Carpal Tunnel Syndrome Symptom Severity Research Articles

Algorithm Versus Expert: Machine Learning Versus Surgeon-Predicted Symptom Improvement After Carpal Tunnel Release.

Surgeons rely on clinical experience when making predictions about treatment effects. Incorporating algorithm-based predictions of symptom improvement after carpal tunnel release (CTR) could support medical decision-making. However, these algorithm-based predictions need to outperform predictions made by surgeons to add value. We compared predictions of a validated prediction model for symptom improvement after CTR with predictions made by surgeons. This cohort study included 97 patients scheduled for CTR. Preoperatively, surgeons estimated each patient's probability of improvement 6 months after surgery, defined as reaching the minimally clinically important difference on the Boston Carpal Tunnel Syndrome Symptom Severity Score. We assessed model and surgeon performance using calibration (calibration belts), discrimination (area under the curve [AUC]), sensitivity, and specificity. In addition, we assessed the net benefit of decision-making based on the prediction model's estimates vs the surgeon's judgement. The surgeon predictions had poor calibration and suboptimal discrimination (AUC 0.62, 95%-CI 0.49-0.74), while the prediction model showed good calibration and appropriate discrimination (AUC 0.77, 95%-CI 0.66-0.89, P = .05). The accuracy of surgeon predictions was 0.65 (95%-CI 0.37-0.78) vs 0.78 (95%-CI 0.67-0.89) for the prediction model (P = .03). The sensitivity of surgeon predictions and the prediction model was 0.72 (95%-CI 0.15-0.96) and 0.85 (95%-CI 0.62-0.97), respectively (P = .04). The specificity of the surgeon predictions was similar to the model's specificity (P = .25). The net benefit analysis showed better decision-making based on the prediction model compared with the surgeons' decision-making (ie, more correctly predicted improvements and/or fewer incorrectly predicted improvements). The prediction model outperformed surgeon predictions of improvement after CTR in terms of calibration, accuracy, and sensitivity. Furthermore, the net benefit analysis indicated that using the prediction model instead of relying solely on surgeon decision-making increases the number of patients who will improve after CTR, without increasing the number of unnecessary surgeries.

Long-Term Outcomes of Non-surgical versus Surgical Treatment for Carpal Tunnel Syndrome: An Observational Cohort Study

Background: Carpal Tunnel Syndrome (CTS) is a common condition that significantly impacts patients' quality of life and work productivity. While both non-surgical and surgical treatments are employed, there is a lack of consensus regarding the most effective management strategy.
 Objective: This study aims to compare the outcomes of non-surgical and surgical treatments for CTS, focusing on symptom severity, functional status, and patient satisfaction.
 Methods: This observational cohort study included 74 participants, with 37 in each treatment group (non-surgical and surgical). Demographic data, including age, gender, occupation, and hand dominance, were recorded. Clinical parameters assessed were duration and severity of CTS symptoms, previous treatments, and comorbid conditions. The non-surgical group underwent treatments like wrist splinting, NSAIDs, and physical therapy, while the surgical group underwent decompression surgery. Outcomes measured included frequency and severity of symptoms, impact on daily activities, and satisfaction with treatment outcomes. Data were analysed using descriptive statistics to compare between groups.
 Results: The average age was 50 ± 9 years in the non-surgical group and 52 ± 8 years in the surgical group, with a predominance of females in both. The non-surgical group showed higher frequency and severity of symptoms, with daily symptoms reported by 76.1% of patients, compared to 44.4% in the surgical group. Severity of pain was higher in the non-surgical group (5.8 out of 10) than in the surgical group (2.8 out of 10). Satisfaction with surgical outcomes was high, with all patients in the surgical group reporting satisfaction despite a 100% rate of postoperative complications.
 Conclusion: The study indicates that surgical treatment for CTS may be more effective in reducing symptom severity and improving patient satisfaction compared to non-surgical methods. However, the high rate of postoperative complications in the surgical group necessitates careful consideration and patient counselling regarding treatment choices.
 Keywords: Carpal Tunnel Syndrome, Non-surgical Treatment, Surgical Treatment, Patient Outcomes, Symptom Severity, Treatment Satisfaction

What is the role of sensitization in carpal tunnel syndrome where pain impacts functional capacity?

