Evidence Of Carpal Tunnel Syndrome Research Articles

Changes in Cross-sectional Area of the Median Nerve and Boston Carpal Tunnel Questionnaire Scores After Carpal Tunnel Release.

We hypothesized that postoperative Boston Carpal Tunnel Questionnaire (BCTQ) scores and ultrasound (US) measurements of the median nerve cross-sectional area (CSA) at the distal wrist crease are significantly decreased at 2-week, 6-week, and ≥ 6 months follow-up appointments, compared with baseline values. This study was a retrospective chart review of patients who presented to a single hand clinic with evidence of carpal tunnel syndrome over a 6-year period (2014-2020). Patients received baseline US measurements of the median nerve CSA as well as completion of the BCTQ, and for the patients who underwent carpal tunnel release (CTR), postoperative US measurements and questionnaire scores were obtained at 2 weeks, 6 weeks, or ≥ 6 months postoperatively. This study included 224 separate wrists. Median Nerve CSA measurements were 13.2 ± 4.5 mm2 at baseline, 11.9 ± 3.6 mm2 at 2 weeks postoperatively, 11.6 ± 4.5 mm2 at 6 weeks postoperatively, and 11.7 ± 4.3 mm2 at 6 months or more (P = .002). The BCTQ Symptom Severity Scale scores were 3.14 ± 0.76 at baseline, 1.76 ± 0.63 at 2 weeks, 1.68 ± 0.70 at 6 weeks, and 1.41 ± 0.64 at 6 months or longer (P < .001). The BCTQ Functional Status Scale scores were 2.56 ± 0.89 at baseline, 2.03 ± .1.0 at 2 weeks, 1.65 ± 0.77 at 6 weeks, and 1.36 ± 0.61 at 6 months or longer (P < .001). These findings demonstrated a sustained decrease in median nerve CSA and patient-reported outcomes following CTR at 2 weeks, 6 weeks, and between 6 and 12 months.

Prediction of carpal tunnel syndrome using the thenar muscle cross-sectional area by magnetic resonance imaging.

Carpal tunnel syndrome (CTS) is a common neuropathy. Although CTS progression is known to be associated with thenar muscle (TM) atrophy, the diagnostic value of TM atrophy for CTS has not been established. In this research, the thenar muscle cross-sectional area (TMCSA) was evaluated to analyze the relationship between the TMCSA and CTS. We assumed that TMCSA is a major diagnostic parameter in the CTS.Both TMCSA and thenar muscle thickness (TMT) samples were acquired from 18 CTS patients, and from 18 control subjects who underwent wrist magnetic resonance imaging with no evidence of CTS. T2-weighted transverse magnetic resonance imaging images were obtained. We measured the TMCSA and TMT at the level of first carpometacarpal joint.The average TMCSA was 296.98 ± 49.39 mm2 in the normal group and 203.36 ± 72.13 mm2 in the CTS group. The average TMT was 8.54 ± 1.45 mm in the normal group and 7.38 ± 1.14 mm in the CTS group. CTS group had significantly lower TMCSA and TMT. Receiver operator characteristics curve analysis showed that the best cutoff point for the TMCSA was 260.18 mm2, with 77.8% sensitivity, 77.8% specificity. The best cutoff point of the TMT was 7.70 mm, with 61.1% sensitivity, 66.7% specificity.Although the TMCSA and TMT were both significantly associated with CTS, the TMCSA was a much more sensitive measurement parameter. Thus, to evaluate CTS patients, the physician should more carefully inspect the TMCSA than TMT.

Sensitivity of Ultrasonography In Clinically Diagnosed CTS Patients With Normal Nerve Conduction Studies

To evaluate the diagnostic accuracy of neuromuscular ultrasound in patients with clinical evidence of carpal tunnel syndrome (CTS) and normal Nerve comduction studies (NCS).

T34. Diagnosing patients with carpal tunnel syndrome: Do you need needle EMG?

