Phalen's Test Research Articles

Residual Symptoms After Carpal Tunnel Decompression and Treatment With Gabapentin: A Multicenter Study

ObjectivesTo identify postoperative residual symptoms of carpal tunnel syndrome (CTS) and to investigate the effectiveness of gabapentin in the treatment of residual symptoms.Materials and methodsOf a total of 412 patients who underwent surgery for CTS in four centers over a four-year period, 14 who had residual symptoms after CTS release and did not receive gabapentin (Group A) and 14 patients with postoperative residual symptoms and received gabapentin were included in this retrospective study. Postoperative residual symptoms were defined as persistent nocturnal numbness and tingling with or without occasional daytime pain. Tinel’s and Phalen’s tests were performed for the diagnosis of residual symptoms. Functional Severity Score (FSS), Symptom Severity Score (SSS), and Visual Analog Scale (VAS) were used to evaluate functional outcomes, severity of symptoms, and numbness and sleep quality, respectively at six and 12 weeks postoperatively.Level of Evidence: III, therapeutic studyResultsThere was no statistically significant difference in the mean postoperative FSS (p=0.845) and VAS-numbness scores (p=0.367) between the groups. However, there was a statistically significant difference in the mean postoperative SSS (p=0.025) and VAS-sleep quality scores (p<0.001) between the groups.ConclusionGabapentin treatment can be a treatment of choice for residual symptoms after CTS surgery and clinical improvement can be achieved owing to its relieving effect, particularly in nocturnal symptoms of patients having neuropathic pain.

HUBUNGAN MASA KERJA DAN SIKAP KERJA DENGAN KELUHAN CARPAL TUNNEL SYNDROME PADA PEKERJA PENENUN ULOS DI GALERI ULOS SIANIPAR MEDAN TAHUN 2020

Carpal tunnel syndrome is an eddy condition where the middle nerve is compressed in the wrist which results in parasthesia, numbness and muscle weakness in the hand. One nactor in the increasing number on carpal tunnel syndrome complaints is the outbreak on activities that use the hands especially those that carry out long periods on time. based on a preliminary study on 10 ulos weavers, there were 7 ulos weavers who had Carpal tunnel syndrome complaints in the norm on hand pain, tingling and numbness in the hands. The purpose on this study was to determine the relationship on work tenure and work attitude with complaints on carpal tunnel syndrome in ulos weaver workers at the Galery Ulos Sianipar Medan. The method in this study is an analytic observer research method with a cross sectional research approach. The respondents on this study are the ulos weavers in the Galery Ulos Sianipar Medan. Research instruments in the norm on questionnaires and measurement on phalen test data were analyzed by chi-square test. Based on the results on the study, the majority on ulos weavers experienced complaints on carpal tunnel syndrome as many as 34 people (65.4%). In this study it was nound that there was a relationship between work period (p = 0.003&lt;0.05) with complaints on carpal tunnel syndrome, while work attitude (p = 0.399 &gt;0.05) had no relationship with complaints on carpal tunnel syndrome. Suggestions nor ulos weaver workers are expected to take regular breaks by bending and straightening hands nor 3-5 minutes to reduce the risk on carpal tunnel syndrome

The treatment effect of intramuscular stimulation on carpal tunnel syndrome: A blinded randomized trial on 75 patients

BackgroundCarpal tunnel syndrome (CTS) is a disorder with a prevalence of about 5.8% for females and 0.6% for males. This study aims to determine whether intramuscular stimulation (IMS) to the pronator teres muscle subsequently reduces the severity of clinical parameters and the diameter of the median nerve. MethodsSeventy-five individuals with a cross-sectional diameter of the median nerve of more than 2 mm were included in this randomized clinical trial. Thirty-seven individuals received IMS to the pronator teres muscle with a depth of up to 45–50 mm. The 38 individuals in the control group received an acupuncture needle at Li11 with a depth of 4–5 mm. Both groups had 7 treatments within 7 weeks. The primary outcome was the cross-section of the median nerve in the carpal tunnel. Additionally, Phalen's test, Tinel's sign, VAS for pain intensity, and pincer grip strength were measured. ResultsBoth IMS subjects and controls showed significant reductions in the cross-section of the median nerve from baseline to follow-up (p < 0.001 and p = 0.002 respectively). The IMS group had the largest change, but the difference in change between the groups was not significant (p = 0.39). On all clinical tests, IMS subjects showed significant improvement from baseline compared with the control group (largest p = 0.002). ConclusionIn this study we found that IMS to the pronator teres muscle significantly improved all clinical variables measured, compared with the group receiving acupuncture. Furthermore, the cross-section of the median nerve reduced over time for both groups. IMS may be a low-risk alternative while patients are waiting for surgery. Trial registrationClinicaltrials. gov Identifier: NCT01102868. Retrospectively registered: March 29th, 2010.

