Course Of Carpal Tunnel Syndrome Research Articles

Characteristics of Carpal Tunnel Syndrome in Wild-Type Transthyretin Amyloidosis (P11-8.007)

<h3>Objective:</h3> The purpose of our study was to evaluate the prevalence, clinical features, severity, and disease course of carpal tunnel syndrome (CTS) in wild-type transthyretin amyloidosis (wtATTR) patients, as well as the risk of recurrence following carpal tunnel release (CTR). <h3>Background:</h3> Wild-type transthyretin amyloidosis is an important cause of infiltrative cardiomyopathy, particularly in older males. Carpal tunnel syndrome is one of the most common extra-cardiac manifestations of wtATTR and can predate cardiac symptoms by 5–10 years. The association between CTS and wtATTR has been described in several case series; however, the characteristics of CTS in this population remain poorly understood. <h3>Design/Methods:</h3> This retrospective cohort study reports findings from a single-center experience of routine neurological screening of newly diagnosed wtATTR patients including nerve conduction studies. Consecutive wtATTR patients between 2014 and 2021 were included. <h3>Results:</h3> Seventy-nine wtATTR patients were included; 73 (92%) males, mean age of 79 years. Seventy-one (90%) met electrodiagnostic criteria for median neuropathy at the wrist (MNW), 50% had a prior diagnosis and 50% were newly diagnosed at screening. The majority with MNW were symptomatic (53, 67%) with moderate or severe disease (66, 84%) bilaterally (42, 53%) on electrophysiologic testing. Fifty-six percent of our asymptomatic patients had moderate disease at the time of screening. Nineteen (24%) had recurrent CTS despite previous CTR. At the time of screening, 19 (24%) were prescribed wrist splinting and 36 (46%) were referred for CTR. <h3>Conclusions:</h3> Median neuropathy at the wrist affects the vast majority of wtATTR patients. CTS was confirmed in 67% of our patients, most had bilateral disease with moderate to severe MNW on electrophysiology at the time of wtATTR diagnosis. Recurrence after CTR was seen in 27% of our patients at the time of screening, which is higher than the rate of recurrence in the general population, estimated at 3–20%. <b>Disclosure:</b> Dr. Russell has nothing to disclose. Dr. Khayambashi has nothing to disclose. Nowell Fine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of the American College of Cardiology: Case Reports. The institution of Nowell Fine has received research support from Pfizer, Akcea. The institution of Dr. Chhibber has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amylyx. Dr. Chhibber has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amylyx. Dr. Hahn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Akcea. Dr. Hahn has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Anylim.

Clinical Characteristics and Treatment of Adult Idiopathic Carpal Tunnel Syndrome Accompanied with Trigger Digit.

Purpose To investigate the clinical characteristics and treatment of adult idiopathic carpal tunnel syndrome (CTS) accompanied with trigger digit. Materials and Methods A retrospective analysis was performed on a total of 74 patients with adult idiopathic CTS accompanied with trigger digit admitted to and treated at the Hand Surgery Department of Ningbo No. 6 Hospital from January 1, 2017 to December 31, 2019. Data on patients' gender, age, occupation, course of the disease, menstruation, surgeries, examination-related information, complications, treatment methods, and prognoses during follow-up were recorded and subsequently used to analyze the pathogeneses, clinical characteristics, and treatment. Results A total of 74 patients (72 females and 2 males) were included. Among female patients, 51 were postmenopausal and 18 were non-postmenopausal. There were 101 fingers with trigger digit, including 14 patients with trigger digit in both hands, and 115 wrists affected by the CTS. The average course of CTS was 34.5 ± 49.3 months, and that of trigger digit was 10.5 ± 22.4 months. Seventy had both trigger digit and CTS in one hand, while among patients with both hands involved, only 4 had trigger digit or CTS in one hand. Eighty-nine fingers underwent A1 pulley release, and 104 hands underwent carpal tunnel surgery, with steroids being injected under the adventitia of the median nerve during the surgery. All patients who underwent surgeries had I/A-healed incisions, and 14 of them had obvious synovial hyperplasia observed in the carpal tunnel and flexor tendon sheath during surgeries. Follow-up visits, which lasted 3 to 35 months, had an average duration of 1.34 years and included 72 patients. In 63 patients (63/72), the syndrome of tenosynovitis and numbness disappeared and normal hand functions were restored; in 6 patients, the numbness in hands greatly improved and normal hand functions were almost completely restored, while no improvement in numbness of hands and limited hand functions were still observed in 3 patients. Conclusion CTS accompanied with trigger digit was more common in postmenopausal females, and the course of CTS was longer than that of trigger digit. CTS and trigger digit were more likely to simultaneously occur in the same hand, while some patients might not have obvious synovial hyperplasia in the carpal tunnel. Surgeries were effective in severe cases.

