Presence Of Carpal Tunnel Syndrome Research Articles

TRANSTYRETIN CARDIAC AMYLOIDOSIS IN ELDERLY PATIENTS: ALWAYS A WILD TYPE?

Abstract Background Transthyretin amyloidosis (ATTR) exists in two forms: a genetic form transmitted by autosomal dominant inheritance (ATTRv) and a wild type form (ATTRwt). Clinically, the hereditary form tends to have an early onset in adulthood and it is characterized by a particular tropism for nervous as well as cardiac tissue. In contrast, the "wild type" form has a later onset with major cardiac involvement and neurological manifestations usually limited to carpal tunnel syndrome. Methods and Results In our centre, from September 2021 to June 2023, 52 patients older than 70 years received a diagnosis of cardiac ATTR (87% male, 13% female, mean age 81±5y). In all patients, blood tests showed a significant and stable increase in the values of troponin Ths (0.079 microg/L±0.074) and NT–proBNP (2000±1800 pg/ml), with the absence of a monoclonal component in the blood and urine, and miocardial bisphosphonate scintigraphy positive grade 2/3. All patients underwent genetic testing by amplification of exons 2,3 and 4 of the TTR gene with subsequent sequencing. Unexpectedly, in 10 elderly (70%male, 30% female, mean age 77±4 y) patients (19%) the genetic test resulted positive with 4 different mutations of pathogenetic significance (Val30Met; Ile68Leu; Val142Ile;, Phe84Leu). Three patients showed peripheral neuropathy with the presence of carpal tunnel syndrome, while isolated carpal tunnel syndrome was present in the remaining 7 cases. The three patients with neurologic involvement started Patisiran therapy, and 7 patients were treated with Tafamidis. First–degree relatives (16 consanguineous, average age 49±12 years) agreed to be subjected to genetic screening; of these 9 (3 male and 6 females, age 47±8 years) were positive for the corresponding mutation and underwent echocardiogram, MRI and myocardial scintigraphy. These tests were normal in 8 probands, included in an annual follow–up protocol to identify an early manifestation of the disease, and was diagnostic for amyloidosis in 1 patient who started specific therapy. Conclusions Our experience shows that 19% of patients older than 70 years with a diagnosis of cardiac ATTR may be affected by a genetic form. Making genetic diagnosis in this context is particularly important for screening family members: current therapies are in fact much more effective if started early before organ damage occurs.

The prevalence of carpal tunnel syndrome in patients with epilepsy

ObjectiveCarpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy caused by compression of the median nerve in the carpal tunnel. Epilepsy is characterised by recurrent seizures caused by abnormal neuronal discharges in the brain.This study aimed to investigate whether there is a link between epilepsy and carpal tunnel and, if so, the underlying factors. Materials and methodsTwo hundred patients with epilepsy were included in this study. The patients' history of epilepsy, seizure type, and seizure frequency were assessed. The Tinel, Phalen, and Flick physical examination tests were performed on patients with complaints that matched those of median nerve neuropathy. Patients with epilepsy and clinically diagnosed carpal tunnel syndrome completed the Boston Carpal Tunnel Syndrome Questionnaire, and nerve conduction studies were performed. The relationship between seizure type and frequency in patients with carpal tunnel syndrome was compared. ResultsCompared to focal-aware motor-onset seizures, the risk of detecting carpal tunnel syndrome was 88.7 times higher in focal-onset bilateral tonic-clonic seizures. Patients with a seizure frequency of one per month or more had a 0.704 times lower risk of CTS than those with a frequency of one per week or more (p = 0.026). DiscussionPatients with epilepsy, especially those experiencing frequent seizures or specific seizure types, may be more susceptible to repetitive wrist flexion-extension postures. Therefore, during clinical follow-up, it is important to inquire about the presence of carpal tunnel syndrome in patients with epilepsy.

Transtyretin cardiac amyloidosis in the elderly patient: always a wild type?

