Peripheral Nerve Entrapment Syndromes Research Articles

Assessing the efficacy of medical vs surgical approaches for treating carpal tunnel syndrome: Systematic review

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome that is caused by compression of the median nerve at the wrist joint causing variety of signs and symptoms. There are several measures to treat CTS including surgical and non-surgical approaches. Objectives: this systematic review aims to compare and evaluate the efficacy of conservative (non-surgical) and surgical approaches in treatment of CTS. Methods: Using predefined keywords related to this condition, an extensive search of medical databases, including PubMed and Cochrane library, was carried out to find and select randomized controlled clinical trials evaluating the effects of conservative treatment compared to surgical treatment released up to August 2023. The quality of the included research was rigorously evaluated, and data were extracted. After reviewing pertinent papers for relevance and quality, data was gathered for analysis. Key outcome measures included pain reduction and functional improvement

Protocol for a double-blinded randomised controlled trial investigating the use of adjunct bicarbonate in carpal tunnel release: a single-centre study

IntroductionThis study aims to compare the effectiveness of buffered and non-buffered long-acting local anaesthetics in pain relief during and after carpal tunnel release (CTR) surgery. Carpal tunnel syndrome (CTS) is...

Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis; Superb Microvascular Imaging Findings

Abstract Background It is well known that the carpal tunnel syndrome (CTS) is the most widespread peripheral nerve entrapment syndrome throughout the world. CTS can also be seen more often in rheumatic disease, especially in psoriatic arthritis (PsA). Usage of ultrasonography to diagnose CTS has been the subject of investigations for many years. Superb microvascular imaging (SMI) is a newly developed ultrasonographic technique to visualise vascularity. More recently, there have been some studies on the diagnosis of CTS with SMI. However, a review of the literature reveals that there there has been no study on the diagnosis of CTS in PsA. This is the subject of the present report, where we evaluate the diagnostic value of SMI in CTS in patients with PsA. Materials and methods 30 PsA patients (56 wrists) and 26 healthy volunteers (52 wrists) were examined in the study. Demographic and clinical features were recorded carefully. All participants underwent a standard electrodiagnostic study (EDS) and ultrasonographic examination within a maximum of one week. CTS was diagnosed using EDS. The vascularity of the median nerve was examined using a new ultrasonographic technique. SMI signals were graded from 0 to 3. Results There were no significant differences between groups, with respect to their age, gender, body mass index, smoking status, and hand dominance. Although CTS was diagnosed in 9 patients (14 wrists) in the PsA group, CTS was not diagnosed for any patient in the control group (p=0.002). The blood flow display ratio of SMI in the median nerve was markedly higher in CTS patients than with controls (median (25th, 75th percentile): 2(0.75, 2), 1(0, 2); p=0.014; respectively) or compared with CTS-free PsA patients (2(0.75, 2), 1(0, 2); p=0.030; respectively). There was no remarkable difference between PsA patients and healthy controls with respect to the median nerve’s blood flow display ratio (median (25th, 75th percentile): 1(0, 2), 1(0, 2); p=0.164; respectively). Conclusion To the best our knowledge, this is the first study assessing SMI in the diagnosis of CTS in PsA patients. We concluded that SMI has important diagnostic value in PsA patients for diagnosing CTS.

Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome in the upper extremities. Acupuncture is often used as a treatment method in CTS and numerous studies consider it effective. However, no study has yet compared the efficacy of physical therapy including bone and neural mobilization, exercise and electrotherapy with and without acupuncture in CTS patients.Purpose: comparing the effect of physiotherapy plus acupuncture with physiotherapy alone on pain, disability and grip strength in CTS patients. MethodForty patients with mild to moderate CTS were randomly divided into two equal groups. Both groups received exercise and manual techniques for 10 sessions. Patients in the physiotherapy plus acupuncture group also received 30 min of acupuncture in every session. The visual analog scale (VAS) score, the score on the Boston carpal tunnel questionnaire for functional status and symptom severity, shortened disability of arm, shoulder, hand (Quick-DASH) score and grip strength were evaluated at pre-test and post-test. ResultsAccording to ANOVA results, there is a significant interaction between group and time for VAS, BCTQ and Quick-DASH parameters. At the post-test, while the parameters of VAS, BCTQ and Quick-DASH in the physiotherapy plus acupuncture group had a statistically significant difference compared to the physiotherapy group, no significant difference was observed between the two groups in the pre-test. Moreover, there is no significant difference between groups in grip strength improvement. ConclusionThis study shows preliminary evidence that physiotherapy plus acupuncture, was more effective than physiotherapy alone in pain relief and improving disability of patients suffering from CTS.

