Cases Of CTS Research Articles

Role of conventional ultrasound and shear wave elastography of median nerve in diagnosis and differentiation of carpal tunnel syndrome severity in correlation with electrodiagnostic studies

BackgroundThe gold standard for CTS diagnosis is abnormalities on electrophysiologic testing in conjunction with specified symptoms. Electrophysiologic testing can also identify the severity of nerve injury.Aim of workAimed to investigate how effective various ultrasonography and elastography parameters at diagnosing and grading the severity of carpal tunnel syndrome in correlation with the electrophysiological evaluation of the median nerve.MethodsThe study included 62 wrists, 31 CTS cases and 25 females. Thirty-one healthy adults served as control group. Eleven males (35.5%) and 20 females (64.5%) were included. All US examinations were done with the subjects sitting with their upper limbs relaxed on a pillow with forearm in supine position, and the fingers are semi-flexed. Ultrasound and elastography parameters were recorded. NCS was done by recording median nerve motor and sensory functions and then comparing median nerve versus radial and ulnar nerves if the previous recordings were normal to detect early starting cases.ResultsUS and elastography can significantly diagnose CTS and detecting its severity (mild/moderate versus severe CTS).ConclusionsIt is noninvasive to examine the median nerve using ultrasound and shear wave elastography, highly sensitive diagnostic modality. It can significantly diagnose CTS and severity of CTS (in contrast to mild, moderate, and severe instances). Mixing high-resolution conventional B-mode US with shear wave ultrasound elastography of the median nerve may increase the diagnostic precision of CTS.

The Carpal Tunnel Syndrome and Ergonomic Risk Factor Profile in Online Motorcycle Taxi Drivers (ojol) in Jakarta

Introduction: The increasing need for online motorcycle taxi driver (ojol) transportation continues to increase in Jakarta. This increases the activity of motorcycle taxi drivers, which can cause Carpal tunnel syndrome risks due to the awkward posture of the wrist while riding the motorcycle (the wrist posture is too long on the motorcycle handlebars with repetitive motion), which will affect the nerves and blood supply to the wrist and hand. This study aims to determine the risk of the motorcycle taxi driver’s upper limb using Rapid Upper Limb Assessment (RULA) and Carpal tunnel syndrome risk factor using the Boston Carpal Tunnel Syndrome Questionnaire (BTCSQ). Method: This research used a cross-sectional study approach with 97 respondents online motorcycle taxi drivers. The respondents were collected based on the activity of online motorcycle taxi drivers who were in or passing through the data collection location and willing to take part in the Rapid Upper Limb Assessment (RULA) and the Boston Carpal Tunnel Syndrome Questionnaire (BTCSQ). The RULA assessment and analysis were performed and supported by video (recording from a cycle of the activity while the respondents were riding the motorcycles). The respondents’ criteria were an online motorcycle taxi driver with a minimum of 1 year of working experience, at least 3 hours working duration per day, and not clinically suffering from rheumatoid arthritis and wrist problems. This study has been approved by Universitas Kristen Krida Wacana ethical committee. Result: The results of BCTSQ and RULA in online motorcycle taxi drivers have found that there’s mild–moderate risk respectively in Jakarta. In RULA, it was found that there were 87.6% of respondents were reported at moderate risk which had an impact on musculoskeletal problems, especially the upper limb. In the BCTSQ, the result showed that there were mild complaints in 38.1% of respondents regarding the wrist which was at risk of developing carpal tunnel syndrome. Discussion: With RULA results, in the form of moderate risk, Further ergonomics investigation and assessment are needed to find out further risk factors, mitigation plans, and best improvements to reduce the risks. The occurrence of mild complaints in the wrist based on BCTSQ requires further clinical examination of carpal tunnel syndrome to reduce the incidence of CTS cases in online motorcycle taxi drivers. Conclusion: This research’s result has found mild-moderate risk factors from the activity and working posture among online motorcycle taxi drivers in Jakarta. Further investigation and research ergonomically are needed.

