CTS Patients Research Articles

Study of effect of various treatments in clinically diagnosed patients of Carpal tunnel syndrome

Carpal tunnel syndrome is the compression neuropathy in upper extremity. Several researches have been done to see the effect of various treatments separately. But very little research work is available for comparison of treatments. So the study was aimed to study the clinical and electrophysiological findings and their Comparision before and after various treatments. NCS was carried out in 200 CTS patients before and after 6weeks of treatment. Patients were divided into 4 groups. Group I- operative, Group II-medicinal treatment, Group III-exercise, Group IV-medicine+exercise. Clinical and electrophysiological parameters all groups were compared before and after treatment. Group (I), showed significant changes in all parameters except SNAP in operated Rt. Hand as compared to Lt. Hand. Group-II showed significant changes in DML,DML(diff.),DSL,DSL(Diff.)except CMAP,SNAP,&SCV in Rt. Hand but in Lt. hand DML,DML(diff.)DSL showed significant changes where as DSL(Diff.) CMAP,SNAP,&SCV were non-significant. Group-III showed significant changes in DML, DML(diff.),DSL,DSL(Diff.) but SCV,SNAP and CMAP were non-significant in Rt. hand but in Lt. hand only DML(diff.) was significant . Group-IV showed significant changes in all parameters except SCV in Rt. hand but in Lt. hand DML, DML (diff.),DSL, DSL(Diff.) were significant , where as SNAP, CMAP, and SCV were non-significant. It was concluded that maximum improvement was observed in clinical and electrophysiological parameters in operative group, then Medicine + exercise Group, then exercise Group and minimum in Medicinal treatment Group. So operative method is the method of choice for CTS; however the duration of treatment should be more so that further improvements can be seen in all parameters.

Effect of a monocyte chemoattractant protein-1 synthesis inhibitor on fibroblasts from patients with carpal tunnel syndrome

BackgroundCarpal Tunnel Syndrome (CTS) is an idiopathic fibrotic disorder. Fibrosis in the subsynovial connective tissues (SSCT) of CTS and many other fibrotic diseases is mediated by Transforming growth factor β (TGF-β). Recently monocyte chemoattractant protein-1 (MCP-1) a cytokine involved in cellular recruitment has been suggested to regulate TGF-β activity. It is related to the onset of diseases which are caused by fibrosis, such as idiopathic pulmonary fibrosis, renal fibrosis, and systemic scleroderma. In this study, we evaluated the effect of the MCP-1 synthesis inhibitor, Bindarit, on primary cultures of fibroblasts from the SSCT of five CTS patients. MethodsFibroblasts were treated with Bindarit (10 μM, 50 μM, 100 μM, or 300 μM). Responses to inhibitors were evaluated by regulation of CTS fibrosis-associated genes, fibrosis gene array and Smad luciferase reporter assay. We also assessed the combination effect of Bindarit and SD208, a TGF-β receptor type 1 inhibitor on TGF-β signaling. ResultsCollagen type III A1 (Col3), connective tissue growth factor (CTGF), and SERPINE1 expression were significantly down-regulated by Bindarit (300 μM) compared to vehicle control. In the fibrosis array, expression of inhibin beta E chain precursor (INHBE), beta actin (ACTB), endothelin 1 (EDN1) and hypoxanthine phosphoribosyltransferase 1 (HPRT1) were significantly down-regulated, and integrin beta-3 (ITGB3) was significantly up-regulated by Bindarit (300 μM). Smad signal transduction activation was significantly down-regulated by Bindarit (300 μM) and/or SD208 (1 μM) with TGF-β1 compared to vehicle control with TGF-β1. ConclusionsThese results suggest that Bindarit in combination with SD208 may be beneficial as medical therapy for the SSCT fibrosis associated with CTS.

