Cases Of Carpal Tunnel Syndrome Research Articles

Impact of technical variations on the ring-finger test for carpal tunnel syndrome

ObjectiveTo assess if recording the sensory latencies of the median and ulnar nerves one-by-one (consecutive) or at the same time (simultaneous) in the ring-finger test for carpal tunnel syndrome (CTS) will show equivalent results or if it will lead to a different clinical classification of patients. MethodsWe assessed the limits of agreement between the simultaneous and the consecutive method based on the median- ulnar sensory latency difference derived by both methods in 80 subjects and compared the number of minimal CTS cases identified by the two methods. ResultsLimits of agreement ranged from −0.23 to 0.29 ms. A significantly higher proportion of subjects with minimal CTS (only detectable by using the comparison test) was found using the simultaneous method (n = 8 and 2, respectively; p = 0.03). ConclusionThe two methods have a poor to moderate agreement as indicated by the range of the limits of agreement (0.5 ms). SignificanceEven small methodological changes to the ring-finger test can lead to results with different clinical meaning in the same individual and one should be aware of which method was used when interpreting results.

Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome: a structural equation modeling approach.

This longitudinal study aimed at exploring the direct and indirect relationships between organizational, psychosocial, biomechanical, and personal factors and carpal tunnel syndrome (CTS) in French workers. Between 2002 and 2005, 3710 workers were included in the Cosali cohort. Between 2007 and 2010, 1611 workers were re-examined using the same standardized clinical protocol. Subjects free from CTS at baseline were studied (804 men and 563 women). We used structural equation models to examine the relationships between incident CTS cases and organizational (machine-paced work or work pace dependent on customers' demand), psychosocial (job strain model), biomechanical (Borg's rating perceived exertion, wrist bending, pinching, and hand-transmitted vibrations), and personal factors at baseline. Symptomatic CTS risk was directly increased by biomechanical factors (standardized coefficient = 0.19, P = 0.011), female gender (0.25, P < 0.001), and age (0.15, P = 0.042). No psychosocial factors had a direct impact on CTS, but decision authority and skill discretion had an indirect impact by influencing biomechanical exposure. Exposure to machine-paced work had an indirect impact on increasing CTS, either by raising biomechanical exposure (0.19, P < 0.001) or by lowering decision authority (-0.18, P < 0.001) and skill discretion (-0.20, P < 0.001), which in turn increased biomechanical exposure. Similar complex relationships were observed between risk factors and CTS defined by a more strict case definition. Biomechanical exposure had a direct impact on CTS, while organizational factors and psychosocial factors had an indirect impact on CTS. The findings support conceptual models linking work organization to CTS.

P52-T Comparison of two variants of the ring-finger test for diagnosing very mild carpal tunnel syndrome

Background To diagnose carpal tunnel syndrome at a very mild stage is prognostically important and only possible by the use of comparison tests, such as the ring-finger test. The Ring-finger test compares the median and ulnar nerve sensory latency. Patients with typical clinical findings and a median- ulnar latency difference ⩾0.5 ms are classified as having very mild carpal tunnel syndrome (CTS). The test can be performed by recording both nerves at the same time (simultaneous) or one-at-a-time (consecutive). We aimed to assess if measuring the median and ulnar nerves simultaneously is equivalent to measuring the two nerves consecutively in the orthodromic ring finger test or if it will lead to a different clinical classification of patients. Methods We calculated the limits of agreement between the simultaneous and the consecutive method based on the median- ulnar sensory latency difference derived by both methods in 80 subjects and compared the number of very mild CTS cases (defined as present clinical symptoms and nerve conduction findings) identified by the two methods. Results Limits of agreement had a range of 0.5 A significantly higher proportion of subjects with very mild CTS was found using the simultaneous method (n = 8 and 2, respectively; p = 0.03). Conclusion The two methods are not equivalent, as indicated by the poor to moderate agreement between them. The simultaneous method is more sensitive for very mild CTS. When comparing and interpreting results from the ring finger test, neurophysiologists and clinicians should be aware which method was used.