The Use of Amniotic membrane in Carpal Tunnel Syndrom, a Cadaver Study

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome worldwide. Even after surgery in 2-25% of patients symptoms persist. Most commonly the carpal tunnel was not completely released. In the other cases perineural scarring is causing recurrent compression of the nerve. The literature states different treatment options including “nerve wraps,” made out of autologous veins or synthetic materials, to protect the nerve from scarring. The human amniotic membrane (HAM) has been proven to express anti-inflammatory and anti-fibrotic properties, without causing a immune reaction. In a rat model it has been shown that nerve gliding could be improved by the application of HAM after introducing a fibrotic scar. The application of HAM in CTS and it´s possible influence on nerve gliding has been examined. Materials and Methods: Fourteen (7 female, 7 male) fresh body donors were dissected. The carpal tunnel was released and a nerve wrap out of HAM was sutured around the median nerve with continuous stitches (7-0). The position of the HAM was measured and the skin was closed (3-0) Next the arm was moved according to a protocol, creating a largest possible movement of the nerve. The position was again evaluated. This was done after 25, 50, 100, 150, 200, 250 movement cycles. Results: The HAM on the median nerve did not change its position significantly between the timepoints. From the beginning to the end of the movements it contracted and reduced its size to about 92% of its starting length. The evaluation of the gliding properties is still in progress. Conclusion: The HAM showed to stay in place and only minor contract on both ends in the carpal tunnel. The application of HAM in the carpal tunnel worked well without any complications and can be seen as feasible treatment method for recurrent carpal tunnel syndrome.

Passive wrist deviation to increase the ultrasound identified procedural safe zone in carpal tunnel syndrome: A retrospective cohort study.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Although prior studies have explored the anatomic changes of the median nerve and carpal arch with different wrist deviations and positionings, the change in safe zone distance between the median nerve and ulnar artery with ulnar or radial wrist deviations has not been adequately investigated. To identify the optimal wrist positioning that increases the safe zone distance between the median nerve and ulnar artery using ultrasound in patients with CTS. Retrospective cohort study. Quaternary medical center multidisciplinary outpatient hand clinic. Twenty five patients (41 wrists) with clinical CTS who received an electrodiagnostic study (EDX) to evaluate CTS within 1 year prior to enrollment. Ultrasound-identified safe zone distance measurements were obtained in each patient between the ulnar aspect of the median nerve and the radial aspect of the ulnar artery with the wrist in neutral radial-ulnar deviation as well as in passive ulnar and radial deviation. The ultrasound-identified safe zone distance with the wrist in each of the three positions. The interstructural safe zone distance was significantly greater when measured in the ulnarly deviated position (1.08 cm) compared with either the neutral (0.61cm, p < .001) or radially deviated positions (0.52 cm, p < .001). Interstructural safe zone distance did not differ between those with normal, mild, moderate, or severe classifications of pathology, or between dominant and nondominant limbs. This study demonstrates that the ultrasound-measured interstructural safe zone distance was significantly greater in the ulnarly deviated position than in either the neutral position or radially deviated position. These findings may lead to improvement in the safety of ultrasound-guided injections.

Work-relatedness of carpal tunnel syndrome: Systematic review including meta-analysis and GRADE.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome with a high prevalence among workers. Insights on the physical work-related risk factors is necessary to develop appropriate preventative methods. The objective of this systematic review, including meta-analyses, is to assess which physical work-related risk factors are associated with carpal tunnel syndrome. Systematic literature searches were carried out using PubMed and Embase until September 6, 2021. Studies were included if: (1) CTS was clinically assessed, (2) the studies were prospective cohort studies, and (3) the exposure was reported using terms of exposed/less or nonexposed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). In total, 9270 patients with CTS from a population of 1,051,707 workers were included from 17 studies. Meta-analyses revealed high-quality evidence for associations between CTS and high exposures to repetition (hazard ratio [HR] 1.87, 95% CI 1.42-2.46), force intensity (HR 1.84, 95%CI 1.22-2.79), exposures above hand activity level of ACGIH (HR 1.75, 95%CI 1.40-2.17), and the Strain Index >10 (HR 1.58, 95% CI 1.09-2.30). No significant associations were found for pinch gripping, hand-arm vibration or force duration. High computer-use exposure was significantly associated with a decreased rate of work-related CTS (HR 0.28, 95% CI 0.12-0.64). This systematic review of prospective cohort studies found high certainty for an increased rate of CTS due to a high Strain Index, exposures exceeding the Activity Level of ACGIH, and high force intensity and high repetition. Workers performing tasks requiring both high force and high repetition even have a higher rate of developing CTS.

