Hand Diagram Research Articles

Burden of carpal tunnel syndrome and its associated factors among construction industry workers in Gondar town, Ethiopia.

Carpal tunnel syndrome is characterized by symptoms such as pain, numbness, or tingling on the anterior surface of the index, middle, or radial half of the ring finger, which is frequently associated with weakness of hand grip, and nocturnal pain and/or numbness resulting from compression of the median nerve at the carpal tunnel between the carpal bones and the transverse ligament. The construction industry involves many activities aside from the building process, such as landscaping, painting, electrical supply, plastering, paving, and telecommunications. Performing such tasks involves repetition of wrist flexion and extension, forceful grip with the hand, and/or vibrations of the hand and arm. This study aimed to assess the prevalence of carpal tunnel syndrome and its associated risk factors among construction workers. An institutional-based cross-sectional study design was conducted among six construction sectors in Gondar from April to July 2021. An interviewer-administered questionnaire was prepared from the literature with a Katz hand diagram, and a physical examination and a special test (carpal compression test, Phalen's, and Tinel's test) were carried out for those participants who reported pain during the interview. Binary logistic regression was conducted with SPSS 25 to identify the associated risk factors for carpal tunnel syndrome. The strength of the association was detected by the adjusted odds ratio. A total of 333 study participants aged 18-70 years were included in this study. Among the participants, 11.7% (AOR: 95%CI: 8.1-15.3) had carpal tunnel syndrome. Age, cigarette smoking, work experience, and working with finger-pressing tools were risk factors significantly associated with carpal tunnel syndrome among construction workers with a p-value of <0.05. The magnitude of carpal tunnel syndrome was 11.7% among construction workers. Being of older age, having more experience, cigarette smoking, and working with finger-pressing tools were risk factors significantly associated with carpal tunnel syndrome among construction workers. Employers should implement work safety education programs that raise awareness about the risks of cigarette smoking and encourage employers and supervisors to seek early medical intervention and treatment for carpal tunnel syndrome before it becomes a chronic problem.

The hand diagram: A novel outcome measure following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer in severe compressive ulnar neuropathy

BackgroundWith advances in the surgical management for severe ulnar neuropathy with the introduction of the super charged-end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfer, a simple and reliable outcome measure is required. There is currently not “one” standardized outcome measure used to represent and compare results. PurposeTo present the abduction hand diagram as a “novel”, reproducible, and simple outcome measure for patients with severe ulnar neuropathy. Study DesignRetrospective case series. MethodsNine patients with severe entrapment/compressive ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative abduction tracings, Medical Research Grade (MRC) muscle strength, key pinch strength, Disability of the Hand Arm and Shoulder (DASH) score, and crossed finger test. Electrodiagnostic data included change in compound muscle action potentials (CMAP) amplitude of the first dorsal interosseous (FDI), and abductor digiti minimi (ADM). Summary statistics were used for demographic and clinical data. ResultsAverage follow-up was 22.8 ± 9.3 months. At 18-months of follow up, 44% had ADM MRC grade 3 strength or higher, mean key pinch strength improved to 72 ± 19.3%, and mean DASH was 33 ± 28.7. There was a mean increase of 16.7 ± 9.1 mm and 31.5 ± 12 mm in total and summed hand abduction tracing measurements respectively. ConclusionsHand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function and can be used in patients with severe ulnar neuropathy following surgical intervention.

Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. Meta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.

Diagnostic scales, questionnaires, and hand diagrams in comparison to nerve conduction studies in the matter of the diagnostic dilemma of carpal tunnel syndrome: a review

Carpal tunnel syndrome (CTS) is considered as the most common peripheral nerve pathology, as it affects 1-3 persons per 1,000 with a percentage of 3.8%, in a female-to-male ratio of 3 : 1. A lot of attempts have been made to set specific diagnostic criteria to facilitate the process of diagnosis and to minimize the cost of investigations, conservatively with splinters, steroid injection, electrotherapy, and manual therapy. Thus, this study aimed to reconstruct a summarized and accessible database regarding a costless diagnosis of CTS to limit the cost of investigations and minimize surgical interventions as much as possible. For this purpose, the selection of articles was conducted through a literature search in Google Scholar, PubMed, and Cochrane databases. The strategy was to identify studies and report on their accuracy, specificity, and sensitivity in diagnosing CTS using different methods which include diagnostic scales, questionnaires, hand symptoms diagram (HSD), and nerve conduction. It was found that Kamath and Stothard built a questionnaire [Kamath and Stothard questionnaire (KSQ)] and HSD are good choices as the initial step in the diagnosis of CTS. However, in the presence of nerve conduction studies (NCSs), it must be considered a gold standard diagnostic modality, and the previous measures could not replace it due to the large differences in accuracy. Furthermore, surgical decompression should not be standardized based on either KSQ or HSD because only precise severity grading by NCS is trustworthy to establish the indication for surgical intervention.

