Phalen's Test Research Articles

Hand Allodynia, Lack of Finger Flexion, and the Need for Carpal Tunnel Release

The clinical features of classic carpal tunnel syndrome are well known. However, some patients who may respond equally well to carpal tunnel release (CTR) display atypical signs and symptoms. The chief differential features are allodynia (painful dysesthesias), lack of finger flexion, and, on examination, pain on passive finger flexion. The goal of the study was to present the clinical features, increase awareness, facilitate accurate diagnosis, and report the outcomes after surgery. Thirty-five hands, from 22 patients with the main features of allodynia and lack of full finger flexion, were gathered in the period 2014-2021. The other common complaints included sleeping disturbances (20 patients), hand swelling (31 hands), and shoulder pain on the same side as the hand problem with limited range of motion (30 sides). The Tinel or Phalen signs were obscured by the pain. However, pain with passive flexion of the fingers was universally present. All the patients were treated with carpal tunnel release through a mini-incision approach: four patients had a trigger finger, which was treated concomitantly in six hands, and one patient underwent contralateral CTR for carpal tunnel syndrome with a more standard presentation. At a minimum of 6 months of follow-up (mean, 22 months; range, 6-60 months), the pain decreased by 7.5 ± 1.9 points on the Numerical Rating Scale, which ranges from 0 to 10. The pulp-to-palm distance improved from 3.7 to 0.3 cm. The mean Disabilities of the Arm, Shoulder, and Hand score decreased from 67 to 20. The mean Single-Assessment Numeric Evaluation score for the whole group was 9.7 ± 0.6. Hand allodynia and lack of finger flexion may be indications of median neuropathy in the carpal canal, which responds to CTR. Awareness of this condition is important because the uncharacteristic clinical presentation may not be considered an indication for surgery that can be beneficial. Therapeutic IV.

Autoimmune hepatitis complicated with entrapment neuropathy & fibromyalgia: A case report

46. y-old right-handed female with history of controlled autoimmune hepatitis since 2001 with negative liver biopsy on 2017 presented with chronic generalized pain affecting neck, upper back, buttocks, knee and chest associated with paresthesia and tingling of left hand with nocturnal exacerbation. Clinical exam revealed; Neurologically Positive Tinel sign over median nerve at wrist bilaterally, Positive Phalen test bilaterally, Musculoskeletal exam revealed multiple tender points bilaterally with limited neck Rom due to pain. Electrophysiological testing of both upper extremities documented bilateral median sensory neuropathy at wrist, demyelinating pathology and bilateral ulnar nerve entrapment at wrist: Guyon canal syndrome; sensory-motor axonal demyelinating. Normal liver and kidney function tests and glycosylated hemoglobin 5.

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.
 OBJECTIVES:To evaluate the efficacy and clinical outcomes of ultrasound guided corticosteroid injection for treatment of carpal tunnel syndrome.
 STUDY SETTING: Department of Orthopedic surgery Services Hospital Lahore .
 STUDY DESIGN: Cross sectional study.
 STUDY DURATION: From December 2018 to December 2019 
 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.
 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.
 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 . 
 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 .
 Electrophysiological study was also improved after 06 weeks and after 03 months
 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

Static and Dynamic Ultrasound Evaluation of the Median Nerve Morphopathology in Carpal Tunnel Syndrome Diagnosis.

