Tunnel Syndrome Research Articles

Determinants associated with carpal tunnel syndrome complaints

Introduction: Carpal Tunnel Syndrome (CTS) is one of the most common problems in the upper extremities caused by the narrowing of the carpal tunnel, which results in pressure on the median nerve. Increased pressure in the carpal tunnel causes compression and damage to the median nerve. Objective: determinants associated with carpal tunnel syndrome . Methods: quantitative research with a cross-sectional research design. The sampling technique in this study used a total sampling technique in which the entire population is equal to the number of samples, namely 36 people. Data obtained by using a questionnaire. The analytical method used was univariate and bivariate analysis using the chi-square test. Result: showed that there was a relationship between length of work and carpal tunnel syndrome (p-value = 0.0190. There is a relationship between age and complaints of carpal tunnel syndrome (p-value = 0.032. There is no relationship between personal protective equipment and complaints of carpal tunnel syndrome (p-value = 0.759). There is no relationship between repetitive movements and carpal tunnel syndrome (p-value = 0.787. Conclusion: It was concluded that there is a relationship between length of service and carpal tunnel syndrome complaints, there is a relationship between age and carpal tunnel syndrome complaints and there is no relationship between body mass index and carpal tunnel syndrome complaints . In this study, researchers suggest to companies to pay more attention to employees who have a long working period so as not to do excessive work and for employees to take advantage of adequate rest time to minimize the occurrence of complaints of Carpal Tunnel Syndrome (CTS).

Effects of the COVID-19 Pandemic on Hand and Arm Dysfunction: A Google Trends Analysis.

Introduction The COVID-19 pandemic prompted individuals to make a number of lifestyle alterations. Few studies have examined the development of any hand and/or arm dysfunctions that may have resulted. The purpose of this study was to identify hand and/or arm overuse injuries that may have occurred as a result of the stay-at-home orders during the COVID-19 pandemic. Methods A Google Trends analysis of the terms "hand pain," "carpal tunnel syndrome," "cubital tunnel syndrome," "trigger finger," "de Quervain tenosynovitis," "elbow pain," "tennis elbow," "golfer's elbow," "thumb base arthritis," and "extensor carpi ulnaris tenosynovitis" in the United States, United Kingdom, Canada, and India was performed from June 2019 to January 2023. The noted timeframe was divided into quarters of 47 weeks, with the first quarter (June 2, 2019, through April 19, 2020) serving as a pre-pandemic baseline. The analysis compared initial results noted in the first quarter to individual results from the second, third, and fourth quarters. Results The most notable findings were the upward trends of the terms "hand pain," "carpal tunnel," and "trigger finger."Specifically, India showed a significant increase in the terms "hand pain" and "carpal tunnel syndrome" in the second, third, and fourth quarters. The United States additionally showed a significant upward trend in the terms "carpal tunnel syndrome" and "trigger finger" in the second, third, and fourth quarters. The United Kingdom also reported a significant upward trend in the term "trigger finger" in the second, third, and fourth quarters. Conclusion Numerous factors likely contributed to the increased interest in these terms, such as the increase in telework and associated mobile device usage due to lockdown during the COVID-19 pandemic. Movements associated with performing these tasks may have led to an increased prevalence of hand pain, thus prompting increased queries of these terms through an online search engine.

Comparison of Effects of Ultrasound Therapy and Nerve-Gliding Techniques on Patients with Carpal Tunnel Syndrome: A Randomized Clinical Trial.

