Chronic Carpal Tunnel Syndrome Research Articles

Adherence to Non-operative Clinical Quality Measures in Carpal Tunnel Syndrome.

Background: Clinical quality measures exist for non-operative management of carpal tunnel syndrome (CTS). Factors predicting adherence are unclear. Methods: A retrospective cohort study of patients with chronic CTS using MarketScan Research Database (2015-2020) was conducted. Six logistic regression models were designed to study adherence to quality measures within 1 year after diagnosis. Results: Of 782,717 patients identified, 514,073 (65.7%) were female with an average (SD) age of 51.4 (13.4) years. Only 88 patients (0.01%) met all quality measures. Greatest compliance observed with receipt of nerve conduction study (NCS; 283,959 [36.3%]), no prescription of medications (336,297 [43.0%]) and no laser therapy (772,979 [98.8%]); 294,305 patients (37.6%) received hand surgeon referral. Hand surgeon referral predicted higher likelihood of NCS and splinting (OR, 1.83; 95% CI: 1.81-1.84; OR, 2.53; 95% CI: 2.50-2.56) and medication over-prescription (OR, 1.05; 95% CI: 1.00-1.10). Females were more likely to be referred to a hand surgeon and be referred for splinting (OR 1.02; 95% CI: 1.01-1.03; OR 1.19; 95% CI: 1.18-1.21) but less likely to have no prescriptions or avoid laser therapy (OR 0.85, 95% CI: 0.84-0.85; OR 0.82, 95% CI: 0.79-0.86). Medicare recipients adhered less to quality measures compared to patients with fee-for-service insurance. As comorbidities increased, patients were less likely to receive hand surgeon referral and carpal tunnel release. Conclusions: Findings suggest that hand surgery referrals increased adherence to quality measures. Females, Medicare recipients and multimorbid patients should be targeted for improved care. Future quality care efforts should incentivise adherence for Medicare beneficiaries and improve guideline recognition amongst physicians. Level of Evidence: Level III (Therapeutic).

Higher densities of T-lymphocytes in the subsynovial connective tissue of people with carpal tunnel syndrome.

Symptoms in people with carpal tunnel syndrome (CTS) are traditionally attributed to neural tissue, but recent studies suggest that the subsynovial connective tissue (SSCT) may also play a role in CTS. The SSCT undergoes fibrotic thickening which is generally described as "non-inflammatory" based on basic histology. This study uses immunohistochemistry to determine the presence of macrophages and T-cells within SSCT and their relationship with symptoms in people with CTS. SSCT was collected from twenty people with CTS and eight controls undergoing wrist fracture surgery. Immunohistochemical quantification of CD3+ T-cells and CD68+ macrophage densities as well as CD4+/CD8+ T-cell subpopulations were compared between groups using independent t-tests. Spearman correlations were used to identify associations between immune cell densities and CTS symptom scores. The density of CD3+ T-cells was significantly higher in SSCT of people with CTS compared to controls (CTS mean 26.7 (SD 13.7); controls 6.78 (6.3), p = 0.0005) while the density of CD68+ macrophages was lower (CTS mean 9.5 (SD 6.0); controls 17.7 (8.2), p = 0.0058). Neither CD68+ nor CD3+ cell densities correlated with symptom scores. In contrast to previous assumptions, our data show that the SSCT in the carpal tunnel in both people with CTS and controls is not devoid of immune cells. Whereas the higher density of CD68+ macrophages in control participants may be associated with their early recruitment after acute fracture, CD3+ cells within the SSCT may play a role in chronic CTS.

Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function.

Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.

Pedicled Pronator Quadratus Transposition for Functional Opponensplasty: A Cadaveric Anatomical Study for Feasibility.