Aims: Expression of carpal tunnel syndrome (CTS) caused by the entrapped median nerve includes pain, paraesthesia and numbness. Extra median spread of pain can furthermore be seen as a clinical requirement defined by neuro inflammation. Central sensitization (CS) constructs a similar mechanism. This study aims to evaluate sensitization in patients diagnosed with CTS.
 Methods: A total number of 152 patients diagnosed with CTS were evaluated, prospectively. Patients data such as gender, age, body mass index (BMI), disease duration, pain severity (NRS), painDETECT questionnaire, Boston CTS symptom severity scale (SSS) and functional status scale (FSS), CS scale, electroneuromyography results have been collected by the author and then the patients are divided into three groups.
 Results: Regarding the age, BMI and CS rate, there was no statistical difference between the three patient groups (p>0.05). However, a statistically significant difference was found between these groups in disease duration, day-time and night-time NRS, Boston SSS, FSS, and pain DETECT scores (p0.05). Yet, statistically significant differences were found in a comparison of the patients with and without CS, in disease duration, NRS night scores, and painDETECT scores (p

Comparison of Effects of Prefabricated Soft Wrist Orthosis and Conventional Wrist Thermoplastic Splint on Symptoms of Carpel Tunnel Syndrome

ABSTRACT Introduction The aim of this study was to examine the short-term effectiveness of a prefabricated wrist orthosis compared with a custom-made wrist orthosis and its long-term effectiveness on alleviating carpal tunnel syndrome (CTS) symptoms. Materials and Methods A total of 109 patients with mild and moderate CTS were prescribed with either a prefabricated wrist or a custom-made wrist orthosis, and the changes in their mean scores on the Carpal Tunnel Syndrome Symptom Severity Scale (CTSSSS) at baseline and the eighth week follow-up. The changes in CTSSSS scores of those prescribed with the prefabricated wrist orthosis were compared with the 32nd week postintervention. Results Repeated-measures analysis of variance (ANOVA) showed significant effect at both mean CTSSSS and subscale scores (P < 0.001). Both prefabricated wrist orthosis (n = 88) and custom-made wrist orthosis (n = 21) were shown to alleviate CTS symptoms at the first follow-up. Repeated-measures ANOVA showed significant differences after the long-term application of the prefabricated wrist orthosis (n = 62) in terms of CTSSSS score, daytime numbness, nighttime numbness, and nocturnal awakening (P = 0.005–0.029). Clinical Relevance Along with the conventional thermoplastic splint, the prefabricated soft wrist orthosis could serve as an appropriate alternative to alleviate neurological symptoms of CTS due to its better long-term compliance.

Does the Severity of Carpal Tunnel Syndrome Symptoms Vary Due to Vitamin and Mineral Deficiencies and Anemia?

ABSTRACT Purpose: The purpose of the study is to investigate the effect of serum vitamin, electrolyte levels, and anemia on carpal tunnel syndrome (CTS) symptoms and findings. Materials and Methods: The study included 166 patients with CTS and 80 healthy controls. The patients with CTS were further divided into two groups: those with positive (EP+) and negative (EP−) electrophysiology findings. The participants completed the Boston Carpal Tunnel Questionnaire (BCTQ) to assess their symptoms, and electromyography investigations were performed to confirm the diagnosis. Results: The mean age of individuals in the EP+ group was older, and the body mass index scores were greater than those of other groups. The hemoglobin (Hb) level was significantly lower in the EP+ group than in the EP− group (P = 0.001). Ferritin levels were substantially lower in both the EP+ and the EP− groups compared with the control group (P = 0.045 and P = 0.017, respectively). However, no correlation was found between Hb and ferritin levels and BCTQ scores. The groups had no significant differences in Vitamin D, B12, calcium, and magnesium levels. No relationship was found between the severity of CTS symptoms and deficiencies in Vitamins D and B12. Conclusions: Based on this study, anemia and lower levels of ferritin were common in patients with CTS, but they did not directly contribute to the severity of symptoms; the significance of this finding concerning CTS is unclear. However, considering the limited number of studies suggesting that iron deficiency reduces axonal excitability and leads to the slowing of nerve conduction velocities, iron deficiency may facilitate the development of CTS.

