurology, Maltepe University, Faculty of Medicine, Istanbul, TUR
| | - Ali Emre Oge
- Departments of Neurology and Clinical Neurophysiolgy, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TUR
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Atthakomol P, Nudchapong J, Sangseekaew K, Manosroi W, Tongprasert S, Wongpakaran T, Wongpakaran N. Field testing and psychometric properties of Thai version of the Boston carpal tunnel questionnaire. Front Neurol 2023; 14:1132218. [PMID: 37533471 PMCID: PMC10392831 DOI: 10.3389/fneur.2023.1132218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The Boston Carpal Tunnel Questionnaire (BCTQ) is a widely recommended patient-reported outcome measure to evaluate symptoms and functions in carpal tunnel syndrome (CTS) patients. We aimed to evaluate the translation and cross-cultural adaptation of the Thai version of the BCTQ (Thai BCTQ) and to investigate the psychometric properties including internal consistency, test-retest reliability, construct validity and responsiveness. Methods The Thai BCTQ was field tested with 15 healthy volunteers and 15 CTS patients to evaluate the item-objective congruence of each item. Following that, one hundred and twenty-four CTS patients were included for psychometric evaluation in this study. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was examined using the intraclass correlation coefficient (ICC). To evaluate construct validity, Spearman's rank correlation of the symptom severity scale (Thai BCTQ -S), the functional status scale (Thai BCTQ -F) and the subscales of the Thai MHQ were analyzed. Responsiveness was determined using the standardized response mean (SRM). Results Minor modification of the Thai version was made to better explain the term "tingling". The Thai BCTQ-S, Thai BCTQ-F and Thai BCTQ demonstrated adequate Cronbach's alpha values (0.91-0.94) and good test-retest reliability (ICC=0.89-0.98). Regarding related dimensions, a strong correlation (r=0.67, P<0.008) was found between the Thai BCTQ-F and the Function subscale of Thai MHQ as well as between Thai BCTQ-F and the Activities of Daily Living subscale of the Thai MHQ (r=0.75, P<0.008). In unrelated dimensions, there was a relatively weak correlation between the Thai BCTQ-S and the Aesthetics subscale of the Thai MHQ (r=0.32, P=0.0116). The SRM of the Thai BCTQ was 1.46, indicating large responsiveness. Discussion The Thai BCTQ has adequate internal consistency in both the symptom and function scales as well as good construct validity and test-retest reliability indicating it is suitable for evaluating Thai CTS patients. This tool also has a high ability to detect clinically significant changes in symptoms and function over time after receiving conservative or surgical treatment.
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Affiliation(s)
- Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jirawat Nudchapong
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kamonwan Sangseekaew
- English for International Communication Program, International College, Chiang Mai Rajabhat University, Chiang Mai, Thailand
| | - Worapaka Manosroi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siam Tongprasert
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Akcay S, Koskderelioglu A, Ince B, Elif Saka F, Eskut N, Goksel Karatepe A. Is the left/right judgment task performance altered in unilateral carpal tunnel syndrome: And associated with symptom severity? Musculoskelet Sci Pract 2022; 62:102641. [PMID: 35961062 DOI: 10.1016/j.msksp.2022.102641] [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: 04/29/2022] [Revised: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Left/right judgment task performance (LRJT) is impaired in severe neuropathic pain conditions. However, comparison of LRJT performance in patients with carpal tunnel syndrome (CTS) with a control group with similar cognitive functions has not been investigated. OBJECTIVE The aim of the study was to compare the LRJT performance of CTS patients with healthy controls and the unaffected side. METHODS Seventy-five CTS patients with dominant, right-hand involvement and 75 control subjects were included in the study. The Recognize® tablet application was used for LRJT performance. Tactile acuity (Two-point discrimination) and handgrip strength; pain severity (Visual Analog Scale) and neuropathic component of pain (Pain Detect Questionnaire); symptom severity and functional impact of CTS (Boston CTS Assessment Test) were evaluated. Mixed-design ANOVAs and correlation analyses were used for data analysis. DESIGN Cross-sectional study. RESULTS Analysis of variance showed that there was no significant effect of side (affected versus unaffected) or group (CTS versus control group) on recognition accuracy or time. Significant group*site interactions were found for the two-point discrimination F (1,148) = 6.388, p = 0.013; and for handgrip strength F (1,148) = 17.552, p < 0.01. A statistically significant negative correlation was found between recognition accuracy and symptom duration and a significant positive correlation was found between recognition accuracy and handgrip strength in CTS patients (r = -0.267, p = 0.020; r = 0.290, p = 0.012). CONCLUSION CTS patients recognize the affected side as accurately and quickly as the unaffected side and control group. Further research is needed to clarify the relationship between LRJT performance in the severely affected CTS group. GOV REGISTRATION NUMBER NCT04967144 CLINICALTRIALS. GOV REGISTRATION DATE 19 July 2021.
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Affiliation(s)
- Seniz Akcay
- University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
| | - Asli Koskderelioglu
- University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Department of Neurology, Izmir, Turkey.
| | - Bugra Ince
- University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
| | - Fikriye Elif Saka
- University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
| | - Neslihan Eskut
- University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Department of Neurology, Izmir, Turkey.
| | - Altinay Goksel Karatepe
- University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
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Reliability, Validity and Temporal Stability of the Serbian Version of the Boston Carpal Tunnel Questionnaire. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111531. [PMID: 36363488 PMCID: PMC9697953 DOI: 10.3390/medicina58111531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
Background and Objectives: The aim of this study was to validate the Serbian version of the Boston Carpal Tunnel Questionnaire (BCTQ) and to evaluate temporal stability for the purpose of its implementation in the evaluation of Serbian patients with carpal tunnel syndrome (CTS). Materials and Methods: For the validation of the Serbian version of the BCTQ (BCTQSR), we tested 69 individuals with diagnosed CTS that were referred for a conservative treatment at the Institute for Rehabilitation. Neurophysiological tests were used for the electrophysiological grading (EG) of CTS severity in the study sample. The final version of the BCTQSR was given to the tested participants from the study on two occasions: test and retest, with a five-day period between the two measurements. Results: The mean value for the symptom severity subscale (SSS) of the BCTQSR was 3.01 ± 0.94; for the functional status subscale (FSS) of the BCTQSR it was 2.85 ± 1.00. Cronbach’s α for the SSS was 0.91 and 0.93 for the FSS. The intraclass correlation coefficients (ICCs) concerning the test−retest were significant (p < 0.001) and were 0.949 for the SSS and 0.959 for the FSS. Those with a higher EG grade had higher values of the SSS and FSS but without a statistical significance (p = 0.103 and p = 0.053, respectively). The intercorrelation of the BCTQSR subscales (SSS and FSS) on the test was significant (p < 0.001) with a correlation coefficient equal to 0.777. Conclusion: The Serbian version of the BCTQ (BCTQSR) was successfully culturally adopted. The BCTQSR was a valid and reliable instrument for the measurement of symptom severity and functional status in adults with CTS. Therefore, it can be used in clinical practice for patients with CTS.
