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Abuharb AI, Almughira AI, Alghamdi HK, Hashem M, Bin Ahmed I, Aloriney A. Prevalence, Awareness, and Management of Carpal Tunnel Syndrome Among Diabetic Patients. Cureus 2024; 16:e53683. [PMID: 38455796 PMCID: PMC10918440 DOI: 10.7759/cureus.53683] [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] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common condition that can significantly affect the quality of life for individuals, particularly those with diabetes. This study aims to examine the severity of CTS symptoms among diabetic patients and explore the associations between demographic factors, diabetic characteristics, knowledge, and management approaches. METHODOLOGY A cross-sectional study was conducted among diabetic patients, and data were collected using standardized questionnaires. The incidence and severity of CTS were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Demographic information, diabetic characteristics, knowledge of CTS, and management approaches were also recorded. Descriptive statistics and inferential analysis were performed to analyze the data. RESULTS The study included 303 participants. The majority of the participants were aged 50 or older (44.9%) (N=136), followed by those aged 39-49 (24.4%) (N=74). In terms of gender, there were more female participants (61.4%) (N=186) than male participants (38.6%) (N=117). Older age groups exhibited higher mean BCTQ scores, suggesting increased severity. Females had significantly higher severity scores compared to males (mean BCTQ score of 17.52 vs 15.56). Regarding diabetic characteristics, complications in the eye and pain/numbness in the legs or feet were significantly associated with higher severity scores of CTS (P=0.0001). The study revealed a knowledge gap among diabetic patients about CTS, with inadequate knowledge about its causes, symptoms, consequences, and treatment options among 68.6% of the patients. The use of medical interventions such as splints, injections, and surgery was associated with higher severity scores. CONCLUSION This study highlights the incidence and severity of CTS symptoms among diabetic patients and its associations with demographic factors, diabetic characteristics, knowledge, and management approaches. Older age, female gender, widowed, diabetic complications in the eye, and pain/numbness in the legs or feet were found to be related to increased severity of CTS. Additionally, inadequate knowledge about CTS was observed among diabetic patients.
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Affiliation(s)
- Abdullah I Abuharb
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Hatan K Alghamdi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Majdi Hashem
- Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Ibrahim Bin Ahmed
- Family Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulmalik Aloriney
- Family Medicine/Diabetes, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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John T, Mathew AE. Natural evolution of idiopathic carpal tunnel syndrome with respect to wrist and hand anthropometry: A prospective cohort study. Clin Neurol Neurosurg 2024; 236:108098. [PMID: 38181679 DOI: 10.1016/j.clineuro.2023.108098] [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: 09/13/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE A greater wrist depth/width ratio and wrist depth/palm length ratio are known risk factors for carpal tunnel syndrome. We hypothesized that these parameters might also predict progression in patients who were not surgically treated. METHODS Seventy-eight patients with moderately severe idiopathic carpal tunnel syndrome of at least 10 months duration at recruitment, who declined surgical treatment and steroid injection, underwent repeated neurophysiological assessments after 3 years. A > 10% increase in median SNAP latency was taken as evidence of significant deterioration. RESULTS Patients with a wrist ratio ≥ 0.72 showed a statistically significant deterioration in SNAP latency from 5.46 (SD 2.09) to 7.16 (SD 1.56) ms and in SNAP amplitude from 30.19 (SD 13.8) to 16.62 (SD 14.42) µv. For those with a wrist-to-palm ratio ≥ 0.42, SNAP latency deteriorated from 5.27 (SD 1.21) to 7.1 (SD 1.52) ms, and amplitude from 32.78 (SD 13.76) to 19.45 (SD 16.62) µv. Patients with lower ratios did not show significant changes in any neurophysiological parameter. The relative risk of significant deterioration in SNAP latency in patients with a wrist ratio ≥ 0.72 was 2.04 (95% CI 1.27-3.27). CONCLUSION In untreated idiopathic carpal tunnel syndrome, patients with larger wrist and wrist-to-palm ratios are more likely to show neurophysiological progression.
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Affiliation(s)
- Thomas John
- Department of Neurology, Amala Institute of Medical Sciences, Amala Nagar, Thrissur 680555, Kerala, India.
| | - Asha Elizabeth Mathew
- Department of Physical Medicine and Rehabilitation, Amala Institute of Medical Sciences, Amala Nagar, Thrissur 680555, Kerala, India
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Bland JDP. Carpal tunnel syndrome in pregnancy. Muscle Nerve 2023; 68:345-347. [PMID: 37606068 DOI: 10.1002/mus.27957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
See article on pages 380–387 in this issue.
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Affiliation(s)
- Jeremy D P Bland
- East Kent Hospitals University Foundation NHS Trust, Kent and Canterbury Hospital, Canterbury, UK
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Curran MWT, Ross M. Patient-Reported Outcomes Improve after Hypothenar Fat Flap for the Treatment of Recurrent Carpal Tunnel Syndrome. J Hand Surg Asian Pac Vol 2023; 28:573-579. [PMID: 37905363 DOI: 10.1142/s2424835523500649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background: Recalcitrant carpal tunnel syndrome (CTS) can present with persistent or recurrent symptoms after carpal tunnel release (CTR). A common aetiology for recurrent CTS is the development of perineural adhesions due to excess scarring. The hypothenar fat pad flap (HFPF) has been described to decrease the amount of scarring formed after revision CTR. Herein, we present a prospective evaluation of these patients. Methods: A prospective series of consecutive patients by a single surgeon with recurrent CTS was conducted. All patients had at least 3 months follow-up. Patients received a revision open CTR with HFPF. The primary outcome was the Boston Carpal Tunnel Questionnaire (BCTQ). Secondary outcomes included pain and satisfaction on visual analogue scale, range of motion, grip strength, patient-reported outcomes and complications. Clinical outcomes were compared between preoperative and postoperative intervals using paired t-tests, with significance defined as p < 0.05. Results: Fifteen wrists (14 patients) were recruited for the study. Patients were predominantly male (n = 9; 66%). Revision open CTR with HFPF was performed a median of 42 months (range: 4-300 months) post primary CTR. Patients demonstrated improved patient-reported outcomes with significantly improved BCTQ pain score (p < 0.01), Patient-Rated Wrist and Hand Evaluation (p < 0.01) and QuickDASH (p < 0.001). Two patients in the series reported postoperative complications; however, there was no incidence of donor site morbidity recorded. Conclusions: Revision open CTR with hypothenar fat pad flap is associated with decreased pain, high patient satisfaction and improved functional measures compared to pre-operative status. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Matthew W T Curran
- Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Ross
- Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
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Yalin M, Key S, Kazez M, Agar A. Carpal tunnel decompression: a comparison of elderly and younger patients' sleep quality. Acta Orthop Belg 2023; 89:253-256. [PMID: 37924542 DOI: 10.52628/89.2.11436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The current study was conducted to evaluate sleep disturbances by age group in patients who underwent carpal tunnel decompression (CTD). Individuals who applied to the orthopedic outpatient clinic and had CTD between 2018 and 2022 had their medical records reviewed. Pre-operative data included patient demographics and the Pittsburgh Sleep Quality Index (PSQI). All post-surgery patients who returned for suture removal were clinically evaluated. Patients were requested to return for re-scoring on the PSQI 6 months after CTD. The cases' average age was 56.44±9.37 years. The study divided its subjects into two age ranges: those between the ages of 45 and 60 (82.2%) (Group1) and those between the ages of 70 and 85 (17.8%) (Group 2). The PSQI values of Group 1 were found to be significantly lower than Group 2. Preoperative PSQI levels were compared to post-op values at 2 weeks and 6 months, and both measurements decreased significantly. Sleep quality improved in all patient groups, regardless of their age, following CTD. Elderly patients had delayed improvements in sleep quality following CTD. The PSQI was effective in determining improvement following CTD, particularly in younger patients, and the progress remained for 6 months.
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Ikumi A, Yoshii Y, Kudo T, Kohyama S, Ogawa T, Hara Y, Ishii T. Potential Relationships between the Median Nerve Cross-Sectional Area and Physical Characteristics in Unilateral Symptomatic Carpal Tunnel Syndrome Patients. J Clin Med 2023; 12:jcm12072515. [PMID: 37048599 PMCID: PMC10095503 DOI: 10.3390/jcm12072515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The present study investigated the relationships between the median nerve cross-sectional area (CSA) and physical characteristics in patients with unilateral symptomatic carpal tunnel syndrome (CTS). Methods: Height, weight, body mass index (BMI), disease duration, results of electrodiagnostic testing (EDX), and median nerve CSA at the level of the wrist crease were recorded in 81 patients with CTS who presented with symptoms on only one side. Correlation coefficients between median nerve CSA and physical characteristics, disease duration, and results of EDX were analyzed. Results: Median nerve CSA at the wrist crease (mm2) was significantly larger on the symptomatic side (14.1 ± 3.8) than on the asymptomatic side (11.5 ± 2.9). Median nerve CSA correlated with body weight (correlation coefficient = 0.39) and BMI (correlation coefficient = 0.44) on the asymptomatic side, but not on the symptomatic side. These correlations were slightly stronger in females (correlation coefficient = 0.46) than in males (correlation coefficient = 0.40). No correlations between median nerve CSA and disease duration and the results of EDX were observed in both sides. Conclusions: In patients with unilateral symptomatic CTS, median nerve CSA correlated with BMI only on the asymptomatic side. The present results suggest that the relationship between median nerve CSA and BMI in CTS is significant until symptom onset but may be masked by edema and pseudoneuroma after its onset. A higher BMI is associated with a larger CSA of the median nerve, which may be a risk factor for the development of CTS.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Tsukuba University Hospital, Tsukuba 305-8576, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
- Correspondence: ; Tel.: +81-29-8871161
| | - Takamasa Kudo
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Sho Kohyama
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda 278-0005, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, Mito Medical Center Hospital, Ibaraki 311-3193, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, National Center of Neurology and Psychiatry, Kodaira 187-8551, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
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Padua L, Cuccagna C, Giovannini S, Coraci D, Pelosi L, Loreti C, Bernabei R, Hobson-Webb LD. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol 2023; 22:255-267. [PMID: 36525982 DOI: 10.1016/s1474-4422(22)00432-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting quality of life for many people. Although it is a well recognised condition, new insights into epidemiology, diagnosis, and treatment have emerged in the past 6 years. The availability of disease-modifying treatments for rare systemic disorders associated with carpal tunnel syndrome (eg, amyloidosis) should alert clinicians to these diagnostic possibilities. Besides clinical evaluation and electrophysiology, the role of ultrasonography as a diagnostic tool has been confirmed and new ultrasound techniques have been applied, the clinical use and feasibility of which require further investigation. Surgical and non-surgical interventions are beneficial for the treatment of carpal tunnel syndrome and several treatment options are now available, giving clinicians the possibility to choose the best approach for every patient. New diagnostic and therapeutic techniques require further validation.