Abstract Background Transthyretin amyloidosis (ATTR) exists in two forms: a genetic form transmitted by autosomal dominant inheritance (ATTRv) and a wild type form (ATTRwt). Clinically, the hereditary form tends to have an early onset in adulthood and it is characterized by a particular tropism for nervous as well as cardiac tissue. In contrast, the "wild type" form has a later onset with major cardiac involvement and neurological manifestations usually limited to carpal tunnel syndrome (1). Methods and results in our centre, from January to October 2022, 20 patients older than 75 years received a diagnosis of cardiac ATTR (73% male, 27% female, mean age 83±5). In all patients, blood tests showed a significant and stable increase in the values of troponin Ths (0.070± 0.074 ng/mL) and NT-proBNP (1533±1204 pg/ml), with the absence of a monoclonal component in the blood and urine, and miocardial bisphosphonate scintigraphy positive grade 2/3. All patients showed absence of peripheral neuropathy with the presence of carpal tunnel syndrome in 9 cases. Before starting therapy with Tafamidis all patients underwent genetic testing by amplification of exons 2,3 and 4 of the TTR gene with subsequent sequencing. Unexpectedly, in 3 elderly male patients (15%) the genetic test resulted positive with 3 different mutations of pathogenetic significance (Val50Met; Ile88Leu; Val142Ile). First-degree relatives (10 consanguineous, average age 49±12 years) agreed to be subjected to genetic screening; of these 4 (1 male and 3 females, age 47±8 years) were positive for the corresponding mutation and underwent echocardiogram, MRI and myocardial scintigraphy. All of these tests were normal and they were included in an annual follow-up protocol at the to identify an early manifestation of the disease. Conclusions our experience shows that 15% of patients older than 75 years and diagnosed with cardiac ATTR may be affected by a genetic form. Making genetic diagnosis in this context is particularly important for screening family members: current therapies are in fact much more effective if started early before organ damage can occur (2).

C65 TRANSTYRETIN CARDIAC AMYLOIDOSIS IN THE ELDERLY PATIENT: ALWAYS A WILD TYPE?

Abstract Background Transthyretin amyloidosis (ATTR) exists in two forms: a genetic form transmitted by autosomal dominant inheritance (ATTRv) and a wild type form (ATTRwt). Clinically, the hereditary form tends to have an early onset in adulthood and it is characterized by a particular tropism for nervous as well as cardiac tissue. In contrast, the "wild type" form has a later onset with major cardiac involvement and neurological manifestations usually limited to carpal tunnel syndrome. Methods and results In our centre, from January to October 2022, 20 patients older than 75 years received a diagnosis of cardiac ATTR (73% male, 27% female, mean age 83±5). In all patients, blood tests showed a significant and stable increase in the values of troponin Ths (0.070± 0.074 ng/mL) and NT–proBNP (1533±1204 pg/ml), with the absence of a monoclonal component in the blood and urine, and myocardial bisphosphonate scintigraphy positive grade 2/3. All patients showed absence of peripheral neuropathy with the presence of carpal tunnel syndrome in 9 cases. Before starting therapy with Tafamidis all patients underwent genetic testing by amplification of exons 2,3 and 4 of the TTR gene with subsequent sequencing. Unexpectedly, in 3 elderly male patients (15%) the genetic test resulted positive with 3 different mutations of pathogenetic significance (Val50Met; Ile88Leu; Val142Ile). First–degree relatives (10 consanguineous, average age 49±12 years) agreed to be subjected to genetic screening; of these 4 (1 male and 3 females, age 47±8 years) were positive for the corresponding mutation and underwent echocardiogram, MRI and myocardial scintigraphy. All of these tests were normal and they were included in an annual follow–up protocol at the to identify an early manifestation of the disease. Conclusions our experience shows that 15% of patients older than 75 years and diagnosed with cardiac ATTR may be affected by a genetic form. Making genetic diagnosis in this context is particularly important for screening family members: current therapies are in fact much more effective if started early before organ damage can occur.