Persistent median artery carpal tunnel syndrome: a case series and literature review

Persistent median artery (PMA) thrombosis is a rare cause of carpal tunnel syndrome (CTS) with only a few cases reported in the literature. The bifid median nerve (BMN) is often associated with PMA and may be a factor in the development of CTS. There is a paucity of information in the literature on the management options for CTS secondary to PMA thrombosis. This paper presents two cases of CTS with associated PMA thrombosis and BMN and offers a discussion on diagnostic and management options.

Post-bariatric surgery peripheral neuropathies: Kuwaiti experience

BackgroundObesity is a major global health problem. Kuwait has a very high prevalence of obesity, and consequently, the number of bariatric surgeries is rising.ObjectivesThe aim of this study is to analyze the clinical presentation and electrodiagnostic features of peripheral nerve complications following bariatric surgery.Subjects and methodsWe retrospectively involved a convenience sample of patients presenting at a tertiary referral center and analyzed the patterns and frequency of peripheral nerve involvement, correlations with operative techniques, perioperative complications, nutritional status, possible risk factors, and functional impairment.ResultsAmong the 58 cases, 23 presented with chronic distal symmetrical sensorimotor neuropathy, 10 suffered from small fiber neuropathy, 22 had mononeuropathies, 2 patients had acute axonal sensorimotor neuropathy, and only 1 patient had lumbar plexopathy. In 22 patients, we observed mononeuropathies (10 cases of carpal tunnel syndrome, 7 cases of peroneal compression at the knee, 4 cases of ulnar neuropathies at the elbow, and 1 case of meralgia paresthetica). Rapid weight loss and protracted postoperative vomiting tended to correlate with generalized neuropathies, while focal compression with loss of the protective subcutaneous tissue pad was associated with mononeuropathies. All patients suffered from a deficiency of at least 1 micronutrient. Compliance with supplementary therapy was poor. Some post-bariatric neuropathies interfere severely with patients’ functional status.ConclusionPrevention by close follow-up, nutritional intervention, and patient education to avoid habitual postures related to nerve compression is appropriate.

A genome-wide association analysis identifies 16 novel susceptibility loci for carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common and disabling condition of the hand caused by entrapment of the median nerve at the level of the wrist. It is the commonest entrapment neuropathy, with estimates of prevalence ranging between 5–10%. Here, we undertake a genome-wide association study (GWAS) of an entrapment neuropathy, using 12,312 CTS cases and 389,344 controls identified in UK Biobank. We discover 16 susceptibility loci for CTS with p < 5 × 10−8. We identify likely causal genes in the pathogenesis of CTS, including ADAMTS17, ADAMTS10 and EFEMP1, and using RNA sequencing demonstrate expression of these genes in surgically resected tenosynovium from CTS patients. We perform Mendelian randomisation and demonstrate a causal relationship between short stature and higher risk of CTS. We suggest that variants within genes implicated in growth and extracellular matrix architecture contribute to the genetic predisposition to CTS by altering the environment through which the median nerve transits.

Three cases of carpal tunnel syndrome associated with Kienböck disease of the elderly patient

Three cases of carpal tunnel syndrome associated with Kienböck disease of the elderly patient

Three cases of carpal tunnel syndrome due to tumoral calcinosis

Three cases of carpal tunnel syndrome due to tumoral calcinosis

Does the Duration and Severity of Symptoms Have an Impact on Relief of Symptoms after Carpal Tunnel Release?

Rationale Carpal tunnel syndrome (CTS) is the most frequently encountered compressive neuropathy of the upper limb. The treatment of CTS ranges from conservative management to carpal tunnel release. Many patients with misconception about the potential morbidity and with the hope of successful conservative treatment delay the surgical release of carpal tunnel. This delay results in reduced recovery of sensory and motor median nerve function. Objective The aim of this study was to evaluate the influence of preoperative duration and severity of symptom on the outcome of carpal tunnel surgery. Method It included 45 cases of CTS, all treated with limited access open carpal tunnel release. The duration of symptoms (i.e., pain, numbness, tingling, waking up at night because of pain/numbness, difficulty in grasping small objects, and their preoperative severity) was noted using Boston CTS questionnaire. To investigate the outcome, patients were divided into three groups based on their duration of symptoms. Result Group1: The severity of symptoms was reduced to normal in a short period of time in patients who presented with duration of symptoms less than 6 months. Group 2: Patients in whom symptoms lasted for 6 to 12 months had reduced or delayed recovery of hand function as compared with first group. Group 3: Patients who had symptoms for more than 12 months had incomplete recovery of grip strength. Return to normal function took the longest time (median: 16 weeks) in this group. Conclusion This study suggests that patients who present late have delayed/incomplete relief of symptoms after carpal tunnel release.

