Carpal Tunnel Syndrome Patients Research Articles

Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients

ABSTRACT Background There is no standard guideline for treating mild to moderate carpal tunnel syndrome (CTS). 5% dextrose perineural injection has been a potential and innovative treatment with long-term effects for CTS; however, there is few published randomized clinical trial comparing the efficacy of 5% dextrose perineural injection versus corticosteroid injection in treating CTS. Materials and Methods In this double-blinded randomized active-controlled trial, we randomly allocated 1 session of either 2 cc 5% dextrose or 1 cc methylprednisolone acetate mixed with 1 cc normal saline in 36 patients with mild to moderate CTS of single or both their wrists. The baseline VAS, BCTQ, electrophysiological studies, and sonography assessment of median nerve CSA were carried out at the baseline and 1-month and 3-month follow-ups, as well as recording demographic variables. Results A statistically significant decreasing trend in VAS (P < 0.0001), BCTQ-ss (P < 0.0001), median nerve CSA (P = 0.05), SNAP-PL (P < 0.0001), and CMAP-OL (P = 0.048) in both methylprednisolone and 5% dextrose groups was observed. No significant difference was observed in slope of the trend of studied parameters, including VAS (P = 0.95), BCTQ-ss (P = 0.88), BCTQ-F (P = 0.34), median nerve CSA (P = 0.321), SNAP-PL (P = 0.9), CMAP-OL (P = 0.799), SNAP-amplitude (P = 0.798), and CMAP-amplitude (P = 0.584). Conclusion 5% dextrose perineural injection is an effective and safe treatment for mild to moderate CTS, in comparison with the short-term results attained from corticosteroids. Further randomized clinical trials with longer follow-up periods are warranted.

Median to ulnar nerve comparison on diagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy - A neurophysiological study.

<p style="text-align: justify;"><strong>Background and purpose </strong>&ndash; To analyze the utility of median nerve (MN) to ulnar nerve (UN) comparative parameters on the diagnosis of carpal tunnel syndrome (CTS) in diabetic patients with distal symmetrical sensorimotor polyneuropathy (DSMPNP). <br><br><strong>Methods</strong> &ndash; Patients who were referred to our electroneuromyography laboratory within the last two years were included. We compared the diagnostic accuracy values of traditional MN conduction parameters, and the MN-to-UN comparative tests on electrodiagnosis of CTS between the patients with DSMPNP involving the nerves of upper and lower extremities (UEI-positive group), and the ones without the involvement of upper extremities (UEI-negative group). <br><br><strong>Results</strong> &ndash; There were 64 upper extremities in the UEI-positive group and 70 patients in the UEI-negative group. The most accurate traditional parameter was MN distal motor latency (DML) with a diagnostic accuracy of 70.2% whereas the most accurate comparative technique was the second lumbricalinterosseous DML difference (2L-INT DMLD) with an accuracy of 81.3%. (p=0.03). In addition, when compared diagnostic accuracy values of MN parameters with their corresponding comparative parameters in the UEI-positive group which carries the major diagnostic challenges for detecting co-morbid CTS, MN to UN minimum F wave latency (mFWL) difference, SNAP amplitude ratio on the ring finger (RF), and 2L-INT DMLD had higher accuracy values than MN mFWL, MN SNAP amplitude on RF, and MN DML on lumbrical muscle, respectively (p&lt;0.05 for all comparisons). <br><br><strong>Conclusion</strong> &ndash; MN to UN comparative studies have high accuracy values in electrodiagnosis of CTS in DSMPNP. In particular, 2L-INT DMLD could be helpful to overcome the diagnostic difficulty in the presence of UEI as an additional conduction technique.</p>.

Which Patients with Carpal Tunnel Syndrome are More Associated with Fibromyalgia Syndrome?

