Carpal Tunnel Research Articles

Sensitivity and specificity of electrodiagnostic parameters in diagnosing carpal tunnel syndrome.

The sensitivity and specificity of electrodiagnostic parameters in diagnosing carpal tunnel syndrome (CTS) have been reported differently, and this study aims to address this gap. This case-control study was conducted on 57 cases with CTS and 58 controls without complaints, such as pain or paresthesia on the median nerve. The main assessed electrodiagnostic parameters were terminal latency index (TLI), residual latency (RL), median ulnar F-wave latency difference (FdifMU), and median sensory latency-ulnar motor latency difference (MSUMLD). The mean age in cases and controls were 50.7 years (SD 9.9) and 47.9 years (SD 12.1), respectively. The CTS severity was mild in 20 patients (34.4%), moderate in 19 patients (32.8%), and severe in 19 patients (32.8%). The sensitivity and specificity of the electrodiagnostic parameters in diagnosing CTS were as follows: TLI 75.4% and 87.8%; RL 85.9% and 82.5%; FdifMU 87.9% and 82.9%; and MSUMLD 94.8% and 60.0%, respectively. Our findings indicated that electrodiagnostic parameters are significantly associated with the clinical manifestation of CTS, and are associated with high diagnostic accuracy in CTS diagnosis. However, further studies are required to highlight the role of electrodiagnostic parameters and their combination in CTS detection.

Top 10 Clinical Pearls in Paraproteinemic Neuropathies.

Paraproteinemic neuropathies represent an important subset of peripheral neuropathies. Once identified, further evaluation into the paraproteinemic subtype, clinical exam pattern, and electrodiagnostic phenotype helps clarify if the paraproteinemia is coincidental or causal of the neuropathy, as not all paraproteinemias cause neuropathy. Of all paraproteinemias, immunoglobulin M (IgM)-associated peripheral neuropathy, or IgM neuropathy, is of particular importance as half of IgM neuropathies also harbor anti-myelin-associated glycoprotein antibodies, which produce a characteristic demyelinating pattern on nerve conduction testing. Immunoglobulin G and immunoglobulin A paraproteinemias are less strongly associated with peripheral neuropathy, except in the setting of multiple myeloma or osteosclerotic myeloma (POEMS syndrome), which have characteristic systemic features. In multiple myeloma, chemotherapy is more likely to result in neuropathy than the myeloma itself. Finally, the presence of systemic features (e.g., cardiomyopathy, nephropathy, recurrent carpal tunnel syndrome, and autonomic insufficiency) should raise concern for hereditary or acquired light (AL) chain amyloidosis. AL amyloidosis can occur in the setting of any light or heavy chain paraproteinemia. Central to the proper evaluation of paraproteinemic neuropathy is electrodiagnostic testing, which helps delineate axonal versus demyelinating paraproteinemic neuropathy, the latter often misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy.

Clinical-applied anatomy of the carpal tunnel regarding mini-invasive carpal tunnel release.

Carpal tunnel release is a widely performed procedure. Despite a high success rate, iatrogenic neurovascular injuries can occur which lead to a painful and unsatisfying outcome. This study conducted a detailed examination of the anatomy of the carpal tunnel and the proximity of neurovascular structures that are particularly susceptible to injury, especially in the context of minimally invasive carpal tunnel release procedures. The anatomy of the carpal tunnel of 104 wrists of 52 body donors was examined. The precise anatomical location and the presence of variations were recorded for the median nerve, ulnar nerve, ulnar artery and Berrettini branch. The distance between the median nerve, the ulnar artery, the ulnar nerve, and the Berrettini branch was measured in a proximo-distal and radio-ulnar direction in relation to the distal ulnar end of the carpal tunnel. The authors identified four main dangerous anatomical situations. (1) A proximal separation of the Long-Finger/Ring-Finger branch of the median nerve together with a narrow safe-zone; (2) an ulnar take-off of the recurrent muscle branch of the median nerve with a close radio-ulnar distance to the distal ulnar end of carpal tunnel; (3) an ulnar arterial arch lying close to the transverse carpal ligament; and (4) a proximal Berrettini branch also lying close to the latter. All situations are illustrated by photographs. Additionally, the authors present a sonographic carpal tunnel assessment protocol in order to reduce the risk of injury of any neurovascular structure in the proximity of the carpal tunnel. Certain patients may inherently face an increased risk of neurovascular injuries during minimally invasive carpal tunnel releases due to their anatomical variations. Four potentially risky scenarios were clearly illustrated. Consequently, one may consider conducting a preoperative ultrasound assessment of neurovascular structures at risk, when endoscopic or ultrasound-guided tunnel release are planned. In high-risk patients, open surgery should be preferred. II.