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Affiliation(s)
- Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Cristina Cuccagna
- UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua, Italy
| | - Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Durham, NC, USA
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Ashworth NL, Bland JDP, Chapman KM, Tardif G, Albarqouni L, Nagendran A. Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database Syst Rev 2023; 2:CD015148. [PMID: 36722795 PMCID: PMC9891198 DOI: 10.1002/14651858.cd015148] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a very common clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the carpal tunnel in the wrist. Direct and indirect costs of CTS are substantial, with estimated costs of two billion US dollars for CTS surgery in the USA in 1995 alone. Local corticosteroid injection has been used as a non-surgical treatment for CTS many years, but its effectiveness is still debated. OBJECTIVES To evaluate the benefits and harms of corticosteroids injected in or around the carpal tunnel for the treatment of carpal tunnel syndrome compared to no treatment or a placebo injection. SEARCH METHODS We used standard, extensive Cochrane search Methods. The searches were 7 June 2020 and 26 May 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-randomised trials of adults with CTS that included at least one comparison group of local injection of corticosteroid (LCI) into the wrist and one group that received a placebo or no treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was 1. improvement in symptoms at up to three months of follow-up. Our secondary outcomes were 2. functional improvement, 3. improvement in symptoms at greater than three months of follow-up, 4. improvement in neurophysiological parameters, 5. improvement in imaging parameters, 6. requirement for carpal tunnel surgery, 7. improvement in quality of life and 8. ADVERSE EVENTS We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 14 trials with 994 participants/hands with CTS. Only nine studies (639 participants/hands) had useable data quantitatively and in general, these studies were at low risk of bias except for one quite high-risk study. The trials were conducted in hospital-based clinics across North America, Europe, Asia and the Middle East. All trials used participant-reported outcome measures for symptoms, function and quality of life. There is probably an improvement in symptoms measured at up to three months of follow-up favouring LCI (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.94 to -0.59; 8 RCTs, 579 participants; moderate-certainty evidence). Up to six months this was still evident favouring LCI (SMD -0.58, 95% CI -0.89 to -0.28; 4 RCTs, 234 participants/hands; moderate-certainty evidence). There is probably an improvement in function measured at up to three months favouring LCI (SMD -0.62, 95% CI -0.87 to -0.38; 7 RCTs, 499 participants; moderate-certainty evidence). We are uncertain if there is a difference in median nerve DML at up to three months of follow-up (mean difference (MD) -0.37 ms, 95% CI -0.75 to 0.02; 6 RCTs, 359 participants/hands; very low-certainty evidence). The requirement for surgery probably reduces slightly in the LCI group at one year (risk ratio 0.84, 95% CI 0.72 to 0.98; 1 RCT, 111 participants, moderate-certainty evidence). Quality of life, measured at up to three months of follow-up using the Short-Form 6 Dimensions questionnaire (scale from 0.29 to 1.0; higher is better) probably improved slightly in the LCI group (MD 0.07, 95% CI 0.02 to 0.12; 1 RCT, 111 participants; moderate-certainty evidence). Adverse events were uncommon (low-certainty evidence). One study reported 2/364 injections resulted in severe pain which resolved over "several weeks" and 1/364 injections caused a "sympathetic reaction" with a cool, pale hand that completely resolved in 20 minutes. One study (111 participants) reported no serious adverse events, but 65% of LCI-injected and 16% of the placebo-injected participants experienced mild-to-moderate pain lasting less than two weeks. About 9% of participants experienced localised swelling lasting less than two weeks. Four studies (229 participants) reported that they experienced no adverse events in their studies. Three studies (220 participants) did not specifically report adverse events. AUTHORS' CONCLUSIONS Local corticosteroid injection is effective for the treatment of mild and moderate CTS with benefits lasting up to six months and a reduced need for surgery up to 12 months. Where serious adverse events were reported, they were rare.
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Affiliation(s)
| | - Jeremy D P Bland
- Electroencephalography (EEG) Department, East Kent Hospitals University NHS Trust, Canterbury, UK
| | - Kristine M Chapman
- Neuromuscular Disease Unit, Diamond Health Care Centre, Vancouver, Canada
| | - Gaetan Tardif
- Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, Canada
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Arjuna Nagendran
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical Neurophysiology, London North West University Healthcare NHS Trust, London, UK
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Hong P, Zheng Y, Rai S, Ding Y, Zhou Y, Liu R, Li J. Efficacy and safety of platelet-rich plasma in the treatment of carpal tunnel syndrome: A network meta-analysis of different injection treatments. Front Pharmacol 2022; 13:906075. [PMID: 36438824 PMCID: PMC9684083 DOI: 10.3389/fphar.2022.906075] [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: 03/28/2022] [Accepted: 10/24/2022] [Indexed: 09/12/2023] Open
Abstract
Purpose: Carpal tunnel syndrome (CTS) is a common form of median nerve compression in the wrist caused by focal peripheral neuropathy. Platelet-rich plasma (PRP) therapy could improve the healing ability by exposing the injured tissues to high concentrations of autologous growth factors. Our study aims to compare all injective treatments for CTS and assess the efficacy and priority of PRP therapy. Methods: We searched Medline, Embase, Web of Science, Cochrane databases, and Clinicaltrial.gov until 17 October 2022. We only included data from randomized controlled trials (RCTs) that evaluated PRP injection therapy or drug injection therapy. The included RCTs measured at least one of the following three outcomes with validated instruments: in the visual analog scale (VAS), symptom severity scale (SSS), and functional status scale (FSS). Results: Overall, 19 studies with 1,066 patients were included in this study. We used the SUCRA rankings to determine the merits of various therapies. In all, 5% dextrose injections were the best treatment strategy for the VAS (MD -1.22, 95% CI -2.66 to 0.23; SUCRA = 79.2%), followed by triamcinolone (high-dose) injections (MD -0.69, 95% CI -2.11 to 0.73; SUCRA = 62.7%) and PRP injections (MD -0.39, 95% CI -1.67 to 0.89; SUCRA = 60.0%). In the SSS, the most effective intervention was hydroxyprogesterone injections (MD -0.62, 95% CI -1.09 to -0.16; SUCRA = 91.0%). The SUCRA ranking of PRP was second only to steroids and estrogen (MD -0.39, 95% CI -0.60 to -0.18; SUCRA = 60.8%). In the FSS, the best regimen strategy was hydroxyprogesterone injections (MD 0.12, 95% CI -0.30 to 0.54; SUCRA = 99.5%), followed by triamcinolone (low-dose) injections (MD -0.02, 95% CI -0.54 to 0.49; SUCRA = 87.4%) and PRP injections (MD -0.26, 95% CI -0.43 to -0.09; SUCRA = 77.1%). Conclusion: PRP is an alternative choice for CTS treatment. PRP injection is second only to steroids and estrogen in the treatment efficacy of CTS, with a wide indication and safe outcome.
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Affiliation(s)
- Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zheng
- Basic Medical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Karama Medical Center, Dubai, United Arab Emirates
| | - Yuhong Ding
- Second Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yeming Zhou
- Basic Medical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruikang Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Koyama T, Matsui R, Yamamoto A, Yamada E, Norose M, Ibara T, Kaburagi H, Nimura A, Sugiura Y, Saito H, Okawa A, Fujita K. High-Dimensional Analysis of Finger Motion and Screening of Cervical Myelopathy With a Noncontact Sensor: Diagnostic Case-Control Study. JMIR BIOMEDICAL ENGINEERING 2022; 7:e41327. [PMID: 38875599 PMCID: PMC11041434 DOI: 10.2196/41327] [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: 07/22/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cervical myelopathy (CM) causes several symptoms such as clumsiness of the hands and often requires surgery. Screening and early diagnosis of CM are important because some patients are unaware of their early symptoms and consult a surgeon only after their condition has become severe. The 10-second hand grip and release test is commonly used to check for the presence of CM. The test is simple but would be more useful for screening if it could objectively evaluate the changes in movement specific to CM. A previous study analyzed finger movements in the 10-second hand grip and release test using the Leap Motion, a noncontact sensor, and a system was developed that can diagnose CM with high sensitivity and specificity using machine learning. However, the previous study had limitations in that the system recorded few parameters and did not differentiate CM from other hand disorders. OBJECTIVE This study aims to develop a system that can diagnose CM with higher sensitivity and specificity, and distinguish CM from carpal tunnel syndrome (CTS), a common hand disorder. We then validated the system with a modified Leap Motion that can record the joints of each finger. METHODS In total, 31, 27, and 29 participants were recruited into the CM, CTS, and control groups, respectively. We developed a system using Leap Motion that recorded 229 parameters of finger movements while participants gripped and released their fingers as rapidly as possible. A support vector machine was used for machine learning to develop the binary classification model and calculated the sensitivity, specificity, and area under the curve (AUC). We developed two models, one to diagnose CM among the CM and control groups (CM/control model), and the other to diagnose CM among the CM and non-CM groups (CM/non-CM model). RESULTS The CM/control model indexes were as follows: sensitivity 74.2%, specificity 89.7%, and AUC 0.82. The CM/non-CM model indexes were as follows: sensitivity 71%, specificity 72.87%, and AUC 0.74. CONCLUSIONS We developed a screening system capable of diagnosing CM with higher sensitivity and specificity. This system can differentiate patients with CM from patients with CTS as well as healthy patients and has the potential to screen for CM in a variety of patients.
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Affiliation(s)
- Takafumi Koyama
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryota Matsui
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Akiko Yamamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriku Yamada
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mio Norose
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidetoshi Kaburagi
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuta Sugiura
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Hideo Saito
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Raut P, Jones N, Raad M, Kieffer W. Common peripheral nerve entrapments in the upper limb. Br J Hosp Med (Lond) 2022; 83:1-11. [PMID: 36322444 DOI: 10.12968/hmed.2022.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Entrapment of peripheral nerves can occur as they travel through restrictive spaces. This nerve compression can result in a constellation of signs and symptoms, which are often called syndromes. Patients initially report pain, paraesthesia and numbness, followed by weakness and clumsiness and, ultimately, muscle wasting. The specific region of paraesthesia and pain and the specific muscle weakness is determined by the peripheral nerve involved and the location of the entrapment. Diagnosis is mainly based on history and examination. Further investigations are available for atypical presentations. Each syndrome has its own set of risk factors, but repetitive action and muscle overuse are commonly associated with most syndromes. The treatment is activity modification followed by steroid injection and finally surgical decompression for ongoing persistent symptoms or severe initial presentation. This article outlines the history, examination, possible investigations and management for common peripheral nerve entrapments of the median, ulnar and radial nerves.