Carpal tunnel syndrome (CTS) is a common neuropathy caused by pressure on the median nerve in the wrist, affecting 1% to 5% of the population. Treatment options include pharmacologic management, rest, splints, local steroid injections, and physical therapy. Conservative treatments, such as ultrasound therapy and nerve-gliding exercises, can also be effective. This study aimed to compare the effects of ultrasound therapy and nerve-gliding exercises on reducing symptoms, improving hand function, and electrodiagnostic tests in patients with CTS. This randomized clinical trial was conducted on patients with CTS at the specialized physical medicine and rehabilitation clinic at Birjand University of Medical Sciences. The study included 48 patients with CTS, divided into two groups. The ultrasound group received therapy at a frequency of 1 MHz and a current intensity of 1 watt/cm², with each session lasting 5 minutes. The nerve-gliding group underwent 10 sessions of treatment, three times a week. Pain intensity was evaluated using VAS criteria, symptom intensity using the BOSTON Questionnaire, and median nerve latency with EMG-NCS. The study included 48 patients with CTS, divided into two groups. Both groups showed improved severity of symptoms and function scores at the end of the study (P < 0.001). The ultrasound group significantly reduced the sensory and motor median nerve latency scores (P < 0.001 and P = 0.001, respectively), and the pain score diminished significantly in both groups (P < 0.001). Ultrasound and neural-gliding techniques are effective in reducing patients' symptoms and pain intensity in the short term. Additionally, ultrasound can improve electrodiagnostic indicators.

Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes.

Type 2 diabetes (T2D) is a major risk factor for carpal tunnel syndrome (CTS) and trigger finger (TF), but less is known regarding the risk of developing T2D after being diagnosed with CTS or TF. CTS and TF could be early signs of preclinical T2D, and early detection of T2D is crucial to prevent complications and morbidity. Therefore, we investigate the association between CTS/TF and T2D in an adult population without previous T2D using big data registers in Sweden. Data were collected by crosslinking five nationwide Swedish registers. Individuals aged 40-85 years on December 31, 2010, without prior overt diabetes, were included (n = 3,948,517) and followed up from baseline (ie, a diagnosis of CTS or TF) or January 1, 2011, for controls, until a diagnosis of T2D, prescription of oral antidiabetics or insulin, or end of follow-up four years after baseline. Multivariate Cox regression models were created to calculate hazard ratios for T2D. In total, 37,346 (0.95%) patients were diagnosed with CTS, whereof 1329 (3.46%) developed T2D. There were 17,432 (0.44%) patients who developed TF, whereof 639 (3.67%) developed T2D. Among the controls, 2.73% developed T2D. Compared with controls, there was an increased risk of developing T2D after being diagnosed with either CTS (HR 1.35; 95% confidence interval 1.28-1.43) or TF (HR 1.21; 95% confidence interval 1.12-1.31). Compared with controls, a diagnosis of CTS or TF was associated with 35% and 21% higher risk for later T2D, respectively, which might indicate the existence of undetected T2D in this population.

Complications after volar plate synthesis for distal radius fractures.

Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor. A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the 'Down and Black's Checklist for measuring quality'. About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient's will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%). The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient's willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.

Systemic low-grade C-reactive protein is associated with proximal symptom spread in carpal tunnel syndrome.

Neuropathic pain is a highly prevalent condition associated with persistent disability. Some patients with neuropathic pain experience symptom spread outside neuroanatomical boundaries; these patients report more severe sensory symptoms and greater disability. However, the mechanisms behind such symptom spread are not fully understood. We used pre-surgical carpal tunnel syndrome (CTS) as a human model system of neuropathic pain to identify differences in the concentration of serologic inflammatory mediators between patients with CTS with territorial symptoms and those with proximal symptom spread to either the elbow or shoulder/neck. We performed a post-hoc analysis, comparing levels of serologic inflammatory mediators in a discovery cohort among 3 symptoms spread profiles (n = 55; n = 25 no spread, n = 21 spread to elbow, n = 9 spread to shoulder/neck). We then de-novo analysed the significantly dysregulated mediators in an independent validation cohort (n = 72; n = 34 no spread, n = 16 spread to elbow, n = 22 spread to shoulder/neck). The discovery cohort revealed higher serum concentrations of C-reactive protein (CRP) and interleukin-6 in patients with any symptom spread proximal to the wrist; interferon-γ was higher in patients with symptom spread to the elbow compared with those without proximal spread. The validation study replicated the association of higher CRP concentrations in patients with proximal spread to the elbow (no spread: median [interquartile range] 2.5 [5.4]; spread to elbow 6.2 [4.6]; spread to shoulder/neck 2.6 [3.7], P = 0.006). No other markers replicated in the validation cohort. Our findings suggest that proximal symptom spread in the context of neuropathic symptoms is associated with low-grade inflammation.

