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Koç Yekedüz M, Köse E, İnci A, Yüksel MF, Doğulu N, Şen Akova B, Yeniay Süt N, Öncül Ü, Yildirim M, Fitoz S, Teber S, Tümer L, Eminoğlu FT. Is Ultrasonography a Reliable Approach for the Evaluation of Carpal Tunnel Syndrome in Patients With Mucopolysaccharidosis? Pediatr Neurol 2024; 155:171-176. [PMID: 38669799 DOI: 10.1016/j.pediatrneurol.2024.03.032] [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: 10/31/2023] [Revised: 02/09/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND One of the most common causes of carpal tunnel syndrome (CTS) in childhood is mucopolysaccharidosis (MPS). While ultrasonography (US) can aid in the diagnosis of CTS in adult patients, there is limited experience of this in the pediatric group. We aimed to investigate the results of wrist ultrasonography, which may be a candidate alternative to electrophysiological examination. METHODS The participants were evaluated for symptoms, physical examination findings, electrophysiological tests and grayscale US. CTS was diagnosed in accordance with the American Academy of Orthopedic Surgeons Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. RESULTS Included in the study were 27 MPS patients aged 4.5-32 years and 30 healthy control subjects aged 4.3-26 years. Of the 54 wrists in the MPS group, 30 were diagnosed with CTS. The median cross-sectional area (CSA) at the proximal carpal tunnel, the CSA at the forearm, and the wrist-forearm ratio (WFR) were higher in the wrists of the MPS with CTS group than in those without CTS and the healthy control subjects. The WFR cutoff of ≥1.35, 56.6% (95% CI: 437.4-74.5) sensitivity, and 89.8% (95% CI: 81.0-95.5) specificity were consistent with a diagnosis of CTS (receiver operating characteristics analysis, area under the curve = 0.775, 95% CI: 0.673-0.877). CONCLUSION Although the US provides results with unsatisfactory specificity and sensitivity, it is a candidate for further investigation for the diagnosis of CTS because it is an innovative, noninvasive, and more accessible method. WFR value may produce more meaningful results than wrist or forearm nerve area measurements.
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Affiliation(s)
- Merve Koç Yekedüz
- Faculty of Medicine, Department of Pediatric Metabolism, Ankara University, Ankara, Turkey
| | - Engin Köse
- Faculty of Medicine, Department of Pediatric Metabolism, Ankara University, Ankara, Turkey; Ankara University Rare Diseases Application and Research Center, Ankara, Turkey.
| | - Aslı İnci
- Faculty of Medicine, Department of Pediatric Metabolism, Gazi University, Ankara, Turkey
| | - Merve Feyza Yüksel
- Faculty of Medicine, Department of Pediatric Neurology, Ankara University, Ankara, Turkey
| | - Neslihan Doğulu
- Faculty of Medicine, Department of Pediatric Metabolism, Ankara University, Ankara, Turkey
| | - Birsel Şen Akova
- Faculty of Medicine, Department of Pediatric Radiology, Ankara University, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Faculty of Medicine, Department of Pediatric Neurology, Ankara University, Ankara, Turkey
| | - Ümmühan Öncül
- Faculty of Medicine, Department of Pediatric Metabolism, Ankara University, Ankara, Turkey
| | - Miraç Yildirim
- Faculty of Medicine, Department of Pediatric Neurology, Ankara University, Ankara, Turkey
| | - Suat Fitoz
- Faculty of Medicine, Department of Pediatric Radiology, Ankara University, Ankara, Turkey
| | - Serap Teber
- Faculty of Medicine, Department of Pediatric Neurology, Ankara University, Ankara, Turkey
| | - Leyla Tümer
