Idiopathic Carpal Tunnel Syndrome Research Articles

Study of Platelet-Rich Plasma Local Injection in Idiopathic Carpal Tunnel Syndrome

Study of Platelet-Rich Plasma Local Injection in Idiopathic Carpal Tunnel Syndrome

Perineural 5% dextrose versus corticosteroid injection in non-surgical carpal tunnel syndrom treatment.

<p>We aimed to investigate the difference of clinical and electrophysiological improvement between perineural corticosteroid injection therapy (PCIT) and perineural 5% dextrose injection therapy (5%PDIT) in carpal tunnel syndrome (CTS).</p>. <p>Total of 92 wrists that were diagnosed as mild-to-moderate idiopathic CTS and completed their follow-up were included in our study. The severity of pain, symptom severity and functional status were asses&shy;sed by visual analog scale (VAS) and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores for treatment effectiveness. Randomized wrists were administered PCIT or 5%PDIT accompanied by ultrasound guidance. VAS, BCTQ scores and the electro&shy;physiological study repeated before and after treatment at the 1st and 6th months after perineural injection therapies (PITs) were recorded.</p>. <p>Compared with baseline data, within groups there was significant improvement in VAS, BCTQ severity and function scores at 1st and 6th months follow-up (all p &lt; 0.001). Considerable advance were detected in the median sensory nerve conduction velocity (SNCV) when pretreatment values were compared with posttreatment first month in both groups (p = 0.01; p &lt; 0.001, respectively). No significant change occurred in median distal motor latency (DML) values between the 1st and 6th months in the groups (p = 0.095; p = 0.113, respectively). No significant difference was observed bet&shy;ween 5%PDIT and PCIT groups.</p>. <p>Clinical and electrophysiologic improvement in CTS began from 1st month after PCIT and 5%PDIT. At the 6th month follow-up of the patients, 5%PDIT and PCIT had similar therapeutic effects. As a result, we can consider the replacement of PCIT with 5%PDIT in mild-to-moderate CTS patients especially in those who are hesitant because of the corticosteroid&rsquo;s adverse effects.</p>.

Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment.

Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand. The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage. Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome. The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments. We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.

Correlation between electrodiagnostic severity and Boston carpal tunnel questionnaire in surgically treated carpal tunnel syndrome patients.

The objectives of this study were to (1) investigate whether electrodiagnostic (EDX) findings reflect the preoperative symptom severity and functional impairment in patients with carpal tunnel syndrome (CTS) and (2) evaluate the relationship between EDX findings and the clinical outcomes reported according to the self-administered patient questionnaires. Patients diagnosed with idiopathic CTS who underwent carpal tunnel release between May 2016 and July 2018 were included. Carpal tunnel syndrome was clinically diagnosed and confirmed based on the EDX findings. The association between EDX findings, such as motor latency, motor amplitude, sensory latency, sensory amplitude, and severity (mild, moderate, and severe), and the Boston symptom and function scores were analyzed. The change in the Boston symptom and function scores from the preoperative baseline values (visit 1) to those recorded 1 year postoperatively (visit 5) was assessed. The effect of disease severity based on the EDX findings on the change in Boston symptom and function scores by visit was also investigated. The EDX severity, motor latency, motor amplitude, sensory latency, and sensory amplitude were not correlated with the Boston symptom and function scores preoperatively and postoperatively. Electrodiagnostic severity did not affect the improvement in the Boston symptom and function scores recorded at each visit. We found no association between the EDX severity and perioperative Boston questionnaire scores, and the degree of improvement in patient symptoms and function did not differ according to the CTS severity based on the EDX findings. Level IV, Prognostic study.

Natural evolution of idiopathic carpal tunnel syndrome with respect to wrist and hand anthropometry: A prospective cohort study

ObjectiveA greater wrist depth/width ratio and wrist depth/palm length ratio are known risk factors for carpal tunnel syndrome. We hypothesized that these parameters might also predict progression in patients who were not surgically treated. MethodsSeventy-eight patients with moderately severe idiopathic carpal tunnel syndrome of at least 10 months duration at recruitment, who declined surgical treatment and steroid injection, underwent repeated neurophysiological assessments after 3 years. A > 10% increase in median SNAP latency was taken as evidence of significant deterioration. ResultsPatients with a wrist ratio ≥ 0.72 showed a statistically significant deterioration in SNAP latency from 5.46 (SD 2.09) to 7.16 (SD 1.56) ms and in SNAP amplitude from 30.19 (SD 13.8) to 16.62 (SD 14.42) µv. For those with a wrist-to-palm ratio ≥ 0.42, SNAP latency deteriorated from 5.27 (SD 1.21) to 7.1 (SD 1.52) ms, and amplitude from 32.78 (SD 13.76) to 19.45 (SD 16.62) µv. Patients with lower ratios did not show significant changes in any neurophysiological parameter. The relative risk of significant deterioration in SNAP latency in patients with a wrist ratio ≥ 0.72 was 2.04 (95% CI 1.27–3.27). ConclusionIn untreated idiopathic carpal tunnel syndrome, patients with larger wrist and wrist-to-palm ratios are more likely to show neurophysiological progression.