Causes of Iatrogenic Median Nerve Injury after Endoscopic Carpal Tunnel Release.

Background: Endoscopic carpal tunnel release (ECTR) is a less invasive procedure but has a higher risk of complications. We analysed ECTR cases dividing them into three periods according to a single surgeon's experience when the ECTR was performed: the initial, midterm and late period. Cases of iatrogenically induced median nerve injuries that occurred after ECTR were then noted and evaluated. Methods: We reviewed 195 ECTRs done with the 2-portal technique and divided the patients into three groups according to periods of when ECTR was done. The indications for ECTR surgery were limited to severe CTS cases. These groups of patients were similar in terms of age, duration of disease, electrophysiological study results and severity of the disease. The patients were evaluated for median neuropathy pre- and postoperatively using Semmes-Weinstein monofilament test (SWT), Disabilities of the arm, shoulder and hand (DASH) Score, Coin-flip test (CFT), postoperative paraesthesias and complications, such as pillar pain, and so on. Electrophysiological evaluation was performed only preoperatively. Results: Postoperative median nerve recovery was overall good. Normal recovery was noted in 181 cases (93%). SWT, DASH and CFT were all significantly improved upon follow-up in all three groups. In terms of iatrogenic neuropathy, median nerve palsy worsened (including those transiently worsened) after ECTR in 11 cases (5.6%), even in the later period. The sensory disturbance was equally worsening from the radial to the ulnar side. Conclusions: The fact that there were neurologically worsened cases even in the later period, when the operator is higher skilled in the technique, suggests that the surgical technique itself may be the one posing higher risk than the level of surgical skill. The most likely causes of aggravated nerve palsy were a direct injury by cannula insertion at the proximal portal, or additional median nerve compression during cannula insertion into the carpal tunnel. Level of Evidence: Level IV (Therapeutic).

Effects of weight loss after bariatric surgery on the median and ulnar nerves conduction studies

BackgroundThe aim of the present study was to compare the nerve conduction study (NCS) of median and ulnar nerves before and after bariatric surgery. MethodsThis prospective cross-sectional study included 32 patients with BMI≥35 who were candidate for Sleeve gastrectomy. NCS of median and ulnar nerves were evaluated before and 3 months after surgery. In CTS cases, Boston Carpal Tunnel Questionnaire (BCTQ) was completed. ResultsEligible participants were 32 patients aged between 19 and 64 years. 20 patients including 34 hands had CTS. Severity of CTS and BCTQ scores were significantly different after surgery. Moreover, sensory amplitude, and motor NCV for both median and ulnar nerves in hands without CTS as well as sensory amplitude of ulnar nerve in hands with CTS were significantly different after bariatric surgery (P value < 0.05). ConclusionsThe results of this study suggest that three months after the bariatric surgery, the clinical and electrophysiological severity of CTS shows a significant improvement. Ethical code of studyIR.IUMS.FMD.REC.1396.15008.

A lateral flow assay for the immunodiagnosis of human cat-transmitted sporotrichosis.

