Phalen's Test Research Articles

Work-related self-reported musculoskeletal disorders in hypermarket cashiers: a study in south of Portugal.

Background:Work-related musculoskeletal disorders are a group of painful disorders which arise from work situations with continuous repetitive movements, carried out with speed and without time for recovery. In the performance of their job tasks, supermarket cashiers are exposed to this type of ergonomic stress.Objectives:This study aimed to determine the incidence of self-reported injuries in Portuguese hypermarket cashiers and to identify the related factors.Methods:The sample included 176 hypermarket cashiers, aged between 18 and 65 years (39.57±11.11), 167 (94.9%) of them women. Symptoms and exposure of interest have been collected through an interview-based questionnaire. The presence of carpal tunnel syndrome was assessed by Phalen’s test.Results:One hundred and seventeen (66.5%) cashiers reported an injury during employment, 100 (56.8%) of them reporting an injury in the previous 6 months. A total of 166 injuries were reported, corresponding to 1.14 injuries per 1,000 hours of work. The most common injuries were non-specific pain (30.4%), located in the shoulder (23.2%), cervical (22%) and lumbar spine (22%). Part-time workers showed a 2.25 times greater risk of injury (95% CI: 1.17-4.32; p=0.015) than full-time workers. Cashiers with more than 6 years of employment length had a 3.59 times higher risk of injury (95% CI: 1.84-6.99; p≤0.001) than those who had been working for a shorter period.Conclusions:Our data showed a high rate of reported injuries among hypermarket cashiers, especially among part-time workers and those with the highest length of employment.

Diagnostic and Research Techniques in Carpal Tunnel Syndrome.

Carpal tunnel syndrome is the most common neuropathy, costing upward of $2B USD annually in North America. Carpal tunnel syndrome is a result of chronic trauma to the median nerve, resulting in nerve damage, decreased conductivity of nerve impulses, and ultimately presents with clinical symptoms such as pain, tingling, numbness, and thumb muscle atrophy in severe cases. Although patient history, symptoms, and a nerve conduction study are the primary diagnosis tools, there are several techniques and tools that may be used to assess carpal tunnel syndrome and characterize the condition. The purpose of this critical review is to discuss the multitude of techniques that can be applied to study carpal tunnel syndrome, including Phalen's and Tinel's tests, nerve conduction study, Semmes-Weinstein monofilaments, laser Doppler flowmetry, pressure catheters, and ultrasound and magnetic resonance imaging. Additionally, this review discusses the reliability, sensitivity, and accuracy of these methods. A combination of these techniques may ultimately improve the accuracy in diagnosing carpal tunnel syndrome, especially in cases where nerve conduction study results are borderline or inconclusive by analyzing other aspects that may differently contribute to the development of carpal tunnel syndrome.

Median Nerve Symptoms, Signs, and Electrodiagnostic Abnormalities Among Working Adults.

Diagnostic screening tests for carpal tunnel syndrome (CTS) have not been rigorously assessed in large populations. This study is a cross-sectional analysis from a prospective cohort study. Participants' (n = 1,194) symptoms and disease prevalence were measured. Sensitivity, specificity, and positive and negative predictive values (NPVs) were calculated. When defining CTS as tingling/numbness in at least two median nerve-served digits and an abnormal median nerve conduction study, the prevalence was 8.9%. The sensitivity of paresthesias with nocturnal awakening was 77.4%. The sensitivity of the Phalen sign was 52.8% and that of the Hoffman-Tinel sign was only 37.7%. The highest sensitivity (77.4%) for a case definition of CTS in this population of workers was for nocturnal tingling/numbness in a median nerve distribution, and the highest specificity (97.5%) was for continuous tingling/numbness. The Phalen sign has a sensitivity of 52.8% and NPV of 95%, suggesting that the NPV is of particular diagnostic value. Hoffman-Tinel signs seem primarily helpful for the NPV (93.7%). Level II diagnostic study.

Is there a correlation between sensory and motor axonal damage of the median nerve during carpal tunnel syndrome?