Techniques on opponensplasty for chronic carpal tunnel syndrome have been described previously. A novel pronator quadratus (PQ) transposition for chronic carpal tunnel syndrome is described. In addition, the relationship of the distal perforating branch of the radial artery to the surrounding tissue is detailed to optimize further use of the PQ flap for clinical applications. Ten cadaver hands underwent PQ dissection, and the perforating branch of the radial artery was identified. Measurements were taken from the radiocarpal joint and the radial styloid to the distal perforating branch. Finally, a proposed surgical technique of PQ transposition with proximal radius periosteum to the first metacarpophalangeal joint and anterior interosseous nerve transfer was performed. The average distance of the perforating branch from the radiocarpal joint was 10 ± 1.05 mm, and the average distance from the radial styloid was 17.1 ± 1.6 mm. Pronator quadratus transposed with a layer of radius periosteum demonstrated anatomical feasibility. The distal perforating branch of the radial artery predictably perfuses the PQ muscle, which may be used in the future as a means of opponensplasty for chronic carpal tunnel syndrome.

A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial

A Multimodal approach of electrotherapy versus nerve flossing technique in patients with chronic carpal tunnel syndrome: a randomized controlled trial

Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome.

Background Carpal tunnel syndrome (CTS) is the symptomatic compression neuropathy of the median nerve at the wrist level that may become a reason for upper limb disability, in the women and men population. Objective This study aimed to compare the efficacy of the neurodynamic technique (NT) and carpal bone mobilization technique (CBMT) incorporated with tendon gliding exercises (TGE) as an effect-enhancing adjunct while managing the participants with chronic CTS. Methods The study followed a two-arm parallel-group randomized comparative design. Thirty participants (aged 30–59 years) with chronic CTS were recruited randomly to both the NT and CBMT groups. In addition to the TGE (a common adjunct), NT and CBMT were performed in the NT and CBMT groups, respectively, for three weeks. The primary outcome measures including pain intensity, functional status, grip strength, and motor nerve conduction study were assessed using a visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand-held dynamometer, and electromyograph, respectively, at baseline, 3 weeks postintervention, and follow-up at one week post end of the intervention. Paired and unpaired t-test were used to calculate the differences in intervention effects within and between the groups with keeping the level of significance α at 0.05. Results The data analysis revealed a significant (95% CI, p < 0.05) difference for all outcomes within each group compared across different time intervals. Similarly, a significant difference was found for all outcomes except pain and grip strength compared between groups at 3 weeks postintervention and follow-up at one week post end of the intervention. Conclusions The NT revealed more effectiveness than the CBMT when incorporated with TGE to improve nerve conduction velocity and functional status of the hand. However, both NT and CBMT were equally effective in improving pain and grip strength while managing the participants with chronic CTS. In addition, the TGE contributed as a beneficial, effect-enhancing adjunct to the NT and CBMT differently. Significance. The study will guide the physiotherapist in applying either of the combination techniques suitable for achieving treatment objectives while managing the participants with chronic CTS.

Pain mechanisms in carpal tunnel syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes.

Carpal tunnel syndrome (CTS) is the most common nerve compression in the arm. A mix of peripheral and central contributions on quantitative sensory testing (QST) has been reported in the literature. Thus, this systematic review or meta-analysis aimed to identify the dominant sensory phenotype and draw conclusive evidence about the presence of central sensitization (CS) in CTS. Based on an a priori published protocol and using PRISMA guidelines, 7 databases were searched (Embase, Web of Science, Scopus, PubMed, SAGE, EBSCOhost, and ProQuest). Eligible studies compared the QST findings of individuals with subacute and chronic CTS with those of healthy controls through thermal, mechanical, and vibration detection thresholds; thermal, pressure, and mechanical pain thresholds; mechanical pain sensitivity; presence of allodynia; wind-up ratio; and conditioned pain modulation. Thirty-seven studies were included in the qualitative analysis. Results showed a significant loss of all detection thresholds of hand median nerve territories and hand extramedian areas (little finger and hand dorsum) in CTS ( P < 0.05) but no significant difference ( P > 0.05) in wind-up ratio, cold, heat, or mechanical pain thresholds of the median nerve territories. Furthermore, there was a significant increase in mechanical pain sensitivity in median nerve territories and remotely in the forearm ( P < 0.05) and a significant gain in pressure and heat pain thresholds in the carpal area ( P < 0.05). Conditioned pain modulation was impaired in CTS. Hypoesthesia and increased thermal and mechanical pain ratings are the dominant sensory phenotype with inconclusive evidence about CS in CTS due to the heterogenous results of thermal and mechanical pain thresholds.

