Frequency Of Carpal Tunnel Syndrome Research Articles

Occupational Risk Factor for Carpel Tunnel Syndrome Related to Computer Usage: A Descriptive Cross-Sectional Study

Carpal tunnel syndrome (CTS) is triggered by compression of the median nerve as it travels through the wrist's carpal tunnel. CTS is also more likely to occur if you work in certain occupations such as Related with clerical and administrative work on Computer. Objective: To identify the frequency and pattern of CTS among clerical and administrative workers using computer. Methods: A descriptive cross-sectional study was started from October 2021 to January 2022 between 20-50 years of age at five Private colleges in Lahore city. The participants fulfilling the inclusion criterion were using computer for more than 6 hours a day, having co-operative attitude, weren’t taking any analgesics and had no associated co-morbidities. After informed consent 200 participants were enrolled using convenient sampling method. Sample size was calculated by taking average from previous research publications. A designed questionnaire was given among the participants to obtain information about demographics and Phalen’s test for CTS. Data were entered and analyzed in SPSS version 21.0. Results: The Results shows that 5 participants have Positive CTS in 20-30, 10 in 31-40, 14 in 41-50 age group. Positive CTS was considered positive via Phalen’s Test. Males have higher frequency of CTS as 21 Males and 8 Females with Positive Phalen’s test. Conclusions: CTS is related with an occupational factor in terms of computer usage. It is common in males because of excess workload and job duties

Association of upper extremity anthropometry and subcutaneus adipose tissue with carpal tunnel syndrome

<p>Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization of adipose tissue differs between the genders. In this study, we purposed to investigate whether there was an association between the amount of local adipose tissue thickness and anthropometry in upper extremity with the presence and/or electrophysiological severity of CTS on both genders.</p>. <p>Our study included 150 patients who were diagnosed with CTS clinically and electrophysiologically and 165 healthy controls. The biceps and triceps skinfold thickness, the diameters of the wrist and metacarpal joints, and the upper arm circumferences over the belly of the biceps muscle were measured by using skinfold caliper and measuring cylinder. All data were analyzed by using the Statistics Open For All package (SofaStats) programme. To detect the role of anthropometric indexes, we used multivariable multinomial logistic regression models.&nbsp;</p>. <p>We revealed that BMI, biceps and triceps adipose tissue thicknesses were higher in females and also in patients with CTS. There was a positive correlation between electrophysiological grades of CTS and BMI with logistic regression analyzes. The mean Wrist circumference/Metacarpo&shy;ph&shy;arengeal Circumference ratio and biceps circumference were higher in moderate CTS groups. Metacarpofarengeal circumference was smaller in mild and moderate CTS cases compared to healthy ones.</p>. <p>We suggest that the differen&shy;ces between the anatomical bone structure and local adiposity between the genders may play an important role in the occurrence of CTS. Moreover, the structures of proximal muscle groups and distal metacarpal joints may contribute both to the development and severity of CTS.</p>.

High frequency of carpal tunnel syndrome and associated factors: A cross-sectional study in Peruvian workers from agro-export industry.

Carpal tunnel syndrome (CTS) is a peripheral mononeuropathy caused by compression of the median nerve at the wrist and has been reported in workers who perform repetitive movements that involve actions of sustained grasping of vibrating objects. We carried out a cross-sectional analytical study in March 2018 to identify the factors associated with the CTS among workers of agro-export companies in Ica-Peru. CTS confirmation in our study was based on having at least 1 positive screening test (Tinel or Phalen) and a presumptive result of CTS by the Kamath and Stothard Questionnaire. We carried out 4 Poisson regression models to evaluate the factors associated with CTS based on epidemiological and statistical criteria. We enrolled 112 agro-export workers in production (42.0%), packing (35.7%), and administration (22.3%) working areas. The CTS frequency in Peruvian agro-export workers in production, packing, and administrative working area were 78.7%, 45.0%, and 28.0%, respectively. The bivariate analysis found a relationship between the CTS with age, female sex, sports practice, job seniority in the working area (year), and repetitive wrist movements (hours per day). In the multivariate analysis, only job seniority in the working area (year) and repetitive wrist movements maintained their association with CTS. Occupational factors are significantly associated with a high frequency of CTS, such as job seniority in the working area (year) and repetitive wrist movements in agro-export workers. Surveillance programs should be held to prevent, reduce, and monitor workers' health status.

