Carpal Tunnel Syndrome Patients Research Articles

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

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

A revised electrodiagnosis-based severity classification for carpal tunnel syndrome

BACKGROUND: An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity. OBJECTIVE: This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS. METHODS: This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens’ classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation were performed to detect anatomical abnormalities. RESULTS: Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group. CONCLUSION: The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups.

Comparison of median nerve area measurement between MRI and electromyography in patients diagnosed with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that occurs when the median nerve is compressed within the carpal tunnel. Electromyography (EMG) is accepted as the most frequently used and important diagnostic method for CTS. Recently, magnetic resonance imaging (MRI) has begun to be used in CTS patients to directly visualize the median nerve and examine the changes occurring in the nerve structure. In this study, the area of the median nerve was measured at various levels in the wrist in patients with CTS using MRI, examining its relationship with signal increase, and comparing this to results obtained with EMG. Overall, 35 patients diagnosed with CTS were included in the study. Patients with normal-mild and moderate-severe EMG tests were included in the study; wrist MRI was taken to investigate the area/mm2 of the median nerve at various levels and whether there was an increase in signal. Thenar muscles included in the imaging were also evaluated. Of the 35 patients included in the study, 24 were women (68.6%) and 11 were men (31.4%). Measurements of the average median nerve area measured in mm2 at the distal radioulnar junction (DRUJ) and the median nerve area measured in mm2 at the hamate bone level were obtained, showing that DRUJ and hamate bone distance measurements were higher in patients with positive EMG. Electromyography findings were also significantly positive in patients with increased signal. In some cases, the diagnosis of CTS can be easily made with history and physical examination or employing confirmatory tests such as EMG, which is considered the gold standard. Magnetic resonsnace imaging can be used as an alternative method for imaging the median nerve in patients with CTS. In our study, EMG findings were also significantly positive in patients with increased signal on MRI, making it a preferable method, especially in soft tissue-related pathological cases.

Clinical results of carpal tunnel Re-release revision surgery and synovial wrap for recurrent carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision surgery with a synovial wrap for cases of recurrent carpal tunnel syndrome in patients who had adhered median nerve, with a minimum 1-year follow-up. Patients and methodsA retrospective analysis was conducted on 10 patients (mean age: 73.7 years, nine females and one male) who underwent treatment for recurrent carpal tunnel syndrome. The approach involved carpal tunnel revision surgery coupled with a median nerve synovial wrap. Patients were followed up for a minimum of 1 year. The procedure involved harvesting a 3.5 cm × 4 cm section of the flexor synovial membrane with a distal ulnar pedicle, which was then wrapped around the adherent site of the median nerve. Physical assessments included the pain visual analogue scale (VAS), Tinel sign in the carpal tunnel, thenar muscle atrophy, the Semmes-Weinstein monofilament test (SW test), manual muscle test (MMT) as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent), and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. The physical variables were compared before surgery and at final follow-up. ResultsAll patients showed some improvement in SW test. The MMT for the abductor pollicis brevis showed significant improvement at final follow-up (3 for four patients, 4 for four patients, and 5 for two patients) compared to pre-surgery assessments (2 for six patients, 3 for two patients, and 4 for two patients). The mean VAS score and DASH score at final follow-up (13.0 ± 10.3, 19.3 ± 12.7, respectively) were significantly lower than those recorded before surgery (76.5 ± 11.1, 52.4 ± 17.1, respectively). The Tinel sign and the thenar muscle atrophy significantly improved from before surgery to final follow-up. ConclusionCarpal tunnel release with a synovial wrap demonstrated significant improvements in muscle strength, pain relief and function. The synovial wrap method is an effective procedure for treating recurrent carpal tunnel syndrome.