Incidence of Shoulder Impingement Syndrome Among Patients with Carpal Tunnel Syndrome: Epidemiological Study

Aim of the work: Measure incidence of shoulder impingement syndrome (SIS) among carpal tunnel syndrome (CTS) patients and relationship with other risk factors. Patients and Methods: This is a cross sectional study at outpatient setting, included 565 patients (210male and 355female) with clinical manifestation of CTS associated with shoulder pain. Exclusion criteria: patients with manifestation suggestive of peripheral neuropathy, cervical radiculopathy or other neuromuscular disorder. Each patient was subjected to the following; detailed history, Pain score by visual analogue score, (VAS), neurological examination including Tinel’s sign and Phalen test, shoulder exam including Neer Impingement sign and Hawkins impingement sign, neck exam, Hemoglobin A1c level, nerve conduction study (NCS) for median, ulnar, Including the comparative techniques, electromyography of both upper extremities, MRI of shoulders if possible. Results: Mean age was 48.2 y, majority was hard worker (56.8%), light worker (22.8%), house wives (16.8%) and house- keeping (3.5%). Only 161 patients (28.5%) had diabetes mellitus type II. Pain score was severe in 58.2%, moderate in 32.6% and mild in 3.7%, no pain in 5.5%. All studied patients (100%) had CTS confirmed by NCS. SIS was found on 380patients (67.25%). shoulder MRI was done for only 298 patients and all showed rotator cuff tendopathy. Significant incidence of SIS among diabetics (p 0.001). Significant incidence of MRI findings among diabetics (p 0.0001). Among diabetics 78.26% have both CTS and clinical impingement together, that is significantly higher than non-diabetics (p=0.0004). SIS had significantly high incidence among hard worker (p=0012). SIS was significantly correlated with prolonged distal median motor latency (right side p=0.011, left side p=0.023) and with prolonged peak median sensory latency (p=0.38 on right side and p=0.033 on left side). Pain score was significantly correlated with SIS (p=0.27) and MRI findings (p=0.031). Conclusions: Significant high incidence of SIS among CTS patients This is higher among diabetic patients and manual worker. SIS significantly increases VAS among CTS patients and is significantly correlated with degree of CTS as reflected by median distal motor and peak sensory latency.

A timed Phalen’s test predicts abnormal electrophysiology in carpal tunnel syndrome

ObjectivePrevious studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen’s test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS).MethodsPatients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.ResultsIn total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant.DiscussionA positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS.

Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery.

Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group ( n = 41) and 77% of the non-TTS group ( n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS ( p = 0.04), neuropathic symptoms ( p = 0.045), and absent Phalen's test ( p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.