Risk of hand and forearm conditions due to vibrating hand-held tools exposure: a retrospective cohort study from Sweden

ObjectivesThe occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population...

Value of multi-modality small fiber assessments in a genotypically diverse cohort of transthyretin-related amyloidosis in the early stages of disease

IntroductionTransthyretin-related amyloidosis (ATTRv) is a progressive multisystem disorder, predominantly involving the peripheral nerve system (PNS) and heart. Quantification of small fiber damage may help guide treatment decisions, as amyloid deposits frequently affect those fibers early in disease course. Corneal confocal microscopy (CCM) is a promising method to monitor patients with ATTRv, due to similarities between corneal nerves and PNS, as the cornea is innervated by Aδ and C fibers. MethodsWe compared CCM measures from ATTRv patients to a group of healthy individuals, matched by age and gender. We then investigated the correlations between small fiber tests (SFT): CCM, LDI-Flare and CDT, COMPASS-31 and disability scales (RODS and ONLS) in patients. ResultsOf 20 patients (6 with V30M), mean age 50.3±15.3Y, 7 female (35%), six (30%) had polyneuropathy and 10 (50%) carpal tunnel syndrome. CDT was abnormal in 9 and LDI-flare in 6 patients. CCM was abnormal in 19 tested patients and significantly reduced when compared to controls (CNFL: 6.31±0.31 vs. 15.21±1.02mm/mm2, p<0.001). Mean COMPASS-31-scores were 22.27±22.84; RODS and ONLS were 38.15±12.33 and 2.05±2.3, with no significant differences between sub-group scores. Disease duration was significantly correlated with ONLS (0.43, p=0.05) and RODS (0.46, p=0.03). There were no significant correlations between measures of disability and SFT. ConclusionsIn a diverse cohort of ATTRv patients, CCM was the most frequent abnormal measurement. CCM can be a useful test to triage patients in the early disease stages and with few or equivocal symptoms.

The median nerve´s system of connective tissue distal to the pronator teres to the carpal tunnel

BackgroundConnective tissue serves a role beyond mere spatial filling. Furthermore, there is increasing evidence that connective tissue plays an important role in the pathogenesis of conditions such as carpal tunnel syndrome (CTS). According to our hypothesis, the median nerve (MN) is surrounded by a system of connective tissue distal to the pronator teres and extending up to, and including, the carpal tunnel. MethodsTo visualize the connective tissue surrounding the median nerve, we dissected the forearms of 15 body donors from pronator teres to the carpal tunnel, created plastination slices stained with Periodic Acid-Schiff (PAS), and injected ink into the seen spaces. We verified our findings with a segmentational analysis of radiological data of 10 healthy individuals. ResultsWe macroscopically describe the median nerve´s system of connective tissue (MC) distal to the pronator teres and up to and including the carpal tunnel. This system creates, connects, and separates spaces. At least from the pronator teres to the carpal tunnel it also creates subspaces from proximal to distal. For the MC, we established a mean cross-sectional area of 153.1 mm2 (SD=37.15) in the carpal tunnel. The median nerve consistently resides at the center of this MC, which further connects to flexor muscles of the forearm, and to the radius bone. In the carpal tunnel, the MC creates subspaces inside. There, it also acts as the outermost internal layer enveloping flexor tendons, and the MN. DiscussionThe term MC does not negate but orders the existence of other “connectives”, like subsynovial connective tissue, endo-, epi- or perineuria, epimysia, periostea, or peritendinea, to a hierarchy related to the median nerve. Diseases of the MN are common. Knowing the anatomy of the MC and how it relates to MN function may help clinicians recognize and understand conditions like CTS.

