Pathogenesis Of Carpal Tunnel Syndrome Research Articles

Association Between Thenar Musculature and Carpal Tunnel Syndrome.

Background: Dynamic forces acting on the transverse carpal ligament (TCL) may influence the mechanics of the carpal tunnel (CT), thus affecting the occurrence of CT syndrome (CTS). Previous studies demonstrated an association between muscle overlying the CT and the diagnosis of CTS. Understanding the location of insertion/origin of the thenar musculature will allow mechanical analysis of the forces applied to the TCL during performance of individual tasks. Our purpose was to determine the location of muscle overlying the CT on magnetic resonance imaging (MRI) in CTS and controls. Methods: Case-control study of 21 normal adult wrist MRI scans. MRI measurements were performed on an axial cut at the level of the hook-of-hamate. Median nerve cross-sectional area (CSA), median nerve shape and increased signal intensity within the CT were associated with CTS. The amount and length of muscle crossing the midline and the CT on the same cut was measured and the association with the occurrence of CTS was analysed. Results: We found an inverse relationship between the amount of muscle crossing the midline and the size of the CT, and a direct relationship with occurrence of CTS p less than 0.01, but no differences regarding length of muscle crossing the midline. Conclusions: This study supports an association between the thenar musculature location relative to the CT and the predictors of CTS on MRI. Since the location of muscle origin/insertion is variable, their effect may differ accordingly, therefore, further study is needed to describe the exact location of origin/insertion and its differential dynamic or static effect on the pathogenesis of CTS. Level of Evidence: Level IV (Diagnostic).

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 >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.

Ultrasound measurement of subsynovial connective tissue thickness in the carpal tunnel: An intrarater/interrater reliability and agreement study

ObjectivesNon-inflammatory thickening of the subsynovial connective tissue (SSCT) in the carpal tunnel is commonly found in subjects with carpal tunnel syndrome (CTS), and quantification may shed light on CTS pathogenesis. To date, information on the reliability of ultrasound quantification of SSCT is scarce. Therefore, we investigated intrarater and interrater reliability/agreement for ultrasound quantification of SSCT thickness in subjects with and without CTS, and predictors for tissue thickness. Material and methodsTwo investigators quantified SSCT thickness and thickness ratio on ultrasound in 16 healthy subjects (age, 24–65 years; 16 left/14 right wrists) and 17 subjects with CTS (age, 37–83 years; 14 left/14 right wrists). Intra- and inter-rater reliability/agreement were assessed on intraclass correlation coefficients, standard error of measurement and minimal detectable change. A mixed-effects model was used to evaluate potential predictors for SSCT thickness. ResultsIntra- and inter-rater reliability analysis showed good to excellent intraclass correlation coefficients in both groups, ranging from 0.772 to 0.965. The maximum percentage standard error of measurement was 8%. The maximum minimal detectable change was 14% within raters, and 20% between raters. Both intra- and inter-rater reliability values for thickness ratio were poor. Presence of CTS (ß = 0.180; p = 0.015) correlated positively with SSCT thickness. ConclusionsUltrasound is a reliable method for quantification of SSCT thickness, but not for thickness ratio. Presence of CTS correlates positively with SSCT thickness.

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.

Measurement of the median nerve strain within the carpal tunnel using a capacitance-type strain sensor: A cadaver study

BackgroundDirect and quantitative measurement of median nerve strain within the carpal tunnel has been difficult because of the technical limitations associated with conventional devices. We used capacitive sensors (C-stretch), which are thin and flexible, to measure the median nerve strain within the carpal tunnel. MethodsWe used 12 fresh frozen upper extremity specimens. The transverse carpal ligament was left in situ, and we attached the sensor to the palmar surface of the median nerve to measure the nerve strain at 60 degrees of wrist extension. The sensor measured the median nerve strain at both the carpal tunnel site and the proximal to the carpal tunnel site before and after the carpal tunnel release. The amount of nerve excursion during wrist extension was also measured with the length change of the attached suture by a digital caliper. FindingsThe mean median nerve strain within the carpal tunnel [8.07% (95 %CI:7.17–8.97)] was significantly higher than that proximal to the carpal tunnel [5.21% (95 %CI:4.46–5.97)] at the wrist extension. There was no significant difference of the mean nerve excursion within and proximal to the carpal tunnel. The mean nerve strain and excursion were unaffected by carpal tunnel release. InterpretationThese results indicated that wrist extension position might lead to increased strain on the median nerve within the carpal tunnel compared with at the proximal to the carpal tunnel. We believe that the current study might provide new information and help us understand the pathogenesis of carpal tunnel syndrome.

