Severity Of CTS Research Articles

The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is the most common compression neuropathy. Grading the severity of carpal tunnel syndrome is an important factor in deciding on the type of treatment. This study aims to determine the relationships between the findings of the electrodiagnosis and ultrasonography methods based on the severity of carpal tunnel syndrome.MethodsIn this prospective clinical study, 50 patients (96 wrists) who were referred to the Physical Medicine and Rehabilitation Department of the Shohada Tajrish Hospital, Tehran, Iran (from March 2021 to November 2022) were studied. All patients with a history and clinical examination related to CTS underwent electrodiagnosis studies. Based on the results of electrodiagnosis, patients were divided into three groups: mild, moderate, and severe. All eligible patients underwent ultrasound at the cross-section of the wrist (at the level of the pisiform bone, the entrance of the canal) and the middle of the forearm.ResultsIn this study, the cross-sectional area of the median nerve was measured in 96 wrists of 50 patients with a mean age of 51.78 ± 9.80 years. The mean CSA of the median nerve in the mild, moderate, and severe groups was reported as 0.12 ± 0.03, 0.14 ± 0.02, and 0.21 ± 0.06, respectively. The mean WFR in different groups of CTS was reported as 1.85 ± 0.56, 1.93 ± 0.56, and 2.45 ± 0.49, respectively. A significant relationship between ultrasound findings, including CSA-inlet and WFR, and electrodiagnosis findings was presented (P value < 0.05).ConclusionBased on our findings, there is a statistically significant relationship between the sonographic findings, including the mean CSA-inlet and WFR, and the severity of CTS based on the electrodiagnosis study. Our findings revealed that as disease severity increases, sonographic parameters also increase significantly.

Assessing the severity of carpal tunnel syndrome during physical examination by measuring two-point discrimination: Post-hoc analysis of prospectively collected data

IntroductionCarpal tunnel syndrome (CTS) commonly presents after distal radius fractures. Assessing its degree of severity is essential to therapeutic decision-making - i.e. operative vs. conservative treatment. The role of the two-point discrimination (2PD) has not yet been evaluated as a potential indicator of severity during physical examination. Therefore, in our cross-sectional study, we aimed to find a correlation between 2PD values and disease severity, based on the gold-standard electromyography and electroneurography (EMG-ENG) and ultrasonography findings. MethodsWe conducted a post-hoc analysis of prospectively assessed CTS patients for 2PD values. We analyzed the correlation between 2PD and EMG-ENG measurement results, patient characteristics, nerve ultrasonography, and relevant CTS questionnaires. CTS severity was determined by EMG-ENG results. The Pearson correlation was calculated between variables. ResultsThe study included 81 patients. The three pre-determined EMG-ENG severity categories showed a significant correlation between both 2PD values and 2PD severity categories (r= 0.29 [0.07–0.48] and r= 0.26 [0.03–0.45]). Distal sensory latency and conduction velocity values correlated significantly with 2PD categories. However, the correlation coefficients (r= 0.25 [0.02–0.46] and r=-0.24 [-0.37–0.07]) were low. The 2PD severity categories showed no significant correlation with the severity assessed by nerve ultrasound (r=-0.07 [-0.38–0.25]). The 2PD values showed a significant correlation between the values of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (r= 0.3 [0.06–0.51]). We concluded that the best cut-off value for differentiating severe from non-severe CTS was at the 9.5 mm 2PD cut-off value (sensitivity = 0.65 [0.45–0.81], specificity = 0.71[0.58–0.82], AUC = 0.71 [0.59–0.83]). ConclusionThere is a significant correlation between 2PD values and the severity of carpal tunnel syndrome as determined by EMG-ENG; however, they are not interchangeable. Based on the results of our study, we propose that measuring two-point discrimination may be a quick and easy, reliable and cost-effective screening method to assess the severity of carpal tunnel syndrome following distal radius fractures.

Role of conventional ultrasound and shear wave elastography of median nerve in diagnosis and differentiation of carpal tunnel syndrome severity in correlation with electrodiagnostic studies

BackgroundThe gold standard for CTS diagnosis is abnormalities on electrophysiologic testing in conjunction with specified symptoms. Electrophysiologic testing can also identify the severity of nerve injury.Aim of workAimed to investigate how effective various ultrasonography and elastography parameters at diagnosing and grading the severity of carpal tunnel syndrome in correlation with the electrophysiological evaluation of the median nerve.MethodsThe study included 62 wrists, 31 CTS cases and 25 females. Thirty-one healthy adults served as control group. Eleven males (35.5%) and 20 females (64.5%) were included. All US examinations were done with the subjects sitting with their upper limbs relaxed on a pillow with forearm in supine position, and the fingers are semi-flexed. Ultrasound and elastography parameters were recorded. NCS was done by recording median nerve motor and sensory functions and then comparing median nerve versus radial and ulnar nerves if the previous recordings were normal to detect early starting cases.ResultsUS and elastography can significantly diagnose CTS and detecting its severity (mild/moderate versus severe CTS).ConclusionsIt is noninvasive to examine the median nerve using ultrasound and shear wave elastography, highly sensitive diagnostic modality. It can significantly diagnose CTS and severity of CTS (in contrast to mild, moderate, and severe instances). Mixing high-resolution conventional B-mode US with shear wave ultrasound elastography of the median nerve may increase the diagnostic precision of CTS.