Diyabetik Polinöropati ve Karpal Tünel Sendromu İlişkisi: Glisemik Kontrol ve Mikrovasküler Komplikasyonların Rolü

Introduction: Carpal tunnel syndrome (CTS) is more common in diabetes mellitus (DM), especially in individuals with diabetic polyneuropathy (DPN). This study aimed to retrospectively investigate the effects of elevated glycosylated hemoglobin (HbA1c) levels, duration of diabetes, and other microvascular complications of DM on the frequency and severity of CTS in patients with DPN. &#x0D; Material and methods: 124 DPN patients were included in the study. In these patients, fasting blood glucose (FBG) and HbA1c levels, duration of DM, antidiabetic drugs used, comorbidities, and other complications of diabetes were questioned. According to the results of the electrophysiological examination, the patients were divided into 2 groups: those with only DPN and those with DPN + CTS. &#x0D; Results: When diabetes complications were investigated, diabetic nephropathy was found only in those with DPN + CTS (p=0.045). Electrophysiologically, in sensory fibers in all patients, In 43 patients (34.7%), involvement of motor fibers was accompanied. A positive correlation was found between the severity of CTS and duration of diabetes, FBG and HbA1c levels, and subcutaneous insulin use (p=0.018, p=0.014, p=0.003, p=0.029, respectively).&#x0D; Conclusion: Good glycemic control can reduce the risk of developing CTS with microvascular complications of diabetes. Therefore, it is important for patients to protect their hand function and prevent the development of CTS by being informed about the complications of diabetes.

Idiopathic carpal tunnel syndrome in male patients

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;The carpal tunnel syndrome (CTS) in male patients, due to anatomical characteristics and the perception of CTS-related symptoms, remains undetected for a long time. Men respond less well to CTS treatment, and early detection enables conservative treatment of mild and moderate CTS. The aim of this paper was to examine the average age, the frequency of bilateral CTS and its correlation with the age, and to determine the grade of electrophysiological damage of the median nerve in male patients with idiopathic CTS diagnosed by electromyoneurography. &amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The retrospective study included 83 male patients, aged from 32 to 81 years, with complaints of unilateral CTS on the right, dominant hand. All patients underwent EMNG for confirmation of CTS and the degree of median nerve damage. Statistical analysis was performed by methods of descriptive statistics, t-test, Wilcoxon signed rank test, and Pearson&amp;amp;rsquo;s correlation coefficient. The value of p &amp;amp;lt; 0.05 was considered statistically significant.&amp;lt;strong&amp;gt; Results.&amp;lt;/strong&amp;gt; The average age of patients was 55.84 years. The bilateral CTS was confirmed in 88.4%, most often of a moderate degree and more pronounced on the right, dominant hand (p=0.001). In cases of bilateral CTS, age did not correlate with the grade of CTS changes in both hands. The changes in the dominant hand were more pronounced in patients older than 51 years.&amp;lt;strong&amp;gt; Conclusion.&amp;lt;/strong&amp;gt; Male patients with idiopathic CTS usually have bilateral CTS, with more pronounced changes on dominant hand. Bilaterality of CTS and the degree of median nerve damage are not connected with age.&amp;lt;/p&amp;gt;