Diabetic cheiroarthropathy in uncontrolled type 2 diabetes with positive anti-nuclear antibodies: a case report from Sudan

Background: Diabetic cheiroarthropathy, also known as limited joint mobility, is one of the long-standing complications of type 2 diabetes mellitus (DM). It affects 8–50% of patients with type 1 diabetes and is also seen in type 2 diabetic patients. Consequently, it can mimic many rheumatological diseases and is often underdiagnosed. The authors present a case of a long-standing poorly controlled diabetes with diabetic cheiroarthropathy and diabetic neuropathy, along with positive ANA in the absence of any correlated autoimmune or rheumatological diseases. Case presentation: A 52-year-old female patient with poorly controlled diabetes (her last HbA1c reading was 9.5%) presented to the Rheumatology clinic with flexion deformities of the fingers. The patient has impaired vibration, two-point discrimination, and pinprick sensation in gloves and stock distribution, indicating peripheral neuropathy, entrapment neuropathy in the forms of bilateral carpal tunnel syndrome, and the diagnosis of diabetic cheiroarthropathy was made. Additionally, she has a positive prayer sign and a tabletop sign. Despite the absence of symptoms and signs of autoimmune disorders, this patient has positive anti-nuclear antibodies global (ANA positive by indirect immuno-fluorescence (IIF) 1\320 nucleolar pattern) with a negative: ANA profile, rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (ACPA). Conclusion: Regular and careful hand examination should be part of clinical assessment for diabetic patients as it could be a very simple and useful screening tool for diabetic cheiroarthropathy. Physicians can use this condition as a mirror for microvascular complications of diabetes. This allows for early detection and appropriate interventions to prevent further progression of diabetes-related complications. It is also essential to consider the presence of positive ANA in diabetic cheiroarthropathy despite the absence of any rheumatological and autoimmune diseases.

The incidence and decompression rates of median and ulnar neuropathies following shoulder surgery

BackgroundUpper extremity peripheral neuropathy is a known, but uncommon complication that can occur after shoulder surgery. The incidence rate is well documented, and most of these cases historically have been treated conservatively. However, we hypothesize peripheral compression neuropathy requires a much higher need for surgical decompression than originally reported. The purpose of this study was to evaluate the incidence, decompression rates, and prognostic factors for developing median and ulnar neuropathies following shoulder surgery. MethodsA retrospective chart review was performed examining patients who underwent open and arthroscopic shoulder surgery from a multi-surgeon, single-institution database. Perioperative data and functional outcomes were recorded. Symptom resolution was assessed with both conservative and surgical management of compression peripheral neuropathy. Further analysis was made to compare open and arthroscopic procedures, the type of neuropathy developed, and EMG severity. ResultsThe incidence rates of compression peripheral neuropathy following open arthroplasty and arthroscopic procedures was 1.80% (31/1722) and 0.54% (44/8150), respectively. 73.33% (55/75) of patients developed ipsilateral disease, while 20.00% (15/75) of patients had bilateral disease.Amongst the 75 included patients, there were 99 cases of neuropathy. Carpal tunnel syndrome (CTS) was more common than cubital tunnel syndrome (CuTS), comprising 61.61% (61/99) cases of neuropathy. 12.00% (9/75) of patients developed both CTS and CuTS.Four patients were lost to follow-up. Decompression surgery was performed for 36.84% (35/95) cases of neuropathy with >90% obtaining symptom resolution with surgery. 63.16% (60/95) cases of neuropathy were managed conservatively, 71.67% (43/60) of which had persistent symptoms.When comparing arthroscopic versus open procedures, patients who underwent open procedures were significantly older (68.62 vs. 49.78 years, p < .001) and developed peripheral neuropathy significantly faster after the index procedure (87.24 vs. 125.58 days, p = .008).EMG severity did not correlate with decompression rates or symptom resolution. There were no differences in the subgroup analyses between beach chair and lateral positioning in regard to the type of neuropathy, laterality of symptoms, and/or treatment received. ConclusionsThe overall incidence of peripheral neuropathy after shoulder surgery was 0.76% (75/9872). The development of peripheral neuropathy is multifactorial, with older patients undergoing open arthroplasty more at risk. Neuropathy symptoms were refractory to conservative management despite the type of shoulder surgery, type of neuropathy, or EMG severity. Decompression consistently led to resolution of symptoms.