Objectives Carpal tunnel syndrome (CTS) is the most common nerve compression. The Electroneuromyography (ENMG) is the most objective test to document neurophysiological abnormalities [1] . Sensory impairment often precedes motor impairment, and demyelination precedes axonal loss. To our knowledge, no study has investigated the relationship between sensory and motor impairment. The aim of this work is to look for a correlation between sensory axonal loss and motor loss of the median nerve. Methods This is a retrospective study that regrouped 60 patients (120 hands) and for whom the diagnosis of CTS was retained following the ENMG. The statistical study was carried out with SPSS 20 software. The correlation was studied by the Pearson test. Results The mean age of the patients was 53.16 ± 11.8 years. The female sex was predominant with a sex ratio of 0.11. Diabetes was present in 40% of patients and hypothyroidism in one patient. The clinical lesion was bilateral in 75% of cases. Tinel sign was positive in 59.2% of the hands and phalen sign in 53.3% of the hands. The ENMG objectified CTS in 89.2% of hands with sensory-motor involvement in 50.8% of hands. Axonal loss was found in 36.7% of the hands. Mean sensory and motor amplitude was 63.4 ± 46.7 uV and 12.54 ± 4.9 mV respectively. The Pearson test showed a significant correlation between the amplitude of the sensory potential and that of the motor potential of the median nerve (P = 0.005). Conclusion This study shows a correlation between sensory and motor axonal loss. A multicenter study is needed to better retain this correlation relationship.

Correlation between clinical and electrophysiological findings of carpal tunnel syndrome

Objective: correlate between clinical and electrophysiological findings of carpal tunnel syndrome Methods: cross sectional study at outpatient setting.109 patients (83females, 26males) with clinical manifestations of carpal tunnel syndrome participated in the study. All the patients had the following: Medical history and neurological examination including Tinel’s sign and Phalen test and nerve conduction studies including median-ulnar, median -radial comparative studies and electromyography of both upper extremities. Results: mean age 57.71±13.4. pain was mild in 9.2%, moderate in 25.7% and severe in 56% of patients. Numbness was present in 87.2%. Impaired sensory exam in 43.1% Impaired motor exam in 8.3%. Positive Tinel’s sign unilateral (38.5%) and bilateral (47.7%). Positive Phalen test unilateral (30.3%) and bilateral (34.9%). Unilateral thenar Muscle wasting in 4.6% and bilateral in 1.8%. Pure sensory median neuropathy was found in 65 patients (59.6%), sensory motor median neuropathy in 44 patients (40.37%). Demyelinating neuropathy in 91.7% and demyelinating-axonal neuropathy in 8.3% of patients. Abnormal distal motor latency was significantly correlated with severity of pain p=0.0025, impaired sensory exam p=0.0001, impaired motor exam p=0.0001, positive Tinel’s sign of both hands p=0.0001, positive Phalen test of both hands p=0.0001. as well as with unilateral or bilateral muscle wasting p=0.001. Prolonged peak median sensory latency was significantly correlated with numbness p=0.0001, severity of pain p=0.001, Impaired sensory exam p=0.005, positive Tinel’s sign for either one or both hands p=0.0001, positive Phalen test of one or both hands p=0.0001 Conclusion: Highly significant correlation was found between subjective and objective sensory manifestation and peak median sensory latency. While distal motor latency were significantly correlated with severe pain, only bilateral positive Tinel’s sign and Bilateral Phalen test and the objective sensory and motor deficit.