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.

EFFICACY OF ULTRASOUND GUIDED CORTICOSTEROID INJECTION IN CARPAL TUNNEL SYNDROME

BACKGROUND : Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The etiology can be hereditary, repetitive movements of the wrist in mechanical workers, injury to the wrist, pregnancy, obesity, metabolic disorders, auto immune conditions such as diabetes mellitus, rheumatoid arthritis and in elderly population. Females are affected more than males. A lot of treatment options are available for carpal tunnel syndrome. Corticosteroid injections are very effective in mild to moderate carpal tunnel syndrome on short and in some cases on long term basis.&#x0D; OBJECTIVES:To evaluate the efficacy and clinical outcomes of ultrasound guided corticosteroid injection for treatment of carpal tunnel syndrome.&#x0D; STUDY SETTING: Department of Orthopedic surgery Services Hospital Lahore .&#x0D; STUDY DESIGN: Cross sectional study.&#x0D; STUDY DURATION: From December 2018 to December 2019 &#x0D; METHODOLOGY: This prospective cross sectional study was carried out from Dec 2018 – Dec 2019 on OPD basis. A total number of 80 patients were included in the study. There were 40 males and 40 females in our study. Each patient was injected triamcinolone 40 mg with 2 % xylocaine. After the injection every patient was followed at 6 weeks, 3 months and at 6 months.&#x0D; At each follow up these patients were assessed by Phalen test, Tinel sign, Boston carpal tunnel syndrome severity score, functional assessment scale, electrophysiological studies and nerve conduction study.&#x0D; RESULTS : Our study included 80 patients with 40 males and 40 females. 40 female patients were housewives, 25 male patients were manual workers and remaining 15 patients were computer operator. 30 patients had mild symptoms of carpal tunnel syndrome, 35 had moderate while the remaining 15 patients had severe symptoms of carpal tunnel syndrome. All these patients were having symptoms for the last 6 – 12 weeks which did not improve with the conservative management. These patients were having symptoms of numbness and tingling at the initial presentation. Phalen test was positive in 95 % (76 patients) patients while Tinel test was positive in 80 % patients ( 64 patients ) at the initial presentation . &#x0D; Boston’s severity symptom score was 35.34 +/- 3.59 and functional status scale was 25.43 + 5.82 (At the initial presentation) in all patients. Following corticosteroid injection at 06 weeks the symptoms severity score was 21+/-3.32 ( mean ) and at 03 months 18.80 + 3.41 ( mean ) in 72 patients while 8 patients did not respond to corticosteroid injection while the functional status scale 17.62 +- 5.01 and 13.45 +- 4.2 at 03 months .&#x0D; Electrophysiological study was also improved after 06 weeks and after 03 months&#x0D; CONCLUSION : Corticosteroid injections are very effective regarding the outcomes on short term basis . However , they are effective in small number of patients on long term basis

Carpal Tunnel Syndrome in Primary Care Settings: What We Should Know

Carpal tunnel syndrome (CTS) remains one of the most common peripheral nerve entrapment syndromes. The patient may experience pain, numbness, and tingling in hand and arm of the affected individual. Treatment for CTS falls under two choices between conservative and surgical therapy. Mild and moderate symptoms are offered to be treated with conservative treatments, including oral and transvenous steroids, vitamin B6, vitamin B12, and corticosteroids injection. A further option is using a surgical procedure with a carpal tunnel release (CTR) by cutting the transverse carpal ligament (TCL) to increase space and relieve the pressure within the tunnel. As there are many cases of CTS worldwide, astute primary care physicians (PCP) must diagnose and choose the right treatment option. Clinicians should acknowledge some basic information about CTS to provide cost-effective and proper treatment. Clinicians can select Conservative treatments before referring the patient to an orthopedic surgeon or neurosurgeon. Failure to respond to conservative therapies is a case that needs hospital referral consideration. Keywords: carpal tunnel syndrome, primary care, primary care physician

Diagnostic value of median nerve shear wave ultrasound elastography in diagnosis and differentiation of carpal tunnel syndrome severity