Introduction Carpal tunnel syndrome (CTS) is a common diagnosis that requires a thorough clinical history and examination. Electrodiagnostic (EDX) evaluation with nerve conduction studies (NCS) is frequently performed to assist the ordering physician when considering additional therapies or surgical intervention. It is a sensitive tool to examine median nerve dysfunction and aids in distinguishing CTS from cervical radiculopathy (CR) by identifying selective slowing of the conduction of median nerve fibers across the carpal tunnel. Some argue that if the NCS shows evidence of CTS, then needle EMG is not necessary. Current practice guidelines consider needle EMG to be an optional test better suited to exclude concurrent causes (cervical radiculopathy) of the patient’s symptoms for improving diagnostic sensitivity. We set out to determine the number of suspected CTS patients with evidence of CTS on NCS who also have concurrent needle EMG evidence of cervical radiculopathy. We aimed to further explore whether clinical examination performed by physicians ordering EDX could distinguish between the diagnoses of CTS and CR before testing is performed. Methods A retrospective chart review of 606 cases of CTS and CR in the Mayo Clinic Arizona EMG Laboratory from January 2015 to January 2016 was performed. Clinical notes of referring physicians for EMG/NCS and final EMG/NCS reports were reviewed for referring diagnoses, clinical history, physical exam and EMG diagnoses. Results Out of 472 patients diagnosed with CTS, 19.1% also had a concurrent diagnosis of CR confirmed by needle EMG ( n = 90). 17.2% of suspected CTS based on clinical assessment were not confirmed after electrodiagnostic testing ( n = 104). 29.0% of suspected CR patients were not confirmed after electrodiagnostic testing ( n = 176). 12 clinical assessment data points (clinical history and physical exam findings) felt to represent a common evaluation of diagnoses of CTS were compiled. These included cervicogenic pain, radicular pain, hand paresthesias, nocturnal pain, symptoms worse with activity, symptoms relieved by shaking out hands (“flick” sign), myotomal weakness, dermatomal sensory abnormalities, hyporeflexia, loss of sensation in the median nerve distribution, thenar atrophy, and hand weakness. The only clinical finding found to have a clinically significant association with both CTS and CR was hand paresthesias ( p = 0.001). Conclusion This series demonstrated that 19% of patients seen with CTS have an associated cervical radiculopathy. Without needle electromyography, these concurrent diagnoses would be missed, which can affect subsequent management and therapy. Clinical assessment alone may not be enough to distinguish between CTS and CR, as has been demonstrated in previous studies. Even though practice guidelines allude to optional needle EMG, this data provides a strong argument in favor of performing both NCS and needle EMG in patients with suspected CTS.

Prevalence of carpal tunnel syndrome among employees at a poultry processing plant

ObjectiveTo determine prevalence of carpal tunnel syndrome (CTS) among poultry processing employees while taking into account non-occupational factors and assess any association between CTS prevalence and exposure groups. MethodsPerformed a cross-sectional survey to assess CTS (n = 318). A CTS case was defined as an employee with self-reported CTS symptoms, an abnormal hand symptom diagram, and an abnormal nerve conduction study (NCS). Log-binomial regression was used to estimate prevalence ratios. ResultsThree hundred and one participants had sufficient symptom information or NCS data to be classified. 126 (42%) of 301 participants had evidence of CTS. In the adjusted analysis, the highest exposure group had CTS prevalence that was significantly higher than that for the lower exposure group [PR: 1.61; 95% CI = (1.20, 2.17)]. ConclusionsIncreasing levels of hand activity and force were associated with increased CTS prevalence among participants. Recommendations were provided to reduce exposure to these risk factors.