Carpal Tunnel Release Despite Normal Nerve Conduction Studies in Carpal Tunnel Syndrome Patients.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy, often requiring carpal tunnel release (CTR) surgery. Often, a nerve conduction study (NCS) is performed before CTR; however, there are various reports questioning the sensitivity of NCS, and some patients do undergo CTR despite normal NCS results. We had the following purposes: (1) to report clinical outcome of CTS patients who undergo CTR despite normal NCS, (2) to identify the characteristics and compare those with abnormal NCS patients in terms of basic features and risk factors, and (3) to analyze and compare normal and abnormal NCS results. Medical records of 546 CTS (30 normal NCS and 516 abnormal NCS) patients were retrospectively reviewed. Of 30 normal NCS patients, 7 were excluded, leaving 23 patients in the experimental group. We investigated the influence of age, sex, operative arm, and body mass index, as well as medical conditions known to be risk factors for CTS. In normal NCS patients, as a functional score, we investigated Boston carpal tunnel scores before and after CTR. The NCS results were compared in terms of median motor and median sensory testing. In normal NCS patients, NCS data were compared with that of the contralateral nonoperated wrists. There were 18 women and 5 men in the normal NCS group (mean age 43.7 years). On physical examination, 22 (94.7%) patients showed a positive Tinel test, 19 (82.6%) showed a positive Phalen test, 8 (34.8%) complained of nocturnal paresthesia, and only 1 (4.3%) presented with thenar atrophy. In 19 of 23 patients, the Boston CTS scores showed significant improvement after CTR. Normal NCS patients were significantly younger and significantly heavier and more likely to be a current smoker. In NCS analysis of normal NCS patients, the operated wrists were closer to the reference values than nonoperated wrists. Surgeons should evaluate the possibility of other combined lesions before CTR in normal NCS patients. Normal NCS can be present with a CTS diagnosis, especially in younger patients. Nevertheless, CTR after failed conservative management, despite normal NCS, could relieve subjective symptoms and function.

Changing Concepts for the Diagnosis of Carpal Tunnel Syndrome in Powerlifting Athletes with Disabilities.

Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.

Intraoperative Evaluation of Median Nerve Excursion in Carpal Tunnel Surgery

Patients complaining of pain and or paraesthesia along the forearm and hand with or without abnormal functions in the small muscles of the hand present with a condition that must be anatomically localized, mecanically understood and pathologically classifed. Numerous causes can produse peopathy including non-surgical causes that must be excluded. This may cause difficulty in the diagnosis even after clinical and radiological evaluation, so we resort to electrophysiological examination to confirm the diagnosis.Methods: The study was carried out on twenty patients, admitted to Benghazi Medical Centre during the period of one year. All patients had a detailed history taken, and complete phyical examination with neurological evaluation. The diagnosis was confirmed by electrophysiological studies. Subsequently, the appropriate surgical procedure was performed. All the cases were followed up clinically and electrophysiologically.Results: The mean age of the patients was (41.55± 10.44) with a high frequency of 30 to 40 years, 80% of cases were females and 20% were males, 75% of Cases were workers, 55% of the patients presented with their right hand and 45% with their left hand, The duration of symptoms prior to operation ranged from 2 to 30 months with a bean of (10.1±7.38). The latter difference had a statistically significant effect on the results. Clinical analysis showed that pain and numbness in the distribution of the median nerve were the most common complaints. The most common physical finding was a positive Phalen's test 1854. Preoperatively 35% of cases were graded mild, 25% were graded moderate and 40% were graded severe. After 6 months of regular follow up we found that 75 our patients showed good improvement as regarded the nerve conduction study result.90% improvement of pain, 77% in lessening of numbness, 66% in lessening of weakness and 50% in lessening of wasting of thenar eminence. A statistically significant difference was found between the preoperative and postoperative nerve conduction studies (motor and sensory). Intraoperatively, there was an increase in the significant excursion of the median nerve in association with the three wrist positions (neutral, flexion, extension) after release of the transverse carpal ligament. Only 10% of our patients developed post-operative complications wound infection and scar tenderness) which were dealt with appropriately. The overall result was good in 75% of cases, fair in 15% of cases and poor in 10% of cases.Conclusion: The finding of this study showed that the position and movement of wrist had a profound effect on an ex-cursion of the median nerve, and may aid in the understanding of the pathophysiology of the carpal tunnel syndrome. Moreover, we should be considering the limitation of median nerve excursion as one of the causes of carpal tunnel syndrome. Also the longer the duration of preoperative symptoms the worse in the result, so early surgery in moderate and or severe grades is recommended.