Which kinesiotaping technique is effective? Comparision of two different techniques in patients with carpal tunnel syndrome

Background & Objective: Although different kinesiotaping (KT) techniques can be applied in the treatment of carpal tunnel syndrome (CTS), to our knowledge, there is no study in the literature showing the superiority of these techniques over each other. The aim of this study is to compare the effectiveness of KT techniques applied to the dorsal surface and palmar surface of the forearm in patients with CTS. Methods: Forty six patients (70 wrists) diagnosed with CTS were randomized into 3 groups. Fabricated night splint was applied to the first group, KT was applied to the palmar surface of the wrist to the second group, and KT was applied to the dorsal surface of the wrist to the third group. Clinical, electrophysiological and ultrasonographic evaluations before treatment and at the end of 3-week treatment were compared. Results: In the comparison pre- and post-treatment, the changes in pain evaluated with Visual Analog Scale, and median motor nerve distal latency were significant in all groups, the change in median nerve sensory conduction velocity was significant in Groups 1 and 2, the change in median motor nerve conduction velocity was significant in only Group 2, the change in The Boston Carpal Tunnel Questionnaire (BCTQ)-Symptom Severity Status was significant in Group 1 and Group 3, the change in BCTQ-Functional Severity Scale and median nerve cross-sectional area was significant in only group 1. When the changes in treatment between the groups were compared, no statistically significant difference was found in any of the parameters. Conclusion: While splinting and different KT methods provided various benefits in CTS patients, they were not statistically superior to each other.

Effectivenes of Gliding Exercise Therapy In Carpal Tunnel Syndrome (CTS) Patients : Literature Review

Carpal Tunnel Syndrome (CTS) is a condition characterized by pain, numbness, and tingling in the hand, particularly in the thumb, index finger, middle finger, and part of the ring finger. This condition occurs due to compression of the median nerve passing through the carpal tunnel in the wrist. This study aims to evaluate the effectiveness of gliding exercises in improving CTS symptoms and the functional status of patients. The method used is a literature review, with inclusion criteria for research articles from 2013 to 2023. The results from the five selected studies indicate that gliding exercises can significantly reduce pressure on the median nerve, thereby alleviating symptoms and enhancing the functional capacity of the hand in CTS patients. These exercises were performed once a week for 30 minutes over a period of 3 to 8 weeks, depending on the patient's condition. Gliding exercises have been proven effective as a non-medical intervention in the management of CTS, though some controversy regarding the potential risk of shifting the involved anatomical structures should be considered.

Bioinformatics Analysis of Differentially Expressed Genes in Carpal Tunnel Syndrome Using RNA Sequencing.

Carpal tunnel syndrome (CTS) is a common disease resulting from the median nerve entrapment at the wrist. Although CTS (prevalence=5%-10% in the general population) is the most common neuropathy, its molecular mechanisms need elucidation. We used bioinformatics to detect genes with differential expressions in CTS and introduce the molecular regulatory noncoding RNAs and signaling pathways involved. The raw files of the RNA sequencing of CTS patients and controls were obtained from GEO (accession: GSE108023), and the samples were analyzed. Differentially expressed genes were isolated using DESeq2 R. Functional analyses were conducted on the signaling pathways, biological processes, molecular functions, and cellular components of the differentially expressed genes. Additionally, interactions between the most differentially expressed genes and miRNAs and lncRNAs were investigated bioinformatically. Upregulation and downregulation were observed in 790 and 922 genes, respectively. The signaling pathway analysis identified the metabolism pathways of arachidonic acid, linoleic acid, and tyrosine as the most significant pathways in CTS. Moreover, PLA2G2D and PLA2G2A with upregulated expressions and PLA2G2F, PLA2G4F, PLA2G4D, PLA2G3, and PLA2G4E with downregulated expressions were genes from the phospholipase family playing significant roles in the pathways. Further analyses demonstrated that hsa-miR-3150b-3p targeted PLA2G2A and PLA2G4F, and RP11-573D15.8-018 lncRNA had regulatory interactions with the aforementioned genes. Molecular studies on CTS will clarify the involved signaling pathways and provide critical data for biomedical research, drug development, and clinical applications.

Dropping Objects in Carpal Tunnel Syndrome: Clinical and Electrophysiological Features.