Serum levels of Interleukin-6 in patients with Idiopathic Carpal Tunnel Syndrome: A case control study in Najaf Province

Background: Carpal Tunnel Syndrome (CTS) is a disease caused by a compression of the median nerve at the wrist within carpal canal that lead to multiple symptoms as paraesthesia, numbness and pain sensation in the median distribution fingers. If untreated, it leads to sensation loss, thenar muscle weakness and atrophy. It is most frequent peripheral neuropathy of upper limbs and is most predominant in female gender. The pathogenesis of CTS is yet unknown, and the majority of conditions are idiopathic. Interleukin 6 is a cytokine that has multiple functions including pro-inflammatory and anti-inflammatory or regenerative actions. The impact of serum inflammatory cytokines on incidence and severity of CTS is still unclear. Aim of the study: this study aims to correlate the clinical severity of CTS and the serum interleukin 6 concentrations. Patients and methods: This is a case control study which involved 140 participants who were categorized into 70 patients with CTS and 70 healthy persons according to clinical assessment and nerve conduction study results. After that, the participants were divided to normal, mild, moderate and severe groups according to Boston carpal tunnel questionnaire (BCTQ). Then, a blood sample was taken from each participant to assess serum interleukin 6 levels. A statistical analysis by SPSS was done for the collected data. Results: The study has shown that there was no significant correlation between serum interleukin 6 levels and the clinical severity score of CTS (P value &gt;0.05). Conclusion: It has been concluded that serum interleukin 6 levels did not have an impact on incidence and clinical severity of CTS and that its role in CTS is yet unclear.

Time-Dependent Change in Carpal Tunnel Cross-Sectional Area and Transverse Carpal Ligament Thickness Using Serial Magnetic Resonance Imaging Studies—An Anatomical Study

Idiopathic carpal tunnel syndrome (CTS) is a common compressive neuropathy. Aging and female sex are risk factors, but the reasons are unclear. The purpose of this study was to evaluate whether identifiable radiographic changes resulting in a decrease in carpal tunnel area (CTA) over time exist. A database search of a multicenter, academic, tertiary institution from 1998 to 2021 identified 433 patients with serial wrist magnetic resonance images (MRI) at least 5 years apart. Fifty-six met the inclusion criteria with adequate films to measure CTA and transverse carpal ligament (TCL) thickness at the same slice location-the carpal tunnel inlet, hook of the hamate, and carpal tunnel outlet-independently by two observers who were blinded to each other's measurements. Rates for the change in CTA and TCL thickness were calculated at all three locations. Thickness of the TCL increased, whereas that of the CTA decreased over time. Inlet CTA decreased by 0.9 mm2 per year (95% CI: 0.34-1.5), outlet CTA decreased by 1.8 mm2 per year (95% CI: 1.2-2.5), and CTA at the hook of the hamate decreased by 1.6 mm2 per year (95% CI: 1.0-2.0 per year). The TCL thickened by 0.02 mm per year at all three sections. Taller patients had a decreased rate of CTA loss. In this select cohort, TCL thickened and CTA decreased with time. TCL thickening accounted for about half of the variation in CTA, suggesting that this is a possible contributor to this change. Hypertrophy of the carpal tunnel floor may account for the remaining variation in CTA. The question of whether these results are reliable and generalizable to the general population, or a major influence in the pathophysiology of CTS, is unknown. Small decreases in CTA and thickening of the TCL occur with aging. Whether this is a contributing factor in the development of CTS requires further study.

Diagnostic utility of anteroposterior measurements of the median nerve on sagittal ultrasonographic images and their correlation with clinical findings in carpal tunnel syndrome.