Objective:The current study included a total of 10 patients, both males and females, who gave their consent to participate in the study and underwent clinical and ultrasound examinations. All patients had a history of carpal tunnel symptoms like tingling, numbness, nocturnal paraesthesia and weakness of the hand (loss of pinch and grip strength) for more than 12 months. Aim: The aim of our study was to investigate the morphopathology of the median nerve in clinically diagnosed carpal tunnel thought static and dynamic ultrasound assessment. Material and methods: The present study included a small group of 10 patients aged over 18, both males and females, who had a history of carpal tunnel symptoms for over 12 months and a positive Tinel's and reverse Phalen's tests during clinical examination. Ultrasound was performed by an experienced orthopaedic surgeon with musculoskeletal ultrasound training. Ultrasound evaluation was made using a standardized method and included transverse and longitudinal static examination and dynamic examination of the median nerve in the carpal tunnel. Side-to-side evaluation was performed and differences of more than 10 mm width in the median nerve have been recorded, which was considered to be a positive test for carpal tunnel syndrome. Furthermore, the major advantage of the dynamic evaluation brought by performing the palmar hand and finger flexion test, while investigating the movement trajectory of the median nerve in the carpal tunnel, provides superior imagistic documentation of this pathology. Results:Dynamic evaluation of the median nerve has shown a decreased mobility of the nerve in the carpal tunnel on the side that also had an increased area value of the median nerve width. If in the asymptomatic hand at the time of dynamic evaluation, the median nerve would suddenly slide under the flexor tendons; therefore, we noted results only of a slight translational movement of the nerve in the carpal tunnel on the affected side. A side-to-side difference in the median nerve area, with values ranging between 3 mm up to 9 mm, was found in our patients. Furthermore, thenar atrophy has been discovered in patients with pre-existing carpal tunnel symptoms for more than 24 months. Conclusion:The present study highlights the importance of ultrasound assessment as an accessible static and dynamic evaluation tool. Ultrasound can be used as an in-office imaging tool to complete the clinical diagnosis of carpal tunnel syndrome by studying the morphology and morphopathology of the median nerve in the carpal tunnel through a bilateral standardized examination technique.

Work Period as one of The Risk Factors of Suspected Carpal Tunnel Syndrome (CTS) among Worker in the “X” Furniture Manufacturing, Gresik-East Java 2018

Background: Carpal Tunnel Syndrome (CTS) is a nerve disorder where an entrapped median nerve in the carpal tunnel causes pain and numbness in the hand. Prolonged condition of CTS will decrease someone’s productivity in daily life that requires hand. Aim: This study aimed to analyze age, sex, and work period as the risk factors that can increase the incidence of suspected CTS in workers at the "X" Furniture Manufacturing, Gresik, East Java. Material and Methods: An analytic observational cross-sectional study, was conducted in August 2018. A number 47 worker of “X” furniture manufacturing in Gresik, East java, counted as samples obtained by consecutive sampling technique. The data were taken by questionnaires and checked by using the Phalen test. The correlation between the risk factors of age, sex, and work period with suspected Carpal Tunnel Syndrome (CTS) were analyzed using chi-square and Fisher exact test. Results: Based on the research, as many as 15 respondents had suspected CTS. Based on the chi-square test, the significance value between suspected CTS with the risk factor of age are p=0.659, sex are p=0.70, and Fisher exact test resulted in the significance value between suspected CTS with work period are p=0.020. Conclusion: There was a significant difference between suspected Carpal Tunnel Syndrome (CTS) with work period (p<0.05) and there were no significant difference between suspected Carpal Tunnel Syndrome (CTS) with age and sex (p>0.05).

Evaluation of different physical examination methods for the diagnosis of carpal tunnel syndrome

In the present study, to evaluate the diagnostic value of different physical examination methods for diagnosing carpal tunnel syndrome (CTS), the scratch collapse test (SCT) and hand elevation test were compared with other traditional tests, such as Tinel's, Phalen's and reverse Phalen's tests, in an aim to improve the current diagnostic standards for CTS. The present study examined 236 (465 hands) patients with CTS and 96 (170 hands) controls who were enrolled in the study from December, 2019 to January, 2021. The participants in both groups were of the same age range, with equal male‑to‑female ratios. An examiner who was familiar with all maneuvers performed the Tinel's, Phalen's and reverse Phalen's tests, as well as the SCT and the hand elevation test in the two groups. The examiner was blinded to the patient histories and diagnoses. The sensitivities and specificities of all the tests were as follows: Tinel's test, 0.4194 and 0.7706; Phalen's test, 0.5613 and 0.7353; reverse Phalen's test, 0.5527 and 0.7882; SCT, 0.6774 and 0.7176; and hand elevation test, 0.7548 and 0.6059, respectively. The sensitivities of the SCT and hand elevation test were significantly higher than those of the other three tests. The areas under the receiver operating characteristic curve of the SCT and hand elevation test were 0.6975 and 0.6804, respectively, both of which were higher than those of Tinel's (0.5950), Phalen's (0.6483) and reverse Phalen's (0.6705) tests. On the whole, the present study demonstrates that the SCT is objective, reliable and has a high sensitivity. Furthermore, the hand elevation test is easy to perform, reproducible and has a high sensitivity. These newer tests are valuable for the diagnosis of CTS and can improve the current diagnostic standard system.