Background Dysfunction in both afferent sensory and efferent motor components of the median nerve may contribute to the manifestation of the symptom of dropping objects (DO) in carpal tunnel syndrome (CTS). The objective of this study was to compare the clinical and electrophysiological characteristics of CTS patients with dropping objects (wDO) and those without dropping objects (w/oDO). The study evaluated the correlation between DO symptoms and median partial conduction block, as well as the reduction in median motor conduction velocity at the wrist. Methodology An examination for CTSand the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were performed. Median and ulnar sensory and motor nerve conduction studies were conducted in both upper extremities, and the percentage decrease in the median compound motor action potential amplitude at the wrist level was calculated. Results The study included 201 female participants aged between 22 and 88 years, comprising 57 patients withCTSwDO, 78 patients with CTSw/oDO, and 66 healthy controls. In the CTSwDO group, compared to the CTSw/oDO group, BCTQscores were significantly higher, the prevalence of sensory deficits was more pronounced, and a larger number of hands, both dominant and non-dominant, were classified as stage 3 or higher in the clinical CTS classification. However, no correlation was found between the presence of DO symptoms and any neurophysiological findings. Conclusions DO may be a symptom of clinical severity in CTS, as previously reported.No neurophysiological parameter that could be associated with DO was identified.

How Does Nerve Mechanical Interface Treatment Impact Pre-Surgical Carpal Tunnel Syndrome Patients? A Randomized Controlled Trial.

Carpal tunnel syndrome (CTS) presents a high burden on the healthcare system. However, no alternative treatments are provided during the waiting period. In addition, the incidence of severe patients with comorbidities is underestimated. The aim of this study was to determine whether nerve mechanical interface treatment improves the symptoms, function, and quality of life in pre-surgical CTS patients. A randomized controlled trial and intention-to-treat analysis were carried out. Forty-two patients with an electrodiagnosis of carpal tunnel syndrome, included on the surgery waiting list of a public healthcare system, were analyzed. The intervention group (n = 20) received a 45 min session/per week of instrument-assisted manual therapy (diacutaneous fibrolysis) for 3 weeks. The Boston Carpal Tunnel Questionnaire (BCTQ) was the primary outcome. The symptoms, mechanical threshold, grip strength, mechanosensitivity of the median nerve, quality of life, and patient satisfaction were included as secondary outcomes. The control group (n = 22) remained on the waiting list. The intervention seems to be beneficial for the BCTQ score (function and symptoms scale), pain, and mechanosensitivity after treatment, at the 3 and 6 months follow-up (p < 0.05). Kinesiophobia was improved at 6 months (p = 0.043; η2 = 0.10) and the mechanical threshold at the 3-month follow-up (p = 0.048; η2 = 0.10). No differences were identified for grip strength. At 6 months, the intervention group patients were satisfied (100%), as opposed to the controls, who felt that they had experienced a worsening of their condition (50.1%). Nerve mechanical interface treatment improved the symptoms, function, and quality of life in pre-surgical CTS patients. One hundred percent of the treated patients, characterized as moderate and severe CTS with associated comorbidities, were satisfied.

Comparative Analysis of Efficacy of Endoscopic versus Open Carpal Tunnel Release

Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomised control study in a single neurosurgery department Participants: 30 patients aged 35-69 years with clinically diagnosed carpal tunnel syndrome Main outcome measures: Primarily - operative duration, bleeding, pain score on day one, requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in hospital and days taken to return to work. Other outcomes include infection, wound status/cosmesis, injury to median nerve, chronic regional pain syndrome and patient satisfaction. Results: 15 patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent for the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however patients were able to return to work an average of 10.6 days earlier after endoscopic surgery. Conclusions: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery.