Large-scale genetic investigation reveals genetic liability to multiple complex traits influencing a higher risk of ADHD

Attention Deficit-Hyperactivity Disorder (ADHD) is a complex psychiatric and neurodevelopmental disorder that develops during childhood and spans into adulthood. ADHD’s aetiology is complex, and evidence about its cause and risk factors is limited. We leveraged genetic data from genome-wide association studies (GWAS) and performed latent causal variable analyses using a hypothesis-free approach to infer causal associations between 1387 complex traits and ADHD. We identified 37 inferred potential causal associations with ADHD risk. Our results reveal that genetic variants associated with iron deficiency anemia (ICD10), obesity, type 2 diabetes, synovitis and tenosynovitis (ICD10), polyarthritis (ICD10), neck or shoulder pain, and substance use in adults display partial genetic causality on ADHD risk in children. Genetic variants associated with ADHD have a partial genetic causality increasing the risk for chronic obstructive pulmonary disease and carpal tunnel syndrome. Protective factors for ADHD risk included genetic variants associated with the likelihood of participating in socially supportive and interactive activities. Our results show that genetic liability to multiple complex traits influences a higher risk for ADHD, highlighting the potential role of cardiometabolic phenotypes and physical pain in ADHD’s aetiology. These findings have the potential to inform future clinical studies and development of interventions.

Closed Ended Structured Questionnaire in Fast Track Familiarization of Nurses to Conduct Telephone Follow-up after Open Carpal Tunnel Release

Background Open carpal tunnel release (OCTR) due to chronic carpal tunnel syndrome (CTS) is the most common procedure in hand surgery. CTS is often bilateral. A follow-up is required to detect any complications and confirm successful recovery before contralateral procedure is booked. Objectives The purpose of this study is to evaluate a closed ended questionnaire to assist nurses when starting routine follow-up telephone interviews after carpal tunnel surgery. Methods In our hospital routine follow-up phone calls to the patients 3 months after OCTR were allocated to nurse practitioners instead of surgeons. Once the practice was started a structured face validated closed ended questionnaire was used to collect data from a total of 61 consecutive patients. Results Nurse practitioners performed the follow-up independently in 97 % (59/61) of the cases. Ten per cent (6/61) of the patients were assigned further appointments to a surgeon and one patient was referred to an occupational therapist. 2 patients contacted the hospital after the telephone interview because of minor complaints. Patient charts were reviewed 18 months after the phone calls. No missed complications were detected. Conclusions We conclude that a structured closed ended questionnaire is useful assist in fast track familiarization of nurse practitioners for the follow-up contact after OCTR.

P335 Comparison of median nerve distal motor responses in patients with chronic inflammatory demyelinating polyneuropathy and carpal tunnel syndrome

Objective Dispersion of distal compound muscle action potential (CMAP) is a useful finding for showing demyelination. In this study, we aimed to compare the duration and area of CMAP of median nerve between cases with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and Carpal Tunnel Syndrome (CTS). Material and methods Ninety-two participants (thirty patients with CDIP, 32 patients with CTS and 30 participants of normal control group) who were evaluated. The CMAP duration was measured from the onset of the initial negative potential to the terminal negative deflection back to baseline. The CMAP area calculation was performed by computerized EMG machine. Results A significant difference was not found between groups as for mean age of the groups, and distribution of genders (CIDP: 52,73 ± 12,34 years, 18 (%40) women, 12 (%60) men; CTS: 52,38 ± 11,83 years, 25 (%78,1) women, 7 (%21,9) men; control: 48,5 ± 14,41 years,22 (%79,3) women, and 8 (%26,7) men). The mean CMAP duration of patients with CIDP was significantly higher than patients with CTS (p: 0.003) and control group (p: 0.001), however there was not any significant difference between the patients with CTS and control group (p > 0.05). The mean CMAP area of patients with CIDP was significantly lower than patients with CTS (p: 0.003) and control group (p: 0.001), however there was not any significant difference between the patients with CTS and control group (p > 0.05). Conclusion These findings suggest that the duration and area of distal CMAP is a useful parameter for the differentiation of patients with CIDPand CTS.