Contralateral Electrodiagnosis in Patients with Abnormal Median Distal Sensory Latency

We hypothesized that electrodiagnostic evidence of carpal tunnel syndrome (CTS) on the contralateral, less-severe side correlates with disease severity. We retrospectively reviewed 285 adults that had bilateral electrodiagnostic testing and a median distal sensory latency (DSL) greater than 3.6 ms on at least one side. Variables associated with abnormal contralateral median DSL were analyzed in bivariable and multivariable analysis. Patients with a nonrecordable median DSL on the worst side were significantly more likely to have electrodiagnostic evidence of contralateral CTS compared to patients with a prolonged DSL on the worst side (90 versus 65%, respectively; p < 0.001). Bilateral symptoms were reported by 75% of patients. The best logistic regression model for electrodiagnostic evidence of contralateral CTS included nonrecordable median DSL of the worst side and polyneuropathy (p < 0.001 and p = 0.14, respectively). The finding that disease severity relates to the probability of contralateral abnormalities is consistent with the concept that CTS is typically bilateral. Patients with CTS on one side should be advised of the likelihood that it can be present or may develop on the other side.

Clinical profile of benign joint hypermobility syndrome from a tertiary care military hospital in India

Joint hypermobility when associated with symptoms in the absence of systemic rheumatologic disease is termed as benign joint hypermobility syndrome (BJHS). BJHS is often an under-recognised and a poorly managed entity. Indian studies on BJHS are very few and none have been carried out in any of the service rheumatology centres. Hence this retrospective study was carried out at a tertiary medical institute of the Indian Army to assess the varied clinical profile of BJHS. All patients consecutively diagnosed as BJHS at the rheumatology clinic of the Army Hospital (Research and Referral) Delhi from May 2010 to May 2011 were included in the study. Their age, sex, presenting features, clinical profile, laboratory and radiological parameters were studied. The mean age of these patients was 30 ± 5.71 years with a median duration of symptoms of 42 (06-120) months. There were 45 males and 39 females (male : female = 1.15 : 1.00). The median Beighton's score in these patients was 6/9 (range 4-9). Most of our patients were military personnel (43/84), and all had knee joint pain with evidence of degenerative changes in 19 and synovitis in two patients. Eleven patients including nine military personnel had evidence of soft tissue rheumatism with associated fibromyalgia in four and anxiety disorder in one. Out of 18 patients with a Beighton's score of ≥ 7, nine had incidental findings of lateral head tilt on frontal observation. There was evidence of carpal tunnel syndrome in a patient with wrist synovitis and one patient had associated skin laxity without features of Ehlers-Danlos syndrome. BJHS is often under-recognized in clinical practice and is usually missed because of a lack of awareness. A high index of clinical suspicion to diagnose this entity is essential due to its associated morbidities, especially among those exposed to strenuous physical activities.

14C. Case Studies on the Outcome of Integrative Management of Carpal Tunnel Syndrome and Trigger Fingers

Focus Areas: Integrative Approaches to Care, Alleviating PainCarpal tunnel syndrome, trigger fingers, and deQuervaines' tenosynovitis are often regarded as surgical lesions. Using an interprofessional team approach, all these conditions can be treated with nonsurgical techniques. A 44-year-old accountant presented with hand pain requiring workplace accommodation. He had electrodiagnositc evidence of carpal tunnel syndrome bilaterally with the right side worse than the left. He was scheduled for surgery when he was offered the opportunity to see an integrative practitioner. He was treated integratively and with intramuscular stimulation, massage, and physical therapies. He achieved nonsurgical resolution of his complaints. He returned to full-time work. The course of treatment was 3 months, and the electrodiagnostics returned to normal after 6 months.A journalist presented with a very painful trigger finger on the index finger of his dominant hand. He was treated with intramuscular stimulation and low-intensity (cold) laser for 5 weekly sessions with resolution of the trigger finger. He resented 6 months later with shoulder pain also on the dominant side. He had a 50% reduction in shoulder abduction and painful internal rotation. He was woken at night by shoulder pain. He was treated with intramuscular stimulation and low-intensity (cold) laser and massage for 3 sessions. He had an improvement in range of motion and pain reduction. He returned to his exercise program and continued to improve.Long-term resolution of carpal tunnel and trigger fingers can be achieved without surgery at reduced risk and great savings to the system.