BackgroundCarpal tunnel syndrome (CTS) is the commonest type of peripheral nerve entrapment syndromes. The study aimed at evaluation of diagnostic value of median nerve stiffness measured by shear wave ultrasound elastography for diagnosis and differentiation of CTS severity, correlated to electrophysiological studies. This case–control study involved 40 patients (56 wrists) with CTS of different severity and 40 controls (40 wrists). All participants underwent electrophysiological study to assess the CTS severity, high-resolution conventional B-mode ultrasound to assess cross-sectional area “CSA” of median nerve at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm, and shear wave ultrasound elastography with measurement of median nerve mean stiffness and correlation to electrophysiological results as the reference standard.ResultsMean median nerve stiffness by shear wave US elastography was increased in patients with CTS compared to controls and across the different CTS severity groups (P value < 0.001 & 0.001, respectively). The cutoff value by ROC curve analysis for median nerve stiffness to differentiate between patients with CTS and control group was 65.4 kPa (P value < 0.001, 94.6% sensitivity, 97.3% specificity). Higher diagnostic accuracy was noted with the combination of shear wave elastography and conventional B-mode US with improved AUC (B-mode + shear wave; 0.962, P value < 0.001).ConclusionsShear wave ultrasound elastography of median nerve was able to discriminate different severity subgroups of CTS with high sensitivity, while conventional US couldn’t. The diagnostic accuracy of CTS was improved when combined high-resolution conventional B-mode US and complementary shear wave ultrasound elastography.

The Effectiveness and Safety of Commonly Used Injectates for Ultrasound-Guided Hydrodissection Treatment of Peripheral Nerve Entrapment Syndromes: A Systematic Review.

Background: Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Ultrasound-guided injection technique using a range of injectates to mechanically release and decompress the entrapped nerves has therefore developed called hydrodissection or perineural injection therapy. Several different injectates from normal saline, local anesthetics, corticosteroids, 5% dextrose in water (D5W), and platelet-rich plasma (PRP) are available and present clinical challenges when selecting agents regarding effectiveness and safety. Aims: To systematically search and summarize the clinical evidence and mechanism of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment. Methods: Four databases, including PubMed, EMBASE, Scopus, and Cochrane were systematically searched from the inception of the database up to August 22, 2020. Studies evaluating the effectiveness and safety of different commonly used injectates for ultrasound-guided hydrodissection entrapment neuropathy treatment were included. Injectate efficacy presents clinical effects on pain intensity, clinical symptoms/function, and physical performance, electrodiagnostic findings, and nerve cross-sectional areas. Safety outcomes and mechanism of action of each injectate were also described. Results: From ten ultrasound-guided hydrodissection studies, nine studies were conducted in carpal tunnel syndrome and one study was performed in ulnar neuropathy at the elbow. All studies compared different interventions with different comparisons. Injectates included normal saline, D5W, corticosteroids, local anesthetics, hyaluronidase, and PRP. Five studies investigated PRP or PRP plus splinting comparisons. Both D5W and PRP showed a consistently favorable outcome than those in the control group or corticosteroids. The improved outcomes were also observed in comparison groups using injections with normal saline, local anesthetics, or corticosteroids, or splinting. No serious adverse events were reported. Local steroid injection side effects were reported in only one study. Conclusion: Ultrasound-guided hydrodissection is a safe and effective treatment for peripheral nerve entrapment. Injectate selection should be considered based on the injectate mechanism, effectiveness, and safety profile.

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.

Effect of extracorporeal shock wave therapy on different severities of carpal tunnel syndrome

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome worldwide.ObjectiveThe current work aimed at determining the effect of extracorporeal shock wave therapy (ESWT) on different severities of carpal tunnel syndrome.Subjects and methodsSixty patients with unilateral carpal tunnel syndrome were participated in this study. They were divided into three equal groups according to severity (mild, moderate, and severe). All patients received shock wave therapy one session per week, for 6 weeks. Nerve conduction studies (NCs) were done for the median nerve. Pinch dynamometer was used to measure the degree of lateral pinch power, and Visual Analogue Scale (VAS) was used to assess degree of pain and Ultrasonography analysis measured cross-sectional area (CSA) of median nerve for all patients at the beginning and at the end of the study.ResultsThere was significant improvement (P < 0.05) in sensory conduction parameters, CSA, lateral pinch power, and VAS after shock wave therapy in all groups. Also, there was significant improvement in motor latency, motor, and sensory amplitudes after shock wave therapy in mild and moderate groups only (P < 0.05). In all group samples, results revealed a highly significant correlations (p < 0.001) between peak sensory latency (PSL) with VAS, CSA with motor latency (ML), CSA with PSL, CSA with VAS, CSA with lateral pinch, and ML with lateral pinch.ConclusionIt is recommended to use ESWT as a conservative treatment in patients with different severities of CTS, except patients with severe motor affection.Trial registrationPACTR201804003293116. Registered on 26 April 2018 as retrospective registration in the pan African clinical trial registry (www.pactr.org).

