Carpal Tunnel Questionnaire Research Articles

Acute Carpal Tunnel Syndrome: Early Nerve Decompression and Surgical Stabilization for Bony Wrist Trauma.

We identified all patients treated at our trauma center following this protocol between January 1, 2014 and December 31, 2019. All patients were clinically reviewed at least 12 months after surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire, the Boston Carpal Tunnel Questionnaire, and sensory assessment with Semmes-Weinstein monofilament testing. The study group was made up of 35 patients. Thirty-three patients were treated within 36 hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36 hours report excellent outcomes at medium term follow-up. We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24 hours; however, where a short period of observation was required, excellent results were generally achieved when treatment was completed within 36 hours.

Early Postoperative Recovery after Modified Ultra-Minimally Invasive Sonography-Guided Thread Carpal Tunnel Release.

Thread carpal tunnel release (TCTR) has been reported to be safe and effective for the treatment of carpal tunnel syndrome. The aim of this study is to evaluate the modified TCTR for safety, efficacy, and postoperative recovery. Seventy-six extremities in 67 patients undergoing TCTR were analyzed pre- and postoperatively using clinical parameters and patient-reported outcome measures. Twenty-nine men and 38 women with a mean age of 59.9 ± 18.9 years underwent TCTR. The mean postoperative time to resume activities of daily living was 5.5 ± 5.5 days, analgesia was completed after 3.7 ± 4.6 days, and return to work was achieved after a mean of 32.6 ± 15.6 days for blue-collar workers and 4.6 ± 4.3 days for white-collar workers. The Boston Carpal Tunnel Questionnaire (BCTQ) and Disability of Arm, Shoulder, and Hand (DASH) scores were comparable with previous studies. Overall, two persistent compressions and one recurrence required open reoperation (3.9%). All three had been operated in the initial phase, and none required reoperation after an additional safety step was introduced. No other complications occurred. TCTR surgery appears to be a safe and reliable technique with almost no wound and scarring and a potentially faster recovery time than open techniques. Although our technical modifications may reduce the risk of incomplete release, TCTR requires both ultrasound and surgical skills and has a considerable learning curve.

Bangla Version of Lymphedema Life Impact Scale Version 2: Reliability and Validity

Background: The use of disease-specific scales would be more valuable for the evaluation of the effects of lymphedema. To manage accordingly, and maintain the optimum quality of life of lymphedema patient, a validated outcome measure is helpful.Objective: To investigate the reliability and validity of Bangla Version of Lymphedema Life Impact Scale Version 2 (B-LLIS V2).Materials and Methods: A structured process that included translation, verification, compromise assessment, reverse translation, feedback, and final correction. B-LLIS V2 reliability and validity were conducted on 52 lymphedema patients. The reliability was evaluated by performing internal consistency and test–retest analyses. Its validity was assessed by comparing the B-LLIS V2 with other scales implying Pearson’s correlation.Results: Internal consistency with Cronbach’s alpha was 0.92 for total score and 0.79, 0.82, 0.80 and 0.78 for physical, psychosocial, functional, and infection respectively. The calculated overall tool score in Intra-class correlation co-efficient (ICC) for test-retest reliability was 0.94 and among subscales, the scores were 0.92, 0.95, 0.91 and 0.93 for physical, Psychosocial, functional, and infection respectively, which signified substantial reliability. The overall values of Pearson’s correlation coefficient for the construct validity were 0.91, 0.78 and 0.86 against reference standard Bengali SF-36 Health Survey, Bangla version of the Boston Carpal Tunnel Questionnaire and Bangla Start Back Screening Tool, and they all were statistically significant.Conclusions: B-LLIS V2 is a valid and reliable tool for the assessment of impairment due to lymphedema.
 KYAMC Journal Vol. 13, No. 04, January 2023: 198-203

Multiple Compression Syndromes of the Same Upper Extremity: Prevalence, Risk Factors, and Treatment Outcomes of Concomitant Treatment