- Faculty of Medicine, Department of Pediatric Metabolism, Gazi University, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Faculty of Medicine, Department of Pediatric Metabolism, Ankara University, Ankara, Turkey; Ankara University Rare Diseases Application and Research Center, Ankara, Turkey
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Hannaford A, Simon NG. Ulnar neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:103-126. [PMID: 38697734 DOI: 10.1016/b978-0-323-90108-6.00006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Ulnar neuropathy at the elbow is the second most common compressive neuropathy. Less common, although similarly disabling, are ulnar neuropathies above the elbow, at the forearm, and the wrist, which can present with different combinations of intrinsic hand muscle weakness and sensory loss. Electrodiagnostic studies are moderately sensitive in diagnosing ulnar neuropathy, although their ability to localize the site of nerve injury is often limited. Nerve imaging with ultrasound can provide greater localization of ulnar injury and identification of specific anatomical pathology causing nerve entrapment. Specifically, imaging can now reliably distinguish ulnar nerve entrapment under the humero-ulnar arcade (cubital tunnel) from nerve injury at the retro-epicondylar groove. Both these pathologies have historically been diagnosed as either "ulnar neuropathy at the elbow," which is non-specific, or "cubital tunnel syndrome," which is often erroneous. Natural history studies are few and limited, although many cases of mild-moderate ulnar neuropathy at the elbow appear to remit spontaneously. Conservative management, perineural steroid injections, and surgical release have all been studied in treating ulnar neuropathy at the elbow. Despite this, questions remain about the most appropriate management for many patients, which is reflected in the absence of management guidelines.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
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3
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Bilateral carpal tunnel syndrome in mucopolysaccharidosis type II: a case report. Childs Nerv Syst 2022; 38:1651-1653. [PMID: 35304625 DOI: 10.1007/s00381-022-05492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
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Thirache C, Gaume M, Gitiaux C, Salon A, Dana C, Pannier S. Carpal tunnel syndrome and finger deformities in children with mucopolysaccharidoses and mucolipidoses: a retrospective review of 52 patients. J Hand Surg Eur Vol 2022; 47:469-474. [PMID: 34851776 DOI: 10.1177/17531934211061980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This single-centre retrospective study reports our management of carpal tunnel syndrome in 52 children (103 hands) with mucopolysaccharidoses and mucolipidoses. All except one were bilateral. The median age at surgery was 4 years (range 1.5 to 12). The diagnosis of carpal tunnel syndrome was confirmed by an electromyogram (EMG) in all patients; 38% of these presented without any clinical signs. Surgical neurolysis was performed in all hands, combined with epineurotomy in 52 hands (50%) and flexor tenosynovectomy in 75 hands (73%). Surgery was bilateral in 98% of children (102 hands). The mean follow-up was 12 years (range 1 to 19) and the EMG was normalized in 78% of hands. Ten patients suffered recurrence, eight of whom required further surgery. Screening for carpal tunnel syndrome is essential for the management of children mucopolysaccharidoses and mucolipidoses. Surgical treatment should be carried out early with follow-up by EMG to detect recurrence.Level of evidence: IV.