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Affiliation(s)
- Pramin Raut
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
| | - Neil Jones
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
| | - Marjan Raad
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
| | - Will Kieffer
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
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12
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Li T, Yan J, Hu J, Liu X, Wang F. Efficacy and safety of electroacupuncture for carpal tunnel syndrome (CTS): A systematic review and meta-analysis of randomized controlled trials. Front Surg 2022; 9:952361. [PMID: 36211261 PMCID: PMC9539120 DOI: 10.3389/fsurg.2022.952361] [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: 05/25/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
AimWe carried out a systematic review and meta-analysis to evaluate the safety and efficacy of electroacupuncture for patients with carpal tunnel syndrome.MethodsWe searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to May 2022 for relevant studies. Relevant studies were identified by using specific eligibility criteria and data were extracted.ResultsA total of 26 randomized controlled trials (RCTs) with 1,698 patients were included. Compared with routine treatment, electroacupuncture treatment had lower visual analog scale (VAS) score [mean difference = −0.79, 95% confidence interval (CI): −1.11 to −0.47, P < 0.00001], and the symptom severity scale and function status scale in electroacupuncture group were significantly lower than the control group (P = 0.0001 and P = 0.006). Moreover, the electrophysiological parameters in the electroacupuncture group were better than the control group. The electroacupuncture group had higher total effective rate than the control group (odds ratio = 4.94, 95% CI: 3.44–7.08, P < 0.00001).ConclusionOur meta-analysis indicated that electroacupuncture had lower VAS score, higher total effective rate, a lower the scores of symptoms and function and electroacupuncture had better electrophysiological parameters. However, these findings needed to be verified further by multicenter, double-blind, and large-sample RCTs.
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Affiliation(s)
- Ting Li
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
- Department of Postgraduate, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, China
- Department of Postgraduate, Qinghai University, Xining, China
| | - Jiang Hu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xilin Liu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
- Correspondence: Fei Wang Xilin Liu
| | - Fei Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, China
- Correspondence: Fei Wang Xilin Liu
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An Ecological Analysis of Hospitalization Patterns for Diseases of the Nervous System in England and Wales over the Last 20 Years. Healthcare (Basel) 2022; 10:healthcare10091670. [PMID: 36141282 PMCID: PMC9498440 DOI: 10.3390/healthcare10091670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aims to provide a comprehensive overview of the hospitalization pattern of nervous system diseases from 1999 to 2019. Methods: This is ecological research based on data from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales, both of which are publicly available. Data on hospital admissions were collected between April 1999 and March 2019. Diagnostic codes (G00−G09: inflammatory diseases of the central nervous system, G10−G14: systemic atrophies primarily affecting the central nervous system, G20−G26: extrapyramidal and movement disorders, G30−G32: other degenerative diseases of the nervous system, G35−G37: demyelinating diseases of the central nervous system, G40−G47: episodic and paroxysmal disorders, G50−G59: nerve, nerve root and plexus disorders, G60−G65: polyneuropathies and other disorders of the peripheral nervous system, G70−G73: diseases of myoneural junction and muscle, G80−G83: cerebral palsy and other paralytic syndromes, and G89−G99: other disorders of the nervous system) from the tenth edition of the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) were used to identify hospital admissions. A Poisson model was used to examine the trend in hospital admissions. Results: During the study period, hospital admission rate increased by 73.5% (from 474.44 (95% CI 472.58−476.31) in 1999 to 823.37 (95% CI 821.07−825.66) in 2019 per 100,000 persons, trend test, p < 0.01). The most prevalent diseases of the nervous system hospital admissions causes were episodic and paroxysmal disorders, nerve, nerve root, and plexus disorders, and demyelinating diseases of the central nervous system which accounted for 37.4%, 22.1%, and 9.3%, respectively. Hospital admission rate between females increased by 79.1% (from 495.92 (95% CI 493.25−498.58) in 1999 to 888.33 (95% CI 884.97−891.68) in 2019 per 100,000 persons). Hospital admission rate between males was increased by 67.5% (from 451.88 (95% CI 449.28−454.49) in 1999 to 756.82 (95% CI 753.69−759.96) in 2019 per 100,000 persons). Conclusion: In the United Kingdom, hospital admissions for diseases of the nervous system are on the rise. Future research is needed to identify high-risk groups and suggest effective interventions to reduce the prevalence of these disorders.
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Forcelini CM, Chichelero ER, de Oliveira AT, Tres da Silva F, Durigan PHB, Ramos NO, Bianchini L, Battistel BLI, Borghetti V. Boston Carpal Tunnel Questionnaire and Severity of Carpal Tunnel Syndrome. J Clin Neuromuscul Dis 2022; 23:183-188. [PMID: 35608641 DOI: 10.1097/cnd.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Carpal tunnel syndrome (CTS) is a common compressive neuropathy linked to disability in severe cases. Tools capable of distinguishing the severity spectrum median nerve entrapment in clinical practice are desirable. METHODS This cross-sectional study included 58 CTS patients assisted in a Brazilian neurologic clinic. Participants were naive of surgical interventions and answered to Boston Carpal Tunnel Questionnaire (BCTQ). CTS was classified as mild, moderate, and severe according to electrodiagnostic testing. RESULTS There was no significant difference in BCTQ scores across the severity spectrum of median nerve entrapment, not even comparing mild cases with the group moderate/severe. Mild cases were younger (mean ± SD: 46.5 ± 9.2 years) than severe ones (60.0 ± 13.5, P = 0.04) and the group moderate/severe (55.5 ± 14.5, P = 0.01). CONCLUSIONS Results suggest that BCTQ is not adequate to assess the interpatient severity of median nerve entrapment on clinical practice.
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Affiliation(s)
| | | | | | | | | | - Nathália Orso Ramos
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo, Brazil; and
| | - Larissa Bianchini
- Faculdade de Medicina, Universidade de Passo Fundo, Passo Fundo, Brazil; and
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15
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Goru P, Butaliu GC, Verma GG, Haque S, Mustafa A, Paul A. Effectiveness of ultrasound-guided local steroid injection to the wrist for the treatment of carpal tunnel syndrome: Is it worth it? EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist level and the most frequent entrapment neuropathy in the upper limb. It can be treated with surgical or non-surgical methods. When nonsurgical treatment is indicated, a local corticosteroid injection into the carpal tunnel can be used to reduce pain and tingling sensation. To assess the clinical outcomes and effectiveness of patient satisfaction following ultrasound-guided steroid injection for the treatment of carpal tunnel syndrome.
Results
The study comprises 44 female (73%) and 16 (27%) male patients, with a mean age of 57 (27–84) years. Thirty-one patients were left-handed and 29 right-handed. Twenty-six (43%) injections were performed on the right side, 8 (13%) on the left, and 26 were bilateral. Fifty-six hands of thirty-seven (70%) patients reported significant improvement symptoms, five (8%) had temporary improvement with recurrence, seventeen patients (28%) failed to improve, and one patient’s symptoms have resolved before intervention. Among temporary responders and nonresponders, two were referred to the neurologist for further evaluation. Out of twenty patients, fourteen patients (23%) had surgical decompression of carpal tunnel with complete resolution of symptoms, four patients had opted for repeat injections, and two patients refused any further intervention.
Conclusions
The use of ultrasound-guided injection for the treatment of mild to moderate carpal tunnel syndrome is a practical procedure before offering surgical treatment. It is also appropriate for the patient with significant medical problems or not willing to undergo surgical intervention. Its ultrasound guide reduces injection-related complications, improves patient satisfaction, is cost-effective, and improves patient compliance.
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Zimmerman M, Gottsäter A, Dahlin LB. Carpal Tunnel Syndrome and Diabetes—A Comprehensive Review. J Clin Med 2022; 11:jcm11061674. [PMID: 35329999 PMCID: PMC8952414 DOI: 10.3390/jcm11061674] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the general population and is frequently encountered among individuals with type 1 and 2 diabetes. The reason(s) why a peripheral nerve trunk in individuals with diabetes is more susceptible to nerve compression is still not completely clarified, but both biochemical and structural changes in the peripheral nerve are probably implicated. In particular, individuals with neuropathy, irrespective of aetiology, have a higher risk of peripheral nerve compression disorders, as reflected among individuals with diabetic neuropathy. Diagnosis of CTS in individuals with diabetes should be carefully evaluated; detailed case history, thorough clinical examination, and electrophysiological examination is recommended. Individuals with diabetes and CTS benefit from surgery to the same extent as otherwise healthy individuals with CTS. In the present review, we describe pathophysiological aspects of the nerve compression disorder CTS in relation to diabetes, current data contributing to the explanation of the increased risk for CTS in individuals with diabetes, as well as diagnostic methods, treatment options, and prognosis of CTS in diabetes.
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Affiliation(s)
- Malin Zimmerman
- Department of Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Orthopaedic Surgery, Helsingborg Hospital, 251 87 Helsingborg, Sweden
- Correspondence:
| | - Anders Gottsäter
- Department of Medicine, Skåne University Hospital, 205 02 Malmö, Sweden;
- Department of Clinical Sciences Malmö, Lund University, 205 02 Malmö, Sweden
| | - Lars B. Dahlin
- Department of Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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Vihlborg P, Pettersson H, Makdoumi K, Wikström S, Bryngelsson IL, Selander J, Graff P. Carpal Tunnel Syndrome and Hand-Arm Vibration: A Swedish National Registry Case-Control Study. J Occup Environ Med 2022; 64:197-201. [PMID: 34873137 PMCID: PMC8887848 DOI: 10.1097/jom.0000000000002451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the increased risk for carpal tunnel syndrome (CTS) in men and women with hand-arm vibration (HAV) exposure. DESIGN Case-control study of CTS where 4396 cases was obtained from National Outpatient Register between 2005 through 2016. Cases were matched to controls and exposure was estimated using a job exposure matrix. RESULTS Exposure to HAV increased the risk of CTS with an OR of 1.61 (95% CI 1.46-1.77). The risk was highest in men <30 years of age and among women <30 years no increased risk was observed. The risk increased with a mean year exposure above 2.5 m/s2 to OR 1.84 (95% CI 1.38-2.46). CONCLUSIONS HAV exposure increase the risk of CTS in both genders, with highest risk increase in younger men. This emphasize identification of HAV exposure in patients with CTS.