Incidence of Cubital Tunnel Syndrome in the U.S. Military Population

Cubital tunnel syndrome (CuTS) is the second most common peripheral nerve entrapment syndrome. However, existing epidemiological evidence regarding the estimated incidence of the CuTS disease burden in specific populations is sparse, especially among the U.S. military. The purpose of this study was to describe the demographics and determine the incidence of CuTS among active duty U.S. military service members. All first-time occurrences for CuTS among military members were identified using International Classification of Diseases, Ninth Revision, clinical modification code 354.2 for ulnar nerve lesions in the U.S. Defense Medical Epidemiology Database. A multivariable Poisson regression analysis was used to estimate the incidence rate ratio (IRR) per 1,000 person-years and 95% confidence intervals (95% CI), while controlling for sex, race, age, rank, and service. Rate-ratios were calculated using different referent factors based on differences in sex, race, age, rank, and service branch. During the 10-year study period, the total number of incident cases of CuTS was 31,568, and a total of 13,745,456 person-years were documented. The overall unadjusted IRR of CuTS during the study period was 2.3 per 1,000 person-years (95% CI, 2.27-2.33). The 35- to 39-year age group had the highest adjusted IRR of CuTS. In addition, females, Caucasians, and junior enlisted service members showed significantly higher IRRs. Our study was able to provide baseline epidemiological data on IRRs and influential risk factors in CuTS. We demonstrated an incidence of CuTS that is comparable with previously reported IRRs, which have varied from 0.08 to 8.0 cases per 1,000 person-years. This study also found significantly higher risk for the development of CuTS with increased age and among U.S. Army service members. Prognostic IV.

Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is reveled to be the most common peripheral nerve entrapment syndrome, estimating for 90% of all compressive. The diagnosis of CTS is based on the use of clinical criteria and imaging technique tests such as ultrasonography (US) and magnetic resonance imaging (MRI). US is a time-saving method in the diagnosis of CTS, which induces less discomfort to the patient and may be a more cost-effective approach to confirm clinical suspicion of this syndrome .The current study was aimed to evaluate the value of US and physical examinations in the diagnosis of CTS. This cross-sectional and cross-sectional prospective case study was conducted to evaluate the usefulness of wrist ultrasonography in diagnosing CTS. Twenty one patients (21 wrists) were invited to participate in the study along with an age- and sex-matched group of participant controls. Physical examination included Phalen, Tinel, Durkan, Tourniquet test. Anteroposterior and mediolateral dimension of carpal tunnel, and the median nerve area at the tunnel were also measured. All the patients underwent the open surgical release of the flexor retinaculum. There was a significant statistical relationship (p=0.05) between anteroposterior diameter of the carpal tunnel and clinical and electro physiologic nerve involvement. Furthermore, some qualitative findings was achieved such as median nerve splitting, hypo echogenicity of the involved nerve, thickening of flexor retinaculum and disappearance of median nerve areas (especially mediolateral direction). In conclusion, ultrasonographic examination of the wrists in the patients with suspected clinical symptoms can improve the diagnostic ability of CTS, especially by improving technology and experience. US can be applied for the median nerve area (MNA) measurement as a first line technique in patients with CTS.

Surgical Treatment of Cubital Tunnel in Pediatric Athletes

Background Cubital tunnel syndrome is the second most common upper extremity peripheral nerve entrapment syndrome. In particular, cubital tunnel has been documented occasionally in young, throwing athletes. Materials and Methods Billing databases were searched for patients undergoing surgical decompression of the ulnar nerve at the elbow, who were age 18 or younger at the time of surgery. Charts were reviewed and patients were included if they had an isolated mononeuropathy consistent with cubital tunnel syndrome and were symptomatic. Data on age of onset, duration of symptoms, Dellon classification, nerve subluxation, provocative testing results, nerve conductions, and exacerbating activities were abstracted. Patients were contacted for a postsurgical follow-up questionnaire. Results Seven patients were identified. The average age was 16, and duration of symptoms was 7 months. All seven patients had normal electrodiagnostic studies and had failed a course of conservative treatment. All were satisfied with surgery and felt improvement. One stopped playing their sport, and three had mild symptoms with varied activities. Conclusion Although uncommon, pediatric cubital tunnel syndrome does occur. Surgical release improves symptoms and return to activities. Nevertheless, some degree of symptoms often persists. Electrodiagnostic studies may be negative in many patients with an otherwise consistent history and examination. Level of Evidence This is a level IV therapeutic study.