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AKÇAY İH, DEMİRDEL E. The Investigation of the Results of Clinical Evaluation, Pain, Functional Status and Sleep Quality According to Electrodiagnostic Test Results in Females with Carpal Tunnel Syndrome: A Pilot Study. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1087891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Amaç: Çalışmamız, elektrodiagnostik test sonuçlarına göre hafif ve orta düzey Karpal Tünel Sendromu (KTS) tanısı almış kadın hastaların klinik semptom şiddetleri, el fonksiyonları ve uyku kalitelerinin karşılaştırılması ve hastaların semptom şiddetleri ile el fonksiyonelliği ve uyku kalitesi arasındaki ilişkinin incelenmesi amacıyla planlandı.Yöntem: Çalışmamız, Erzurum Atatürk Üniversitesi Eğitim ve Araştırma Hastanesi Fizik Tedavi Polikliniğine başvuran, hafif-orta düzey KTS tanısı alan ve 35-65 yaş aralığında olan 32 kadın hasta ile gerçekleştirildi. KTS şiddetinin elektrofizyolojik tanılaması için elektromiyografi (EMG), ağrı ölçümü için Vizüel Analog Skalası (VAS), KTS fonksiyonel durum şiddeti ve semptom şiddeti için Boston KTS Anketi, el fonksiyonelliği için Duruöz El İndeksi, uyku kalitesi için Jenkins Uyku Skalası kullanıldı. Veriler SPSS programı ile değerlendirildi.Bulgular: Çalışmamız sonuçlarına göre hafif ve orta şiddette KTS tanısı almış hastaların ağrı, Boston KTS Anketi, Jenkins Uyku Skalası sonuçlarının benzer olduğu (p>0.05); Duruöz El İndeksi sonuçlarının ise orta şiddette KTS tanısı almış hastalarda hafif şiddette KTS hastalarına göre daha yüksek olduğu belirlendi (p<0.05). Hastaların semptom şiddetleri ile el fonksiyonelliği ve uyku kalitesi arasındaki ilişki incelendiğinde ise; semptom şiddeti yüksek olan hastalarda fonksiyonel durum ve uyku kalitelerinin daha kötü olduğu belirlendi (p<0.01).Sonuç: KTS hastalarında EMG sonuçları ile klinik semptomlar her zaman birbiri ile uyumlu olmayabilmekte, EMG sonuçlarına göre farklı şiddette KTS’si olan hastaların yaşadığı semptomlar hastaya özgü değişiklikler gösterebilmektedir. Buna göre KTS hastalarının klinik durumları ile EMG sonuçlarının birlikte değerlendirilmesi ile hastaya özgü planlanacak tedaviler ile daha etkili sonuçlara ulaşılabileceğini düşünmekteyiz.
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Affiliation(s)
- İbrahim Halil AKÇAY
- ANKARA YILDIRIM BEYAZIT UNIVERSITY, ANKARA STUDIES APPLICATION AND RESEARCH CENTER
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Yilmaz E, Toluk Ö. Comparison of clinical findings and electromyography results in patients with preliminary diagnosis of carpal tunnel syndrome. J Electromyogr Kinesiol 2022; 65:102688. [PMID: 35901602 DOI: 10.1016/j.jelekin.2022.102688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/03/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the link between EMG findings and clinical status, the Boston questionnaire and the severity of pain in patients with pre-diagnosis of carpal tunnel syndrome. METHODS A total of 85 patients (133 hands) who presented to the Physical Therapy and Rehabilitation outpatient clinic consecutively with complaints of numbness, tingling, pain and weakness in their hands were evaluated for their demographic and clinical features. After the initial evaluation, the diagnosis of CTS was confirmed by EMG. Visual analog scale (VAS), the Boston Questionnaire (Symptom Severity Scale = SSS, Functional Status Scale = FSS) and nerve conduction study results (sensory conduction velocity = SCV, distal motor latency = DML, compound muscle action potential = CMAP) were enrolled. RESULTS Eighty-five patients (58 female and 27 male) participated in this study yielding 133 hands (73 right hands, 60 right hands) with CTS. The mean age was 48.3 ± 10.41 years. Of all patients, 68.2 % were female and 31.8 % were male. A statistically significant relationship was found between SSS and duration of symptoms, VAS, both right and left SCV, DML and CMAP. A statistically significant relationship was found between FSS and duration of symptoms, VAS and only right SCV, DML and CMAP. CONCLUSION The diagnosis of CTS should be evaluated not only as an electrodiagnostic finding, but also the clinical picture of the patients. According to our results, both SSS and FSS had good correlations with VAS and the findings of EMG. Therefore, the Boston Questionnaire can provide a standardized measure of symptom severity and functional status in patients with CTS.
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Affiliation(s)
- Ebru Yilmaz
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakıf University, İstanbul, Turkey.
| | - Özlem Toluk
- Department of Biostatistics and Medical Informatics, Bezmialem Vakıf University, İstanbul, Turkey.
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Kurtul S, Mazican N. Prevalence and risk factors for self-reported symptoms of carpal tunnel syndrome among hospital office workers: a cross-sectional study. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 29:461-465. [PMID: 35296224 DOI: 10.1080/10803548.2022.2054580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We aimed to determine the prevalence of self-reported symptoms of carpal tunnel syndrome (CTS) and associated risk factors among hospital office workers. MATERIAL AND METHODS This cross-sectional study was carried out between May and August 2021 with office workers actively working in a hospital in Izmir, Turkey. The Boston Carpal Tunnel Syndrome Questionnaire was used to evaluate the severity of self-reported CTS symptoms and their effect on the functional status of the participants. RESULTS The study included 151 people, 68.2% of whom were women. The CTS symptoms were reported by 74.1% of the participants, the majority of whom (73.2%) were women. These reported symptoms were mild in 43%, moderate in 24.5%, severe in 5.3%, and very severe in 1.3%. Significant differences were found between those with and without CTS symptoms regarding the age, body-mass index, a previous diagnosis of CTS, daily work hours, using a wrist-supported mousepad, and perceived workload (p < 0.05). CONCLUSION It was found that the CTS symptoms of office workers in the hospital were associated with occupational characteristics as well as individual factors. These risk factors should be taken into account while planning for future preventive and interventional measures in workplaces.
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Affiliation(s)
- Seher Kurtul
- Medical Doctor, Occupational Diseases Physician, University of Health Sciences, Bozyaka Training And Research Hospital, Department of Occupational Disease, Izmir, Turkey
| | - Nejdiye Mazican
- Medical Doctor, Occupational Diseases Physician, Department of Occupational Disease, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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ÖTEN E. The efficacy of ultrasound and low-intensity laser therapy in carpal tunnel syndrome. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1054837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study. Turk J Phys Med Rehabil 2022; 68:126-135. [PMID: 35949973 PMCID: PMC9305635 DOI: 10.5606/tftrd.2022.7187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS).
Patients and methods: Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3±11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups and evaluated. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing.
Results: The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001).
Conclusion: This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.
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Yusifov M, Alpaydin Baslo S, Tekin B, Erdogan M, Ozturk O, Atakli D. Metabolic syndrome and anthropometric indices in CTS hands: an electrophysiological study. Neurol Sci 2022; 43:1375-1384. [PMID: 34245382 DOI: 10.1007/s10072-021-05430-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study aims to evaluate the effect of metabolic syndrome (MetS) and anthropometric indices on carpal tunnel syndrome (CTS). METHODS Forty-three healthy controls and 41 CTS patients were enrolled. Complaints of patients were assessed by Boston Questionnaire (BQ). MetS components were investigated. Wrist circumference, wrist depth, wrist width, palm width, and palm length were measured. Routine nerve conduction studies of median and ulnar nerves as well as the "sensitive" comparison tests were performed. Cutaneous silent period (CuSP) was studied by stimulating both second and fifth digital nerves while recording over thenar muscles. RESULTS The vast majority of the participants were female and right-handed. CTS was bilateral in 61% of patients. Data of 109 hands were analyzed. MetS was more frequent in CTS patients. BQ scores were not related to MetS. Waist circumference, serum TG, and fasting glucose levels were higher in CTS patients. CTS hands with MetS had lower median CMAP amplitudes and increased sensory thresholds. Sensory thresholds were increased with both median and ulnar nerve stimulations suggesting a wider spread of peripheral nerve excitability changes in MetS presence. CuSPs were recorded from all 109 hands. CuSP latencies and durations were similar between controls and CTS patients. Wrist ratio was the only anthropometric index that was a statistically significant predictor for CTS development. CONCLUSION MetS was more prevalent in CTS patients. Some clinical and electrophysiological features (mainly sensory thresholds) may worsen in presence of MetS, but not the wrist ratio.
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Affiliation(s)
- Mahir Yusifov
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Sezin Alpaydin Baslo
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey.
| | - Betül Tekin
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Mucahid Erdogan
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Oya Ozturk
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Dilek Atakli
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
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Celenlioglu AE, Unal-Artık HA, Guler G. Comparison of ultrasound-guided pulsed radiofrequency versus steroid injection in the treatment of carpal tunnel syndrome. Ir J Med Sci 2022; 191:2751-2757. [PMID: 35129753 DOI: 10.1007/s11845-022-02923-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most widespread form of nerve entrapment neuropathy results from increase compression pressure of the median nerve at the wrist under the transverse carpal ligament. AIMS To compare ultrasound (US)-guided median nerve steroid injection and pulsed radiofrequency (PRF) on pain intensity, functional status, and patient satisfaction in the treatment of CTS. METHODS A total of 90 hands of 59 patients who underwent steroid injection at the level of proximal carpal tunnel or PRF for CTS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. The pain severity was assessed using the Numerical Rating Scale (NRS), and the functional status and clinical outcomes were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ) before the procedure and at Week 1, Month 1, and Month 3 after the procedure. Time to pain relief was evaluated at week 1. Patient satisfaction was evaluated at Month 3. RESULTS There was no significant difference in the NRS and BCTQ scores between the two treatment methods (p > 0.05 for both). In addition, a significant decrease in the NRS and BCTQ scores were detected at all follow-ups compared to baseline in treatment groups (p < 0.001). The mean time to pain relief was significantly shorter in the PRF group (p < 0.001). Patient satisfaction was similar at Month 3 between the treatment methods (p > 0.05). CONCLUSIONS Our study results suggest that both US-guided steroid injection to the median nerve and PRF are effective and safe methods in the short-term in the treatment of CTS.