The relationship between QDASH scale and clinical, electrophysiological findings in carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) occurs as a result of compression of the median nerve at the wrist. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire is a selfadministered region-specific outcome instrument which measures symptom severity and functional status. The aim of this study was to evaluate the clinical and electrophysiological relationship with QDASH scale in CTS. The study included 99 females and 22 males in total out of 121 idiopathic CTS patients with the mean age of 47.9 ±9.5 years. Patients were divided clinically and electrophysiologically into 2 groups as severe and mild based on modified criteria defined by Italian CTS working group. Pain severity was evaluated by visual analog scale (VAS). Patients were evaluated functionally by QDASH scale and the relationship between clinical and electrophysiological effect intensity (degree) was examined. QDASH scores were found significantly high in female patients, in patients with long disease duration (6 years and more), patients with clinically severe symptoms, and the ones with positive phalen test in both hands. Statistically significant positive relationship was found between QDASH scores, disease duration and clinical severity. However, no relationship was found between electrophysiological severity and QDASH. A mild and positive correlation was observed among disease duration, clinical severity and VAS. A small and positive correlation was detected between VAS and QDASH. Although electrophysiological findings were prioritized in the follow-up and treatment strategies of CTS patients, clinical and patient-oriented assessment scales should be dealt together. Despite the electrophysiological findings, we believe that individual differences are effective in clinical and functional capacity. We conclude that since QDASH scale has a simple applicability in a short time, it can be used for assessing the symptom severity and disability of patients with CTS.

Effect of Alpha-Lipoic Acid on Clinical and Neurophysiologic Recovery of Carpal Tunnel Syndrome: A Double-Blind, Randomized Clinical Trial.

The objective of our study was to examine the effect of alpha-lipoic acid (ALA) on clinical and neurophysiologic outcomes after surgery for idiopathic carpal tunnel syndrome (CTS). We conducted a randomized, double-blind, placebo-controlled clinical trial in 20 adults diagnosed with idiopathic CTS after clinical and neurophysiologic assessment. Eligible participants took 600 mg ALA or placebo per day for 1 month before surgery, and for 2 months afterward. Further clinical and neurophysiologic assessments were undertaken immediately before surgical decompression, and at 12 weeks postoperatively with additional clinical assessments at the 4th and 8th week after surgery. Clinical outcome measures were taken by Boston Questionnaire score, the presence or absence of Tinel's sign, and Phalen's test findings. Median nerve conduction studies were also undertaken and interpreted according to Dumitru's reference values. Nineteen patients completed the study; one member of the placebo group was lost during follow-up. There were significant improvements in clinical and neurophysiologic variables in the ALA treatment group, present even before surgery. Boston Questionnaire scores had improved significantly in both groups. In the ALA group, none of the participants had positive Phalen's or Tinel's signs at 12 weeks, and motor and sensory fiber latency and amplitude had significantly improved; in the placebo group, only the sensory distal latency had improved significantly. In conclusion, ALA administered 1 month before open decompression and for 2 months afterward improves the clinical and neurophysiologic outcomes after surgery.

Problems of the diagnosis and treatment of compression neuropathy of the median nerve: an analysis of typical medical practice

An analysis of typical medical errors in the diagnosis and treatment of compression neuropathy of the median nerve at the level of the wrist (carpal tunnel syndrome - CTS). Previous diagnoses and treatment of 85 patients with CTS (14 men and 71 women), aged from 36 to 84 years (middle age 62±10.6 years), who underwent surgery in our clinics were evaluated. The wrong diagnosis was made in most of patients (60%). The osteochondrosis of cervical spine (45.8%) and diabetic polyneuropathy (5.8%) were the most common mistaken diagnoses. Proper neurophysiological measurements using the Phalen's test and Tinel's sign were not performed in the majority of patients. Magnetic resonance imaging (MRI) of the cervical spine was often unreasonably made, the electroneuromyography was not used. Nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B group were improperly prescribed to the patients diagnosed with CTS. Local corticosteroids injections were not prescribed to most of patients, immobilization of the wrist was not recommended at the early stage of disease and decompressive surgery at the advanced stage of disease. Clinical observation of the patient with long period of misdiagnosing is presented. Despite the long-standing history of CTS, surgical decompression led to regression of symptoms and complete professional rehabilitation. It is necessary to inform physicians about manifestations, diagnostic criteria and effective methods of treatment of CTS.

Factors Correlated with Unfavorable Outcome after Carpal Tunnel Release Surgery.