The relationship of psychological factors and sleep quality with the severity of carpal tunnel syndrome

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy, is graded as mild, moderate and severe. We aimed to evaluate the relationship between CTS severity and depression, anxiety, sleep quality and daytime sleepiness. One hundred and forty-nine patients with a diagnosis of CTS were prospectively included in the study. There was a statistically significant difference between the painDETECT questionnaire, age, pain severity, Pittsburgh Sleep Quality Scale, Boston CTS Symptom Severity Scale and Functional Status Scale scores and the severity of CTS (p<0.05). There was a statistically significant difference between the Epworth sleepiness scale and the severity of CTS (p<0.05). There was no statistically significant difference between body mass index, Beck Anxiety, Beck Depression Score and CTS severity (p>0.05). We found an increase in daytime sleepiness in the severe type of CTS, which particularly affects hand functions and causes a decrease in the quality of life.

Long-Term Follow-Up Results of Mechanical Wrist Traction as Non-Invasive Treatment for Carpal Tunnel Syndrome.

Background: For patients with carpal tunnel syndrome (CTS), the only long-term effective treatment option is carpal tunnel release surgery. Up to one-third report recurrent symptoms, and 12% needs repeated surgery. This study aimed to evaluate the long-term effects of mechanical traction as a non-invasive treatment option for CTS compared to care as usual.Methods: Patients with electrodiagnostically confirmed CTS [N = 181; mean age, 58.1 (13.0) years; 67% women] were recruited from an outpatient neurology clinic in the Netherlands. Patients completed baseline questionnaires and randomized to the intervention group (12 treatments with mechanical traction, twice a week for 6 weeks) or care as usual. The primary clinical outcome measure was surgery during the 12-month follow-up. Secondly, we assessed symptom severity with the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline and at the 12-month follow-up. Changes in CTS symptom severity between baseline and the 12-month follow-up were analyzed between groups using t-tests and a multiple linear regression analyses, adjusting for duration of complaints, age, gender, and symptom severity at baseline.Results: At the 12-month follow-up, 35 of 94 (37%) patients in the intervention group had surgery, compared to 38 of 87 (44%) in the care-as-usual group ( = 0.78, p = 0.377). Symptom severity and functional status scores did not significantly differ between the intervention (n = 81) and care-as-usual group (n = 55) at follow-up. For patients who did not have surgery, BCTQ scores decreased significantly more from baseline to the 12-month follow-up in the intervention group (n = 53) compared to patients in the care-as-usual group (n = 25). For patients who did not have surgery, belonging to the intervention group and a higher BCTQ score at baseline were related to a greater decrease in BCTQ scores from baseline to the 12-month follow-up, as well as symptom severity and functional status.Conclusions: Mechanical traction is effective in reducing symptom severity compared to current conservative treatment options in standard care and can therefore benefit the large number of patients that prefer conservative treatment for CTS.Clinical Trial Registration: Clinical Trials NL44692.008.13. Registered 19 September 2013, https://clinicaltrials.gov/ct2/show/NCT01949493

Neuromuscular ultrasound (NMUS) O-NU001. Feasibility of shear wave elastography and high definition color in evaluation of carpal tunnel syndrome