Significance of Early Diagnostic of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. The conservative treatment remains the first therapeutic choice in the treatment of mild and moderate CTS. The aim of this paper was to examine the average age of female patients with CTS diagnosed by EMNG, the frequency of bilateral CTS and its correlation with the age, and to determine the grade of electrophysiological damage of the nerve when the CTS diagnosis is confirmed for the first time. The retrospective examination included 187 female patients, aged from 27 to 79, with complains on unilateral CTS. All patients underwent EMNG for confirmation of CTS and the degree of damage to median nerve. Statistical analysis was performed by methods of descriptive statistics, Kruskal-Wallis test, and the Student t-test. The value of p 0.05 was considered statistically significant. The average age of the female examinees was 54.53 years. The bilateral CTS was confirmed in 67.9 %, most often of a moderate degree and more often on the right hand. No statistically significant difference was found in grades of CTS between the analysed age groups of patients that had the bilateral CTS (p = 0.206), nor there was a difference in years of life between the patients with unilateral and bilateral CTS (p = 0.638). Bilaterality of CTS, as well as the degree of the damage are not connected with age. The patients report timely for the first examination and diagnostics of CTS when there is still a possibility of the conservative treatment.

Frequency of Carpal Tunnel Syndrome and Related Functional Status in Computer Operators

Objective:&#x0D; To find out the frequency of Carpal Tunnel Syndrome (CTS) and associated functional limitations in computer operators.&#x0D; &#x0D; Materials &amp;Methods:&#x0D; This cross-sectional study was conducted in the premises of DUHS, Ojha campus, Karachi. The duration of study is from 1st Dec 2019 to 29th February 2020.Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to evaluate the frequency of CTS in computer users, total sample size taken was 95, data was collected in the premises of DUHS, Ojha campus including both males and females employs between age group of 25 to 50 years that were working on the current job for more than 2 years, members that were &lt;25 or &gt;50 years were excluded from the study.&#x0D; Results:&#x0D; The study indicated possible association of Symptom severity and functional limitations with respect to age. The frequency of CTS symptoms with moderate to severe severity was 17.9% and 35.8% respectively whereas 46.3% reported mild symptoms. According to functional status scale 55.8% had mild functional limitations whereas moderate to severe difficulty in performing day to day activities was found 21.1% and 23.0% respectively.&#x0D; &#x0D; Conclusion:&#x0D; This study survey indicated that computer using is associated with the development of CTS symptoms. It also results in the increasing the severity of the symptoms, causing prominent functional limitations that interferes with proper working of employs.&#x0D; &#x0D; Keywords: carpal tunnel syndrome, frequency, computer users, functional limitations.&#x0D; &#x0D;

Frequency of carpal tunnel syndrome and hand dysfunction in prediabetes: A cross-sectional, controlled study.

Objectives This study aims to evaluate the frequency of carpal tunnel syndrome (CTS), to investigate the impairment of hand functions in patients with prediabetes (PD), and to compare laboratory findings of PD patients with and without CTS. Patients and methods Between June 2018 and January 2019, a total of 115 patients (29 males, 86 females; mean age: 51.4±11.8 years; range, 24 to 78 years) who were recently diagnosed with PD and a total of 54 healthy participants (17 males, 37 females; mean age: 48.4±13.2 years; range, 21 to 78 years) as the control group were included. Demographic and clinical data of the patients including oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) were recorded, and both groups were examined for the presence of CTS. Clinically suspected CTS was confirmed by electrodiagnostic studies. The hand grip strength (HGS) was measured and hand functions were evaluated using the Duruöz Hand Index (DHI). Results There were no significant differences in the age, sex, occupation, body mass index (BMI), or insulin resistance between the groups. A total of 24 (20.9%) patients with PD and eight (14.8%) healthy controls had CTS (p=0.349). Hand functions were worse in the PD patients than the control group (p=0.044). Age, occupation, BMI, insulin resistance, OGTT at 0 and 2 h, and HbA1c values were similar between the PD patients with or without CTS. Conclusion Our study, for the first time, reveals that CTS is slightly more common and hand functions are impaired in PD compared to the healthy individuals. Based on these findings, we suggest that hand functions should be evaluated in PD patients.