Multiple nerve compression syndromes can co-occur. Little is known about this coexistence, especially about risk factors and surgical outcomes. Therefore, this study aimed to describe the prevalence of multiple nerve compression syndromes in the same arm in a surgical cohort and determine risk factors. Additionally, the surgical outcomes of concomitant treatment were studied. The prevalence of surgically treated multiple nerve compression syndromes within one year was assessed using a review of patients' electronic records. Patient characteristics, comorbidities, and baseline scores of the Boston Carpal Tunnel Questionnaire were considered as risk factors. To determine the treatment outcomes of simultaneous treatment, patients who underwent concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) were selected. The treatment outcomes were Boston Carpal Tunnel Questionnaire scores at intake and at 3 and 6 months after the surgery, satisfaction 6 months after the surgery, and return to work within the first year. A total of 7,867 patients underwent at least one nerve decompression between 2011and 2021. Of these patients, 2.9% underwent multiple decompressions for the same upper extremity within one year. The risk factors for this were severe symptoms, younger age, and smoking. Furthermore, the treatment outcomes of concomitant CTR and CubTR did notdiffer from those of CubTR alone. The median time to return to work after concomitant treatment was 6 weeks. Patients who underwent CTR or CubTR alone returned to work after4 weeks. Approximately 3% of the patients who underwent surgical treatment for nerve compression syndrome underwent decompression for another nerve within 1 year. Patients who report severe symptoms at intake, are younger, or smoke are at a greater risk. Patients with carpal and cubital tunnel syndrome may benefit from simultaneous decompression. The time to return to work may be less than if they underwent decompressions in separate procedures, whereas their surgical outcomes are comparable with those of CubTR alone. Therapeutic IV.

Effectiveness of kinesio taping and night splinting along with physical therapy intervention on symptoms and functionality: A Double-Blind Randomized Controlled Trial for Moderate Carpal Tunnel Syndrome.

To compare the effects of kinesio taping (KT) and night splinting (NS) along with physical therapy intervention on symptoms in patients with moderate carpal tunnel syndrome (CTS) undergoing rehabilitation. In this double-blind, randomized controlled trial, forty-five patients with moderate CTS were included and randomly assigned to three groups: KT Group (n = 15), NS Group (n = 15), and control group (CG) (n = 15). All patients received 20 physical therapy intervention sessions. The primary outcome was self-reported disability status measured by the Boston Carpal Tunnel Questionnaire, and secondary outcomes were pain and paresthesia (rest, activity, and night) measured by the Numeric Rating Scale. Outcomes were recorded at baseline and four weeks. All patients showed clinically meaningful improvements for all outcome measures over time (p < 0.05). The intergroup analysis revealed that the KT group demonstrated better results in all measures than the NS (p < 0.05) except for pain during activity (p = 0.054), at night (p = 0.191), and paresthesia at rest (p = 0.575). Additionally, the KT group showed better outcomes than the CG (p < 0.05) except for the activity pain (p = 0.022). However, there were negligible differences between NS and CG (p > 0.05). Kinesio taping in combination with physical therapy intervention is more effective than NS in combination with physical therapy intervention or physical therapy intervention alone and may be recommended.

Comparison efficacy of ultrasound-guided needle release plus corticosteroid injection and mini-open surgery in patients with carpal tunnel syndrome.

This retrospective study was to compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection vs. mini-open surgery in patients with carpal tunnel syndrome (CTS). From January 2021 to December 2021, 40 patients (40 wrists) with CTS were analyzed in this study. The diagnosis was based on clinical symptoms, electrophysiological imaging, and ultrasound imaging. A total of 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A), and the other 20 wrists were treated with mini-open surgery (Group B). We evaluated the Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of the median nerve), and ultrasound parameters (cross-sectional area, flattening ratio, and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time, and complications were also recorded for the two groups. The Boston carpal tunnel questionnaire and electrophysiological and ultrasound outcomes at preoperatively and 3 months postoperatively had a significant difference for each group (each with P < 0.05). There were no complications such as infection, hemorrhage, vascular, nerve, or tendon injuries in both groups. Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment, and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.

