Cases Of Carpal Tunnel Syndrome Research Articles

Correlating symptom severity index, clinical diagnostic criteria of CTS-6 and timed Phalen’s test in clinical evaluation of carpal tunnel syndrome

ABSTRACT Background: Carpal Tunnel Syndrome (CTS) poses significant diagnostic challenges, especially in resource-limited settings. Reliable tools such as the 6-item Symptom Severity Index, Timed Phalen’s Test (TPT) and CTS-6 are promising but under investigated. Correlation between these tools and symptom severity remains underexplored. Aim: To correlate the 6-item Symptom Severity Index and CTS-6 diagnostic tool with TPT in clinically diagnosed CTS cases, evaluating their diagnostic performance. Methods: Prospective cross-sectional study, conducted in a tertiary care hospital in eastern India. 105 patients were enrolled after fulfilling inclusion criteria, assessing them with the 6-item Symptom Severity Index, CTS-6 diagnostic tool and TPT. Pearson’s and Spearman’s correlation coefficients were used, and statistical significance was set at P < 0.05. Results: Of 188 evaluated hands, TPT showed a significant negative correlation with CTS-6 scores (r = -0.59, P < 0.0001), indicating lower scores with higher TPT values. CTS-6 scores positively correlated with symptom severity (r = 0.34, P < 0.0001), indicating higher Symptom Severity Indices associated with increased diagnostic probability. Positive predictive value for TPT was 70.1%, with sensitivity of 83.7% and specificity of 61.1%. Symptom Severity Indexing demonstrated higher sensitivity (100%) but lower specificity (3.3%). Conclusions: This study highlights the utility of integrating subjective and objective assessment tools in CTS diagnosis. The findings underscore the importance of comprehensive evaluation and suggest the potential value of TPT as an adjunctive diagnostic tool. Further research is warranted to validate these findings and refine diagnostic algorithms for CTS management.

Fluorescein Angiography for Monitoring Neural Blood Flow in Chronic Nerve Compression Neuropathy: Experimental Animal Models and Preliminary Clinical Observations.

Pathologies associated with neural blood disturbance have been reported in patients with chronic nerve compression (CNC) neuropathy. Fluorescein angiography (FAG) and laser Doppler flowmetry (LDF) are effective for real-time peripheral nerve blood flow assessment. However, their reliability in severe neuropathy models in large animals or clinical conditions remains unclear. Initially, we aim to apply FAG to two different CNC animal models and evaluate their characteristics in comparison with those of LDF. In FAG, we quantified the peak luminance at the compression site following fluorescein injection. Then, we positioned the LDF probe at the center of the compression site and recorded the blood flow. Subsequently, we analyzed whether the FAG characteristics obtained in this animal experiment were consistent with those of clinical studies in patients with severe carpal tunnel syndrome (CTS). In the CNC rat model, FAG and LDF effectively monitored reduced neural blood flow over time. We observed significant blood flow reduction using both techniques in a newly developed severe CNC rabbit model. Notably, FAG correlated strongly with the compound muscle action potential (CMAP) amplitude in electrodiagnostic findings, unlike LDF. As a next step, we performed FAG after open carpal tunnel release in clinical cases of CTS. FAG correlated significantly with preoperative CMAP amplitude. This indicates FAG's importance for assessing nerve blood flow during surgery, potentially improving diagnostic accuracy and surgical outcomes.

Relationships between the global symptom score and electrophysiological findings after surgical release for carpal tunnel syndrome: Indications and outcomes.

Regarding surgical indications for carpal tunnel syndrome (CTS), the hypothesis that the recovery processes of subjective symptoms differ among pain, sensory, and motor symptoms and correlate with recovery in objective nerve conduction studies was examined in the present study. The global symptom score (GSS) is a method used to assess clinical outcomes and covers subjective symptoms, including pain (pain and nocturnal awakening), sensory (numbness and paresthesia), and motor (weakness/clumsiness) symptoms. The relationships between long-term changes in GSS and recovery in nerve conduction studies were investigated. Forty patients (40 hands) were included (mean age 65years; 80% female; 68% with moderate CTS: sensory nerve conduction velocity < 45m/s and motor nerve distal latency > 4.5ms). Pain and nocturnal awakening rapidly subsided within 1month after surgery and did not recur in the long term (median 5.6years). Paresthesia significantly decreased 3months after surgery and in the long term thereafter. Weakness/clumsiness significantly decreased at 1year. Sensory nerve distal latency, conduction velocity, and amplitude significantly improved 3months and 1year after surgery, and correlated with nocturnal awakening in the short term (3months) in moderate CTS cases. The patient satisfaction rate was 91%. Rapid recovery was observed in pain and nocturnal awakening, of which nocturnal awakening correlated with the recovery of sensory nerve conduction velocity. Patients with pain symptoms due to moderate CTS may benefit from surgical release.