THE BOSTON CARPAL TUNNEL QUESTIONNAIRE /BCTQ/ − A RELIABLE METHOD FOR DIAGNOSIS AND ASSESSMENT OF THE TREATMENT OF CARPAL TUNNEL SYNDROME

CTS is the most common compression neuropathy with an incidence of 125-515/100 000. It is a result of compression of the median nerve by the transverse carpal ligament. It is observed in 2 to 5% of the general population, more frequently in women.In the last few years the scientific society has acknowledged the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and more and more frequently it is being used as a standard in CTS patients. The literature also contains numerous studies on the diagnostics and treatment of CTS using BCTQ.Aim of study. To investigate the effect of a complex of physical factors on the reverse development of symptoms of moderate carpal tunnel syndrome using BCTQ and to compare the results of the BCTQ subjective rating (SSS) (symptom severity scale) and function − FSS (functional status scale) with objective assessment measured by the ENG parameters of n. medianus Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were examined. 38.60% of the patients were with right hand affected, 9 patients (15.80%) with left hand affected and 26 patients (45.60%) with bilateral involvement (n=26), In the last group, we examined both hands, i.e. 57 patients and 82 hands were investigated.Based on the analysis of our own studies, we applied the following complex physiotherapeutic program to the patients involved in the study: ultrasound, electrophoresis with Nivalin (Galantamine), and traditional kinesitherapy program.Results and discussion. By analyzing the results of the symptom severity assessment of the first part of the questionnaire we find that subjective complaints of patients decreased statistically significantly at the end of physiotherapy course from an average of 2.67 before treatment to 2.21 at the end of FTP (p <0.01). This trend continues within 1 − 4 months after the end of physiotherapy − average 1.79 and maintains up to 4 − 8 months when the mean of the results is 1.69 (p <0.001). We found that with regard to the recovery of the function of the affected hand and the way it affects some of the activities of daily living, the results of the second part of the BCTQ - functional status scale - show a statistically significant improvement at the end of the physiotherapy course 1.91 to an average of 1.63 (p <0.001), with a tendency for long-term retention and a slight decrease in the average of the results obtained to 1.37 within the first control examination at 1-4 months (p <0.001) and resistance to this trend in the following months (4-8) − 1.31 (p <0.001).Based on the ANOVA analysis and the calculation of the η coefficient, we proved that there is no significant difference in the results obtained from the Boston questionnaire and those from the ENG examination. There is a high percentage of overlap - from 53.10% to 95.60%.Although the results of the questionnaire are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of CТ C studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severityConclusions. In the presented facts of the discussion impression makes the patient's influence both on the subjective complaints and the clinical symptoms as well as on the degree of restoration of the affected hand functions at the end of the physiotherapy course, the continuation of this trend up to 4 months after the end of the treatment and maintaining it for 4 to 8 months.Although the results of BCTQ are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of carpal tunnel studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severity

The Impact of Pre-Referral Advanced Diagnostic Testing on Wait Time to See a Hand Surgeon for Common Upper-Extremity Conditions

We sought to evaluate the use of pre- and post-referral advanced diagnostic testing among patients with 3 common hand conditions, rates of subsequent tests, and differences in wait time to see a hand surgeon. We analyzed a single academic tertiary care center administrative database of encounters from 2006 to 2015 to identify adult patients who were referred to a hand surgeon for 3 conditions (carpal tunnel syndrome [CTS], soft tissue masses [STM], and joint pain [JP]). We recorded patient characteristics, use and timing of diagnostic tests, and wait time for the initial hand surgeon evaluation. Among patients who received advanced diagnostic tests before the surgeon evaluation, CTS patients had the highest rate of receiving pre-referral advanced testing (53.4%) compared with JP (10.6% ) and STM patients (5.8%). The CTS patients had the highest rates of repeat testing (19.5%) compared with patients with JP (1.4%) and STM (0%). Across all 3 conditions, patients who received pre-referral advanced testing waited an additional 19 to 94 days to see a surgeon, compared with patients who received only post-referral testing or no testing. Use of pre-referral advanced diagnostic tests is associated with an increased time to see a hand surgeon for common hand conditions. Hand surgeons should have a role in identifying patients who do or do not benefit from advanced testing before referral to ensure that tests ordered before consultation are useful to both patients and treating surgeons.