Assessment of Neuropathic Pain in Erosive Hand Osteoarthritis.

Background/Objectives: Erosive hand osteoarthritis (EHOA) is an aggressive form of hand osteoarthritis (OA) and a severely disabling condition. Patients affected by OA frequently lament symptoms suggestive of neuropathic pain (NP). The aim of our study was to ascertain the presence and severity of NP in patients with EHOA and correlate its presence with EHOA clinical characteristics. Methods: In this retrospective study, we included all consecutive EHOA patients with NP symptoms who underwent upper limb electroneurography (ENoG) and nerve ultrasound. The presence of NP was screened using the ID pain neuropathic pain-screening questionnaire (ID-Pain). In addition, the following NP questionnaires were also used: Douleur Neuropathique en 4 Questions (DN4), PainDETECT, and Neuropathic Pain Symptom Inventory (NPSI). Moreover, patients completed the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Dreiser's algofunctional finger index questionnaires assessing EHOA disease activity. The following clinical and laboratory data were collected: age, sex, BMI, disease duration, intensity of pain (VAS 0-10), painful and swollen joints, and inflammatory indices, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Of the 34 patients studied, 24 (70.6%) presented NP to the ID-Pain questionnaire. According to DN4, 14 (41.2%) patients had NP, while using the PainDETECT questionnaire, 67.6% had NP. Patients with NP were statistically younger and had a higher VAS pain score compared to subjects without NP. The ENoG and median nerve ultrasound were normal in 81% of patients, while four patients had carpal tunnel syndrome. The ID-Pain questionnaire correlated with the number of painful joints (r = 0.48, p = 0.03) and with the AUSCAN questionnaire (r = 0.37, p = 0.05). The DN4 questionnaire correlated with PainDETECT (r = 0.58, p < 0.01). The PainDETECT questionnaire correlated with VAS pain (r = 0.49, p = 0.02), the DN4 questionnaire (r = 0.58, p < 0.01), and AUSCAN (r = 0.51, p = 0.02). The NPSI questionnaire correlated negatively with BMI (r = -0.53, p = 0.01) and positively with the PainDETECT questionnaire (r = 0.49, p = 0.02). Conclusions: Our study revealed that 32% to 70% of EHOA patients exhibited symptoms consistent with NP, with observed variability depending on the questionnaire utilized. Despite patients frequently exhibiting symptoms compatible with NP, only 19% of patients presented alterations on ENoG and ultrasound examinations confirming CTS. This suggests a probable nociplastic component for pain in patients with EHOA, which warrants tailored treatment. In the present study, NP correlated with clinical and functional indices of EHOA.

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)

Median Nerve Cross-Sectional Area and Carpal Tunnel Syndrome in Specific Populations: Sonographic Analysis of Patients With Type 2 Diabetes or Bifid Anatomy.

Evaluate diagnostic accuracy of median nerve cross-sectional area (CSA) to determine severity versus presence of carpal tunnel syndrome (CTS) across existing electrodiagnostic-based (EDX) classification systems in patients with type 2 diabetes or bifid anatomy. Retrospective analysis of cross-sectional patient data. Receiver operating characteristic analysis used to determine median nerve CSA cutoff values and associated diagnostic likelihood ratios for all consolidated and binary EDX-based classifications of CTS in patients with type 2 diabetes or bifid anatomy. Determine shifts in diagnostic probability based on established cutoff values and associated likelihood ratios. Distal CSA measured at or near carpal tunnel inlet, proximal CSA at level of pronator quadratus muscle, and delta CSA by subtracting proximal from distal. Binary categorizations of CTS were statistically superior to consolidated categorizations of CTS severity in patients with type 2 diabetes or bifid anatomy. Binary categorizations established reasonably consistent median nerve CSA cutoff values across all EDX-based classifications examined resulting in the following for distal CSA or delta CSA: ≤10 or ≤4 mm2 to rule out and ≥11 or ≥5 mm2 to rule in CTS, respectively. These cutoff values resulted in small shifts in diagnostic probability in patients with type 2 diabetes and small to conclusive shifts in diagnostic probability in patients with bifid anatomy. Binary categorizations to rule out or rule in CTS based on the proposed cutoff values provide the most meaningful information about shifts in diagnostic probability across all EDX-based classifications examined. The use of median nerve CSA to categorize severity of CTS is not recommended in patients with type 2 diabetes or bifid anatomy.