Retractor endoscopic techniques in the treatment of entrapment peripheral neuropathies

With increasing awareness for minimally invasive approaches, endoscopic techniques for peripheral nerve decompression are becoming increasingly popular. The first endoscopic approach to release a pinched nerve was for carpal tunnel release through a single entry port, whereby the compressed canal was dilated with bougies and an endoscope introduced into this canal to transect the transverse carpal ligament. Since most of the manipulations with the blunt bougie in this technique were done in a blind fashion, there was a lurking potential for iatrogenic nerve injury using the bougie technique. Thus the retractor-integrated endoscopic technique was developed. In this technique, the retractor bearing the endoscope is introduced into a plane above the compressing ligaments and the nerve proper and a bird’s eye perspective of the anatomical site is gained. Owing to the simplicity of the technique, the retractor-endoscope was used to decompress any nerve at any site in the body: furthermore it was employed for harvesting nerves, vessels and tendons for transplantation. In this paper, we describe the various endoscopic techniques used for decompression in peripheral nerve entrapment syndromes and provide a comprehensive and comparative metaanalysis of the techniques.

Associations between hand anthropometric measurements, and degree of severity of carpal tunnel syndrome in Suez Canal area, Egypt

Background: Carpal tunnel syndrome (CTS) is considered as the most commonly reported peripheral nerve entrapment syndrome resulting from compression of the median nerve at the wrist level. Many studies have investigated the association between anthropometric characteristics and the degree of severity of the disease. Most literature supports a causal association between overweight and CTS; moreover, there is strong evidence that anatomical characteristics of the hand-wrist system may change the risk, and perhaps the severity of CTS. The aim of this study was to investigate the association between hand anthropometric measurements in patients with CTS and severity of the disease. Methodology: A cross-sectional study was conducted among patients with CTS (n = 600). For this purpose, a brief questionnaire and physical examination were done; hand dominance also was recorded. Body and hand anthropometric measurements were performed and recorded followed by electrodiagnostic testing at the same visit. Results: Patients had significantly prolonged distal latency, prolonged peak latency, lower compound muscle action potential and sensory nerve action potential amplitudes, and slower sensory nerve conduction velocity. Patients had significantly higher wrist depth, higher wrist ratio (WR), shorter palm length, shorter hand length, and lower hand ratio. Correlations of WR and wrist depth were also found. Conclusion: Anthropometric characteristics of the wrist and hand are significantly correlated with CTS. These measurements could be used in certain occupations to screen for those individuals who have increased liability to develop CTS.

Pain Relief and Health-Related Quality-of-Life Improvement After Microsurgical Decompression of Entrapped Peripheral Nerves in Patients With Painful Diabetic Peripheral Neuropathy

Surgery had been shown to be effective for superimposed peripheral nerve entrapment syndrome in patients with diabetic peripheral neuropathy (DPN), with pain relief and sensation restored. Few studies, however, have reported the quality-of-life outcomes of surgery for the treatment of painful DPN (PDPN). The objective of the present study was to evaluate the effects of microsurgical decompression of multiple entrapped peripheral nerves on pain and health-related quality of life in patients with refractory PDPN of the lower limbs. Eleven patients with intractable PDPN of the lower limbs were recruited for the present study. All the patients underwent microsurgical decompression of the common peroneal nerve, deep peroneal nerve, and posterior tibial nerve. The pain intensity was assessed using the visual analog scale and health-related quality of life was measured using the short-form 36-item quality-of-life survey. Six (54.6%) patients experienced >50% pain relief (both daytime pain and nocturnal pain) at 2weeks after the decompression procedure and 8 (72.7%) patients at 24months postoperatively. Two (18.2%) patients experienced a >50% decrease in peak pain at the 2weeks after the procedure and 8 (72.7%) patients at 24months. Additionally, the scores from the short-form 36-item quality-of-life survey were significantly improved in the following 2 domains: bodily pain and general health at 2weeks after the decompression procedure. Also, at 24months postoperatively, 6 domains had significantly improved, including physical function, bodily pain, general health, social function, role emotional, and mental health. No significant side effects were recorded during the study. Microsurgical decompression of peripheral nerves is an effective and safe therapy for intractable PDPN with superimposed nerve compression.