Objective: In this study, it was aimed to detect the presence of Fibromyalgia Syndrome (FMS) and related factors in patients diagnosed by Carpal Tunnel Syndrome (CTS). Materials and Methods: Demographic data and the features of CTS were noted by applying face-to-face questionnaire method. The existence of FMS in patients with CTS was investigated using the 2016 American College of Rheumatology (ACR) Fibromyalgia Diagnostic criteria. The Fibromyalgia Impact Questionnaire (FIQ) was introduced to patients diagnosed with FMS. Then, the correlations between the incidence of FMS in CTS patients, the presence of FMS and the hand with CTS, the severity of CTS and the existence of FMS, the presence of FMS and the duration of CTS symptoms, and finally CTS severity and FIQ were concurrently examined. Results: 151 patients included in the study. Bilateral CTS was detected in 89 (58.9%) patients. CTS was mild in 55 (36.4%), moderate in 87 (57.6%), and severe in 9 (6.0%) patients. Concomitant FMS was detected in 73 (48.3%) of all CTS patients. FMS rate is higher in patients with bilateral CTS (p=0.001). No significant relevance was observed between the severity of CTS and the presence of FMS (p = 0.864). The median duration of CTS symptoms with FMS patients was 24 (1-240) months; this period was found to be 12 (1-120) months in those without FMS. No significant relations between the presence of FMS and the duration of CTS symptoms were encountered (p = 0.073). The severity of CTS and FIQ demonstrated no significant difference (p=0.955). Conclusion: The case of FMS is high in specially bilaterally CTS patients. The fact that there may be common points in the pathogenesis of these two diseases suggests that it should be considered for diagnosis and treatment.

Risk factors for carpal tunnel syndrome in patients attending the primary care center of a tertiary hospital in Riyadh, Saudi Arabia: A case-control study.

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy in the upper extremity, is known to be a multi-factorial disease that raises medical and nonmedical risk factors. The aim of the current study was to determine the risk factors of CTS in patients attending the primary care center at a tertiary hospital. A case-control study was conducted by reviewing all medical records of patients above the age of 18 years old diagnosed with CTS from 2015 to 2021. The selected cases were evaluated by physical examination and confirmed by a nerve conduction study. Cases and controls were matched by age, gender, and nationality, with a case-to-control ratio of 1:2. Odds ratios were calculated for association between carpel tunnel syndrome and various factors and Chi-sqauare test determined statistical significance. Multiple logistic regression was performed to adjust for confounding. The study recruited 144 cases with a mean age of 53.38 ± 12.20 years and 288 controls with a mean age of 53.80 ± 12.27 years. The majority of subjects were female (84.7%) and of Saudi nationality (68.3%). There was a significant difference in body mass index, employment status, number of years of employment, occupation, mean systolic blood pressure, mean low-density lipoprotein cholesterol level, and mean blood urea level between cases and controls (P < 0.05). Laboratory tests that were found to be significantly associated with CTS in univariate analysis were thyroid-stimulating hormone (crude odds ratio [COR] = 0.828) and urea level (COR = 0.802). In fully adjusted analyses, obesity (adjusted odds ratio [AOR] =3.080), chronic kidney disease (AOR = 3.629), and the use of corticosteroid (AOR = 0.470) were also significantly associated with CTS. Similar to the findings of other studies, this study identified several potential risk factors for CTS. More large-scale longitudinal studies are required to establish a precise causal association.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Median nerve ultrasound cross sectional area and wrist-to-forearm ratio in relation to carpal tunnel syndrome related axonal damage and patient age

ObjectivePrimary objective was to retrospectively examine the effects of patient age and carpal tunnel syndrome (CTS) related axon loss on median nerve (MN) high resolution ultrasound (HRUS) in younger and older patients. HRUS parameters evaluated in this study were MN cross sectional area at the wrist (CSA) and wrist-to-forearm ratio (WFR). MethodsThe material comprised 467 wrists of 329 patients. The patients were categorized into younger (<65 years) and older (≥65 years) groups. Patients with moderate to extreme CTS were included in the study. Axon loss of the MN was assessed by needle EMG and graded by the interference pattern (IP) density. The association between axon loss and CSA and WFR was studied. ResultsThe older patients had smaller mean CSA and WFR values compared to the younger patients. CSA correlated positively to the CTS severity only in the younger group. However, WFR correlated positively to CTS severity in both groups. In both age groups, CSA and WFR correlated positively with IP reduction. ConclusionsOur study complemented recent findings on the effects of patient age on the CSA of the MN. However, although the MN CSA did not correlate with the CTS severity in older patients, the CSA increased in respect to the amount of axon loss. Also, as a new result, we presented the positive association of WFR with CTS severity among older patients. SignificanceOur study supports the recently speculated need for different MN CSA and WFR cut-off values for younger and older patients in assessing the severity of CTS. With older patients, WFR may be a more reliable parameter to assess the CTS severity than the CSA. CTS related axonal damage of the MN is associated to additional nerve enlargement at the carpal tunnel intel site.