A NOVEL METHOD OF DIAGNOSING AUTONOMIC DYSFUNCTION IN CARPAL TUNNEL SYNDROME: MEASURING SKIN CAPACITANCE

Carpal Tunnel Syndrome (CTS) is normally diagnosed via its sensory and motor manifestations. The associated autonomic dysfunction has not been exploited to its full potential as a diagnostic tool due to the difficulties in quantifying it. We aim to demonstrate that autonomic dysfunction of CTS can be quantified by measuring skin capacitance. Fifty-one patients with clinical signs and electrophysiological evidence of CTS in 89 hands were recruited. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH) from the palmar aspect of the distal phalanx of the index and little finger of the affected hand. Healthy gender- and age-matched individuals were recruited as controls. The mean ratio of hydration of the index to the little finger was 0.82. The mean difference was 10.98 arbitrary units. The control group consisted of 151 subjects (80 Male & 71 Female) and 302 hands with an average age of 40.1 years (18-81 years). The mean ratio of hydration of the index to the little finger was 0.87. The mean difference was 8.67 arbitrary units. The measurement ratios (index to little finger skin hydration) between the two groups was compared directly and gave a significant mean difference of 0.05 arbitrary units. Statistically significant differences in skin capacitance between CTS patients and controls have been demonstrated and quantified using a rapid and simple method. This can be used in clinic to reduce the reliance on Nerve Conduction Studies for diagnosing CTS.

Abstract P5-11-18: Investigating Early Features of Aromatase Inhibitor-Induced Arthralgia

Abstract Background: Aromatase inhibitors (AI) are well known to be associated with troublesome musculoskeletal side effects but the underlying mechanisms are poorly understood and methods of objective assessment poorly defined. We have performed a prospective detailed evaluation of grip strength (primary endpoint), symptoms, imaging and biomarkers in patients receiving either an AI, tamoxifen or no endocrine therapy. Methods: 77 patients with early breast cancer from two specialist Breast Units were recruited prior to starting one of 4 treatment arms: upfront AI (A), switch from tamoxifen to AI (B), tamoxifen (C) and no treatment (D). Arthralgia was defined as worsening of joint pain score at 3 months and a positive Tinel's or Phalen's test was taken as evidence of carpal tunnel syndrome. Grip strength was measured (average of three readings from each hand) using a Jamar Dynamometer at baseline, 1, 2, 3, 6 and 12 months. In addition, biochemical (endocrine and collagen markers), rheumatological (inflammatory and cytokine markers) and radiological assessments of the hands (diagnostic ultrasound, bone density using DXA and plain radiograph) were performed at protocol-specified intervals. A subset of patients also underwent hand MRI at baseline, 3 and 12 months. Detailed rheumatological examination and questionnaire (DAS-28, SF-36, HAQ-DI and BPI-SF) assessment were performed at each visit. Grip strength was analysed using analysis of covariance with age, prior chemotherapy and baseline grip as covariates. The Kruskal-Wallis test was used for questionnaire data. The 3 month data on grip strength, questionnaire, clinical assessment and hand ultrasound are presented here. Results: 47 patients received an AI (34 upfront, 13 switch), 22 tamoxifen and 8 no endocrine treatment (controls). Median age (yearrs) for each group was: 62.1 (A), 51.0 (B), 65.2 (C) and 61.2 (D). The incidence of arthralgia at 3 months was 38% (A), 17% (B), 38% (C) and 14% (D). Mean baseline grip strength was similar in each arm: 22.5kg (A), 23.1kg (B), 20.2kg (C) and 23.2kg (D) (p=0.342 ANOVA). At 3 months, the mean percentage change in grip strength was +0.2% (A), +2.2% (B), +4.5% (C),+1.2% (D) (p=ns ANCOVA). In those on AI, the development of arthralgia was not shown to be associated with change in grip strength (p=0.82). Morning stiffness was also no different at 3 months. Clinical signs of carpal tunnel syndrome were evident in 10/45 (22%) of patients receiving AI therapy compared to 4/28 (14%) on tamoxifen/control. There were 4 cases of trigger thumb or finger, all in patients receiving AI treatment. Changes in HAQ-DI and pain (VAS) at 3 months were no different between groups (p=0.27, p=0.1 respectively). Ultrasound assessment of the flexor tendons at 3 month identified an increase in median score for tendon sheath fluid in those in the AI groups (3 (AI) v 1 (No AI) p=0.07, Mann-Whitney U test). There was no significant change in average median nerve cross-sectional area at 3 month. Conclusion: This study suggests that patient reported arthalgia does not correlate with early changes in and mean grip strength. However, there may be early signs of carpal tunnel syndrome, trigger finger and fluid in the flexor tendon sheaths detectable by ultrasound. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-18.