SENSITIVITIES OF THE ELECTRODIAGNOSTIC TESTS IN IDIOPATHIC MILD CARPAL TUNNEL SYNDROME

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The diagnosis is based on the history, clinical signs and symptoms of the patient, but electrodiagnostic studies are done to confirm the diagnosis and to manage the treatment. This study aimed to assess sensitivities of clinical symptoms, provocative tests and electrodiagnostic studies (EDS) in patients with idiopathic mild CTS.MATERIAL AND METHODS:The study included 90 hands of 75 patients with idiopathic mild CTS and 30 hands of 15 healthy volunteers. The patients were questioned for symptoms in the innervation area of the median nerve such as pain, paresthesia, weakness in the hand and numbness and pain worsening at night, relief from the symptoms by shaking hands. Tinel and Phalen tests were done. The EDS included; motor, mixed and sensorial (digits 1-2-3-4 and palm) nerve conduction studies (NCS) for median nerve; motor, mixed and sensorial (fifth digit) NCS for ulnar nerve, sensorial NCS (first digit) for radial nerve, median and ulnar F waves. The values for distal latency and nerve conduction velocity (NCV) were calculated for all studied nerves. Sensitivities of median sensory distal latency and NCV to digits 1,2,3,4 and palm-wrist segments and sensitivities of the following comparative tests were detected; median-radial sensory distal latency difference (SDLD) to the first digit, median-ulnar SDLD to the fourth digit, median-ulnar SDLD to the digits 2-5, 3-5, 4-5 and median-ulnar F latency difference.RESULTS: The most common symptoms in patients with idiopathic mild CTS were paresthesia (95.6%) and nocturnal numbness (88.8%). The sensitivity of Phalen’s and Tinel’s tests were 67.8% and 56.7%, respectively. Among the EDS, first digit and palm-wrist sensorial NCV were the most sensitive tests (98.9%). Of the comparative tests, median-ulnar SDLD to digits 4-5 was the most sensitive one (93.3%). Median-ulnar F latency difference had the lowest sensitivity (38.9%).CONCLUSIONS: The most sensitive EDS were first digit and palm-wrist sensorial NCV. Median-ulnar SDLD to digits 4-5 was more sensitive than the other tests. With use of these tests, the diagnostic sensitivity of EDS may be increased in patients with mild CTS.

Prévalence du syndrome du canal carpien chez les athlètes sur la base du diagnostic clinique

BackgroundElectrical studies are often used to diagnose carpal tunnel syndrome (CTS). We noticed differences in results when we considered the clinical tests. ObjectivesWhat's the prevalence of CTS in adapted sports’ athletes based on clinical diagnostic? Is there any relationship between the presence of symptoms and the use of wheelchairs, the type of sport practiced, dominance and how long the sport had been practiced? HypothesisThe prevalence of CTS in adapted sports’ athletes is close to that of the general population. Study designCross-sectional study. MethodsWe evaluated adapted athletes. Data collection included the dominant side, type of sports, sports practice time, wheelchair or non-wheelchairs users. To evaluate intensity of pain in the hands, we used the numerical pain rating scale (NPRS). For the evaluation of nocturnal paresthesia, we asked athletes about this symptom's presence. We evaluated the presence of paresthesia through the Tinel signal and Phalen test. For this study's purpose, we characterized CTS by the presence of two or more signs or symptoms. ResultsWe evaluated 72 athletes, 144 hands. No athlete reported pain in the hands or nocturnal paresthesia. Fifteen athletes had at least one sign or symptom in a total of 21 hands. The presence of two concomitant clinical symptoms occurred in 4 (6%) right hands and 3 (4%) left hands. The presence of more than two concomitant clinical symptoms did not occur in any hand. We did not find a relation between the presence of signs and/or symptoms with the type of adapted sport, wheelchair use, the dominant side and the time of sports practice. DiscussionReviewing the literature, we observed that the most researchers used electrodiagnostic studies to determine the diagnosis of CTS on persons with disabilities, without considering physical examination. ConclusionThe prevalence of CTS in the disabled athletes was 6 in 72 (8%). Level of evidenceIII.