Introduction . Diagnosis of carpal tunnel syndrome (CTS) is based on clinical findings and electrodiagnostic tests (EDT). However, EDT has high false negative rates, and the results often do not reflect the severity of symptoms. The aim of this study is to investigate the value of shear wave elastography (SWE) and high definition (HD) color in diagnosis and evaluation of symptom severity in CTS. Methods . The study prospectively enrolled 39 wrists from 23 patients with EDT-confirmed CTS, 15 wrists from 12 patients who have CTS symptoms without EDT abnormality and 28 wrists from 14 healthy volunteers. Cross-sectional area (CSA) and longitudinal diameter of median nerve were measured. SWE of median nerve at the wrist and midforearm were performed, and the ratio between them was calculated. SWE of abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were also measured and the ratio was obtained. HD color was conducted in the longitudinal plane at carpal tunnel. Results . The CSA of the median nerve at the carpal inlet and longitudinal diameter were significantly larger for the EDT-confirmed CTS group compared to control group (13.21[11.28,17.23] vs 7.98[6.53,8.94]; p < 0.001, 2.77[2.41,3.08] vs 2.07[1.79,2.24]; p < 0.001). It also had significantly higher median nerve elasticity ratio (2.59[1.77,4.09] vs 1.61[1.32,1.94]; p = 0.007). HD color showed significantly higher grades in the former group (p = 0.004). In ROC analysis, a 1.97 cut-off value on SWE ratio revealed sensitivity, specificity, PPV, NPV of 74.4%, 78.6%, 82.9%, 68.8%, respectively (AUC: 0.796[0.687,0.905]). Inter-rater reliability was excellent for SWE measurements (ICC: 0.908(0.761,0.967)). There was no significant correlation of CSA, elasticity and HD color grade with clinical symptom scores. In comparison between the group of CTS patients without EDT abnormality and control group, the former had significantly larger CSA in carpal inlet and elasticity ratio (9.61[7.21,11.55] vs 7.98[6.53,8.94]; p = 0.011, 2.59[0.94,4.65] vs 1.61[1.32,1.94]; p = 0.009). Conclusion . SWE and HD color are helpful supportive tools in diagnosing CTS, especially in patients who have typical CTS symptoms but normal results in EDT.

Risk factors for self-reported carpal tunnel syndrome among hairstylists in Gaborone, Botswana.

Hairstylists form an occupational group whose tasks involve repetitive and forced movements of hands and wrists, thus posing a risk of developing carpal tunnel syndrome (CTS). This study assessed the prevalence of and factors associated with CTS symptoms among hairstylists in Gaborone, Botswana. A cross-sectional study was conducted using a self-administered questionnaire distributed among randomly selected hairstylists. The questionnaire gathered information on demographic characteristics, lifestyle, work-related characteristics and psychosocial factors. The Boston Carpal Tunnel Syndrome Questionnaire was used to determine the severity of CTS symptoms and its functional effects. Data were then analyzed using χ2 and logistic regression models. The level of significance was determined at p < 0.05. A total of 165 hairstylists took part in the study, with 92 (56%) of the respondents being females. The mean age (M±SD) of the respondents was 35.05±7.54 years with an age range of 22-63 years. Seventy-three (42.2%) hairstylists reported CTS symptoms, with the majority (73%) being females. Out of all the CTS cases, 53 (72.6%) and 16 (21.9%) had mild and moderate symptoms, respectively. Over 80% of the hairstylists did not know about CTS. Among individual factors, CTS symptoms were associated with being female (the odds ratio [OR] of 9.99, and the 95% confidence interval [CI]: 3.64-27.44), increasing age (OR 9.84, 95% CI: 2.74-35.36), the length of employment (OR 3.73, 95% CI: 1.39-9.95), hair washing (OR 2.88, 95% CI: 1.41-5.85), an awkward posture (OR 2.52, 95% CI: 1.03-6.19), and the use of a great muscular effort when performing a task (OR 2.39, 95% CI: 1.01-5.72). Perceived heavy workload and stressful work were also risk factors. The results suggest a high prevalence of CTS among female hairstylists in Gaborone, and also point out that individual, work-related and psychosocial factors are associated with this syndrome. Future large-scale research is needed to establish the extent of CTS countrywide to influence policy-making. Currently, CTS is not listed amongst occupational health diseases in Botswana. Int J Occup Med Environ Health. 2021;34(3):437-50.