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.

Diagnostic capability of the scratch collapse test compared with other clinical diagnostic tests for diagnosis of carpal tunnel syndrome: a prospective case-control study

Background: Diagnostic performance of the scratch collapse test for carpal tunnel syndrome (CTS) is not clear. This study evaluated its diagnostic capability for CTS diagnosis in comparison with other widely used clinical CTS tests, including the Tinel’s sign, Phalen’s test, and Durkan’s test. Methods: In a prospective case-control study, 78 CTS patients and 78 group-matched healthy control subjects were included. The electrodiagnostic testing was regarded as a reference standard CTS diagnostic method. The tests were conducted separately for the case and control groups; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the tests were calculated. Results: The sensitivity, specificity, PPV, NPV, and accuracy of CTS diagnosis were 7.7%, 100%, 100%, 52% and 53.8% for the scratch collapse test; 91%, 97.4%, 97.3%, 91.6%, and 94.2% for the Tinel’s sign test; 84.6%, 100%,100%, 88.6%, and 93.6% for the Phalen’s test; and 87.2%, 100%, 100%, 88.6%, and 93.6% for the Durkan’s test, respectively. Conclusions: Scratch collapse test has a low sensitivity and accuracy for diagnosing CTS. These results do not support its routine use for the diagnosis of CTS. Level of Evidence: Level III

Rehabilitation robot for carpal tunnel syndrome patients

Carpal Tunnel Syndrome (CTS) represents a prevalent neurological condition frequently encountered among individuals engaged in repetitive hand movements, particularly those involving the wrist and fingers. Pregnant women, people employed in the tea and cinnamon industries, in the hospitality sector where chefs engage in repetitive cutting tasks, musicians who play and practice musical instruments for extended periods, and employees in the IT sector where repetitive finger movements are used, are all prone to be diagnosed with this ailment.

Electrophysiological Changes in Patients with Carpal Tunnel Syndrome after Open Carpal Tunnel Release

Objective: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy affecting the upper limbs. Various treatment methods exist for this disease, but only a few reports have compared the effects of various treatments using objective indicators. This study analyzed the changes in electrophysiological parameters after carpal tunnel release.Methods: In patients planning to undergo surgical treatment for CTS, electrophysiological studies, including nerve conduction studies and electromyography (EMG), of both upper extremities were performed before and 6 to 8 weeks after mini-open transverse carpal ligament release and median nerve neurolysis.Results: After surgical intervention, the onset latency and amplitude of the sensory nerve action potential (SNAP) and the onset latency of the compound muscle action potential (CMAP) of the median nerve improved. Additionally, the grade of abnormal spontaneous activity in needle EMG of the abductor pollicis brevis (APB) and the severity of the electrodiagnostic study results significantly decreased after the intervention compared to the initial evaluation.Conclusion: This study shows that the onset latency of SNAP and CMAP, the amplitude of SNAP of the median nerve, and EMG findings in the APB can be useful electrodiagnostic parameters for postoperative monitoring in CTS patients.