The Social and Economic Impact of Carpal Tunnel Syndrome among Maintenance-of-Way Employees

Thousands of railroad Maintenance-of-Way (MOW) workers develop Carpal Tunnel Syndrome (CTS) from their work. Objective: This study calculates the social and economic burdens of carpal tunnel syndrome borne by thousands of MOW workers. Methods: Economic calculations are derived from the literature and also from a survey of 4,800 MOW respondents, 155 in-depth interviews, and two focus groups. Results: This one health problem alone costs at least $128.6 million to $225.3 million over the course of CTS cases currently diagnosed among MOW workers. Many individuals work through significant pain or have to leave the profession. Some are crippled for life. Conclusion: When a worker has carpal tunnel syndrome, beyond pain and suffering, there are often financial burdens that affect families, railroad companies, insurers, communities, and taxpayers as well as the injured workers.

Effect of Conservative Treatment on Alleviation of Symptoms in 36 cases of Carpal Tunnel Syndrome in Pregnancy: A Prospective Study

Background: Carpal Tunnel Syndrome (CTS) is the most common upper extremity compression neuropathy which is a common entrapment neuropathy seen in pregnant women.Objective: The purpose of the present study was to assess presentation and severity of various symptoms among women with CTS in pregnancy and to see the effect of conservative management protocols in alleviation of symptoms of the disease and restoration of functional capability of the affected hands.Methodology: This interventional study was included 36 pregnant women attended in the Outpatient Department of Physical Medicine and Rehabilitation Specialist in the Hi-Tech Multicare Hospital, Dhaka during the period from January 2015 to January 2016 for a period of one year and one month. Detail history was taken and examined physically by a specialist in physical medicine to ascertain the clinical diagnosis. Out of 48 referred cases, 42 pregnant women were identified clinically as CTS cases based on symptoms and signs. However, 2 cases were not enrolled because of severe form of pain and referred to other hospital for admission and 6 patient dropped out. Therefore, 36 cases with CTS symptoms included in this study. All the patients were given conservative treatment (Wrist splint, Exercise and activity modification) for 8 weeks. All patients were followed up at 4 weeks interval. Treatment outcome were measured by Boston carpal tunnel questionnaire (BCTQ).Result: The mean age of the patients is 30±3.5 years. 26 (78%) patients mild to moderate type of CTS symptoms showed improvement in conservative management. Before treatment the mean symptoms severity scale (SSS) of BCTQ) was 2.32±0.4 and for functional status scale (FSS) was it was 1.99±0.43. After treatment for SSS 1.86±0.47 and for FSS 1.53±0.42. And in SSS the p value&lt;.05 and in FSS p value is &lt;.05 which was statistically significant.Conclusion: In conclusion conservative management protocols are sufficient enough in alleviation of symptoms of the disease and is effective for the restoration of functional capability of the affected hand or hands.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 101-107

Menopausal hormone therapy and the incidence of carpal tunnel syndrome in postmenopausal women: Findings from the Women's Health Initiative.