A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study.

BackgroundCarpal tunnel syndrome (CTS), the most common neuropathy, is caused by a compression of the median nerve in the carpal tunnel and is related to aging. The initial symptom is numbness and pain of the median nerve distributed in the hand area, while thenar muscle atrophy occurs in advanced stages. This atrophy causes failure of thumb motion and results in clumsiness; even after surgery, thenar atrophy does not recover for an extended period. Medical examination and electrophysiological testing are useful to diagnose CTS; however, visits to the doctor tend to be delayed because patients neglect the symptom of numbness in the hand. To avoid thenar atrophy-related clumsiness, early detection of CTS is important.ObjectiveTo establish a CTS screening system without medical examination, we have developed a tablet-based CTS detection system, focusing on movement of the thumb in CTS patients; we examined the accuracy of this screening system.MethodsA total of 22 female CTS patients, involving 29 hands, and 11 female non-CTS participants were recruited. The diagnosis of CTS was made by hand surgeons based on electrophysiological testing. We developed an iPad-based app that recorded the speed and timing of thumb movements while playing a short game. A support vector machine (SVM) learning algorithm was then used by comparing the thumb movements in each direction among CTS and non-CTS groups with leave-one-out cross-validation; with this, we conducted screening for CTS in real time.ResultsThe maximum speed of thumb movements between CTS and non-CTS groups in each direction did not show any statistically significant difference. The CTS group showed significantly slower average thumb movement speed in the 3 and 6 o’clock directions (P=.03 and P=.005, respectively). The CTS group also took a significantly longer time to reach the points in the 2, 3, 4, 5, 6, 8, 9, and 11 o’clock directions (P<.05). Cross-validation revealed that 27 of 29 CTS hands (93%) were classified as having CTS, while 2 of 29 CTS hands (7%) did not have CTS. CTS and non-CTS were classified with 93% sensitivity and 73% specificity.ConclusionsOur newly developed app could classify disturbance of thumb opposition movement and could be useful as a screening test for CTS patients. Outside of the clinic, this app might be able to detect middle-to-severe-stage CTS and prompt these patients to visit a hand surgery specialist; this may also lead to medical cost-savings.

Anxiety and depression in patients with suspected carpal tunnel syndrome - A case controlled study.

PurposeCarpal tunnel syndrome (CTS) is a common entrapment neuropathy causing significant, and often disabling, pain. We aimed to establish the prevalence of anxiety and depressive symptoms in patients who were referred with suspected CTS and identify potential determinants.MethodsAll patients underwent nerve conduction studies (NCS) and were classified into mild, moderate, severe, and no CTS groups. Volunteers, without symptoms or signs of CTS, formed the control group. Anxiety and depressive symptoms were assessed via the Hospital Anxiety and Depression Scale.ResultsNinety‐one patients and 41 controls were recruited. Following NCS the patients were classified as follows: mild CTS (n = 20), moderate CTS (n = 21), severe CTS (n = 11), and no CTS (n = 31). CTS patients had significantly higher depression scores compared to controls but not anxiety scores. Patients experiencing pain and itchiness had significantly higher anxiety scores compared to those who did not. Patients who reported symptoms suggestive of CTS but did not meet the electrodiagnostic criteria for a diagnosis had significantly higher anxiety and depression scores compared to CTS patients and controls.ConclusionsPatients suffering with CTS may be at an increased risk of depression. Experiencing pain in CTS may further increase the likelihood of experiencing mental health difficulties. Poor mental health can give rise to functional symptoms, similar to those seen in CTS, demonstrating the need for electrophysiological testing before considering surgical intervention.

Outcome after carpal tunnel release: effects of learning curve.