Objectives:Carpal tunnel release surgery has excellent results. The aim of this study was to identify which baseline clinical and demographic factors could predict a good outcome from surgery. Understanding the impact of prognostic factors will enable surgeons to indicate surgical intervention better, provide appropriate preoperative counseling, and manage expectations postoperatively.Materials and Methods:A prospective, observational study included 620 carpal tunnel syndrome patients (age 42.38 ± 11.18 years; mean ± standard deviation). After the diagnosis had been confirmed by electrodiagnostic studies, patients underwent open carpal tunnel release surgery. Patients were evaluated initially after 2 weeks and eventually after 6 months. Surgical outcome was compared with presurgical findings.Results:Response to surgery was good in 89.4% and 94.2% after 2 weeks and 6 months, respectively. Factors correlated significantly with unfavorable outcome of surgery included old age, longer duration of symptoms, negative Phalen's test, abnormal two-point discrimination test, and weakness of abductor pollicis brevis muscle. Gender, retrograde radiation, and nocturnal symptoms did not correlate with surgical outcome.Conclusion:Elderly patients with longstanding disease, neurological deficits, and negative Phalen's test may not respond to surgery as others. This should be kept in mind in preoperative counseling and postoperative expectations.

Hypothenar fat pad flap vs conventional open release in primary carpal tunnel syndrome: A randomized controlled trial.

AIMTo compared outcomes between the hypothenar fat pad flap (HTFPF) and conventional open carpal tunnel release (COR) in primary carpal tunnel syndrome (CTS).METHODSForty-five patients (49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients (41 hands) by computer generated (Block of four randomization) into COR and HTFPF group. Nerve conduction study (NCS) included distal sensory latency (DSL), distal motor latency (DML), sensory amplitude (S-amp), motor amplitude (M-amp) and sensory nerve conduction velocity (SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale (VAS)], 2-point discrimination (2-PD), Semmes-Weinstein monofilament test (SWM), Phalen test and Tinel’s sign were evaluated in order to compare treatment outcomes.RESULTSThe COR group, 19 patients (20 hands) mean age 50.4 years. The HTFPF group, 20 patients (21 hands) mean age 53.3 years. Finally 33 patients (36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk (P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups (P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain (VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel’s sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSIONThere is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.

Value of oxyneurography, based on near infrared spectroscopy, in the diagnosis of carpal tunnel syndrome in comparison to provocative clinical diagnostic tests and nerve conduction studies

ObjectiveEvaluation of the diagnostic utility of the oxyneurography (ONG) in diagnosing carpal tunnel syndrome (CTS). MethodsONG examination of the median nerve was performed in 260 patients. The results were compared with nerve conduction studies and clinical provocative tests. ResultsONG index greater than or equal to 62% was found in 95.18% of the patients with no or minimal Nerve Conduction Study (NCS) changes (1–2 according to the Padua classification) but only in 1.69% of the patients with advanced NCS changes (Padua 3–6). The sensitivity and specificity of the ONG study i.e. 95.18% and 98.31%, respectively, were compared with standard clinical tests: Tinel sign (61.45% and 14.69%), Phalen test (34.94% and 45.20%), reverse Phalen test (81.93% and 34.46%) and carpal compression test (91.57% and 72.32%). ConclusionsONG index lower than 62% was indicative of CTS. ONG has higher sensitivity and specificity then other clinical tests and it is an accurate and reliable method for the diagnosis of CTS. SignificanceOxyneurography is a non-invasive, fast and safe study which may play role in the diagnosis of carpal tunnel syndrome.

Clinical Evaluation and Diagnostic Utilities of Different Nerve Conduction Tests in 100 Patients with Carpal Tunnel Syndrome.