BackgroundCat‐transmitted sporotrichosis (CTS) caused by Sporothrix brasiliensis has emerged as an important zoonosis in Brazil and neighbouring countries.ObjectivesEvaluate the performance of a lateral flow assay (LFA) for the detection of anti‐Sporothrix antibodies in human sera.MethodsA LFA for the detection of anti‐Sporothrix antibodies (Anti‐Sporo LFA) in human sera, developed by IMMY, was evaluated using 300 human sera collected prospectively at the Hospital de Clínicas, Federal University of Paraná (HC‐UFPR), in Curitiba, Brazil. These specimens included 100 sera from patients with CTS. CTS cases were classified as follows: 59 lymphocutaneous, 27 fixed cutaneous,13 ocular, and one mixed form. One‐hundred specimens from patients with other mycoses, including cryptococcosis (n = 32), candidemia (n = 27), paracoccidioidomycosis (n = 14), aspergillosis (n = 10), histoplasmosis (n = 9), fusariosis (n = 4), lobomycosis (n = 1), chromoblastomycosis (n = 1), mucormycosis (n = 1) and trichosporonosis (n = 1). And 100 specimens from apparently healthy volunteers (AHV).ResultsThe Anti‐Sporo LFA showed a global sensitivity of 83% (95% confidence interval [CI] = 74%–90%), a global specificity of 82% (95% CI = 76%–87%), and accuracy of 82% (95% CI = 77%–86%). By clinical form sensitivity was as follows: Mixed form 100%, ocular 92%, lymphocutaneous 83% and fixed cutaneous 78%. False‐positive results were observed in 11 specimens from people with other mycoses and 26 specimens from AHV.Conclusion and discussionThis study presents the results of the evaluation of the first lateral flow assay for the detection of anti‐Sporothrix antibodies in human sera. The findings here show evidence that IMMY's Anti‐Sporo LFA is a promising tool for the rapid diagnosis of CTS.

The Most Important Risk Factors for Carpal Tunnel Syndrome

Background: The aim of this study was to determine the risk factors for carpal tunnel syndrome and its relationship with the severity of the disease. Methods: A total of 131 patients with clinical symptoms of CTS and 131 normal subjects were enrolled, of whom 121 were female both in the CTS cases and the controls. All cases were electro diagnostically confirmed and assigned to three severity groups. BMI, wrist ratio, shape index, digit index and hand length/height ratio were measured in all participants. Mean values for each item were compared between cases and controls and severity subgroups. A logistic regression analysis was performed to determine independent CTS risk factors. Results: The mean values of BMI, wrist ratio and shape index were significantly higher in all CTS patients and females compared to controls, whereas in males only BMI and wrist ratio were higher. The patients in the mild severity subgroup had a significantly lower age and wrist ratio. BMI, wrist ratio and shape index were found to be independent risk factors of CTS development in all patients and females. Conclusion: Our study showed BMI, wrist ratio and shape index as independent risk factors for CTS. These findings are important anatomically and clinically and these are the risk factors of anatomical malfunction of the wrist in CTS.

Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study

BackgroundCarpal tunnel syndrome (CTS) is a common cause of pain, numbness and tingling in the wrist and hand region and is associated with repetitive wrist and hand use in office workers. However, scarce knowledge exists about the epidemiology of clinically confirmed CTS among Chinese office workers. This study aimed to investigate the prevalence of wrist/hand symptoms and CTS in office workers in China and to identify associated risk factors.MethodsA cross-sectional survey was carried out in a metropolitan city in China involving 969 respondents (aged 17–49 years) from 30 workplaces. A questionnaire was distributed to each participant to collect their demographic, work-related physical and psychosocial factors, and wrist and hand symptoms. The wrist and hand pain/numbness symptoms were marked on a body chart and the nature and intensity of symptoms, nocturnal symptoms, as well as aggravating activities were also recorded. Clinically confirmed CTS cases were screened based on the history, Phalen’s test, Tinel Sign and skin sensation testing among symptomatic respondents. Logistic regression was employed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of self-reported wrist and hand symptoms and clinically confirmed CTS.ResultsThe clinically confirmed CTS prevalence was 9.6%. The prevalence of wrist and hand symptoms were 22 and 15%, respectively. Frequently working in pain was associated with higher odds of CTS. Multivariate modelling adjusted for age and gender showed that prolonged computer use time and working without breaks were associated with presence of wrist/hand symptoms (adjusted ORs: 1.11 (95% CI 1.02–1.22) and 1.88 (95% CI 1.12–3.14)). Educational level was inversely associated with CTS and smoking was associated with wrist/hand complaints (adjusted OR: 2.20 (95% CI 1.19–4.07)).ConclusionsThe prevalence of work-related clinically confirmed CTS symptoms among young office workers in China is high. Frequently working in pain is closely associated with clinically confirmed CTS. Intense computer use and no breaks at work are associated with wrist and hand symptoms.