Relationship of Vitamin D Level, Fasting Blood Sugar, and Body Mass Index, to Carpal Tunnel Syndrome Severity

Aim: This study aims to investigate the relationship between Idiopathic Carpal Tunnel Syndrome (CTS) and Vitamin D Level, Body Mass Index (BMI), and Fasting Blood Sugar.Materials and Methods: 54 CTS patients diagnosed electrophysiologically were included in the study. These patients' ages, genders, height and body weights, and body mass index values were recorded. Laboratory tests including vitamin D levels and fasting blood sugars were performed for each participant. The CTS stage was determined electrophysiologically and the Boston questionnaire and the visual analogue scale (VAS) were filled to assess total pain scores, symptom severities (CNS), and functional states (FSS).Results: There was a statistically significant difference between the distribution of CTS stages in female patients and male patients (p = 0.008). There was no statistically significant difference between mild, moderate, and severe CTS stages in terms of age, body mass index, and fasting blood glucose (p = 0.459; p = 0.232; p = 0.413, respectively). There is a statistically significant difference between CTS stages in terms of vitamin D levels (p0.001). Vitamin D averages were observed to decline from mild to severe stages of CTS. According to the Boston Carpal Tunnel Syndrome functional status scale, it was determined that there is marginal statistical significance between the stages of CTS. It was observed that the mean functional status scale scores increased from the mild stage to the severe stage (p = 0.055). There was no statistically significant difference between mild, moderate, and severe CTS stages in terms of VAS pain and paresthesia scores and the Boston Carpal Tunnel Syndrome symptom severity scale (p = 0.340; p = 0.359; p = 0.250, respectively).Conclusion: We found a significant relationship between the vitamin D level and the CTS stage. According to Boston Carpal Tunnel Syndrome Questionnaire, we found that there is a marginal statistical significance between the stages of CTS.

Diagnostic Value of Ultrasound in CTS in Diabetic Versus Nondiabetic Populations

PurposeDiabetes mellitus (DM) is a well-known risk factor for carpal tunnel syndrome (CTS). However, few studies have compared differences in the cross-sectional area (CSA) of the median nerve in patients with and without DM. The purpose of this study was to compare the utility of ultrasound for the diagnosis of CTS in diabetic versus nondiabetic patients.MethodA total of 248 hands of 155 patients were evaluated: 154 hands belonged to non-DM patients with CTS, 80 to DM patients with CTS, 13 patients with DM but no CTS, and 51 patients without DM or CTS. All hands underwent ultrasonography of the median nerve at the wrist for determination of CSA; patients completed a CTS Symptom Severity Scale and Functional Status Scale for each hand.ResultsAverage CSA (mm2) of non-DM patients with CTS was 11.25 whereas the average in DM patients with CTS was 12.23 (P = .17). Cross-sectional area of 9.5 or greater was the most powerful predictor of CTS in patients without DM, and CSA of 10.5 or greater in patients with DM.ConclusionsCross-sectional area of the median nerve was similar for patients with and without DM; however, cutoff values for positive diagnosis may need to be adjusted in patients with DM. Ultrasonography of the wrist is a valuable resource for diagnosing CTS in patients with and without DM.Type of study/level of evidenceDiagnostic II.

Prevalence and severity of carpal tunnel syndrome symptoms among Iranian butchers and their association with occupational risk factors: Implications for ergonomic interventions.

