Onset Of Carpal Tunnel Syndrome Research Articles

Influence of the thickness of the transverse carpal ligament in carpal tunnel syndrome

ObjectiveTo determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. ResultsNo statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. DiscussionAn increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. ConclusionCarpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.

Influencia del espesor del ligamento transverso del carpo en el síndrome del túnel carpiano

ObjectiveTo determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. ResultsNo statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. DiscussionAn increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. ConclusionCarpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.

Delineation of the mechanisms of tendon gliding resistance within the carpal tunnel

BackgroundForceful, high-velocity, and repetitive manual hand tasks contribute to the onset of carpal tunnel syndrome. This study aimed to isolate and identify mechanisms that contribute to tendon gliding resistance in the carpal tunnel. MethodsEight human cadaver hands (four pairs) were used. Tendon gliding resistance (force, energy, and stiffness) was measured under different conditions: with intact and with divided subsynovial connective tissue, at 2mm/s and 60mm/s tendon excursion velocity, and with and without relaxation time before tendon excursion. ResultsSubsynovial connective tissue stretching substantially contributed to increased gliding resistance force and energy during higher tendon excursion velocities, and subsynovial connective tissue stiffening was observed. Poroelastic properties of the tendon (and possibly the subsynovial connective tissue) also appear to be involved because relaxation time significantly increased gliding resistance force and energy (P<0.01), and the difference in energy and force between high- and low-velocity tendon excursions increased with relaxation time (P=0.01 and P<0.01). Lastly, without relaxation time, no difference in force and energy was observed (P=0.06 and P=0.60), suggesting contact friction. InterpretationThese findings are consistent with the hypothesis that the mechanics of tendon motion within the carpal tunnel are affected by the integrity of the subsynovial connective tissue. While not tested here, in carpal tunnel syndrome this tissue is known to be the fibrotic, thickened, and less-fluid-permeable. An extrapolation of our findings suggests that these changes in the subsynovial connective tissue of carpal tunnel syndrome patients could increase contact friction and carpal tunnel pressure.

Morphologic and functional evaluation of the carpal tunnel syndrome before and after treatmen

Background . The carpal tunnel is defined as the space deep to the transverse carpal ligament. The transverse carpal ligament extends medially from the hook of hamate and the triquetrum to the scaphoid and the trapezium laterally. The carpal tunnel is bordered posteriorly by the carpal bones. Within this narrow space, is not only the median nerve, but also nine flexor tendons. Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It’s related to compression of the median nerve (MN), which results in pain, numbness, and tingling. Among the potential factors that may contribute to the onset of CTS, repetitive maneuvers, trauma, pregnancy, sex and age seem to be the most frequent causes. It is more common in females with an average ratio F: M 3,8:1 and the most represented age of onset is between 50 and 59 yrs. Diagnostic tests are based on physical examination, electrodiagnostic tests (EDTs) (nerve conduction studies and electromyography) and imaging techniques such as ultrasound (US). The use of US provide additional valuable anatomical information to that obtained from clinical tests and EDTs. Aim . The purpose of this study was to perform a morphological analysis of the carpal tunnel using US and to correlate the data obtained with clinical and functional evidences. Furthermore, another aim was to assess the morphologic changes, by imaging techniques, after beginning treatment. Materials and methods . Patients with clinical and EDTs evidence of CTS were enrolled. Patients with a history of other conditions associated with neuropathy (such as diabetes mellitus, hypothyroidism, chronic renal failure, etc.) were not included. Before starting treatment, every patient was administered a questionnaire for pain, visual analogue scale (VAS). Ultrasound was performed to evaluate all morphological features of carpal tunnel syndrome: cross-sectional area, hypervascularity and hypoechoic of median nerve, flexor muscles and tendons. Results and conclusion . Our results show changes in cross sectional area of median nerve, in sensory latency and in the VAS score before and after starting treatment. Ultrasonography is useful in the evaluation of soft tissues of the carpal tunnel and the median nerve; this technique has increased in its sensitivity and specificity: an increasing number of studies have supported early suggestions that measurement of the cross-sectional area and morphology of the median nerve with high-resolution sonography compares favorably with physical examination alone; thus, this technique is proving to be a useful tool for diagnosis.

Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel

Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3kPa, α=8.5 for the superficial tendons, μ=39.4kPa, α=9.2 for the deep tendons, μ=24.9kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome.