Pathophysiology, Diagnosis, Treatment, and Genetics of Carpal Tunnel Syndrome: A Review.

Carpal tunnel syndrome (CTS) is a common peripheral canalicular nerve entrapment syndrome in the upper extremities. The compression of or injury to the median nerve at the wrist as it passes through a space-limited osteofibrous carpal canal can cause CTS, resulting in hand pain and impaired function. The present paper reviews the literature on the prevalence, pathology, diagnosis, treatment, and risk factors of CTS in conjunction with the role of genetic factors in CTS etiology. CTS diagnosis is primarily linked with clinical symptoms; still, it is simplified by sophisticated approaches such as magnetic resonance imaging and ultrasonography. CTS symptoms can be ameliorated through conservative and surgical strategies. The exact CTS pathophysiology needs clarification. Genetic predispositions to CTS are augmented by various variants within genes; however, CTS etiology could include risk factors such as wrist movements, injury, and specific conditions (e.g., age, body mass index, sex, and cardiovascular conditions). The high prevalence of CTS diminishes the quality of life of its sufferers and imposes costs on health systems, hence the significance of research and clinical trials to elucidate CTS pathogenesis and develop novel therapeutic targets.

A genome-wide meta-analysis identifies 50 genetic loci associated with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and has a largely unknown underlying biology. In a genome-wide association study of CTS (48,843 cases and 1,190,837 controls), we found 53 sequence variants at 50 loci associated with the syndrome. The most significant association is with a missense variant (p.Glu366Lys) in SERPINA1 that protects against CTS (P = 2.9 × 10−24, OR = 0.76). Through various functional analyses, we conclude that at least 22 genes mediate CTS risk and highlight the role of 19 CTS variants in the biology of the extracellular matrix. We show that the genetic component to the risk is higher in bilateral/recurrent/persistent cases than nonrecurrent/nonpersistent cases. Anthropometric traits including height and BMI are genetically correlated with CTS, in addition to early hormonal-replacement therapy, osteoarthritis, and restlessness. Our findings suggest that the components of the extracellular matrix play a key role in the pathogenesis of CTS.

The Morphological and Dynamic Changes of Ultrasound in the Evaluation of Effects of Oral Steroids Treatment for Patients with Carpal Tunnel Syndrome.

The role of oral steroids in carpal tunnel syndrome (CTS) remains elusive. This study aims to depict the ultrasound findings and conceivable mechanisms in relation to the efficacy of oral steroids for patients with CTS by measuring the morphological and motion changes in the median nerve. In this study, CTS patients were randomized to the oral steroid group (14 participants and 22 wrists) or nicergoline group (22 participants and 35 wrists) for 4 weeks. Both treatment arms were given global symptom score (GSS) measurements and completed an ultra-sound at baseline and at 2- and 4-weeks post-treatment. In the nerve conduction study (NCS), distal motor latency (DML) was used to assess the treatment response at baseline and 4 weeks post-treatment. The cross-sectional area (CSA) and amplitude (AMP) evaluated by the maximum lateral sliding displacement represented the morphological and dynamic changes in the median nerve, respectively. The results showed that AMP, CSA, GSS, and DML were significantly im-proved in the steroid group, as compared to the nicergoline group at weeks 2 and 4 (p < 0.05). The mean improvement in ultrasound parameters CSA (15.03% reduction) and AMP (466.09% increase) was better than the DML (7.88% reduction) parameter of NCS, and ultrasound changes were detectable as early as 2 weeks after oral steroid administration. Ultrasounds can serve as a tool for the quantitative measurement of treatment effects and can potentially elucidate the pathogenesis of CTS in a non-invasive and more effective manner.