Use of machine learning methods in diagnosis of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common condition diagnosed using physical exams and electromyography (EMG) data. This study aimed to classify CTS severity using machine learning techniques. EMG data from 154 patients, including measurements of motor and sensory latency, velocity, and amplitude, were used to form a six-dimensional feature space. Classifiers such as DT, LDA, NB, SVM, k-NN, and ANN were applied, and the feature space was reduced using ANOVA, MRMR, Relieff, and PCA. The DT classifier with ANOVA feature selection showed the best performance for both full and reduced feature spaces.

Association of polymorphic variants of the GSTP1 and GSTM1 genes with signs of tunnel syndromes in patients with vibration disease (pilot study)

Introduction. The data on the association between GSTs gene variants and the risk of developing carpal tunnel syndrome (CTS) determine the feasibility of studying the relationship with changes in the nerve structure of the upper limbs identified by ultrasound examination in patients with vibration disease (VD). The aim of the study was to investigate the association of polymorphic variants of the GSTP1 and GSTM1 genes with signs of tunnel syndromes in VD patients. Materials and methods. Polymorphic variants of the GSTP1 (rs1695 and rs1138272) and GSTM1 genes in one hundred forty male VD patients were studied using PCR-RT method. High-resolution ultrasonography parameters were used to evaluate the morphological structure of the peripheral nerves of the upper limbs in patients, including the cross-sectional area (CSA) of the peripheral nerves. Results. A significant gain in CSA maximum of the median nerve was found in carriers of the GSTM1–/– genotype relative to those in the GSTM1+ polymorphic variant of the GSTM1 gene (p=0.014). At the same time, AG-GSTP1 (Ile105Val) heterozygote carriers were less resistant to vibration exposure compared to the AA homozygote ones. The AG carriers had a shorter period of vibration exposure (p=0.017), which was observed against the background of a pronounced tendency to a decrease in the period of vibration exposure at the time of VD diagnosis (p=0.034). Limitations. Limitations include the small number of examined patients and the analysis of associations of polymorphic variants of GSTs genes only with CSA values without taking into account the clinical and functional status of patients. Conclusion. The results obtained indicate that GSTs genes involved in protection against oxidative stress, may be associated with the development of CTS in VD patients. Further investigations are needed involving a larger number of VD patients with simultaneous analysis of the morphological structure of peripheral nerves, as well as of electrophysiological and clinical studies.

Comparing the efficacy of multiple quantitative and qualitative ultrasound parameters for the diagnosis of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a compression neuropathy causing significant morbidity. Over the years, ultrasound has been evaluated as an alternative to nerve conduction study (NCS) for diagnosing CTS, however, there is no consensus as to which ultrasound parameter is the best. Our study aimed to determine and compare the efficacy of various ultrasound-based variables for diagnosis of CTS. 80 patients with clinical suspicion of CTS underwent ultrasound examination with calculation of cross-sectional area (CSA), delta CSA, wrist forearm ratio (WFR), palmer bowing (PB), flattening ratio (FR), flexor retinaculum thickness (FT), and evaluation of echogenicity and vascularity of median nerve. NCS was taken as the gold standard and the diagnostic efficacy of all these variables was compared, followed by receiver operator curve (ROC) analysis. Delta CSA had the highest accuracy (91.25%), followed by CSAc (80%), WFR (78.75%), and PB (73.75%). Youden's index and sensitivity were highest for delta CSA (0.783 and 96.15% respectively), while specificity was highest for FT (89.29%). The highest area under the curve was noted for delta CSA (97.1%), followed by WFR (AUC = 87.4%) and CSAc (AUC = 86.0%). Delta CSA was found to be the best ultrasound parameter for diagnosis of CTS, followed by CSAc, WFR, and PB, and can be used as an alternative to NCS. Using ROC analysis this study also predicted the best cut-off values for these parameters which could improve their diagnostic accuracy and further research is needed to confirm these findings.