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Affiliation(s)
- Clément Thirache
- Paediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris, France
| | - Mathilde Gaume
- Paediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris, France
| | - Cyril Gitiaux
- Paediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris, France
| | - Arielle Salon
- Paediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris, France
| | - Caroline Dana
- Paediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris, France
| | - Stéphanie Pannier
- Paediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris, France
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Giostri GS, Souza CDA, Nagai AK, Santos MLSF, Sampaio JSP, de Masi Nassif FDJ. Functional results after carpal tunnel release in mucopolysaccharidosis. Orphanet J Rare Dis 2021; 16:382. [PMID: 34503540 PMCID: PMC8427841 DOI: 10.1186/s13023-021-01982-3] [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: 07/20/2020] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucopolysaccharidosis consists of a group of diseases caused by the deficiency of lysosomal enzymes, which may lead to the compression of the median nerve in the carpal tunnel due to the accumulation of glycosaminoglycan, resulting in the hand disability. The study purpose is to present functional results of carpal tunnel release in mucopolysaccharidosis patients. Patients were selected from an enzyme replacement group in the Department of Pediatric Neurology. The legal guardians of the patients were informed about the likely functional change of the hands induced by compression of the median nerve. Clinical evaluation was performed in those patients who received their legal guardians' consent to participate and was included inspection, assessment of functional level, wrinkle test and the digital pinch function to manipulate small and large objects. Ultrasound and electromyography were performed to confirm the clinical median nerve compression. Bilateral extended opening technique was performed to access the carpal tunnel and analyze the anatomic findings of the median nerve and the flexed tendons of the fingers. After the surgical release of the carpal tunnel, the clinical evaluation was repeated. Subjective observations of the legal guardians were also considered. RESULTS Seven patients underwent bilateral surgical opening of the carpal tunnel; six boys, mean age of 9.5 (5 to 13), five of them presenting Type II mucopolysaccharidosis, 1 Type I and 1 Type VI. The average follow-up was 12 months (10-13 months). The functional results observed included the improvement in the handling of small and large objects in all children who underwent decompression of the median nerve. The comparison between the pre-operative and post-operative functional levels revealed that 2 patients evolved from Level II to IV, 3 from Level III to IV, 1 from Level IV to V and 1 patient remained in Level III. Tenosynovitis around the flexor tendons and severe compression of the median nerve in the fourteen carpal tunnels were observed during the surgical procedure. In 6 wrists, partial tenosynovitis was performed. CONCLUSIONS Despite the improvement in the overall function of the children' hands, we cannot conclude that only surgery was responsible for the benefit. Better designed studies are required.
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Affiliation(s)
| | - Camila Deneka Arantes Souza
- Serviço de Cirurgia da Mão do Hospital Pequeno Príncipe, Curitiba, PR, Brazil. .,Ambulatório Ortopedia Pediátrica, Rua Desembargador Motta, 1070 - Água Verde,, Curitiba, PR, 80250-060, Brazil.
| | - Alencar Kenji Nagai
- Serviço de Cirurgia da Mão do Hospital Pequeno Príncipe, Curitiba, PR, Brazil
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Hannaford A, Vucic S, Kiernan MC, Simon NG. Review Article "Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date". Int J Gen Med 2021; 14:4579-4604. [PMID: 34429642 PMCID: PMC8378935 DOI: 10.2147/ijgm.s295851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular ultrasound is rapidly becoming incorporated into clinical practice as a standard tool in the assessment of peripheral nerve diseases. Ultrasound complements clinical phenotyping and electrodiagnostic evaluation, providing critical structural anatomical information to enhance diagnosis and identify structural pathology. This review article examines the evidence supporting neuromuscular ultrasound in the diagnosis of compressive mononeuropathies, traumatic nerve injury, generalised peripheral neuropathy and motor neuron disease. Extending the sonographic evaluation of nerves beyond simple morphological measurements has the potential to improve diagnostics in peripheral neuropathy, as well as advancing the understanding of pathological mechanisms, which in turn will promote precise therapies and improve therapeutic outcomes.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, Australia
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Rüsch CT, Knirsch U, Weber DM, Rohrbach M, Eichenberger A, Lütschg J, Weber K, Broser PJ, Stettner GM. Etiology of Carpal Tunnel Syndrome in a Large Cohort of Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:624. [PMID: 34438514 PMCID: PMC8392332 DOI: 10.3390/children8080624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 01/22/2023]
Abstract
(1) Background: Carpal tunnel syndrome (CTS), a compressive mononeuropathy of the median nerve at the wrist, is rare in childhood and occurs most frequently due to secondary causes. (2) Methods: Medical history, electrodiagnostic findings, and imaging data of patients with CTS from two pediatric neuromuscular centers were analyzed retrospectively. The etiology of CTS was investigated and compared with the literature. (3) Results: We report on a cohort of 38 CTS patients (n = 22 females, n = 29 bilateral, mean age at diagnosis 9.8 years). Electrodiagnostic studies of all patients revealed slowing of the antidromic sensory or orthodromic mixed nerve conduction velocities across the carpal tunnel or lack of the sensory nerve action potential and/or prolonged distal motor latencies. Median nerve ultrasound was diagnostic for CTS and confirmed tumorous and vascular malformations. Etiology was secondary in most patients (n = 29; 76%), and mucopolysaccharidosis was the most frequent underlying condition (n = 14; 37%). Idiopathic CTS was rare in this pediatric cohort (n = 9; 24%). (4) Conclusion: Since CTS in childhood is predominantly caused by an underlying disorder, a thorough evaluation and search for a causative condition is recommended in this age group.