The Inlet and Outlet Ratio: Retrospective and Prospective Study on an Improved Diagnostic Ultrasound Tool for Carpal Tunnel Syndrome

This study hypothesized that ratios of sonographic cross-sectional areas (CSAs) throughout the median nerve provide a more reliable tool for diagnosing carpal tunnel syndrome (CTS) than a single CSA value. We first tested this hypothesis in a retrospective cohort and subsequently confirmed it in a prospective blinded case-control series. Seventy patients were included in the retrospective study, and 50 patients and matched controls were included for the prospective study. We evaluated 4 CSAs, at the forearm, inlet, tunnel, outlet, and their ratios (Rforearm, Rinlet, Routlet, Routlet forearm) to evaluate compression of the median nerve. All patients underwent nerve conduction studies. For the prospective cohort, Disabilities of the Arm, Shoulder, and Hand scores and Boston Carpal Tunnel Questionnaire scores were evaluated, and ultrasound was performed by 2 examiners for each participant. The Boston and Disabilities of the Arm, Shoulder, and Hand scores showed worse subjective function in patients with CTS than in controls. Three ultrasonography parameters (CSAs at the inlet, Rinlet, and Routlet) correlated significantly with subjective function. Age and Rinlet were significantly correlated with severity of CTS in the nerve conduction studies. In both the retrospective and prospective patient groups, the numbers of CSAs at the inlet and outlet were significantly higher than that of CSAs at the tunnel, whereas in the control group, no such compression was found. Of the single measurements, CSAs at the inlet had the best diagnostic performance with an optimized cutoff of 11.75 mm2. The Rinlet and Routlet ratios performed even better and showed the highest adjusted odds ratios for predicting CTS of all parameters (cutoff Rinlet, 1.25; Routlet, 1.45). Inter-observer correlation was generally high, with better values for single CSAs than for ratios. The 3 CSA measurements of the median nerve and the associated ratios improved diagnostic power for ultrasonography in CTS in our study. Diagnostic I.

Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis.

In this systematic review and meta-analysis, we evaluated ultrasound (US)-guided injections of platelet-rich plasma (PRP) as conservative treatment of tendinopathies. We searched MEDLINE, EMBASE, SCOPUS, OVID, and the Cochrane Library to identify randomized controlled trials (RCT) on the use of US-guided PRP for tendinopathies. We found 33 RCT (2,025 subjects) that met our inclusion criteria: 8 in lateral epicondylitis, 5 in plantar fasciitis, 5 in Achilles tendinopathy, 7 in rotator cuff tendinopathy, 3 in patellar tendinopathy and 5 in carpal tunnel syndrome. PRP, given as a single injection (20 trials) or multiple injections (13 trials), was compared to US-guided injection of steroids, saline, autologous whole blood, local anesthetic, dry needling, prolotherapy, bone marrow mesenchymal stem cells, or with non-injective interventions. The outcomes more commonly reported included pain and functional measures, subgrouped as in the short-term (<3 months from the intervention), medium-term (3 to 6 months) or long-term (≥12 months). No clear between-group differences in these outcomes were observed in patients with lateral epicondylitis, plantar fasciitis, or Achilles, rotator cuff or patellar tendinopathy. In patients with carpal tunnel syndrome, visual analog scale scores for pain at 3 and 6 months and Boston Carpal Tunnel Questionnaire severity scores at 1, 3 and 6 months were significantly lower in PRP recipients than in controls. The certainty of evidence of all these comparisons was graded as low or very low due to risk of bias, imprecision and/or inconsistency. Pain at the injection site was more common among PRP recipients than among controls receiving other US-guided injections. In patients with tendinopathies, a trend towards pain reduction and functional improvement from baseline was observed after US-guided PRP injection, but in the majority of the comparisons, the effect size was comparable to that observed in control groups.

A "Clear" Carpal Tunnel Syndrome Diagnosis on Ultrasound Examination Does Not Predict Improved Outcomes When Compared With a "Borderline" Diagnosis.