Does Addition of a Longer Acting Local Anesthetic Improve Postoperative Pain After Carpal Tunnel Release? A Randomized Controlled Trial

Carpal tunnel release (CTR) is a simple and effective treatment for carpal tunnel syndrome in patients who have failed nonsurgical management. This surgery is often performed in the ambulatory clinic under local anesthesia, with lidocaine, a short-acting agent. Few studies have investigated the use of longer acting agents, such as bupivacaine, for outpatient CTR. Therefore, the aim of our study was to compare the postoperative pain experience after CTR with the use of either our standard lidocaine solution (control) or a mixture consisting of lidocaine and bupivacaine in equal amounts (intervention). Patients undergoing CTR were randomized into control or intervention groups. Postoperative pain severity and numbness were recorded at several timepoints within the first 72 hours. The timing and quantity of postoperative analgesic use (acetaminophen and/or ibuprofen) was also documented. Both patients and assessor were blinded to allocation. Our study cohort included 139 patients: 67 in the control group and 72 in the intervention group. Postoperative pain scores were significantly lower in the intervention group at 6 hours (2.3 vs 3.2) and 8 hours (2.9 vs 3.9). Additionally, patients in the intervention group reported longer time to first analgesic use than those in the control group (5.2 hours vs 3.7 hours). A greater proportion of patients in the intervention group reported postoperative numbness at nearly all time points, compared to the control group. Our study shows that a mixture of bupivacaine and lidocaine improves early postoperative pain but causes prolonged finger numbness when compared to lidocaine alone. As both medications are effective and feasible for outpatient CTR, surgeon and patient preference should guide local anesthetic choice. Therapeutic Ib.

Understanding the Mechanosensitivity of the Median Nerve in Pre-Surgical Carpal Tunnel Syndrome Patients: A Correlational Study

(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon’s visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman’s rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman’s rho = −0.353) and moderately with SF-36 subscale, Social Functioning (Spearman’s rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients.

Potential Role of Subclinical Hypothyroidism in Carpal Tunnel Syndrome Patients (Case Control Study)

Potential Role of Subclinical Hypothyroidism in Carpal Tunnel Syndrome Patients (Case Control Study)

Exploring pathogenic pathways in carpal tunnel syndrome: sterile inflammation and oxidative stress.

The main objective of the current study was to find the association between oxidative stress, inflammatory markers, and electrophysiological profile with symptom severity in patients of carpal tunnel syndrome (CTS). Thirty-two carpal tunnel syndrome patients and 32 controls were included in the study. Boston CTS questionnaire along with plasma oxidative stress markers including superoxide dismutase, malondialdehyde, and nitric oxide and inflammatory markers including IL-6 and TNF-α were compared with the electrophysiological parameters derived from nerve conduction studies. Statistical significance of the levels between groups was calculated using unpaired-t test after checking for normality with D'Agostino & Pearson omnibus normality test. We found that the median nerve conduction velocity was prolonged, amplitude was decreased, while the levels of oxidative stress markers like malondialdehyde (MDA), superoxidase dismutase (SOD), and nitric oxide (NO) were increased in CTS patients compared to controls. Inflammatory markers like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were also increased in CTS patients. We found that plasma SOD and TNF-α correlated well with the median motor amplitude. There was no other significant correlation between oxidative stress markers and inflammatory markers with nerve conduction studies or disease severity. Patients with mild disease also showed lesser levels of SOD, NO, IL-6, and TNF-α markers than patients with severe disease. CTS is probably a disease of sterile inflammation and disbalance of oxidative stress, with higher inflammatory and oxidative stress markers pointing to a more severe disease.

Three in one - unusual palmaris longus muscle anatomical variation.

The palmaris longus muscle (PLM) is one of the most variable muscles in human body, pre-senting a wide range of morphological variants such as reversed course, biventer muscle, bi-furcated tendon or total agenesis. Their clinical impact is particularly important in diagnosis and treatment of carpal tunnel syndrome and reconstructive surgery. We present a case of PLM including a previously undescribed combination of variations. A routine dissection of male cadaver aged approximately 60 demonstrated a biventer muscle, with superior and inferior belly being interrupted by a long tendon. The inferior belly passed deep to the flexor retinaculum and its terminal tendon connected to flexor digitorum superfi-cialis tendon for 5th finger. The clinical importance of variations found have been described separately, including unsuita-bility of biventer muscles for tendon reconstruction and increased risk for developing carpal tunnel syndrome in patients with PLM tendon passing deep to the flexor retinaculum. In conclusion, as another variation of PLM is described, it is crucial to bear in mind the poten-tial morphological types of the muscle in diagnosis and treatment of patients, especially in surgery of the hand and forearm.