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Affiliation(s)
- Alp Eren Celenlioglu
- Department of Pain Medicine, Health Sciences University Gulhane Training and Research Hospital, General Dr. Tevfik Sağlam Cd. No. 1, 06010, Etlik, Ankara, Turkey.
| | - Hanzade Aybuke Unal-Artık
- Department of Pain Medicine, Usak University Training and Research Hospital, Fevzi Çakmak, Gazi Blv. Yanyolu No. 50, 64300, Usak, Merkez, Turkey
| | - Gulen Guler
- Department of Anesthesiology and Reanimation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, Köşk Mah. Prof. Dr. Turhan Feyzioğlu Cad. No. 42, 38039, Melikgazi, Kayseri, Turkey
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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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Nalbant M, Ümit Yemişci O, Özen S, Tezcan Ş. Ultrasonographic and electrophysiological outcomes of carpal tunnel syndrome treated with low-level laser therapy: A double-blind, prospective, randomized, sham-controlled study. Arch Rheumatol 2021; 37:19-30. [PMID: 35949869 PMCID: PMC9326377 DOI: 10.46497/archrheumatol.2022.8605] [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: 11/26/2020] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives
The aim of this study was to investigate the therapeutic effects of low-level laser therapy (LLLT) on clinical, ultrasonographic (US), and electrophysiological findings in carpal tunnel syndrome (CTS). Patients and methods
Between January 2015 and August 2015, 42 patients (7 males, 35 females; mean age: 50.4±8.7 years; range, 32 to 65 years) with mild-to-moderate CTS were randomly assigned to one of two groups: active LLLT (therapy group, n=22) 0.8 J/painful point and sham LLLT groups (n=20). Both groups wore neutral wrist orthoses. The patients were evaluated before and after 15 sessions of therapy (670 nm, 4 J/session over the carpal tunnel). Follow-up parameters included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), nerve conduction studies and US evaluation of the median nerve cross-sectional area (CSA), vascularization (via power Doppler), flattening ratio (FR), and palmar bowing of the flexor retinaculum. Results
Nocturnal paresthesia improved in both groups; however, pain and patients with a positive Phalen’s test reduced only in the therapy group (p=0.031). The FSS and SSS scores also improved only in the therapy group (p<0.001). Electrophysiologically, median sensory nerve conduction velocities showed a significant improvement only in the therapy group (p=0.002). The CSA, FR, and vascularization of the median nerve showed a significant improvement in the therapy group alone (p<0.001, p=0.048, and p=0.021, respectively). Conclusion
Improvements in the signs and symptoms of CTS and hand function, the improvements in sensory nerve conduction studies, and reduction in median nerve CSA, FR and vascularity in the LLLT group can be attributed to the anti-inflammatory and analgesic effects of LLLT. This study provides new US data demonstrating efficacy of LLLT along with a clinical and electrophysiological improvement. The LLLT seems to be an easily applied, non-invasive treatment option.
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Affiliation(s)
- Merve Nalbant
- Department of Rheumatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Oya Ümit Yemişci
- Department of Physical Medicine and Rehabilitation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Selin Özen
- Department of Physical Medicine and Rehabilitation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Şehnaz Tezcan
- Department of Radiology, Koru Hospital, Ankara, Turkey
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DEMİR B, AKALTUN MS, ALTINDAĞ Ö, KARAOGLAN H, ALTINDAĞ A, GÜRSOY S, GÜR A. Anxiety, health anxiety and somatosensory amplification levels in individuals with carpal tunnel syndrome with normal electromyography. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.903677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Çamur S, Bayram S, Polat Ö, Özcan MS, Batıbay SG. Clinical outcomes comparison of distal radius fractures between two conservative treatment methods: Below-arm cast versus reverse sugar tong splint. J Orthop Sci 2021; 26:804-811. [PMID: 32962906 DOI: 10.1016/j.jos.2020.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique with a below-arm cast, in terms of patient radiological and clinical outcomes. METHODS One hundred and forty patients who presented to our clinic between April 2017 and March 2019 were randomly divided into two groups: 70 received reverse sugar tong (RST group) and 70 received below arm cast (BAC group). Clinical and radiological follow-up was performed 7-10 days, three weeks, 5 or 6 weeks, 12 weeks and one year after the treatment. Clinical outcomes including wrist range of motion, complication rates, Health Assessment Questionnaire (HAQ) score at end of treatment, Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire and Mayo Elbow Performance score (MEPS) score at 12 weeks and last follow-up. RESULTS Finally, sixty-five patients were treated with BAC, and their average age was 58.2 years and sixty-two patients with an average age of 57.4 years were treated with RST were completed the radiological and clinical one-year follow-up. There were no significant differences in range of motion, radiological parameters, the Q-DASH and MEPS scores between the groups the 12th week and last visit; however, the HAQ score was significantly higher in the cast group during the 6th visit (p < 0.001). The BAC group had a higher complication rate (40%) than the RST group (19.3%) (p = 0.01). CONCLUSION Patient treated with RST had a higher functional status at end of treatment and lower complications when comparing traditional below arm cast. LEVEL OF EVIDENCE Level I prognostic randomized controlled trial.
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Affiliation(s)
- Savaş Çamur
- Department of Orthopedics and Traumatology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Ömer Polat
- Department of Orthopedics and Traumatology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Muhammet Sefa Özcan
- Department of Orthopedics and Traumatology, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sefa Giray Batıbay
- Department of Orthopedics and Traumatology, Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey
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Using Carpal Tunnel Questionnaire in clinical practice: A systematic review of its measurement properties. J Hand Ther 2021; 33:493-506. [PMID: 32151499 DOI: 10.1016/j.jht.2019.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/09/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Carpal Tunnel Questionnaire (CTQ) is widely used for assessing condition-specific impairments in individuals with carpal tunnel syndrome (CTS) or for assessing outcomes after carpal tunnel surgery (carpal tunnel release [CTR]). A systematic review of its measurement properties can greatly facilitate its evidence-based use in clinical practice. The purpose of this study was to systematically locate, appraise, and synthesize the evidence concerning the reliability, responsiveness, validity, minimal detectable change (MDC), and minimal clinically important difference (MCID) for the CTQ and its scales. STUDY DESIGN This is a systematic review of measurement properties. METHODS Using predefined keywords, PubMed, CINAHL, PsychInfo, and ProQuest were searched to locate primary studies that assessed measurement properties of the CTQ. The methodological quality of the included studies was assessed using a standardized tool. Data concerning the measurement properties were extracted and synthesized. The pooled estimates for the indices of test-retest reliability, standard error of measurement, responsiveness, MDC, and MCID were calculated from the included studies. RESULTS A total of 34 articles were deemed eligible and included in this review. The methodological quality of these 34 studies was generally good. Most studies suggested that the CTQ and its scales had good test-retest reliability and internal consistency. However, few studies found that the Symptom Severity Scale had more than one factor. The responsiveness of the CTQ and its scales was excellent across the studies. The pooled estimates for the MDC90 and MCID for Symptom Severity Scale/Functional Status Scale were 0.72/0.79 and 1.05/1.13, respectively. DISCUSSION The results of this review support the use of CTQ and its scales in assessing conditions-specific impairments in individuals with CTS or after CTR. However, an effort should be made to review and modify the content of the symptom severity scale due to multiple reports challenging its unidimensional structure. CONCLUSIONS The totality of evidence emerging from this systematic review suggests that the CTQ and its scales provide reliable and valid estimate of impairments resulting from CTS or after CTR.