Vücut Kitle İndeksi ve Mononöropatiler Arasındaki İlişki

Aim: The study aimed to find out whether there is a relationship between the mononeuropathies of the median, ulnar, radial, peroneal, and sciatic nerves and body mass index (BMI). Material and Methods: Patients whose clinical and electrodiagnostic findings were compatible with carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy at the spiral groove (RNS), peroneal neuropathy at the fibular head (PNFH), and sciatic injury due to intramuscular injection (SNIII) were included in this retrospective cohort study. In addition, controls whose clinical and electrodiagnostic features were not compatible with mononeuropathy were included in the study. The BMI values of all participants were analyzed. Results: One hundred thirty-one CTS patients, 53 UNE patients, 6 RNS patients, 25 PNFH patients, 72 SNIII patients, and 53 controls were included in the study. The BMI of CTS patients was higher than the BMI of controls (p&amp;lt;0.001), PNFH patients (p&amp;lt;0.001), and SNIII patients (p&amp;lt;0.001). The BMI of SNIII patients was lower than the BMI of controls (p&amp;lt;0.001), CTS patients (p&amp;lt;0.001), and UNE patients (p&amp;lt;0.001). The BMI of PNFH patients was lower than that of CTS patients (p&amp;lt;0.001) and UNE patients (p=0.004). No significant correlation was found between BMI values and electrodiagnostic classification of mononeuropathies in the groups. Conclusion: This study showed that high BMI is a risk factor for CTS and low BMI is a risk factor for SNIII. There may also be a relationship between BMI and PNFH, but this should be confirmed by further studies.

The Application of Ultrasound Image-Based Radiomics in the Diagnosis of Mild Carpal Tunnel Syndrome.

The ultrasound diagnosis of mild carpal tunnel syndrome (CTS) is challenging. Radiomics can identify image information that the human eye cannot recognize. The purpose of our study was to explore the value of ultrasound image-based radiomics in the diagnosis of mild CTS. This retrospective study included 126 wrists in the CTS group and 88 wrists in the control group. The radiomics features were extracted from the cross-sectional ultrasound images at the entrance of median nerve carpal tunnel, and the modeling was based on robust features. Two radiologists with different experiences diagnosed CTS according to two guidelines. The area under receiver (AUC) operating characteristic curve, sensitivity, specificity, and accuracy were used to evaluate the diagnostic efficacy of the two radiologists and the radiomics model. According to guideline one, the AUC values of the two radiologists for CTS were 0.72 and 0.67, respectively; according to guideline two, the AUC were 0.73 and 0.68, respectively. The radiomics model achieved the best accuracy when 16 important robust features were selected. The AUC values of training set and test set were 0.92 and 0.90, respectively. The radiomics label based on ultrasound images had excellent diagnostic efficacy for mild CTS. It is expected to help radiologists to identify early CTS patients as soon as possible, especially for inexperienced doctors.

Frequency of risk factors in patients with carpal tunnel syndrome

Objective: This study aimed to ascertain the frequency of carpal tunnel syndrome risk factors. Materials and Methods: A cross-sectional study was conducted at the Department of Neurology, Nishtar Hospital Multan, Pakistan. One hundred and twenty patients with Carpal Tunnel Syndrome (CTS) who attended the study site were enrolled. Baseline data, including age, gender, residential area, Duration of CTS, smoking, hypertension, diabetes mellitus, and obesity, were obtained. The blood samples were obtained for screening for hypothyroidism. Results: It was observed that most of the CTS patients were males (63.3%). The observed mean age was 44.3 ± 12.1 years, and 65.8% of cases belonged to urban areas. The most common risk factor observed among the currently enrolled CTS patients was obesity (70.8%), followed by smoking (50.8%), diabetes mellitus (45%), hypertension (34.2%), and hypothyroidism (22.5%). Conclusion: Our study shows that the most common risk factor for CTS was obesity, followed by smoking, diabetes mellitus, hypertension, and hypothyroidism.

Serum Levels of Inflammatory and Fibrotic Cytokines in Patients with Carpal Tunnel Syndrome and Hip Osteoarthritis.