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Affiliation(s)
- Per Vihlborg
- Department of Geriatrics and Odensbackens Health Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Dr Vihlborg); School of Medical Sciences, Örebro University, Örebro, Sweden (Dr Wikström); Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (Dr Pettersson); Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Dr Makdoumi); Center for Clinical Research and Education, County Council of Värmland, Sweden (Dr Wikström); Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Mr Bryngelsson); Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Selander); National Institute of Occupational Health (STAMI), Oslo, Norway (Dr Graff)
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18
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Novel Motor-Sparing Ultrasound-Guided Neural Injection in Severe Carpal Tunnel Syndrome: A Comparison of Four Injectates. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9745322. [PMID: 35224104 PMCID: PMC8872692 DOI: 10.1155/2022/9745322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
Nerve hydrodissection uses fluid injection under pressure to selectively separate nerves from areas of suspected entrapment; this procedure is increasingly viewed as potentially useful in treating carpal tunnel syndrome (CTS). The usage of normal saline (NS), 5% dextrose water (D5W), platelet-rich plasma (PRP), and hyaluronic acid (HA) as primary injectates for hydrodissection without an anesthetic can limit anesthetic-related toxicity and preserve the motor functions of the median nerve. Here, we describe a novel motor-sparing neural injection and compare the effect of these four injectates for severe CTS. We retrospectively reviewed the outcomes of 61 severe CTS cases after a single neural injection with NS, D5W, PRP, or HA. Outcomes were evaluated on the 1st and 6th months postinjection, including the Boston Carpal Tunnel Questionnaire (BCTQ) scores and the nerve cross-sectional area (CSA). The results revealed that PRP, D5W, and HA were more efficient than NS at all measured time points (
), except for CSA at the 1st month between the NS and D5W groups. Single-injections of PRP and D5W seemed more effective than that of HA within 6 months postinjection for symptom and functional improvement (6th-month BCTQ-symptom, D5W vs. HA,
; 1st-month BCTQ-symptom, PRP vs. HA,
; 1st- and 6th-month BCTQ-function, D5W vs. HA,
and 0.016, respectively; 1st-month BCTQ-function, PRP vs. HA,
). For reducing CSA, PRP and HA seemed more effective than D5W (
on the 1st month and HA vs. D5W,
;
on the 6th month and PRP vs. D5W,
).
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Yang C, Chen HH, Lee MC, Kao HK, Lin YT, Chen CT, Chang CJ, Tsai CH. Risk Factors of Carpal Tunnel Syndrome in Taiwan: A Population-Based Cohort Study. Ann Plast Surg 2022; 88:74-78. [PMID: 34270471 DOI: 10.1097/sap.0000000000002950] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS), 1 of the most common peripheral neuropathies of the upper extremity, has been studied for decades regarding its epidemiology and associated medical conditions. We conducted a large-scale, age- and gender-matched study from an Asian population database to investigate the relationship between the incidence and the demographic characteristics. METHODS A retrospective cohort study using data of National Health Insurance Research Database was conducted. One million enrollees in Taiwan was used to identify 9442 patients with CTS and 37,768 randomly selected controls, in a control-case ratio of 4:1. Diagnoses of CTS were ascertained from January 1, 2003, to December 31, 2012. Sociodemographic and medical characteristics were evaluated to assess the correlation with CTS. RESULTS Annual incidence of CTS was approximately 0.4% during the 10-year-period in Taiwan, with higher incidence rate in female sex and middle age of group (50-59 years). Among the medical conditions, previous wrist injuries, obesity, gout, and rheumatoid arthritis were associated with CTS most significantly. CONCLUSIONS Carpal tunnel syndrome has presented a relatively constant incidence in Taiwan. Female gender with middle age seemed to have the highest incident rate during a 10-year period from 2003 to 2012. Among the risk factors of CTS, previous wrist injuries, obesity, gout, and rheumatoid arthritis were demonstrated to be the most significantly correlated comorbidities.
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Affiliation(s)
- Cristhiam Yang
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Hung Chen
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Min-Chao Lee
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Tzung Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou & Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Sciences and Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsuan Tsai
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung & Chang Gung University College of Medicine, Taoyuan, Taiwan
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20
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Wiberg A, Smillie RW, Dupré S, Schmid AB, Bennett DL, Furniss D. Replication of epidemiological associations of carpal tunnel syndrome in a UK population-based cohort of over 400,000 people. J Plast Reconstr Aesthet Surg 2021; 75:1034-1040. [PMID: 34916160 PMCID: PMC8982328 DOI: 10.1016/j.bjps.2021.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 01/17/2023]
Abstract
Introduction Several phenotypic factors are associated in the literature with an increased risk of carpal tunnel syndrome (CTS). Along with female sex and older age, certain systemic diseases show an association with CTS, with varying degrees of evidence. Methods This study was performed using the UK Biobank resource – a cohort study of over 500,000 participants who have allowed linkage of phenotypic data with their medical records. We calculated the prevalence of CTS and a sex-specific prevalence ratio and compared the body mass index (BMI) between cases and controls. We performed a series of nested case-control studies to compute odds ratios for the association between CTS and three systemic diseases. Results There were 12,312 CTS cases within the curated UK Biobank dataset of 401,656 (3.1% prevalence), and the female:male ratio was 1.95:1. CTS cases had, on average, a BMI > 2.0 kg/m2 greater than controls. Odds ratios for the association with CTS for three systemic diseases were 2.31 (95% CI 2.17–2.46) for diabetes, 2.70 (95% CI 2.44–2.99) for rheumatoid arthritis, and 1.47 (95% CI 1.38–1.57) for hypothyroidism. Adjusted for BMI, these odds ratios fell to 1.75 (95% CI 1.65–1.86), 2.43 (95% CI 2.20–2.69), and 1.35 (95% CI 1.26–1.43), respectively. Discussion We harnessed the size and power of UK Biobank to provide robust replication of evidence for the associations between CTS and female sex, raised BMI, and three systemic diseases, which are only mediated in part by raised BMI.
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Affiliation(s)
- A Wiberg
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Oxford, OX3 7LD, UK; Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - R W Smillie
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Oxford, OX3 7LD, UK
| | - S Dupré
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Oxford, OX3 7LD, UK
| | - A B Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - D L Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - D Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Oxford, OX3 7LD, UK; Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Zhang Y, Liu X, Jia J, Zhang Q, Lin Y, Zhang L, Lu Q, Lv H, Zheng X. Diabetic polyneuropathy and carpal tunnel syndrome together affect hand strength, tactile sensation and dexterity in diabetes patients. J Diabetes Investig 2021; 12:2010-2018. [PMID: 34003578 PMCID: PMC8565424 DOI: 10.1111/jdi.13580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) can occur together, and this concomitance is thought to be higher in diabetes patients. We aimed to examine and compare hand function in type 2 diabetes mellitus patients without CTS and DPN (CTS-DPN-), patients with CTS without DPN (CTS+DPN-), patients with DPN without CTS (CTS-DPN+), and patients with CTS and DPN (CTS+DPN+). MATERIALS AND METHODS A total of 161 type 2 diabetes mellitus patients underwent physical examination and electrodiagnostic tests. Grip and pinch strengths, tactile sensory thresholds were measured for each participant. Purdue pegboard test was used in evaluating the hand dexterity of the participants. RESULTS Of the 161 type 2 diabetes mellitus participants, 36 (22.4%) had both CTS and DPN. CTS participants had lower grip (26.6 ± 10.6 vs 35.2 ± 14.3, P < 0.001) and pinch (6.3 ± 2.6 vs 7.5 ± 2.9, P = 0.026) strengths compared with non-CTS participants, whereas DPN participants had elevated tactile sensory thresholds of both the second (2.8 [2.8-3.6] vs 2.4 [2.4-2.8], P < 0.001) and the fifth (2.8 [2.8-3.6] vs 2.4 [2.4-2.8], P < 0.001) fingers compared with non-DPN participants. The CTS+DPN+ group had lower Purdue pegboard test scores than other groups. Grip (r = 0.482, 0.530, 0.467, 0.498, all P < 0.001) and pinch (r = 0.246, P = 0.003; r = 0.265, P = 0.001; r = 0.264, P = 0.001; r = 0.235, P = 0.005) strengths were positively correlated with Purdue pegboard test scores, whereas tactile sensory thresholds were negatively correlated with Purdue pegboard test scores (r = -0.447 to -0.359, all P < 0.001). CONCLUSION Type 2 diabetes mellitus patients with both DPN and CTS had lower grip and pinch strengths and decreased tactile sensation, both of which were correlated with poorer hand dexterity.
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Affiliation(s)
- Yan Zhang
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| | - Xinhua Liu
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Jie Jia
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Qi Zhang
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Yifang Lin
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Li Zhang
- Department of Rehabilitation MedicineHuashan HospitalFudan UniversityShanghaiChina
| | - Qi Lu
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| | - Haidong Lv
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
| | - Xianzhao Zheng
- People's Hospital of Jiaozuo CityJiaozuoHenan ProvinceChina
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Rhee SY, Cho HE, Kim JH, Kim HS. Incidence and Reappraisal of Known Risk Factors Associated with Carpal Tunnel Syndrome: A Nationwide, 11-Year, Population-Based Study in South Korea. J Clin Neurol 2021; 17:524-533. [PMID: 34595860 PMCID: PMC8490900 DOI: 10.3988/jcn.2021.17.4.524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Previous studies have revealed various risk factors for carpal tunnel syndrome (CTS), but few large-scale studies have been conducted. We used data from the 11-year, longitudinal, nationwide population-based National Health Insurance Service–National Health Screening cohort to identify the actual risk factors for CTS. Methods We collected patients with CTS newly diagnosed using electrodiagnostic studies while excluding radiculopathy, plexopathy, or polyneuropathy, which can be confused with CTS. The crude and standardized incidence rates of CTS were calculated. Univariate and multivariate Cox analyses and the incidence of CTS were used to identify the risk factors for newly diagnosed CTS. Results The standardized incidence was 130.8/100,000 person-years based on the World Health Organization World Standard Population as a reference. Multivariate Cox analysis identified that the risk factors for CTS were being middle-aged, female, and obese, and having rheumatoid arthritis and Raynaud's syndrome, whereas gout and hypothyroidism were not risk factors. Diabetes and end-stage renal disease did not show a significant hazard ratio, although it is implicit that the durations of these diseases affect the development of CTS. Conclusions This study calculated the incidence of CTS and reappraised the associated risk factors found in previous studies. This information will be helpful for determining the pathophysiology of CTS, and hence aid the establishment of effective new public health policies.