International Health Project for Improving the Level of Mother and Child Health in Developing Countries: Focusing on KOICA CTS Cases in Vietnam

우리는 전세계 최초로 무선 초음파 진단기를 개발하였다. 임산부의 원활한 출산을 위해 WHO에서는 4번의 사전 진찰을 받도록 하고 있으며, 이를 위해 초음파 진단기의 사용이 필수적이다. 하지만, 개발도상국의 소득수준과 의료시설은이에 미치지 못하고 있다. 우리는 자체개발한 무선 초음파 진단기를 이용해 KOICA의 CTS 프로그램을 베트남에서 진행하였다. 우리는 베트남 흥화현 내 보건소 및 병원에 휴대용 무선 초음파 진단기인 Sonon300C를 보급하였고, 사업성과를 더욱 높이기 위한 노력으로 진단 교육과 실습을 병행하고 아웃리치(Outreach) 프로그램을 실시하였다. 그 결과, 해당 지역의 초음파 진단기 보급률은 100%를 달성하였고, 교육 수료인원 비율은 59%까지 끌어올리는 성과를 얻었다.

Combined Sensory Index Test versus Diagnostic Ultrasonography in Early Detection of Carpal Tunnel Syndrome

Abstract Objectives to evaluate combined sensory index test (CSI) versus diagnostic ultrasonography in early detection of carpal tunnel syndrome. Patients and Methods case control cross sectional study was performed on twenty patients with symptoms and signs suggestive of carpal tunnel syndrome with duration 1 to 4 months and twenty apparently healthy volunteers included as a control group. All patients and controls were assessed and underwent ultrasound of the wrist and electrophysiological testing. Data from patients and control groups were compared to determine the diagnostic relations in patients with CTS. Results This study include 20 Patient with ages ranged from 25 to 45 with mean±SD (36.8±6.1) years with symptoms and signs suggestive of carpal tunnel syndrome with duration 1 to 4 months. The control group ages ranged from 25 to 45 with mean±SD (57.63±6.41) years. Our results revealed that CSI ranged from (0.7-1.9ms) with mean ± SD (1.36± 0.366) in CTS group and ranged from (0.2-0.8ms) with mean ±SD (0.59± 0.187) in control group (P &amp;lt; 0.001), cutoff point was &amp;gt; 0.8ms with sensitivity 85%, specificity 100% and accuracy 97.5%. Our diagnostic ultrasound results revealed that Inlet Outlet Ratio of CSA of median nerve ranged from (1-1.6) with mean ± SD (1.26 ± 0.226) in CTS group and from (0.7-1.1) with mean ± SD (0.92 ± 0.134) in control group (P &amp;lt; 0.001) with sensitivity was 80%, specificity 70% and accuracy 85%. By combination of both electrodiagnostic test (CSI) and diagnostic ultrasound (IOR) in early detection of CTS, our results revealed highly statistically significant difference between patient and control groups (P &amp;lt; 0.001) with sensitivity 100%, specificity 70%, and accuracy 85%. Conclusion Combined sensory index (CSI) is indicated in suspected cases of CTS with positive symptoms and negative signs. US is not an alternative diagnostic tool to electrodiagnostic tests but they are complementary.

Role of High Frequency Ultrasound in Diagnosing Carpal Tunnel Syndrome as Compared with Conventional Nerve Conduction Studies.