Background and Purpose:The purpose of the study is to determine whether the clinical profile of patients with carpal tunnel syndrome (CTS) has been same over the years with the help of routine and comparative electrodiagnostic tests.Methods:A prospective study of 100 patients with suspected CTS was conducted without controls. Three provocative maneuvers were performed. Routine and comparison nerve conduction tests were performed, i.e., second lumbrical interossei motor latency difference (2 LIMLD), digit 4 median-ulnar sensory latency difference (D4MUSLD), palm wrist distal sensory latency difference (PWDSLD), and digit 1 median-radial sensory latency difference (D1MRSLD). Data entry, analysis, and statistical evaluation were done using International Business Machines Corporation Statistical Package for the Social Sciences statistics package (IBM, SPSS).Results:A total of 195 hands of 100 patients met the criteria for CTS. Forty-three percentage of patients were homemakers. Considering the rapidly changing communication technology, we observed 84% patients had aggravation of symptoms with continuous long-term daily mobile phone use (>30 min per session per day). We noted positive Tinel's sign in only 25%. Phalen's sign was positive in 53 right hands with mean duration of 11.49s (standard deviation [SD] ± 2.54 s) and was positive in 26 left hands with mean being 10.4 s (SD ± 1.91 s). The mean motor distal latency of median was 4.67 ms (SD ± 1.71 ms) and mean sensory distal latency of median was 3.24 ms (SD ± 1 ms). On internal comparison testing, mean difference in 2 LIMLD was 0.7 ± 0.3 ms, in D4MUSLD was 0.81 ± 0.32, in PWDSLD was 0.71 ± 0.20, and in D1MRSLD was 0.76 ± 0.32.Conclusion:Further analysis of clinical profile needs to be done, and new risk or provoking factors should be analyzed in patients with CTS.

Effects of electronic device overuse by university students in relation to clinical status and anatomical variations of the median nerve and transverse carpal ligament.

This study investigates the results of a questionnaire, provocative tests, and ultrasonographic measurements of carpal tunnel morphological parameters in intensive and nonintensive electronic device users. Forty-eight university students (equal numbers of intensive and nonintensive users, ≥5 h/day and <5 h/day of electronic device usage, respectively) were randomly selected after questionnaire responses were received and evaluated clinically and by ultrasonography. All participants were right-handed. Intensive users had significantly more positive results in Phalen's and Durkan's tests and reported more wrist/hand pain compared with nonintensive users (P < 0.05). Intensive users also had significantly larger median nerve cross-sectional areas, flattening ratios, and perimeters as well as greater bowing of the transverse carpal ligament compared with nonintensive users (P < 0.05). Overuse of electronic devices may adversely affect the median nerve within the carpal tunnel and the transverse carpal ligament, resulting in numbness, tingling, and pain in the hand. Caution may be warranted when using handheld electronic devices. Muscle Nerve 56: 873-880, 2017.

That Tendon is the Median Nerve: Perils of a Palmaris Longus Deficient Wrist.

To document the course of the median nerve in the distal forearm in palmaris longus (PL) deficient forearms and elucidate features that help distinguish it from the PL. In the cadaveric study, 56 cadaveric forearms were dissected and the location and course of the median nerve were documented. In the clinical study, 20 healthy subjects with absent PL were examined with provocative tests to elucidate the PL (Schaeffer's test and Thompson's test), and modified Durkan's and Phalen's tests. In the imaging study, one subject with a clearly visible and palpable median nerve was further evaluated with MRI with a superficial fiducial marker. Cadaveric dissection revealed that the median nerve was deep to the antebrachial fascia and superficial to the FDS tendons in the distal forearm. In 9 specimens without a PL, the median nerve was the most superficial structure deep and lay draped over the FDS tendons. In the clinical study, PL absence was bilateral in 4 subjects and unilateral in 16. The nerve was visible and palpable in 4 forearms and palpable but not visible in 20 forearms. In all 24 forearms, the nerve was palpable as a lax, mobile, cord-like structure that could be rolled over the taut FDS tendons. Tinel's and Durkan's signs were positive in 11 subjects. In the imaging study, MRI confirmed that the palpable structure was the median nerve. Unlike the PL, the nerve is non-contractile and remains flaccid on provocative testing. It is usually palpable and may also be visible in thin forearms. Careful scrutiny may reveal it to be distinct from, and draped over underlying FDS tendons. These findings may help avoid inadvertent median nerve harvest in place of a PL tendon graft.