The Prevalence and Severity of Carpel Tunnel Syndrome during Pregnancy

Objective: The aim of this study is to determine the prevalence and severity of carpel tunnel syndrome during pregnancy. Study Design: Descriptive/cross-sectional study Place and Duration: Orthopaedic Department Mardan Medical Complex/BKMC and OBS &amp; Gynae department THQ Hospital Takht Bhai Mardan from June 2019 to June 2021. Methods: Two hundred pregnant women were enrolled in this study. Patients were having18-45years of ages. Patients’ detailed demographics including age, residency, economic status and body mass index were recorded after taking informed written consent. Clinical test Phalen and Tinel were used to diagnose the CTS. CTS among patients were calculated in terms of mild, moderate and severity. Complete data was analyzed by SPSS 24.0version. Results: Mean age of the patients was 29.86±6.75 years with mean BMI 27.24 ± 2.48 kg/m2. Most of the patients 80 (40%) were from third trimester followed by 2nd trimester 70 (35%) and the rest were 50 (25%) women from first trimester. 90 (45%) women were educated and 70 (35%) were from urban areas. Among 200 pregnant women, frequency of carpal tunnel syndrome was found among 60 (30%) patients. There were 25 (41.7%) cases had mild CTS, 15 (25%) patients had moderate and 20 (33.3%) patients had severe CTS. Conclusion: We concluded in this study that the prevalence of CTS among pregnant women was high and most of the patients had mild to severe CTS. It is more prevalent among the patients of third semester. Keywords: Pregnancy, Carpel Tunnel Syndrome, Severity, Women

P-NE003. Frequency of carpal tunnel syndrome in patients having diabetes mellitus with neuropathy in a tertiary care hospital

Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

What Factors Are Associated with Increased Financial Burden and High Financial Worry For Patients Undergoing Common Hand Procedures?

Few studies have examined whether orthopaedic surgery, including hand surgery, is associated with patients' financial health. We sought to understand the level of financial burden and worry for patients undergoing two common hand procedures-carpal tunnel release and open reduction and internal fixation for a distal radius fracture-as well as to determine factors associated with a higher financial burden and worry. In patients undergoing operative treatment for isolated carpal tunnel syndrome with carpal tunnel release or open reduction and internal fixation for a distal radius fracture, we used validated financial burden and worry questionnaires to ask: (1) What percentage of patients report some level of financial burden, and what is the median financial burden composite score? (2) What percentage of patients report some level of financial worry, and what percentage of patients report a high level of financial worry? (3) When accounting for other assessed factors, what patient- and condition-related factors are associated with financial burden? (4) When accounting for other assessed factors, what patient- and condition-related factors are associated with high financial worry? In this cross-sectional survey study, a hand and upper extremity database at a single tertiary academic medical center was reviewed for patients 18 years or older undergoing operative treatment in our hand and upper extremity division for an isolated distal radius fracture between October 2017 and October 2019. We then selected all patients undergoing carpal tunnel release during the first half of that time period (given the frequency of carpal tunnel syndrome, a 1-year period was sufficient to ensure comparable patient groups). A total of 645 patients were identified (carpal tunnel release: 60% [384 of 645 patients]; open reduction and internal fixation for a distal radius fracture: 40% [261 of 645 patients). Of the patients who underwent carpal tunnel release, 6% (24 of 384) were excluded because of associated injuries. Of the patients undergoing open reduction and internal fixation for a distal radius fracture, 4% (10 of 261) were excluded because of associated injuries. All remaining 611 patients were approached. Thirty-six percent (223 of 611; carpal tunnel release: 36% [128 of 360]; open reduction and internal fixation: 38% [95 of 251]) of patients ultimately completed two validated financial health surveys: the financial burden composite and financial worry questionnaires. Descriptive statistics were calculated to report the percentage of patients who had some level of financial burden and worry. Further, the median financial burden composite score was determined. The percentage of patients who reported a high level of financial worry was calculated. A forward stepwise regression model approach was used; thus, variables with p values < 0.10 in bivariate analysis were included in the final regression analyses to determine which patient- and condition-related factors were associated with financial burden or high financial worry, accounting for all other measured variables. The median financial burden composite score was 0 (range 0 [lowest possible financial burden] to 6 [highest possible financial burden]), and 13% of patients (30 of 223) reported a high level of financial worry. After controlling for potentially confounding variables like age, insurance type, and self-reported race, the number of dependents (regression coefficient 0.15 [95% CI 0.008 to 0.29]; p = 0.04) was associated with higher levels of financial burden, while retired employment status (regression coefficient -1.24 [95% CI -1.88 to -0.60]; p < 0.001) was associated with lower levels of financial burden. In addition, the number of dependents (odds ratio 1.77 [95% CI 1.21 to 2.61]; p = 0.004) and unable to work or disabled employment status (OR 3.76 [95% CI 1.25 to 11.28]; p = 0.02) were associated with increased odds of high financial worry. A notable number of patients undergoing operative hand care for two common conditions reported some degree of financial burden and worry. Patients at higher risk of financial burden and/or worry may benefit from increased resources during their hand care journey, including social work consultation and financial counselors. This is especially true given the association between number of dependents and work status on financial burden and high financial worry. However, future research is needed to determine the return on investment of this resource utilization on patient clinical outcomes, overall quality of life, and well-being. Level III, therapeutic study.