Pain score evaluation in patient underwent hand surgery under walant compared to those under local or general anesthesia with tourniquet

Background: The Wide Awake Local Anesthesia No Tourniquet (WALANT) has been reported to offer simpler pre-surgical instruction and assessment, faster operating time, better surgical visualization, shorter hospital stay, fewer complications, and side effects, lower cost, faster postoperative recovery time, better patient's satisfaction, and less pain and discomfort. This study aims to review the pain score in hand surgery using the WALANT technique compared to local anesthesia or general anesthesia with a tourniquet. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and Google Scholar in March 2021. Eligible randomized-controlled trials (RCTs) and cohort studies comparing injection time, intra-operative, or postoperative pain using Visual Analog Score (VAS) in WALANT and local anesthesia or general anesthesia with tourniquet were included. Results: Five studies (3 RCTs and 2 cohorts) were included in this article, including 645 hand surgeries (376 carpal tunnel syndrome cases, 181 trigger finger cases, 42 cubital tunnel syndrome cases, 44 de Quervain's disease cases, and 2 ganglion cyst cases). Three studies reported a significantly lower VAS in the WALANT group, while the other two studies reported a lower VAS in the WALANT group, but it was not statistically significant. Conclusion: WALANT is still a technique worth considering in hand surgery because of its superiority in minimizing intra-operative and postoperative pain.

Diagnostic Accuracy of Integrating Ultrasound and Shear Wave Elastography in Assessing Carpal Tunnel Syndrome Severity: a Prospective Observational Study.

Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28-57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. CSAu and CSAu-CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.

Opposition Transfer Using the Extensor Indicis Muscle and the Extensor Pollicis Brevis Tendon

PurposeThis study aimed to introduce a novel technique utilizing the extensor pollicis brevis and extensor indicis proprius tendons as power sources for thumb opposition reconstruction in cases of severe carpal tunnel syndrome (CTS) associated with thenar muscle atrophy. Further, the efficacy of this novel method and the traditional Camitz technique was compared. MethodsPatients with severe CTS and thumb opposition dysfunction who underwent surgery using the novel technique (n = 7, 9 surgeries) or the Camitz technique (n = 8, 8 surgeries) were included in the analysis. The pre- and postoperative palmar abduction angle, thumb–ring finger opposition (T–R) angle, and Kapandji score were assessed. The repeated measures ANOVA and the Mann–Whitney U test were used for statistical analysis. ResultsThe novel technique was associated with a significant postoperative improvement in palmar abduction angle, T–R angle, and Kapandji score. In particular, the T–R angle of patients who underwent surgery using this technique was superior to that of patients who underwent surgery using the Camitz technique. Therefore, the novel technique was highly effective in improving thumb pronation. ConclusionThe novel technique using the extensor pollicis brevis and extensor indicis proprius tendons is promising for thumb opposition reconstruction in severe CTS cases. Unlike the traditional Camitz technique, this approach promotes stable thumb opposition function without requiring a pulley, thereby yielding satisfactory outcomes. Nevertheless, further studies with a larger sample size should be conducted to validate these findings.

Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System.

Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.

Association of upper extremity anthropometry and subcutaneus adipose tissue with carpal tunnel syndrome

<p>Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization of adipose tissue differs between the genders. In this study, we purposed to investigate whether there was an association between the amount of local adipose tissue thickness and anthropometry in upper extremity with the presence and/or electrophysiological severity of CTS on both genders.</p>. <p>Our study included 150 patients who were diagnosed with CTS clinically and electrophysiologically and 165 healthy controls. The biceps and triceps skinfold thickness, the diameters of the wrist and metacarpal joints, and the upper arm circumferences over the belly of the biceps muscle were measured by using skinfold caliper and measuring cylinder. All data were analyzed by using the Statistics Open For All package (SofaStats) programme. To detect the role of anthropometric indexes, we used multivariable multinomial logistic regression models.&nbsp;</p>. <p>We revealed that BMI, biceps and triceps adipose tissue thicknesses were higher in females and also in patients with CTS. There was a positive correlation between electrophysiological grades of CTS and BMI with logistic regression analyzes. The mean Wrist circumference/Metacarpo&shy;ph&shy;arengeal Circumference ratio and biceps circumference were higher in moderate CTS groups. Metacarpofarengeal circumference was smaller in mild and moderate CTS cases compared to healthy ones.</p>. <p>We suggest that the differen&shy;ces between the anatomical bone structure and local adiposity between the genders may play an important role in the occurrence of CTS. Moreover, the structures of proximal muscle groups and distal metacarpal joints may contribute both to the development and severity of CTS.</p>.