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Pattankar S, Roy R, Warade A, Desai K. Analysis of the Long-Term Outcome in Open Carpal Tunnel Release Surgeries with and without External Neurolysis of Median Nerve, Using Boston Carpal Tunnel Questionnaire (BCTQ)-Hindi Version. J Neurosci Rural Pract 2021; 12:470-477. [PMID: 34295100 PMCID: PMC8289532 DOI: 10.1055/s-0041-1723100] [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] [Indexed: 11/21/2022] Open
Abstract
Background
The effectiveness of open carpal tunnel release (OCTR) in treating carpal tunnel syndrome (CTS) is well known. However, the role of ancillary external neurolysis of the median nerve is not well-documented. The Boston carpal tunnel questionnaire (BCTQ) is a commonly used disease-specific outcome instrument for CTS, which is validated across major languages of the world. No such validated Hindi version of BCTQ exists.
Objectives
To analyze and compare the long-term outcome in patients who underwent OCTR alone and OCTR with external neurolysis of the median nerve, using BCTQ–Hindi version, while checking its validity.
Materials and Methods
A retrospective, cross-sectional study was conducted at a tertiary care institute. The BCTQ was translated into Hindi language by a language expert. Eighty-four consecutive patients who underwent either unilateral/bilateral OCTR, with or without external neurolysis of the median nerve, between 2009 and 2019 were included in the study. Outcome analysis was done using BCTQ–Hindi version and patient satisfaction scoring. BCTQ–Hindi version was examined for statistical validity. Subgroup analysis of the outcome based on surgical technique (OCTR vs. OCTR with external neurolysis) used was carried out.
Results
Response rate was 80.9%. Total hands evaluated were 108. BCTQ–Hindi version showed statistical validity. Overall symptom severity score (SSS) and functional severity score (FSS) were 1.14 ± 0.4 and 1.12 ± 0.35, respectively. Subgroup analysis of outcome revealed statistically significant results in favor of OCTR with external neurolysis of the median nerve.
Conclusions
BCTQ–Hindi version is statistically validated. OCTR with external neurolysis of the median nerve is a promising avenue in surgical management of CTS. Further prospective studies are warranted.
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Affiliation(s)
- Sanjeev Pattankar
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Rohan Roy
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Anshu Warade
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Ketan Desai
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
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22
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Mosegaard SB, Stilling M, Breddam M, Hansen TB. Measurement properties of the Danish version of the Boston Carpal Tunnel Questionnaire. JPRAS Open 2021; 29:17-25. [PMID: 33997223 PMCID: PMC8099587 DOI: 10.1016/j.jpra.2021.03.007] [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: 01/18/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aims Patient reported outcome measures are often used in medical research to evaluate symptoms and functional status in patients. The Boston Carpal Tunnel Questionnaire is specifically designed to evaluate functional status and symptom severity in patients with Carpal Tunnel Syndrome. The aim of this study was to validate and examine the measurement properties of the Functional Status Scale and Symptom Severity Scale from the Danish translated Boston Carpal Tunnel Questionnaire. Material and Methods We analyzed 88 prospectively enrolled patients in the validity and responsiveness group and 31 prospectively enrolled patients in the reliability group. Patients in the validity and responsiveness group answered the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire and the Danish translated Boston Carpal Tunnel Questionnaire preoperatively and after surgery. Patients in the responsiveness group answered the same questionnaire two times prior to surgery. Results Responsiveness of the two subscales were high (Effect Size 0.99/1.76; Standardized Response Mean 0.86/1.50). Correlation to the Danish validated QuickDASH was high (rho 0.75/0.89). Test-retest reliability was high (ICC 0.94/0.90) and the internal consistency was high (Cronbach's alpha 0.93/0.92). Conclusion Our study shows satisfactory results of both subscales of the Danish translated Boston Carpal Tunnel Questionnaire. This makes it highly useful when conducting research on patients with Carpal Tunnel Syndrome. Trial registration The Danish Data Protection Agency: jr. nr. 2007-58-0010.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, 7500 Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, 7500 Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Marianne Breddam
- Department of Orthopaedics, Sonderborg University Hospital, 6400 Sønderborg, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, 7500 Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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Extracorporeal shock wave therapy as a conservative treatment option for carpal tunnel syndrome: A double-blind, prospective, randomized, placebo-controlled study. Turk J Phys Med Rehabil 2020; 66:388-397. [PMID: 33364558 PMCID: PMC7756840 DOI: 10.5606/tftrd.2020.3956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives
This study aims to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in carpal tunnel syndrome (CTS) compared to the wrist splint treatment.
Patients and methods
Between April 2016 and March 2017, a total of 189 patients (22 males, 167 females, mean age 48.8±9.5 years, range, 24 to 70 years) with mild-to-moderate CTS were included in this double-blind, prospective, randomized, placebo-controlled study. The patients were divided into four treatment groups using stratified randomization: splint group (Group 1, n=47), splint+ESWT (Group 2, n=47), ESWT (Group 3, n=45), and splint+placebo ESWT (Group 4, n=50). All patients were evaluated at baseline, and one and three months. Pain using the Visual Analog Scale (VAS), finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and electrophysiological examination were assessed.
Results
A total of 168 patients completed the study. There was no significant difference among the four groups in terms of age, sex, comorbid diseases, symptom duration, VAS-pain, BCTQ, and LANSS scores (p>0.05). Pain and functionality significantly improved in all groups (p<0.05). In the group with ESWT and using wrist splint combined, a greater improvement of the hand function and electrophysiological measures was observed.
Conclusion
Our study results show that ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS.
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Küçük EB, Taşkıran ÖÖ. Evaluation of Duruöz Hand Index in diagnosis and staging of Carpal tunnel syndrome. J Clin Neurosci 2020; 82:111-114. [PMID: 33317717 DOI: 10.1016/j.jocn.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/27/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022]
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients' demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r: 0.306, p < 0.001) and Boston functional status scale (FSS) (r: 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR: 2.36, p: 0.01), Phalen positivity (OR: 2.22, p: 0.02), Boston symptom severity scale (SSS) scores (OR: 1.76, p: 0.024), increasing age (OR: 1.06, p < 0.001) and increased BMI (OR: 1.07, p: 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.
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Affiliation(s)
- Esin Benli Küçük
- Physical Theraphy and Rehabilitation Department, Niğde Ömer Halisdemir University, Faculty of Medicine, Niğde, Turkey.
| | - Özden Özyemişçi Taşkıran
- Physical Theraphy and Rehabilitation Department, Koç University School of Medicine, İstanbul, Turkey
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Carpal tunnel syndrome in patients with rheumatoid arthritis and psoriatic arthritis: an electrophysiological and ultrasonographic study. Rheumatol Int 2020; 41:361-368. [PMID: 33185703 DOI: 10.1007/s00296-020-04745-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to investigate the carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compare the electrophysiological and ultrasonographic findings and evaluate related variables. Cut-off value of median nerve cross-sectional area (MCSA) was determined for the diagnosis of CTS. 70 RA patients, 39 PsA patients, a control group of 70 healty people were included in this study. Demographic characteristics, disease activity and functional status were recorded. Patients were referred for nerve conduction studies performed according to the American Academy of Neurology standards. Sonographic examination was carried on for MCSA evaluation. The mean age of patients was 51.87 ± 8.47, 50.61 ± 11.33, 49.75 ± 10.52 years and female ratio was 72.9%, 71.8%, 75.7% in RA, PsA and controls, respectively. Electrophysiologically, CTS frequency was found to be 13.2%, 15.4%, 3.5% in RA, PsA, control group, respectively, and a significant difference was found compared to the control group (p < 0.05). Ultrasonographically MCSA was measured as 8.52 ± 2.19 mm2, 8.97 ± 2.41 mm2, 7.09 ± 1.83 mm2 in RA, PsA, control group, respectively, a significant difference was observed compared to the control group (p < 0.05). As a result of the Receiver Operating Characteristics analysis, the thereshold value of MCSA for CTS was determined as 10.5 mm2.The frequency of CTS was found to be 30% in RA and 41% in PsA. The frequency of CTS with both ENMG and USG (MCSA) were higher in patients with RA and PsA as compared to the control group. Although it was not statistically significant, CTS frequency was higher in PsA than RA. To our knowledge this is the first study assessing CTS in patients with PsA, and adressing MCSA cut off value for CTS diagnosis in RA and PsA.