Nerve conduction studies (NCS) and ultrasound (US) remain imperfect compared with clinical diagnosis and/or diagnostic tools such as carpal tunnel syndrome-6 (CTS-6) for diagnosis of carpal tunne syndrome (CTS). One potential reason for the discrepancy between clinical diagnosis and testing is "borderline" case inclusion. This study aims to compare clinical outcomes after carpal tunnel release (CTR) between "borderline" and "clear" patients with CTS determined by NCS and US. This was a retrospective review of patients who underwent CTR. We collected NCS and US measurements of the median nerve cross-sectional area (MNCSA) at the carpal tunnel inlet, and the Boston Carpal Tunnel Questionnaire (BCTQ) scores comprised of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). Ultrasound measurements defined patients as having "borderline" (MNCSA < 13 mm2) or "clear" (MNCSA ≥ 13 mm2) CTS. The study included 94 unilateral patients with CTS. "Borderline" CTS was diagnosed in 58 patients (62%), and "clear" CTS was diagnosed in 36 patients (38%). No significant differences in BCTQ scores were found between groups. At greater than 6-month follow-up, the mean FSS was 1.44 and 1.45 for clear and borderline groups, respectively (P = .97) and the mean SSS was 1.47 and 1.51, respectively (P = .84). However, a significant difference between groups when comparing distal motor latency (DML) and distal sensory latency (DSL) existed. The mean DSL was 3.71 and 4.44 for the clear and borderline groups, respectively (P = .02). The mean DML was 4.59 and 5.36 (P = .048). Categorizing CTS diagnosis into "borderline" and "clear" based on preoperative US and NCS testing did not correlate with BCTQ changes after CTR. It remains unclear whether the BCTQ is a valid postoperative assessment tool, despite its frequent use in literature.

Splinting for carpal tunnel syndrome.

Splinting for carpal tunnel syndrome.

Оцінка функціональних порушень верхніх кінцівок у хворих на ревматоїдний атрит

The purpose of the study was to assess functional disorders of the upper limbs in patients with rheumatoid arthritis using the Boston Carpal Tunnel Questionnaire. Materials and methods. To assess the functional status of the affected upper limbs of patients with rheumatoid arthritis, the Boston Carpal Tunnel Questionnaire was used, which consists of two scales: the Symptom Severity Scale and the Function Status Scale, which were filled out by the patients themselves. The study was conducted on the basis of rheumatology department of the Municipal Enterprise “Yuriy Semeniuk Rivne Regional Clinical Hospital” in Rivne during the period from 2016 to 2018. 216 patients took part in the examination, of which 178 (82%) were women and 38 (18%) were men. The patients’ age is from 25 to 59 years old (average age is 46 ± 0.24). The inclusion criteria were: the presence of an established diagnosis of rheumatoid arthritis based on the ACR/EULAR 2010 criteria, and in accordance with the Order of the Ministry of Health of Ukraine dated April 11, 2014 No. 263 “Unified clinical protocol of primary, secondary, of tertiary medical care and medical rehabilitation of patients with rheumatoid arthritis”, the presence of informed consent of patients to participate in the study. Patients' rights were respected in accordance with the Declaration of Helsinki “Ethical Principles of Medical Research Involving Human Subjects” developed by the World Medical Association, “Universal Declaration of Bioethics and Human Rights (UNESCO)”. Results and discussion. During the initial examination, it was found that the majority of patients had moderate (20.3%) and severe pain (16.6%) in the affected upper limbs (hands / wrists), which in the last two weeks had caused the patients to wake up at night: once – 10.6% of patients, 2–3 times –15.7% of patients. During the day, 20.3% of patients complained of moderate pain in a hand / wrist, and 17.5% of people were bothered by severe pain. The majority of patients (15.7%) noted that the pain lasted from 10 to 60 minutes. As for functional disorders, the greatest difficulties for patients occurred when buttoning clothes – 45.3%, doing household chores – 39.8%, and opening a bottle – 36.1% of patients. Manifestation of local symptoms of damage to the carpal tunnel affects the general physical and psychological condition of the patient. The patient loses work capacity, concentration, and the quality of his / her life decreases. Conclusion. Considering the above results, we are convinced of the need to implement the concept of physical rehabilitation/therapy, which would be able to reduce the level of existing functional disorders and improve the quality of life for patients with rheumatoid arthritis