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Affiliation(s)
- Christina T. Rüsch
- Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (C.T.R.); (U.K.)
- Division of Pediatric Neurology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland; (J.L.); (P.J.B.)
| | - Ursula Knirsch
- Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (C.T.R.); (U.K.)
| | - Daniel M. Weber
- Division of Hand Surgery, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Marianne Rohrbach
- Division of Metabolism, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - André Eichenberger
- Division of Radiology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Jürg Lütschg
- Division of Pediatric Neurology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland; (J.L.); (P.J.B.)
| | - Kirsten Weber
- Division of Hand Surgery, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland;
| | - Philip J. Broser
- Division of Pediatric Neurology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland; (J.L.); (P.J.B.)
| | - Georg M. Stettner
- Neuromuscular Center Zurich and Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland; (C.T.R.); (U.K.)
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8
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Andre E, Hamel A, Perrot P, Duteille F. [Median nerve compression in the carpal tunnel in children - a delayed diagnosis. About 20 clinical cases]. ANN CHIR PLAST ESTH 2021; 66:298-304. [PMID: 34144846 DOI: 10.1016/j.anplas.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/04/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The carpal tunnel syndrome is rare in children. We performed a retrospective study of 10 children. The aim is to show that the diagnosis of carpal tunnel syndrome is difficult in children. PATIENTS AND METHODS We identified all children with median nerve compression in the carpal tunnel between 2010 at 2020, managed in our service. RESULTS Ten children with 20 hands included. There was different etiologies of carpal tunnel syndrome: 5 lysosomal storage diseases, 4 idiopathic carpal tunnel syndrome, 1 genodermatose, 1 Byler syndrome and 1 VACTERL syndrome. Common presenting symptoms were pain (five patients) and under use of fingers (five patients). Two children had opposition deficit of the thumb. We operated 19 hands. Median age at diagnosis was 4 years and 7 months. One children or 2 hands had a reanimation of opposition by tendinous transfer of flexor digitorum superficialis tendon of the ring finger. All children had a complete regression of the painful symptoms, a use improvement of fingers and recovery of the opposition of the thumb. CONCLUSION The diagnosis of carpal tunnel syndrome is difficult in children. It is common to be confronted with an advanced clinical symptoms. The atypical symptoms may cause diagnostic delay. Due to the quality of the clinical results obtained, we recommend open carpal tunnel release even when the diagnosis seems delayed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Andre
- Service de chirurgie orthopédique pédiatrique, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France.