Comparison of the modified method and the median sensory-ulnar motor latency difference in the diagnosis of carpal tunnel syndrome

ObjectivesThis study aimed to compare the modified method and the median sensory-ulnar motor latency difference in the diagnosis of carpal tunnel syndrome. MethodsThe study recruited the electromyography results of 105 hands of 60 patients who had a complaint of carpal tunnel syndrome (CTS) on the hand diagram. The average sensory-ulnar motor delay difference (MSUMLD) was determined by simple subtraction, and the modified method was calculated based on the results of the classic method. The modified method and the MSUMLD were compared according to their sensitivity and specificity in the diagnosis of CTS. ResultsIn this study, 54 hands were evaluated with a unilateral nerve conduction study (45 right; 9 left). A total of 23 hands with CTS and 31 hands without CTS were diagnosed electrophysiologically. The MSUMLD had 91.3% sensitivity and 93.5% specificity; however, the modified method showed 95.7% sensitivity and 96.8% specificity in the diagnosis of CTS. Moreover, the modified method had 100% sensitivity and specificity in the diagnosis of moderate CTS. ConclusionsThe modified method may have higher diagnostic accuracy than the MSUMLD for diagnosing CTS.

Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study.

BACKGROUNDCarpal tunnel syndrome (CTS) is one of the most common peripheral nerve compressive neuropathies. The clinical symptoms and physical examinations of CTS are widely recognised, however, there is still debate around what is the best approach for assessment of CTS. Clinical assessment is still considered the gold standard, however, controversies do exist regarding the need for investigations such nerve conduction studies (NCS) to aid with management decisions. AIMTo correlate the severity of NCS results to a scoring system which included symptoms, signs and risk factors.METHODSThis was a prospective correlation study. We scored patients’ signs and symptoms using our CTS scoring system. This was then correlated with the findings of the NCS. The scoring system included - four symptoms (2 Katz hand diagrams – one for tingling and one for numbness; nocturnal paresthesia and bilateral symptoms) and four clinical signs (weak thumb abduction test; Tinel’s sign; Phalen sign and hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). We classified the NCS results to normal, mild, moderate and severe. RESULTSThere were 61 scores in 59 patients. The mean scores for the categories were as follows: 6.75 for normal NCS; 5.50 for mild NCS; 9.17 for moderate NCS and 9 for severe NCS. All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS. Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.CONCLUSIONWe feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.

Demographic and Occupational Risk Factors of Carpal Tunnel Syndrome among Dental students in their Final Year at King Abdulaziz University, Jeddah, Saudi Arabia

Carpal tunnel syndrome (CTS) is a common peripheral compression neuropathy that accounts for 90% of all entrapment neuropathies. Dentists typically have a higher prevalence of work-related musculoskeletal disorders including CTS. Currently, there is a lack of literature on CTS prevalence and risk factors among dentistry in Saudi Arabia. Our study was the first to examine the prevalence and the associated demographic and occupational factors of CTS among dental students. This cross-sectional study was conducted in the School of Dentistry at King Abdulaziz University. A total of 120 dental students in their final year were included. We used a validated self-administered questionnaire that included demographic data, work, medical history, and a modified Katz's hand diagram to assess the symptoms and occupational exposures. Descriptive statistics and logistic regression were applied using SPSS software version 16. The prevalence of CTS among dental students was 13.3%. It was higher in females 10% compared to male 3.3%. There was a significant relationship between the body mass index (P= 0.03) with underweight category by having a higher prevalence of CTS. The use of finger pinch grip showed an inverse association with CTS (P=0.04). Other risk factors were not significantly associated with CTS. The prevalence of CTS among dental students was higher than the general population. However, many previously identified risk factors showed no significant association with CTS adding to the controversy of the contributing risk factors of this disease among dentistry. Finger pinch grip showed inverse association which was contrary to published literature. Future studies may include exposure time for each occupational risk factor preferably in a prospective cohort.