To investigate the efficacy of sagittal ultrasonography of the median nerve in diagnosing carpal tunnel syndrome (CTS). Seventy-six hands with idiopathic CTS and 80 hands of asymptomatic subjects were included. All patients with CTS underwent ultrasonographic examination, electrodiagnostic testing, and CTS-6 assessment. In the sagittal ultrasonographic examination, the maximum and minimum median nerve diameters (MNDs) were measured at the proximal and distal ends of the carpal tunnel, respectively. The median nerve stenosis rate (MNSR) was computed as (1 - minimum MND/maximum MND) × 100 (%). The cross-sectional area (CSA) of the median nerve at the level of the pisiform was measured. In the sagittal ultrasonographic examination, the mean maximum MNDs were 0.252 cm and 0.202 cm, mean minimum MNDs were 0.145 cm and 0.165 cm, and mean MNSRs were 41.83% and 17.35% in the CTS and control groups, respectively; the mean maximum MND and MNSR were considerably larger in the CTS group. The maximum MND and MNSR were correlated with the electrodiagnostic testing results and CTS-6 score. The MNSR with a cut-off value of 34.0% had a higher sensitivity and specificity than the CSA in diagnosing CTS. Sagittal ultrasonographic examination is useful in diagnosing CTS.

Association between three-dimensional motion analysis of the thumb and clinical parameters in patients with carpal tunnel syndrome.

We analysed the relationship between motor dysfunction of the thumb and the clinical parameters of carpal tunnel syndrome using three-dimensional motion analysis. This single-centred, prospective study included 65 hands in 51 patients with idiopathic carpal tunnel syndrome and 30 healthy hands. Three-dimensional thumb kinematics were acquired using a motion capture system with a retroreflective surface-based marker method. The trajectory area of thumb tip, adduction and abduction of the trapeziometacarpal joints and metacarpophalangeal joints were correlated with the clinical parameters. There was no significant correlation between the results of motion analysis values and patient-reported outcomes measures. Thumb movement disorder associated with carpal tunnel syndrome affected specific activities of daily living based on the pinching movements, such as 'writing' and 'buttoning clothes' among the patient-reported outcome measure items.Level of evidence: III.

Retracted: Clinical Characteristics and Treatment of Adult Idiopathic Carpal Tunnel Syndrome Accompanied with Trigger Digit.

[This retracts the article DOI: 10.1155/2022/8104345.].

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;

Bilateral Idiopathic Carpal Tunnel Syndrome: Clinical-Functional Characterization and Efficacy of Two Combined Postoperative Physiotherapeutic Treatments.

To evaluate the efficacy of combined association instrument myofascial mobilization (IASTM) and stretching in patients with idiopathic bilateral carpal tunnel syndrome (CTS) operated on one hand and to analyze the response of the operated (OH) and non-operated (NH) hand according to the sequence of therapies. Research on these parameters has not yet been found in the literature. Randomized controlled crossover study with 43 participants using the objective and subjective outcome variables. Patients were randomly assigned to two groups: starting with stretching followed by IASTM and starting with IASTM followed by stretching. Then patients underwent surgery on the hand with more severe involvement and physical therapy rehabilitation was started 30 days after for a period of 4 weeks. After the 1-week interval the participants who started with stretching were referred to IASTM and vice versa, following the same previous patterns. The outpatient reassessments took place at 3 to 6 months. Crossover ANOVA and effect sizes were used as analysis methods. Time was the most significant outcome for all variables both during therapies and at 6-month follow-up. Regarding response to the combined therapies between OH and NH, there were differences for both OH and NH, with the greatest impact on NH for the palmar grip and VAS variables. The treatment sequences were significant for pain on the NH and mental SF-12, suggesting that starting with IASTM followed by stretching had a superior outcome for these outcomes. The combination of IASTM with stretching, used in the postoperative period of bilateral idiopathic CTS, proved to be supplementary, with significant results and large effect sizes for most of the outcomes assessed, both during the time of application of the therapies and in the 6-month follow-up for both hands, and may constitute a viable therapeutic alternative for this population.

The significance of wrist immobilization for endoscopic carpal tunnel release.