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.

POSITIVE SCRATCH COLLAPSE TEST IN ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME (ACNES): EVIDENCE FOR A PERIPHERAL NEUROPATHY?

Abstract Background Chronic abdominal pain is occasionally caused by an abdominal wall entity such as Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). This syndrome is thought to occur due to entrapped intercostal nerve branches (Th7-12) within the rectus abdominis muscles. This clinical diagnosis is based on subjective clues in patient history and physical examination. In contrast, in carpal tunnel syndrome an additional diagnostic test is used, which is referred to as the scratch collapse test (SCT). The SCT has shown positive results not only in other peripheral entrapment neuropathies involving the ulnar, peroneal, and long thoracic nerve, but also in three recently described ACNES patients. We investigated whether the SCT is of diagnostic use in patients suspected of having ACNES. Method A prospective, case-control study was performed among patients with ACNES (n = 20) and two control groups without ACNES (acute abdomen n = 20; healthy n = 20), all were consecutively included. ACNES was diagnosed based on previously published criteria. The SCT test was executed at the painful abdominal area in both patient groups and at a corresponding area in healthy controls. Predictive values, sensitivity, and specificity were calculated. Videos of tests were evaluated by blinded observers. Results SCT was judged positive in 19 of 20 ACNES patients, but not in any of the 40 controls. A 95% sensitivity (CI:75–99) and 100% specificity (CI: 83–100) were calculated. Conclusion This study provides strong evidence that ACNES should be considered as an entrapment neuropathy, while a positive SCT should be considered as a major diagnostic criterion.

Comparison of ultrasonographic parameters in the diagnosis of carpal tunnel syndrome in pregnancy

Comparison of ultrasonographic parameters in the diagnosis of carpal tunnel syndrome in pregnancy

A Novel IMU-Based System for Work-Related Musculoskeletal Disorders Risk Assessment.

This study introduces a novel wearable Inertial Measurement Unit (IMU)-based system for an objective and comprehensive assessment of Work-Related Musculoskeletal Disorders (WMSDs), thus enhancing workplace safety. The system integrates wearable technology with a user-friendly interface, providing magnetometer-free orientation estimation, joint angle measurements, and WMSDs risk evaluation. Tested in a cable manufacturing facility, the system was evaluated with ten female employees. The evaluation involved work cycle identification, inter-subject comparisons, and benchmarking against standard WMSD risk assessments like RULA, REBA, Strain Index, and Rodgers Muscle Fatigue Analysis. The evaluation demonstrated uniform joint patterns across participants (ICC=0.72±0.23) and revealed a higher occurrence of postures warranting further investigation, which is not easily detected by traditional methods such as RULA. The experimental results showed that the proposed system's risk assessments closely aligned with the established methods and enabled detailed and targeted risk assessments, pinpointing specific bodily areas for immediate ergonomic interventions. This approach not only enhances the detection of ergonomic risks but also supports the development of personalized intervention strategies, addressing common workplace issues such as tendinitis, low back pain, and carpal tunnel syndrome. The outcomes highlight the system's sensitivity and specificity in identifying ergonomic hazards. Future efforts should focus on broader validation and exploring the relative influence of various WMSDs risk factors to refine risk assessment and intervention strategies for improved applicability in occupational health.