Objective:Our aim was to evaluate High Frequency Ultrasonography as a tool for diagnosis in patients withcarpal tunnel syndrome in comparison with electrophysiological study.Methods:Thirty- one patients [56 hands] with CTS and twenty-five asymptomatic controls [50 hands] were assessed and underwent ultrasonography of the wrists and electrophysiological testing. Data from the patient and the control groups was compared for both the investigations to determine the CTS and the grade of severity.Results:There was a high degree of correlation between the conduction abnormalities of the median nerve as detected by electrodiagnostic tests, historic and objective scale [Hi-Ob] and the measurement of the cross-sectional area of the nerve by US (P < 0.05). A cut-off point of 0.88 mm2 for the mean cross-sectional area of the median nerve was found to be the upper limit for normal values. Compared to Ultrasonography which found one hand negative, six hands (10%) were negative on the electrophysiological tests. Using critical CSA value of 1.0 mm2 in these CTS cases by US with sensitivity and specificity of 100% and 88%. Based on the results of this study, ultrasonography of wrist is another useful tool along with nerve conduction studies as per sensitivity and specificity patterns found in our study in diagnosis of carpal tunnel syndrome.Conclusion:High-frequency US examination of the median nerve and measurement of its cross-sectional area can be strongly considered as useful diagnostic diagnostic modality for the evaluation of CTS along with nerve conduction studies. In addition to its high diagnostic accuracy it is able to define the cause of nerve compression, aids treatment planning and provides a reliable method to follow response to therapy.

Asymptomatic congenital tracheal stenosis.

Key messageCongenital tracheal stenosis (CTS) is often identified by characteristic wheezes and cyanosis in childhood. However, an asymptomatic progression to adulthood is rare. Asymptomatic latent CTS cases with a mild degree of stenosis may exist.

Why does Carpal Tunnel Syndrome Still Occur in our Chronic Hemodialysis Patients?

Despite the numerous advances in hemodialysis practice, cases of CTS are still observed in our patients. The aim of this study was to assess the prevalence of CTS and factors associated to its occurrence in our chronic HD patients.Methods: We performed a cross-sectional study in December 2017, including consenting chronic hemodialysis patients, with a dialysis vintage of at least three months, in a reference state center in Oujda- Eastern Morocco. Diagnosis was based on signs and symptoms reported by the patient, and manoeuvres of Tinel and Phalen. Symptomatic patients underwent electromyography (EMG) on non-dialysis days, by the same neurologist in the same conditions.Results: Our study included 112 chronic HD patients, who met the inclusion criteria. CTS was diagnosed and verified using nerve conduction examination in 8.04% of the patients. Diabetic nephropathy was the most observed initial nephropathy in CTS patients in 36.3% of the cases. Patients with CTS were older (mean age: 52.99 ± 11.32 vs. 48.4 ± 12.6; p=0.002), mainly males (63.6% vs. 55.4%; p=0.03), active smokers in 18.5% of the cases. They also had a longer HD duration (95.8 ± 15.75 vs. 82.11 ± 17.22 months; P 100 ml/day (27.2% vs. 3.98%; P=0.003). Multivariate logistic regression showed that HCV (OR: 1.45, 95% confidence interval (CI): 1.17-1.87, p=0.034), HD vintage [OR: 1.95, 95% CI: 1.89-3.65, P<0.001] and urin output <100ml/day (OR:1.72, 95% CI: 1.03-2.57, P=0.01) were positively associated with CTS.Conclusion: In this cross-sectional study, we observed that a long dialysis vintage, positive HCV and loss of residual renal function were associated with CTS in chronic HD patients. However, additional studies are required for further clarification of the pathogenesis of CTS in chronic HD patients.

Aromatase inhibitor-induced carpal tunnel syndrome: prevalence in daily practice.

We aim to evaluate prevalence and characteristics of CTS in routine daily practice over a 5-year period, with a review of the literature. Patients treated with endocrine therapy (441) were retrospectively analyzed looking for CTS cases in aromatase inhibitors (219, 49.6%) and in tamoxifen (222, 50.3%) patients. We described patient's characteristics and CTS management. We also reviewed the literature reporting CTS in aromatase inhibitors clinical trials. Six cases of CTS were diagnosed, all in patients on aromatase inhibitors given in the adjuvant setting. Prevalence was 2.7%. Median age was 54years. CTS occurred under anastrozole in four cases and letrozole in two cases. One patient had severe intensity presentation. Median time to symptoms onset was 14months, and resolution was obtained within 4months after a nonsurgical treatment. Aromatase inhibitor-induced CTS is rare. It should be recognized and treated in order to avoid endocrine therapy discontinuation.

Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática

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

Ultrasonographic diagnosis of carpal tunnel syndrome: introducing a new approach.

CTS, the most common nerve entrapment syndrome of the upper limb, is being diagnosed by clinical criteria, in most cases supported by the electrodiagnosis method, which appears limits regarding its sensitivity and specificity and suggests an intervening and expensive technique. The purpose of this study was to contribute to establishing U/S examination as a method with at least of the same accuracy with electrodiagnosis. A sample of 60 healthy individuals and 30 patients suffering from CTS was scanned. The diagnosis was conducted by both clinical and electrodiagnostic criteria, or by clinical criteria supported by postsurgical outcome. In order to improve the accuracy of measurements, the anteroposterior to transverse diameter of the median nerve inside the canal and in its entrance was scanned and compared, by sonography. The examination conducted three times for each dimension, and the mean value per individual was calculated. The mean ratios for the 60 healthy wrists was found to range within the interval 0.49-0.88 (presenting a mean value of 0.66), and the corresponding for the 30 suffering from CTS wrists was within the interval 1.12-1.59 (with a mean value of 1.39). The statistical analysis of the examination results clearly demonstrates that the interval of ratios over the value 1.07 can be considered completely safe to diagnose that someone is suffering from CTS. In correspondence, a U/S measurement of ratios in the area up to 0.79 is completely safe to opine that this wrist refers to a healthy individual. The intermediate range of ratios 0.79-1.0 suggests a grey zone, which, by the rational of this study, does not include discrete CTS or healthy cases. This "gap" may describe subclinical or mild cases of CTS which were not been taken under consideration and for which there is no rational to interfere surgically. In the everyday's practice clinical point of view, the grey zone cases are considered healthy.

Impact of carpal tunnel syndrome on the expectant woman's life

IntroductionCarpal Tunnel Syndrome is known to be a common complication during pregnancy especially during the third trimester.AimThis article focuses on its impact to the third trimester pregnant mothers with CTS.MethodsThird trimester pregnant mothers with no other known risk factors for CTS, were interviewed and examined for a clinical diagnosis of CTS. The severity of CTS was assessed by means of symptoms severity and functionality using the Boston Carpal Tunnel Questionnaire.ResultsOut of 333 third trimester pregnant mothers, 82 (24.6%) were clinically diagnosed with CTS. Malay race was found to have significant correlation with the diagnosis of CTS (p = 0.024) and are two times more likely to get CTS during pregnancy (OR = 2.26) compare to the non-Malays. Bilateral CTS was two times higher (n = 58, 63.4%) than unilateral cases (n = 30, 36.6%), however no significant correlation between the two was found with severity (p = 0.284) or functional (p = 0.906). The commonest complaint was numbness/tingling during day time (n = 63, 76.8%). Majority of the CTS cases were mild (n = 66, 80.5%) and approximately one third (n = 28, 34.1%) had affected hand functions. All symptoms related to pain was found to have significant correlation with severity (p = 0.00, OR = 12.23) and function (p = 0.005, OR = 5.01), whereas numbness and tingling does not (Severity, p = 0.843, function, p = 0.632).ConclusionThis study shows that even though CTS in third trimester pregnancy is prevalent, generally it would be mild. However, function can still be affected especially if patients complain of pain.

Historical review of carpal tunnel syndrome

The first description of median nerve compression in the carpal tunnel goes back to 1854, but it was only a century later that the term "carpal tunnel syndrome" (CTS) appeared in print. Until then, patients with symptoms, which we now know were due to CTS, were sometimes diagnosed as having acroparaesthesia, and at other times compression of the motor branch of the median nerve or the brachial plexus. The first description of an operation to open the carpal tunnel goes back to 1933, but only with Brain and Phalen was idiopathic CTS defined from both clinical and anatomopathological viewpoints. Since 1960, CTS has become the most frequently diagnosed of peripheral compression-induced neuropathies. The last part of this paper reports the latest theories giving an aetiological explanation of cases of CTS until now considered to be idiopathic.