The Effects of Oscillatory Biofield Therapy on Pain and Functional Limitations Associated with Carpal Tunnel Syndrome: Randomized, Placebo-Controlled, Double-Blind Study.

Biofield treatments have been used for pain control in patients with cancer and chronic pain. However, research on the effect of biofield treatment on specific somatic disorders is lacking. This study intends to investigate the effect of oscillating biofield therapy (OBFT) on symptoms of carpal tunnel syndrome. Randomized, placebo-controlled, double-blind study. Thirty patients with chronic carpal tunnel syndrome participated in the study. Patients were randomly assigned to active or placebo treatment groups. Those in the treatment group received six sessions of OBFT with intention to treat during a period of 2 weeks. Patients in the placebo group had the same number of treatment sessions with mock OBFT treatment. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; Symptom Severity Scale (SSS); and Functional Status Scale (FSS) were used for outcome assessment. Both clinically and statistically significant changes in intensity of pain with activity (95% confidence interval [CI], 2.5-4.2; p = 0.000), night pain (p = 0.000, 95% CI, 3.2-5.7), DASH questionnaire (95% CI, 12.0-21.9; p = 0.000), SSS (95% CI, 0.64-1.15; p = 0.003), and FSS (95% CI, 0.41-0.97; p = 0.029) were found between the treatment and placebo groups. Statistically significant reduction in number of patients with positive results on the Phalen test (87%; p = 0.000), Tinel sign (73%; p = 0.000), and hand paresthesia (80%; p = 0.000) was noted in the treatment group. During 6-month follow-up, 86% of patients in the treatment group remained pain free and had no functional limitations. OBFT can be a viable and effective treatment for improving symptoms and functional limitations associated with chronic carpal tunnel syndrome.

Pain is Associated to Clinical, Psychological, Physical, and Neurophysiological Variables in Women With Carpal Tunnel Syndrome.

To investigate potential relationships of clinical (age, function, side of pain, years with pain), physical (cervical range of motion, pinch grip force), psychological (depression), and neurophysiological (pressure and thermal pain thresholds) outcomes and hand pain intensity in carpal tunnel syndrome (CTS). Two hundred and forty-four (n=224) women with CTS were recruited. Demographic data, duration of the symptoms, function and severity of the disease, pain intensity, depression, cervical range of motion, pinch tip grip force, heat/cold pain thresholds (HPT/CPT), and pressure pain thresholds (PPT) were collected. Correlation and regression analysis were performed to determine the association among those variables and to determine the proportions of explained variance in hand pain intensity. Significant negative correlations existed between the intensity of pain and PPTs over the radial nerve, C5/C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle, HPT over the carpal tunnel, cervical extension and lateral-flexion, and thumb-middle, fourth, and little finger pinch tip forces. Significant positive correlations between the intensity of hand pain with function and depression were also observed. Stepwise regression analyses revealed that function, thumb-middle finger pinch, thumb-little finger pinch, depression, PPT radial nerve, PPT carpal tunnel, and HPT carpal tunnel were significant predictors of intensity of hand pain (R²=0.364; R² adjusted=0.343; F=16.87; P<0.001). This study showed that 36.5% of the variance of pain intensity was associated to clinical (function), neurophysiological (localized PPT and HPT), psychological (depression), and physical (finger pinch tip force) outcomes in women with chronic CTS.

The Effect of Longitudinal Stretching of Muscles and Nerve versus Deep Transverse Friction Massage in the Management of Patients with Carpal Tunnel Syndrome

Background and Purpose: Carpal tunnel syndrome (CTS) is a common source of hand numbness and pain. The goal of this study was to compare longitudinal stretching of muscles and nerve to deep transverse friction massage for decreasing pain and improving hand function in patients with chronic CTS. Subjects and Methods: Thirty patients, 25 to 40 years old, were included in this study and randomized into two groups: the first group (36.8 ± 0.262) followed a physical therapy program group receiving stretching of wrist and hand flexors in combination with ultrasound, strengthening exercises of wrist and hand flexors, and wrist splint, three sessions per week for 12 weeks; and the second group (35.9 ± 0.225) followed the physical therapy program of deep transverse friction massage on the carpal tunnel site at the wrist joint, with using ultrasonic therapy, strengthening exercises of wrist and hand flexors and wrist splint, three sessions per week for 12 weeks. Outcome measures were range of motion (ROM), pain using visual analog scale (VAS), and hand grip strength measured with a sphygmomanometer. Results: There was a significant difference in both groups in all outcome measures compared to baseline. Over stretching group showed significant difference at the end of study in terms of range of motion of wrist flexion, extension and strength of handgrip when compared to deep friction massage group P < 0.05. However, there is no significant difference between groups in pain. Discussion and Conclusion: This study showed that the effect of stretching exercises is more beneficial than deep transverse friction massage in the treatment of patients with CTS in decreasing the compression of the median nerve in the tunnel.