Central Sensitization in Patients with Chronic Pain Secondary to Carpal Tunnel Syndrome and Determinants.

Central sensitization (CS) is commonly seen in chronic pain disorders, including neuropathic pain. However, there exist inconsistencies concerning the presence of CS in chronic pain secondary to carpal tunnel syndrome (CTS). CS and neuropathic pain manifestations in CTS remain not well established. Therefore, this study aims to investigate the CS and pain profiles in patients with CTS and to explore the potential determinants associated with CS. Patients with suspected CTS symptoms lasting 3 months or above and healthy controls were enrolled. History, physical examinations, and nerve conduction studies were employed to confirm the diagnosis and severity of median nerve dysfunction. The central sensitization inventory (CSI) was used to screen CS. Other outcomes included neuropathic pain, CTS-specific symptom severity and functions, emotion, and health-related quality of life. Between-group comparisons were conducted in terms of the CS presence. Logistic regression analysis was performed to identify determinants associated with CS. Over 60% of participants with CTS were found with clinical CS, significantly higher than that in the control group. More than 70% of the CTS participants were identified to have possible or very likely neuropathic pain components. In addition, one-fourth of CTS cases had depression or anxiety. Anxiety was associated with an increased risk of developing CS in CTS (adjusted OR=1.31, 95% CI 1.08-1.59), whereas higher self-perceived general health rating was negatively associated with the presence of CS (adjusted OR=0.92, 95% CI 0.88-0.97) in the multivariate adjusted regression model. CS is prevalent in patients with CTS. Predominant neuropathic pain characteristics were uncovered in CTS patients as well as comorbid psychological distress. Significant association was found between anxiety and CS presence. Self-perceived general health was inversely related to CS. Further research is warranted to explore the mechanisms of anxiety and central pain processing in painful entrapment neuropathy.

Neurostimulation in severe carpal tunnel release: A more precise technique for opponensplasty decision-making.

In this study, we aimed to investigate the relationship between intraoperative thenar muscle neurostimulation responses and postoperative thumb function recovery in patients with severe carpal tunnel syndrome (CTS). Between January 2019 and December 2021, a total of 21 severe CTS cases in 20 patients (7 males, 13 females; mean age: 56.3±19.3 years; range, 52 to 76 years) based on clinical and electrophysiological findings were retrospectively analyzed. The median nerve motor branch (MNMB) was stimulated intraoperatively with a nerve stimulator. The patients were divided into two groups according to contraction response on abductor pollicis brevis (APB) muscle: Group C (contractile, n=13) and Group NR (non-responsive, n=7) with and without muscular contraction. The Levine Functional Severity Scale (LFSS) was used to measure the functional status of CTS patients. The Manual Muscle Testing (MMT) was used to assess muscle strength. Clinical outcomes were compared between the groups at one year of follow-up. The mean total preoperative LFSS score was significantly higher in Group NR than in Group C (p=0.010). The mean postoperative MMT score was significantly higher in Group C than in Group NR (p<0.001). There was no positive result in pick-up, button fastening, and needle pinch tests in Group NR (p<0.001). However, there were significant improvements in postoperative LFSS scores in Group C (p<0.05), while the scores remained unchanged in Group NR (p>0.05). Direct stimulation of the median nerve motor branch and observation of contraction response on APB muscle can be used to predict clinical recovery and facilitates making the decision for opponensplasty in severe CTS.

Carpal Tunnel Syndrome Associated with Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors (ICIs) have transformed the therapeutic approach to diverse malignancies, leading to substantial enhancements in patient prognosis. However, along with their benefits, ICIs also increase the incidence of immune-related adverse events (irAEs). In the present paper, we highlight four cases of carpal tunnel syndrome (CTS) as an uncommon manifestation of toxicity induced by ICIs. Although diagnosed with different malignancies, the patients were undergoing ICI therapy when they developed CTS-consistent side effects accompanied by severe neuropathy. Prompt treatment with corticosteroids, intravenous immunoglobulins, or methotrexate resulted in complete symptomatic relief for all patients. This article therefore emphasizes the importance of recognizing and managing rare adverse events associated with ICI use to ensure optimal patient care.