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Is Boston questionnaire an alternative to electromyography for evaluation of the surgical outcome for carpal tunnel syndrome? Turk J Phys Med Rehabil 2020; 66:336-342. [PMID: 33089090 PMCID: PMC7557623 DOI: 10.5606/tftrd.2020.3136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/06/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives
This study aims to identify the optimal follow-up method for evaluation of the surgical outcome for carpal tunnel syndrome (CTS). Patients and methods
Between January 2006 and December 2010, 61 hands of a total of 46 patients (7 males, 39 females; mean age 56.0±10.4 years; range, 20 to 71 years) with a diagnosis of CTS were retrospectively analyzed. All operations were performed by a single surgeon with a mini-incision distal to the transverse carpal ligament. At a mean follow-up of seven years after surgery, electromyography (EMG) was repeated for all patients. The Boston Carpal Tunnel Questionnaire (BCTQ), Boston Symptom Severity Scale, Boston Functional Status Scale, palmar pinch strength, grip strength, and EMG of the patients were compared before and after surgery. Results
The mean follow-up was 84±10 (range, 72 to 104) months. There were significant improvements in the Boston Symptom and Functional Scale scores postoperatively, as well as in the grip and pinch strength. After surgery, EMG findings improved in 83.6% of the patients. However, there was no significant correlation between pre- and postoperative Boston Symptom Severity Scale scores, functional status, pinch and grip strengths, and pre- and postoperative EMG results. Conclusion Our study results demonstrate that the symptom severity and functional status scores of the BCTQ are favorable, and this tool is reliable and easy-to-apply for the diagnosis and follow-up of CTS surgeries.
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Civi Karaaslan T, Berkoz O, Tarakci E. The effect of mirror therapy after carpal tunnel syndrome surgery: A randomised controlled study. HAND SURGERY & REHABILITATION 2020; 39:406-412. [DOI: 10.1016/j.hansur.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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Multanen J, Ylinen J, Karjalainen T, Ikonen J, Häkkinen A, Repo JP. Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery. BMC Musculoskelet Disord 2020; 21:609. [PMID: 32919457 PMCID: PMC7488577 DOI: 10.1186/s12891-020-03626-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Boston Carpal Tunnel Questionnaire (BCTQ) and its shorter version, the Six-Item Carpal Tunnel Symptoms Scale (CTS-6), are widely used for assessing function and/or symptoms in patients with carpal tunnel syndrome. This study examined the structural validity of the BCTQ and CTS-6 among patients who had undergone surgery for treatment of carpal tunnel syndrome. Methods The data for this cross-sectional analysis were obtained from 217 adult patients who had undergone carpal tunnel release surgery 1 year earlier. All patients completed the CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ at 12 months after surgery. The Rasch Measurement Theory (RMT) was applied to investigate the unidimensionality, residual correlation, differential item functioning, scale coverage/targeting, and person separation of the CTS-6, SSS and FSS of the BCTQ. Results The FSS showed unidimensionality and good scale and item fit. All items showed ordered response category thresholds. Eight of the FSS items displayed differential item functioning favoring age or gender. The multidimensional structure of the CTS-6 was absorbed by creating a testlet for frequency of symptoms or testlets for pain and numbness. The testlets supported unidimensionality in the BCTQ SSS. One item in the CTS-6 and two items in the BCTQ SSS showed differential item functioning favoring age or gender. Four items in the BCTQ SSS and two items in the CTS-6 exhibited disordered response category thresholds. Merging of the relevant response categories led to ordered response category thresholds. The person separation indices were 0.73, 0.86 and 0.77 for the CTS-6, BCTQ SSS and FSS, respectively. Conclusions Based on the RMT analysis, the CTS-6 has superior psychometric properties compared to the BCTQ SSS in surgically treated patients. The CTS-6 might be more accurate when separated into item sets measuring pain or numbness. The FSS of the BCTQ has acceptable construct validity, although gender differences at some ages were observed in responses.
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Affiliation(s)
- Juhani Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland. .,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Teemu Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Joona Ikonen
- Department of Hand Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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Asgari MR, Mosaviinejad SS, Ebrahimian A, Aminianfar A, Ghorbani R, Babamohamadi H. The effects of acupressure on the symptoms severity and function status and electrodiagnostic findings in patients with carpal tunnel syndrome. Complement Ther Med 2020; 51:102420. [PMID: 32507434 DOI: 10.1016/j.ctim.2020.102420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effects of acupressure on the symptoms severity, function status and electrodiagnostic findings in patients with Carpal tunnel syndrome (CTS). DESIGN This double blind, randomized, controlled clinical trial study was conducted on 57 patients with CTS that selected through convenience sampling. The patients were randomly assigned to three groups, including (1) acupressure; (2) placebo acupressure; and (3) control. SETTING The study was conducted in the medical centers affiliated to Semnan University of Medical Sciences, Iran. INTERVENTION The intervention groups received acupressure or placebo for one month. The control group received only routine cares (splints and analgesics) with no additional intervention. PRIMARY OUTCOMES The severity of symptoms and hand function were evaluated by the Boston Carpal Tunnel Syndrome Questionnaire, and electrodiagnostic findings, including Nerve Conduction Velocity (NCV), Distal Sensory Latency (DSL), and Distal Motor Latency (DML) were measured by Electromyography device before and after the intervention. RESULTS The results showed significant differences in the mean severity of symptoms, hand function, NCV, DSL, and DML before and after the intervention in the acupressure group (P < 0.05). Significant differences were also observed between the means difference in severity of symptoms, hand function, and NCV, DSL, and DML before and after the intervention in the three groups (P < 0.05). CONCLUSION According to the results, acupressure was effective in reducing the severity of clinical symptoms, improving the hand function, and improving the electrodiagnostic findings. Therefore, the application of acupressure can be recommended for improving clinical symptoms of patients with CTS.
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Affiliation(s)
- Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Abbasali Ebrahimian
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Atefeh Aminianfar
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
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Ozsoy-Unubol T, Bahar-Ozdemir Y, Yagci I. Diagnosis and grading of carpal tunnel syndrome with quantitative ultrasound: Is it possible? J Clin Neurosci 2020; 75:25-29. [PMID: 32234336 DOI: 10.1016/j.jocn.2020.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/21/2020] [Indexed: 12/22/2022]
Abstract
The recent diagnostic tools for carpal tunnel syndrome (CTS) include nerve conduction studies (NCS) and ultrasound (US). Quantitative US (QUS) can be used for demonstrating muscle changes according to denervation. The aim of this study was to evaluate if QUS can diagnose and grade the severity of CTS. In this single blinded cross-sectional study, female patients diagnosed with CTS and age-matched healthy female subjects were included in the study. Median and ulnar nerve conduction studies (NCS) were performed for CTS diagnosis. Median and ulnar nerve cross-sectional area (CSA) was measured, and the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles were longitudinally and transversally visualised. Axial images were analysed for echo intensity (EI) via computer-assisted, grayscale analysis. Intra-rater and inter-rater reliability analysis was performed. The Boston questionnaire was used for the evaluation of symptom severity and functional status. Forty-two patients (42 hands) and 32 controls were included. In the CTS group, 17 patients had mild, 13 patients had moderate, and 12 patients had severe CTS. CSA of the median nerve and APB echo intensity was significantly higher in patients with CTS. However, according to the CTS grade, no significant difference was detected for APB EI. The intraclass correlation coefficient (ICC) was calculated as 0.928 for intra-rater reliability and 0.768 for inter-rater reliability. QUS evaluation is helpful for the diagnosis of CTS, but not for grading. Further studies are needed with a larger population including both genders.
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Affiliation(s)
- Tugba Ozsoy-Unubol
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey.
| | - Yeliz Bahar-Ozdemir
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey
| | - Ilker Yagci
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey
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Aktürk S, Büyükavcı R, Ersoy Y. Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests. Acta Neurol Belg 2020; 120:43-47. [PMID: 29949031 DOI: 10.1007/s13760-018-0963-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/07/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. METHODS This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). RESULTS CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. CONCLUSION US can help the clinicians with the diagnosis of carpal tunnel syndrome in patients with clinical symptoms but negative nerve conduction study results.