Carpal Tunnel Syndrome: correlation between preoperative clinical findings and intraoperative findings

Background and objectives: Carpal tunnel syndrome is a puzzling and disabling condition which can be diagnosed on clinical bases only. The aim of this study is to find the correlation between specific clinical findings and intraoperative findings to help us define which clinical finding is the most dependable. Methods: Sixty-five patients (72 hands) with carpal tunnel syndrome were enrolled in this study. Seven clinical findings (pain &amp; parasthesia, touch sensation, two-point discrimination, weak thumb abduction test, Phalen test, Tinel test &amp; Durkan test) were correlated with 3 intraoperative findings (hour-glass deformity, fibrosis &amp; vascular interruption). Results: Pain and paresthesia was present in all 65(100%) of the cases, of this 47(72.3%) had hourglass formation, while fibrosis was present in 58(89.3%) and in both conditions; their correlation was highly significant. Decreased 2 point discrimination was present in 50(76.9%) of the cases, of this 41(63.1%) had hourglass formation and fibrosis was present in 47(72.3%) and in both conditions; their correlation was highly significant. Vascular interruption was present in 41(63.1%) and the correlation was highly significant too. Conclusions: Most clinical findings were associated with specific intraoperative findings. Of all; pain &amp; parasthesia with 2-point discrimination were associated with 2 and 3 of 3 intraoperative findings respectively and regarded as the most relevant clinical findings when positive.

The prevalence of carpal tunnel syndrome in adapted Sports athletes based on clinical diagnostic

BackgroundElectrical studies are often used to diagnose carpal tunnel syndrome (CTS). We noticed differences in results when we considered the clinical tests. ObjectivesWhat's the prevalence of CTS in adapted sports athletes based on clinical diagnostic? Is there any relationship between the presence of symptoms and the use of wheelchairs, the type of sport practiced, dominance and how long the sport had been practiced? HypothesisThe prevalence of CTS in adapted sports athletes is close to that of the general population. Study designCross-sectional study. MethodsWe evaluated adapted athletes. Data collection included the dominant side, type of sports, sports practice time, wheelchair or non-wheelchairs users. To evaluate intensity of pain in the hands, we used the numerical pain rating scale (NPRS). For the evaluation of nocturnal paresthesia, we asked athletes about this symptom's presence. We evaluated the presence of paresthesia through the Tinel signal and Phalen test. For this study's purpose, we characterized CTS by the presence of two or more signs or symptoms. ResultsWe evaluated 72 athletes, 144 hands. No athlete reported pain in the hands or nocturnal paresthesia. Fifteen athletes had at least one sign or symptom in a total of 21 hands. The presence of two concomitant clinical symptoms occurred in 4 (6%) right hands and 3 (4%) left hands. The presence of more than two concomitant clinical symptoms did not occur in any hand. We did not find a relation between the presence of signs and/or symptoms with the type of adapted sport, wheelchair use, the dominant side and the time of sports practice. DiscussionReviewing the literature we observed that the most researchers used electrodiagnostic studies to determine the diagnosis of CTS on persons with disabilities, without considering physical examination. ConclusionThe prevalence of CTS in the disabled athletes was 6 in 72 (8%). Level of evidenceIII.

The Diagnostic Accuracy of Phalen Test and Prayer Test in Carpal Tunnel Syndrome

Background of Study: Carpal Tunnel Syndrome is a series of symptoms and signs because of pressure on the median nerve in a small space in the wrist called carpal tunnel. In diagnosing CTS, it is required anamnesis and thorough physical examination which includes CTS provocation test, for instance Phalen test, Prayer test, and Tinel sign. The aim of this study is to reveal the diagnostic accuracy of Phalen test and Prayer test in diagnosing CTS. Methods: The samples that fulfilled inclusion criteria were 19 subjects went through Phalen test, Prayer test, and nerve conduction study using CSI in Department of Physical Medicine and Rehabilitation Dr. Soetomo General Hospital Surabaya, Indonesia. The nerve conduction study using CSI was conducted by EMG Cadwell equipment. The data analysis was conducted by using SPSS software. Result of the Study: The sensitivity of the Phalen test and Prayer test combination in diagnosing CTS was 94.1 %. The specificity of Phalen test and Prayer test combination in diagnosing CTS was 100%. The positive predictive value was 100% while the negative predictive value was 66.7%. The result of person chisquare examination was obtained asymp. Sig value of 0.001 &lt; ? 0.05. Conclusion: There was a correlation between the combination of Phalen test and Prayer test with CTS.