Effectiveness of Contrast Bath and Nerve Gliding Exercises in Carpal Tunnel Syndrome Among Software Workers

Carpal Tunnel Syndrome (CTS) is a complex symptom resulting from compression of the median nerve at the carpal tunnel. Locations of monitors, keyboard (or) mouse are associated with musculoskeletal problems. Among musculoskeletal problems, Carpal tunnel syndrome (CTS) is commonly reported in computer professionals. The purpose of this study was to examine the effectiveness of contrast bath and nerve gliding exercises for carpal tunnel syndrome in software workers. 30 subjects (20 males and 10 females) were participating in this study based on inclusion and exclusion criteria. They were assigned into groups Group A and B with 15 subjects each. Group A (Experimental group) received Contrast bath and Nerve Gliding Exercises, while Group B (Control group) received conventional exercises for the wrist. The outcome measures used were NPRS and ROM. Statistical analysis was done using paired-t test. On comparing the pre-test and post-tests within Group A & Group B on the Numerical Pain Rating Scale (NPRS), wrist flexion and extension Range of Motion (ROM) show a significant difference in mean values at P ≤ 0.001. There was a significant difference in the mean values of NPRS (6.33 to 3.40), wrist flexion (54.00 to 72.66), and wrist extension (55.66 to 72.80) in subjects from Group A who underwent contrast bath and nerve gliding exercises, compared to the significant difference in the mean values of NPRS (6.26 to 4.46), wrist flexion (53.66 to 63.00), and wrist extension (56.00 to 61.66) in subjects from Group B, which served as the control group.

Leveraging wearable sensors and machine learning for posture-based detection of carpal tunnel syndrome

Abstract Carpal tunnel is associated with long-term use of the wrist and hand for various activities such as typing, welding, or poor working postures. Carpal Tunnel Syndrome (CTS) may cause severe pain and discomfort in the hand and wrist, and in some circumstances, surgery becomes inevitable. The objective of this study is to prevent typing postures, which can be ascertained as predisposing subjects to CTS development. The data used in this study is an array of wrist wearable sensors to capture flexion, extension, and bending of fingers while using a keyboard or mouse. Machine learning is employed on the data in order to identify risk factors indicative of a high probability of CTS. The analyzed models are linear regression, Support Vector Machine, Random Forest, Multilayer Perceptron, Convolution Neural Network, and Long Short Term Memory. The conditions for assessing the performance of the data models include RMS error, coefficients of determination, and mean absolute percentage error. In this research, I conducted an exploratory data analysis (EDA) to gain an initial understanding of the dataset. Following the exploratory phase, I applied feature extraction techniques, specifically Principal Component Analysis (PCA). As put forward for the proposed research, the strategies to prevent risky occupations have broad potential at the present time, especially in the case of CTS when preventing repetitive wrist movements.

The Impact of Lymphatic Drainage and Nerve Mobilization Techniques on Nerve Morphology in Mild-to-Moderate Carpal Tunnel Syndrome: A Randomized Controlled Trial

Objective To investigate whether nerve mobilization related to nerve mobility or the removal of edema using lymphatic drainage affects the cross-sectional area of the nerve, hand function, and symptom severity in carpal tunnel syndrome. Design The study is a prospective randomized controlled trial. Data were analyzed between groups using ANOVA, Chi-squared test, and Kruskal–Wallis test. Setting Treatment lasted 4 weeks. Splint group wore the splint daily. Splint+manual lymphatic drainage received lymphatic drainage 5 days a week. Splint+nerve mobilization performed neuromobilization exercises as home exercises 5 days a week. Evaluations were conducted before and after 4 weeks of treatment. Participants The study included 80 patients with mild-to-moderate carpal tunnel syndrome. Interventions The patients were randomly divided into three groups: splint (n = 27), splint+manual lymphatic drainage (n = 27), or the splint+nerve mobilization (n = 26). Main Outcome Measures The main outcome measures were ultrasound assessments and the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Boston Functional Status Scale). Results Compared to the other groups, the nerve cross-sectional area decreased at both the carpal tunnel (p = 0.003) and mid-forearm (p = 0.014) levels in the drainage group. Nerve mobilization did not result in a significant change in the nerve cross-sectional area. All groups showed significant improvements in both symptom severity and functional status scores (p < 0.001). Conclusion The reduction of edema through lymphatic drainage contributes to a decrease in the cross-sectional area of the median nerve. Additionally, all three methods appear to positively impact the functional capacity of the hand and alleviate symptoms.