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Affiliation(s)
- Semra Aktürk
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu Universitym, Malatya, Turkey.
| | - Raikan Büyükavcı
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu Universitym, Malatya, Turkey
| | - Yüksel Ersoy
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu Universitym, Malatya, Turkey
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Mansiz Kaplan B, Akyuz G, Kokar S, Yagci I. Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study. J Hand Ther 2020; 32:297-304. [PMID: 29463420 DOI: 10.1016/j.jht.2017.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 12/23/2017] [Accepted: 12/30/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). STUDY DESIGN A single-blind randomized controlled study. METHODS Patients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. RESULTS There were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05). CONCLUSION Adding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS.
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Affiliation(s)
- Basak Mansiz Kaplan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Gulseren Akyuz
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Kokar
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
| | - Ilker Yagci
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey
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De Kleermaeker FGCM, Levels M, Verhagen WIM, Meulstee J. Validation of the Dutch Version of the Boston Carpal Tunnel Questionnaire. Front Neurol 2019; 10:1154. [PMID: 31787920 PMCID: PMC6854027 DOI: 10.3389/fneur.2019.01154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/14/2019] [Indexed: 01/23/2023] Open
Abstract
The Boston Carpal Tunnel Questionnaire (BCTQ) is a scale that has been developed specifically for carpal tunnel syndrome (CTS). It consists of the Functional Status Scale (FSS) and the Symptom Severity Scale (SSS). It is the most widely used patient reported outcome measure in CTS and has been validated in many languages. Although already widely used, psychometric properties of the Dutch version of the BCTQ are yet unknown. The aim of this study was to assess the validity, reliability, responsiveness, and acceptability of the Dutch version. Moreover, this paper focuses the longitudinal validity (the use after an intervention) of the BCTQ, which has not been investigated before. A total of 180 patients completed the BCTQ in addition to a six-point Likert scale for perceived improvement, before and about 6–8 months after carpal tunnel release (CTR). Principal factor analysis revealed that the FSS is unidimensional, consisting of a single latent factor (“functionality”) and has a high internal consistency (Cronbach's α = 0.825). However, the SSS has three dimensions, which are all highly internally consistent: “daytime symptoms” (Cronbach's α = 0.805), “nighttime symptoms” (Cronbach's α = 0.835), and “operational capacity” (Cronbach's α = 0.723). Post-treatment, the FSS still consisted of one factor, but the SSS changed in dimensionality, as it had only two factors left post-treatment. The ΔFSS and ΔSSS had good correlation with the six-point Likert scale for perceived improvement (r = 0.524; p < 0.01 and r = 0.574; p < 0.01, respectively), a moderate correlation between FSS and pinch grip (r = 0.259; p < 0.01) was found, and a weak correlation between SSS and pinch grip (r = 0.231; p < 0.01) was found. Standard Response Mean for FSS and SSS was 0.76 and 1.49, respectively. Effect size was 0.92 and 1.96, respectively, both indicating a good responsiveness. Response rate was high (82–84%). We concluded that the Dutch version of the BCTQ has a proper reliability, validity, responsiveness, and acceptability to assess the symptom severity and functional disabilities of CTS patients. Because of multidimensionality, we would recommend to create sum scores of the four different dimensions instead of two. Caution is required when interpreting the results postoperatively, due to the insufficient longitudinal validity of the SSS.
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Affiliation(s)
- Floriaan G C M De Kleermaeker
- Department of Neurology, Viecuri Medical Center, Venlo, Netherlands.,Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Mark Levels
- Research Centre for Education and the Labor Market, Maastricht University, Maastricht, Netherlands.,Sociology Group, Nuffield College, Oxford, United Kingdom
| | - Wim I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Jan Meulstee
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
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Ertem DH, Sirin TC, Yilmaz I. Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:638-645. [PMID: 31553394 DOI: 10.1590/0004-282x20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. METHODS Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. RESULTS A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). CONCLUSION Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.
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Affiliation(s)
- Devrimsel Harika Ertem
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Tuba Cerrahoglu Sirin
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Ilhan Yilmaz
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurosurgery, Istanbul, Turkey
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35
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Reliability and validity of Duruoz Hand Index in carpal tunnel syndrome. Turk J Phys Med Rehabil 2019; 64:277-283. [PMID: 31453522 DOI: 10.5606/tftrd.2018.1685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives The aim of this study is to investigate the reliability and validity of Duruoz Hand Index (DHI) in patients with carpal tunnel syndrome (CTS). Patients and methods A total of 55 patients (50 females, 5 males; mean age 51.0±10.2 years: range, 30 to 73 years) aged ≥18 years who were admitted to the outpatient clinic of a rehabilitation hospital between December 2010 and December 2012 with the diagnosis of CTS both clinically and electrophysiologically were included in this study. All patients completed DHI at baseline and repeated after a week interval. The Boston Questionnaire (BQ) and Health Assessment Questionnaire Disability Index (HAQ-DI) were filled out at baseline. And the internal consistency reliability was tested using the Cronbach's alpha. For the test-retest reliability, intraclass correlation coefficients (ICC) were calculated. The correlations between the DHI and both BQ and HAQ-DI were investigated for the construct validity. Results Of the patients, 41 (74.5%) were housewives. Carpal tunnel syndrome was bilateral in 29 patients (52.7%). The Mean Body Mass Index was 31.2±5.5 kg/m2. The mean symptom duration was 22.8±23.7 months. The mean DHI scores for the first and second evaluations were 23.25±20.64 and 20.45±20.07, respectively. The mean BQ symptom severity and functional status scores were 2.87±0.80 and 2.72±1.03, respectively. The mean HAQ-DI score was 0.91±0.66. The Cronbach's alpha was 0.97 indicating excellent internal consistency reliability. There was a statistically significant correlation between the two measurements of DHI. The ICC value for total score was 0.88 indicating good reliability. There was a statistically significantly positive correlation between the DHI and BQ (r=0.638, p<0.001). Also, DHI was significantly correlated with the HAQ-DI (0.613, p<0.001). Conclusion Our study results suggest that DHI is a reliable and valid test which can be used for evaluating hand functions in CTS patients.
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Hamzeh HH, Alworikat NA. Cross cultural adaptation, reliability and construct validity of the Boston Carpal Tunnel Questionnaire in standard Arabic language. Disabil Rehabil 2019; 43:430-435. [PMID: 31223034 DOI: 10.1080/09638288.2019.1629651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To perform cross cultural adaptation of Boston Carpal Tunnel Questionnaire in standard Arabic language and assess the reliability and construct validity of the new tool. MATERIALS AND METHODS Cross cultural adaptation was performed according to guidelines. One hundred and one Arabic patients with carpal tunnel syndrome agreed to participate in the study and filled the questionnaire. Cronbach's alpha was calculated to assess internal consistency. Test-retest reliability was assessed after two weeks by calculating Intraclass correlation coefficient. To assess construct validity; Spearman correlation coefficient with the Disabilities of the Arm, Shoulder and Hand Questionnaire was calculated. RESULTS Arabic Boston Carpal Tunnel Questionnaire version had excellent internal consistency, Cronbach's Alpha was 0.877 for Symptoms Severity Scale and 0.895 for Functional Status Scale. Test-retest reliability was excellent (Interclass Correlation Coefficient was 0.899 for Symptoms Severity Scale and 0.944 for Functional Status Scale). Correlation with the Disabilities of the Arm, Shoulder and Hand Questionnaire was high which reflects excellent construct validity. All results were similar to the results of previous studies. CONCLUSIONS Arabic Boston Carpal Tunnel Questionnaire was produced. The tool demonstrated excellent internal consistency, test-retest reliability and construct validity. The questionnaire is suitable for use with carpal tunnel syndrome patients in the Middle East and North Africa region. Implications for rehabilitation Carpal tunnel syndrome is the most common peripheral neuropathy worldwide with many affected in Arabic speaking countries. Specific outcome measures like Boston Carpal Tunnel Questionnaire are important in evaluating the impact of different interventions on patients' wellbeing. The Arabic Boston carpal tunnel questionnaire is a valid and reliable tool to use with Arabic speaking people with Carpal Tunnel Syndrome.
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Affiliation(s)
- Hayat H Hamzeh
- Department of Physiotherapy, The University of Jordan, Amman, Jordan
| | - Nida A Alworikat
- Department of Occupational Therapy, The University of Jordan, Amman, Jordan
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Multanen J, Ylinen J, Karjalainen T, Kautiainen H, Repo JP, Häkkinen A. Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients. Scand J Surg 2019; 109:343-350. [PMID: 31132964 DOI: 10.1177/1457496919851607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties. MATERIALS AND METHODS We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test-retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects. RESULTS The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach's alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test-retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants. CONCLUSION Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.