The Frequency of Fibromyalgia in Patients Presenting with Symptoms of Carpal Tunnel Syndrome

Karpal tünel sendromu (KTS), en sık görülen tuzak nöropatisidir. Ellerde ağrı, uyuşma ve kuvvetsizlik gibi yakınmalarla karakterizedir. Fibromiyalji (FM) ise yaygın ağrının eşlik ettiği kronik kas iskelet sistemi hastalığıdır. Geniş semptom yelpazesi içinde parestezi yakınması sık görülmekte olup KTS ile karışabilmektedir. FM’li hastalarda KTS sıklığını araştıran az sayıda çalışma olup sonuçlar çelişkili bulunmuş-tur. Bu çalışmada amaç, klinik olarak KTS ile uyumlu yakınmaları olup sinir ileti çalışmalarında KTS saptanan ve saptanmayan iki grup arasında FM açısından farlılık olup olmadığını araştırmaktır. Fiziksel Tıp ve Rehabilitasyon Polikliniği’ne başvuran ve KTS ön tanısı ile elektrofizyoloji laboratuvarına yönlendirilen kadın hastalar çalışmaya dahil edilmiştir. Tüm hastalara FM 2016 ACR tanı kriterleri uygulan-mış ve Yaygın Ağrı İndeksi (YAİ), Semptom Şiddet Skalası (SSS), Fibromiyalji Şiddet Skoru (FŞS) kaydedilmiştir. Hastalar elektrofizyolo-jik olarak KTS saptanan ve saptanmayan iki gruba ayrılarak sonuçlar karşılaştırılmıştır. Çalışmaya ellerde uyuşma yakınması olan ve sinir ileti çalışması sonucunda 30 KTS pozitif, 25 KTS negatif hasta alındı. İki grup arasında yaşa ve beden kitle indeksine göre farklılık saptan-madı. KTS saptananların %26,7’sinde, saptanmayanların %24’ünde ACR 2016 kriterlerine göre FM saptanmış olup, iki grup arasında istatis-tiksel olarak anlamlı fark bulunmamıştır. YAİ, SSS ve FŞS incelendiğinde de gruplar arasında istatistiksel fark saptanmamıştır. Diğer yandan FM saptanan ve saptanmayan iki grup karşılaştırıldığında FM saptanmayan grupta median sinir ileti hızları anlamlı olarak daha yavaş bulun-du. Sonuç olarak, KTS hastalarında FM prevalansı yüksek bulunmuştur. FM olan ve olmayan KTS hastalarının median sinir iletim hızların-da anlamlı farklılıklar olduğundan, FM hastalarında KTS tanısı için elektrofizyolojik doğrulama önerilebilir.

Carpal tunnel syndrome in patients with rheumatoid arthritis and psoriatic arthritis: an electrophysiological and ultrasonographic study.