Carpal tunnel syndrome (CTS) is a common disorder among occupations where upper extremities are actively involved in. Many occupational and non-occupational risk factors may contribute to this disorder. Knowledge regarding occupational risk factors can guide us to implement interventional programs. The aim of the present study was to assess the prevalence and severity of CTS symptoms among butchers and their association with several occupational and non-occupational risk factors. In this study, 152 butchers in Hamadan, Iran, were examined. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to investigate the severity of CTS symptoms among the individuals. Several risk factors such as body mass index (BMI), wrist ratio, active working hours per day, working experience, and the ergonomic quality of hand tools used by butchers were also investigated. Statistical tests such as the crude and robust regression were used to analyze the data. The prevalence of moderate and mild symptoms of CTS were 7% and 54%, respectively. Moreover, 39% of the butchers were free of CTS symptoms. Crude regression analyses showed that the severity of CTS symptoms had a significant relationship with age, work experience, active working hours per day, working hours per week, and ergonomic quality of the hand tools (p value <0.05). There was no significant relationship between the severity of CTS symptoms and wrist ratio and BMI. Results of the robust regression analysis showed a significant relationship between the severity of CTS symptoms with experience, active working hours, and quality of the hand tools. Occupational risk factors such as working experience, active working hours per day, and the ergonomic quality of hand tools are significant risk factors of CTS symptoms among butchers. Slippery handle is the main non-ergonomic feature of knives and cleavers used by butchers. There was no association between BMI and wrist ratio with CTS symptoms.

Full cup test (FCT) for symptom severity assessment in carpal tunnel syndrome/comparing scores with clinical and neurophysiological findings

Aim: Carpal tunnel syndrome (CTS) is a compression neuropathy. There is neuropathic pain in the clinic. Treatment is planned according to electrodiagnostic testing (EDX) and symptom severity. This study was planned to evaluate of full cup test (FCT) to demonstrate symptom severity in CTS and investigate the relationship between FCT and EDX.Material and Methods: This study included patients with idiopathic CTS. The self-administered Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and FCT were used to determine the severity of clinical symptoms. The severity of CTS was classified as mild, moderate and severe according to EDX. Results: A total of 97 hands (55 right, 42 left) were evaluated. 29 patients had bilateral symptoms. The severity of CTS was 51.5% mild, 44.3% moderate, and 4.1% severe. The mean FCT score was 51.13 ± 20.80 (min: 6.6-max: 100). The mean symptom severity scale (SSS) of the BCTQ was 24.25 ± 7 and the functional severity scale (FSS) was 13.26 ± 4.55. The score of FCT was significantly correlated with SSS and the FSS (r=0.60 p 0.001, r=0.65 p 0.001). Significant correlation was observed between FCT and EDX (r=0.57, p=0.001). Conclusion: FCT can be used to assess the severity of neuropathic pain in CTS and may be a guide in planning treatment.

A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient.

Background: Surgical management of carpal tunnel syndrome includes performing an endoscopic (ECTR) or open (OCTR) carpal tunnel release. Several studies have shown less postoperative pain and improvement in grip and pinch strength with the endoscopic technique. The goal of this study was to prospectively examine outcomes, patient satisfaction, and complications after both ECTR and OCTR in the opposite hands of the same patient. Methods: This was a prospective study in which patients with bilateral carpal tunnel syndrome underwent surgical release with both techniques, with initial operative approach randomized in the more symptomatic hand. Demographic data and functional outcomes were recorded, including the pain score, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength testing, grip strength, carpal tunnel syndrome functional status score, carpal tunnel syndrome symptom severity score, and overall satisfaction. Results: Thirty patients completed the study; there were no significant differences in any measure at any of the postoperative time points. Symptom severity and functional status scores were not significantly different between groups at any evaluation. Subjectively, 24 of 30 patients did state they preferred the ECTR, mostly citing less pain as their primary reason, although pain scores were not significantly different. Differences in overall satisfaction were also not significant. Conclusions: Both techniques are well tolerated with no differences in outcomes. With the added cost and equipment associated with ECTR, and no added benefit, the usefulness of ECTR is questionable.