Syndromes from segmental vibration and nerve entrapment: observations on case definitions for carpal tunnel syndrome

The purpose of this paper is to assess the overlap and stability of two different case definitions of carpal tunnel syndrome CTS. The analysis considers the association between different case definitions and objective tests (sensory nerve conduction velocities, SNCVs and vibrotactile perception thresholds, TTS), and the natural history of CTS, in the context of two vibration-exposed cohorts. Clinical CTS cases were defined in two ways: (1) by the study physician using fixed criteria, and; (2) by questionnaire and hand diagram. SNCV in median and ulnar nerves was measured for digital, transpalmar, and transcarpal segments, and conventionally as from wrist-digit. Skin temperature was assessed as a point measurement by thermistor and regionally by thermal imaging. VTTs were determined at the bilateral fingertips of the third and fifth digits using a tactometer meeting the requirements of ISO 13091-1 (ISO 2001). The subjects were cohorts of shipyard workers in 2001 and 2004, and dental hygienists in 2002 and 2004. Results are reported for 214 shipyard workers in 2001 and 135 in 2004, and for 94 dental hygienists in 2002 and 66 in 2004. In 2001, 50% of shipyard workers were diagnosed as CTS cases by at least one of the diagnostic schemes, but only 20% were positive by both criteria. Among study physician diagnosed cases, 64% were CTS negative in 2001, 76% were negative in 2004, 13% were positive in both years, 22% became negative after being positive, and 11% became positive after being negative. For only study physician diagnosed CTS did VTTs differ between cases differ and non-cases in digit 3; there was no such distinction in digit 5. The dental hygienists had little CTS. Clinical case definitions of CTS based on diagrams and self-assessment, and clinical evaluation have limited overlap. Combining clinical criteria to create a more narrow or specific case definition of CTS does not appear to predict SNCV. The natural history of CTS suggests a protean disorder with considerable flux in case status over time.

Carpal tunnel syndrome—The role of the subsynovial connective tissue

textabstractCarpal tunnel syndrome (CTS) is the most common compression neuropathy, yet the cause of the compression is in most cases idiopathic. The most common clinical finding associated with the nerve compression is non-inflammatory fibrosis of the subsynovial connective tissue (SSCT) which surrounds the flexor tendons in the carpal canal. The normal SSCT has a multi-layer gliding mechanism, reminiscent of a series of sleeves around the tendon, with each successive sleeve being connected to its neighbors with fine collagenous fibers. We have conducted a series of experiments which have outlined the pathology, kinematics and material properties of the SSCT in normal individuals and in individuals with CTS, and have identified specific features within the SSCT of individuals with CTS that suggest that injury to the SSCT may play a role in the etiology of CTS. Specifically, we have identified evidence of a shearing injury of the SSCT, with fibrosis, and obliteration o! f the gliding, sleeve-like mechanism, being greatest close to the tendon, and with a tendency of greater degrees of fibrosis being observed in more severe cases of CTS. This fibrosis may be associated with tethering of the SSCT to the underlying tendon, which may increase the work of finger movement in patients with CTS, and impair differential finger movement. Based on these observations, we propose a vicious cycle of SSCT injury and repair as a working hypothesis of the etiology of CTS, and have developed a rabbit model to test this hypothesis in vivo.

Transverse carpal muscle in association with carpal tunnel syndrome: Report of three cases

Anomalous muscles of the upper extremity are common, however, symptomatic anomalies causing CTS are rare. Three cases of CTS that are believed to be caused by an anomalous muscle located palmar to the transverse carpal ligament with transversely oriented muscle bundles is presented. Despite the arguments in literature, this is certainly an anomalous muscle that can be encountered during carpal tunnel release and be problematic to manipulate when minimally invasive approaches are chosen.