Carpal tunnel syndrome conservative treatment: a literature review.

Carpal tunnel syndrome (CTS) is the most common compression neuropathy, which is associated with a significant psy- chosocial and economic burden. In this paper, the literature on the current knowledge about the physiology and pathology of peri- pheral nerves during the course of CTS is reviewed, with a focus on currently used treatment options and the rationale for their use. Epidemiology, risk factors, etiology, clinical features and conservative treatment have been searched for, with all full-text, English language articles being included in the study. This paper aims to present the recent findings on CTS treatment while also suggesting a direction for further clinical trials. The search in PubMed and Google Scholar Databases revealed 229 articles of which 71 met the research criteria. The evi- dence regarding standard treatment methods of conservative CTS treatment is presented. CTS is a relatively common condition, which affects women more often than men. It is a multifactorial disease, and its clinical presentation mostly consists of symptoms distal to the entrapment site, including numbness, tingling, weakness and pain. Electrodiagnostic studies are considered to be the gold standard in CTS diagnosis. The conservative treatment methods reviewed are acupuncture, extracorporeal shock wave the- rapy, hydrodissection, kinesiotaping, corticosteroid injection, low level laser therapy, splints, platelet-rich plasma injection, manual therapy, ultrasound and phonophoresis. Based on the current body of knowledge, we conclude that the conservative CTS treatment is very safe, but the effec- tiveness of reviewed methods differs. The first promising results presented by various studies motivate the need for further research on novel treatment methods.

Atypical Course of Carpal Tunnel Syndrome in Dyskinetic Cerebral Palsy after Treatment

Atypical Course of Carpal Tunnel Syndrome in Dyskinetic Cerebral Palsy after Treatment

Carpal Tunnel Syndrome During Pregnancy

Objectives: To assess the current frequency of carpal tunnel syndrome during pregnancy in our area and to assess the course of carpal tunnel syndrome during pregnancy in those patients. Material and Methods: This is a prospective study of 400 women attending antenatal outpatients’ clinic. This study was conducted between the 1st of July 2009 and the end of August 2010 at King Hussein Medical Center, Jordan. At each demographic details and issues related to their problems were obtained. Results: During the study period, 400 pregnant women attending antenatal outpatients’ clinic in our hospital, 74 (18.5%) women were found to have carpel tunnel symptoms. Most of them were in third trimester of pregnancy 81.1% (no=60) followed by the second trimester 16.2% (no=12) and the least were in the first trimester 2.7% (no=2). The most common complaint was numbness, particularly during the daytime (78.4%), while the least frequent symptom reported was pain. However, about half of women with CTS during pregnancy still complained of CTS symptoms one year after delivery. Conclusion: A large number of pregnant women suffer from the frequent occurrence of CTS in pregnancy and are first noted during the third trimester, but only in half of women CTS symptoms disappeared one year after delivery.

The natural course of carpal tunnel syndrome in a working population

The aim of this study was to assess prevalence, incidence, and persistence of carpal tunnel syndrome (CTS) and associated symptoms over a one-year period in a working population. We conducted a one-year prospective study of 418 active workers in 12 worksites. Detailed health interviews, psychosocial questionnaires, and electrophysiological studies [ie, nerve conduction velocity (NCV) tests] were conducted at baseline and one-year follow-up. Individual-observed exposure assessments of wrist posture, hand activity, and hand forces were conducted. Prevalence of CTS cases at baseline was 10.8% [95% confidence interval (95% CI) 7.8-13.7%] on the dominant side and 6.0% (95% CI 3.7-87.3%) on the non-dominant side; CTS symptoms were 14.1% (95% CI 10.8-17.5%) and 11.0% (95% CI 8.0-14.0%), respectively. Incidence of CTS cases were 7.5% (95% CI 4.8-10.2%) and 5.6% (95% CI 3.3-7.9%), respectively. Higher proportions of subjects with current symptoms or positive electrophysiological test findings at baseline became CTS cases at one year compared to those with neither (28.6% and 13.9%, respectively, versus 0.5%). One-year persistence of CTS case status was 44.4% (95% CI 29.9-59.0%) for the dominant hand and 52.0% (95% CI 32.4-71.6) for non-dominant hand. There were significant differences at baseline between asymptomatic subjects and CTS cases with respect to higher job demands (P=0.027), lower job satisfaction (P=0.036), lower general health (P=0.0009), higher exposure to vibrating hand tool use (P=0.039), and greater time using a forceful power grip (P=0.035) among cases. CTS symptoms more than positive NCV test results alone appear to predict CTS at one year. Persistence of CTS at one year is high.

Carpal Tunnel Syndrome in Patients with Diabetes

The aim of this study was to evaluate the relation of clinical and neurographic data and their possible influence factors on the course of carpal tunnel syndrome (CTS) in patients with diabetes. From a cohort of 230 patients with diabetes, CTS was found in 1/3 of these patients, 52 patients with 82 affected hands were included in our study. Number of examinations varied from 2 to 11 (mean 5) over 1 to 15 years (mean 5,4 years). Outcome variables were: duration of diabetes, type of diabetes, diabetic neuropathy and grade of CTS affection. Measurement were made of sensible and motor nerve conduction velocity of the Nn. medianus, ulnaris, peronaeus, tibialis and suralis. In 51% of the affected hands we found a latent – and in 49% a symptomatic – CTS at study onset. Women were 3-fold more affected than men, 56% of the patients showed diabetic neuropathy. In regard to the neurographic data, in 61% the results decreased, in 22% they increased the course and in 17% the course remained stable. There was a significant difference (p<0.05) between type 1 and type 2 diabetes, i.e., patients with type 1 (+3.09 pts) decreased in our affection scale (0–21) more than type 2 patients (+0.6 pts). Duration of diabetes as covariate showed a significantly better outcome (p=0.003) for patients with a shorter time of affection. A neuropathy had no severe influence on the course of CTS, in only 1/3 of the patients was there a correlation between the course of CTS and the course of neuropathy. 2/3 of 42 latent courses of CTS turned into a symptomatic one, 1/3 remained clinically latent but with decreasing neurographic values. Due to decreased neurographic and/or clinical results, 26 hands had an operation. Most of these patients suffered from type 2 diabetes with a neuropathy. Post-operatively all patients had an increase in the course of CTS, especially patients without neuropathy. Type 2 patients have a better prognosis in the course of CTS than type 1 and patients with a shorter time of diabetes affection had also a better prognosis. The courses of neuropathy and CTS were not parallel, i.e., neuropathy had no direct influence on the course of CTS. All patients who underwent an operation for CTS improved; especially those without neuropathy. Patients should be neurographically and clinically examined regarding a possible entrapment with a focus on the N. medianus. An operation should not always be the first step in the treatment of CTS.

Carpal tunnel syndrome in patients on long-term haemodialysis.

The purpose of this study was to describe the pathophysiology of carpal tunnel syndrome (CTS) in patients on long-term haemodialysis. We examined 110 patients, who had been having haemodialysis for chronic renal failure and had CTS, to clarify the clinical features and electrophysiological changes in peripheral nerves. There was a significant correlation between the incidence of CTS and the duration of haemodialysis. Compared with idiopathic CTS, CTS caused by long-term haemodialysis had relatively limited postoperative improvement. Symptoms recurred postoperatively in 11 patients (19%) of those with CTS caused by long-term haemodialysis. Electrophysiological measurements of sensory nerve conduction velocity showed that it was slower in distal segments of the median nerve in patients on haemodialysis compared with normal volunteers. Nerve conduction velocity in the carpal tunnel was significantly delayed (p < 0.05) in the patients with CTS on long-term haemodialysis. N9-13 interpeak latencies were significantly longer (p < 0.05) in subjects who had had haemodialysis for at least 10 years. All the patients with advanced destructive spondyloarthropathy had longer N9-13 interpeak latency. These results suggest that CTS in patients on long-term haemodialysis has its basis in neuropathy. The clinical course of CTS in these patients is different from that of patients with idiopathic CTS, because the neuropathy involves not only the carpal tunnel region, but also the proximal part of the median nerve both diffusely and progressively.

Carpal Tunnel Syndrome

We evaluated 44 patients with carpal tunnel syndrome and performed histological evaluations of tenosynovium taken at the time of carpal tunnel release. Age, disease and work history, radiographs, and outcome were assessed. The clinical parameters were then compared with the histologic features to determine if the histology was predictive of the clinical course of carpal tunnel syndrome. We found no significance in the histologic changes in patients with carpal tunnel syndrome when age, duration of symptoms, work history, radiographs, and outcome were evaluated.

Nonsurgically Treated Carpal Tunnel Syndrome in the Manual Worker

This study evaluates the course of carpal tunnel syndrome in a group of manual laborers who declined surgery for personal or social reasons. Thirty-five patients and 67 extremities with carpal tunnel syndrome were evaluated in a group of manual laborers. The carpal tunnel syndrome was classified as mild, moderate, or severe on the basis of initial evaluation data. Sensory batteries, motor and sensory conduction velocities, and electrical studies were performed on a scheduled basis. Follow-up ranged between 14 and 58 months, with an average of 34.3 months. Three patients became worse and one improved during the study period. All others remained unchanged. Six patients returned to work, but only three returned to their original jobs. Although carpal tunnel syndrome does not appear to be a progressive condition once the triggering cause is removed, nonsurgical treatment does not seem to be the treatment of choice for patients who must continue in a manual labor position.