In carpal tunnel release, it is yet unclear whether a learning curve exists among surgeons. The aim of our study was to investigate if outcome after carpal tunnel release is dependent on surgeon's experience and to get an impression of the learning curve for this procedure. A total of 188 CTS patients underwent carpal tunnel release. Patients completed the Boston Carpal Tunnel Questionnaire at baseline and 6-8months postoperatively together with a six-point scale for perceived improvement. Patients operated by an experienced resident or certified surgeon reported a favorable outcome more often than patients operated by an inexperienced resident (adjusted OR 3.23 and adjusted OR 3.16, respectively). In addition, a negative association was found between surgeon's years of experience and postoperative Symptom Severity Scale and Functional Status Scale scores. Outcome after carpal tunnel release seems to be dependent on surgical experience, and there is a learning curve in residents.

Evaluation of Carpal Tunnel Diagnosis, Management, and Outcome in Primary Health Care Center

Background: tunnel syndrome (CTS) is one of the commonest conditions encountered in primary care centers as mentioned earlier. CTS of mild to moderate severity can often be effectively treated in a primary care environment. However, many patients being referred immediately to hospital for consideration of surgical decompression. Objective: In this study, we aim to evaluate the available primary care options and their efficacy in dealing with CTS. Methods: PubMed database was used for articles selection, and the following keys used in the mesh ((Carpal tunnel syndrome[Mesh]) AND (Carpal tunnel syndrome/Management[Mesh] OR Carpal tunnel syndrome/Diagnosis[Mesh] OR Carpal tunnel syndrome/ Primary Health Care Center)). 5 studies were enrolled according to our inclusion, and exclusion criteria. Results: Patients successfully treated with wrist splinting alone reported a higher level of satisfaction with their treatment compared to patients who failed wrist splint treatment or had surgical decompressionMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months’ follow-up was similar in both groups.Steroid injection combined with splinting resulted in modestly greater reduction of symptoms, functional recovery, and improvement of nerve function at 12-week follow-up compared to steroid injection alone. Conclusion: CTS is commonly encountered in primary care. So, a trial of conservative treatment can be done before referral for surgical decompression. Conservative treatment of CTS had shown a clear reduction in hand surgery waitlists, thus reduction in expenditures and costs. Wrist splinting is recommended as first line treatment for patients with symptoms of CTS. Other methods of non-surgical treatment include steroid injection, osteopathic manipulative therapy, mechanical wrist traction and combining wrist splinting with steroid injection or with NSAIDs use. Referral for surgical decompression may be a more appropriate option when the level of numbness and other symptoms are getting worse, or when conservative management has failed and is likely to lead to dissatisfaction.

Body mass index and vitamin D level in carpal tunnel syndrome patients

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. The aim of this study is to evaluate the body mass index (BMI) and vitamin D levels in CTS patients.MethodsThe current study was conducted at Zagazig University Hospitals. It included 50 CTS patients and 50 controls. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including vitamin D levels, glycosylated hemoglobin, liver, and kidney function were carried out for every participant. All patients underwent electrodiagnostic study and completed Boston questionnaire to assess their pain sum score, symptom severity (SSS), and functional status (FSS).ResultsPatients had significantly higher BMI and lower vitamin D levels compared to controls (p = 0.003 and p = 0.001, respectively). Those with severe CTS had a significantly higher BMI and lower vitamin D levels than the others (p = 0.03 and p = 0.01 respectively). No significant difference was found between CTS subgroups regarding the SSS, while a higher significant FSS and pain sum score were reported in the severe CTS patients compared to the other two groups (p = 0.01 and p = 0.04 respectively). A significant negative correlation was detected between vitamin D levels and both of BMI, and Boston pain sum scores (p = 0.01 and p = 0.03 respectively). Also, an inverse correlation was detected between vitamin D levels and both of SSS and FSS (p = 0.14, p = 0.06). Furthermore, a significant positive and negative correlation between vitamin D levels and both of conduction velocity and distal motor latency respectively was observed (p = 0.02 and p = 0.01 respectively).ConclusionsCarpal tunnel syndrome was significantly associated with hypovitaminosis D especially in patients with higher BMI. This highlights the importance of vitamin D supplements and weight loss regimes to minimize the severity of their pain.