99 Perfecting the Proforma – A Full-Cycle Audit on The Quality of Documentation of The Hand Trauma Proforma At the Regional Plastic Surgery Department

Abstract Aim We aimed to assess the quality of record-keeping of the departments hand trauma proforma, identify areas of improvement, and to implement and assess the quality of an updated proforma. Method Data from 101 parameters was collected for 20 patients undergoing surgery for an upper limb injury in November 2019. An updated proforma was implemented and a further 20 patients were analysed in February 2020. All fields were compared between two audit cycles and comments were collected. Results The overall completion rate increased. Documentation of the responsible consultant increased to 100%, along with an increase in documenting of hobbies and injury mechanism. X-ray findings (55% to 85%) and antibiotic plan (35% to 80%) increased. Implementation of a free text box resulted in written descriptions of injury to compliment sketches. In the operation note, documentation of anaesthetic type used increased, along with tourniquet use and time. There was clearer documentation of the injury, findings, and procedure, with greater use of diagrams to illustrate the repair. There was a drop in the recording of post-op plans (100% to 85%), post-op antibiotics (90% to 75%), and follow-up plan (95% to 60%). Clinicians commented to increase the size of the free-text box and hand diagram on the operative page to facilitate easier drawings. Conclusions The Hand Trauma Proforma has made good progress from its original version but requires further adjustments to ensure complete data input. It sets a high standard for data collection and presents itself as a useful tool for units across the United Kingdom.

Response to letter from Dr M. D. O'Brien.

Dear Sir, We are grateful to Dr O’Brien for highlighting the anatomy of the median nerve and its superficial palmar sensory branch. We agree that, based on anatomy alone, one would expect the palm to be unaffected in carpal tunnel syndrome (CTS), but the functional distinction between the palmar branch and the median nerve itself may not be as great as the anatomy suggests. Dr O’Brien highlights the anomaly of carpal tunnel decompression improving symptoms that would appear anatomically to be related to a more proximal lesion. We quoted work demonstrating glove distribution of symptoms in 35% of cases of CTS. Nora et al. [1] found that among patients with neurophysiological CTS, 44.4% had palmar pain and 62.2% had palmar paraesthesiae. Clark et al. found 39% prevalence of little finger symptoms in cases of CTS diagnosed by hand diagrams, neurophysiology and monofilaments [2]. A further confusion...

Accuracy of diagnostic clinical tests and questionnaires in screening for carpal tunnel syndrome among workers- A systematic review

ObjectiveTo synthesize and appraise the evidence on the diagnostic accuracy of the clinical examination tests and questionnaires for screening carpal tunnel syndrome (CTS) among workers. DesignSystematic review of diagnostic test accuracy MethodsElectronic search of 3 online databases (CINAHL, Embase, Medline) was done on August 31, 2020. Studies reporting the diagnostic accuracy of clinical examination tests in workers, compared to a reference standard test, were included. Diagnostic accuracy measures such as sensitivity (Sn) and specificity (Sp) were extracted and reported for different clinical examination tests. The risk of bias and applicability concerns were rated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool by 2 independent reviewers. Diagnostic tests accuracy extension of the PRISMA guidelines were followed. ResultsTwelve studies reporting on the diagnostic accuracy of the clinical examination tests for workers suspected of CTS were included. Fourteen different clinical examination tests were evaluated in the studies, including sensorimotor, provocative maneuvers, questionnaires, and hand symptom diagrams (HSD). Ten of the included studies had an either unclear or high risk of bias. The most accurate tests to diagnose CTS in workers were the Katz HSD (with Sn ranging from 38%-93%, and Sp ranging from 25%-89%) and Kamath and Stothard questionnaire (Sn and Sp = 100%). Combination of Katz HSD with either the Phalen’s maneuver or the Tinel’s sign resulted in excellent Sp (83% and 89%, respectively). ConclusionsLow to moderate quality evidence indicates variability in individual clinical examination tests used to screen for CTS in workers. Diagnostic self-report tools consisting of hand diagrams and/or diagnostic questions provide low burden and high accuracy. Still, they require more rigorous investigation about their value alone or in combination with clinical assessment tests.

Evaluation of occupational and non-occupational risk factors associated with carpal tunnel syndrome in dentists

BACKGROUND: Musculoskeletal disorders are very prevalent among dentists. Of these disorders, carpal tunnel syndrome (CTS) is notable. OBJECTIVE: The aim of this study was to investigate the relationship between the occupational and non-occupational risk factors and CTS among dentists. METHODS: It is a cross-sectional study. We evaluated 106 dentists from dental schools in Tehran. We collected data by a general questionnaire, a hand diagram, and physical examination. A nerve conduction velocity (NCV) test was used to confirm the diagnosis of CTS. The analysis was performed using an independent T-test and logistic regressions on SPSS software. RESULTS: The prevalence of CTS among dentists was 17.9%. Significant risk factors of CTS included: vibration exposure greater than two hours per day (OR: 2.5), a wrist diameter ratio of greater than 0.7 (OR: 10.14), and female sex (OR: 13.38). CONCLUSIONS: Exposure to the hand-arm vibration should be considered as an occupational risk factor for CTS in dentists. Female dentists should take more preventive measures.