| | - A Hamel
- Service de chirurgie orthopédique pédiatrique, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, Centre des Brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, Centre des Brûlés, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Smart BD, Cartwright MS. Neuromuscular ultrasound as the sole diagnostic test for carpal tunnel syndrome in Hunter syndrome. Muscle Nerve 2021; 64:E9-E11. [PMID: 34050942 DOI: 10.1002/mus.27334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Benjamin D Smart
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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10
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Codd CM, Abzug JM. Upper Extremity Compressive Neuropathies in the Pediatric and Adolescent Populations. Curr Rev Musculoskelet Med 2020; 13:696-707. [PMID: 32720100 PMCID: PMC7661676 DOI: 10.1007/s12178-020-09666-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Although somewhat rare, upper extremity compressive neuropathies can occur in the pediatric and adolescent populations due to various etiologies. Some of the most common conditions seen include thoracic outlet syndrome, supracondylar process syndrome, cubital tunnel syndrome with subluxation of the ulnar nerve, and carpal tunnel syndrome. This review will focus on these diagnoses and how to address them in the pediatric and adolescent populations. RECENT FINDINGS Due to the rarity of upper extremity compressive neuropathies in the pediatric and adolescent populations, substantial advancement in the literature does not routinely occur. However, recent literature has found a difference in the rate of various subtypes of thoracic outlet syndrome in children versus adults. Additionally, cubital tunnel syndrome associated with ulnar nerve subluxation/instability has recently been found to have better outcomes following surgical decompression of the ulnar nerve and transposition than those with stable ulnar nerves. In summary, this review provides the most recent knowledge surrounding upper extremity compressive and entrapment neuropathies in the pediatric and adolescent populations.
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Affiliation(s)
- Casey M. Codd
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
| | - Joshua M. Abzug
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD USA
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11
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Neuromuscular Ultrasound in the Pediatric Population. Diagnostics (Basel) 2020; 10:diagnostics10121012. [PMID: 33255940 PMCID: PMC7760629 DOI: 10.3390/diagnostics10121012] [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: 10/10/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
The diagnosis and evaluation of neuromuscular disorders traditionally involves electrodiagnostic (EDx) testing, including nerve conduction studies (NCSs) and electromyography (EMG). These tools can cause pain and discomfort, an important consideration when performed on children. Neuromuscular ultrasound is noninvasive, cost-effective, and increasingly utilized for the detection of neuromuscular pathology. Studies investigating the performance and clinical implementation of ultrasound have primarily been performed in adult populations. Ultrasound in children has the potential to guide EDx testing and ultimately improve diagnostic efficiency and accuracy. This review aims to describe key features of neuromuscular ultrasound in the pediatric population based on the available studies, including our own institutional experience.
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12
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Gallone G, Di Gennaro GL, Farr S. Peripheral Nerve Compression Syndromes in Children. J Hand Surg Am 2020; 45:857-863. [PMID: 32646712 DOI: 10.1016/j.jhsa.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/12/2020] [Accepted: 04/12/2020] [Indexed: 02/02/2023]
Abstract
Nontraumatic neuropathies of the upper limb are rare in children. In this paper, we present the latest updates in this field and also critically review the diagnosis and treatment of nerve compression syndromes in children. This review describes the most common manifestations including idiopathic carpal tunnel syndrome (CTS), CTS occurring as a component of lysosomal storage diseases (mucopolysaccharidosis) and hereditary neuropathies, ulnar nerve neuropathy, and atraumatic radial nerve neuropathies.
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Affiliation(s)
- Giovanni Gallone
- Pediatric Orthopedics and Traumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Sebastian Farr
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria.
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Patel P, Antoniou G, Clark D, Ketteridge D, Williams N. Screening for Carpal Tunnel Syndrome in Patients With Mucopolysaccharidosis. J Child Neurol 2020; 35:410-417. [PMID: 32157938 PMCID: PMC7153223 DOI: 10.1177/0883073820904481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mucopolysaccharidoses (MPSs) are a group of rare lysosomal storage diseases with multisystem manifestations, including carpal tunnel syndrome (CTS). This study comprised a systematic review of literature and hospital guidelines addressing the method and frequency of screening for carpal tunnel syndrome in mucopolysaccharidosis patients and a review of carpal tunnel syndrome in patients seen in the multidisciplinary mucopolysaccharidosis clinic of a pediatric hospital, in order to develop screening recommendations. The literature reported the importance of routine carpal tunnel syndrome screening from early childhood in patients with mucopolysaccharidosis I, II, IV, and VI. Screening methods included physical examination, nerve conduction studies, electromyography, and ultrasonography. Ten of 20 mucopolysaccharidosis patients in our series underwent carpal tunnel syndrome surgery. Given the high incidence of carpal tunnel syndrome at a young age in mucopolysaccharidosis, the authors recommend performing physical examination and obtaining patient and caregiver history for carpal tunnel syndrome every 6 months from the time of mucopolysaccharidosis diagnosis, supplemented by annual nerve conduction studies in cases with poor history or equivocal examination.