THE PREVALENCE OF CARPAL TUNNEL SYNDROME AMONG FEMALE DAIRY MILKERS

Introduction: Occupation-related Carpal tunnel syndrome represents one of the major health problems among workers in various occupations throughout the world that possess a complex symptoms resulting from compressing the median nerve at the carpal tunnel. Farmers in Egypt are known to use the traditional manual milking of their cattle which needs bilateral repetitive hand movements. Aim of the work: To determine the prevalence and severity of CTS among farmers who performed hand-milking task of cattle and correlate these findings with working years and work duration per hours. Materials and methods: A structured questionnaire was used to determine demographics; work history, present medications and history of any chronic illness. Clinical examination for CTS symptoms as nocturnal exacerbation, Phalen sign, Tinel sign, sensory hyperalgesia, thenar atrophy and thenar weakness. Electrophysiologic studies were done for 240 female farmers, where half of them were milking their cattle manually the other half is used as control. Both groups are matched for age, and Body Mass Index (BMI). Results: The prevalence and clinical severity of CTS were significantly higher among female farmers who milk their cattle than non milkers in both hands (P<0.001), The median nerve motor and sensory conductive study was significantly higher among milkers than non milkers farmers (P value<0.001). The electrophysiological findings were significantly correlated with the longer years of work and longer working hours. Conclusion: These findings suggest that CTS is a significant occupational health issue for farmers that continue the traditional methods of manual milking. Introduction of automated milking machines may help to reduce this problem among the coming generations of the Egyptian farmers who represents a noticeable part of our community

The investigation of association between IL-1Ra and ACE I/D polymorphisms in carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a common neurologic impairment caused by injury on the median nerve in the wrist, characterized by pain and loss of sensory. CTS usually occurs through three factors, such as a mechanical pressure on median nerve, immunologic changes, and oxidative stress. The aim of this study was to evaluate the influence of interleukin-1 receptor antagonist (IL-1Ra) and angiotensin-converting enzyme (ACE) I/D polymorphisms on the susceptibility of patients to the CTS. One hundred fifty-eight patients with CTS and 151 healthy controls were enrolled in this study. Each patient was analyzed according to diseases symptoms, such as gender, a positive Tinel's sign, a positive Phalen maneuver, disease sides, EMG findings, and clinical stage. We applied the polymerase chain reaction (PCR) to determine the polymorphisms of IL-1Ra and ACE I/D. The statistically significant relation was not found between IL-1Ra, ACE I/D polymorphisms and CTS (respectively, P>.05; P>.05, OR: 1.51, CI: 0.82-1.61). Additionally, in the result of the statistical analysis compared with gene polymorphisms and clinical characteristics, we did not find any correlation (P>.05). Our findings showed that there are no associations of IL-1Ra and ACE I/D polymorphisms with susceptibility of a person for the development of CTS. So, it means that these polymorphisms do not create a risk for the development of CTS. Further studies with larger populations will be required to confirm these findings in different study populations.

Postures of upper extremity correlated with carpal tunnel syndrome (CTS).

Non-medical hospital staff members are in frequent contact with patients and therefore are required to perform a wide variety of repetitive and high-frequency activities. The objective of this study was to assess the relationships between upper extremity activity and carpal tunnel syndrome (CTS) among non-medical hospital staff members. Carpal tunnel syndrome in 144 non-medical hospital staff members was diagnosed using the Nordic Musculoskeletal Questionnaire (NMQ), a physician's diagnosis, physical examination (Tinel's signs and Phalen test) and a nerve conduction velocity (NCV) test. In addition, an ergonomic assessment was performed and a video camera was used to record the physical activities at work. The prevalence rate of CTS was highest for the NMQ (51.9%), followed by physician's diagnosis (49.5% for the right hand, 29.9% for the left hand), physical examination (54.7%), and nerve conduction test (motor nerve 27.5% and 25%, sensory nerve 21.7% and 15%, for right and left hands, respectively). Based on logistic regression models for the NMQ and physician's diagnoses, there was a dose-dependently higher risk of CTS with the upper extremity index among participants, but this was non-significant based on the physical examination and nerve conduction tests. Nerve conduction velocity is the gold standard in diagnosis of CTS, but use of NMQ and physician's diagnosis may overestimate the incidence of CTS in workers who have been engaging in repetitive stress activities for a relatively short time. Int J Occup Med Environ Health 2017;30(2):281-290.