Is there an association between the Hand Diagram and Electrodiagnostic Testing for Carpal Tunnel Syndrome?

Objective Verify if there is an association between the hand diagram of paresthesia (HDP) and the results of electroneuromyography (ENMG) in the diagnosis of carpal tunnel syndrome. Methods A total of 92 people filled in a schematic drawing of the hand with the exact location of the paresthesia (167 hands). The main author classified the diagrams according to the criteria of Katz et al. 5 The results of the HDP were crossed with the positive results of ENMG for the diagnosis of carpal tunnel syndrome. Results The possible pattern of the HDP was prevalent both in isolation and after crossing with the degrees of ENMG. Conclusion There was no association between the HDP and ENMG in the diagnosis of carpal tunnel syndrome.

Hydrochemistry of shallow groundwater and its assessment for drinking and irrigation purposes in Tarmiah district, Baghdad governorate, Iraq

The present study evaluates the hydrochemistry of shallow groundwater and its suitability for drinking and irrigation purposes in Tarmiah district, Baghdad governorate, Iraq. Tarmiah is located in the north of Baghdad and represents an important area for a study due to its human and agriculture activity in addition to lack of information. Twenty groundwater samples were collected from shallow tube wells and analyzed for various related physicochemical tests to produce the relevant piper diagram, Gibbs plot, and Schoeller index values. Piper diagram revealed that there is a broad variation in hydrochemical properties. Gibbs plot showed a remarkable impact on water chemistry due to evaporation. The Schoeller index values demonstrate that 60% of samples are with negative values which in turn show the disequilibrium in a chloro-alkaline relationship while the rest (40%) admit a direct base exchange reaction “cation-anion” as a result of their positive values. The hydrochemistry of the region is dominated by evaporation, silicate and carbonate weathering. To estimate whether the samples are drinkable or not, Water Quality Index (WQI) method was followed. On the other hand, Magnesium Hazard (MH), US salinity and Wilcox diagrams were used as a relevant indication for irrigation usability. The results have shown that the quarter of the samples were suitable for both studied purposes. Statistically, the multivariate methods were used by applying Q and R mode cluster analysis (CA) on the groundwater quality data. The conclusion upon this was finding three kinds of pollution levels for the whole samples. R mode CA revealed two main groups indicating that the study area is influenced by natural processes and anthropogenic sources.

Prevalence of carpal tunnel syndrome presenting with symptoms in an ulnar nerve distribution: A prospective study.

Patients presenting with symptoms of pain/paresthesias primarily in an ulnar nerve distribution may be noted to have exclusive median mononeuropathy at the wrist on subsequent electrodiagnostic testing. There has been limited research looking at the prevalence of this clinical presentation. A cohort of adults were surveyed to assess for severity and localization of hand symptoms using the Katz hand diagram and Boston Carpal Tunnel Questionnaire Symptoms Severity Scale. Thirty volunteers met our case definition for ulnar neuropathy and underwent a standardized physical examination, electrodiagnostic testing, and nerve ultrasound. Eleven of 30 subjects (37%) were found to have exclusive median mononeuropathy at the wrist. Carpal tunnel syndrome should remain high on the differential for patients presenting with symptoms of pain/paresthesias primarily in an ulnar nerve distribution. Muscle Nerve 59:60-63, 2019.

Reversible median nerve impairment after three weeks of repetitive work.

Objectives The aim of this study was to evaluate the development of impaired median nerve function in relation to hand-intensive seasonal work. We hypothesized that at end-season, median nerve conduction would be impaired and then recover within weeks. Methods Using nerve conduction studies (NCS), we examined median nerve conduction before, during, and after engaging in 22 days of mink skinning. For a subgroup, we used goniometry and surface electromyography to characterize occupational mechanical exposures. Questionnaire information on symptoms, disability, and lifestyle factors was obtained. Results The study comprised 11 male mink skinners with normal median nerve conduction at pre-season (mean age 35.7 years, mean number of seasons with skinning 8.9 years). Mink skinning was characterized by a median angle of wrist flexion/extension of 16º extension, a median velocity of wrist flexion/extension of 22 °/s, and force exertions of 11% of maximal voluntary electrical activity. At end-season, mean distal motor latency (DML) had increased 0.41 ms (P<0.001), mean sensory nerve conduction velocity (SNCV) digit 2 had decreased 6.3 m/s (P=0.004), and mean SNCV digit 3 had decreased 6.2 m/s (P=0.01); 9 mink skinners had decreases in nerve conduction, 5 fulfilled electrodiagnostic criteria and 4 fulfilled electrodiagnostic and clinical criteria (a positive Katz hand diagram) for carpal tunnel syndrome (CTS). Three to six weeks post-season, the changes had reverted to normal. Symptom and disability scores showed corresponding changes. Conclusions In this natural experiment, impaired median nerve conduction developed during 22 days of repetitive industrial work with moderate wrist postures and limited force exertion. Recovery occurred within 3-6 weeks post-season.