T111. Median nerve area in diabetic carpal tunnel syndrome patients: a retrospective review of 1030 cases

Association of CTS and diabetes mellitus (DM) is very common. DM is a known risk factor for CTS, but the impact of DM on the median nerve cross-sectional area augmentation remains uncertain. This is a retrospective review of patients presenting to the Duke Electromyography (EMG) Laboratory during 2013–2014 with a final diagnosis of CTS. US diagnosis of CTS was based upon median nerve cross-sectional area of >9 mm2 and/or wrist-to-forearm ratio of >1.4. EDx studies were the gold standard for diagnosis. The objective of this study is to determine if median nerve CSA is higher in diabetic CTS patients as compared to non-diabetic CTS patients. A total of this is a retrospective review of 1030 consecutive patients presenting to the Duke EMG Laboratory during 2013–2014 with a final EDX diagnosis of CTS were examined. Median nerve CSA at the wrist We analyzed wrist-CSA (W-CSA) and, forearm (F-CSA) were measured-CSA and a wrist-forearm ratio (WFR) calculated. Statistical analysis was performed in diabetic and non-diabetic CTS patients with ANCOVA test and Bonferroni correction using as covariates: age, gender, pregnancy, handedness, and body mass index (BMI). The mean age was 56 ± 14.0 (range from 20 to 90 years). 263 were men (36.8%) and 451 were women (63.2%, 10 women were pregnant). 41.9% of patients were diabetic. 521 were Caucasians, 162 African-Americans and 31 other ethnicities (Asians, Indians, Hispanic). 539 were right-handed, 174 left-handed and 1 was ambidextrous. The mean body mass index (BMI) was 32.2 ± 8.0 (range from 15.5 to 112.1), and the patients were classified in groups I-V following international classification (underweight + normal weight, preobese, obese, severely obese and morbidly obese).The CSA of the median nerve in diabetic patients: (1) At the wrist was 12.8 ± 4.7 mm2 on the right and 11.7 ± 4.8 mm2 on the left. (2) At the forearm, median nerve CSA was 6.5 ± 2.2 mm2 on the right, and 6.1 ± 2.3 mm2 on the left. (3) Mean WFR was 2.1 ± 0.9 on the right and 2.0 ± 0.8 on the left. We had 43 bifid median nerves, and 3 with persistent median artery. There was no difference between wrist CSA (W-CSA) of non-diabetic and diabetic patients (right W-CSA p = 0.992, left W-CSA p = 0.253), and the same was observed with forearm-CSA (right forearm-CSA p = 0.498, left forearm-CSAp = 0.181) and WFR (right-WFR p = 0.706, left WFR p = 0.444 mean = 2.0 ± 0.8), and Bonferroni-correction p-values were also non-significant (value = 1) for all the analysis. There was no difference in CSA or WFR considering the severity of CTS between non-diabetic and diabetic patients (right hand p = 0.237 and left hand p = 0.458). There is no correlation between higher median nerve CSA and diabetes in patients with CTS.

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.

Carpal tunnel syndrome in patients with and without diabetes mellitus in Upper Egypt: The impact of electrophysiological and ultrasonographical studies

BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Nerve conduction studies (NCS) is the most valid way of diagnosing CTS in combination of these clinical symptoms together with positive signs by physical examination. Ultrasonography is a useful non-invasive diagnostic method for CTS and there is considerable correlation between the electrophysiological tests and the measurements of cross-sectional area (CSA) by ultrasonography. Many studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycemic control. Although diabetes mellitus is a risk factor for CTS, reports about median nerve CSA measurements between CTS patients with and without DM are scant. This prospective study aimed to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non-DM-CTS patients. To correlate the diagnostic results in both DM and non-DM-CTS patients. Patients and methodsThirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography (US). ResultsHigh mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups. Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients. ConclusionThe CSA of median nerve is larger in CTS hands in both DM and non-DM patients. Mean electro-diagnostic parameters were not significant predictors of CTS in patients with diabetes. The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.