Mechanosensitivity of the median nerve in patients with chronic carpal tunnel syndrome

The aim was to investigate the relationship between the effects of median nerve strain during the elbow extension component of the upper limb neurodynamic test 1 (ULNT1) and the evoked musculoskeletal changes. 11 patients with chronic carpal tunnel syndrome (CTS) and 11 matched asymptomatic controls participated in the study. In all subjects, elbow extension was carried out in both ULNT1 and neutral positions of the shoulder and arm. From these two starting positions a KIN-COM(®) dynamometer carried out passive elbow extension while EMG activity of 10 arm and shoulder muscles, elbow-flexor resistive torque and elbow extension ROM were measured concurrently. The result showed that, in the ULNT1 position, increased EMG activity of the involved muscles, increased elbow extension resistive torque and pain responses occurred much earlier in the range of elbow extension in the CTS group compared to healthy controls. These findings demonstrated increased mechanosensitivity of the median nerve in CTS patients compared to healthy controls.

Response of Pain Intensity to Soft Tissue Mobilization and Neurodynamic Technique: A Series of 18 Patients With Chronic Carpal Tunnel Syndrome

ObjectiveThe purpose of this prospective case series was to examine the combined effects of soft tissue mobilization and nerve slider neurodynamic technique on pain and pressure sensitivity in women with chronic carpal tunnel syndrome (CTS). MethodsEighteen women with a clinical and electromyographic diagnosis of CTS participated. Patients completed the numerical pain rating scale (NPRS) for current, worst, and lowest pain intensity and underwent pain pressure threshold (PPT) testing over the median, radial, and ulnar nerves; the C5-C6 zygapophyseal joint; the carpal tunnel; and the tibialis anterior muscle. Pain was assessed at baseline and 1-week follow-up, whereas PPT were assessed at baseline and immediately after and 1-week after intervention. Each received soft tissue mobilization and nerve slider neurodynamic technique directed at different anatomical sites of potential entrapment of the median nerve. ResultsA decrease in the mean current intensity and worst level of hand pain (P < .01) was found 1 week after the treatment session (mean changes, 2.2 ± 1.1 points). A treatment effect for PPT levels over the C5-C6 zygapophyseal joint (P < .001) was found: PPT increased bilaterally 1 week after the intervention. No other significant changes in PPT levels were found (P > .195). ConclusionsThe application of soft tissue mobilization and neurodynamic technique decreased the intensity of pain but did not change pressure pain sensitivity in this group of women with chronic CTS.

Chronic Carpal Tunnel Syndrome: Results Of Carpal Tunnel Release

BACKGROUND/OBJECTIVE: Carpal tunnel syndrome (CTS) is the commonest entrapment neuropathy for which several conservative and surgical treatment options are available. In majority of cases the cause of CTS is unknown (idiopathic CTS), however, there are numerous medical conditions associated with CTS. Surgery for CTS is one of the most often performed procedures. The purpose of this study was to evaluate the clinical outcome of surgical treatment of chronic carpal tunnel syndrome. METHODS: Thirty patients with chronic CTS were selected for open carpal tunnel release. Twenty patients had bilateral disease. Thirty hands had thenar muscle atrophy. Fifty hands of thirty patients were operated from May 1997 to December 2002. RESULTS: Sensation improved within three months in all patients. Nocturnal pain disappeared within first week after surgery. Grip strength improved gradually even up to two years after surgery. All of thirty hands with thenar muscle atrophy showed symptomatic relief, but recovery of the wasted muscle in term of regaining bulk was very slow in most of cases. Only ten hands showed complete recovery of bulk of thenar muscles in three years time. CONCLUSION: Surgery is an excellent treatment option in chronic CTS in terms of symptomatic relief.Wasted thenar muscles recover slowly in fraction of cases.