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Affiliation(s)
- Seung Yeon Rhee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Han Eol Cho
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Shin J, Kim YW, Lee SC, Yang SN, Chang JS, Yoon SY. Effects of diabetes mellitus on the rate of carpal tunnel release in patients with carpal tunnel syndrome. Sci Rep 2021; 11:15858. [PMID: 34349164 PMCID: PMC8338959 DOI: 10.1038/s41598-021-95316-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
The objective of this study was to evaluate the effects of diabetes mellitus (DM) on the rate of carpal tunnel release (CTR) using a large nationwide cohort in Korea and to identify risk factors, including comorbidities and socioeconomic status (SES), associated with CTR. Patients with a primary or secondary diagnosis of carpal tunnel syndrome (CTS; ICD-10 code: G560) were selected and divided into two groups according to the presence of DM. A Cox proportional hazard model was used to assess the rate of CTR between the two groups. To evaluate the influence of demographic factors, comorbidities, and SES on CTR, multivariate Cox proportional hazard regression models were used to adjust for confounding variables. In total, 12,419 patients with CTS were included in the study: 2487 in DM cohort and 9932 in non-DM cohort. DM duration was negatively related with the rate of CTR (HR = 0.89, 95% CI 0.87–0.91) in CTS patients with DM. The rate of CTR was decreased in patients with DM compared to those without DM in the unadjusted model; however, after adjusting for comorbidities, DM had no significant effect on the rate of CTR. Female sex (HR = 1.50, 95% CI 1.36–1.67) correlated with the rate of CTR, and an inverse relationship between the number of comorbidities and CTR was found (p < 0.001) irrespective of DM. Diabetic polyneuropathy (DPN) was not associated with CTR, and we did not find any factors correlating with CTR in DPN patients. We found that CTS patients with more comorbidities or combined with a longer duration of DM were undertreated in real-word practice. Actual outcomes of CTR in CTS patents with various comorbidities should be investigated in future studies for optimal management of CTS.
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Affiliation(s)
- Jaeyong Shin
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Yeon Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
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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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Abstract
LEARNING OBJECTIVES After reading this article and viewing the videos, the participant should be able to: 1. Recognize the following five wrist operations as consistent options for different wrist injuries: carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis. 2. Know the state-of-the-art of these five procedures. 3. State the indications of each operation. 4. List the surgical steps of these five procedures. SUMMARY The wrist is a complex joint that concentrates different types of tissues (e.g., bone, cartilage, ligaments, nerves, vessels) and a broad different spectrum of diseases. Treatment of wrist injuries has improved during recent years, mainly because of improvement in strategy, techniques, microsurgical equipment, understanding anatomy and improvements in technology. In this article, we present the five operations (i.e., carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis) that have consistently given good outcomes in patients suffering from different wrist injuries/maladies.
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Koyama T, Sato S, Toriumi M, Watanabe T, Nimura A, Okawa A, Sugiura Y, Fujita K. A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study. JMIR Mhealth Uhealth 2021; 9:e26320. [PMID: 33714936 PMCID: PMC8005991 DOI: 10.2196/26320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 01/23/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on a CTS-screening app that uses a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. Objective To make data collection for machine learning easier and more available, we developed a screening app for CTS using a smartphone and an anomaly detection algorithm, aiming to examine our system as a useful screening tool for CTS. Methods In total, 36 participants were recruited, comprising 36 hands with CTS and 27 hands without CTS. Participants controlled the character in our app using their thumbs. We recorded the position of the thumbs and time; generated screening models that classified CTS and non-CTS using anomaly detection and an autoencoder; and calculated the sensitivity, specificity, and area under the curve (AUC). Results Participants with and without CTS were classified with 94% sensitivity, 67% specificity, and an AUC of 0.86. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92% sensitivity, and 100% specificity. Conclusions Our app could reveal the difficulty of thumb opposition for patients with CTS and screen for CTS with high sensitivity and specificity. The app is highly accessible because of the use of smartphones and can be easily enhanced by anomaly detection.
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Affiliation(s)
- Takafumi Koyama
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shusuke Sato
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Madoka Toriumi
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Takuro Watanabe
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuta Sugiura
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Lee JK, Yoon BN, Cho JW, Ryu HS, Han SH. Carpal Tunnel Release Despite Normal Nerve Conduction Studies in Carpal Tunnel Syndrome Patients. Ann Plast Surg 2021; 86:52-57. [PMID: 33141768 DOI: 10.1097/sap.0000000000002570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Carpal tunnel syndrome (CTS) is a common entrapment neuropathy, often requiring carpal tunnel release (CTR) surgery. Often, a nerve conduction study (NCS) is performed before CTR; however, there are various reports questioning the sensitivity of NCS, and some patients do undergo CTR despite normal NCS results. We had the following purposes: (1) to report clinical outcome of CTS patients who undergo CTR despite normal NCS, (2) to identify the characteristics and compare those with abnormal NCS patients in terms of basic features and risk factors, and (3) to analyze and compare normal and abnormal NCS results. MATERIALS AND METHODS Medical records of 546 CTS (30 normal NCS and 516 abnormal NCS) patients were retrospectively reviewed. Of 30 normal NCS patients, 7 were excluded, leaving 23 patients in the experimental group. We investigated the influence of age, sex, operative arm, and body mass index, as well as medical conditions known to be risk factors for CTS. In normal NCS patients, as a functional score, we investigated Boston carpal tunnel scores before and after CTR. The NCS results were compared in terms of median motor and median sensory testing. In normal NCS patients, NCS data were compared with that of the contralateral nonoperated wrists. RESULTS There were 18 women and 5 men in the normal NCS group (mean age 43.7 years). On physical examination, 22 (94.7%) patients showed a positive Tinel test, 19 (82.6%) showed a positive Phalen test, 8 (34.8%) complained of nocturnal paresthesia, and only 1 (4.3%) presented with thenar atrophy. In 19 of 23 patients, the Boston CTS scores showed significant improvement after CTR. Normal NCS patients were significantly younger and significantly heavier and more likely to be a current smoker. In NCS analysis of normal NCS patients, the operated wrists were closer to the reference values than nonoperated wrists. CONCLUSIONS Surgeons should evaluate the possibility of other combined lesions before CTR in normal NCS patients. Normal NCS can be present with a CTS diagnosis, especially in younger patients. Nevertheless, CTR after failed conservative management, despite normal NCS, could relieve subjective symptoms and function.
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Affiliation(s)
- Jun-Ku Lee
- From the Department of Orthopaedic Surgery
| | - Byung-Nam Yoon
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul
| | - Jin Woo Cho
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Han-Seung Ryu
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea
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Chen SR, Ho TY, Shen YP, Li TY, Su YC, Lam KHS, Chen LC, Wu YT. Comparison of short- and long-axis nerve hydrodissection for carpal tunnel syndrome: A prospective randomized, single-blind trial. Int J Med Sci 2021; 18:3488-3497. [PMID: 34522175 PMCID: PMC8436111 DOI: 10.7150/ijms.63815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/02/2021] [Indexed: 01/04/2023] Open
Abstract
Background: This study is to compare the efficacy of short-axis hydrodissection with long-axis hydrodissection for patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods: Forty-seven patients with mild-to-moderate CTS were enrolled in a prospective, randomized, single-blinded, controlled trial (6 months follow-up). With ultrasound guidance, patients in both groups (short-axis or long-axis groups) were injected with normal saline (5 mL per session). Assessments were performed before and 2 weeks after the injection, as well as at 1, 3, and 6 months post-intervention. The primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score and secondary outcomes included the cross-sectional area of the median nerve and electrophysiological studies. Results: Forty-four patients (21 wrists in the short-axis group and 23 wrists in the long-axis group) completed the study. Compared with the baseline, both groups showed improved BCTQ and cross-sectional area at all follow-up assessments (p<0.05). The short-axis group was not more effective except significant improvements in BCTQ-severity and BCTQ-function 1 month post-injection compared to the long-axis group (p = 0.031 and p = 0.023, respectively). Conclusions: Both short- and long-axis hydrodissection were effective for patients with mild-to-moderate CTS and the short-axis approach was not more effective than long-axis injection. Further studies with larger sample sizes, multiple injections, and larger injection volume are encouraged in the future.
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Affiliation(s)
- Si-Ru Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Department of Physical Medicine and Rehabilitation, Taichung Armed Forces General Hospital, No. 348, Sec. 2, Chungshan Road, Taiping District, Taichung City, Taiwan, Republic of China
| | - Yu-Ping Shen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong.,Department of Family Medicine, the Chinese University of Hong Kong, Hong Kong.,Department of Family Medicine, the University of Hong Kong, Hong Kong
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan, Republic of China
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29
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Gatheridge MA, Sholty EA, Inman A, Pattillo M, Mindrup F, Sanderson DL. Splinting in Carpal Tunnel Syndrome: The Optimal Duration. Mil Med 2020; 185:e2049-e2054. [PMID: 32870276 DOI: 10.1093/milmed/usaa222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate optimal neutral wrist splint duration in treatment-naive mild and mild to moderate carpal tunnel syndrome (CTS). Neutral wrist splinting is a conservative treatment for CTS; however, no clear guidelines exist for how long splinting should be prescribed for optimal outcomes. MATERIALS AND METHODS In this prospective clinical trial subjects were assigned to wear a neutral wrist splint for 6 (group A) or 12 weeks (group B). Symptom and functional outcomes were assessed by questionnaire at baseline, 6 and 12 weeks. Median nerve sensory and motor latencies were recorded at baseline and 12 weeks. Pretreatment, midtreatment, and posttreatment measures were compared within and between treatment groups where applicable. This study was approved by the United States Air Force Academy institutional review board. RESULTS A total of 30 subjects (37 hands) were randomized to 2 treatment groups. Mean symptom severity and median sensory peak latency significantly improved in both groups at 12 weeks, without a significant difference between groups. Mean functional severity significantly improved only in group A. CONCLUSION Neutral wrist splint for 6 weeks resulted in better clinical improvements in patients with untreated mild and mild to moderate CTS. There was no additional benefit in extending splinting 6 additional weeks. This is the first study to compare duration of wrist splint use beyond 8 weeks. A larger sample size is needed to identify the reason for lack of functional improvement in group B. Long-term follow-up of this cohort will be helpful to determine the natural history of initial wrist splint use.