Ergonomic rubber tapping knife relieves symptoms of carpal tunnel syndrome among rubber tappers

BackgroundRubber tapping is an occupation with a high risk for developing carpal tunnel syndrome (CTS). Exposure to excessive ulnar deviation and wrist flexion, among other risk factors, contributes to increased carpal tunnel pressure contributing to the development of carpal tunnel syndrome. Prior, an ergonomic tapping knife was developed to improve wrist posture and to prevent or reduce CTS symptoms in rubber tappers. This study evaluated changes in the severity of symptoms of carpal tunnel syndrome after using the ergonomically designed tapping knife. MethodsThis was a non-randomized controlled trial among rubber tappers in Pawong subdistrict, Mueang district, Songkhla province, Thailand, conducted from September 2014 to March 2015. Two hundred and eight rubber tappers were assigned into two groups, an intervention group who used the new ergonomic rubber tapping knife and the control group who used the traditional knife. Both groups consisted of 52 tappers with CTS symptoms and 52 without CTS symptoms. All subjects were followed for 7 months after the new ergonomic knife was introduced to the intervention group. Face-to-face interviews using the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were used for primary data collection, and the Rapid Upper Limb Assessment (RULA) was used to assess wrist posture before and after the intervention. ResultsThe overall mean age of tappers was 49.7 years. The demographic characteristics of subjects were similar across all trial groups. The CTS symptom severity scores were significantly decreased and right wrist radial and/or ulnar deviation significantly reduced among tappers using the ergonomic knife compared with those of tappers using the traditional knife. ConclusionThe ergonomic rubber tapping knife was associated with a decrease in all CTS symptoms and improved wrist posture among the CTS participants, and reduced CTS symptom occurrence among non-CTS tappers. Relevance to industryThe results of this study suggest the ergonomic rubber tapping knife can be used to decrease the severity of CTS symptoms among CTS tappers and prevention to CTS symptom development among non-CTS tappers.

Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort

ObjectivesThe Prediciting factors for response to treatment in carpal tunnel syndrome (PALMS) study is designed to identify prognostic factors for outcome from corticosteroid injection and surgical decompression for carpal tunnel...

Carpal tunnel syndrome in inherited neuropathies: A retrospective survey.

This study evaluates carpal tunnel syndrome (CTS) symptom severity, functional status, and outcome of CTS therapies in patients with inherited neuropathies. Validated questionnaires were used to compare symptom severity and functional status in patients with and without a diagnosis of CTS and a diagnosis of an inherited neuropathy. 309 patients with inherited neuropathies participated in this study. The CTS symptom severity score (SSS) was found to be the most useful tool in assessing CTS severity in patients with inherited neuropathy. Splint therapy and surgery were associated with significant improvement in carpal tunnel symptoms as measured through the SSS. This study provides insight into the assessment of CTS symptom severity and patient-reported outcomes to CTS therapy in individuals with inherited neuropathies. The SSS appears useful for evaluation of CTS symptoms and patient-reported outcomes following CTS interventions in individuals with inherited neuropathies. Muscle Nerve 57: 388-394, 2018.

Correlation of vitamin D levels with electrophysiological findings and pain in the patients with Carpal Tunnel Syndrome.