The effect of metabolic syndrome on recurrence in patients who had undergone surgery for carpal tunnel syndrome.

This study aims to investigate whether or not metabolic syndrome (MS) affects recurrence in patients who had undergone surgery for carpal tunnel syndrome (CTS). The study included 86 hands of 78 patients (19 males, 59 females; mean age 52.0±8.2 years; range 36 to 78 years) who underwent CTS surgery. Patients were examined clinically and demographically for the presence of MS. Patients were also evaluated using a visual analog scale and the Boston Carpal Tunnel Syndrome Questionnaire. Diagnoses of recurrence were established using electromyography in patients with clinical CTS and Tinel and/or Phalen test positivity. The effect of MS on recurrent CTS was examined statistically by independent t-test. At the end of a mean follow-up period of 36.2±19.2 months (range 12 to 60 months), recurrence was identified in 31 (36%) of the 86 hands. Of these 31 hands, MS was present in 23 (74.2%). In the 55 hands (64%) without recurrence, MS was present in 10 (18.2%). According to these differences, the effect of MS on recurrent CTS was statistically significant (p<0.001). Our study indicated that MS affected recurrence in patients who had undergone CTS surgery.

The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

Objective. The aim of the study was to examine the relation between clinical findings, neurological examination and electrophysiological studies in diagnosing carpal tunnel syndrome (CTS) and share our institutional experience in patients with CTS. Methods. Patients presenting with complaints of pain, paresthesia, and weakness in hands who diagnosed CTS between 2014 and 2015 were examined retrospectively. Demographic characteristics, clinical and neurological examination findings and electrodiagnostic evaluations were analyzed. Results. A total of 348 patients were included to the study. Weight and height measurements were significantly higher in patients with CTS on the right side ( p =0.05 and p =0.04, respectively). Right hand side was the most dominant lateralization in patients with CTS ( p =0.001) but there was no significant correlation for left side ( p >0.05). The score of visual analogue scale was positively correlated with the severity of CTS ( p =0.001). Thenar atrophy, hypoesthesia, positivity of Tinel and Phalen tests were also related to bilateral CTS ( p =0.001 for each). Conclusion. We agree that clinical features, neurological examination findings and electrophysiological studies are effective diagnostic means in patients with CTS.

Diffusion tensor imaging of mild-moderate carpal tunnel syndrome: correlation with nerve conduction study and clinical tests.

The purpose of this study was to assess diffusion tensor imaging in the diagnosis of mild-moderate carpal tunnel syndrome (CTS) and to correlate fractional anisotropy (FA) and apparent diffusion coefficient (ADC) with nerve conduction study and clinical tests. This prospective study was conducted upon 39 patients (9 males, 30 females; mean age=33years) with early stage of CTS. Twenty age- and sex-matched healthy volunteers were included as a control group. All patients underwent clinical tests and nerve conduction studies with calculation of the distal motor latency (DML) and distal sensory latency (DSL). Patients with CTS and volunteers underwent diffusion tensor imaging of the median nerve. The cross-sectional area (CSA), FA, and ADC of the median nerve were calculated. There was significant difference in FA and ADC between patients and controls (P=0.001 respectively) and between mild and moderate CTS (P=0.001 respectively). The cutoff FA and ADC of the median nerve used for the diagnosis of CTS were 0.45 and 1.31×10-3mm2/s with areas under the curve (AUC) of 0.985 and 0.954, respectively, and the values used to differentiate mild from moderate CTS were 0.42 and 1.35×10-3mm2/s with AUC of 0.964 and 0.688, respectively. The FA and ADC of the median nerve were correlated with CSA (r=0.894; -0.769), DML (r=-0.935; 0.781), DSL (r=-0.953; 0.781), Tinel's test (r=0.742; 0.684), and Phalen's test (r=0.862; 0.742). Diffusion tensor imaging can be used for the diagnosis of mild-moderate CTS and well correlated with nerve conduction studies and clinical tests.