Mini-incision Carpal Tunnel Release

Carpal tunnel syndrome has been reported as the most common neuropathy in humans. The syndrome has a major impact on socio-economic life due to its high incidence and it usually affects the working-age population. The purpose of this study was to evaluate the results and reliability after our own mini-open incision with simple retractors from eye surgery, through a 1.5–2.0 cm long incision. For this reason, we used Disabilities of the Arm, Shoulder, and Hand score, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index. The study included 24 operated hands in 23 patients (79% females; 21% males). The right hand was affected in 19 patients (83%), the left – in three patients (13%) and in one patient (4%) we performed bilateral decompression. The mean length of the incision scar was 1.5 ± 0.3 cm.В Subjectively, most of the patients (20 of 23) had improvement of paresthesia after 3 months postoperative examination. No patients reported recurrence of the symptoms that would require second decompression. Significant differences between the preand postoperative evaluation were observed in Disabilities of the Arm, Shoulder, and Hand score, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index. In conclusion, our study presented that the median nerve decompression with a mini-incision technique was safe and effective operative technique with short learning curve, especially for experienced with opened techniques hand surgeons. The final results revealed that patients with mini-incision approach have satisfactory surgical outcomes, low postoperative complications, good patient satisfaction and appearance.

Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Riyadh: A Cross-Sectional Study.

Background Carpal tunnel syndrome (CTS) is a musculoskeletal disorder (MSD) afflicting the upper limbs with a prevalence of approximately14.4% in the general population. Previous studies have noted the increasing prevalence of MSDs among teachers but have not investigated in depth the prevalence and predictors of CTS symptoms in this population. The aim of this study was to help fill this gap in the literature by investigating teachers working in Riyadh, Saudi Arabia. Methods We conducted this cross-sectional study in Riyadh using an online survey. We distributed the Boston carpal tunnel questionnaire (BCTQ) to schoolteachers in the city through the social media applications Twitter, WhatsApp, and Telegram. We assessed the respondents' symptoms using Univariate association analyses with a Wilcoxon rank sum test for the continuous variables and Fisher's exact test and Pearson's chi-squared test for the categorical variables. We assessed the independent risk factors for CTS by constructing multivariate binary logistic regression models and expressed the results using the odds ratio (OR) and 95% confidence intervals (95% CIs), with p < 0.05 indicating statistical significance. Results The sample for this study included 490 teachers. Among them, the prevalence of moderate to severe CTS symptoms was 40.0%, and self-reported CTS was 9.1%. The teachers who were female, relatively old, left-handed, retired, and spent significant time using a pen, keyboard, and/or blackboard were more likely than those who were male, relatively young, right-handed, and did not spend significant time using a pen, keyboard, and/or blackboard to self-report CTS and exhibit moderate to severe symptoms. Conclusions We found a relatively high percentage (40.0%) of CTS symptoms among teachers working in Riyadh. This finding suggests that any sign of CTS symptoms should be checked to ensure early diagnosis and treatment, which contribute to positive outcomes, particularly given the recent increase in such risk factors for CTS as diabetes, hypothyroidism, and high BMI in populations worldwide.

Comparative study between blind and ultrasound-guided steroid injection for carpal tunnel syndrome

BackgroundCarpal tunnel syndrome is the most common entrapment neuropathy. Local injections of corticosteroids have proven to be an effective treatment option. Injections are either blind (non-guided) or guided by ultrasound. The current study aimed to compare the efficiency of both approaches and determine which one yields better results.MethodThis study involved 30 patients (8 males, 22 females, aged 36–58 years, mean age 48.3 years) with 30 affected hands with mild or moderate carpal tunnel syndrome. Patients were randomly divided into two equal groups. Steroid injections were performed blindly in group 1 and ultrasound-guided in group 2. A mixture of 2 ml of triamcinolone and lidocaine was administered at both groups. Follow-up (using the Boston Carpal Tunnel Questionnaire and ultrasound assessment) was performed 4 weeks after the injection.ResultsThe symptom severity scale, functional status scale, cross-sectional area, and flattening ratio were significantly reduced in both groups at 4 weeks after the procedure. The ultrasound-guided group showed a statistically significant improvement compared to the blindly injected group.ConclusionsLocal steroid injection is an effective method in the management of both idiopathic and secondary carpal tunnel syndrome. Although clinical and sonographic improvement was achieved with blind and guided steroid injections, better results were obtained when ultrasound was used.