Assessment of Carpal Tunnel Syndrome Symptoms and Functional Status among Medical Students: A Cross-Sectional Survey in Lahore, Pakistan.

Background: Medical students may be at a higher risk for developing CTS due to the repetitive nature of their work and prolonged use of computers. This survey investigated the severity of CTS symptoms and functional status among medical students.&#x0D; Methodology: Among medical students, a quantitative observational cross-sectional survey was carried out in Lahore, Pakistan. A total of 112 students of both gender, aged between 19 to 27 years, participated in this study. A demographic questionnaire and a Boston carpel tunnel syndrome questionnaire were used, and questions related to moderate and strenuous exercise were included in the survey. &#x0D; Results: The functional status of a medical student is categorized as 22.3% in the asymptomatic category, 40.2% in the mild category, 19.6% in the moderate category, and 17.9% fall in the severe category. An association was found between symptom severity and prolonged hand use &amp; functional status. The study results provide insights into the risk factors and potential preventive measures for CTS in this population.&#x0D; Conclusion: The study has collected data on the prevalence of CTS among medical students, the severity of their symptoms, the impact of CTS on their academic performance, and the factors associated with the development and severity of CTS among medical students. Our survey results show that medical students of the study site have not been classified as high-risk.

Effects of weight loss after bariatric surgery on the median and ulnar nerves conduction studies

BackgroundThe aim of the present study was to compare the nerve conduction study (NCS) of median and ulnar nerves before and after bariatric surgery. MethodsThis prospective cross-sectional study included 32 patients with BMI≥35 who were candidate for Sleeve gastrectomy. NCS of median and ulnar nerves were evaluated before and 3 months after surgery. In CTS cases, Boston Carpal Tunnel Questionnaire (BCTQ) was completed. ResultsEligible participants were 32 patients aged between 19 and 64 years. 20 patients including 34 hands had CTS. Severity of CTS and BCTQ scores were significantly different after surgery. Moreover, sensory amplitude, and motor NCV for both median and ulnar nerves in hands without CTS as well as sensory amplitude of ulnar nerve in hands with CTS were significantly different after bariatric surgery (P value < 0.05). ConclusionsThe results of this study suggest that three months after the bariatric surgery, the clinical and electrophysiological severity of CTS shows a significant improvement. Ethical code of studyIR.IUMS.FMD.REC.1396.15008.

Carpal tunnel syndrome in rheumatoid arthritis patients: the role of combined ultrasonographic and electrophysiological assessment

BackgroundCarpal tunnel syndrome (CTS) is known as one of the most common neurological extra-articular manifestations in rheumatoid arthritis (RA) patients. Studies on CTS in RA depend mostly on electrophysiological assessment. Few studies have used ultrasonography for evaluation of the local causes with much focus on wrist arthritis and tenosynovitis as the main cause of entrapment neuropathy of the median nerve in RA. The aim of our study is to assess the local causes of carpal tunnel syndrome in rheumatoid arthritis patients by ultrasonography and whether inflammatory or anomalous variations could affect decision-making and patient management.ResultsCarpal tunnel syndrome was diagnosed in 71 out of 74 examined RA wrists by nerve conduction studies (NCSs) and was categorized from minimal to severe according to Padua et al.’s (Ital J Neurol Sci 18:145–50, 1997) grading criteria. Median nerve CSA at the level of the carpal tunnel inlet and flattening ratio showed statistically significant relation with CTS severity. Bifid MN was found in 20 wrists (10 mild CTS wrists and 10 moderate CTS wrists), a persistent median artery was found in 4 wrists with moderate CTS, and an accessory muscle bundle was present in 3 wrists (2 mild CTS and 1 moderate CTS). The majority of the examined hands (85.1%) showed flexor tendon tenosynovitis at the wrist level and radio-carpal joint synovitis. The US7-joint score using GSUS7 & PDUS7 for synovitis, tenosynovitis and erosions showed significant relation with patients’ disease activity by DAS28 score. Significant relations between CTS severity and the following nerve conduction studies’ parameters, median nerve distal motor latency (DML), motor/sensory NCV, peak sensory latency, amplitude of SNAP, and median-radial latency difference test, were observed.ConclusionSynovial inflammation and local causes of median nerve compression such as bifid median nerve, persistent median artery, and accessory muscle bundle are collectively contributing factors in the etiology of carpal tunnel syndrome in rheumatoid arthritis patients. