CTS Patients Research Articles

Assessing the severity of carpal tunnel syndrome during physical examination by measuring two-point discrimination: Post-hoc analysis of prospectively collected data

IntroductionCarpal tunnel syndrome (CTS) commonly presents after distal radius fractures. Assessing its degree of severity is essential to therapeutic decision-making - i.e. operative vs. conservative treatment. The role of the two-point discrimination (2PD) has not yet been evaluated as a potential indicator of severity during physical examination. Therefore, in our cross-sectional study, we aimed to find a correlation between 2PD values and disease severity, based on the gold-standard electromyography and electroneurography (EMG-ENG) and ultrasonography findings. MethodsWe conducted a post-hoc analysis of prospectively assessed CTS patients for 2PD values. We analyzed the correlation between 2PD and EMG-ENG measurement results, patient characteristics, nerve ultrasonography, and relevant CTS questionnaires. CTS severity was determined by EMG-ENG results. The Pearson correlation was calculated between variables. ResultsThe study included 81 patients. The three pre-determined EMG-ENG severity categories showed a significant correlation between both 2PD values and 2PD severity categories (r= 0.29 [0.07–0.48] and r= 0.26 [0.03–0.45]). Distal sensory latency and conduction velocity values correlated significantly with 2PD categories. However, the correlation coefficients (r= 0.25 [0.02–0.46] and r=-0.24 [-0.37–0.07]) were low. The 2PD severity categories showed no significant correlation with the severity assessed by nerve ultrasound (r=-0.07 [-0.38–0.25]). The 2PD values showed a significant correlation between the values of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (r= 0.3 [0.06–0.51]). We concluded that the best cut-off value for differentiating severe from non-severe CTS was at the 9.5 mm 2PD cut-off value (sensitivity = 0.65 [0.45–0.81], specificity = 0.71[0.58–0.82], AUC = 0.71 [0.59–0.83]). ConclusionThere is a significant correlation between 2PD values and the severity of carpal tunnel syndrome as determined by EMG-ENG; however, they are not interchangeable. Based on the results of our study, we propose that measuring two-point discrimination may be a quick and easy, reliable and cost-effective screening method to assess the severity of carpal tunnel syndrome following distal radius fractures.

Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study

BackgroundCarpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life.PurposesThis study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients.MethodWe employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023.ResultsThe results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates.ConclusionThis study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS.

Measuring tactile sensitivity and mixed-reality-assisted exercise for carpal tunnel syndrome by ultrasound mid-air haptics.

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation. Twenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program. Thresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature. The results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS.

Relationship Between Compression Severity and Hand Dexterity, Sleep, Quality of Life, Neuropathic Pain, and Anxiety-Depression in Patients with Carpal and Cubital Tunnel Syndrome

Objective: Carpal and cubital tunnel syndromes are common entrapment neuropathies [1]. Some previous studies showed that carpal tunnel syndrome and, to a lesser extent, cubital tunnel syndrome can impair sleep and quality of life [2-4]. But there are only few studies comparing these two syndromes [5]. However, no study, which evaluates hand dexterity, sleep quality, quality of life, and neuropathic pain in relation to the severity of compression determined by Electroneurography (ENMG) in both syndromes, could be found in the literature. Thus, it was aimed in the present study to investigate the relationship between hand dexterity, sleep quality, quality of life, neuropathic pain, and anxiety-depression symptoms with different levels of compression severity in patients clinically and electro-physiologically diagnosed with carpal tunnel syndrome and cubital tunnel syndrome. Materials and methods: This study involved patients, who applied to the ENMG laboratory and were18 years or older and clinically and electro-physiologically diagnosed with carpal tunnel syndrome and cubital tunnel syndrome. The sociodemographic and clinical data of the patients who agreed to participate in the study were recorded. Carpal tunnel syndrome was classified as mild, moderate, and severe by using the American Association of Electrodiagnostic Medicine Classification [12] based on electrophysiological data, whereas the classification of cubital tunnel syndrome was performed by using the electrodiagnostic grading system created by Zeidman and Pandey based on the American Association of Electrodiagnostic Medicine practice guidelines [13]. The Pittsburgh Sleep Quality Index [14,15] and Epworth Sleepiness Scale [16,17] were used in evaluating the sleep quality of the patients, the EuroQuol-5D Quality of Life Scale [18,19] for quality of life, the 4-item neuropathic pain scale [20,21] for neuropathic pain, the Hospital Anxiety and Depression Scale [22,23] for anxiety and depression levels, and the 9-Hole Peg Test [24] for hand dexterity. After the forms were filled in, the data of the patients having carpal tunnel syndrome and those of patients having cubital tunnel syndrome were compared statistically. Moreover, after staging them as mild, moderate, and severe, the findings of patients in both groups were compared within each group, and their relationships were investigated. Results: Sleep disorders, neuropathic pain, depression, and anxiety disorders were observed to be much more prevalent among patients with CTS when compared to the patients with CuTS and the severity of these disorders increases together with an increase in the severity of the disease. It was also determined that CTS patients lag behind CuTS patients in fine motor skills. Conclusion: It should be noted that all of these parameters negatively affect the quality of life of patients. Early physiotherapy and rehabilitation can be beneficial in the treatment of patients and can contribute to their quality of life.

Management Physiotherapy for Carpal Tunnel Syndrome: A Case Report

Carpal Tunnel Syndrome is a peripheral neuropathy in which there is increased pressure around the median nerve which causes various symptoms such as tingling, wrist pain, paresthesia, and a burning sensation in the hands. Various factors have been speculated to contribute to the occurrence of CTS, including hereditary neuropathy, trauma to the forearm, repetitive motion work on the wrist, inflammation of the tendons, metabolic and endocrine diseases, malignancy to degenerative diseases. To reduce pain when the patient is at home, physiotherapists provide independent exercises that can be done at home with modified myofascial stretching. Kinesio tapping is an adjunctive treatment method that is suggested to be effective in regulating normal tissue function and supporting wound healing mechanisms. It has been found to be effective in muscle problems for pain relief by reducing pressure on pain receptors and supporting and protecting muscle tissue. Kinesio tapping is also known to be effective in the conservative treatment of CTS either alone or in combination with other therapeutic agents. To determine the effect of exercise therapy and kinesio tapping given to CTS patients. This study uses a case study. measurement of pain using the Numeric Rating Scale (NRS), measurement of muscle strength using Manual Muscle Testing (MMT), Goniometer to measure the Range of Joint Motion (ROM), Evaluation of Functional Ability with the Buston Questionaire Carpal Tunnel Syndrome (BQCTS) is a measuring tool to measure functional ability in CTS. After 3 physiotherapy interventions, results were obtained which showed a decrease in pain. Silent pain from 1 to 0, tenderness from 5 to 2, and motion pain from 6 to 2. For muscle strength, there was an increase in the wrist flexor muscle group from 3+ to 4. For the range of motion of the joints, there was no significant increase due to the time of intervention very limited. As well as found an increase in functional activity and a decrease in the degree of pain. Exercise therapy and Kinesio Taping are effective for reducing pain, increasing muscle strength, and increasing range of motion resulting in increased functional ability.

Effect of Adding Kinesiotaping to Median Nerve Gliding Exercise Toward Hand Performance of Patients with Carpal Tunnel Syndrome by Using Michigan Hand Outcomes Questionnaire

Background: CTS occurs due to local compression of the median nerve with manifestations of neuropathy, mostly in the productive population. Many conservative treatments have been observed to reduce the degree of pain and quality of life in CTS patients. Kinesiotaping is a new therapy that has been widely used for various musculoskeletal conditions and is known for reducing median nerve compression. Aim: To determine the effect of adding kinesiotaping to median nerve gliding exercise on hand function in CTS patients by using the Michigan Hand Outcomes Questionnaire. Methods: This research was an experimental randomized pre-and post-test group design. A sample of 24 patients from the Medical Rehabilitation Outpatient in RSUP Dr. Kariadi were divided into two groups randomly. The intervention group (n=12, dropout 1) got kinesiotaping application and median nerve gliding exercise. The control group (n=12, dropout 1) did the median nerve gliding exercise only. Hand performance has been evaluated before and at the end of the 4th week of treatment by using the Michigan Hand Outcomes Questionnaire. Result: There were significant improvements in the intervention group’s right-hand function (p&lt;0,001), activities of daily living (ADLs) or the ability of the right hand to do certain tasks (p&lt;0,001), work performance (p&lt;0,001), pain (p=0,024), and satisfaction (p&lt;0,001), as compared to the control group. Meanwhile, the intervention and the control group did not show significant differences in left-hand function score (p=0.884), left-hand ability score (p=0.884), and aesthetics score (p=1,000). Conclusion: There was a positive effect on improving hand performance in CTS patients by adding kinesiotaping to median nerve gliding exercises.

The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study

Study designSingle-blinded, randomized controlled study. IntroductionCarpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. Purpose of the studyThis study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. MethodsA total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. ResultsWe found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. DiscussionThis study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. ConclusionsMWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program.

Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome in the upper extremities. Acupuncture is often used as a treatment method in CTS and numerous studies consider it effective. However, no study has yet compared the efficacy of physical therapy including bone and neural mobilization, exercise and electrotherapy with and without acupuncture in CTS patients.Purpose: comparing the effect of physiotherapy plus acupuncture with physiotherapy alone on pain, disability and grip strength in CTS patients. MethodForty patients with mild to moderate CTS were randomly divided into two equal groups. Both groups received exercise and manual techniques for 10 sessions. Patients in the physiotherapy plus acupuncture group also received 30 min of acupuncture in every session. The visual analog scale (VAS) score, the score on the Boston carpal tunnel questionnaire for functional status and symptom severity, shortened disability of arm, shoulder, hand (Quick-DASH) score and grip strength were evaluated at pre-test and post-test. ResultsAccording to ANOVA results, there is a significant interaction between group and time for VAS, BCTQ and Quick-DASH parameters. At the post-test, while the parameters of VAS, BCTQ and Quick-DASH in the physiotherapy plus acupuncture group had a statistically significant difference compared to the physiotherapy group, no significant difference was observed between the two groups in the pre-test. Moreover, there is no significant difference between groups in grip strength improvement. ConclusionThis study shows preliminary evidence that physiotherapy plus acupuncture, was more effective than physiotherapy alone in pain relief and improving disability of patients suffering from CTS.

Study on the effect, safety, prognosis quality and application value of extracorporeal shock wave based neural activity in carpal tunnel syndrome patients

BackgroundMild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization.MethodsThe clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed.ResultsThe clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P < 0.05). ADL scores are negatively correlated.ConclusionExtracorporeal shock wave combined with nerve mobilization has a significant effect in the treatment of CTS patients, which can significantly improve the symptoms and pain scores of patients, and enhance the function of patients’ upper limbs. At the same time, the incidence of complications in patients is less, and it has high safety.

Image analysis can reliably quantify median nerve echogenicity and texture changes in patients with carpal tunnel syndrome

ObjectiveTo study the ability of image analysis measures to quantify echotexture changes of median nerve in order to provide a complementary diagnostic tool in CTS. MethodsImage analysis measures (gray level co-occurrence matrix (GLCM), brightness, hypoechoic area percentage using max entropy and mean threshold) were calculated in normalized images of 39 (19 younger and 20 older than 65y) healthy controls and 95 CTS patients (37 younger and 58 older than 65y). ResultsImage analysis measures were equivalent or superior (older patients) to subjective visual analysis. In younger patients, GLCM measures showed equivalent diagnostic accuracy with cross sectional area (CSA) (Area Under Curve (AUC for inverse different moment = 0.97). In older patients all image analysis measures showed similar diagnostic accuracy to CSA (AUC for brightness = 0.88). Moreover, they had abnormal values in many older patients with normal CSA values. ConclusionsImage analysis reliably quantifies median nerve echotexture alterations in CTS and offers similar diagnostic accuracy to CSA measurement. SignificanceImage analysis may offer added value to existing measures in the evaluation of CTS, especially in older patients. Its clinical implementation would require incorporation of mathematically simple software code for online nerve image analysis in ultrasound machines.

Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis: Ultrasonography and Magnetic Resonance Imaging Findings.

The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls. Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI. Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001). CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients.

Pengaruh Lower Limb Tension Test Terhadap Penurunan Nyeri Terhadap Nyeri Punggung Bawah di RSUD KRMT Wongsonegoro

Background: Lower back pain (NPB) Ischialgia is a pinched ischialgia nerve in the lower back area which causes the buttocks, thighs, lower legs and even feet to become tingling, painful, and sometimes causing weakness. Nerve mobilization is a manipulation technique by moving and stretching nerve tissue to increase axonal transportation so that it can improve nerve conduction. Nerve mobilization can reduce the pressure in the nerves so that there is an increase in blood flow to the nerves, which can have a regenerative and healing effect on injured nerves (Butler, 1991). Nerve mobilization is often used as a form of diagnosis and treatment for musculoskeletal conditions with nerve involvement (Butler, 1991). Nerve mobilization in the Lower Limb Tension Test (LLTT) is carried out at the branches of the Brachial plexus such as the radial nerve, median nerve and ulnar nerve. But here the author only discusses LLTT in the ishiadic nerve, namely LLTT 1 which is related to lower back pain.&#x0D; The aim is to determine physiotherapy management and the effect of Ultrasoundtherapy therapy and nerve mobilization using the LLTT 1 method in cases of lower back pain on reducing pain and increasing the functional ability of the hand. Two group pre test and post test method. RESEARCH PLACE: Physiotherapy clinic, RSU Sidoarjo. TIME: Measuring instrument: Visual Analouge Scale (VAS). Results: treatment using the Mann-Whtney test. With confidence interval (CI) (95%) The results of the study revealed that there was a significant difference in pain in group 1 (p = 0.00) and group 2 (p = 0.00). But there was no significant difference between the two groups in pain improvement (p = 0.152), so there was no better treatment between the two groups. Conclusion: It is concluded that ULTT is useful in treating CTS patients to reduce pain in two groups. The targeted outcomes are publications in national journals indexed by Sinta and HAKI. The TKT target for implementing this gamelan accompaniment exercise is level 2.

Electrophysiological Evaluation in Carpal Tunnel Syndrome

IntroductionCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy in society. Based on the data obtained from basic conventional CTS studies, patients can be staged, and the changes in CTS severity can be followed according to the electrophysiological parameters derived from the data. This study aimed to assess the electrophysiological findings of CTS patients using the Bland and Padua grading systems and median terminal latency index (mTLI) and to evaluate the findings that may indicate the transition to the advanced stage.Material and methodsThe study included 822 patients. After electrophysiological examination, both hands of the patients were staged according to the grading systems proposed by Padua and Bland. Additionally, mTLI was calculated for each hand.ResultsWith the increase in stages, a significant decrease was found in mTLI, median sensory nerve conduction velocity (mSNCV), median sensory amplitude (mSA), median motor nerve conduction velocity (mMNCV), and median motor amplitude (mMA), whereas a significant increase was observed in median sensory distal latency (mSDL) and median motor distal latency (mMDL) (p&lt;0.001) The parameter with the highest sensitivity regarding the indication of transition between stages was mSNCV, the sensitivity increased with the progression of stage, and a cut-off value of 40.5 m/s showed a sensitivity of 94.2% and a specificity of 90% regarding the indication of transition to the advanced stage.ConclusionsOur results showed that with a cut-off value of 40.5 m/s, mSNCV is an accurate sensitive and specific parameter regarding the indication of transition to the advanced stage.

TH-155. The existence of all three forms of MGA in two CTS patients

TH-155. The existence of all three forms of MGA in two CTS patients

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.

Brain Structural Changes in Carpal Tunnel Syndrome Patients: From the Perspectives of Structural Connectivity and Structural Covariance Network.

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy. However, CTS-related changes of brain structural covariance and structural covariance networks (SCNs) patterns have not been clearly studied. To explore CTS-related brain changes from perspectives of structural connectivity and SCNs. Brain structural magnetic resonance images were acquired from 27 CTS patients and 19 healthy controls (HCs). Structural covariance and SCNs were constructed based on gray matter volume. The global network properties including clustering coefficient (Cp), characteristic path length (Lp), small-worldness index, global efficiency (Eglob), and local efficiency (Eloc) and regional network properties including degree, betweenness centrality (BC), and Eloc of a given node were calculated with graph theoretical analysis. Compared with HCs, the strength of structural connectivity between the dorsal anterior insula and medial prefrontal thalamus decreased (P <.001) in CTS patients. There was no intergroup difference of area under the curve for Cp, Lp¸ Eglob, and Eloc (all P >.05). The real-world SCN of CTS patients showed a small-world topology ranging from 2% to 32%. CTS patients showed lower nodal degrees of the dorsal anterior insula and medial prefrontal thalamus, and higher Eloc of a given node and BC in the lateral occipital cortex (P <.001) and the dorsolateral middle temporal gyrus (P <.001) than HCs, respectively. CTS had a profound impact on brain structures from perspectives of structural connectivity and SCNs.

Effect of exercise on nerve conduction study of Carpal tunnel syndrome patients

Background: Carpal tunnel syndrome is the most common entrapment neuropathy of the median nerve at the wrist. In general population CTS is known to be a very common disease and the prevalence of CTS is estimated to be 2.7% as confirmed by clinical and electrophysiological findings. Typical symptoms of CTS are tingling, numbness and parasthesia in thumb, index, middle finger and radial half of ring finger which is often exaggerated at night. Previously research studies have been done on pain control, grip strength, wrist function. Very little research work has been done on effect of exercise on NCS of CTS patients. So the aim of the study is to find the short term (6weeks) effects of exercise on NCS of CTS patients. Methodology: Bilateral sensory and motor nerve conduction studies were carried out in 50 CTS patients before and after 6weeks of exercise. Exercise treatment was given to patients under the guidance of trained physiotherapist. Clinical examination was also done after 6 weeks. RMS machine from Chandigarh was used. Statistical analysis was done by INSTAT- 3.6 software. Result: DML, DML (diff.) DSL, DSL (diff.) showed significant decrease after 6 weeks of exercise in symptomatic (Rt.) hand, but no significant difference was found in SCV, CMAP, SNAP of median nerve. Whereas in Lt. hand only DML (diff.) between median and ulnar nerve showed significant change. There was also improvement in clinical signs and symptoms and pain scale. Conclusion: It was concluded that exercise treatment for 6 weeks under the proper guidance of trained physiotherapist showed significant improvements in clinical as well as electrophysiological parameters in symptomatic hands. So, exercise treatment can be suggested as choice of treatment for CTS patients.

Effects of diabetes mellitus on the rate of carpal tunnel release in patients with carpal tunnel syndrome

The objective of this study was to evaluate the effects of diabetes mellitus (DM) on the rate of carpal tunnel release (CTR) using a large nationwide cohort in Korea and to identify risk factors, including comorbidities and socioeconomic status (SES), associated with CTR. Patients with a primary or secondary diagnosis of carpal tunnel syndrome (CTS; ICD-10 code: G560) were selected and divided into two groups according to the presence of DM. A Cox proportional hazard model was used to assess the rate of CTR between the two groups. To evaluate the influence of demographic factors, comorbidities, and SES on CTR, multivariate Cox proportional hazard regression models were used to adjust for confounding variables. In total, 12,419 patients with CTS were included in the study: 2487 in DM cohort and 9932 in non-DM cohort. DM duration was negatively related with the rate of CTR (HR = 0.89, 95% CI 0.87–0.91) in CTS patients with DM. The rate of CTR was decreased in patients with DM compared to those without DM in the unadjusted model; however, after adjusting for comorbidities, DM had no significant effect on the rate of CTR. Female sex (HR = 1.50, 95% CI 1.36–1.67) correlated with the rate of CTR, and an inverse relationship between the number of comorbidities and CTR was found (p < 0.001) irrespective of DM. Diabetic polyneuropathy (DPN) was not associated with CTR, and we did not find any factors correlating with CTR in DPN patients. We found that CTS patients with more comorbidities or combined with a longer duration of DM were undertreated in real-word practice. Actual outcomes of CTR in CTS patents with various comorbidities should be investigated in future studies for optimal management of CTS.