Hand Surgical Operating Room Size Allocation: A Comparative Space Utilisation Study.

Background: This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. Methods: A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia. Space requirements were compared to general surgery cases (laparoscopic appendectomy) and general orthopaedic surgery cases (cephalomedullary nail [CMN]). Necessary operative equipment was measured (ft2) to calculate requirements for each procedure. Results: Large hand cases such as digit replantation necessitated the most OR space (125 ft2), followed by general orthopaedic cases (CMN; 118 ft2), medium-sized hand cases (CRPP phalanx; 107 ft2), general surgery laparoscopic appendectomy (68 ft2), small hand cases (CTR; 85 ft2) and minor procedures (49 ft2). Conclusions: Hand procedures can be divided into major procedures requiring significant OR space (125 ft2), medium procedures in standard OR suites (107 ft2), procedures in small ORs with anaesthesia (81 ft2) or office-based setting without anaesthesia (49 ft2). These findings help define space utilisation for hand procedures and may have practical implications related to efficiency, cost and patient safety in the hospital and outpatient setting. Level of Evidence: Level IV (Economic and Decision Analyses).

Manual Therapy vs. Surgery: Which Is Best for Carpal Tunnel Syndrome Relief?

Background: Carpal Tunnel Syndrome (CTS) is a common condition characterized by compression of the median nerve, leading to pain, numbness, and hand dysfunction. Both manual therapy and surgical decompression are widely used interventions, but their comparative effectiveness remains uncertain. Methods: A systematic review and a meta-analysis were conducted to compare the short- and long-term efficacy of manual therapy versus surgery for CTS. Studies were selected based on randomized controlled trials (RCTs) that met the inclusion criteria, focusing on outcomes such as pain intensity, hand function, symptom severity, and quality of life. Data were extracted and analyzed by using standardized tools to assess treatment effects. Results: Five RCTs with a total of 533 participants were included. Manual therapy was more effective for short-term pain relief, with significant improvements at 1 and 3 months compared with surgery. However, at 6 to 12 months, surgical intervention provided greater improvements in hand function and symptom severity. Quality-of-life improvements were similar in both groups. Risk of bias was moderate to low across the studies, with limitations in blinding due to the nature of the interventions. Conclusions: Manual therapy offers effective short-term relief for CTS, making it a viable option for patients with mild to moderate symptoms. Surgery provides more durable, long-term outcomes, particularly for severe cases. The choice of treatment should be individualized, considering patient preferences and symptom severity.

Surgical Treatment of Periarticular Distal Radius Fracture in Elderly: A Systematic Review

Background/Objectives: The treatment of periarticular distal radius fractures remains challenging. Different surgical treatment options have been proposed as alternatives to conservative treatment. This systematic review aims to compare the functional outcomes, radiological outcomes, and complications among volar locking plates (VLPs), Kirschner-wire fixations, and external fixations (EFs) for distal radius fractures in patients aged 60 years and older. Methods: We conducted a comprehensive search of PubMed, Cochrane, and Science Direct databases assessing the effects of VLP, EF, and K-wire treatments for distal radius fractures in patients aged 60 years and over. The primary outcome was the evaluation of the range of motion (ROM) degrees after three surgical procedures, trying to assess the best treatment option. The secondary outcome included evaluation of the Disabilities of the Arm, Shoulder, and Hand (DASH) score, quick-DASH score, Patient-Rated Wrist Evaluation (PRWE) score, Visual Analog Scale (VAS) score, grip strength, radiographic assessment, and complications comparing VLPs, EFs and K-wires. Results: A total of 23 studies were included, comparing VLP, EF, and K-wire fixation. The overall population comprised 5618 patients, with 4690 females and 1015 males, of which 4468 patients were treated with VLP, 503 with EF, and 647 with K-wire. The most common complications among the VLP group were complex regional pain syndrome (7.5%) and carpal tunnel syndrome (6.8%); for the EF group, infections (9.8%) and carpal tunnel syndrome (6.8%); and for the K-wire group, carpal tunnel syndrome (7.5%) and infections (6.9%). Conclusions: VLP showed better clinical outcomes in the first few months after treatment. However, these differences decreased over time and became similar after one year. EF and K-wire fixations remain easier to manage during surgery.