Sensitivities of Sensory Nerve Conduction Study Parameters in Carpal Tunnel Syndrome

It is generally accepted that median sensory nerve conduction studies are more sensitive than motor nerve conduction studies in the electrodiagnostic evidence of carpal tunnel syndrome (CTS). This study was conducted to compare the sensitivities of various parameters of sensory nerve conduction studies in the diagnosis of CTS. This prospective study included 88 consecutive patients (151 hands) with CTS and 106 control subjects. CTS was diagnosed clinically by two neurologists. Median sensory nerve responses with wrist stimulation were determined. The onset and peak latencies, peak-to-peak amplitudes, negative peak duration, and area were measured. The differences between the peak and onset latencies were also calculated as a measure of waveform temporal dispersion. Among each measured parameter, values between the 2.5th and the 97.5th percentile range of the control subjects served as the normal limits. Among the 151 hands with suspected CTS, five (3.3%) had normal electrodiagnostic studies and 146 (96.7%) had at least one abnormal electrodiagnostic study. Among the 146 hands with an abnormality, 138 had abnormal onset latency, 143 had abnormal peak latency, and 88 had abnormal difference between peak and onset latency. In addition, 87 had abnormal amplitude, 70 had abnormal duration, and 59 had abnormal area. The sensitivity was 91.4% for onset latency, 94.7% for peak latency, 58.3% for difference between peak and onset latency, 57.6% for amplitude, 46.4% for duration, and 39.1% for area. Our study shows that in patients with CTS, the most sensitive sensory nerve conduction parameter is the peak latency. Studying various additional sensory nerve conduction parameters did not significantly increase the diagnostic yield.

Anatomic Variations of the Hook of Hamate and the Relationship to Carpal Tunnel Syndrome

To determine the incidence of anatomic variations of the hook of hamate and to evaluate its association with the development of carpal tunnel syndrome (CTS). Radiographs of 3,218 hands (2,070 patients) were evaluated. This group included 2,866 hands diagnosed with CTS and 352 hands without the diagnosis of CTS. Using the carpal tunnel view variations of the hook of hamate were identified. Variants were classified based on appearance and measurements. Patients having variant hooks of hamate who were diagnosed with CTS then were compared with patients with variant hooks of hamate who had no evidence of CTS. Endoscopic carpal tunnel release using the Chow technique was performed on all patients with CTS who had a known variation of the hook of hamate without difficulty or complication. Variations of the hook of hamate were found in 96 hands: 42, bipartite hook; 50, hypoplastic hook; and 4, aplastic hook. Ninety-three hands with variant hooks of hamate were diagnosed with CTS. The remaining 3 hands identified with variants had no evidence of CTS. After comparing the 2 groups, we found that the incidence of a variant hook of hamate in the group with CTS was significantly greater than the incidence of variations in the group without CTS. Three variations of the hook of hamate were identified with radiographic evaluation using the carpal tunnel view. Variations are more prevalent than once thought. There was a significant increase in the incidence of variation in the hook of hamate in the group with CTS compared with the group without CTS.