Over the years, endoscopic carpal tunnel release (ECTR) has gained significant interest as an alternative to surgery. However, no consensus has been reached on the necessity of postoperative wrist immobilization. This study aims to compare the outcomes of wrist immobilization for a period of 2 weeks to immediate wrist mobilization after ECTR. A total of 24 patients with idiopathic carpal tunnel syndrome undergoing dual-portal ECTR from May 2020 to Feb 2022 were enrolled and randomly divided into two groups postoperatively. In one group, patients wore a wrist splint for 2 weeks. In another group, wrist mobilization was allowed immediately after surgery. The two-point discrimination test (2PD test); the Semmes-Weinstein monofilament test (SWM test); the occurrence of pillar pain, digital and wrist range of motion (ROM); grip and pinch strength; the visual analog score (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ) score; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and complications were evaluated at 2 weeks and 1, 2, 3, and 6 months after the surgery. All 24 subjects finished this study with no dropouts. During the early follow-up, patients with wrist immobilization demonstrated lower VAS scores, lower occurrence of pillar pain, and higher grip and pinch strength compared with the immediate mobilization group. No significant difference was obtained between these two groups in terms of the 2PD test, the SWM test, digital and wrist ROM, BCTQ, and the DASH score. In total, two patients without splints reported transient scar discomfort. No one complained of neurapraxia, injury of the flexor tendon, median nerve, and major artery. At the final follow-up, no significant difference was found in any parameters between both groups. The local scar discomfort mentioned above disappeared and left no serious sequela. Wrist immobilization during the early postoperative period demonstrated significant pain alleviation along with stronger grip and pinch strength. However, wrist immobilization yielded no obvious superiority regarding clinical outcomes at the final follow-up.

Serum Transforming Growth Factor β1 and Its Genetic Variants Are Associated with Increased Macrophage Inflammatory Protein 1β and Susceptibility to Idiopathic Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy in which one of the body's peripheral nerves becomes pinched or crushed. Transforming growth factor beta 1 (TGF-β1) plays an important role in the pathogenesis of CTS. An association between TGF-β1 polymorphisms and the susceptibility or progression of a number of diseases has been reported. In this study, three TGF-β1 single nucleotide polymorphisms (SNPs), serum TGF-β1, and macrophage inflammatory protein 1 beta (MIP-1β) were investigated as potential diagnostic markers for the progression of CTS in Egyptian patients. One hundred CTS patients and 100 healthy controls were recruited for the study. TGF-β1 SNPs +915G/C, -509C/T and -800G/A were determined by TaqMan genotyping assay. Serum TGF-β1 and MIP-1β levels were measured by ELISA. Serum TGF-β1 and MIP-1β levels increased significantly and were strongly correlated with the occurrence of CTS. The C allele of +915G/C, the T allele of -509C/T, and the G allele of -800G/A occurred more frequently in patients from CTS than in controls. The serum levels of TGF-β1 and MIP-1β in the group of carriers of the genotypes +915G/C GC and CC, the genotype -509C/T TT and the genotype -800G/A GA and AA were significantly higher in CTS patients. TGF-β1 and its +915G/C, -509C/T, and -800G/A SNPs and MIP-1β could be useful prognostic markers for the occurrence of CTS.

The Effect of Socioeconomic Disparity on Improvement in QuickDASH at 3 Months after Carpal Tunnel Release.

A single-institutional, prospective, longitudinal study was performed of 85 patients who underwent isolated, unilateral CTR for idiopathic carpal tunnel syndrome. Sixty-three patients (74%) who completed patient-reported outcome measures at 3 months after surgery comprised our study cohort. Socioeconomic disparity was assessed using the zip code level Distressed Communities Index (DCI) and the neighborhood level Area Deprivation Index. The outcome variables were the improvement in the QuickDASH score, 3 months postoperative QuickDASH score, and the preoperative QuickDASH score. Associations between continuous variables were assessed using simple linear regression. The mean DCI of the study cohort was in the 23rd national percentile, and the mean Area Deprivation Index was in the 15th national percentile. The mean preoperative QuickDASH of the study cohort was 49.3. The mean 3 months postoperative QuickDASH of the study cohort was 29.8. The mean improvement in QuickDASH at 3 months after surgery was 19.5, which was statistically significant and clinically meaningful. Area Deprivation Index and DCI were not associated with improvement in QuickDASH score or 3 months postoperative QuickDASH score. Higher DCI was associated with poorer baseline preoperative QuickDASH score. Patients of various socioeconomic backgrounds can expect similar short-term improvements in symptoms and function after CTR.