Evaluation of Functional and Symptomatic Outcomes After Vitamin D3 Administration in Carpal Tunnel Syndrome With Hypovitaminosis D.

Vitamin D deficiency is now recognized as an independent risk factor and is involved in the pathogenesis of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the effects of vitamin D3 supplementation on functional and symptomatic outcomes in CTS patients with vitamin D deficiency. This was a prospective, single-arm study with a pretreatment or posttreatment quasi-experimental design. Carpal tunnel syndrome patients with vitamin D deficiency were treated with vitamin D3 (60 000 IU/week) plus standard treatment for a period of 3 months. Carpal tunnel syndrome-related pain and functional and symptomatic outcomes were assessed at baseline and at 3 months posttreatment using the Visual Analogue Scale (VAS) and the Boston Carpal Tunnel Questionnaire, respectively, along with serum vitamin D. A total of 42 patients were analyzed. At 3 months posttreatment, there was a significant reduction in the severity of pain (VAS score) from baseline (Z = -5.71, P < .001). Similarly, the functional and symptomatic outcomes (Boston symptoms severity scale [SSS] and Boston functional status scale [FSS] score) at 3 months posttreatment significantly improved in comparison with baseline (Boston SSS: Z = -5.66, P < .001; Boston FSS: Z = -5.68, P < .001). Vitamin D3 supplementation was associated with improvement in functional and symptomatic outcomes and CTS-related pain in CTS with vitamin deficiency. However, further robust randomized controlled trials are warranted to validate the results.

Karpal Tünel Sendrom Cerrahisinde Tenosinovektominin Hasta Sonuçlarina Etkisi

INTRODUCTION: Carpal tunnel syndrome (CTS) is estimated to be the most frequently seen mononeuropathy, needing surgical intervention. Its prevalence is known to range between 1, and 3 percent. The components contained in this tunnel are the median nerve, four deep digital flexor tendons, as well as four superficial flexors and the tendon of flexor pollicis longus. Between the tendons and bursae an anatomical structure is present called subsynovial connective tissue (SSCT). SSCT absorbs and transmits stress between tendons and the median nerve and it functions as a scaffold for vascular elements. To find out the role of compression or pathologic proliferation of SSCT in the pathogenesis of CTS, we aimed to conduct a study about the surgical technique of this pathology and compared the long- term results of patients operated with or without SSCT excision in our neurosurgery clinic. METHODS: Between 2003 and 2019 we operated 1279 patients at our neurosurgery clinic. Among them 250 patients who had SSCT excision (syn+) were chosen and they were compared with other 250 patients operated without SSCT excision (Syn-). RESULTS: All patients were evaluated preoperatively and 12 months postoperatively based on the results of Boston Carpal Tunnel Syndrome Questionnaire. When pre-, and post-operative results were compared, we didn’t observe a statistically significant intergroup difference. DISCUSSION AND CONCLUSION: Although our primary goal in patients in whom we performed excision of tenosynovium is to relieve the median nerve by increasing decompression, we observed that there was no difference between the two groups in this large-scale study. We think that only liberation of the transverse carpal ligament during surgery will be sufficient.

Quantitative Evaluation of the Echo Intensity of Paraneural Area and Myofascial Structure around Median Nerve in Carpal Tunnel Syndrome.