Evaluation of Iontophoresis and Local Corticosteroid Injection in the Treatment of Carpal Tunnel Syndrome

The aim of this study was to compare the efficacy of local corticosteroid injection with iontophoresis of corticosteroids in the treatment of carpal tunnel syndrome. This study was a prospective, randomized, unblinded clinical trial with follow-up at 2 and 8 wks. Thirty patients (48 median nerves) with clinical and electrophysiologic evidence of carpal tunnel syndrome were included in the study. Patients were evaluated by use of clinical variables, a functional status scale, a symptom severity scale, and visual analog scale. A total of 48 median nerves were randomly assigned to one of two groups; group 1 received 40 mg of methylprednisolone acetate injected locally in the carpal tunnel, and group 2 received iontophoresis of dexamethasone sodium phosphate. Clinical variables and scales were evaluated at regular intervals: at the beginning and at the end of therapy in the second and eighth week. Twenty-seven patients (90%) were women and three patients (10%) were men. The mean age of patients was 48.0 +/- 8.2 (range, 29-61) yrs. There was a statistically significant improvement in the clinical examination variables, visual analog scale, symptom severity scale, and functional status scale scores of the patients in both of the treatment groups posttreatment (at 2 and 8 wks) compared with baseline (P < 0.05). However, there was a statistically significant difference between the values of the two group. A significant difference in mean symptom severity scale, functional status scale, and visual analog scale scores was found in second week and eighth week in the injection group compared with iontophoresis. Our study comparing a standardized treatment protocol for incorporating local corticosteroid injection and iontophoresis of dexamethasone sodium phosphate in carpal tunnel syndrome revealed success of both iontophoresis of dexamethasone sodium phosphate and injection of corticosteroids, but symptom relief was greater at 2 and 8 wks with injection of corticosteroids.

Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome.

In total, 41 consecutive patients with "idiopathic carpal tunnel syndrome" and abnormal electrophysiologic findings who underwent carpal tunnel release were studied prospectively. The focus of this investigation was the evaluation of the levels of specific chemical mediators within the serum and flexor tenosynovium of these patients. Blood was collected from these patients within 1 week prior to carpal tunnel release, and flexor tenosynovium was obtained at time of surgery. Specimens were then analyzed to determine the levels of interleukins 1 and 6, prostaglandin E(2) (PGE(2)), and malondialdehyde bis diethyl acetal. These values were compared to those of controls who had no evidence of carpal tunnel syndrome. A significant increase was noted in the serum malondialdehyde and tenosynovial levels of malondialdehyde, interleukin 6, and prostaglandin PGE(2) compared to controls. The elevated levels of these biologic factors and the absence of interleukin 1 elevation support a noninflammatory ischemia-reperfusion etiology for so-called "idiopathic carpal tunnel syndrome" that causes progressive edema and fibrosis of the tissues within the carpal canal. These findings correlate with previous histopathology reports. We believe that "idiopathic carpal tunnel syndrome" is an "-osis" not an "-itis."

Clinical, radiological and serum amyloid P component scintigraphic features of beta2-microglobulin amyloidosis associated with continuous ambulatory peritoneal dialysis.

Beta2-Microglobulin (beta2M) amyloidosis occurs in patients with end-stage renal failure (ESRF) who undergo long-term continuous ambulatory peritoneal dialysis (CAPD), but its prevalence in patients treated exclusively by CAPD is unknown. In addition, its features may differ from those of haemodialysis-associated beta2M amyloidosis because CAPD is more biocompatible. We performed serum amyloid P component (SAP) scintigraphy, a specific technique for imaging amyloid deposits, in 13 consecutive patients with ESRF who had been dialysed for >5 years, at least 80% of the time by CAPD. Clinical and radiological features of beta2M amyloidosis were sought and compared with the results of SAP scintigraphy. SAP scans showed articular amyloid deposits in seven patients, all of whom had evidence of carpal tunnel syndrome and four of whom had arthralgia characteristic of dialysis amyloidosis. Typical radiographic bone cysts were present in only one case who had been dialysed for >17 years. The remaining six patients had no clinical, radiological or scintigraphic evidence of beta2M amyloidosis. The prevalence of beta2M amyloidosis in this study was comparable with that in reported haemodialysis populations. Many of the amyloid deposits demonstrated by SAP scintigraphy were not associated with symptoms, but larger and longer term studies are required to determine whether CAPD favourably influences their clinical expression.