ImportanceCarpal tunnel syndrome (CTS) is a common and debilitating condition that commonly affects postmenopausal women.ObjectiveTo determine the effect of menopausal hormone therapy (HT) in healthy postmenopausal women on CTS risk.DesignWe conducted a secondary analysis of the Women’s Health Initiative’s (WHI) HT trials linked to Medicare claims data. Separate intention-to-treat analyses were performed for the two trials; the conjugated equine estrogens alone (CEE alone) and the trial of CEE plus medroxyprogesterone acetate (MPA) trial. (ClinicalTrials.gov, NCT number): NCT00000611.SettingTwo randomized, double-blind, placebo-controlled trials conducted at 40 US clinical centers.ParticipantsThe sample size included in the analysis was 16,053 community-dwelling women aged ≥65 years at study entry or those who later aged into Medicare eligibility, and who were enrolled in Medicare (including Part A and/or Part B coverage).InterventionWomen with hysterectomy were randomized to 0.625 mg/d of conjugated equine estrogens (CEE) or placebo (n = 8376). Women without hysterectomy were randomized to estrogen plus progestin (E+P), given as CEE plus 2.5 mg/d of medroxyprogesterone acetate (n = 14203).Main outcome(s)The primary outcome was incident CTS and the secondary outcome was therapeutic CTS procedure occurring during the intervention phases of the trials.ResultsA total of 16,053 women were randomized in both trials. During mean follow up of 4.5 ± 2.8 years in the CEE trial (n = 6,833), there were 203 incident CTS cases in the intervention and 262 incident CTS cases in the placebo group (HR, 0.78; 95% CI, 0.65–0.94; P = 0.009). The CEE+MPA trial (n = 9,220) followed participants for a mean of 3.7 ± 2.3 years. There were 173 incident CTS cases in the intervention compared to 203 cases in the placebo group (HR, 0.80, 95% CI, 0.65–0.97; P = 0.027).ConclusionsThese findings suggest a protective effect of menopausal HT on the incidence of CTS among postmenopausal women. A potential therapeutic role for other forms of estrogen therapy in the management of CTS warrants future research.

Rates of Carpal Tunnel Syndrome in a State Workers' Compensation Information System, by Industry and Occupation - California, 2007-2014.

Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed as it passes through the wrist within the carpal tunnel, resulting in pain, tingling, weakness, or numbness in the hand or the wrist. Occupational risk factors for CTS include engaging in work activities that require forceful, repetitive tasks, prolonged use of the hands or wrists in an awkward posture, or vibration (1). To assess trends and identify high-risk industries and occupations for CTS, the California Department of Public Health (CDPH) analyzed California workers' compensation claims for CTS by industry (2007-2014) and occupation (2014) and calculated rates per full-time equivalent (FTE) worker. During 2007-2014, a total of 139,336 CTS cases were reported (incidence=6.3 cases per 10,000 FTE) in California workers; the rate among women (8.2) was 3.3 times higher than that among men (2.5). Industries with the highest rates of CTS were textile, fabric finishing, and coating mills (44.9), apparel accessories and other apparel manufacturing (43.1), and animal slaughtering and processing (39.8). Industries with high rates of CTS should consider implementing intervention measures, including ergonomic evaluations and development of tools and instruments that require less repetition and force and that correct awkward postures.

Frequency of Carpal Tunnel Syndrome in Patients Having Diabetes Mellitus with Neuropathy in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 240-245

Emphysematous Pyelonephritis: Experience of Managing 15 Consecutive Cases in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 246-250

Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review

BackgroundCarpal tunnel syndrome is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. It presents a high prevalence and is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild-to-moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of carpal tunnel syndrome in the last 15 years. MethodsA systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild-to-moderate carpal tunnel syndrome; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. ConclusionsSeveral conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate carpal tunnel syndrome. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.

T34. Diagnosing patients with carpal tunnel syndrome: Do you need needle EMG?