Efficacy of kinesio taping on hand functioning in patients with mild carpal tunnel syndrome. A double-blind randomized controlled trial

Study designDouble-blind randomized controlled trial. IntroductionCarpal tunnel syndrome (CTS) is a common mononeuropathy that causes pain and disability in the affected hand. Kinesio taping (KT) has been recently proposed as a promising conservative approach in CTS patients. Purpose of the studyTo investigate the effectiveness of KT compared to a sham taping on symptoms and hand function in patients affected by mild CTS. MethodsPatients affected by mild CTS with symptoms for at least 8 weeks were enrolled and randomly allocated into two groups: KT group, according to the technique proposed by Kase plus specific exercises; control group, undergoing a sham taping plus specific exercise. All patients performed 2 sessions/week for 5 weeks of exercises of mobilization of fingers and carpal joint. At the baseline, after 5 weeks (T1), and after 6 months (T2), a physician unaware of patients’ allocation assessed the Boston Carpal Tunnel Questionnaire (BCTQ) symptom (BCTQ-S) and functional (BCTQ-F) subscales. ResultsForty-two patients (mean age:54.3 ± 15.0 y) were randomly allocated into KT (n = 21) and control group (n = 21). At T1, in both groups we found a significant improvement in hand function and symptoms, as showed by BCTQ-F (KT:4.2 ± 0.7 vs 3.0 ± 0.6, P < .001; sham: 2.2 ± 0.3 vs 1.7 ± 0.3, P = .012) and by BCTQ-S (KT: 2.2 ± 0.3 vs 1.7 ± 0.3, P < .001; sham: 2.3 ± 0.4 vs 1.9 ± 0.5, P = .007). At T2, only in the KT group there was a significant difference in both sub-items of primary outcome. There were significantly better results in the KT group at T1 and T2. DiscussionThe present study showed that KT compared to a sham taping might be more effective in reducing perceived symptoms in mild CTS patients, reporting a clinically significant difference. ConclusionKT might be considered as an effective technique combined to rehabilitative treatment in terms of hand function and symptoms in patients affected by mild CTS.

Combination of high-frequency ultrasound and virtual touch tissue imaging and quantification improve the diagnostic efficiency for mild carpal tunnel syndrome

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment symptom in the peripheral nerves. High-frequency ultrasound (HFUS) is widely used in the diagnosis of CTS. Virtual Touch Tissue Imaging and Quantification (VTIQ), which provides more information about the hardness of organization, is used to diagnose CTS. However, the data of diagnostic value of them in various degrees of CTS are limited. Whether the combination of HFUS and VTIQ can improve the diagnostic efficiency also remains unknown. The study aimed to explore the diagnostic value of HFUS and VTIQ in various degrees of CTS and whether combination of HFUS and VTIQ could improve the diagnostic efficiency of CTS.MethodsA collection and analysis of 133 CTS patients and 35 volunteers from January 2016 to January 2019 were performed. We compared the clinical characteristics, cross-sectional area (CSA) value and shear wave velocity SWVmean value of CTS group with volunteer group.ResultsThe CSA value and SWVmean value of CTS cohort were significantly higher than volunteer group (10.79 ± 2.88 vs. 8.06 ± 1.39, p < 0.001, 4.36 ± 0.95 vs. 3.38 ± 1.09, p < 0.001, respectively). The area under the curve (AUC) of receiver operating characteristic (ROC) curve of CSA value and SWVmean value were 0.794 and 0.757, respectively. Hierarchical analysis of CSA value and SWVmean value showed that the AUC in the moderate and severe CTS group were higher than in mild CTS group. Furthermore, the CSA value combined with SWVmean value used to diagnose mild CTS was 0.758, which was higher than that of single CSA value or single SWVmean value.ConclusionsBoth HFUS and VTIQ technology were feasible to evaluate CTS. HFUS was suitable for use in diagnosis of moderate and severe CTS. For mild CTS, combination of HFUS and VTIQ was relevant to improve the diagnostic efficiency of CTS.