This study aimed to investigate the carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compare the electrophysiological and ultrasonographic findings and evaluate related variables. Cut-off value of median nerve cross-sectional area (MCSA) was determined for the diagnosis of CTS. 70 RA patients, 39 PsA patients, a control group of 70 healty people were included in this study. Demographic characteristics, disease activity and functional status were recorded. Patients were referred for nerve conduction studies performed according to the American Academy of Neurology standards. Sonographic examination was carried on for MCSA evaluation. The mean age of patients was 51.87 ± 8.47, 50.61 ± 11.33, 49.75 ± 10.52years and female ratio was 72.9%, 71.8%, 75.7% in RA, PsA and controls, respectively. Electrophysiologically, CTS frequency was found to be 13.2%, 15.4%, 3.5% in RA, PsA, control group, respectively, and a significant difference was found compared to the control group (p < 0.05). Ultrasonographically MCSA was measured as 8.52 ± 2.19 mm2, 8.97 ± 2.41 mm2, 7.09 ± 1.83 mm2 in RA, PsA, control group, respectively, a significant difference was observed compared to the control group (p < 0.05). As a result of the Receiver Operating Characteristics analysis, the thereshold value of MCSA for CTS was determined as 10.5 mm2.The frequency of CTS was found to be 30% in RA and 41% in PsA. The frequency of CTS with both ENMG and USG (MCSA) were higher in patients with RA and PsA as compared to the control group. Although it was not statistically significant, CTS frequency was higher in PsA than RA. To our knowledge this is the first study assessing CTS in patients with PsA, and adressing MCSA cut off value for CTS diagnosis in RA and PsA.

Carpal tunnel syndrome in patients with arteriovenous fistula for haemodialysis: A narrative review of the current literature.

The ideal choice of vascular access in patients requiring haemodialysis is an arteriovenous fistula. However, an important often under-reported complication encountered at follow-up is symptoms of tingling or numbness in the hand. This may represent carpal tunnel syndrome, impairment of the median nerve as it traverses through the carpal tunnel at the wrist by focal compression of this nerve. Contributory factors in the presence of an arteriovenous fistula may include venous hypertension and varying steal syndrome phenomena provoking micro-ischaemia. Studies that investigated the evolution of carpal tunnel syndrome in haemodialysis patients with an arteriovenous fistula revealed that the frequency of carpal tunnel syndrome associated with an arteriovenous fistula on haemodialysis ranged from 10.4% to 42.6%. An association between duration of haemodialysis with arteriovenous fistula and carpal tunnel syndrome development was also observed. Surgical release of carpal tunnel provided complete relief of paraesthesia in all treated patients in the examined, demonstrating an alleviation of symptoms and improved function of hand and quality of life in patients with an arteriovenous fistula. However, the aetiology and risk factors for development of carpal tunnel syndrome remain unclear and further studies should attempt to elucidate the pathophysiology of this occurrence in the presence of arteriovenous fistulas.

Frequency of Carpal Tunnel Syndrome in Patients Having Diabetes Mellitus with Neuropathy in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 240-245

Emphysematous Pyelonephritis: Experience of Managing 15 Consecutive Cases in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 246-250

Carpal Tunnel Syndrome in Obstructive Sleep Apnea Patients.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. It is usually associated with the compression of the median nerve in the median groove. Because the main symptoms of CTS pain and numbness worsen at night, sleep disorders in CTS patients and the impact of preferred sleeping position on CTS development have been formerly studied. However, to the best of our knowledge, this is the first study assessing the frequency of CTS in obstructive sleep apnea (OSA) patients. This study aimed to determine the frequency of CTS in OSA patients and evaluate the causative relation between the two diseases. Records of individuals who were admitted to our sleep laboratory were retrospectively scanned. Eighty patients who were diagnosed with OSA and did not have comorbidities that might cause OSA (e.g., diabetes mellitus, hypothyroiditis, rheumatic diseases, and cervical radiculopathy) were included in the study along with 80 healthy controls who matched for age, sex, and BMI of OSA patients. To maintain observer blindness, patients were not questioned regarding their symptoms or the clinical data that would be used in the study. All participants underwent nerve conduction studies. Those who were diagnosed with CTS were questioned regarding CTS symptoms and the preferred sleeping position. Subsequently, patients were given the Boston CTS questionnaire. CTS frequency in OSA patients was found to be 27.5%. There was no significant relation between preferred sleeping position or being a manual worker and having CTS. CTS frequency in OSA patients is significantly higher than that in healthy individuals. In contrast to previous studies that have been performed in the absence of polysomnographic and electrophysiological data, in our study biomechanical factors were not associated with CTS presence. Therefore, we conclude that intermittent hypoxemia is the main etiological factor for CTS in OSA patients. Inflammation may be a common factor for etiopathogenesis for both diseases, but this hypothesis needs further investigation.