Introduction Carpal tunnel syndrome (CTS) is a common diagnosis that requires a thorough clinical history and examination. Electrodiagnostic (EDX) evaluation with nerve conduction studies (NCS) is frequently performed to assist the ordering physician when considering additional therapies or surgical intervention. It is a sensitive tool to examine median nerve dysfunction and aids in distinguishing CTS from cervical radiculopathy (CR) by identifying selective slowing of the conduction of median nerve fibers across the carpal tunnel. Some argue that if the NCS shows evidence of CTS, then needle EMG is not necessary. Current practice guidelines consider needle EMG to be an optional test better suited to exclude concurrent causes (cervical radiculopathy) of the patient’s symptoms for improving diagnostic sensitivity. We set out to determine the number of suspected CTS patients with evidence of CTS on NCS who also have concurrent needle EMG evidence of cervical radiculopathy. We aimed to further explore whether clinical examination performed by physicians ordering EDX could distinguish between the diagnoses of CTS and CR before testing is performed. Methods A retrospective chart review of 606 cases of CTS and CR in the Mayo Clinic Arizona EMG Laboratory from January 2015 to January 2016 was performed. Clinical notes of referring physicians for EMG/NCS and final EMG/NCS reports were reviewed for referring diagnoses, clinical history, physical exam and EMG diagnoses. Results Out of 472 patients diagnosed with CTS, 19.1% also had a concurrent diagnosis of CR confirmed by needle EMG ( n = 90). 17.2% of suspected CTS based on clinical assessment were not confirmed after electrodiagnostic testing ( n = 104). 29.0% of suspected CR patients were not confirmed after electrodiagnostic testing ( n = 176). 12 clinical assessment data points (clinical history and physical exam findings) felt to represent a common evaluation of diagnoses of CTS were compiled. These included cervicogenic pain, radicular pain, hand paresthesias, nocturnal pain, symptoms worse with activity, symptoms relieved by shaking out hands (“flick” sign), myotomal weakness, dermatomal sensory abnormalities, hyporeflexia, loss of sensation in the median nerve distribution, thenar atrophy, and hand weakness. The only clinical finding found to have a clinically significant association with both CTS and CR was hand paresthesias ( p = 0.001). Conclusion This series demonstrated that 19% of patients seen with CTS have an associated cervical radiculopathy. Without needle electromyography, these concurrent diagnoses would be missed, which can affect subsequent management and therapy. Clinical assessment alone may not be enough to distinguish between CTS and CR, as has been demonstrated in previous studies. Even though practice guidelines allude to optional needle EMG, this data provides a strong argument in favor of performing both NCS and needle EMG in patients with suspected CTS.

Casuística e Follow Up de 1.639 casos de Síndrome do Túnel do Carpo operados por técnica aberta protocolada no serviço

Introdução: A síndrome do túnel do carpo é uma afecção muito frequente , acometendo até 10% da população mundial ao longo da vida e corresponde a aproximadamente 90% de todas as neuropatias periféricas compressivas. Como fatores de risco, alem do sexo feminino e as idades referidas, também são relatados na literatura o tabagismo, a obesidade, o uso de anticoncepcionais orais, de terapias para emagrecer, os transtornos digestivos e principalmente doenças concomitantes como a artrite reumatóide, a acromegalia, gota, tuberculose, insuficiência renal, hipotireoidismo, amiloidose e diabetes mellitus. Objetivo: Comparar a experiência de 1639 pacientes operados com técnica aberta em nosso serviço, com os resultados obtidos por outras técnicas cirúrgicas consagradas pela literatura mundial. Material e Métodos: Apresentamos 1639 casos de Síndrome do Túnel do carpo, todos conduzidos segundo mesmo protocolo: diagnóstico clínico associado a eletrofisiológico, tratamento cirúrgico em pacientes com quadro moderado a severo sem resposta ao tratamento clínico ou piora neurológica, sempre através da técnica aberta protocolada no serviço, com seguimentoambulatorial pós-cirúrgico quinzenal e posteriormente mensal por 6 a 12 meses. Resultados: Os resultados obtidos mostraram que 1490 pacientes (90,9%) apresentaram melhora imediata e significativa do quadro. Não houve nenhum caso de lesão cirúrgica do nervo mediano e nenhum dos pacientes apresentou déficit motor sequelar. Os resultados cirúrgicos diferiram da literatura, principalmente se comparados a resultados relatados por serviços que realizam técnicas cirúrgicas por vias endoscópicas. Conclusão: A técnica usada em nossos casos demonstra baixa incidência de complicações, comparada com outros métodos descritos na literatura, que apresentam complicações maiores, curva de aprendizado mais longa e ao nosso ver, o fato de os poucos casos bons publicados voltarem mais cedo ao trabalho, não justifica seu uso pela gravidade das complicações.

Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study.

ObjectivesWe aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex.MethodsWe analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers.ResultsAfter adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher.ConclusionsOur analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks).

Four cases of carpal tunnel syndrome associated with Kienböck disease

Four cases of carpal tunnel syndrome associated with Kienböck disease