Persistent Pain as an Early Indicator for Operative Carpal Tunnel Revision after Primary Release: A Retrospective Analysis of Recurrent and Persistent Carpal Tunnel Syndrome.

Prolonged symptoms of carpal tunnel syndrome (CTS) after primary carpal tunnel release (CTR) can reduce the quality of life and lead to multiple referrals across specialties. The following study aimed to identify differences in symptoms, signs, and intraoperative findings between recurrent and persistent CTS cases to avoid undesired outcomes after primary CTR. A retrospective analysis was conducted on revision CTRs performed between 2005 and 2015 using literature-based definitions for recurrent (a relapse of symptoms occurs following a symptom-free period of ≥3 months) and persistent (symptoms persisting longer than three months after surgical release) CTS. The parameters assessed were symptoms, clinical signs, and intraoperative findings. Out of 53 cases, 85% (n = 45) were external referrals, whereby our own revision rate was 0.67% (n = 8/1199). Paresthesia and numbness were frequent in both groups; however, abnormal postoperative pain was reported more often in persistent cases (86%; n = 30/35) in comparison to recurrent cases (50%; n = 9/18; p = 0.009). Scarring around the median nerve was observed in almost all recurrent cases (94%; n = 17/18) and in 40% (n = 14/35) of persistent cases (p < 0.001). Incomplete division of the palmar ligament was the primary cause for revision in the persistent cohort (49%; n = 17/35). For patients experiencing symptoms for more than three months after CTR, primarily presenting as pain, it is advisable to consider referring the patient to a certified hand clinic for additional evaluation.

Novel Endoscopic Approach for Carpal Tunnel Syndrome: Functional Outcomes - A Prospective Study

Abstract Introduction: Carpal tunnel syndrome (CTS), a common entrapment neuropathy, can cause debilitating symptoms affecting hand function and sleep. While conservative treatments are initially attempted, surgical intervention becomes necessary for severe cases. The study introduces endoscopic carpal tunnel release (ECTR) as a minimally invasive alternative to open procedures to enhance patient outcomes. Methods: A prospective study from January 2019 to January 2022 investigated arthroscope-assisted carpal tunnel release for CTS. Patients with chronic medical conditions were excluded. The surgical procedure involved local anesthesia, a 1.5 cm incision, flexor retinaculum release under arthroscopic guidance, and postoperative care. Outcomes were assessed using the Global Symptom Scoring Scale (GSS). Results: The affected population (n = 60) had a mean age of 47.58 years, with 42 females and 18 males. Common symptoms included numbness (43.3%), paresthesia (35%), and weakness (13%). Most patients (67.1%) had no comorbidities. Complications were minimal (5.0% paresthesia, 1.7% scar tenderness, and 3.3% infection). The mean preoperative GSS was 38.57, reducing significantly (P &lt; 0.001) to 4.6 at 12 months’ follow-up. Conclusion: The study demonstrates the efficacy and safety of ECTR as a minimally invasive alternative for severe cases of CTS. With a low rate of complications and significant improvement in symptoms, including numbness, paresthesia, weakness, and surgeon expertise remains vital for successful outcomes.

Carpal Tunnel Syndrome: Neuropathic Pain Associated or Not with a Nociplastic Condition.

Carpal tunnel syndrome (CTS) has been traditionally classified as primarily a neuropathic condition with or without pain. Precision medicine refers to an evidence-based method of grouping patients based on their susceptibility to biology, prognosis of a particular disease, or in their response to a specific treatment, and tailoring specific treatments accordingly. In 2021, the International Association for the Study of Pain (IASP) proposed a grading system for classifying patients into nociceptive, neuropathic, or nociplastic phenotypes. This position paper presents data supporting the possibility of subgrouping individuals with specific CTS related-pain into nociceptive, neuropathic, nociplastic or mixed-type phenotypes. Carpal tunnel syndrome is a neuropathic condition but can also be comorbid with a nociplastic pain condition. The presence of extra-median symptoms and the development of facilitated pain processing seem to be signs suggesting that specific CTS cases can be classified as the nociplastic pain phenotype. The clinical responses of therapeutic approaches for the management of CTS are inconclusive. Accordingly, the ability to identify the predominant pain phenotype in patients with CTS could likely be problematic for producing efficient treatment outcomes. In fact, the presence of a nociplastic or mixed-type pain phenotype would explain the lack of clinical effect of treatment interventions targeting the carpal tunnel area selectively. We propose a clinical decision tree by using the 2021 IASP classification criteria for identifying the predominant pain phenotype in people with CTS-related pain, albeit CTS being a priori a neuropathic pain condition. The identification of a nociplastic-associated condition requires a more nuanced multimodal treatment approach to achieve better treatment outcomes.