A certain percentage of carpal tunnel syndrome (CTS) is associated with inflammatory conditions. Osteoarthritis (OA) increases the risk of CTS, and both diseases are common in the general population. Moreover, OA and CTS are often present in the same patients. Since inflammation and fibrosis are found in both conditions, the question is whether circulating inflammatory cytokines and cytokines involved in fibrosis in OA and CTS patients could serve as indicators of coexisting CTS and OA pathology. This investigation was performed on 31 CTS patients, 29 hip OA patients, and 15 healthy volunteers. Blood samples were collected, and serum levels of TGF-β1, BMP-7, IL-1β, and TNFα were measured using the ELISA method. The statistical analysis was performed to reveal the most significant differences in the serum levels of these cytokines. Statistical significance was set at p-values ≤&amp;nbsp;0.05. The serum level of TGF-β1 was the highest in CTS patients (16.36 pg/mL) and significantly different compared to OA and healthy control. Analysis of the cytokine serum level in the subdivided group revealed that serum levels of TGF-β1 and BMP-7 were significantly higher in CTS+/OA+ patients as well as BMP-7 in the OA+/CTS+ group. There was no significant difference in serum levels of the inflammatory cytokines TNFα and IL-1β among all groups. This study showed that in the end stage of CTS and OA, serum levels of inflammatory cytokines (IL1-β and TNFα) were not altered, while the serum levels of TGF-β1 and BMP-7 were significantly higher, especially in patients with coexisting OA and CTS. These findings suggest the possible values of TGF-β1 and BMP-7 as a predictive factor for the comorbidity of CTS and OA.

Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis: Ultrasonography and Magnetic Resonance Imaging Findings.

The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls. Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI. Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001). CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients.

Fibrosis-Associated Signaling Molecules Are Differentially Expressed in Palmar Connective Tissues of Patients with Carpal Tunnel Syndrome and Dupuytren's Disease.

Carpal tunnel syndrome (CTS) and Dupuytren's disease (DD) are fibrotic conditions that affect the connective tissue of the hand and limit its functionality. The exact molecular mechanism underlying the fibrosis is unknown, and only some profibrotic factors have been investigated. In this cross-sectional study, we analyzed the expression of FGF signaling pathway molecules associated with fibrotic changes in the palmar fascia and the flexor retinaculum of 15 CTS patients and both clinically affected and unaffected palmar fascia of 15 DD patients, using immunofluorescence techniques. The expression of FGFR1, FGFR2, and CTGF in the blood vessel walls and surrounding connective tissue cells differed significantly between the analyzed groups, with changes in expression present even in clinically unremarkable tissues from DD patients. We also found altered expression of the analyzed factors, as well as TGF-β1 and syndecan-1 in DD-associated sweat glands, possibly implicating their role in the pathophysiology of the disease. The increased expression of profibrotic factors in the clinically unaffected palmar fascia of DD patients may indicate that more extensive excision is needed during surgical treatment, while the profibrotic factors could be potential targets for developing pharmacological therapeutic strategies against DD-associated fibrosis.

Prevalence of carpal tunnel syndrome in patients with long-term type 2 diabetes mellitus

Generally, Carpal tunnel syndrome (CTS) is more common in diabetes mellitus (DM), especially in subjects with coexisting diabetic polyneuropathy (DPN) and/or long-term DM. Based on the analysis of nerve conduction velocity (NCV), the prevalence of CTS and the features of nerve injury were retrospectively explored in type 2 diabetes mellitus (T2DM) patients. In this cohort, there were 353 T2DM patients who were hospitalized in Taiyuan Central Hospitalbetween January 2018 and January 2019. The pathological rates of NCVs between the left and right median nerves were compared, including the gender effect. The examinations were mainly directed to analyze the median nerve injury features. Among 353 patients, 139 patients (39.3%) presented with CTS. These 139 T2DM patients with CTS were then divided into groups based on the nerve injury location and injured nerve type. The prevalence of sensory nerve injury (SNI) was higher than that of motor nerve injury (MNI). The CTS patients had a significantly higher occurrence rate of SNI than MNI (P < 0.05). The abnormal rate of sensory nerve conduction velocity (SCV, P = 0.01) and motor nerve conduction velocity (MCV, P < 0.05) were higher in the right median nerve. No significant differences were detected for other nerves on either side. Significant differences in abnormal rates of SCV of the left (P = 0.04) and the right (P = 0.03) median nerves between the two genders were found. There were no significant abnormalities for other nerves on either side and either gender. Early screening of NCV is needed for T2DM patients to detect CTS with a high prevalence rate. This study suggests that early detection of NCV can identify CTS in the absence of clinical conditions and SNI may occur earlier in long-term T2DM patients with CTS.