Surgery for carpal tunnel syndrome in patients with and without diabetes-Is there a difference in the frequency of surgical procedures?

Carpal tunnel syndrome (CTS) occurs more often among individuals with diabetes. The aim of this retrospective observational registry study was to examine whether individuals with diabetes and CTS are treated surgically to the same extent as individuals with CTS but without diabetes. Data on CTS diagnosis and surgery were collected from the Skåne Healthcare Register (SHR). A total of 35,105 individuals (age ≥ 18 years) diagnosed with CTS from 2004-2019 were included. Data were matched to the Swedish National Diabetes Register (NDR. Cox regression models were used to calculate the risk of the use of surgical treatment. Of the 35,105 included individuals with a CTS diagnosis, 17,662 (50%) were treated surgically, and 4,966 (14%) had diabetes. A higher number of individuals with diabetes were treated surgically (2,935/4,966, 59%) than individuals without diabetes (14,727/30,139, 49%). In the Cox regression model, diabetes remained a significant risk factor for surgical treatment (PR 1.14 (95% CI 1.11-1.17)). Individuals with type 1 diabetes were more frequently treated surgically (490/757, 65%) than individuals with type 2 diabetes (2,445/4,209, 58%). There was no difference between the sexes and their treatment. The duration of diabetes was also a risk factor for surgical treatment in diabetes type 2, but high HbA1c levels were not. Individuals with diabetes are more likely to be treated surgically for CTS than individuals without diabetes. Individuals with type 1 diabetes are more likely to be treated surgically for CTS than individuals with type 2 diabetes.

Concomitant amyloidosis is the primary cause of endothelial and coronary microvascular dysfunction in carpal tunnel syndrome

Study objectivesPatients with carpal tunnel syndrome (CTS) show manifestations of arterial abnormalities, including carotid intimal thickening and increased vascular stiffness. As carpal tunnel syndrome is associated with amyloidosis, we hypothesized that previously observed abnormalities can largely be related with concomitant amyloidosis rather than CTS itself. DesignProspective observational study. SettingMedeniyet University Goztepe Hospital Participants61 patients with CTS (of whom 32 had biopsy-proven amyloidosis) and 36 healthy controls. InterventionsSubjects underwent ultrasound examinations for the measurement of coronary flow velocity reserve (CFVR), flow-mediated vasodilatation (FMD) and carotid intimal-media thickness (CIMT). Main outcome measuresComparison of CFVR, FMD and CIMT in CTS patients with or without amyloidosis. ResultsPatients with either CTS or CTS with concomitant amyloidosis (CTS-A) had significantly lower FMD (9.7 % ± 4.0 % in CTS and 10.3 % ± 4.6 % in CTS-A groups, p < 0.05 for both) and CFVR (2.4 (2.1–2.8) in CTS and 1.8 (1.6–2.1) in CTS-A groups, p < 0.001 for both) as compared to controls, while CIMT was only increased in CTS-A group (0.70 (0.60–0.80), p < 0.001). The reduction in CFVR was solely related to an increased basal flow velocity in CTS patients while there was also a reduced hyperemic flow velocity in patients with CTS-A. ConclusionMost arterial phenomena in CTS patients could be attributable to concomitant amyloidosis, although endothelial dysfunction was present even in patients with CTS without amyloidosis.

Is Ultrasonography a Reliable Approach for the Evaluation of Carpal Tunnel Syndrome in Patients With Mucopolysaccharidosis?