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Affiliation(s)
- Michele A Gatheridge
- United States Air Force Academy, 10th Medical Group, 4102 Pinion Dr., USAF Academy, CO 80840
| | - Elsa A Sholty
- United States Air Force Academy, 10th Medical Group, 4102 Pinion Dr., USAF Academy, CO 80840
| | - Alexander Inman
- United States Air Force Academy, 10th Medical Group, 4102 Pinion Dr., USAF Academy, CO 80840
| | - Meghan Pattillo
- Department of Mathematics, United States Air Force Academy, 2354 Fairchild Drive, Suite 6D102, USAF Academy, CO 80840
| | - Frank Mindrup
- Department of Mathematics, United States Air Force Academy, 2354 Fairchild Drive, Suite 6D102, USAF Academy, CO 80840
| | - Dawn L Sanderson
- Department of Mathematics, United States Air Force Academy, 2354 Fairchild Drive, Suite 6D102, USAF Academy, CO 80840
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30
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Lin MT, Liao CL, Hsiao MY, Hsueh HW, Chao CC, Wu CH. Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial. Front Pharmacol 2020; 11:625830. [PMID: 33391002 PMCID: PMC7773892 DOI: 10.3389/fphar.2020.625830] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022] Open
Abstract
Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.
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Affiliation(s)
- Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Li Liao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsueh-Wen Hsueh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of General Medicine, National Taiwan University Hospital Biomedical Park Branch, Hsinchu, Taiwan
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31
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Ashworth NL, Bland JDP, Chapman KM, Tardif G, Albarqouni L, Nagendran A. Local corticosteroid injection for carpal tunnel syndrome. Hippokratia 2020. [DOI: 10.1002/14651858.cd013785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nigel L Ashworth
- Physical Medicine & Rehabilitation; University of Alberta; Edmonton Canada
| | - Jeremy D P Bland
- Electroencephalography (EEG) Department; East Kent Hospitals University NHS Trust; Canterbury UK
| | - Kristine M Chapman
- Neuromuscular Disease Unit; 8th Floor, Diamond Health Care Centre; Vancouver Canada
| | - Gaetan Tardif
- Division of Physical Medicine & Rehabilitation; University of Toronto; Toronto Canada
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare; Bond University; Gold Coast Australia
| | - Arjuna Nagendran
- Department of Clinical Neurophysiology; National Hospital for Neurology and Neurosurgery; London UK
- Department of Clinical Neurophysiology; London North West University Healthcare NHS Trust; London UK
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32
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Cavalcante JBDF, Cembraneli PN, Cavalcante RBDF, Junior VFV, Cavalcante JEDS. Post-surgical complications of median nerve release at the wrist level. Pan Afr Med J 2020; 36:173. [PMID: 32952817 PMCID: PMC7467894 DOI: 10.11604/pamj.2020.36.173.23685] [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: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 11/11/2022] Open
Abstract
Carpal tunnel syndrome is a set of signs and symptoms caused by compression of the median nerve as it travels through the wrist at the carpal tunnel. The diagnosis is clinical and based on the presence of characteristic signs and symptoms. Proper nonsurgical treatment can stop the progression of this disorder and prevent the development of permanent disability. Surgical treatment may be indicated to patients with complications rated as moderate to severe. Although the surgery is relatively simple, basic antisepsis care before, during, and after the procedure, and guidance of patients for the management of wound hygiene upon discharge, make recovery more secure and prevent disabling sequelae. We report a case of a patient that had infection, edema, and temporary loss of flexibility of the fingers after a surgical procedure to release the median nerve.
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Affiliation(s)
| | - Pedro Nogarotto Cembraneli
- Medical Sciences Course, Health Sciences School, Faculdade Ceres (FACERES), São José do Rio Preto, SP, Brazil
| | | | | | - José Edison da Silva Cavalcante
- Neurosurgeon, PhD in Neurosurgery, Member of the Brazilian Society of Neurosurgery, Professor at Santa Mônica Hospital, Goiânia, GO, Brazil
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33
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Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Clinical Outcomes in Carpal Tunnel Syndrome. AJR Am J Roentgenol 2020; 217:460-468. [PMID: 32876476 DOI: 10.2214/ajr.20.24383] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND. Ultrasound guidance allows performance of carpal tunnel release with smaller incisions and quicker recovery than traditional open or endoscopic surgery. OBJECTIVE. The purpose of this study was to evaluate the long-term effectiveness of ultrasound-guided carpal tunnel release in improving function and discomfort in patients with carpal tunnel syndrome. METHODS. Retrospective review was conducted of 61 ultrasound-guided carpal tunnel release procedures performed on 46 patients (15 bilateral procedures) with clinically diagnosed carpal tunnel syndrome. The procedures were performed with a single-use transection device and local anesthesia at an outpatient radiology office. Patients answered three questionnaires (Quick Disabilities of the Arm, Shoulder, and Hand [QDASH] and two parts of the Boston Carpal Tunnel Syndrome Questionnaire-the symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS] scales) to assess the function of and discomfort in the affected wrist immediately before and 2 weeks and at least 1 year after the procedure. Higher scores indicated increasing disability. Patients also answered a global satisfaction question at follow-up. Preprocedure and postprocedure scores were compared by paired Wilcoxon signed rank tests. RESULTS. The 46 patients (25 women, 21 men; mean age, 60.6 years; range, 21-80 years) had median preprocedure scores of 45.4 for QDASH, 3.2 for BCTSQ-SS, and 2.5 for BCTSQ-FS. The median scores 2 weeks after the procedure were 22.5 for QDASH, 1.7 for BCTSQ-SS, and 1.9 for BCTSQ-FS. All scores decreased (p < .001) from preprocedure scores and surpassed reference standards for clinically important difference in scores. Follow-up questionnaires obtained for 90% (55/61) of wrists a median of 1.7 years (range, 1.0-2.8 years) after the procedure showed further declines (p < .001) in median scores: 2.3 for QDASH, 1.2 for BCTSQ-SS, and 1.1 for BCTSQ-FS. At long-term follow-up evaluation, 96% (52/54) of wrists had lower QDASH and 98% (53/54) had lower BCTSQ (average of BCTSQ-SS and BCTSQ-FS) scores compared with the preprocedure scores. Among the patients who participated in the survey, 93% (37/40) were satisfied or very satisfied with the long-term outcomes. No immediately postoperative complications occurred. Two patients needed surgical intervention 8 and 10 days after surgery, one for infection after injury and one for posttraumatic compartment syndrome. CONCLUSION. Ultrasound-guided carpal tunnel release quickly improves hand function and reduces hand discomfort; improvement persists beyond 1 year. CLINICAL IMPACT. Ultrasound-guided carpal tunnel release may be a safe, effective, and less invasive alternative to traditional surgery.
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Giller A, Andrawus M, Gutman D, Atzmon G. Pregnancy as a model for aging. Ageing Res Rev 2020; 62:101093. [PMID: 32502628 DOI: 10.1016/j.arr.2020.101093] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 04/21/2020] [Accepted: 05/23/2020] [Indexed: 12/12/2022]
Abstract
The process of aging can be defined as the sum accumulation of damages and changes in metabolism during the life of an organism, due to both genetic predisposition and stochastic damage. During the gestational period and following parturition, similar damage can be seen due to the strenuous effect on the maternal body, exhibited on both the physiological and cellular level. In this review, we will focus on the similar physiological and cellular characteristics exhibited during pregnancy and aging, including induction of and response to oxidative stress, inflammation, and degradation of telomeres. We will evaluate any similar processes between aging and pregnancy by comparing common biomarkers, pathologies, and genetic and epigenetic effects, to establish the pregnant body as a model for aging. This review will approach the connection both in respect to current theories on aging as a byproduct of natural selection, and regarding unrelated biochemical similarities between the two, drawing on existing studies and models in humans and other species where relevant alike. Furthermore, we will show the response of the pregnant body to these changes, and through that illuminate unique areas of potential study to advance our knowledge of the maladies relating to aging and pregnancy, and an avenue for solutions.
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Affiliation(s)
- Abram Giller
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Mariana Andrawus
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Danielle Gutman
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel
| | - Gil Atzmon
- Faculty of Natural Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa, 349888, Israel; Departments of Genetics and Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, New York, 10461, USA.
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Mitake T, Iwatsuki K, Hirata H. Differences in characteristics of carpal tunnel syndrome between male and female patients. J Orthop Sci 2020; 25:843-846. [PMID: 31780367 DOI: 10.1016/j.jos.2019.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/05/2019] [Accepted: 10/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sex difference is known to be a risk factor of carpal tunnel syndrome. However, sex differences with regard to the clinical presentation of carpal tunnel syndrome have not received much attention. Thus, this study aimed to detect any difference in the characteristics of carpal tunnel syndrome between male and female and thereby add new insights into disease prevention. METHODS A total of 647 patients (male 193 hands and female 454 hands) with carpal tunnel syndrome who underwent endoscopic or open carpal tunnel release were retrospectively reviewed. The average age at time of surgery was 66 years. Clinical and electrophysiological data of all patients were collected. Six medical conditions, including trigger finger, diabetes mellitus, hemodialysis, hyperlipidemia, hypertension, and obesity were also investigated. RESULTS A significant difference was found in the distribution of comorbidities between the male and female groups. Particularly, the prevalence of diabetes mellitus, hemodialysis, and hypertension were significantly higher in the male group than in the female group. Meanwhile, the presence of thenar muscle atrophy was significantly higher in the female group than in the male group. CONCLUSIONS Women are more likely to experience carpal tunnel syndrome even though they have no comorbidities. We suggest that carpal tunnel syndrome especially in male patients may be reduced by early intervention for diabetes mellitus. Prospective studies are needed to validate the causal relationship between diabetes mellitus and carpal tunnel syndrome.
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Affiliation(s)
- Tatsunori Mitake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10080596. [PMID: 32824261 PMCID: PMC7460039 DOI: 10.3390/diagnostics10080596] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
With the widespread use of high-resolution ultrasonography, ultrasonic examination has been shown to be useful as a diagnostic method for carpal tunnel syndrome. The main advantages of ultrasonography are that it is simple, quick, non-invasive, and economical. Another advantage is that tissue dynamics can be observed with real-time imaging. In recent reports, it has been shown that ultrasonic examination can provide similar diagnostic accuracy as nerve conduction study in the diagnosis of carpal tunnel syndrome. It has been expected that ultrasound demand in daily medical care will continue to increase. Ultrasonography in carpal tunnel syndrome shows an enlarged median nerve in proximal carpal tunnel, thickening of the flexor retinaculum, and edema around flexor tendons in cross-sectional images. In addition, with the introduction of new technologies such as ultrasonic elastography and speckle tracking, it has become possible to quantify dynamics and material property changes of nerves, tendons, and their surrounding structures. In this review, we describe recent advancements of carpal tunnel syndrome diagnosis based on ultrasound dynamic images, and discuss its pathology.