Effects of forearm pronation/supination on carpal tunnel pressure

The effects of forearm rotation and metacarpophalangeal (MP) flexion on carpal tunnel pressure were investigated in 17 healthy adults who had no evidence of carpal tunnel syndrome (CTS). Pressure was continuously recorded with a saline-filled catheter inserted into the carpal tunnel and connected to a pressure transducer while test subjects slowly rotated the forearm from full pronation to full supination. Forearm rotation was repeated with MP flexion of 0 degrees, 45 degrees, and 90 degrees. Both forearm rotation and MP flexion, and their interaction term, significantly affected carpal tunnel pressure and accounted for most of the variability in the data. Highest mean pressures (55 mmHg) were recorded in full supination and 90 degrees MP flexion and lowest pressures (12 mmHg) were recorded at 45 degrees pronation and 45 degrees MP flexion. These data may be useful in the design of tasks and hand tools in the management and prevention of CTS.

Symptoms Experienced by Patients with Carpal Tunnel Syndrome

Patients with carpal tunnel syndrome (CTS) sometimes report sensory symptoms outside the median nerve distribution. This study was designed to provide a more detailed assessment of these symptoms. Patients with clinical suspicion of upper limb neuromuscular lesions were divided into those with electrodiagnostic (EDX) evidence of CTS, and those without. CTS patients with superimposed nerve abnormalities were excluded. Motor and sensory symptoms were assessed in the exclusive CTS patients. Over 50% of patients with exclusive CTS reported tingling or numbness over the whole hand, ulnar or radial nerve distributions. Some patients reported symptoms proximal to the wrist. Sensory signs did not extend beyond the median nerve distribution. Numbness and nocturnal pain were predictive of positive EDX evidence of CTS. Sensory symptoms outside the distribution of the median nerve are common in CTS. For enhanced sensitivity in diagnosis it is useful to be aware of these "atypical" symptoms. Reports of numbness and nocturnal pain are strong indicators of CTS.

Short Term Results of Local Steroid Injection in Carpal Tunnel Syndrome

The aim of this study was to verify the effects of local steroid treatment on both the clinical symptoms and motor and sensory conduction of the median nerve. Fifteen patients (20 nerves) with clinical and electrophysiological evidence of carpal tunnel syndrome (CTS) were included in the study. In order to assess the efficacy of local steroid therapy, clinical and electrophysiological findings were evaluated at regular intervals: before therapy, 3 weeks and 3 months after the injection. A student's t-test for paired observations was applied to evaluate clinical and electrophysiological data. At follow-up, the sensory nerve conduction velocities, distal sensory latencies and amplitudes of the median nerve showed a significant improvement trend with respect to the baseline values (p

Diagnosing Carpal Tunnel Syndrome

An improved method and device are disclosed for diagnosing carpal tunnel syndrome. Direct pressure is applied to the median nerve as it passes through the carpal tunnel at the base of the wrist. Application of 100-200 mm mercury pressure to the nerve for thirty seconds produces numbness and paresthesias in the distribution of the median nerve distal to the carpal tunnel in patients having anatomic evidence of carpal tunnel syndrome. The disclosed device is a clamp having an opposing wrist support member and pressure application member. The distance between the support and pressure application members can be varied to alter the amount of pressure applied to the median nerve in the carpal tunnel. Use of the disclosed method and device provides a much more sensitive and specific clinical test for carpal tunnel syndrome than could previously be obtained with Phalen's test or Tinel's sign. Clinical use of this test can, in some cases, eliminate the need for electromyographic studies.

Self-mutilation in a patient with mucolipidosis III

An 8-year-old girl with mucolipidosis III had self-mutilation of the distal phalanges of the second and third digits of her hands. She had neurophysiologic evidence of carpal tunnel syndrome, and consequent insensitivity to pain, which could explain the self-mutilation. Self-mutilation has not been previously described in lysosomal diseases in which carpal tunnel syndrome is frequently observed.