BackgroundOne of the most common causes of carpal tunnel syndrome (CTS) in childhood is mucopolysaccharidosis (MPS). While ultrasonography (US) can aid in the diagnosis of CTS in adult patients, there is limited experience of this in the pediatric group. We aimed to investigate the results of wrist ultrasonography, which may be a candidate alternative to electrophysiological examination. MethodsThe participants were evaluated for symptoms, physical examination findings, electrophysiological tests and grayscale US. CTS was diagnosed in accordance with the American Academy of Orthopedic Surgeons Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. ResultsIncluded in the study were 27 MPS patients aged 4.5–32 years and 30 healthy control subjects aged 4.3–26 years. Of the 54 wrists in the MPS group, 30 were diagnosed with CTS. The median cross-sectional area (CSA) at the proximal carpal tunnel, the CSA at the forearm, and the wrist-forearm ratio (WFR) were higher in the wrists of the MPS with CTS group than in those without CTS and the healthy control subjects. The WFR cutoff of ≥1.35, 56.6% (95% CI: 437.4–74.5) sensitivity, and 89.8% (95% CI: 81.0–95.5) specificity were consistent with a diagnosis of CTS (receiver operating characteristics analysis, area under the curve = 0.775, 95% CI: 0.673–0.877). ConclusionAlthough the US provides results with unsatisfactory specificity and sensitivity, it is a candidate for further investigation for the diagnosis of CTS because it is an innovative, noninvasive, and more accessible method. WFR value may produce more meaningful results than wrist or forearm nerve area measurements.

Application of Machine Learning Algorithms for Carpal Tunnel Syndrome

Introduction: Median nerve entrapment is commonly related to alterations in the anatomy of the surrounding tissues in the carpal tunnel. Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral entrapment neuropathy. Machine learning (ML) is utilized in a variety of fields. After conferring with a physician, ML enables doctors to conduct the necessary examinations and make an early diagnosis. Methods based on artificial intelligence have the potential to be utilized in clinical practice as a supplementary instrument for accurate evaluation of median nerve entrapment. Despite the rise in ML-based medical research, median nerve entrapment has received less attention. The purpose of this study was to evaluate the performance of classification approaches with ML algorithms in CTS patients utilizing electromyography test data from patients exhibiting varied CTS symptoms and indications. Materials and Methods: Our study includes message and demographic information derived from the electromyography results of 315 individuals. In classification procedures, the logistic regression, support vector machine (SVM), K-nearest neighbor, and naïve Bayes algorithms from ML techniques were utilized. Results: As a result of the classification, performance values for accuracy, precision, sensitivity, specificity, and F1-score were obtained. As a result of our research, the SVM algorithm achieved a 96% success rate. Conclusion: ML algorithms are an emerging method of analysis. The diagnosis and treatment of diseases are gradually gained by clinicians through observation and experience. Therefore, categorization systems can aid in the accurate and timely diagnosis of median nerve entrapment by clinicians.

Perineural Injection of Mecobalamin Versus Dextrose 5% Against Clinical Changes and Electrophysiological Features of Carpal Tunnel Syndrome Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Carpal tunnel syndrome (CTS) is a common compression neuropathy with symptoms of pain, tingling, and numbness in the hands. Perineural injections of steroids and mecobalamin have been shown to be effective in relieving CTS symptoms. This study aims to compare the effectiveness of the perineural injection of mecobalamin and 5% dextrose on clinical changes and electrophysiological features in CTS sufferers.&#x0D; Methods: This research is a pilot study open-label randomized controlled trial conducted at Dr. Mohammad Hoesin General Hospital Palembang. A total of 24 CTS patients were randomly divided into two groups: the mecobalamin group (n=12) and the 5% dextrose group (n=12). Patients in both groups received a single perineural injection.&#x0D; Results: In the mecobalamin group, there were significant improvements in pain scores (NPRS), Boston carpal tunnel questionnaire (BCTQ) - symptom severity scale (SSS) and functional status scale (FSS), as well as median nerve motor and sensory conduction after 2 weeks. In the 5% dextrose group, there were significant improvements in pain scores and BCTQ-SSS but not in BCTQ-FSS and nerve conduction. Comparison between groups showed significant differences in BCTQ-SSS and sensory conduction amplitude.&#x0D; Conclusion: Perineural injection of mecobalamin and 5% dextrose is effective in improving clinical symptoms of CTS. Mecobalamin showed better effects on BCTQ-SSS and sensory conduction amplitude than 5% dextrose.