Most Frequent Compressive Limb Neuropathies: A Literature Review

AbstractPeripheral nerve injuries vary in length and severity, and they can occur secondary to trauma, compression and ischemia, leading to both motor and sensory neurological deficits. Nerve compression can occur in both the upper and lower limbs. These injuries can affect the quality of life, including the total or partial loss of the individual's productive capacity. The diagnostic methods are based on clinical criteria, but they may also include imaging and electroneurophysiological studies. A clinical examination using the Tinel and Phalen tests, for example, may suggest carpal tunnel syndrome. Complementary exams are used to confirm the diagnosis and rule out other possibilities, and the most used are electroneuromyography (ENMG), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Depending on the type of injury, recovery may be spontaneous or may require conservative or surgical treatment.

Accuracy of the Most Common Provocation Tests for Diagnosing Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis.

To estimate the screening performances of the most important provocation tests for diagnosing carpal tunnel syndrome (CTS). Diagnostic test accuracy systematic review with meta-analysis. We systematically searched the MEDLINE, Scopus, Web of Science, and Cochrane databases from inception to November 2020. Observational studies comparing the accuracies of the Durkan test (DT), the hand elevation test (HET), the Phalen test (PT), the Tinel test (TT), and the upper-limb neurodynamic test specific to the median nerve (ULNT1) with electrodiagnosis for screening for CTS. Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of these tests. Hierarchical summary receiver operating characteristic curve analyses were used to summarize the overall test performance. Thirty-seven studies were included in the meta-analysis, with a total sample of 2662 wrists for DT, 864 wrists for HET, 6361 wrists for PT, 6094 wrists for TT, and 571 wrists for ULNT1. The pooled dORs for screening for CTS were 15.84 (95% CI: 3.78, 66.38) for DT, 128.63 (95% CI: 40.64, 407.12) for HET, 7.23 (95% CI: 4.06, 12.86) for PT, 5.31 (95% CI: 3.49, 8.09) for TT, and 1.78 (95% CI: 0.61, 5.19) for ULNT1. HET has the best clinical performance for detecting CTS and should be considered the first screening test of choice during the physical examination. The most common tests (DT, PT, and TT) have good accuracies for screening for CTS. J Orthop Sports Phys Ther 2022;52(8):522-531. Epub: 19 June 2022. doi:10.2519/jospt.2022.10828.

Liverpool carpal tunnel scoring system to predict nerve conduction study results: A prospective correlation study.

BACKGROUNDCarpal tunnel syndrome (CTS) is one of the most common peripheral nerve compressive neuropathies. The clinical symptoms and physical examinations of CTS are widely recognised, however, there is still debate around what is the best approach for assessment of CTS. Clinical assessment is still considered the gold standard, however, controversies do exist regarding the need for investigations such nerve conduction studies (NCS) to aid with management decisions. AIMTo correlate the severity of NCS results to a scoring system which included symptoms, signs and risk factors.METHODSThis was a prospective correlation study. We scored patients’ signs and symptoms using our CTS scoring system. This was then correlated with the findings of the NCS. The scoring system included - four symptoms (2 Katz hand diagrams – one for tingling and one for numbness; nocturnal paresthesia and bilateral symptoms) and four clinical signs (weak thumb abduction test; Tinel’s sign; Phalen sign and hypoalgesia in median nerve territory) and two risk factors (age more than 40 years and female sex). We classified the NCS results to normal, mild, moderate and severe. RESULTSThere were 61 scores in 59 patients. The mean scores for the categories were as follows: 6.75 for normal NCS; 5.50 for mild NCS; 9.17 for moderate NCS and 9 for severe NCS. All scores of 8 or more matched with NCS results of moderate and severe intensity apart from three scores which were greater than seven that had normal NCS. Eta score was 0.822 for the CTS score being the dependent value and the NCS category being the independent variable showing a strong association between the scoring system and the NCS group.CONCLUSIONWe feel that this simple scoring system can be used to predict and correlate the severity of NCS in patients with CTS.