Updates on Common Mononeuropathies.

This article provides an overview of the most common mononeuropathies. It includes a description of the neuroanatomy and function of each nerve which allows clinical localization of the lesion. It also describes the clinical presentation, findings in electrodiagnostic studies, updates in imaging including neuromuscular ultrasound and magnetic resonance neurography, and recommended treatment. While mononeuropathies may be part of polyneuropathy, this scenario is beyond the scope of this article. The most common mononeuropathy is carpal tunnel syndrome. Its prevalence in the United States is estimated at 50 per 1,000. The second most common entrapment neuropathy is ulnar neuropathy at the elbow. The incidence was calculated as 20.9% in a 2005 study. The most common compressive neuropathy of the lower extremity is peroneal neuropathy. Other common mononeuropathies included in this article are radial neuropathy, tibial neuropathy, and femoral neuropathy.

The quality of the electrodiagnostic referral system and the electrodiagnostic patterns in a sample of Egyptian patients

BackgroundElectrodiagnosis is a localizing, diagnostic, and prognostic tool for individuals with suspected neuromuscular diseases. In addition to detailed history taking and thorough clinical examination, correct execution and interpretation of these tests can provide vital insights into the underlying neuromuscular disorders and frequently guide the need for proper management decision. The request for an electrodiagnosis examination should include brief clinical information and a provisional clinical diagnosis; this enhances the efficient easy performance of the test. The current study aims to detect the pattern of neuromuscular diseases in the Alexandria Main University Hospital, Egypt, and to evaluate the quality of the referral system to the electrodiagnosis unit.ResultsThe study included 371 patients, out of which, 65% were referred from the Governmental Specialized Medical Councils and the Neurosurgery department. Although sensory complaints were the main reason for referral, yet 28.8% of patients did not show any electrodiagnosis abnormality. A compatible referral note led to shorter test times and fewer electromyography needle insertions.ConclusionDisorders of the peripheral nerves are the most frequent neuromuscular diseases referred to the electrodiagnosis unit with carpal tunnel syndrome being the most common disorder. A compatible referral letter is necessary when requesting an electrodiagnosis test, to save the physician time and focus on targeted procedures.

Clinical Outcome of Endoscopically Assisted Mini-open Carpal Tunnel Release.

Background: Carpal tunnel syndrome (CTS) can be treated surgically. Although the minimally invasive open surgical method is widely used, it is not possible to directly visualise the entire length of the carpal tunnel, especially the proximal end, which is on the side away from the skin incision. In this study, we performed a mini-open carpal tunnel release with endoscopic assistance to release the entire length of the carpal tunnel under direct vision and investigated the treatment outcomes. Methods: The surgical method included an incision of ≤2 cm in the palm, cutting of the transverse carpal ligament under direct vision and cutting of the forearm fascia under endoscopic vision. A uniquely designed sheath was used for the endoscopic resection. We investigated the sex, age, medical history, symptoms, examination findings, anaesthesia method, operation time, thenar motor branch variation, postoperative complications, presence or absence of pillar pain and final examination findings of the target patients. Results: A total of 100 hands (85 patients) were included. Anatomical variations of the thenar motor branches were observed in 19 hands. At the final follow-up, hand numbness improved in all patients, while mild numbness was observed in 25 hands. The abductor pollicis brevis muscle improved in all patients with paresis, but 8 of the 27 hands remained completely paralysed. Pillar pain was observed in 36 hands at 8 weeks postoperative, but the condition improved in all patients. The clinical outcomes of this study were good with no cases of major complications or reoperation. Conclusions: The minimally invasive open surgical method described here can be reliably used to release the forearm fascia proximal to the carpal tunnel. The thenar motor branch can also be confirmed under direct visualisation, making it a relatively safe and useful approach. Level of Evidence: Level Ⅳ (Therapeutic).

The Role of Confirmatory Testing in Carpal Tunnel Syndrome: Electrodiagnostic Study, Ultrasound and CTS-6.

Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy. The reference standard for the diagnosis of CTS remains an area of controversy. The diagnosis can be established clinically, but options for confirmatory testing include electrodiagnostic studies, ultrasound and diagnostic aids such as the CTS-6 score. This review article summarises the current evidence for each confirmatory testing modality, contrasts their advantages and disadvantages and discusses future directions for investigation. Level of Evidence: Level V (Diagnostic).

The Effect of Patient-Reported Allergies on Patient-Reported Outcomes in Carpal Tunnel Release.

Patient-reported allergies have been shown to be a risk factor for poor surgical outcomes in a variety of orthopedic procedures. The relationship between patient-reported allergies and outcomes in carpal tunnel surgery remains unclear. A retrospective electronic medical chart review was conducted on 390 patients who underwent primary carpal tunnel releases, without concomitant procedures, who completed preoperative and postoperative Quick Disabilities of Arm, Shoulder, and Hand or Patient-Rated Wrist Evaluation scores, with a minimum of 1-year follow-up. Patient demographic data and patient-reported outcome measures were collected. Patients were grouped based on the number of allergies reported (≤3 allergies or ≥4 allergies), and statistical analysis was performed. Three hundred and ninety patients were included in the analysis (347 patients [89.0%] with ≤3 allergies; 43 patients [11.0%] with ≥4 allergies). Patients were predominantly female (n = 243, 62.3%), and the median age at surgery was 61 years. Patients with ≥4 allergies were more likely to be female (88.4% vs 59.1%), older (64.3 years vs 60.3 years), and more likely to be taking psychotropic medication (51.2% vs 28.2%). No differences were seen in patient-reported outcomes at any time point preoperatively or postoperatively, with both groups showing similar postoperative improvement. Patients with a high number of reported allergies have similar improvement in patient-reported outcomes following carpal tunnel release as low-allergy cohorts.

Study of Carpal Tunnel Syndrome Using Electroneurography and Ultrasound in a Spanish Cohort

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Its diagnosis is clinically supported by the electroneurography (ENG). The use of ultrasound (US) has increased in recent years. Our objectives are: to describe the ENG and US findings in patients with suspected CTS, based on age, sex and anthropometric data; and to study the correlation of both tests based on the severity of CTS. Material and methods: prospective study of patients with suspected CTS who undergo ENG and US. ENG examination: antidromic sensory median at 3rd and 4th finger; distal motor of median. US: crosssectional area (CSA) prior to or within the tunnel (higher values). Inclusion criteria: patients aged 18 to 85 years. Exclusion criteria: previous trauma or previous surgery for CTS or forearm, carpus or hand. Statistical study with the SPSS 29.0 program. Results: 400 nerves from 266 patients (52.59 ± 12.09 years) were studied, 183 women and 83 men. According to the ENG, 129 did not have CTS, 61 were incipient, 113 mild, 19 moderate and 75 severe. The mean CSA was 8.37 ± 1.21 mm2 in non-CTS, 10.09 ± 1.45 mm2 in early, 11.33 ± 1.87 mm2 in mild, 14.63 ± 1.92 mm2 in moderate and 15.46 ± 3.33 mm2 in severe CTS, with a significance of p&lt;0.01 (95% CI) in the ANOVA test. The highest and inverse correlation appears between the conduction velocities (CV) at the 4th finger with CSA (-0.816) and CV at the 3rd finger with CSA (-0.800), which coincides with the most sensitive ENG values for the diagnosis of CTS. Discussion: CSA is an appropriate test as a complement to ENG in the diagnosis of CTS. However, it has limitations when establishing the cut-off point between normality and neuropathy, as well as when classifying based on severity

7061 Incidence of Adrenal Crisis In Congenital Adrenal Hyperplasia (CAH) Patients During A Prospective Monitored Long-Term Study Of Modified-Release Hydrocortisone (MRHC) Capsules, (Efmody)