The relationship between fatigue, neuropathic pain, and neurophysiological features in carpal tunnel syndrome

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy and can affect patients' daily living activities. In this study, it was aimed to find out whether there is a relationship between fatigue, neuropathic pain and neurophysiological features in CTS.&#x0D; Material and Method: Patients with clinical features compatible with CTS were included in this retrospective study. Median nerve compound muscle action potential (CMAP) and compound nerve action potential (CNAP) of the patients were analyzed. The Turkish version of the Fatigue Severity Scale (FSS) was administered to all patients. Patients with a mean FSS score of ≥4 were considered to have fatigue. In addition, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was applied to some patients. If the LANSS score was 12 or higher, these patients were considered to have neuropathic pain.&#x0D; Results: Thirty-two female and eight male CTS patients were included in the study. Thirty-two patients had clinically bilateral CTS and eight patients had right-sided CTS. FSS and LANSS were administered to 40 and 18 patients, respectively. There were 29 CTS patients (72.5%) with an FSS score ≥ 4. CNAP/CMAP amplitudes and sensory/motor nerve conduction velocities of patients with fatigue were lower than those without fatigue (p

The relationship between carpal tunnel syndrome, smartphone use, and addiction: A cross-sectional study.

This study aims to investigate the use of and addiction to smartphones in individuals with and without carpal tunnel syndrome (CTS). The cross-sectional study included a total of 404 participants (286 females, 118 males; mean age: 39.7±11.6 years; range, 16 to 75 years) who applied to the Neurology Department of the Fırat University Faculty of Medicine, between April 2019 and October 2019. The participants were divided into two groups: 202 patients diagnosed with CTS were included in the case group, and 202 patients and their relatives who did not have hand and wrist complaints were included in the control group. The diagnosis of CTS was made by evaluating the history, physical examination, and electromyography findings. Data were collected with participant information forms and the Smartphone Addiction Scale. It was found that the risk of CTS increased 1.022 times with a one-unit increase in the SAS score and 1.292 times with a 1-h increase in daily smartphone use. Smartphone addiction can be considered as a potential risk factor for CTS; however, the effect of smartphone addiction on CTS severity was not examined in this study. The relationship between disease severity, smartphone use, and smartphone addiction in CTS patients requires further investigation to provide clarification on this issue.

Impaired median nerve mobility in patients with carpal tunnel syndrome: a systematic review and meta-analysis.

This systematic review and meta-analysis investigated the mobility of the median nerve (MN) in carpal tunnel syndrome (CTS) patients compared to healthy people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed and the electronic databases including PubMed, Scopus, EMBASE, and Cochrane Library were searched up to April 2022. All published observational studies comparing the excursion of MN between participants with and without CTS were included. The quality of research was assessed by the Newcastle-Ottawa Scale tool. The primary outcome was the excursion of the MN under dynamic examination, representing nerve mobility quantified by the standardized mean difference (SMD) for random effect meta-analysis. Fourteen studies were included in the qualitative review, and twelve entered the meta-analysis involving a total of 375 CTS patients and 296 healthy controls. The forest plot revealed that the mobility of the MN significantly decreased in the CTS group compared to the non-CTS control (SMD = -1.47, 95% CI: -1.91, -1.03, p < 0.001, heterogeneity 82%). In subgroup analysis, both transverse and longitudinal methods for nerve excursion showed less nerve mobility in CTS than in non-CTS. This meta-analysis showed that the patients with CTS exhibited less mobility of the MN than those without CTS, suggesting MN mobility as a potential CTS marker. • The patients with CTS revealed less mobility of the median nerve than those without CTS. • The mobility of the median nerve could be regarded as a potential CTS marker.