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Abstract
With the widespread use of high-resolution ultrasonography, ultrasonic examination has been shown to be useful as a diagnostic method for carpal tunnel syndrome. The main advantages of ultrasonography are that it is simple, quick, non-invasive, and economical. Another advantage is that tissue dynamics can be observed with real-time imaging. In recent reports, it has been shown that ultrasonic examination can provide similar diagnostic accuracy as nerve conduction study in the diagnosis of carpal tunnel syndrome. It has been expected that ultrasound demand in daily medical care will continue to increase. Ultrasonography in carpal tunnel syndrome shows an enlarged median nerve in proximal carpal tunnel, thickening of the flexor retinaculum, and edema around flexor tendons in cross-sectional images. In addition, with the introduction of new technologies such as ultrasonic elastography and speckle tracking, it has become possible to quantify dynamics and material property changes of nerves, tendons, and their surrounding structures. In this review, we describe recent advancements of carpal tunnel syndrome diagnosis based on ultrasound dynamic images, and discuss its pathology.
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Recent Advances in Ultrasound Diagnosis of Carpal Tunnel Syndrome. Diagnostics (Basel) 2020; 10:596. [PMID: 32824261 PMCID: PMC7460039 DOI: 10.3390/diagnostics10080596+10.1055/s-0032-1325397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
With the widespread use of high-resolution ultrasonography, ultrasonic examination has been shown to be useful as a diagnostic method for carpal tunnel syndrome. The main advantages of ultrasonography are that it is simple, quick, non-invasive, and economical. Another advantage is that tissue dynamics can be observed with real-time imaging. In recent reports, it has been shown that ultrasonic examination can provide similar diagnostic accuracy as nerve conduction study in the diagnosis of carpal tunnel syndrome. It has been expected that ultrasound demand in daily medical care will continue to increase. Ultrasonography in carpal tunnel syndrome shows an enlarged median nerve in proximal carpal tunnel, thickening of the flexor retinaculum, and edema around flexor tendons in cross-sectional images. In addition, with the introduction of new technologies such as ultrasonic elastography and speckle tracking, it has become possible to quantify dynamics and material property changes of nerves, tendons, and their surrounding structures. In this review, we describe recent advancements of carpal tunnel syndrome diagnosis based on ultrasound dynamic images, and discuss its pathology.
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Hashimoto S, Ikegami S, Nishimura H, Uchiyama S, Takahashi J, Kato H. Prevalence and Risk Factors of Carpal Tunnel Syndrome in Japanese Aged 50 to 89 Years. J Hand Surg Asian Pac Vol 2020; 25:320-327. [PMID: 32723040 DOI: 10.1142/s2424835520500356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy worldwide, but there are few reports investigating its prevalence using subjects diagnosed by both clinical symptoms and nerve conduction studies (NCSs) in a population-based cohort. This study aimed to determine the epidemiology of CTS diagnosed by sensory disturbance findings and NCSs using a randomly sampled resident population. Methods: Subjects aged between 50 and 89 years were randomly sampled from the basic resident registry of a rural Japanese town. Subjects indicating a history of CTS surgery in a written questionnaire were classified as having past CTS. Subjects with both sensory disturbance of the median nerve area and delays in NCSs were diagnosed as having present CTS. Subjects with past or present CTS were judged as affected with CTS. We calculated the prevalence of CTS and investigated for possible risk factors. Results: Seventeen subjects (14 female and 3 male) were affected with CTS among 379 enrolled subjects. Adjusting these results to Japanese population values, the weighted prevalence of CTS was 4.7% (female: 7.2%, male: 1.8%) in the Japanese population aged 50 to 89 years. Statistically significant positive correlations were found between CTS and female, higher BMI, rheumatoid arthritis, and trigger digit. In females affected with CTS, third metacarpal length was significantly shorter than in those without CTS. Conclusions: This epidemiological study clarified the prevalence of CTS among Japanese seniors as 4.7%. Female, higher BMI, rheumatoid arthritis, trigger digit, and shorter third metacarpal length in females were risk factors for CTS.
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Affiliation(s)
- Shun Hashimoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hikaru Nishimura
- Rehabilitation Center, Shinshu University Hospital, Nagano, Japan
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan.,Department of Orthopaedic Surgery, Okaya City Hospital, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan
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Roquelaure Y, Garlantézec R, Rousseau V, Descatha A, Evanoff B, Mattioli S, Goldberg M, Zins M, Bodin J. Carpal tunnel syndrome and exposure to work-related biomechanical stressors and chemicals: Findings from the Constances cohort. PLoS One 2020; 15:e0235051. [PMID: 32584856 PMCID: PMC7316232 DOI: 10.1371/journal.pone.0235051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the effects of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS in a large cohort of French workers. Methods Prospective study using the data collected at baseline and at the first 12 month-follow-up for the 18,018 participants included in the population-based Constances cohort between 2012 and 2015. CTS at follow-up and exposure to biomechanical wrist stressors and chemicals at baseline were assessed using a self-administered questionnaire. Associations between CTS and co-exposure to biomechanical wrist stressors and chemicals were studied using multivariate logistic regression models, adjusted for personal/medical factors. Results 184 men (2.1%, 95%CI 1.8–2.4) and 331 women (3.6%, 3.2–3.9) free from chronic hand symptoms at baseline declared suffering from unilateral/bilateral CTS at follow-up. A potentiating effect of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS was found for both genders, with higher OR in the co-exposure group (OR = 3.38 [2.29–5.01] in men and OR = 4.12 [2.73–6.21] in women) than in the biomechanical exposure group (OR = 2.14 [1.51–3.03] in men and OR = 2.19 [1.72–2.78] in women) compared to no exposure group. Conclusions The study showed an association between CTS and co-exposure to biomechanical wrist stressors and chemicals, after adjustment for the main personal and medical factors. This finding should be confirmed using more objective case definition of CTS and assessment of the chemical exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemical on the median nerve.
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Affiliation(s)
- Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
| | - Ronan Garlantézec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Vincent Rousseau
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
- INSERM UMS 011, Population Based Epidemiological cohorts Unit and Paris Descartes University, Paris, France
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, Occupational Medicine, University of Bologna, Bologna, Italy
| | - Marcel Goldberg
- INSERM UMS 011, Population Based Epidemiological cohorts Unit and Paris Descartes University, Paris, France
| | - Marie Zins
- INSERM UMS 011, Population Based Epidemiological cohorts Unit and Paris Descartes University, Paris, France
| | - Julie Bodin
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Angers, France
- * E-mail:
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Tadjerbashi K, Åkesson A, Atroshi I. Incidence of referred carpal tunnel syndrome and carpal tunnel release surgery in the general population: Increase over time and regional variations. J Orthop Surg (Hong Kong) 2020; 27:2309499019825572. [PMID: 30798784 DOI: 10.1177/2309499019825572] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the change in incidence of referred carpal tunnel syndrome (CTS) and carpal tunnel release (CTR) surgery over time and regional variations. METHODS From the nationwide patient registry, we identified all adult individuals who had received first-time CTS diagnosis (International Classification of Diseases, 10th Revision code G560) at secondary or tertiary level and first-time CTR surgery during the period of 9 years. RESULTS From 2001 through 2009, the incidence (per 100,000 person-years) of CTS diagnosed at secondary or tertiary level increased from 216 to 243 in women and from 95 to 119 in men and of CTR from 117 to 168 in women and from 52 to 78 in men. The mean annual increase in first-time CTR (95% confidence interval) was 5.1% (4.7-5.4) in women and 6.2% (5.6-6.7) in men. The age-standardized 3-year (2007-2009) incidence varied significantly across Sweden's 21 counties; compared to the county with the lowest incidence of CTR, the incidence rates in the other counties were higher by 6-152% (mean 60%) in women and by 20-182% (mean 85%) in men. The proportion of CTS-diagnosed individuals treated with surgery varied across counties from 53% to 81% in women and from 51% to 77% in men. CONCLUSION The incidence of referred CTS and of CTR surgery increased over time in both sexes, with large regional variations found in the incidence rates and in the proportion of individuals treated with surgery.
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Affiliation(s)
- Kamelia Tadjerbashi
- 1 Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.,2 Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden
| | - Anna Åkesson
- 3 Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
| | - Isam Atroshi
- 1 Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.,2 Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden
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Roquelaure Y, Jégo S, Geoffroy-Perez B, Chazelle E, Descatha A, Evanoff B, Garlantézec R, Bodin J. Carpal Tunnel Syndrome Among Male French Farmers and Agricultural Workers: Is It Only Associated With Physical Exposure? Saf Health Work 2020; 11:33-40. [PMID: 32206372 PMCID: PMC7078553 DOI: 10.1016/j.shaw.2019.12.003] [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: 07/18/2018] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Exploratory study to investigate whether co-exposure to physical wrist stressors and chemicals is associated with carpal tunnel syndrome (CTS) in French male farmers and agricultural workers. Methods Cross-sectional study of 711 men aged 30–65 years and working as either farmers or agricultural workers in 2009–2010 within a cohort covered by the French Agricultural Workers' and Farmers' Mutual Benefit Fund. CTS and exposure to physical wrist stressors and chemicals were assessed using a self-administered questionnaire. Associations between CTS and personal/medical factors, exposure to physical wrist stressors, exposure to chemicals, and co-exposure to physical wrist stressors and chemicals were studied using multivariate logistic regression models. Results Forty-four men {5.6% [95% confidence interval (CI) 4.0–7.7]} reported that they had suffered from unilateral/bilateral CTS during the last 12 months. CTS was associated with age, current smoking [odds ratio (OR) = 2.1 (1.0–4.5)], and exposure to physical wrist stressors [OR = 2.6 (1.1–5.9)]. An association was found between CTS and co-exposure to physical wrist stressors and chemicals [OR = 3.3 (0.8–14.3), p = 0.044] in comparison with the no-exposure group. Conclusions This exploratory study shows an association of CTS with exposure to biomechanical wrist stressors in male farmers and agricultural workers and suggests an association of CTS with co-exposure to physical wrist stressors and chemicals. Owing to the limitations of the study, this result must be confirmed by a prospective study with objective assessments of the outcome and exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemicals on the impairment of the median nerve.