Abstract Disclosure: R.J. Ross: Consulting Fee; Self; Diurnal. D.P. Merke: Research Investigator; Self; Diurnal. A. Mallappa: Research Investigator; Self; Diurnal. W. Arlt: Research Investigator; Self; Diurnal. A. Brac de la Perriere: Research Investigator; Self; Diurnal. A.L. Hirschberg: Research Investigator; Self; Diurnal. J.D. Newell-Price: Research Investigator; Self; Diurnal. A. Prete: Research Investigator; Self; Diurnal. A. Rees: Research Investigator; Self; Diurnal. N. Reisch: Research Investigator; Self; Diurnal. M. Quinkler: Research Investigator; Self; Diurnal. P.A. Touraine: Research Investigator; Self; Diurnal. K. Maltby: Employee; Self; Diurnal. J. Quirke: Employee; Self; Diurnal. N. Aslam: Employee; Self; Diurnal. H. Coope: Employee; Self; Diurnal. J. Porter: Employee; Self; Diurnal. Background: Adrenal crisis is the leading cause of excess mortality in patients with CAH[1]. Retrospective studies report an adrenal crisis incidence of 5-10/100 patient years (PY), with mortality 0.5/100 PY2. Modified-release hydrocortisone (MRHC) capsules, (Efmody), replicate cortisol diurnal rhythm and improve androgen control in CAH compared to standard glucocorticoid therapy2. Here, we report the incidence of adrenal crisis in CAH patients from a prospective study of MRHC in CAH patients. Methods: Patients completing MRHC Ph2 and Ph3 studies were eligible to enter a single-arm, open-label extension study. Study visits occurred at baseline, weeks 4, 12, 24 and 6-monthly thereafter. The primary endpoint was the safety of MRHC over time. Adrenal crisis was defined according to Allolio 20153. MRHC doses were adjusted on the basis of an adrenal insufficiency checklist, and measurement of androstenedione (A4) and 17-hydroxyprogesterone (17-OHP) at 9am and 1pm. Results: 91 patients entered the study, mean age 37 years, 68% female, 32% male. 22 discontinued; 11 at patient request, 5 due to pregnancy, 2 undergoing fertility treatment, 2 at physician/sponsor request, 1 due to an AE (carpal tunnel syndrome), and 1 due to death (myocardial infarction). Median treatment duration was 1500 days, range 0.2 to 5.8 years. Median MRHC dose at study entry was 30mg/day, reducing to 20mg/day from 24-weeks until end of study. Signs and symptoms of adrenal insufficiency due to under-treatment were reported for 41 (45.1%) participants, most frequently fatigue which was reported at some point by 41.8% of all participants. Signs and symptoms of overtreatment were reported for 25 (27.5%) participants, most frequently sudden weight gain which was reported at some point by 16.5% of all participants. Signs and symptoms of both over- and undertreatment occurred predominantly during the first 24 weeks. The study encompassed 357 participant years, and 18 adverse events considered indicative of adrenal crisis occurred in 7 participants, giving an incidence rate of 5.043 adrenal crises / 100 PY. Conclusions: Data from this longest prospectively monitored study in CAH suggest that the incidence of adrenal crisis on MRHC is at the low end of that reported in retrospective studies and the safety profile of MRHC is otherwise similar to immediate release hydrocortisone.

Morphometric indices and carpal tunnel syndrome: aradiological study in female patients.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy syndrome of the upper extremities. The carpal tunnel is an osteofibrous canal that is medially bordered by hamulus ossis hamati and pisiform bone, and laterally by scaphoid and trapezoid bones. In this retrospective case-control study, we investigated the relationship between radiologically measured morphometric indices and CTS in female patients. Clinical, radiological, and demographic data were collected for 55 hands of 40 female patients diagnosed with CTS and 58 hands of control subjects. Radiological measurements included various morphometric parameters derived from wrist and hand X-rays. Statistical analysis was conducted to assess associations between morphometric indices and CTS. Significant associations were observed between CTS and several morphometric indices, including carpal height, capitate length, palm length, and others. Notably, these values were lower in CTS patients, suggesting a potential link between reduced carpal tunnel volume and increased pressure due to synovial hypertrophy. Additionally, a newly introduced index, Scaphoid Pisiform Width Index (SPWI), showed promise in assessing the proximal part of the carpal tunnel. It was found that the values for Capitate length, Carpal height, Palm length, SPWI, and Palmar ratio were lower in the patient group. These results suggested that decreasing volume of the carpal tunnel allows for an easier increase in carpal tunnel pressure due to increased synovial hypertrophy and the carpal bone configuration affects the proximal part of the carpal tunnel, and influences the compression of the median nerve, in female patients.