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Affiliation(s)
- J Multanen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - J Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - T Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - H Kautiainen
- Department of General Practice, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J P Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - A Häkkinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Güven SC, Özçakar L, Kaymak B, Kara M, Akıncı A. Short‐term effectiveness of platelet‐rich plasma in carpal tunnel syndrome: A controlled study. J Tissue Eng Regen Med 2019; 13:709-714. [DOI: 10.1002/term.2815] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/07/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Serdar Can Güven
- Department of Physical and Rehabilitation MedicineHacettepe University Medical School Ankara Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation MedicineHacettepe University Medical School Ankara Turkey
| | - Bayram Kaymak
- Department of Physical and Rehabilitation MedicineHacettepe University Medical School Ankara Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation MedicineHacettepe University Medical School Ankara Turkey
| | - Ayşen Akıncı
- Department of Physical and Rehabilitation MedicineHacettepe University Medical School Ankara Turkey
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Tanrıverdi M, Hoşbay Z, Candan Algun Z. The relationship of pain on the upper extremity functions and quality of life in patients with carpal tunnel syndrome. J Back Musculoskelet Rehabil 2019; 32:71-76. [PMID: 30149437 DOI: 10.3233/bmr-171097] [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: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim of study was researching the relationship of pain in patients with carpal tunnel syndrome on Quality of Life (QoL) and upper limb functionality. METHODS Demographical and physical measurements were performed by a physiotherapist. Pain levels were measured by Visuel Analog Scale at rest, on motion and in fatique, and the patients' results were recorded. Functionality levels were evaluated by 'Boston Carpal Tunnel Syndrome Questionnaire' and QoL by 'Short Form 12' (SF-12). Patients had 10 sessions of the physiotherapy and rehabilitation program. Assessments were repeated 1 month later. RESULTS The mean age 49.97 ± 11.15 years of 28 patients were included. While pre- and post-treatment between pain and functionality evaluation found a significant relationship (p< 0.05); there was no significant relationship in QoL (SF-12 p> 0.05). CONCLUSIONS As a result while we found statistical differences between pain and symptomatic status; there were no statistical differences between functionality, daily living activities and QoL. Appropriate rehabilitation programs should be taken into consideration to help patients obtain functionality, daily living activities and QoL.
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Affiliation(s)
- Müberra Tanrıverdi
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Zeynep Hoşbay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Z Candan Algun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Avsaroglu H, Ozcakir S. Effects of Anthropometric Measurements on Treatment Outcomes in Patients with Carpal Tunnel Syndrome. J Hand Surg Asian Pac Vol 2018; 23:528-532. [PMID: 30428797 DOI: 10.1142/s2424835518500534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between anthropometric hand/wrist measurements and outcomes following static wrist splintage in patients with mild-to-moderate carpal tunnel syndrome (CTS). METHODS Thirty nine patients with mild-to-moderate CTS were enrolled in this study. Anthropometric measurements of hand and wrist including wrist width, wrist depth, palm length, hand length, wrist ratio (wrist depth/wrist width) and wrist/palm ratio (wrist depth/palm length) were recorded as well as body mass index and ultrasonographic cross sectional area of median nerve. Patients were treated with static wrist splints and evaluated at 2nd, 4th and 12th weeks with Boston Carpal Tunnel Questionnaire, median nerve nerve conduction studies, Visual Analog Scale for pain and Likert Scale for numbness. RESULTS Following treatment with a static wrist splint, the wrist ratio was correlated significantly with improvements in Boston Functional Status Scale at the second and forth weeks (r = -0.354, p = 0.027 and r = -0.320, p = 0.050 respectively) and Visual Analog Scale at the forth and 12th weeks (r = -0.352, p = 0.030 and r = -0.360, p = 0.029 respectively). CONCLUSIONS Splinting provides symptomatic improvement in mild-to-moderate CTS and this study suggests that the wrist anthropometric measurements may influence treatment outcomes.
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Affiliation(s)
- Hazim Avsaroglu
- * Department of Physical Medicine and Rehabilitation, Uludag University School of Medicine, Bursa, Turkey.,† Department of Physical Medicine and Rehabilitation, Nevsehir State Hospital, Nevsehir, Turkey
| | - Suheda Ozcakir
- * Department of Physical Medicine and Rehabilitation, Uludag University School of Medicine, Bursa, Turkey
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Bougea A, Zambelis T, Voskou P, Katsika PZ, Tzavara C, Kokotis P, Karandreas N. Reliability and Validation of the Greek Version of the Boston Carpal Tunnel Questionnaire. Hand (N Y) 2018; 13:593-599. [PMID: 28825339 PMCID: PMC6109897 DOI: 10.1177/1558944717725379] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Boston Carpal Tunnel Questionnaire (BCTQ) is an easy, brief, self-administered questionnaire developed by Levine et al for the assessment of severity of symptoms and functional status of patients with carpal tunnel syndrome. The aim of our study was to develop and validate the Greek version of BCTQ. METHODS We conducted a cross-sectional study of 90 patients with idiopathic carpal tunnel syndrome. The original English version of BCTQ was adapted into Greek using forward and backward translation. Reliability was assessed by internal consistency (Cronbach α and item-total correlation) and reproducibility. Validity was examined by correlating the Boston Questionnaire scores to Canterbury severity scale for electrodiagnostic severity grading. RESULTS The Greek version showed high reliability (Cronbach α 0.89 for Symptom Severity Scale and 0.93 for Functional Status Scale) and construct validity (Pearson correlation coefficient 0.53 for Symptom Severity Scale and 0.68 for Functional Status Scale). Test-retest were 0.75 for Symptom Severity Scale and 0.79 for Functional Status Scale ( P < .05). Receiver operating characteristic curve analysis showed that the optimal cutoff of Symptom Severity Scale for the discrimination of subjects with low electrodiagnostic severity grading than subjects with high electrodiagnostic severity grading was 1.95 with sensitivity equal to 75.5% and specificity equal to 68.3%. CONCLUSIONS The Greek version of the BCTQ is a valid, reliable screening tool for assessment in daily practice of symptoms and functional status in patients with carpal tunnel syndrome.
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Affiliation(s)
- Anastasia Bougea
- National and Kapodistrian University of
Athens, Greece,Anastasia Bougea, First Department of
Neurology, Aeginition Hospital, Medical School, National and Kapodistrian
University of Athens, 72-74 Vasilissis Sofias Avenue, 11528 Athens, Greece.
| | | | | | | | - Chara Tzavara
- National and Kapodistrian University of
Athens, Greece
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Aktürk S, Büyükavcı R, Aslan Ö, Ersoy Y. Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study. Clin Rheumatol 2018; 37:2465-2469. [DOI: 10.1007/s10067-018-4176-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 01/11/2023]
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Karaahmet ÖZ, Gürçay E, Kara M, Serçe A, Kıraç Ünal Z, Çakcı A. Comparing the effectiveness of ultrasound-guided versus blind steroid injection in the treatment of severe carpal tunnel syndrome. Turk J Med Sci 2017; 47:1785-1790. [PMID: 29306239 DOI: 10.3906/sag-1704-97] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: This study aimed to compare the effectiveness of ultrasound (US)-guided injection versus blind injection of corticosteroids in the treatment of carpal tunnel syndrome (CTS). Materials and methods: This prospective, randomized clinical trial included patients with severe CTS based on clinical and electrophysiological criteria. The patients were evaluated for clinical and electrophysiological parameters at baseline and 4 weeks after treatment. Symptom severity and hand function were assessed by the Boston questionnaire. The patients underwent blind injection or US-guided injection. Results: When compared with baseline, both groups showed significant improvement in Boston questionnaire scores and all electrophysiological parameters. Significant differences were observed between the groups for clinical parameters (Boston Symptom Severity Scale: P = 0.007; Functional Status Scale: P < 0.001) in favor of the US-guided group. Conclusion: This study demonstrated that both US-guided and blind injections were effective in reducing symptoms and improving hand function. US-guided injections may yield more effective clinical results in the short-term than blind injections in the treatment of patients with severe CTS.