Recurrent carpal tunnel syndrome: Outcomes after neurolysis and synovial flap

ObjectivesIf symptoms recur after primary neurolysis of the median nerve, surgical revision is required. Soltani et al. (2013) demonstrated that surgical revision with vascularized flap coverage had a higher success rate (86%) than surgical revision without a flap (75%). The aim of this retrospective study was to present clinical outcomes in 36 cases of secondary open neurolysis of the median nerve, with synovial flap in case of recurrent carpal tunnel syndrome. MethodThirty-three patients (36 hands) who had undergone secondary neurolysis of the median nerve combined with synovial flap coverage between 2012 and 2019 were selected for this study. We included only recurrent carpal tunnel syndrome cases presenting with scarring of the transverse carpal ligament or epineural fibrosis of the median nerve and with a symptom-free period of at least 3 months. The results were ranked on a 4-point scale as excellent, good, null or poor, depending on progression at last follow-up. ResultsDescriptive analysis showed that 80% of patients had a positive outcome (excellent 33%, good 47%), 6% null outcome and 14% poor outcome. ConclusionThis is an interesting, relatively non-invasive surgical option, and should be part of the therapeutic armamentarium for recurrent carpal tunnel syndrome in case of adherence of the nerve to the transverse carpal ligament.

Feasibility study of juxta-articular-type volar distal radius plate (ARIX Wrist System) for surgically treating marginal distal radius fractures

PurposeWe evaluated the feasibility of a juxta-articular-type volar distal radius plate for the surgical treatment of marginal distal radius fractures. Materials and methodsTwenty marginal distal radius fractures, defined by the location of the fracture line within 10 mm of the joint line of the lunate fossa, were retrospectively reviewed between July 2020 and July 2022. The fractures were fixed using a juxta-articular-type volar plate (ARIX Wrist System). The characteristics of the implant and surgical technique, radiologic, and clinical outcomes, and related complications were evaluated. ResultsBony union was achieved in all patients within six months. Acceptable radiological alignment was achieved with no significant differences between the fractured and the normal sides. The clinical outcomes were favorable, with satisfactory functional outcomes. There was one case of post-traumatic arthritis and two cases of carpal tunnel syndrome. No implant-related complications including flexor tendon problems were observed. ConclusionThe juxta-articular distal radius plate of the Arix Wrist system is feasible for treating marginal distal radius fractures and achieves favorable clinical outcomes without implant-related complications in East Asian patients.

AĞIR KARPAL TÜNEL SENDROMU İÇİN RİSK FAKTÖRLERİNİN İNCELENMESİ - EV HANIMLIĞI BİR RİSK Mİ?

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. In this study, risk factors of severe CTS were examined. This study was conducted on 227 patients diagnosed with CTS in EMG laboratuary. The criteria of American Academy of Electrodiagnostic Medicine was used as the diagnosis for CTS. All patients were examined for bilateral median and ulnar motor and sensory peak latency, amplitude and conduction velocities. The patients were classified into 4 groups electrophysiologically; Normal, Light, Medium, Severe. Electrophysiological classification was compared with the identified risk factors. The mean age of the patients was 51.04±13.37 (min=18-max=83). Severe CTS cases in both hands were higher in housewives. Housewifery increased the risk of severe CTS in the right and left hand by 2.74 and 2.23 times, respectively. In addition, obesity increased the risk of severe CTS in the right and left hand by 5.10-4.40, presence of lateral epicondylitis was 2.73-4.19 and medial epicondylitis was 4.39-4.93, respectively. Hand dominancy was increased the risk of severe CTS by 6.88 times for the left hand and 1.15 times for the right hand. Otherwise in multivariate analyse of left hand results, obesity increase the risk of severe CTS by 3.34, left hand dominancy 7.83 times, chronic disease 2.62 times, and for the right hand being a housewife increases the risk by 2.14, obesity 4.68 times and medial epicondylitis 6.40 times. This study put forth that being a housewife, obesity, dominant hand, presence of lateral or medial epicondylitis are the risk factors of severe CTS.