Abstract 15382: Geriatric HFpEF: When It Isn’t Hypertensive Heart Disease

Introduction: Transthyretin amyloid cardiomyopathy (ATTR) is thought to be a rare cause of HF, but recent studies showed this is the cause of 30% of HFpEF patients older than 75. With new treatments for amyloidosis, timely diagnosis has become critical. Case: A 78-female with HFpEF, HTN, and diabetes followed for progressive functional decline and hospitalizations for HFpEF exacerbations. EKG at baseline showed LBBB with normal QRS voltages. Serial echocardiogram (echo) showed an ejection fraction (EF) of 60-70%, mild LVH, and moderate TR with RVSP >50 mmHg. Latest echo showed progressive LA enlargement, MR, a new small pericardial effusion, and EF 50%. Regadenoson nuclear scan showed normal perfusion with preserved LVEF. Despite adequate control of her HTN, dyspnea continued to worsen. Because of this, the diagnosis of Cardiac amyloidosis was considered. Further review revealed a history of Carpal Tunnel Syndrome (CTS) and speckled pattern within the ventricular wall on echo. A technetium pyrophosphate scintigraphy ( 99m Tc-PYP) confirmed ATTR with grade three uptake, AL amyloid was ruled out with normal SPEP/UPEP, and she was started on Tafamidis. Discussion: Cardiac amyloidosis should be considered in HFpEF patients with functional decline despite medical optimization. It can mimic LVH caused by HTN on echo and easily dismissed in patients with traditional risk factors, but presence of CTS or lumbar spinal stenosis can be supportive. Traditionally ATTR is associated with low-voltage EKG, however this patient presented with normal QRS voltages for years, making the diagnosis more elusive. Conclusion: Advances in noninvasive imaging and treatments allow for early diagnosis of cardiac amyloidosis, reducing morbidity and mortality. Diagnosis is often delayed or missed, as features could be subtle and mimic other more common cardiac disease. Screening  99m Tc-PYP for elderly patients with HFpEF could translate to improved outcomes

The Utility of the Carpal Tunnel Syndrome-6 for Predicting the Outcomes of Carpal Tunnel Release

Considering the cost of, discomfort with, and time required for nerve conduction testing, the Carpal Tunnel Syndrome-6 (CTS-6) is often used to determine the likelihood of the presence of carpal tunnel syndrome. We sought to determine whether the CTS-6, designed as a diagnostic instrument, could serve a dual purpose and predict the outcome of carpal tunnel release (CTR) based on postoperative changes in the Boston Carpal Tunnel Questionnaire (BCTQ) score. This prospective observational study enrolled 118 adults before they underwent open CTR at a tertiary center. A primary regression analysis was used to determine the association between preoperative CTS-6 scores and changes in the BCTQ score at ≥6 months after surgery. Additional demographic, social, electrodiagnostic, and mental health variables were assessed for associations with changes in the BCTQ score. The secondary outcomes included single questions rating satisfaction with the result of CTR as well as symptom changes and the Decision Regret Scale. Noneffective CTR was defined as a BCTQ score change of <1.0 point or reported dissatisfaction. Postoperatively, the BCTQ score improvement averaged 1.38 ± 0.77. Although 102 of 109 patients (94%) noted symptom improvement, 94 of 109 (86%) were satisfied with the result of CTR, and 78 of 109 patients (72%) demonstrated a meaningful change in the BCTQ score. Preoperative CTS-6 scores were not correlated with changes in BCTQ scores. CTS-6 scores were not associated with Decision Regret Scale scores, reported satisfaction, or the single-question assessment of symptom changes. Satisfaction, decision regret, and the single symptom change question were correlated with changes in the BCTQ score and each other. Dissatisfied patients were distinguished by a differential improvement in the BCTQ score (1.5 vs 0.7), but no preoperative variable consistently predicted noneffective CTR. The CTS-6 score does not predict changes in BCTQ scores after CTR. Patient satisfaction with surgical results is associated with postoperative changes in carpal tunnel symptoms but is not predictable using preoperative information. A single question of symptom change may offer an efficient assessment of CTR outcomes. Prognostic II.

The Accuracy of Provocative Tests on Diabetic Patients with Suspected Carpal Tunnel Syndome and Comparison with Nondiabetics