The sensitivity of median versus ulnar palmar mixed nerve study in the early diagnosis of carpal tunnel syndrome

BackgroundElectrodiagnostic tests (EDX) are the most frequent and applicable studies in early diagnosis of carpal tunnel syndrome (CTS), but the definitive sensitive and specific tests are still under study. We aimed to evaluate the role of the median versus ulnar palmar mixed nerve study (Mix M-U), and its sensitivity in comparison to other provocative comparison studies, in supporting the early diagnosis of CTS. This cross-sectional study included 142 idiopathic early CTS hands from 100 patients and 71 hands from 50 healthy subjects as a control group. We did routine median motor and sensory studies and 4 comparative tests namely median versus radial sensory study (MVR), Mix M-U, median versus ulnar sensory study (MVU), and median versus ulnar lumbrical-interossei motor study (LU-IN).ResultsThe routine median motor and sensory latency and amplitude showed a statistically significant difference between CTS and control groups as (p< 0.05) and a highly statistically significant difference between the 2 groups as regards the 4 comparative tests as (p< 0.0001). The specificities of all the 4 comparative tests were higher than 90%. MVR test had the highest sensitivity (92.2%) and followed by Mix M-U study (82.2%) and MVU (78.7%), and the least sensitive test was the LM-IN (66.9%).ConclusionsAlthough the patients’ results fall within the normal range according to the reference range in the literature, it showed a statistically significant difference when compared to controls. A high percentage of those symptomatic patients showed results of typical CTS when tested with the comparative studies so there is a need to use these sensitive tests to diagnose cases with early CTS. According to sensitivity studies, the selection of which tests to do in order is a challenging choice. For the diagnosis of cases with early CTS with a normal ordinary motor and sensory studies, MVR comparative technique appeared as the best sensitive and specific provocative electrophysiological test followed by the Mix M-U test. We recommend the use of a combination of both tests first in the diagnosis of early CTS and if one of them was negative we can use the other comparative studies MVU and then LM-IN studies.

Comparative study between blind and ultrasound-guided steroid injection for carpal tunnel syndrome

BackgroundCarpal tunnel syndrome is the most common entrapment neuropathy. Local injections of corticosteroids have proven to be an effective treatment option. Injections are either blind (non-guided) or guided by ultrasound. The current study aimed to compare the efficiency of both approaches and determine which one yields better results.MethodThis study involved 30 patients (8 males, 22 females, aged 36–58 years, mean age 48.3 years) with 30 affected hands with mild or moderate carpal tunnel syndrome. Patients were randomly divided into two equal groups. Steroid injections were performed blindly in group 1 and ultrasound-guided in group 2. A mixture of 2 ml of triamcinolone and lidocaine was administered at both groups. Follow-up (using the Boston Carpal Tunnel Questionnaire and ultrasound assessment) was performed 4 weeks after the injection.ResultsThe symptom severity scale, functional status scale, cross-sectional area, and flattening ratio were significantly reduced in both groups at 4 weeks after the procedure. The ultrasound-guided group showed a statistically significant improvement compared to the blindly injected group.ConclusionsLocal steroid injection is an effective method in the management of both idiopathic and secondary carpal tunnel syndrome. Although clinical and sonographic improvement was achieved with blind and guided steroid injections, better results were obtained when ultrasound was used.

Does idiopathic carpal tunnel syndrome deteriorate proprioception of the hand? A case-control study.

This study aims to investigate the deterioration in kinesthetic kinesthesia (KKS) and visual kinesthesia (VKS) of the hand as a component of proprioception in patients with idiopathic carpal tunnel syndrome (CTS). This study included a total of 90 hands of 60 patients (9 males, 51 females; mean age: 47.6±9.4 years; range, 28 to 60 years) who were diagnosed with CTS and 25 hands of 25 healthy individuals (8 males, 17 females; mean age: 42.6±14.4 years; range, 20 to 60 years) as the controls between January 2019 and January 2021. The KKS and VKS scores were compared between the groups. Clinical parameters such as pain levels, hand grip strength (HGS) values, and two-point discrimination (2PD) test scores were compared between the patients with and without KKS or VKS deficits. The association between the severity of electromyographic findings and KKS or VKS deficits was examined. The mean VKS score of the CTS group was 22.9±1.6 and the KKS score was 20.8±3.4, which was significantly lower than that of the control group (p=0.002 and p<0.001, respectively). The CTS patients performed less accurate repetitions in visually cued (60%) and kinesthetically cued (40%) positions than the control group (100% both). There were significantly more patients with VKS and KKS deficits in the moderate or severe CTS groups than in the mild CTS group (p<0.001 and p=0.007, respectively), and KKS or VKS deficits were significantly associated with the impaired HGS (p=0.042 and p=0.048, respectively) and functional status (p=0.020 and p=0.016, respectively) accompanied by the increased symptom severity (p=0.010 and p=0.002, respectively). Our study results suggest that idiopathic CTS is associated with impaired proprioception and kinesthetic sense of the hand. In addition, idiopathic CTS is related to impaired hand function and severe symptoms. Screening kinesthetic sense in patients with idiopathic CTS prior to decompression surgery or postoperative hand therapy is helpful to set realistic goals and achieve superior clinical outcomes.