Can Electrodiagnostic Tests be Omitted from Surgical Decision-making for Typical Carpal Tunnel Syndrome? – A Randomized Controlled Trial

ABSTRACT Background: Although carpal tunnel syndrome (CTS) is common and frequently seen in daily practice, diagnostic criteria remain the subject of debate. Some authors consider electrodiagnostic tests as essential, whereas others view them as an unnecessary luxury. Objective: The objective is to investigate whether electrodiagnostic tests are necessary for surgical decision-making for typical CTS. Materials and Methods: The study was planned as a randomized controlled trial. After determining normative values for the population of the geographic region, 101 consecutive cases of typical CTS of the hand (suffering palmar dysesthesia that waking from sleep at night) were enrolled in the study. Hands were randomized into two groups using simple randomization. The first group comprised patients whose surgical candidacy was evaluated without electrodiagnostic tests, and the second group comprised patients whose surgery decisions were based on the results of electrodiagnostic testing. The patients were evaluated at 1, 3, and 12 months postoperatively. Results: Sixty-one hands were randomized to the first group and 40 hands were randomized to the second group. Four cases in the second group received medical treatment because their electrodiagnostic test results were within the normal limits, despite the presence of typical CTS symptoms. There were no differences in favor of the second group regarding any evaluation criteria during the entire follow-up period; however, the first group reported significantly more positive outcomes regarding awakening at the 3-month follow-up and regarding satisfaction at the 1-month follow-up. Conclusion: Additional electrodiagnostic tests may not be mandatory to clinically identify classical CTS or make surgical decisions in these cases. However, many cases may be caused by entrapment of the median nerve in the carpal tunnel, but they may lack typical CTS symptoms, such as waking from night-time sleep. In such cases, properly applied electrodiagnostic tests may be of immense help.

Yuna Gloves, Sarung Tangan Anti Carpal Tunnel Syndrome (CTS)

&lt;em&gt;Carpal Tunnel Syndrome (CTS) is a symptom of compression neuropathy of the median nerve at the wrist. Characterized by increassed pressure in the carpal tunnel and decreased nerve function. The Most Common Complain are pain, numbness and tingling along the distribution of the median nerve. The prevalence of carpal tunel syndrome in the adult population ranges from 0.7 – 9.2%, 0.4% in women and 2.1% in men. Women have a riskof developing CTS 3 times higher in pregnant women then in non-pregnant women. The purpose of this study was tu produce yuna gloves which were effective in reducing the incidence of CTS in pregnant women at the Cipanas Health Center in 2021. This study was conducted using the case control method, which is to campare existing Products with research products. This researche process lasted for 3 months. The population in this study were all pregnant women in the third trimester at the Cipanas Public Health, which amaunted to 150 people, the sample in this study amounted 33 people. From the results of the case study, its expected to further improve the quality of service delivery for health workers, aspecially in handling cases of CTS in pregnant women at the Cipanas Health Center.&lt;/em&gt;

The Diagnostic Value of the Median Nerve Sonography in Chronic Phase Carpal Tunnel Syndrome Cases in Indonesia

Background. Ultrasound evaluation on the median nerve in carpal tunnel syndrome (CTS) patients by measuring cross-sectional area (CSA) is widely known. However, studies have shown that CSA of the median nerve could vary in different demographical factors. Therefore, the cut-off CSA value for CTS in the Indonesian population could be significantly different. Purpose. To compare mean CSA of the median nerve between normal and CTS populations and establish a cut-off point of CSA to diagnose CTS. Materials and Methods. A comparative cross-sectional study was conducted involving 40 people divided equally into CTS and normal groups. Normal and CTS subjects are determined by Electrodiagnostic study (EDx) using EMG and Nerve Conduction Study (NCS). The CSA measurement was performed at the level of the carpal tunnel inlet. Results. The mean CSA value at the level of tunnel inlet of the normal group was 8.3 ± 1.4 mm2 and for the CTS group is 15.4 ± 4.4 mm2. The receiver operating characteristics (ROC) analysis showed 10.6 mm2 as the cut-off point with 95% sensitivity and 95% specificity (P&lt;0.001). Conclusion. The median nerve CSA at the tunnel inlet is significantly larger in the CTS population and the cut-off point can be recommended in detecting CTS in the Indonesian population.