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Affiliation(s)
- Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-49000, Angers, France
| | - Sylvaine Jégo
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-49000, Angers, France
| | - Béatrice Geoffroy-Perez
- Santé Publique France, French National Public Health Agency, Direction of Occupational Health, F-94415, Saint-Maurice, France
| | - Emilie Chazelle
- Santé Publique France, French National Public Health Agency, Direction of Occupational Health, F-94415, Saint-Maurice, France
| | - Alexis Descatha
- INSERM UMS 011, Population Based Epidemiological Cohorts Unit and University Versailles St-Quentin, F-78035, Versailles, France
| | - Bradley Evanoff
- Washington University School of Medicine, Division of General Medical Sciences, St. Louis, MO, 63310, USA
| | - Ronan Garlantézec
- Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Julie Bodin
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-49000, Angers, France
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Carpal Tunnel Syndrome as Sentinel for Harmful Hand Activities at Work: A Nationwide Danish Cohort Study. J Occup Environ Med 2020; 62:375-382. [PMID: 32167999 DOI: 10.1097/jom.0000000000001852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate incidence rates (IRs) of carpal tunnel syndrome (CTS) as sentinels to identify job groups with high hand-wrist exposures. METHODS A nationwide register-based cohort study of all born in Denmark. During follow-up 2010 to 2013, we identified first-time CTS diagnoses. We established job groups, calculated sex-specific age-standardized IRs (SIRs) per job group. We linked occupational codes with a job exposure matrix, calculated mean hand load estimate per job group, and plotted hand load against the SIRs. RESULTS We followed 1,171,580 men and 1,137,854 women for 4,046,851 and 3,994,987 person-years; identified 4405 cases among men, 7858 among women; obtained crude IRs of 10.9 and 19.7 per 10,000 person-years. For both sexes, there was a positive association between SIRs and hand load. CONCLUSIONS Higher SIRs pointed to job groups with higher hand load. Elevated SIRs of CTS may serve as sentinels of harmful hand activities.
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Hulkkonen S, Lampainen K, Auvinen J, Miettunen J, Karppinen J, Ryhänen J. Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study. J Hand Surg Eur Vol 2020; 45:226-230. [PMID: 31739732 DOI: 10.1177/1753193419886741] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to investigate the incidence rates and operations for carpal tunnel syndrome and ulnar and radial neuropathies in specialist care in Finland. Patients diagnosed with entrapment neuropathies of the upper extremity were identified from the Care Register for Health Care, 2007-2016. There were 81,911 cases in 54,095,070 person-years. The total crude incidence rates per 100,000 person-years among women and men were 197 and 105 for carpal tunnel syndrome, 26 and 36 for ulnar neuropathies, and 5.7 and 8.5 for radial neuropathies, respectively. Of these, carpal tunnel syndrome was operated on in 63% of women and 61% of men, ulnar neuropathy in 43% of women and 47% of men, and radial neuropathy in 11% of women and 8% of men. Incidence of carpal tunnel syndrome and ulnar neuropathies increased up to late middle age, while radial neuropathies were less common. Level of evidence: III.
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Affiliation(s)
- Sina Hulkkonen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Lampainen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland *Hulkkonen Sina and Lampainen Kaisa have contributed equally to this work
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Alcan V, Kaya H, Zinnuroğlu M, Karataş GK, Canal MR. A novel approach to the diagnostic assessment of carpal tunnel syndrome based on the frequency domain of the compound muscle action potential. ACTA ACUST UNITED AC 2020; 65:61-71. [PMID: 31377730 DOI: 10.1515/bmt-2018-0077] [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: 05/15/2018] [Accepted: 03/18/2019] [Indexed: 11/15/2022]
Abstract
Conventional electrophysiological (EP) tests may yield ambiguous or false-negative results in some patients with signs and symptoms of carpal tunnel syndrome (CTS). Therefore, researchers tend to investigate new parameters to improve the sensitivity and specificity of EP tests. We aimed to investigate the mean and maximum power of the compound muscle action potential (CMAP) as a novel diagnostic parameter, by evaluating diagnosis and classification performance using the supervised Kohonen self-organizing map (SOM) network models. The CMAPs were analyzed using the fast Fourier transform (FFT). The mean and maximum power parameters were calculated from the power spectrum. A counter-propagation artificial neural network (CPANN), supervised Kohonen network (SKN) and XY-fused network (XYF) were compared to evaluate the classification and diagnostic performance of the parameters using the confusion matrix. The mean and maximum power of the CMAP were significantly lower in patients with CTS than in the normal group (p < 0.05), and the XYF network had the best total performance of classification with 91.4%. This study suggests that the mean and maximum power of the CMAP can be considered as less time-consuming parameters for the diagnosis of CTS without using additional EP tests which can be uncomfortable for the patient due to poor tolerance to electrical stimulation.
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Affiliation(s)
- Veysel Alcan
- Department of Software Engineering, Faculty of Technology, Tarsus University, Mersin 33400, Turkey
| | - Hilal Kaya
- Department of Computer Engineering, Faculty of Engineering and Natural Science, Ankara Yıldırım Beyazıt University, Ankara 06010, Turkey
| | - Murat Zinnuroğlu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Gazi University, Ankara 06500, Turkey
| | - Gülçin Kaymak Karataş
- Department of Physical Medicine and Rehabilitation, School of Medicine, Gazi University, Ankara 06500, Turkey
| | - Mehmet Rahmi Canal
- Department of Biomedical Engineering, Faculty of Engineering, İnönü University, Malatya 44280, Turkey
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Shen Y, Li T, Chou Y, Ho T, Ke M, Chen L, Wu Y. Comparison of perineural platelet‐rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized, single‐blind, head‐to‐head comparative trial. J Tissue Eng Regen Med 2019; 13:2009-2017. [PMID: 31368191 DOI: 10.1002/term.2950] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 07/27/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Yu‐Ping Shen
- Department of Physical Medicine and RehabilitationTri‐Service General Hospital Taiwan, Republic of China
- School of MedicineNational Defense Medical Center Taiwan, Republic of China
| | - Tsung‐Ying Li
- Department of Physical Medicine and RehabilitationTri‐Service General Hospital Taiwan, Republic of China
- School of MedicineNational Defense Medical Center Taiwan, Republic of China
- Integrated Pain Management CenterTri‐Service General Hospital Taiwan, Republic of China
| | - Yu‐Ching Chou
- School of Public HealthNational Defense Medical Center Taiwan, Republic of China
| | - Tsung‐Yen Ho
- Department of Physical Medicine and RehabilitationTri‐Service General Hospital Taiwan, Republic of China
- School of MedicineNational Defense Medical Center Taiwan, Republic of China
| | - Ming‐Jen Ke
- Department of Physical Medicine and RehabilitationTri‐Service General Hospital Taiwan, Republic of China
- Force Rehabilitation Clinic Taiwan, Republic China
| | - Liang‐Cheng Chen
- Department of Physical Medicine and RehabilitationTri‐Service General Hospital Taiwan, Republic of China
- School of MedicineNational Defense Medical Center Taiwan, Republic of China
| | - Yung‐Tsan Wu
- Department of Physical Medicine and RehabilitationTri‐Service General Hospital Taiwan, Republic of China
- School of MedicineNational Defense Medical Center Taiwan, Republic of China
- Integrated Pain Management CenterTri‐Service General Hospital Taiwan, Republic of China
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Is carpal tunnel syndrome in the elderly a separate entity? Evidence from median nerve ultrasound. Muscle Nerve 2019; 60:217-218. [DOI: 10.1002/mus.26618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 02/01/2023]
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Vergara-Amador E, Tovar-Cuella W, Viveros-Carreño JM. Resultado clínico y electrodiagnóstico en pacientes con liberación quirúrgica del síndrome del túnel del carpo. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n3.69698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La cirugía de síndrome del túnel del carpo (STC) es efectiva, aunque algunos reportes muestran satisfacción de solo el 75% luego de los procedimientos. La escala funcional HiOb es la que mejor se correlaciona con el estado neurofisiológico del nervio mediano.Objetivo. Determinar los resultados clínicos, funcionales y electrofisiológicos luego de una liberación quirúrgica en pacientes con STC.Materiales y métodos. Estudio analítico y descriptivo de pacientes con STC operados entre 2013 y 2014. Todos los individuos tenían pruebas clínicas y electrofisiológicas pre y post quirúrgicas.Resultados. Se estudiaron 36 pacientes con edad promedio de 49 años; los signos clínicos prequirúrgicos más frecuentes fueron Phalen y elevación de manos (91%). El seguimiento mínimo fue 6 meses. Hubo mejoría del dolor; de los signos de Tinel, de Phalen y de elevación de manos; en la escala HiOb, y en el Cuestionario de Boston, tanto en la función como en los síntomas. Los resultados electrofisiológicos mostraron mejoría en latencia distal motora del nervio mediano, latencia distal sensitiva del nervio mediano y delta sensitivo.Conclusiones. La liberación quirúrgica del STC es un procedimiento eficaz en la mejoría del dolor, los síntomas, las escalas funcionales y los hallazgos electrofisiológicos. El signo de Tinel prequirúrgico se asocia a peores resultados en el cuestionario de Boston.
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Farioli A, Curti S, Bonfiglioli R, Baldasseroni A, Spatari G, Mattioli S, Violante FS. Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study. Ann Work Expo Health 2019; 62:505-515. [PMID: 29579135 PMCID: PMC5905650 DOI: 10.1093/annweh/wxy015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives We aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex. Methods We analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers. Results After adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher. Conclusions Our analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks).
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Affiliation(s)
- Andrea Farioli
- Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy
| | - Roberta Bonfiglioli
- Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy
| | - Alberto Baldasseroni
- Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Firenze, Italy
| | - Giovanna Spatari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, Piazza Pugliatti, Messina, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy
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Mulroy E, Pelosi L. Carpal tunnel syndrome in advanced age: A sonographic and electrodiagnostic study. Muscle Nerve 2019; 60:236-241. [DOI: 10.1002/mus.26496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Eoin Mulroy
- Department of Neurology and Clinical NeurophysiologyAuckland District Health Board 2 Park Road, Grafton, Auckland 1023 New Zealand
| | - Luciana Pelosi
- Bay of Plenty District Health Board Tauranga New Zealand
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