The aim of this study was to investigate whether the echo intensity (EI) of the paraneural area (PA), the median nerve (MN) at the carpal tunnel, the EI of the myofascial structure (MS) around MN, the ‘PA and MN’ at the mid-forearm, and the MN transversal displacement at both sites differs between persons with carpal tunnel syndrome (CTS) and control subjects. Methods: In total, 16 CTS patients and 16 controls, age- and gender-matched, were recruited. Cross-sectional ultrasound images of MN were obtained to evaluate the EI of the PA, the MN at carpal tunnel, the EI of MS, and the ‘PA and MN’ at the mid-forearm in a natural position, then images were taken after a whole-hand grasp movement, to evaluate MN transversal displacement. Inter-rater and intra-rater reliability in control, and differences in the EI and MN displacement between CTS and control, were analyzed. In addition, the correlations between ultrasound parameters and MN displacement were evaluated. Results: The quantitative EI of PA, MN, EI of MS, ‘PA and MN’ had high inter-rater and intra-rater reliability in the control. The EI of PA, MS and ‘PA and MN’ were significantly higher in CTS subjects (p < 0.01), whilst there was no significant difference in the EI of MN at the carpal tunnel. MN displacement was significantly decreased both at the carpal tunnel and the mid-forearm in CTS subjects (p < 0.01). In addition, there were negative correlations among the EI of PA (rs = −0.484, p = 0.004), EI of MS (rs = −0.479, p = 0.002), EI of ‘PA and MN’ (rs = −0.605, p < 0.001) and MN transversal displacement. Conclusions: The higher EI of PA and MS around MN in CTS may indicate greater fibrosis along the course of MN, reducing fascial adaptability, influencing the synergy and coordination of the MS, and increasing the shear stress between MS and MN, and it may further increase the abnormal pressure on the MN not only at the carpal tunnel, but also at the mid-forearm. These results may partly explain the role of PA and MS in CTS pathogenesis.

Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.

The Influence of Transverse Carpal Ligament Thickness on Treatment Decisions for Idiopathic Mild to Moderate Carpal Tunnel Syndrome.

The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. In addition, the effect of TCL properties on the progression course of idiopathic CTS is unknown.Therefore, we hypothesized that TCL thickness, measured using ultrasonography, would influence the results of conservative treatment for CTS patients with mild to moderate symptoms. We aimed to investigate the relationship between the ultrasound-measured TCL thickness and idiopathic carpal tunnel conservative treatment surgery rate. We analyzed the wrists of 127 patients with mild to moderate symptoms of CTS. The patients were diagnosed on the basis of electrophysiological assessment outcomes, median nerve cross-sectional area in the carpal tunnel, and clinical symptoms. The Boston carpal tunnel questionnaire score was also measured. Patients with a TCL thinner than 1.5 mm were classified into group A (n = 62), and those with a TCL thicker than 1.5 mm were classified into group B (n = 65). Patients with severe symptoms or other diseases were excluded. The patients were initially treated with night splinting after diagnosis. If symptoms were not ameliorated, steroid injection and surgical treatment were performed consecutively. The procedures were determined by a single surgeon. The mean TCL thickness was 1.51 mm: 0.98 mm in group A and 2.28 mm in group B. The percentages of patients who underwent surgery were 43.0% in group A and 67.7% in group B. Group B was 1.77 times more likely to have surgery, and the interval between diagnosis and surgery and/or steroid injection was shorter. The TCL thickness in group B was also related to cross-sectional area and symptom duration. Transverse carpal ligament thickness affects disease progression and may affect treatment efficacy, depending on the treatment method. Transverse carpal ligament thickness may be a criterion for deciding between surgical and conservative treatments based on a thickness threshold of 1.5 mm.

Mutations in COMP cause familial carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, affecting a large proportion of the general population. Genetic susceptibility has been implicated in CTS, but the causative genes remain elusive. Here, we report the identification of two mutations in cartilage oligomeric matrix protein (COMP) that segregate with CTS in two large families with or without multiple epiphyseal dysplasia (MED). Both mutations impair the secretion of COMP by tenocytes, but the mutation associated with MED also perturbs its secretion in chondrocytes. Further functional characterization of the CTS-specific mutation reveals similar histological and molecular changes of tendons/ligaments in patients’ biopsies and the mouse models. The mutant COMP fails to oligomerize properly and is trapped in the ER, resulting in ER stress-induced unfolded protein response and cell death, leading to inflammation, progressive fibrosis and cell composition change in tendons/ligaments. The extracellular matrix (ECM) organization is also altered. Our studies uncover a previously unrecognized mechanism in CTS pathogenesis.