PHALEN TEST POSITIVATION TIME AND ITS CORRELATION WITH ELECTRONEUROMYOGRAPHY.

ABSTRACTObjective:To compare the classification of CTS by the Phalen test with electromyography.Methods:Cross-sectional observational study. Patients at orthopedic outpatient clinic with carpal tunnel syndrome were evaluated by the Phalen test and compared with the result of the electroneuromyography.Results:Sample of 33 patients, mostly women (87.9%). Most patients were already diagnosed with severe CTS by ENMG. The results of the Phalen test and the electromyography were equal in 26 of the 33 patients (78.8%).Conclusion:The Phalen test showed its applicability, since it had results similar to those of ENMG in most cases, especially in the most severe ones. The exam studied is a possible tool for the classification and recommendation of surgical treatment. Level of evidence IV, Retrospective observational study.

The Carpal Tunnel Syndrome and the Double Crush Syndrome Hypothesis: Revisited

AbstractBackground: The commonest application of the double crush hypothesis is its association to median nerve entrapment at the wrist. The double crush concept has gained popularity because it provides a reason to evaluate the cervical spine and roots when treating carpal tunnel syndrome (CTS). It is more likely for CTS to occur as DCS rather than occurring by itself. Up to 90% of CTS patients are misdiagnosed, whereas only 10% have the problem at their wrists.Aim of Study: To examine the validity of DCS hypothesis in CTS patients, to support or disregard the theory.Patients and Methods: This study was conducted on 80 patients; 40 patients claiming failed carpal tunnel release operation (Group I) and 40 cases presenting with brachialgia (Group II). Diagnostic work up included neurological exam-ination, Phalen test, Tinel sign, electromyographic examination (EMG) and nerve conduction studies (NCS) and cervical MRI. Group I patients had undergone the EMG and NCS at our laboratory pre and post operatively.Results: EMG and NCS showed 10 cases with CTS (25%), 20 (50%) with DCS and 10 (25%) with cervical radiculopathy in group I, while group II patients showed 10 cases (25%) with CTS and 30 (75%) with DCS. In all patients, 50 cases (62.5%) showed DCS. On comparing the EMG and NCS preoperative results of Group (I), with their postoperative follow-up results, there was a high statistically significant difference (p-value <0.001) with 34 cases (85%) who showed improvement of the NCS results, while 6 cases (15%) deteri-orated postoperatively. There was a high statistically significant difference between both; CTS and DCS (p-value <0.001), denoting a positive correlation between the two syndromes.Conclusion: The DCS hypothesis was supported, while the concept of frequent failure of CTS release surgery was not supported for the benefit of DC hypothesis.

Risk Factors Affecting Carpal Tunnel Syndrome in Women Laborer of Tobacco Warehouse Ajung District, Jember

Carpal Tunnel Syndrome frequently experienced by workers whose daily activities always use repetitive movements on the wrist. Carpal Tunnel Syndrome is a syndrome that can actually be prevented because there is no risk factor that can’t be changed except the age factor. Previous research has shown a fairly high prevalence about 42%-93% in factory workers. This study aims to determine the factors that affect the occurence of Carpal Tunnel Syndrome in women workers warehouse tobacco. This is an analytical observational study with cross sectional study design which using 50 samples who met inclusion and exclusion criteria. Instrument in this research is clinical questionnaire to diagnose CTS and Phalen test. Spearman correlation test result obtained long working p=0,036, r=0,298 and pain intensity p= &lt;0,01, r=0,635 which means there is significant correlation with moderate strength between length of work with CTS and strong correlation between the intensity of pain with CTS.&#x0D; Keywords: Carpal Tunnel Syndrome, risk factor, women laborer

The Effects of Nerve and Tendon Gliding Exercises Combined with Low-level Laser or Ultrasound Therapy in Carpal Tunnel Syndrome.