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Mansiz-Kaplan B, Akdeniz-Leblecicier M, Yagci I. Are extramedian symptoms associated with peripheral causes in patient with carpal tunnel syndrome? Electrodiagnostic and ultrasonographic study. J Electromyogr Kinesiol 2017; 38:203-207. [PMID: 28818412 DOI: 10.1016/j.jelekin.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/17/2017] [Accepted: 08/06/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the relationship between extramedian spreading of sensorial symptoms and median and ulnar nerve cross-sectional area (CSA) and to compare the ultrasonographic and electrophysiological findings in patients with carpal tunnel syndrome (CTS) with or without extramedian sensory symptoms. DESIGN Cross-sectional study. MATERIALS AND METHODS Patients with CTS were divided into two groups as with or without extramedian symptoms and were assessed clinically, electrophysiologically and ultrasonographically by three blind investigators. In electrophysiological tests, median and ulnar nerve conduction studies were performed. Nerve cross-sectional areas were measured at hook of hamate, psiform bone, radio-ulnar joint, one-third distal part of forearm, and medial epicondyle by ultrasonography. FINDINGS The study was completed with 61 patients (108 hands). Extramedian symptoms were present in 31 patients (54 hands). Finger grip strength was lower, pain values evaluated with visual analogue scale were higher in patients with extramedian symptoms (p<0.05). There was no statistically significant difference in electrophysiological and ultrasonographic parameters. CONCLUSION According to our results, extramedian symptoms are not related to nerve conduction studies or nerve ultrasonography, these symptoms may be explained with central sensitization in patient with CTS.
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Affiliation(s)
- Basak Mansiz-Kaplan
- University of Health Sciences, Ankara Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey.
| | | | - Ilker Yagci
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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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.
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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
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Han HY, Kim HM, Park SY, Kim MW, Kim JM, Jang DH. Clinical Findings of Asymptomatic Carpal Tunnel Syndrome in Patients With Diabetes Mellitus. Ann Rehabil Med 2016; 40:489-95. [PMID: 27446786 PMCID: PMC4951368 DOI: 10.5535/arm.2016.40.3.489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/13/2015] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the clinical differences between patients with diabetes mellitus (DM) who have asymptomatic carpal tunnel syndrome (CTS) and those who have symptomatic CTS. Methods Sixty-three patients with DM were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), nerve conduction studies (NCS), and ultrasonographic evaluation of the cross-sectional area (CSA) of the median nerve. According to the BCTQ responses and NCS results, the patients were divided into the following three groups: group 1 (n=16), in which NCS results did not reveal CTS; group 2 (n=19), in which NCS results revealed CTS but the group scored 0 points on the BCTQ (asymptomatic); and group 3 (n=28), in which NCS results revealed CTS and the group scored >1 point on the BCTQ (symptomatic). The clinical findings, NCS results, and CSA of the median nerve were compared among the three groups. Results There were no significant differences in age, DM duration, glycated hemoglobin levels, and presence of diabetic polyneuropathy among the three groups. The peak latency of the median sensory nerve action potential was significantly shorter in group 1 than in groups 2 and 3 (p<0.001); however, no difference was observed between groups 2 and 3. CSA of the median nerve at the carpal tunnel in group 2 was significantly larger than that in group 1 and smaller than that in group 3 (p<0.05). Conclusion The results of our study suggest that the symptoms of CTS in patients with diabetes are related to CSA of the median nerve, which is consistent with swelling of the nerve.
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Affiliation(s)
- Hye Young Han
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ha Min Kim
- GwangGyo Charm and Good Hospital, Yongin, Korea
| | - So Young Park
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jae Min Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Erkol İnal E, Eroğlu P, Görükmez O, Özemri Sağ Ş, Yakut T. Association between the catechol-o-methyltransferase val158met polymorphism with susceptibility and severity of carpal tunnel syndrome. Balkan J Med Genet 2016; 18:43-48. [PMID: 27785396 PMCID: PMC5026268 DOI: 10.1515/bjmg-2015-0085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. In this study, we aimed to clarify the relationships between the catechol-O-methyltransferase (COMT) gene Val158Met (rs4680) polymorphism and development, functional and clinical status of CTS. Ninety-five women with electro diagnostically confirmed CTS and 95 healthy controls were enrolled in the study. The functional and clinical status of the patients was measured by the Turkish version of the Boston Questionnaire and intensity of pain related to the past 2 weeks was evaluated on a visual analog scale (VAS). The Val158Met polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), method. We divided patients according to the genotypes of the Val158Met polymorphism as Val/Val, Val/Met and Met/Met. There were not any significant differences in terms of Val158Met polymorphisms between patients and healthy controls (p >0.05). We also did not find any relationships between the Val158Met polymorphism and CTS (p >0.05). In conclusion, although we did not find any relationships between CTS and the Val158Met polymorphism, we could not generalize this result to the general population. Future studies are warranted to conclude precise associations.
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Affiliation(s)
- E Erkol İnal
- Department of Physical Medicine and Rehabilitation, Süleyman Demirel University, Faculty of Medicine, Çünür, Isparta, Turkey
| | - P Eroğlu
- Department of Physical Medicine and Rehabilitation, Ankara Occupational Disease Hospital, Ankara, Turkey
| | - O Görükmez
- Department of Medical Genetics, Bursa Şevket Yılmaz Education and Research Hospital, Bursa, Turkey
| | - Ş Özemri Sağ
- Department of Medical Genetics, Uludağ University, Faculty of Medicine, Bursa, Turkey
| | - T Yakut
- Department of Medical Genetics, Uludağ University, Faculty of Medicine, Bursa, Turkey
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Gürsoy AE, Bilgen HR, Dürüyen H, Altıntaş Ö, Kolukisa M, Asil T. The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci 2016; 37:1055-61. [PMID: 26939675 DOI: 10.1007/s10072-016-2530-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/22/2016] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP- group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP- group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP- groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP- group was lower than EP+ group, statistically difference was not significant between EP+ and EP- groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP- groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results.
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Affiliation(s)
- Azize Esra Gürsoy
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey.
| | - Halide Rengin Bilgen
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Hümeyra Dürüyen
- Department of Neurology, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Özge Altıntaş
- Department of Neurology, Niğde-Bor State Hospital, Niğde, Turkey
| | - Mehmet Kolukisa
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Talip Asil
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
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Tosun B, Aslan Ö, Tunay S, Akyüz A, Özkan H, Bek D, Açıksöz S. Turkish Version of Kolcaba's Immobilization Comfort Questionnaire: A Validity and Reliability Study. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 9:278-84. [PMID: 26724235 DOI: 10.1016/j.anr.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/10/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the validity and reliability of the Turkish version of the Immobilization Comfort Questionnaire (ICQ). METHODS The sample used in this methodological study consisted of 121 patients undergoing lower extremity arthroscopy in a training and research hospital. The validity study of the questionnaire assessed language validity, structural validity and criterion validity. Structural validity was evaluated via exploratory factor analysis. Criterion validity was evaluated by assessing the correlation between the visual analog scale (VAS) scores (i.e., the comfort and pain VAS scores) and the ICQ scores using Spearman's correlation test. The Kaiser-Meyer-Olkin coefficient and Bartlett's test of sphericity were used to determine the suitability of the data for factor analysis. Internal consistency was evaluated to determine reliability. The data were analyzed with SPSS version 15.00 for Windows. Descriptive statistics were presented as frequencies, percentages, means and standard deviations. A p value ≤ .05 was considered statistically significant. RESULTS A moderate positive correlation was found between the ICQ scores and the VAS comfort scores; a moderate negative correlation was found between the ICQ and the VAS pain measures in the criterion validity analysis. Cronbach α values of .75 and .82 were found for the first and second measurements, respectively. CONCLUSIONS The findings of this study reveal that the ICQ is a valid and reliable tool for assessing the comfort of patients in Turkey who are immobilized because of lower extremity orthopedic problems.
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Affiliation(s)
- Betül Tosun
- Department of Fundamentals of Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.
| | - Özlem Aslan
- Department of Fundamentals of Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
| | - Servet Tunay
- Department of Orthopedics and Traumatology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Aygül Akyüz
- Department of Obstetrics and Gynecology Nursing, School of Nursing, Koc University, Istanbul, Turkey
| | - Hüseyin Özkan
- Department of Orthopedics and Traumatology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Doğan Bek
- Department of Orthopedics and Traumatology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Semra Açıksöz
- Department of Fundamentals of Nursing, School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey
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