Ozone Therapy in Idiopathic Carpal Tunnel Syndrome. Biochemical, Neurophysiological and Clinical Aspects [abstract

PURPOSE: Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy.&#x0D; The aim of the paper was to design a prospective study to evaluate clinical and neurophysiological outcome following Ozone Therapy .&#x0D; We also focusing the attention on the evidences concerning the role of Subsynovial Connective Tissue (SSCT )in the pathogenesis of CTS and the ozone pre-conditioning effects linked to pain pathways and to fibrosis induced by Ischemia-Reperfusion Injury.&#x0D; &#x0D; MATERIALS and METHODS: Thirty-one patients, aged between 36 and 86 23 women and 8 men), were stratified clinically by Boston Carpal Tunnel Questionnaire (B.C.T.Q.) and Neurophysiologically by Padua’s Gravity Scale classifying patients into five Electro-myographic categories (Minimal, Slight, Moderate, Severe and Extreme) . The mean symptom duration was also recorded.&#x0D; The patients included in the B.C.T.Q. underwent diagnostic neurophysiological tests, strictly standardized in stimulation parameters, electrodes distances and skin temperature, before and after treatment.&#x0D; The Ozone Therapy was performed by injecting 4 ml of O3-O2 mixture at 10 mcrg/mL concentration under the transverse carpal ligament twice a week for eight sessions.&#x0D; &#x0D; RESULTS: We compared the B.C.T.Q. scores and the neurophysiological parameters obtained before and after O2-O3 treatment: the improvement of symptoms was significantly greater than the improvement of motor and sensory nerve conduction.&#x0D; The highest clinical improvement degree was found in patients classified in Slight and Moderate Groups.&#x0D; &#x0D; DISCUSSION: Chemical mediators, neo-angiogenesis and Ischemia-Reperfusion Injury lead to oxidative stress and non-inflammatory fibrosis that play a central role at various stages in CTS pathogenesis that can be recognized by clinical and neuro-physiological tests.&#x0D; Further studies have to be carried out to better understand these relationships and optimize timing of Ozone Therapy.

Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study.

This study investigated the connections between the median nerve paraneural sheath and myofascial structures near it, from both macroscopic and microscopic points of view. Four samples of median nerve and surrounding tissues were excised from nine non-embalmed upper limbs for microscopic analysis. Ultrasound images were analysed in 21 healthy subjects and 16 carpal tunnel syndrome patients to evaluate median nerve transversal displacement during finger motion at carpal tunnel and forearm levels. An anatomical continuity between epimysium and paraneural sheath and a reduction of paraneural fat tissue from proximal to distal was found in all samples. Median nerve displacements at both levels were significantly reduced in carpal tunnel syndrome subjects (P<0.001). It was observed that the median nerve is not an isolated structure but is entirely connected to myofascial structures. Therefore, unbalanced tension of epimysial fasciae can affect the paraneural sheath, limiting nerve displacement, and consequently this must be included in carpal tunnel syndrome pathogenesis.

A genome-wide association analysis identifies 16 novel susceptibility loci for carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common and disabling condition of the hand caused by entrapment of the median nerve at the level of the wrist. It is the commonest entrapment neuropathy, with estimates of prevalence ranging between 5–10%. Here, we undertake a genome-wide association study (GWAS) of an entrapment neuropathy, using 12,312 CTS cases and 389,344 controls identified in UK Biobank. We discover 16 susceptibility loci for CTS with p < 5 × 10−8. We identify likely causal genes in the pathogenesis of CTS, including ADAMTS17, ADAMTS10 and EFEMP1, and using RNA sequencing demonstrate expression of these genes in surgically resected tenosynovium from CTS patients. We perform Mendelian randomisation and demonstrate a causal relationship between short stature and higher risk of CTS. We suggest that variants within genes implicated in growth and extracellular matrix architecture contribute to the genetic predisposition to CTS by altering the environment through which the median nerve transits.