Comparison of Surgery and Local Steroid Injections for the Treatment of Carpal Tunnel Syndrome

Background: There is no consensus about the optimum treatment or treatment algorithm for carpal tunnel syndrome (CTS). In previous randomized studies that compared open carpal tunnel release and local steroid injections (LSIs), the two most used nonconservative treatments, conflicting results were found. Objective: The objective of the study was to compare the efficacies of surgery and LSI in the treatment of CTS. Subjects and Methods: A randomized, controlled clinical trial was conducted with 80 patients who were clinically diagnosed as having idiopathic CTS. The requirements for enrollment were awakening from sleep due to nocturnal paresthesia and a diagnosis to be confirmed through electrodiagnostic tests. Patients were randomly assigned to the surgery and the steroid groups. Assessments were performed at baseline and 1, 3, 6, and 12 months after initial treatment. The primary outcome measure was the improvement of awakening from sleep. Results: A total of 80 patients were enrolled in the study. Thirty-six patients were assigned to the surgery group and 44 to the steroid group. None of our patients were lost to follow-up. Fourteen out of the 44 patients in the steroid group and all 36 patients in the surgery group had a successful outcome at the 12-month assessment. Success rates in the steroid group at 1, 3, 6, and 12 months were 77.3%, 61.4%, 45.5%, and 31.8%, respectively. When the injection group was evaluated separately, LSI was found more successful in mild cases and unilateral cases. Conclusion: Surgery should be chosen for the treatment of moderate-to-severe idiopathic CTS, but LSI may be used for mild cases. The historical-objective scale may predict which patient will benefit from which treatment.

The Relationship Between Clinical, Physical, Electrophysiological, Functional Findings and Body Mass Index in Patients with Idiopathic Carpal Tunnel Syndrome

Amaç: Bu çalışmada idyopatik karpal tünel sendromu (KTS) tanısı almış hastalarda klinik, fiziksel, elektrofizyolojik, fonksiyonel bulgular ve vücut kitle indeksi (VKİ) arasındaki ilişkiyi araştırmak amaçlanmıştır. Method: Çalışmaya toplam 105 (48 bilateral, 9 unilateral) idiopatik KTS’li el katıldı. Hastaların demografik ve klinik bulguları ve tinel, phalen, ters phalen, karpal kompresyon bulguları değerlendirilerek kaydedildi. VKİ ≥ 30 olan hastalar obez olarak değerlendirildi. Hastaların fonksiyonlarını değerlendirmek amacıyla Boston Semptom Şiddet ve fonksiyonel kapasite skalası uygulandı. Hastalar klinik ve elektrofiyolojik incelemelerine göre evrelendirildiler. Bulgular: Hastaların yaş ortalaması 44.09 ± 10.97 idi. Elektofizyolojik evreleme ile yaş, cinsiyet, fonksiyonel kapasite ve semptom şiddet derecesi arasında istatistiksel olarak anlamlılık saptanmazken, provakatif testlerden tinel testi pozitifliği ile ağır KTS arasında ve klinik evreleri ile KTS derecesi arasında anlamlı bir ilişki saptandı. Semptom şiddeti ve fonksiyonel kapasitesi, obez hasta grubunda, obez olmayan gruba göre anlamlı olarak daha yüksek bulundu. Obez ve obez olmayan grubun elektrofizyolojik özellikleri karşılaştırıldığında obez grubun median sinir duysal amplitüd değeri anlamlı olarak obez olmayan gruba göre düşük saptandı Sonuç: Obez KTS’li hastaların fonksiyon kaybı ve şiddet semptomlarının, obez olmayanlara göre daha fazla olması, bu hastalarının tedavisinde kilo kontrolünün önemini göstermektedir. Klinik bulgu ile elektrofizyolojik bulguların birbirini desteklemediği durumlarda, dikkatli bir muayene ile hastalık şiddeti hakkında bilgi edinilebileceği, ayrıca tedavinin etkinliğinin değerlendirilmesi ve hastaların takibinde yararlı olacağını düşünüyoruz. Yine hastalık takibinde özellikle fonksiyon kaybının ve şiddet semptomların değerlendirilmesinde uyarıcı testlerinin önemli olduğunu ve muayenemizde rutin olarak yer alması gerektiğini düşünmekteyiz.