Mechanical wrist traction as a non-invasive treatment for carpal tunnel syndrome: a randomized controlled trial

BackgroundCarpal tunnel syndrome (CTS) is a common, compressive nerve-entrapment disorder with symptoms of numbness, paresthesia, and pain. Carpal tunnel release surgery is the only known long-term effective treatment. However, surgery is invasive and up to 30% of patients report recurrence or persistence of symptoms or suffer from post-surgical complications. A promising non-surgical treatment for CTS is mechanical wrist traction. The purpose of this study was to evaluate clinical outcomes following mechanical traction in patients with CTS compared to care as usual.MethodsAdult patients (N = 181, mean age 58.1 (13.0) years, 67% women) with electrodiagnostically confirmed CTS were recruited from an outpatient neurology clinic in the Netherlands between October 2013 and April 2015. After baseline assessments, patients were randomized to either the intervention group (12 treatments with mechanical traction, twice a week for a period of 6 weeks) or “care as usual”. The main clinical outcome measure was surgery during 6 months’ follow-up. In addition, symptom severity was measured using the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline, 3, and 6 months’ follow-up. Baseline characteristics and severity of CTS symptoms at follow-up were compared between the intervention and care-as-usual groups using a t test and χ2 tests. Time to event (surgery) between the groups was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards analysis.ResultsThe intervention group had fewer surgeries (28%) compared to the care-as-usual group (43%) during follow-up (χ21 = 4.40, p = .036). Analyses of the survival curves revealed a statistically significant difference between the groups over time (log-rank test χ21 = 6.94, p = .008). At 6 months’ follow-up, symptom severity and functional status scores had significantly decreased from baseline in both groups (p < .001) and the improvements did not differ between the two groups.ConclusionsMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months’ follow-up was similar in both groups. The long-term effects of mechanical traction require further evaluation.Trial registrationClinicalTrials.gov, ID: NL44692.008.13. Registered on 19 September 2013.

Effet de la vitamine D sur la douleur dans le syndrome du canal carpien

BackgroundCarpal tunnel syndrome (CTS) and vitamin D deficiency are two discrete common clinical pictures that can cause chronic pain. In this study, we aimed to evaluate the association of 25 (OH) D deficiency with electrophysiological findings and severity of pain in patients with mild CTS. MethodThe consecutive patients admitted to our laboratory with the symptoms of CTS between May 2016 and August 2016 were enrolled in this study. According to their electrophysiological examination results, only the patients with normal conduction results and ones with mild grade CTS were included. Demographic data, the results of the electrophysiological studies, vitamin D levels (our laboratory normal is >20ng/mL), duration of pain and pain intensity due to CTS which was assessed with visual analog scale were collected. ResultsTotally, 76 patients (36 patients with mild CTS and 40 without CTS) were included. In the mild CTS patients, vitamin D levels were significantly lower than those electrophysiologically normal patients (P=0.003). The relationship between gender, duration of pain and vitamin D levels were evaluated in the normal and mild CTS group. There was no significant relationship between the pain and vitamin D levels in the normal group, while vitamin D level was significantly lower in the mild CTS group (P=0.730 and P=0.002; respectively). DiscussionVitamin D deficiency increases the pain intensity in patients with CTS. Treatment of vitamin D deficiency in these patients may play a role in pain relief. Further studies involving analyses of post-vitamin D replacement therapy are warranted to confirm the association between vitamin D deficiency and pain due to CTS.