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a well-known, most commonly diagnosed compressive neuropathy and makes up 90% of all neuropathies and is present in the general population at the rate of 3.8%. It is caused by median nerve (MN) damage in the area of the carpal tunnel, restricted by the carpal bones and the transverse carpal ligament. CTS is classified as idiopathic and secondary. Pathogenesis of CTS is complex and includes compression and traction of MN in the carpal tunnel area, and is still not fully clarified. Many clinical tests, electromyoneurography, ultrasonic diagnostics and magnetic resonance imaging are used in diagnostics of CTS. The treatment of CTS can be conservative and surgical. Conservative treatment is recommended for patients with mild to moderate levels, while surgical treatment (MN decompression) is performed in patients with severe impairment. The aim of this review is to show the latest findings related to that clinical syndrome, and to motivate clinicians to speed up diagnosis and treatment. The findings 2are based on the latest results of system reviews and meta-analysis.

Ozone therapy in idiopathic carpal tunnel syndrome. Biochemical, neurophysiological and clinical aspects.

Purpose.&#x0D; Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy; however few and only retrospective studies have been found in search engines about Ozone Therapy. &#x0D; The aim of this paper was to evaluate clinical and neurophysiological outcome following Ozone Therapy in CTS.&#x0D; We focused the attention on the evidences concerning the role of Subsynovial Connective Tissue (SSCT) in the pathogenesis of CTS and the ozone pre-conditioning effects linked to pain and inflammatory pathways and to fibrosis induced by Ischemia-Reperfusion Injury.&#x0D; &#x0D; Materials and methods.&#x0D; Thirty-five patients, aged between 21 and 80, were stratified clinically by Boston Carpal Tunnel Questionnaire (B.C.T.Q.) and Neurophysiologically by Padua’s Gravity Scale classifying patients into five Electro-myographic categories. The mean symptom duration was also recorded.&#x0D; The patients filled in the B.C.T.Q. before and after treatment as well underwent diagnostic neurophysiological tests, strictly standardized in stimulation parameters, electrodes placement and skin temperature.&#x0D; The Ozone Therapy was performed by injecting 4 ml of O2-O3 mixture at 10 ug/ml concentration under the transverse carpal ligament twice a week for eight sessions. &#x0D; &#x0D; Results.&#x0D; We compared the B.C.T.Q. scores and the neurophysiological parameters obtained before and after O2-O3 treatment: the improvement of symptoms was significantly greater than the improvement of motor and sensory nerve conduction.&#x0D; The highest clinical improvement degree was found in patients classified in Mild and Moderate Groups.&#x0D; &#x0D; Discussion and Conclusion.&#x0D; Ischemia-Reperfusion Injury triggers oxidative stress in SSCT with activation of chemical mediators and neo-angiogenesis leading to non-inflammatory fibrosis that represent the allmark of CTS.&#x0D; Previous and retrospective studies based O2-O3 treatment on the main mechanisms of action shared by the treatment of herniated disc in the spine; our study focused the attention on pathophysiology of the SSCT trying to recognize the various stages of CTS pathogenesis by correlating with clinical and neuro-physiological tests.&#x0D; Further studies have to be carried out to better understand these relationships and optimize timing of Ozone Therapy.

Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study

Introduction: Carpal Tunnel Syndrome (CTS) is the most common hand problem affecting 1-3% of the population (Atroshi et al 1999), while recurrence of CTS following surgery is reported to be between 7-20% (Jones et al 2012). However, the relationship between the fasciae around the median nerve (MN) and pathogenesis is unknown. The aim of this study was to investigate the connection between myofascial structure, epineurium, and paraneural sheath of MN to evaluate a possible role of fascia in the pathogenesis of CTS.