Objective: Carpal tunnel syndrome in diabetic patients differ in some aspects from those in the nondiabetic population. The study was designed to evaluate the diagnostic accuracy of widely used provocative tests in the diabetic population in comparison to nondiabetic population. Materials and Methods: 87 nondiabetic and 25 diabetic hands suspicious of carpal tunnel syndrome were included in this retrospective study. The presence of carpal tunnel syndrome is confirmed by nerve conduction studies. The hands were divided into DM- and DM+ groups based on patients’ diabetes mellitus history. From patient records, results of Tinel’s, Phalen’s, Durkan’s, median nerve compression, and scratch collapse tests were obtained. Sensitivity, specificity, positive predictive value, and negative predictive values of tests are calculated for each population and then compared with each other. Results: Tinel’s test had a higher sensitivity in the diabetic population. Accuracies of Phalen’s, Durkan’s, median nerve compression, and scratch collapse tests in diabetic patients were similar to those in diabetic patients. None of the tests had a high enough sensitivity to be used alone in either group. Scratch collapse test had very high specificity in both groups but very low sensitivity. Conclusion: The studied provocative tests have comparable accuracy for carpal tunnel syndrome in diabetic patients to those in nondiabetic patients, with Tinel even having higher sensitivity. But excluding scratch collapse test, none of the tests is strong enough to achieve a diagnosis and none is sensitive enough to rule out a disease.

Assessment of carpal tunnel syndrome via ultrasonography among hospital workers: a screening study

BackgroundCarpal tunnel syndrome is a reasonably common disorder among working individuals. It may also be a cause of functional impairment. The aim of the study was to screen for the presence of carpal tunnel syndrome among hospital workers by non-invasive ultrasound.ResultsThe prevalence of carpal tunnel syndrome diagnosed by ultrasound among hospital workers was 21.5%. Age and Boston carpal tunnel questionnaire scale were positively correlated to median nerve cross sectional area.ConclusionsUltrasound can be used as a non-invasive and convenient method for screening for carpal tunnel syndrome.

The Interaction of Diabetic Peripheral Neuropathy and Carpal Tunnel Syndrome.

Diabetes mellitus (DM) increases the risk for carpal tunnel syndrome (CTS) and is associated with its own neuropathic complications. Diabetic peripheral neuropathy (DPN) is a common complication seen in diabetic patients. In this study, we examine the relationship between the severity of DPN and CTS. Type 2 diabetic and control patients (n = 292) were recruited at a clinic visit. The Michigan Neuropathy Screening Instrument (MNSI) questionnaire was used to collect data related to peripheral neuropathy. The MNSI scores were compared for patients with CTS with and without DM in univariable and multivariable analyses. χ2 analyses were performed to quantitatively measure the associations between peripheral neuropathy and the presence of CTS. Of the 292 patients, 41 had CTS, and 19 of these had both CTS and DM. Of the 138 diabetic patients, 85 had peripheral neuropathy. There was no association between a diagnosis of CTS and an MNSI score indicative of peripheral neuropathy. In the diabetic population, CTS was inversely associated with DPN (P = .017). The MNSI scores between diabetic and control patients with CTS were comparable. The severity of peripheral neuropathy in diabetic patients with and without CTS is comparable. Diabetic patients without peripheral neuropathy have an association with higher incidence of CTS in this study, suggesting that there are disparate mechanisms causing DPN and CTS. Nevertheless, diabetes and CTS are risk factors for developing the other, and future studies should further explore how DPN and CTS differ to tailor patient interventions based on their comorbidities.

Associations between hand function and electrophysiological measurements in hand osteoarthritis patients of different ages with or without carpal tunnel syndrome

Osteoarthritis is a common degenerative disease that most frequently involves the hand. The objective was to compare clinical functional outcome measures including hand grip, pinch strength, and dexterity with various electrophysiological measures in patients of different ages with hand osteoarthritis with or without the presence of carpal tunnel syndrome (CTS). Patients with hand osteoarthritis (208 patients, 404 hands) who underwent hand-function tests and motor and sensory nerve conduction studies (NCS) between June 2015 and June 2016 were enrolled. The patients’ hands were assigned to carpal tunnel syndrome (CTS) (206 hands; mean age, 56.37 ± 10.52; male:female, 46:160) or control groups (198 hands; mean age, 57.88 ± 9.68; male:female, 55:143). The strength of hand grip and lateral pinch, the time required to complete the nine-hole pegboard test (9HPT), and motor and sensory nerve conduction parameters were measured and compared across age groups and between hands with or without CTS. The CTS group showed significantly lower hand grip and lateral pinch strength, and a longer time to complete the 9HPT in comparison with the control group. Female patients showed significantly lower hand grip and lateral pinch strength than male patients. However, there was no difference in the 9HPT completion time between genders. Multivariate regression analysis identified the amplitude of the median compound muscle action potential (CMAP), age, and male gender as independent predictors of grip strength (adjusted R2 = 0.679), and amplitude of median CMAP and male gender as independent predictors of KP strength (adjusted R2 = 0.603). Velocity of median CMAP, amplitude of median sensory nerve action potential, and age were identified as independent predictors of 9HPT time (adjusted R2 = 0.329). Nerve conduction measurements were significantly related to hand-function test results, and CTS induced significant deficits in strength and performance of the affected hand.

