Abstract
Objectives: Analyze the literature data on the incidence and manifestation of carpal tunnel syndrome (CTS), as well as the pathogenesis and treatment options. Perform a specially designed, validated test - Pain Detection. Evaluate the objective state of patients with CTS - sensory impairment, compression test. Assess patients’ neurologic and neurophysiologic data before and after the blockade and evaluate its effectiveness. Perform a specially designed, validated test - Patients` Global Impression of Change scale (PGIC) one month after corticosteroid injection (CSI).Methods and Materials: The study includes an analysis of 55 arms of patients of different age with mild and moderate CTS who came for a neurological examination at the Neurology Outpatient Department of the Pauls Stradiņš Clinical University Hospital during the period of 01.08.2018 – 01.01.2019. All patients were analyzed clinically and neurophysiologically before CSI and one month after CSI. A Pain Detect scale, PGIC scale, compression tests and sensory tests were used for the evaluation of clinical symptom. A median nerve sensory and motor nerve conduction study was performed.Results: According to the Pain Detect scale, 60% of patients showed neuropathic pain before CSI, and 78% of patients presented clinical effectiveness after CSI. 98% of patients present clinical effectiveness after CSI in the PGIC scale. 85% of patients had improvement in neurophysiological studies – motor distal latency decreased after CSI. Before CSI, the average motor distal latency was 5.7ms (range 4.5-12.9ms SD±1.5), which was on average 130% from the maximal norm (range 102- 293 SD±36). After the CSI, the average motor distal latency was 5.2ms (range 3.8-10.7ms SD±1.3), which was on average 120% from the maximal norm (range 88-243 SD±30). We didn’t find any significant correlation between the improvement of the patient's clinical condition and the improvement of electrophysiological outcomes.Conclusions: The study concludes that the Pain Detect sensitivity for neuropathic pain evaluation of patients with CTS is 60%. Patients show clinical and neurophysiological improvement after CSI, but there is no correlation between neurophysiological and clinical improvement. The study concludes that the PGIC scale can be used to quickly assess the effectiveness of therapy.
Highlights
Carpal tunnel syndrome (CTS) is the most common compression neuropathy (Atroshi et al, 1999; Blanc et al, 1996; Patterson, 2002; Katz et al, 2002)
According to the Pain Detect scale, 60% of patients showed neuropathic pain before corticosteroid injection (CSI), and 78% of patients presented clinical effectiveness after CSI. 98% of patients present clinical effectiveness after CSI in the Patients Global Impression of Change scale (PGIC) scale. 85% of patients had improvement in neurophysiological studies – motor distal latency decreased after CSI
The study concludes that the Pain Detect sensitivity for neuropathic pain evaluation of patients with CTS is 60%
Summary
Carpal tunnel syndrome (CTS) is the most common compression neuropathy (Atroshi et al, 1999; Blanc et al, 1996; Patterson, 2002; Katz et al, 2002). “Tunnel” we define as a carpal tunnel. Median Nerve Compression Syndrome was first reported in medicine in 1854, but only a century later it was defined as CTS which we use (Stecco et al, 2008). It is possible to diagnose CTS at a very early stage of the disease development and it tends to progress over time. CTS is a very topical problem because the disorder it causes can have a significant impact on the ability to work, social activity and care
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