The Effect of Long-Distance Bicycling on Ulnar and Median Nerves

Background Distal ulnar neuropathies have been identified in cyclists because of prolonged grip pressures on handlebars. The so-called cyclist palsy has been postulated to be an entrapment neuropathy of the ulnar nerve in the Guyon canal of the wrist. Previous studies utilizing nerve conduction studies have typically been either case reports or small case series. Hypothesis Electrophysiologic changes will be present in the ulnar and median nerves after a long-distance multiday cycling event. Study Design Cohort study; Level of evidence, 2. Methods A total of 28 adult hands from 14 subjects underwent median and ulnar motor and sensory nerve conductions, which were performed on both hands before and after a 6-day, 420-mile bike tour. A ride questionnaire was also administered after the ride, evaluating the experience level of the cyclist, equipment issues, hand position, and symptoms during the ride. Results Distal motor latencies of the deep branch of the ulnar nerve to the first dorsal interosseous were significantly prolonged after the long-distance cycling event. The median motor and sensory studies as well as the ulnar sensory and motor studies of the abductor digiti minimi did not change significantly. Electrophysiologic and symptomatic worsening of carpal tunnel syndrome was observed in 3 hands, with the onset of carpal tunnel syndrome in 1 hand after the ride. Conclusion Long-distance cycling may promote physiologic changes in the deep branch of the ulnar nerve and exacerbate symptoms of carpal tunnel syndrome.

A Longitudinal Study of Industrial and Clerical Workers: Incidence of Carpal Tunnel Syndrome and Assessment of Risk Factors

This study followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome (CTS). The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS. This prospective study followed 432 industrial and clerical workers over 5.4 years. Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening. On the basis of logistic regression, significant predictors for CTS include baseline median-ulnar peak latency difference, a history of wrist/hand/finger tendonitis, a history of numbness, tingling, burning, and/or pain in the hand, and work above the action level of the peak force and hand activity level threshold limit value. This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS.

Cystic radio-lucency of carpal bones in haemodialysis patients An early indicator of the onset of carpal tunnel syndrome

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radiolucency of carpal bones in 35% of the hands. Radiographs were classified into three groups: Group A—cyst growing, Group B—cyst not growing, and Group C—cyst absent. The prevalence of carpal tunnel syndrome was 100% ( 27 27 ) in Group A, 5.6% ( 1 18 ) in Group B, and 6.5% ( 6 93 ) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.

Current Perception Threshold Screening for Carpal Tunnel Syndrome

Screening for the onset of carpal tunnel syndrome (CTS), which is associated with excess ergonomic stresses of the wrist and hand, is a major concern in occupational medicine. CTS questionnaires, physical examinations, and quantitative sensory function determination through neuroselective current perception threshold (CPT) measurements were obtained from the median digital nerves of 16 assembly line workers who were symptomatic with hand pain. Median nerve evaluations by CPT detected sensory abnormalities in 75% of the workers, and abnormalities in 50% of the workers were detected by clinical evaluations (p less than .05, df = 22). CPT abnormalities were characterized as "hypoesthetic" in 25% and hyperesthesic in 42% of the workers. The noninvasive, nonaversive CPT technique provided sensitive and easily obtained quantitative measures. Regular use of this procedure in the occupational setting may assist in preventing the development of advanced CTS for it provides early detection of median nerve abnormalities.

HIGHER INCIDENCE OF CARPAL TUNNEL SYNDROME IN OOPHORECTOMIZED WOMEN

To determine whether the hormonal changes of the menopause are related to the onset of carpal tunnel syndrome (CTS), 53 healthy women, younger than 44 years, and subjected to bilateral oophorectomy between 1 and 4 years before the study, were evaluated. Seventy healthy menstruating women matched for age were used as controls. In those complaining of symptoms and presenting signs suggestive of CTS, sensory and motor nerve conduction studies were done. In the oophorectomized group, 17 of 53 (32%) had clinical CTS, while only seven of 70 of the control group (10%) did so (relative risk for the oophorectomized group = 4.25; 95% confidence intervals 1.47 and 12.61). The nerve conduction studies were abnormal in 14 of 16 oophorectomized women (87.5%), and in only one of seven of the control group (14.2%; P less than 0.002). Symptoms tended to be milder in the controls. Symptoms developed in the first year after oophorectomy in 14 of the 17 women with CTS. This suggests that women develop CTS after oophorectomy more frequently than controls.