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Affiliation(s)
- Prajay Patel
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery, Women’s and Children’s Hospital, Adelaide, Australia
| | - Damian Clark
- Department of Neurology, Women’s and Children’s Hospital, Adelaide, Australia
| | - David Ketteridge
- Department of Genetics and Molecular Pathology, Women’s and Children’s Hospital, Adelaide, Australia
| | - Nicole Williams
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia,Department of Orthopaedic Surgery, Women’s and Children’s Hospital, Adelaide, Australia,Nicole Williams, BMed, BMedSc (Hons), Department of Orthopaedic Surgery, Women’s and Children’s Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia.
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Giugliani R, Harmatz P, Lin SP, Scarpa M. Assessing the impact of the five senses on quality of life in mucopolysaccharidoses. Orphanet J Rare Dis 2020; 15:97. [PMID: 32306998 PMCID: PMC7168888 DOI: 10.1186/s13023-020-01368-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background The mucopolysaccharidoses (MPSs) are lysosomal storage disorders associated with progressive multi-organ and skeletal abnormalities. Clinical manifestations can affect each of the five senses: hearing, vision, smell, taste, and touch. Main body of the abstract On 24–26 May 2018, 46 specialists with expertise in managing symptoms of MPS and experts specialized in evaluating and managing impairments in each one of the five senses gathered in Lisbon, Portugal at the “MPS & the five senses” meeting to discuss how loss of one or multiple senses can affect activities of daily living (ADL) and quality of life (QoL) in MPS patients and best practices in evaluating and managing the loss of senses in these individuals. The meeting confirmed that MPS can affect the senses considerably, but how these impairments affect ADL and overall QoL from a patient’s perspective remains unclear. A better insight may be achieved by prospectively collecting patient-reported outcome (PRO) data internationally in a standardized way, using a standard battery of tools. To identify relevant PRO tools, a systematic literature review and a selection of existing published questionnaires, focused on adults with no intellectual delay, were performed after the meeting. The search strategy identified 33 PRO tools for hearing, 30 for speech, 125 for vision, 49 for touch (including pain and upper limb function), and 15 for smell/taste. A further selection was made based on several criteria, including applicability/relevance for MPS, applicability in different countries (languages)/cultures, availability in English, ease of use, validation, and normative data, resulting in a final set of 11 tools. In addition to these sense-specific PRO tools, a general QoL tool, the EuroQol (EQ)-5D-5 L, was selected to assess overall QoL and reveal coping behaviors. Short conclusion MPS can affect each of the five senses, but current knowledge on the impact of sense impairments on QoL/ADL in MPS patients remains limited. Collection of data in a standardized fashion using sense-specific patient-reported outcome tools and a general QoL tool may fill the current knowledge gap.
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Affiliation(s)
- Roberto Giugliani
- Department of Genetics/UFRGS, Medical Genetics Service/HCPA, DR BRASIL Research Group/HCPA, and INAGEMP, Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-903, Brazil.
| | - Paul Harmatz
- Department of Gastroenterology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Shuan-Pei Lin
- Department of Genetics and Metabolism, MacKay Children's Hospital, Taipei, Taiwan
| | - Maurizio Scarpa
- Regional Center for Rare Diseases, University Hospital of Udine, Udine, Italy
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Abstract
PURPOSE OF REVIEW To determine the current evidence for various non-operative therapies in the treatment of carpal tunnel syndrome RECENT FINDINGS: Multiple non-operative treatment modalities exist in the treatment of mild to moderate carpal tunnel syndrome. While certain modalities such as splinting and corticosteroid injections have moderate- to high-quality evidence to support use, other less commonly used treatments have fewer therapeutic indications in the current literature. Healthcare providers should be able to initiate the appropriate diagnostic evaluation and assess the utility of non-operative therapies in the treatment of carpal tunnel syndrome. Moreover, healthcare providers should also be able to understand the evidence behind each treatment and the indications for surgical intervention.