Differential diagnostic of stenosing ligamentitis and rheumatoid arthritis

Objective — to study the presented clinical case from the perspective of differential diagnosis of 2 pathologies: rheumatoid arthritis and stenosing ligamentitis. Material and methods . Patient M., 40 years old was examined. We studied complaints, an anamnesis of the disease and life, data from medical documentation. Description of the clinical case . Patient M. was admitted with a diagnosis of probable rheumatoid arthritis (RA) in the department of rheumatology to verify the diagnosis. The diagnosis was established based on damage to the hands, positive rheumatic tests. It turned out that the patient worked as a typesetter. And with a detailed analysis of the clinical picture, it turned out that polyneuropathic signs prevail over the articular syndrome. On the basis of ultrasound examination of the hands, electromyography data, and X-ray data, the presence of carpal tunnel syndrome was established. After a consultation with a traumatologist, the diagnosis of stenotic ligamentitis (SL) was verif ed. Conclusion . Study of complaints, anamnesis allows timely and high-quality differential diagnosis of SL and RA, prescribe adequate treatment and timely prepare for surgical treatment.

A Clinical Approach to Diagnosing Trigger Wrist.

Trigger wrist is a relatively unusual condition, produced by wrist or finger motion. The various causes of trigger wrist can originate from flexor tendon, extensor tendon, bones, or tumour. A proper clinical approach is required to diagnose and manage patients with trigger wrist. A keyword search was performed across Google Scholar and PubMed. Articles describing trigger wrist conditions were analysed. Based on the information obtain from the articles, the clinical manifestations and approach to diagnosing the cause of trigger wrist is discussed. A detailed history alone may lead to a reasonably accurate diagnosis. Patients can present with trigger wrist occurring during movement of the fingers or with wrist movements. Presence of tenderness around A1 pulley suggest trigger finger. Absence of tenderness over the A1 pulley may suggest trigger wrist. The wrist should be examined for any swelling or malunion around the wrist joint. Palpate for any bony prominence, clicking, or crepitus with the movement of the wrist. Examination for the presence of carpal tunnel syndrome should be performed. A simple radiograph of the wrist joint is needed to see any possible bony pathology such as malunion, instability or arthritis of the carpal bone. For soft tissue assessment ultrasound would be a good choice and can be done during finger or wrist movement. MRI is useful for further assessment of space occupying lesion within the carpal tunnel and is useful for surgical planning. Nerve conduction study is indicated for patients with median nerve compression symptoms. During the initial stage, the patient should be advised for activity modification to reduce the wrist and finger movements. Surgical treatment will depend on the causative factor. Surgery done under local anaesthesia has the advantage of reconfirming with the patient, resolution of triggering during surgery by asking the patient to actively move the fingers or wrist. Trigger wrist is a relatively rare condition compared with trigger finger, which is the most common disorder of the hand. To avoid inadequate and ineffective treatment of patients with trigger wrist, careful examination and proper diagnosis are vital.

Articular and skeletal affection in regularly dialyzed patients with end-stage renal disease