Nucleo CMP Forte™ for the treatment and rehabilitation of patients with carpal tunnel syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common and best well-known cause of peripheral nerve compression. To date, none of the studies have determined the optimal combination of pyrimidine nucleotides and electrical stimulation (ES) in CTS patients. The objective of the study was to evaluate the effectiveness of a novel product containing uridine and cytidine monophosphate (Nucleo CMP Forte™) in combination with ES for the treatment of CTS. Methods: This open-label, randomized, controlled study involved 60 patients with CTS at the Azerbaijan Medical University (Baku, Azerbaijan) and Research Institute of Medical Rehabilitation between 2017 and 2021 years. Patients were randomized to receive the exploratory treatment (Nucleo CMP Forte™ and ES) or single ES treatment for ten days. The combination treatment included two stages: Nucleo CMP Forte™ and ES for ten days (stage one), and Nucleo CMP Forte™ as monotherapy (stage two) for ten days. Results: In the exploratory group, the complete restoration of pain sensitivity was achieved by 17.1% of patients and the narrowing of the existing zone of hypesthesia by 74.3%. Positive Tinel test was revealed in 52.4% of patients after the first and 76.2% after the second stage in the exploratory group, versus 43.8% in the control group. Mean values in the Boston Carpal Tunnel Questionnaire significantly decreased in both groups. Conclusion: Nucleo CMP Forte™ in combination with ES contributes to a more pronounced regression of patients' complaints, clinical manifestations, severity, and neurophysiological indicators in mild-to-moderate CTS.

Pregnancy-related carpal tunnel syndrome; non-invasive early diagnosis and postpartum evaluation

The diagnosis of pregnancy-related carpal tunnel syndrome (PRCTS) was made with noninvasive methods and evaluated the effect of PRCTS on quality of life, its treatment and prognosis. Third-trimester pregnant women between the ages of 18-45 and diagnosed with PRCTS were included. For diagnosis; the presence of pain, positive motor and sensory tests, Carpal Tunnel Symptoms Scale-6 (CTS-6), and Boston Carpal Tunnel Questionnaire (BCTQ) were evaluated. The criteria used to determine improvement were the regression of complaints and symptoms based on a VAS score of 0 and a CTS-6 score of less than 5. According to these criteria, patients whose complaints regressed in the postpartum eighth week were called group A, whose complaints regressed in the postpartum sixth month were called group B, and women who still did not meet the criteria were called group C. The study included 102 wrists of 94 women. When the type of delivery, gestational age at birth, gravida, and parity were compared according to the continuity of complaints and symptoms, no differences were found. When the first trimester body mass index (BMI) measurements were compared between groups A and B, it was observed that group B had higher first trimester BMI values; this difference was statistically significant. The mean age was 29.2 years in group A, was 32.6 years in group B and the difference was significant. Conclusions: We recommend that pregnant women over 30 years old with a high BMI should be screened for PRCTS using non-invasive diagnostic tools, CTS-6, and VAS.

Does the Severity of Carpal Tunnel Syndrome Symptoms Vary Due to Vitamin and Mineral Deficiencies and Anemia?

ABSTRACT Purpose: The purpose of the study is to investigate the effect of serum vitamin, electrolyte levels, and anemia on carpal tunnel syndrome (CTS) symptoms and findings. Materials and Methods: The study included 166 patients with CTS and 80 healthy controls. The patients with CTS were further divided into two groups: those with positive (EP+) and negative (EP−) electrophysiology findings. The participants completed the Boston Carpal Tunnel Questionnaire (BCTQ) to assess their symptoms, and electromyography investigations were performed to confirm the diagnosis. Results: The mean age of individuals in the EP+ group was older, and the body mass index scores were greater than those of other groups. The hemoglobin (Hb) level was significantly lower in the EP+ group than in the EP− group (P = 0.001). Ferritin levels were substantially lower in both the EP+ and the EP− groups compared with the control group (P = 0.045 and P = 0.017, respectively). However, no correlation was found between Hb and ferritin levels and BCTQ scores. The groups had no significant differences in Vitamin D, B12, calcium, and magnesium levels. No relationship was found between the severity of CTS symptoms and deficiencies in Vitamins D and B12. Conclusions: Based on this study, anemia and lower levels of ferritin were common in patients with CTS, but they did not directly contribute to the severity of symptoms; the significance of this finding concerning CTS is unclear. However, considering the limited number of studies suggesting that iron deficiency reduces axonal excitability and leads to the slowing of nerve conduction velocities, iron deficiency may facilitate the development of CTS.