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Affiliation(s)
- Peter J. Ostergaard
- Division of Hand Surgery, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Maximilian A. Meyer
- Division of Hand Surgery, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Brandon E. Earp
- Division of Hand Surgery, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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16
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Abstract
Advances in high-resolution ultrasound have provided clinicians with unique opportunities to study diseases of the peripheral nervous system. Ultrasound complements the clinical and electrophysiology exam by showing the degree of abnormalities in myopathies, as well as spontaneous muscle activities in motor neuron diseases and other disorders. In experienced hands, ultrasound is more sensitive than MRI in detecting peripheral nerve pathologies. It can also guide needle placement for electromyography exam, therapeutic injections, and muscle biopsy. Ultrasound enhances the ability to detect carpal tunnel syndrome and other focal nerve entrapment, as well as pathological nerve enlargements in genetic and acquired neuropathies. Furthermore, ultrasound can potentially be used as a biomarker for muscular dystrophy and spinal muscular atrophy. The combination of electromyography and ultrasound can increase the diagnostic certainty of amyotrophic lateral sclerosis, aid in the localization of brachial plexus or peripheral nerve trauma and allow for surveillance of nerve tumor progression in neurofibromatosis. Potential limitations of ultrasound include an inability to image deeper structures, with lower sensitivities in detecting neuromuscular diseases in young children and those with mitochondrial myopathies, due to subtle changes or early phase of the disease. As well, its utility in detecting critical illness neuromyopathy remains unclear. This review will focus on the clinical applications of neuromuscular ultrasound. The diagnostic values of ultrasound for screening of myopathies, neuropathies, and motor neuron diseases will be presented.
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17
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Maegawa GH. Lysosomal Leukodystrophies Lysosomal Storage Diseases Associated With White Matter Abnormalities. J Child Neurol 2019; 34:339-358. [PMID: 30757954 PMCID: PMC6459700 DOI: 10.1177/0883073819828587] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The leukodystrophies are a group of genetic metabolic diseases characterized by an abnormal development or progressive degeneration of the myelin sheath. The myelin is a complex sheath composed of several macromolecules covering axons as an insulator. Each of the leukodystrophies is caused by mutations in genes encoding enzymes that are involved in myelin production and maintenance. The lysosomal storage diseases are inborn disorders of compartmentalized cellular organelles with broad clinical manifestations secondary to the progressive accumulation of undegraded macromolecules within lysosomes and related organelles. The more than 60 different lysosomal storage diseases are rare diseases; however, collectively, the incidence of lysosomal storage diseases ranges just over 1 in 2500 live births. The majority of lysosomal storage diseases are associated with neurologic manifestations including developmental delay, seizures, acroparesthesia, motor weakness, and extrapyramidal signs. These inborn organelle disorders show wide clinical variability affecting individuals from all age groups. In addition, several of neurologic, also known as neuronopathic, lysosomal storage diseases are associated with some level of white matter disease, which often triggers the diagnostic investigation. Most lysosomal storage diseases are autosomal recessively inherited and few are X-linked, with females being at risk of presenting with mild, but clinically relevant neurologic manifestations. Biochemical assays are the basis of the diagnosis and are usually confirmed by molecular genetic testing. Novel therapies have emerged. However, most affected patients with lysosomal storage diseases have only supportive management to rely on. A better understanding of the mechanisms resulting in the leukodystrophy will certainly result in innovative and efficacious disease-modifying therapies.