BackgroundPatients on regular hemodialysis (HD) are vulnerable to develop different articular and skeletal problems that interfere with life quality and affect morbidity and mortality in these patients. To, properly, overcome or even prevent the development of these complications, early detection, especially of the commonly affected parts, is required.AimThe aim was to detect articular and skeletal manifestations in patients with end-stage renal disease on regular HD, their relation to duration of dialysis, and which is more affected.Patients and methodsA total of 50 patients (34 males and 16 females) with end-stage renal disease on regular HD, who were attendants of the dialysis unit of Internal Medicine Department at Al-Azhar University hospital, New Damietta, with duration of dialysis ranging between 3 and 15 years and age ranging from 26 to 70 years old were recruited for the study. They were classified into three groups: group I: mild, group II: moderate, and group III: severe joint affection. Full history taking, thorough clinical examination, especially for uremic and rheumatologic manifestations; laboratory investigations (inflammatory and metabolic markers); synovial fluid analysis and culture; and radiological investigations (radiography, dual-energy X-ray absorptiometry scan, ultrasound, computed tomography, and MRI of the affected parts) were done.ResultsThere was a significant association between the duration of dialysis and the presence of joint affection. The most common affected joints were knee joints [n=23 patients (46%)] and shoulder joints [n=10 (20%)]. There was a statistically significant association between the severity of joints involvement and the prolonged duration of dialysis. The most common crystals present were the urate crystals (26%) followed by calcium pyrophosphate dihydrate (12%), and lastly oxalate crystals (8%). Carpal tunnel syndrome was diagnosed in 12 patients, with high significant association between the duration of dialysis and presence of carpal tunnel syndrome. There was increase in the level of parathyroid hormone with increase in the duration of renal dialysis. Moreover, 64% of patients had hyperparathyroid bone disease. The mean alkaline phosphatase level was increased in all groups of patients but was more in patients with severe joint affection. Serum albumin was maintained within normal level in HD patients. Radiological study of our HD patients showed that the most frequent radiological findings were signs of secondary hyperparathyroidism (subperiosteal resorption; acroosteolysis in the terminal tufts; pathological fracture, with two fractures in the spine, one in the neck of femur, and one fracture in the rib; and periarticular calcification, with one was found in the hand, and two were found in the pelvis). The incidence of these radiological findings increased with the increase of duration of HD. In addition, 18 patients had normal bone mineral density values, 18 patients had osteopenia, whereas 14 patients had osteoporosis.ConclusionThe increased duration of dialysis is associated with increased incidence of articular and skeletal complications mainly renal osteodystrophy in the form of crystal-induced arthritis, osteoporosis, and periarticular calcification. Knee and shoulder joints, spine, neck of femur, wrist joints, and ribs are the main targets for complications and then for proper prophylaxis.

P90-T Nerve conduction, silent period, anthropometric and metabolic syndrome indices in patients with carpal tunnel syndrome

Background Some of the anthropometric features of the hand or wrist are risky for the development of carpal tunnel syndrome (CTS) like the presence of metabolic disorders. This study aims to search the electrophysiological aspect of CTS and its relation to anthropometric measurements as well as to metabolic syndrome (MS) indices. Material and methods Fifteen healthy participants and 17 patients with CTS were enrolled. Sensory and motor nerve conduction studies of median and ulnar nerves and the “sensitive” comparison tests were performed. Cutaneus silent period (CSP) was searched by stimulating either second or fifth digit while recoding over thenar. Hand and wrist width, wrist depth and palm length were measured. Indices for MS were determined. Results CTS patients revealed abnormal conduction of median nerve. The only significant anthropometric measure that correlated to electrophysiological aspect of CTS was short palm length. Cutaneus silent period (CSP) was induced in similar rate between the groups likewise the onset latency and duration of CSP. Patients with CTS revealed higher sensory threshold and needed more powerful stimulus on 2nd digit to induce CSP. Anthropometric measures of CTS patients with metabolic syndrome were similar to ones who don’t have it. CTS patient with MS revealed slightly lower median motor amplitude and prolonged latency difference between median and ulnar nerves on palmar mixed afferent conduction. Conclusions CSP can inducible in CTS patients who had preserved sensory and motor responses. Short palm length predicts the presence of CTS. MS slightly affects median nerve conduction in patients with CTS.

Acute Carpal Tunnel Syndrome in Inpatients With Operative Distal Radius Fracture.