Comparison of Ultrasound-Guided versus Anatomical Landmark-Guided Approach for Perineural Steroid Infiltration in Carpal Tunnel Syndrome: A Prospective Randomised Controlled Trial

Background: Carpal tunnel syndrome (CTS), a compressive neuropathy is usually managed by conservative treatment and/or decompressive surgery. Minimally invasive perineural steroid injections have been shown to be very effective in early-onset CTS. We evaluated the clinical efficacy and safety of ultrasound (USG)-guided steroid injection over anatomical landmark-guided approach in CTS. Methodology and Results: Eighty-four consecutive Stage I-II primary CTS patients enrolled between August 2017 and December 2018 were randomised prospectively into two groups in 1:1 fashion. In Group I, anatomical landmark guided and in Group II, USG guided 1 ml steroid (40 mg methylprednisolone) was injected perineurally. Symptom and functional assessments were done using Boston Carpal Tunnel Questionnaire (BCTQ) and Visual Analogue Scale (VAS) score at 3, 6 and 12 weeks’ follow-up. Significant improvement was seen in BCTQ and VAS scores of both groups at 3 weeks follow-up. At subsequent follow-ups (at 6 and 12 weeks), marked improvement of BCTQ and VAS scores in USG-guided group was observed. Conclusion: USG-guided perineural steroid injections had early-onset significant and sustained symptom reduction and functional improvement at 6- and 12-weeks follow-up when compared to anatomical landmark-guided approach with both the techniques being equally safe.

A Polish Version of the Boston Carpal Tunnel Questionnaire (BCTQ-PL) for Use Among Patients with Carpal Tunnel Syndrome Undergoing Physiotherapy: Translation, Cultural Adaptation, and Validation

A Polish Version of the Boston Carpal Tunnel Questionnaire (BCTQ-PL) for Use Among Patients with Carpal Tunnel Syndrome Undergoing Physiotherapy: Translation, Cultural Adaptation, and Validation

Comparison of Ultrasound-Guided Steroid and Platelet-Rich Plasma (PRP) Injection in Patients with Carpal Tunnel Syndrome

Objective: Imaging-guided injection treatments can yield effective results in patients with mild-to-moderate carpal tunnel syndrome (CTS) resistant to conservative methods. Methods: Patients who presented with typical median nerve entrapment findings for at least 3 months, were diagnosed with mild-moderate CTS electrophysiologically, and underwent ultrasound-guided steroid and PRP injection were included in the study. Visual analog scale (VAS) scores, Boston Carpal Tunnel Questionnaire (Functional status scale (FSS) and Symptom severity scale (SSS) parameters) scores were recorded in the pre-procedure, 1st month and 6th month controls of the patients. Sonographically, median nerve cross-sectional area (CSA) measurements were recorded at pre-procedure and post-procedure 1st and 6th month controls. Results: In 27 patients (21 women, 6 men), 40 median nerve injections (9 patients right, 5 patients left, 13 patients bilateral) were evaluated. In all patients, CSA, VAS, FSS, and SSS scores were significantly lower at 1 month and 6 months after the procedure than before the procedure. (p=0.000, p=0.000, p=0.000, P=0.000, respectively). While the VAS scores were found to be significantly lower in the steroid group than in the PRP group at 1 month (p=0.04), there was no significant difference between the two groups in terms of CSA, FSS, and SSS scores (p=0.1, p=0.5, p=0.8, respectively). At 6 months, CSA, VAS, FSS, and SSS scores were significantly lower in the PRP group compared to the steroid group (p=0.000, p=0.000, p=0.000, p=0.000 respectively). Conclusion: In mild-to-moderate carpal tunnel syndrome, steroid injections applied under ultrasonography guidance of the median nerve are effective for a short time, and PRP injections are a superior and safe option to steroids for long-term efficacy.