Efficacy of Ultrasound-Guided Particulate Versus Nonparticulate Steroid Injection in Carpal Tunnel Syndrome: An Open-Label Randomized Control Trial.

IntroductionPerineural corticosteroid injection is an extensively used and accepted treatment for carpal tunnel syndrome (CTS). However, to this date, there is no guideline as to which corticosteroid has to be used as the standard treatment for CTS. Triamcinolone acetonide is a commonly used particulate steroid that can cause permanent nerve injury if it is accidentally injected into the nerve. Conversely, dexamethasone sodium phosphate is a nonparticulate steroid that would not cause permanent nerve damage following accidental injection.MethodsMild to moderate cases of CTS, confirmed by nerve conduction studies (NCS), with symptoms greater than three months were recruited. The participants received one session of ultrasound-guided perineural injection by the in-plane axial ulnar-sided approach with 4 mL of either dexamethasone (dexamethasone sodium phosphate 8 mg (2 mL) + 2 mL 0.5% bupivacaine) or triamcinolone (triamcinolone acetonide 40 mg/mL (1 mL) + 2 mL 0.5% bupivacaine + 1 mL normal saline) solution. The parameters assessed were Phalen’s test time (in seconds), visual analog scale (VAS), and Boston carpal tunnel questionnaire (BCTQ) scores at baseline and two and four months, and NCS changes in sensory nerve conduction velocity (SNCV) and distal motor latency (DML) of the median nerve at baseline and four months. Statistical analysis was conducted using the software SPSS version 26.0 (IBM Corporation, Armonk, NY, USA). Independent samples t-test was used for comparison between groups and the paired t-test for improvement within each group. P values < 0.05 were considered statistically significant.ResultsThe mean age was 42.64 ± 10.99 in the dexamethasone and 45.22 ± 10.602 in the triamcinolone group cases (P = 0.324).There were 58 females (84.06%) and 11 males (15.94%). Each of Phalen’s test time, VAS, and BCTQ scores significantly improved within both dexamethasone and triamcinolone groups at the second and fourth months after injection (P < 0.05). The NCS parameters (SNCV and DML) also significantly improved in both groups at the fourth month after the injection (P < 0.05). However, there were no significant differences in the improvement of Phalen’s test time between the two groups (P = 0.745), VAS score (P = 0.319), BCTQ score (P = 0.137), SNCV (P = 0.511), or DML (P = 0.753). Postprocedural pain lasted significantly longer in the triamcinolone group (P < 0.05). No major complications were noted in either of the two groups.ConclusionDexamethasone is as effective as triamcinolone in improving the symptoms of CTS and can be used as a safer and more effective alternative in the treatment of mild to moderate CTS cases.

Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study.

To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1min per point at a wavelength of 830nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).

Role of homoeopathic medicine in the treatment of a case of carpal tunnel syndrome with dysthymia: A case report

This case report focuses on 50-year-old woman who was diagnosed with dysthymia and carpal tunnel syndrome (CTS). After reviewing her detailed history, she was prescribed homoeopathic medicine Natrum Carb considering the grief after death of her middle daughter, suppression of emotions since her childhood and her characteristic mental state of desiring to be alone and weeping when alone; her characteristic physical generals and dispositional qualities were also considered. After taking homoeopathic medicine, significant improvement occurred in her subjective symptoms such as paraesthesia as well as in the objective CTS-related signs such as the Tinel sign and Phalen test. Her anger, weeping spells, sleep disturbances and sadness were ameliorated as well. Homoeopathic medicine was found to be effective in relieving CTS and dysthymia in this case. Further research is needed to prove the efficacy of this treatment method in this disease.