Examining the association between musculoskeletal injuries and carpal tunnel syndrome in manual laborers.

The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study. Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies. A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance. Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016.

PREVALENCE AND RISK FACTOR OF CARPAL TUNNEL SYNDROME AMONG WORKERS IN THE CONSTRUCTION INDUSTRY

Introduction: In terms of lost-work time, restricted workdays and rehabilitation, one of the most costly occupational musculoskeletal disorders is carpal tunnel syndrome (CTS). Aim of work: determination of CTS prevalence and evaluation of some personal and occupational risk factors among construction workers. Materials and Methods: In this descriptive cross-sectional study, 116 cases were enrolled. A questionnaire was used to assess socio-demographic data, and occupational history. CTS was assessed by symptoms on the Katz hand diagram and physical examination. Phalen’s test was done for all participants. Results: According to this study, the prevalence of CTS was 27.6% among workers in construction industry. The rate of CTS was significantly higher among electricians than in other workers (P < 0.05). The risk of developing CTS increase with age ≥ 30 years and work duration ≥ 5 years. Conclusion: Our findings suggest that construction workers are at an increased risk of CTS, so awareness should be raised and interventions should specifically target this risk group.

Forget What the Statisticians Told You: Size Matters. Commentary on “The Relationship Between Catastrophic Thinking and Hand Diagram Areas”

Forget What the Statisticians Told You: Size Matters. Commentary on “The Relationship Between Catastrophic Thinking and Hand Diagram Areas”

The Relationship Between Catastrophic Thinking and Hand Diagram Areas

To evaluate the relationship between the total area marked on pain and numbness diagrams and psychosocial factors (depression, pain catastrophic thinking, and health anxiety). A total of 155 patients marked painful and numb areas on separate hand diagrams. Patients also completed demographic, condition-related, and psychosocial (Pain Catastrophizing Scale, Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test, and Short Health Anxiety Inventory) questionnaires. Bivariate and multivariable analyses were used to determine factors associated with total area marked on the pain and numbness diagrams. The total area marked on the pain diagram correlated with catastrophic thinking, symptoms of depression, and health anxiety. In multivariable analysis, catastrophic thinking was the sole predictor of marked pain area, accounting for 10% of variance in the hand pain diagram. The total area marked on the numbness diagram correlated with the interval between onset and visit, diagnosis, catastrophic thinking, and symptoms of depression. In multivariable analysis, the interval between onset and visit, a diagnosis of carpal tunnel syndrome, and catastrophic thinking were independently associated with total area marked on the hand numbness diagram. Catastrophic thinking was independently associated with larger pain and numbness areas on a hand diagram. This suggests that larger symptom markings on hand diagrams may indicate less effective coping strategies. Hand diagrams might be used as a basis for discussion of coping strategies and illness behavior in patients with upper extremity conditions. Diagnostic III.

Pathological changes in the subsynovial connective tissue increase with self-reported carpal tunnel syndrome symptoms

BackgroundFibrosis and thickening of the subysnovial connective tissue are the most common pathological findings in carpal tunnel syndrome. The relationship between subsynovial connective tissue characteristics and self-reported carpal tunnel syndrome symptoms was assessed. MethodsSymptoms were characterized using the Boston Carpal Tunnel Questionnaire and Katz hand diagram in twenty-two participants (11 with symptoms, 11 with no symptoms). Using ultrasound, the thickness of the subsynovial connective tissue was measured using a thickness ratio (subsynovial thickness/tendon thickness) and gliding function was assessed using a shear strain index ((Displacementtendon−Displacementsubsynovial)/Displacementtendonx 100). For gliding function, participants performed 10 repeated flexion–extension cycles of the middle finger at a rate of one cycle per second. FindingsParticipants with symptoms had a 38.5% greater thickness ratio and 39.2% greater shear strain index compared to participants without symptoms (p<0.05). InterpretationUltrasound detected differences the SSCT in symptomatic group that was characterized by low self-reported symptom severity scores. This study found ultrasound useful for measuring structural and functional changes in the SSCT that could provide insight in the early pathophysiology associated with carpal tunnel syndrome symptoms.