Prevalence of carpal tunnel syndrome and its correlation with pain amongst female hairdressers.

Carpal tunnel syndrome (CTS) may develop with repetitive and forced movements of the hands and wrists. In this study, we have aimed to evaluate whether the frequency of CTS is increased amongst female hairdressers as compared with unemployed women or not. Besides, we have also analyzed whether the functionality and pain intensity levels amongst female hairdressers with CTS are different from the ones of unemployed women with CTS or not. The consecutive female hairdressers and unemployed women who had referred to our electroneuromyography (ENMG) laboratory for the upper extremity nerve conduction studies were included. They were evaluated in terms of clinical and ENMG findings, socio-demographic characteristics, functionality and pain intensity levels determined with the Boston CTS Questionnaire and visual analog scale (VAS). In this study, 110 women (70 female hairdressers and 40 unemployed women) were included. The frequency of CTS among hairdressers (74.3%) was higher than the one of the unemployed control group (55%) (p = 0.032). We detected that as the time period of occupation in hairdressing increased, the risk of developing CTS also increased among hairdressers (p < 0.001). Additionally, pain intensity and functional loss levels were higher for hairdressers with CTS than those for the control group with CTS (p = 0.005, p < 0.001, p = 0.028, respectively). The frequency of CTS is elevated for female hairdressers with respect to the unemployed women as in many other occupations requiring forced or repetitive hand movements. Besides, the occupational exposure in hairdressing also results in more elevated pain intensity and functional loss levels related with CTS as compared with the unemployed subjects. Int J Occup Med Environ Health 2018;31(3):333-339.

The frequency of carpal tunnel syndrome in patients on hemodialysis

The frequency of carpal tunnel syndrome in patients on hemodialysis

The Frequency of Carpal Tunnel Syndrome in Hurler Syndrome After Peritransplant Enzyme Replacement Therapy: A Retrospective Comparison

Children with Hurler syndrome (HS) develop carpal tunnel syndrome (CTS) owing to glycosaminoglycan deposition secondary to enzyme deficiency. Advancement in the treatment of the underlying enzyme deficiency now commonly includes peritransplant intravenous enzyme replacement therapy (ERT). The primary objective of this study was to determine if the use of limited ERT in addition to hematopoietic stem cell transplantation (HCT) for the treatment of children with HS reduces the incidence of surgical intervention for CTS compared with a cohort of historical controls treated with HCT alone. The secondary objectives were to evaluate the impact of demographic and transplant-related characteristics on the incidence of CTS. Lastly, the results of surgical treatment of CTS in HS are reported. Medical records for a historical group of 43 HS patients who underwent HCT alone (group 1) were compared with 31 HS patients who underwent HCT+ ERT (group 2). Both groups were compared for genotype, age at transplant, sex, transplant graft source, median/ulnar nerve conduction study parameters as well as the incidence and treatment of CTS. Pre- and postoperative nerve conduction studies were compared for children treated surgically for CTS. The cumulative incidence of CTS at 5 years for HS children treated with HCT+ ERT was 51% compared with 47% for HS children treated with HCT alone. The incidence of CTS did not depend upon graft source, age at transplant, or sex. Median nerve conduction velocity for both sensory and motor potentials demonstrated significant improvement after carpal tunnel release. Although the administration of ERT prior to and for several months after HCT has become routine in our institution, our findings do not suggest this combined therapy is sufficient to decrease thedevelopment of CTS. Surgical intervention for median nerve compression remains the treatment of choice for CTS in HS children. Therapeutic IV.