Effects of Benign Joint Hypermobility Syndrome on the Clinical Characteristics of Carpal Tunnel Syndrome in Females.

Background and PurposeThe study aim was to determine the effects of benign joint hypermobility syndrome (BJHS) on symptom severity and functional capacity in females with carpal tunnel syndrome (CTS) based on the findings of physical examinations.MethodsOne hundred female patients diagnosed with bilateral CTS in electrophysiological testing were included in this study. The participants were evaluated for BJHS using the Brighton 1998 criteria, and divided into two groups: one consisting of 56 CTS patients with BJHS, and the other comprising 44 CTS patients without BJHS. Tinel’s, Phalen’s, and reverse Phalen’s tests were applied to all patients, and the severity and functional capacity of CTS were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire.ResultsSymptom severity and functional capacity varied significantly between the two groups in the right hand (p=0.037 and p=0.039, respectively) and in the left hand (p=0.016 and p=0.029). The hypermobile group yielded more positive results on the right side during Tinel’s, Phalen’s, and reverse Phalen’s tests (p=0.032, p=0.032, and p=0.018, respectively).ConclusionsHypermobility in females exacerbated the symptoms of CTS and led to a further reduction of functional capacity. Therefore, hypermobility should be tested and an intense exercise program should be implemented in BJHS patients, especially in females with CTS.

Carpal tunnel syndrome at Jordan University Hospital

Objective: To assess the age and sex distribution, risk factors, clinical, nerve conduction study findings and treatment of patients with carpal tunnel syndrome (CTS) seen at Jordan University Hospital (JUH) and compare the results with Western and Middle/Far Eastern studies. Methods: This is a retrospective study of 150 patients with CTS seen at Jordan University Hospital ( JUH) over a one-year-period (January 2019-January 2020). Results: The mean age of the patients = 52 years (range 16-86), 121 females, 29 males. The most common predisposing factors were stressful manual work followed by diabetes mellitus and hypothyroidism. The most frequent symptoms were nocturnal hand paresthesiae. The respective sensitivities of Tinel and Phalen signs were 30 and 33%. The diagnostic yield of nerve conduction studies (NCS) ranged between 19 and 56% and the most sensitive NCS technique was the median palm-to-wrist (PW) technique with a yield of 56%. Fifty-two percent of the hands with electrophysiological CTS were moderate and severe. One hundred and thirty six patients received conservative treatment and 14 underwent surgical decompression. Conclusion: Compared to other studies, there was a high proportion of young patients with, however, similar clinical symptoms and risk factors. The majority of the patients had moderate and severe CTS despite the absence of heavy manual industrial labour in Jordan.

Surgeon Ratings of the Severity of Idiopathic Median Neuropathy at the Carpal Tunnel Are Not Influenced by Magnitude of Incapability.