Background:Carpal tunnel syndrome (CTS) is a common medical condition that doctors and physiotherapists come across in clinical practice. There are no explicit recommendations concerning which physical therapy methods should be applied in its treatment; however, there have also been no studies on the effects of combining low-level laser therapy (LLLT) or ultrasound with nerve and tendon gliding exercises. The purpose of this study was to evaluate the therapeutic efficacy of ultrasound and LLLT combined with gliding exercises.Materials and Methods:A total of seventy patients with mild to moderate CTS, divided into two groups, were included in this study. Group 1 received ultrasound treatment, whereas Group 2 underwent LLLT. The treatment lasted 2 weeks (5 sessions/week). In addition, both groups were treated with nerve and tendon gliding exercises three times daily. The clinical evaluation involved an interview on subjective and objective sensory abnormalities, the intensity of pain, the measurement of grip strength, Phalen's test, Tinel's sign, and the Boston Carpal Tunnel Questionnaire. The assessment was performed before and after the treatment.Results:A decrease in sensory impairments, improvement in visual analog scale, hand grip strength and the Boston Questionnaire results were significant in all patients after therapy. No meaningful differences between groups were noted in any of the examined variables after treatment. No adverse effects were observed.Conclusions:The results of this study may suggest the clinical efficacy of LLLT or ultrasound combined with gliding exercises in patients with mild to moderate CTS.

Factors determining the effectiveness of conservative treatment in patients with carpal tunnel syndrome.

The study aims to assess selected factors contributing to the long-term effects of the conservative treatment of carpal tunnel syndrome (CTS). Forty-nine individuals diagnosed with CTS were enrolled in the study. The symptoms resulted from occupational hand overuse in 37 patients. The assessment involved 78 hands before the therapy (study 1) and 1 year after the end of the therapy (study 2). The clinical symptoms assessed included: pain, numbness, tingling, morning stiffness, vegetative disorders and difficulties in activities of daily living (ADL). The range of motion (ROM) in the hand joints and the pressure generated during the cylindrical grip were measured. Phalen's tests, an electrodiagnostic test and a 2-point discrimination study were performed. A significant reduction of symptoms and improvement in tested parameters were found in study 2. The largest ROM in the hand, the lowest level of pain and the largest reduction in the frequency of daytime tingling were found in the oldest patients in study 2. In subjects with better initial electrodiagnostic test results, a significant reduction in daytime numbness and daytime tingling was obtained. In individuals previously subjected to conservative therapy, a significant improvement in the ROM of the hand and a better quality of sensation were noted in study 2. A higher level of pain, a lower reduction in the frequency of daytime tingling, and a smaller improvement in ADL capacity were noted in individuals who overused their hands at work after the therapy. The effects of conservative CTS treatment after 1 year, expressed as the reduction of subjective symptoms, were independent of the patient's age. A worse initial electrodiagnostic test result is a predictor of less favorable therapy results. Hand overuse during occupational activity may negatively affect the effects of conservative treatment in individuals with CTS. A change in the nature of occupational activity positively influenced the long-term maintenance of the effects of conservative treatment. Int J Occup Med Environ Health. 2019;32(2):197-215.

Review of Symptoms and Signs for Working Adults with Median Nerve Entrapment

Abstract Physicians often must evaluate patients who present with symptoms in a median nerve distribution and typically diagnose carpal tunnel syndrome (CTS), but an accurate diagnosis is critical to determine causation and to define possible impairment. CTS is a constellation of symptoms and signs that result from mononeuropathy of the median nerve in the carpal tunnel; symptoms typically include tingling and/or numbness, dysesthesias, and/or pain in the radial palm and palmar aspect of the thumb, index, middle, and perhaps ring fingers. The American Academy of Orthopaedic Surgeons suggests use of the CTS-6 scoring aid (shown in a table) as a clinical aid for diagnosing CTS. Electrodiagnostic testing, nerve conduction studies in particular, are considered the gold standard for diagnosis of CTS, but research suggests that the definitions of relevant sensory and assignment of CTS are sensitive to threshold changes from a latency of, eg, &gt;4.4 msec vs &gt;4.5 msec. Other factors to consider include whether there are effects from the known association between wrist ratio and CTS and assessing the benefits of neuromuscular ultrasound to diagnose CTS. Nocturnal paresthesias and paresthesias while holding onto an object were sensitive indicators of the presence of CTS but use of the Phalen and Hoffmann-Tinel signs has significant potential to be unreliable.