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Affiliation(s)
- Gustavo H.B. Maegawa
- University of Florida, Department of Pediatrics/Genetics
& Metabolism, Gainesville, FL 32608, USA
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18
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Abstract
CLINICAL/METHODICAL ISSUE For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. STANDARD RADIOLOGICAL METHODS Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. METHODICAL INNOVATIONS Using ultrasonography for peripheral nerve diagnostics. PERFORMANCE With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. ACHIEVEMENTS Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. PRACTICAL RECOMMENDATIONS Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves.
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Affiliation(s)
- T Bäumer
- Institut für Neurogenetik, Universität zu Lübeck (CBBM; Haus 66), Marie-Curie-Straße, 23562, Lübeck, Deutschland.
| | - A Grimm
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Schelle
- Neurologische Klinik, Städtisches Klinikum Dessau, Dessau, Deutschland
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19
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Viskochil D, Muenzer J, Guffon N, Garin C, Munoz-Rojas MV, Moy KA, Hutchinson DT. Carpal tunnel syndrome in mucopolysaccharidosis I: a registry-based cohort study. Dev Med Child Neurol 2017; 59:1269-1275. [PMID: 28892147 DOI: 10.1111/dmcn.13545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/27/2022]
Abstract
AIM To characterize carpal tunnel syndrome (CTS) in patients with mucopolysaccharidosis I (MPS I). METHOD Data were included for patients with MPS I who had either nerve conduction examination that included a diagnosis of CTS or who had CTS release surgery. Although this represented a subset of patients with CTS in the MPS I Registry, the criteria were considered the most objective for data analysis. RESULTS As of March 2016, 994 patients were categorized with either severe (Hurler syndrome) or attenuated (Hurler-Scheie or Scheie syndromes) MPS I. Among these, 291 had a CTS diagnosis based on abnormal nerve conduction (n=54) or release surgery (n=237). Median ages (minimum, maximum) at first CTS diagnosis were 5 years 2 months (10mo, 16y 2mo) and 9y 11mo (1y 8mo, 44y 1mo) for patients with severe and attenuated MPS I respectively. Most patients had their first CTS diagnosis after MPS I diagnosis (94%) and treatment (hematopoietic stem cell transplant and/or enzyme replacement therapy) (74%). For 11% of patients with attenuated disease, CTS diagnosis preceded MPS I diagnosis by a mean of 7 years 6 months. INTERPRETATION CTS is a rare complication in pediatric patients and should alert medical care providers to the potential diagnosis of MPS I. Significant delays exist between diagnosis of CTS and MPS I for patients with attenuated disease. WHAT THIS PAPER ADDS There are significant delays in diagnosing carpal tunnel syndrome (CTS) in patients with mucopolysaccharidosis I (MPS I). Enzyme replacement therapy or hematopoietic stem cell transplant do not prevent the development of CTS. Testing for CTS in patients with MPS I is recommended to prevent irreparable damage. CTS in pediatric patients should alert physicians to potential diagnosis of MPS I.
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Affiliation(s)
- David Viskochil
- Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | - Joseph Muenzer
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Nathalie Guffon
- Department of Pediatrics, Hôpital Femme Mère Enfant, Lyon, France
| | - Christophe Garin
- Department of Pediatric Orthopedic Surgery, University of Lyon, Lyon, France
| | | | - Kristin A Moy
- Epidemiology and Biostatistics, Sanofi Genzyme, Cambridge, MA, USA
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20
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Jester AAM. Ultrasonography for diagnosis and follow-up of carpal tunnel syndrome in mucopolysaccharidosis. Dev Med Child Neurol 2016; 58:1104. [PMID: 27189664 DOI: 10.1111/dmcn.13148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea A M Jester
- Birmingham Children's Hospital - Hand and Upper Limb Service, Plastic Surgery, Birmingham, UK
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