Accurately distinguishing the severity of pathophysiology from the level of symptom intensity and incapability is a foundation of effective treatment strategies under the biopsychosocial paradigm of illness. With respect to idiopathic median neuropathy at the carpal tunnel (the symptoms and signs of which are referred to as carpal tunnel syndrome), surgeons who are more likely to recommend surgery based on the magnitude of symptoms and incapability rather than the severity of neuropathy may be underappreciating and undertreating mental health opportunities and overtreating mild, and on occasion unmeasurable, disease. A survey-based experiment that randomizes elements of the patient presentation can help determine the relative influence of magnitude of incapability on ratings of pathology severity. What factors are associated with severity rating of idiopathic median neuropathy at the carpal tunnel on an 11-point ordinal scale? One hundred eight hand and wrist members of the Science of Variation Group (among approximately 200 participants who complete at least one survey-experiment a year related to the upper extremity on average) reviewed seven scenarios of fictional median neuropathy with seven randomized variables: age, gender, limitations of daily activity (incapability), Tinel and Phalen test results, duration of numbness episodes, prevention of numbness with nocturnal splint immobilization, constant numbness, and weakness of palmar abduction. Participants had a mean age of 51 ± 10 years, 90% (97 of 108) were men, and 74% (80 of 108) were subspecialized in hand surgery. Surgeons were asked to rate the severity of idiopathic median neuropathy at the carpal tunnel on a on an 11-point ordinal scale. Factors associated with rated severity were sought in multilevel ordered logistic regression models. Fifteen surgeons did not complete all of their assigned randomized scenarios, resulting in a total of 675 ratings. After controlling for potentially confounding variables such as magnitude of incapability, factors associated with severity rating on the 11-point ordinal scale included palmar abduction weakness (odds ratio 11 [95% confidence interval 7.7 to 15]), longer duration of symptom episodes (OR 4.5 [95% CI 3.3 to 6.2]), nocturnal numbness in spite of splint immobilization (OR 3.2 [95% CI 2.3 to 4.3]), constant numbness (OR 2.5 [95% CI 1.9 to 3.4]), positive Tinel and positive Phalen test results (OR 2.2 [95% CI 1.6 to 2.9]), and older age (OR 1.6 [95% CI 1.2 to 2.1]). Our results suggest that surgeons rate the severity of idiopathic median neuropathy at the carpal tunnel based on evidence of worse pathophysiology and are not distracted by greater incapability. Surgeons who consider greater incapability as an indication of more severe pathology seem to be practicing outside the norm and may be underappreciating and undertreating the unhelpful thoughts and feelings of worry or despair that consistently account for a notable amount of the variation in symptom intensity and magnitude of incapability.

Demographical, Anatomical, Disease-Related, and Occupational Risk Factors for Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy. It causes characteristic symptoms, including numbness and paresthesia in the hand due to median nerve compression at the wrist. Objectives: We aimed to investigate CTS prevalence and personal, psychosocial, biomedical, and occupational factors related to it comprehensively, according to scattered publications, without the simultaneous evaluation of all CTS risk factors. Methods: A total of 345 patients referred to a hand clinic with a complaint of paresthesia in upper extremities and suspected CTS. The patients underwent neurological assessment and electrodiagnostic (EDX) tests to confirm the diagnosis. The demographic information, past medical history, past trauma history, and occupational history of all the patients were recorded and finally analyzed with SPSS software. Results: Of the patients, 213 (67.1%) met the criteria for CTS, of whom 160 (75%) were female. Females were significantly more affected by CTS than males (P &lt; 0.05). The mean age was higher in the CTS patients (53.80 ± 11.57 years) than in non-patients (42.39 ± 12.31 years, P &lt; 0.001). No statistical relevance was found between CTS prevalence with occupational history, underlying medical conditions, positive Tinel’s and Phalen's tests, and muscle atrophy. Conclusions: We recognized age and gender as main determinants in developing CTS. We also found that older age was related to higher CTS intensity.

Association of Carpal Tunnel Syndrome in Diabetes Patient

Objective: The objective of our study was to determine Prevalence of carpel tunnel syndrome among diabetic patients and the significant association between carpel tunnel syndrome and diabetes mellitus.&#x0D; Materials and Methods: Study was conducted on 250 patients at Saveetha medical college and hospital. Study was conducted after getting proper ISE approval. Subjects were selected according to inclusion and exclusive criteria's. For every study subject after getting consent demographic information, past medical history of Diabetes such as type, duration, any associated complication (diabetic neuropathy, retinopathy, etc.), medication, and lifestyle modification were obtained via a self-reporting structured questionnaire and confirmed by the subject's medical record. For every subject, clinical tests such as Tinel's test and Phalen test were performed and nerve conduction study was used for diagnose carpal tunnel syndrome among the subjects who were showing positive clinical test. All data collected were entered into the standardized database and statistic analysis was calculated.&#x0D; Results: After analysing the data collected on association between carpel tunnel syndrome and a diabetes patient.&#x0D; Conclusion: It implies that there is a significant relationship between carpal tunnel syndrome and diabetes patients.