This study aimed to assess the correlation between vitamin D deficiency and electrophysiological findings and pain level in patients with symptoms of carpal tunnel syndrome (CTS). A total of 131 patients with symptoms of CTS, 70 with vitamin D deficiency and 61 without vitamin D deficiency, were included in the study. Using demographic data and findings from electrophysiological examinations, the patients were divided into two groups based on their vitamin D level (Group 1: <20 ng/ml; Group 2: ≥20 ng/ml). The Boston Carpal Tunnel Syndrome Questionnaire was used to assess their CTS- related pain level. Although the rate of CTS in the patients with a low vitamin D level was found to be high, no statistically significant correlation was observed between low vitamin D level and the frequency and severity of CTS. Additionally, the pain and functional loss ratio induced by CTS was found to be higher in the group with a lower vitamin D level than in the group with normal levels. Low vitamin D levels may increase the severity of CTS symptoms. Treatment of vitamin D deficiency in patients with CTS can play a role in reducing pain and disability.

Carpal tunnel release in patients with diabetes result in poorer outcome in long-term study

The aim of this prospective study was to compare the results of surgical decompression of carpal tunnel syndrome (CTS) in patients with diabetes mellitus with those with idiopathic CTS. The results of surgical decompression of CTS in 27 patients with diabetes mellitus were compared with 42 patients with idiopathic CTS. All patients underwent surgical release of transverse carpal ligament by the mini-incision of palm technique. Patient self-administered Boston Questionnaire (BQ) for the assessment of severity of CTS symptoms and hand functional status was evaluated before and 6 months and 10 years after surgery. After surgical release, all the patients of both groups reported an absence of pain, disappearance or reduction of paresthesia, and improvement in hand function. Six months after surgery, there was a significant improvement of symptomatic and functional BQ scores compared with preoperative state in both groups. Ten years after surgery, there was statistical difference in preoperative and postoperative 10th year functional BQ score between DM (-) and DM (+) (p < 0.01). DM status affected statistically functional BQ score between preoperative and postoperative 10th year. Diabetes mellitus was a risk factor for poor outcome of surgical decompression of CTS. Patients with diabetes had worse surgical outcome compared with patients with idiopathic CTS in long-term follow-up.

Methylprednisolone Injections for the Carpal Tunnel Syndrome

Steroid injections are used in idiopathic carpal tunnel syndrome (CTS), but evidence of efficacy beyond 1 month is lacking. To assess the efficacy of local methylprednisolone injections in CTS. Randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT00806871). Regional referral orthopedic department in Sweden. Patients aged 18 to 70 years with CTS but no previous steroid injections. Three groups (37 patients each) received 80 mg of methylprednisolone, 40 mg of methylprednisolone, or placebo. The patients and treating surgeons were blinded. Primary end points were the change in CTS symptom severity scores at 10 weeks (range, 1 to 5) and rate of surgery at 1 year. Three patients had missing 10-week data. All patients had 1-year data. Improvement in CTS symptom severity scores at 10 weeks was greater in patients who received 80 mg of methylprednisolone and 40 mg of methylprednisolone than in those who received placebo (difference in change from baseline, -0.64 [95% CI, -1.06 to -0.21; P = 0.003] and -0.88 [CI, -1.30 to -0.46; P < 0.001], respectively), but there were no significant differences at 1 year. The 1-year rates of surgery were 73%, 81%, and 92% in the 80-mg methylprednisolone, 40-mg methylprednisolone, and placebo groups, respectively. Compared with patients who received placebo, those who received 80 mg of methylprednisolone were less likely to have surgery (odds ratio, 0.24 [CI, 0.06 to 0.95]; P = 0.042). With time to surgery incorporated, both the 80- and 40-mg methylprednisolone groups had lower likelihood of surgery (hazard ratio, 0.46 [CI, 0.27 to 0.77; P = 0.003] and 0.57 [CI, 0.35 to 0.94; P = 0.026], respectively). The study was conducted at 1 center, and wrist splinting had previously failed for all patients. Methylprednisolone injections for CTS have significant benefits in relieving symptoms at 10 weeks and reducing the rate of surgery 1 year after treatment, but 3 out of 4 patients had surgery within 1 year. Region of Scania Research and Development Foundation and Hässleholm Hospital Organization.