Acute carpal tunnel syndrome (CTS) may occur concomitantly with distal radius fracture (DRF) and is often managed with carpal tunnel release (CTR). Carpal tunnel syndrome may also develop postoperatively after DRF fixation. The authors sought to determine the rate of CTS with DRF, prophylactic CTR, and postoperative development of CTS. Furthermore, they also sought to identify predictors of these. The Nationwide Inpatient Sample database was queried (2002 to 2014) to identify adult inpatients undergoing surgical fixation of DRFs. They were segregated by the presence of CTS and further stratified by the timing of CTR in relation to DRF fixation. Those with a CTS diagnosis undergoing CTR on the same day as or prior to DRF fixation were classified as having CTS concomitantly. Patients undergoing CTR without a CTS diagnosis were considered prophylactically released. Carpal tunnel releases on any day after fracture fixation were considered complications. The authors identified 275,052 inpatients who had fixation of DRFs. Of these, 11,816 patients (4.3%) had CTS concomitantly. A total of 530 patients developed CTS after their DRF fixation (0.3%). Of those without CTS, 4420 patients (1.6%) underwent prophylactic CTR. Male sex, age younger than 50 years, and polytrauma status were associated with concomitant CTS and prophylactic CTR. Age younger than 50 years and polytrauma status were associated with postoperative development of CTS. The authors identified the rate of concomitant CTS, prophylactic CTR, and CTS developing postoperatively in inpatients undergoing DRF fixation. As early recognition and treatment optimizes outcomes after acute CTS, these data draw attention to the high rate of CTS and may be useful to surgeons treating patients with DRFs. [Orthopedics. 2019; 42(4):227-234.].

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.

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.

Progression from Injection to Surgery for Trigger Finger: A Statistical Analysis.

The purpose of this study was to identify predictive factors of poor response to intra-flexoral sheath corticosteroid injection, as well as to identify factors associated with patients' decisions to undergo surgical treatment. Data from 112 patients who received steroid injection treatment for trigger finger were reviewed retrospectively. Logistic regression was used to assess the prognostic value of factors assumed to affect prognosis (age, sex, underlying disease, history of illness, presence of carpal tunnel syndrome, multiple digit involvement, and pre- and post-operative disability scores). Multiple digits were affected in 42 patients. Associated and underlying conditions were carpal tunnel syndrome (n = 36), hypertension (n = 23), hyperlipidemia (n = 14), and history of malignant tumor (n = 10). Logistic regression analysis showed that multiple digit involvement and Froimson clinical severity score were factors significantly associated with surgical treatment after intra-flexoral sheath corticosteroid injection treatment. These two factors were also found to be associated with the patients' decisions to undergo surgical treatment. Although local corticosteroid injection is useful in most cases, providers need to counsel patients with multiple digit involvement and/or severe cases about the possibility of requiring additional surgical treatment.

Compresión del nervio cubital en el canal de Guyon. Estudio retrospectivo de 12 casos

ObjectiveTo assess the causes and the ulnar nerve compression areas in Guyon's canal. Material and methodA retrospective study, with a mean follow-up of 9 months, was conducted on 12 patients intervened due to cubital tunnel syndrome. An electrophysiological study was performed on all cases and it was observed if there was a relationship with the presence of carpal tunnel syndrome. ResultsA clear origin of the nerve compression was only found in 3 cases. There is a higher presence of carpal tunnel syndrome in those cases of with idiopathic ulnar nerve compression, but it is not statistically significant. ConclusionsIn our experience, the majority of ulnar nerve compressions in the wrist are of idiopathic origin. There is a clinical improvement of the symptoms with surgery.

Ultrasound elastographic evaluation of the median nerve in hemodialysis with carpal tunnel syndrome

The aim of this study was to compare the elasticity of the median nerve (MN) between hemodialysis (HD) patients without carpal tunnel syndrome (CTS) and with CTS, and to evaluate the diagnostic usefulness of the elasticity of the MN in HD-CTS. The MN in 22 HD patients without CTS and 49 HD-CTS patients was studied. The cross-sectional area (CSA) and the elasticity of the MN, which was measured as the subcutaneous fat/median nerve (SF/MN) strain ratio, were evaluated. The mean SF/MN strain ratio in the groups that had received hemodialysis for 0-5,>5-10, and>10-15years was 1.4±0.28, 1.7±0.18, and 2.0±0.67, respectively. The mean CSA of the MN in the three groups was 9.9±1.30, 11.6±1.61, and 13.4±2.14mm2, respectively. The presence of CTS was predicted by means of SF/MN strain ratio and CSA cutoff values of 1.8 and 11mm2, respectively. Both the SF/MN strain ratio and the CSA in the patients with CTS were higher than those in the patients without CTS (P<0.05). The sensitivity and specificity of the SF/MN strain ratio and CSA of the MN were 75 and 92% and 79.2 and 84%, respectively. Sonoelastography helps to improve the diagnostic accuracy of the ultrasonographic assessment of CTS.