Flexor carpi radialis motoneuron pool in subjects with chronic carpal tunnel syndrome are more excitable than matched control subjects

We compared excitability of the flexor carpi radialis (FCR) motoneuron pool in subjects with and without carpal tunnel syndrome (CTS). The study involved 11 subjects with chronic idiopathic CTS and 11 asymptomatic subjects as controls. The H-reflex and M-response of FCR muscle were obtained by stimulating the median nerve in the cubital fossa in the presence of an isometric background contraction using surface stimulating and recording electrodes. There was a significantly higher H-reflex latency and amplitude and H max / M max in CTS subjects ( P < 0.0 5 ). Latency and amplitude of the M-response remained unaffected in CTS group. The results support the hypothesis that central hypersensitivity does occur in chronic CTS. Therefore even in the presence of pathology in peripheral structures central mechanisms should be considered by clinicians.

Flexor Superficialis Abductor Transfer With Carpal Tunnel Release for Thenar Palsy

In patients with advanced chronic carpal tunnel syndrome (CTS) the ability of the thumb to abduct and perform functional opposition is impaired greatly, primarily because of denervation and paralysis of the abductor pollicis brevis muscle. The purpose of this study was to evaluate the results of transfer of the flexor digitorum superficialis to the abductor pollicis brevis for restoration of thumb abduction in thenar paralysis caused by advanced chronic CTS. Fifty patients (51 hands) with advanced CTS and loss of thumb abduction had a flexor digitorum superficialis transfer (37 small, 10 ring, 4 middle finger donors) to the abductor pollicis brevis with simultaneous carpal tunnel release (49 of 51 endoscopic). Thirty patients (60%) were women with an average age of 70 years (range, 35-90 y). Forty-three patients (84%) were in their sixth through eighth decades. We analyzed retrospectively preoperative and postoperative abduction, abduction strength, thenar muscle recovery and function, and patient satisfaction and complications. All patients reported improved thumb and hand function. Thumb abduction increased almost 20 degrees and 3 British Medical Research Council strength grades. Abduction was improved by the transfer in all patients, with some thenar recovery found in 35 of 40 cases followed-up longer than 12 months. Harvest of the flexor digitorum superficialis from the ring and middle fingers was associated with donor finger proximal interphalangeal joint contracture, although harvest from the small finger was not. Carpal tunnel release with simultaneous flexor digitorum superficialis-to-abductor pollicis brevis transfer provides satisfactory results for patients with profound CTS and thenar paralysis. The use of the small finger superficialis as the donor motor has minor morbidity compared with other methods and has predictable improvement and patient satisfaction. This transfer method is combined easily with endoscopic carpal tunnel release (as in 49 of our 51 cases), 2-portal, or open method releases.

Carpal Tunnel Syndrome: A Frequently Misdiagnosed Common Hand Problem

Carpal tunnel syndrome (CTS) is one of the most common hand problems. The incidence is greater in females and in activities where repetitive, vibrating and/or firm grasping work is prevalent. The diagnosis of CTS may be elusive to practitioners unfamiliar with the nonspecific and intermittent symptoms. The purpose of this article is to describe CTS and the assessment needed to detect early signs and symptoms and to describe the various diagnostic tests that practitioners can perform. In addition, data are offered conservative conservative measures that can be used for the acute stage of CTS and various surgical methods for the individual with chronic CTS. The priority in patient education is to teach individuals how to reduce or eliminate environmental risks and activities that potentiate the carpal tunnel syndrome.

Carpal Tunnel Syndrome in Black South Africans

The incidence and the aetiology of chronic carpal tunnel syndrome in black South Africans was evaluated. This study showed that the incidence of idiopathic carpal tunnel syndrome was very low in this population group and that most patients who presented with symptoms and signs of chronic carpal tunnel syndrome had a specific pathology. A rare case of tumoral calcinosis causing carpal tunnel syndrome is presented. A case of perineural lipofibroma causing carpal tunnel syndrome is also described.