P336 The carpal tunnel syndrome and the double crush syndrome hypothesis: Revisited

Objective To examine the use of Double Crush Syndrome (DCS) hypothesis in CTS patients in order to support or disguard the theory. Methods This study was conducted on 80 adult patients, 40 presenting with brachialgia (Group I) and 40 patients claiming of failed CT release operation (Group II). Diagnostic work up included neurological examination, MRI of cervical spine, Phalens, Tinel’s sign, EMG examination and motor and sensory nerve conduction studies. Results EMG examination and nerve conduction studies results show 10 cases with CTS (25%), 20 cases (50%) with DCS and 10 cases (25%) with cervical radiculopathy in group I, while group II proved 10 cases (25%) with CTS and 30 cases (75%) with DCS. Accordingly, studied patients showed 20 cases with CTS (25%), 50 cases with DCS (62.5%) and only 10 cases with cervical radiculopathy alone (12.5%). When comparing the first nerve conduction studies of Group II before the operation and the follow up nerve conduction studies of the same group after the operation we found 32 cases (80%) with improvement of the NCS and 8 cases (20%) with deterioration of the nerve conduction studies results. Significance The double crush syndrome element should be excluded whenever examining for CTS, to guide for treatment. Conclusions DCS hypothesis was supported by this sudy. Discussion The double crush concept has gained some popularity among chiropractors because it seems to provide a rationale for evaluating the condition of the cervical roots when treating CTS, which was supported by this study.

Effectiveness of Lavendula stoechas essential oil in treatment of mild to moderate carpal tunnel syndrome: A randomized controlled trial

Study DesignRandomized controlled trial. IntroductionCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. To date, no previous study has evaluated the efficacy of topical Lavendula stoechas (Lavender) oil in CTS patients. Purpose of the StudyTo investigate the effectiveness of topical Lavender essential oil in pain intensity, isometric pinch strength, electrophysiological features, and functional status of patients with mild to moderate CTS. MethodsForty eight patients with mild to moderate CTS were enrolled in this randomized placebo-controlled trial. Group A was treated with night wrist orthotic and topical lavender oil ointment. Group B was treated with night wrist orthotic and a placebo ointment. Patients were evaluated at baseline, and after 40 days of intervention with Boston CTS questionnaire (BCTQ), visual analog scale (VAS) for pain, pinch grip strength, power grip, median compound motor action potential latency, and median sensory nerve action potential latency. ResultsAt the end of the study period, both groups improved significantly in terms of BCTQ, VAS, isometric pinch powers, and electrodiagnosis study parameters. However, group A showed significantly greater improvements in BCTQ (mean difference, 0.39 ± 0.31 vs 0.6 ± 0.35; P = .03), VAS (3.37 ± 1.86 vs 1.33 ± 2.07; P = .001), and pinch grip strength (0.73 ± 0.63 vs 0.27 ± 0.54; P = .01) than group B. No significant differences in power grip, median compound motor action potential latency, and median sensory nerve action potential latency were seen between the 2 groups. ConclusionThis study was the first trial of topical lavender oil used in patients with CTS. Wrist orthotic combined with topical lavender oil was more effective than orthotic and placebo in treatment of mild to moderate CTS. Level of Evidence1b.

The effect of vitamin D levels on pain in carpal tunnel syndrome

BackgroundCarpal tunnel syndrome (CTS) and vitamin D deficiency are two discrete common clinical pictures that can cause chronic pain. In this study, we aimed to evaluate the association of 25 (OH) D deficiency with electrophysiological findings and severity of pain in patients with mild CTS. MethodThe consecutive patients admitted to our laboratory with the symptoms of CTS between May 2016 and August 2016 were enrolled in this study. According to their electrophysiological examination results, only the patients with normal conduction results and ones with mild grade CTS were included. Demographic data, the results of the electrophysiological studies, vitamin D levels (our laboratory normal is>20ng/mL), duration of pain and pain intensity due to CTS, which was assessed with visual analog scale, were collected. ResultsTotally, 76 patients (36 patients with mild CTS and 40 without CTS) were included. In the mild CTS patients, vitamin D levels were significantly lower than those electrophysiologically normal patients (P=0.003). The relationship between gender, duration of pain and vitamin D levels were evaluated in the normal and mild CTS group. There was no significant relationship between the pain and vitamin D levels in the normal group, while vitamin D level was significantly lower in the mild CTS group (P=0.730 and P=0.002; respectively). DiscussionVitamin D deficiency increases the pain intensity in patients with CTS. Treatment of vitamin D deficiency in these patients may play a role in pain relief. Further studies involving analyses of post-vitamin D replacement therapy are warranted to confirm the association between vitamin D deficiency and pain due to CTS.