Сurrent medical rehabilitation methods for patients after carpal tunnel syndrome surgical treatment: a review

INTRODUCTION. Carpal tunnel syndrome is one of the most common tunnel syndromes types and ranks sixth in the all-occupational diseases’ registry. The high interest in this pathology and its’ postoperative management peculiarities study is due to the disease widespread prevalence, social significance, often unsatisfactory surgical treatment results and a long hand function restoration period. The purpose of this work was to study modern concepts of postoperative rehabilitation of patients with carpal tunnel syndrome. SOURCE SEARCH METHODOLOGY. When preparing the review, open electronic databases of scientific literature were used: PubMed, ClinicalTrials.gov, eLibrary.ru. The search for medical literature data was carried out using the following keywords: “rehabilitation”, “carpal tunnel syndrome”, “carpal tunnel syndrome”, “median nerve”, “compressive neuropathy”. The criteria for inclusion in the analysis of literature sources were: randomized controlled clinical trials, systematic reviews and meta-analyses. Preference was given to publications over the past 5–10 years. DISCUSSION. The article presents the most commonly used techniques in the postoperative management of patients with carpal tunnel syndrome, discusses the mechanisms of their action and prospects for the development of this area. The review discussed the following rehabilitation methods: a wide range of methods of hardware physiotherapy, manual therapy, kinesiotaping, manual lymphatic drainage, as well as the possibilities of physical therapy and robotic mechanotherapy. Despite the high level of development of medicine, the long process of rehabilitation of these patients remains an important problem, while the clinical effectiveness of a wider range of proposed techniques still remains poorly understood. Some of the most promising methods of rehabilitation of patients after surgical treatment for carpal tunnel syndrome are methods of robotic mechanotherapy and extracorporeal shock wave therapy. CONCLUSION. For the effective use of the described techniques as part of the postoperative rehabilitation of patients with carpal tunnel syndrome in clinical practice, further research and study of their long-term effects, as well as comparison of their effectiveness with the aim of the most complete and rapid restoration of the function of the affected hand, is necessary.

When is it safe to operate after the failure of therapeutic steroid injections in carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a multifactorial neuropathy caused by the compression of the median nerve due to its entrapment as it passes through the carpal tunnel in the wrist. It accounts for nearly 90% of neuropathies and usually presents as numbness, tingling, weakness, and pain. These symptoms are predominantly present in the thumb, second finger, third finger, and radial half of the hand's fourth finger. In the US, CTS has a prevalence of 50 per 1,000, which is similar to the prevalence in other developed countries.1 Overall, the prevalence of CTS in the general population in developed countries ranges from 3% to 6%, whereas the prevalence of CTS in developing countries like Pakistan has been reported to be from 10% to 15%.2 The management of mild to moderate CTS ranges from conservative management, including ultrasound therapy using the pulsed mode, wrist splinting, and tendon gliding exercises, to Neuro-mobilization.3 On the other hand, the management of moderate to severe CTS, which is unresponsive to the above-mentioned therapies comprises therapeutic steroid injections and surgical decompression of the median nerve. In many cases, surgical decompression is used as a last resort after the failure of therapeutic steroid injections. However, studies have shown that surgical decompression in these cases is associated with poor postoperative outcomes, including increased risk of pain and paresthesia.4 Furthermore, such cases are also associated with an increased risk of surgical site infections, non-infectious wound complications, and 1 year-reoperation. The risk of these complications is maximum when surgery is performed within 30 days of the last therapeutic steroid injection along with a high number of therapeutic steroid injections (infections 1.77%, non-infectious complications 1.12%, 1-year re-operation 2.09%), and is minimal when performed from 90 to 180 days of the last therapeutic steroid injection with a low number of therapeutic steroid injections (infections 1.19%, non-infectious complications 0.44%, 1-year re-operation 1.58%). Therefore, surgical decompression of the median nerve should be delayed for 90 to 180 days after the last therapeutic steroid injection, depending on the severity.5 There is a high prevalence of CTS in developing countries like Pakistan and therapeutic steroid injections are frequently prescribed as first-line treatment for moderate to severe CTS. ---Continue