Carpal Tunnel Syndrome:Diagnosis and Treatment

Carpal tunnel syndrome(CTS)is a common entrapment neuropathy caused by compression of the median nerve around the wrist. The risk factors of CTS include female sex, diabetes mellitus, hypothyroidism, obesity, arthritis, hemodialysis, acromegaly, and pregnancy. CTS is characterized by paresthesia in the distribution of the median nerve. Patients are often unaware of ring-finger splitting and the combination of Tinel's sign and Phalen's test improves diagnostic accuracy. In addition, electrophysiological assessments can help to confirm a CTS diagnosis; their sensitivity ranges from 57-94% and their specificity from 51-97%. CTS negatively affects the quality of life but improvement by surgery can be expected. For conservative treatment, a neutral wrist splint worn at night or oral medication such as nonsteroidal anti-inflammatory drugs, vitamin B12, and pregabalin have been shown to be effective against CTS. CTS surgery may be indicated in patients with thenar muscle atrophy and when conservative treatment is ineffective. The surgery involves a small skin incision under a microscope and local anesthesia. Long-term outcomes with respect to pain, numbness, function, symptomatology relapse, and frequency of re-surgery do not significantly differ between patients subjected to open or endoscopic surgery.

Effects of classical acupuncture in the treatment of carpal tunnel syndrome: A clinical study

ObjectiveThe purpose of this clinical study is to demonstrate the effect of classical acupuncture on the Carpal Tunnel Syndrome (CTS) and the relationships that integrate the view of classical acupuncture treatment with current anatomical-physiological knowledge. DesignA clinical study was carried out with patients with CTS. SettingThe treatments were conducted in a private healthcare practice by a licensed acupuncturist. ParticipantsThe five participants presented symptomatology for a period of no less than 6 months, had been diagnosed through electromyography, and additionally showed a positive test for Phalen's maneuver test. All the patients had surgical indications. InterventionsClassical Chinese acupuncture was applied during a cycle of treatments. Main measurementsThe Visual analog scale (VAS) was used to assess the level of discomfort regarding daytime paresthesia, nighttime paresthesia, pain, decrease in strength, and a proposed converted value of pressure pain threshold. ResultsAll the parameters showed significant improvement. The mean difference was negative for pain (−7,4 points), daytime paresthesia (−5,2 points), nighttime paresthesia (−6,2 points), and loss of strength (−4,6 points), whereas the estimation for the pressure pain threshold was positive (+0,683 kgf/cm2). ConclusionsIn the analysis of the results obtained through the classical acupuncture therapy, all parameters showed an improvement, which suggests and supports evidence of clinical efficacy on the CTS.

Sensory Nerve Conduction Velocity Predicts Improvement of Hand Function with Nerve Gliding Exercise Following Carpal Tunnel Release Surgery.

This study aims to investigate the effects of nerve gliding exercise following carpal tunnel release surgery (NGE-CTRS) and the probing factors affecting the effect of NGE-CTRS on hand function. A total of 86 patients after CTRS participated. Grip strength (grip-s), pinch strength (pinch-s), Semmes-Weinstein monofilament test (SWMT), two-point discrimination (2PD), numbness, pain, and Phalen test (Phalen) were measured and compared between pre- and post-NGE-CTRS. The results showed that the combination of surgery and NGE significantly improved the postoperative grip-s, pinch-s, SWMT, 2PD, numbness, and Phalen; however, no improvement was observed in pain. Background factors that influenced the improved grip-s and pinch-s included gender and preoperative sensory nerve conduction velocity (SCV). Additionally, numbness and Phalen were not affected by age, gender, fault side, bilateral, trigger finger, dialysis, thenar eminence atrophy, motor nerve conduction velocity, SCV, the start of treatment, and occupational therapy intervention. In conclusion, the combination of surgical procedures and NGE showed a high improvement. SCV and time-to-start treatment of intervention for carpal tunnel syndrome may be useful in predicting the function after the intervention.