Carpal Tunnel Syndrome in Patients with and without Diabetes Mellitus in Upper Egypt: The Impact of Electrophysiological and Ultrasonographical Studies

Introduction: Reports about median nerve CSA measurements between CTS patients with and without DM are actually scant. This study aimed to correlate the diagnostic accuracy of ultrasonography with electrodiagnosis in both DM and non-DM CTS patients. Patients and Methods: Thirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to electrophysiological assessment of wrists and grayscale ultrasonography (US). Results: High mean cross sectional area of median nerve (CSA) on ultrasonography was detected with nonsignificant difference between both groups. A non-significant difference for flattening ratio was found between two groups. There was a highly significant positive correlation between electrodiagnosis and ultrasonography in diabetic patients. Conclusion: The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. The combination of electrophysiology and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients.

Neurophysiologic Pattern and Severity Grading Scale of Carpal Tunnel Syndrome in Sudanese Patients

Background: Carpal tunnel syndrome is the most frequent compression-induced neuropathy, where the median nerve is compressed at the wrist causing sensory and motor deficits. It is more common in females than males and accounts for a higher number of days off work than all other work-related musculoskeletal disorders. Objectives: The aim of this study is to describe electrophysiological criteria for diagnosis of CTS among Sudanese patients, to classify patients with CTS according to severity based on NCS results and clinical presentation, and to determine the age group most affected beyond finding any gender difference. Material and methods: This is a retrospective analytic electrophyisologic study performed in 671 clinically diagnosed CTS patients. NCS was performed in more than 1089 hands which included the median and ulnar nerves. Onset and peak latencies, amplitude, conduction velocity, F waves and distance were calculated. Result and discussion: Out of 671patients with CTS; females were 81.7% and males were 18.3%. The most affected age group was (48-58) years. The classic history of CTS was reported by 484 patients, Parasethisa was reported by 339 patients (70%), Parasethisa and pain 205 patients (42.3%), diurnal day and night pain by 127 patients (26%), nocturnal pain only by 283 patients (57%), and numbness by 340 patients (70.2%). Weakness of abductor policis brevis (APB) muscle was found in 127 patients (26%), of these 78 patients showed wasting of the same muscle (16%). Conclusion: Beside the Italian and Canterbury grading of CTS, a new modified scale was adopted in our patients rated as very mild, mild, mild to moderate, moderate, moderate to severe, severe, and very severe.

The value of quantitative MRI using 1.5 T magnet in diagnosis of carpal tunnel syndrome

ObjectiveThe aim of this study was to assess the efficacy of quantitative MRI parameters using 1.5T magnet in evaluation of MN in CTS. Patients and methodsFrom August 2015 and July 2016. Twenty patients diagnosed as having CTS and other ten healthy volunteers, underwent a quantitative MRI examination of the wrist with T2 SPAIR and DWI sequences. A computation of SIR, ADC values at different levels and ADC ratio was made. ResultsThere was significant increase in SIR in CTS patients at DRUJ and pisiform. SIR at pisiform was significantly correlated with operative documentation of bulbous nerve swelling. There was increase in mean ADC value of MN in CTS when moving from proximal to distal locations, in contrast to normal subjects. SIR and ADC value were specific especially when measured at the pisiform. Cutoff values of 1 for ADC ratio showed high Specificity, and Overall accuracy. ConclusionQuantitative 1.5T MRI is an accurate diagnostic tool in CTS. The increase in MN ADC value from proximal to distal with an ADC ratio cutoff value of 1 is highly accurate in diagnosing CTS.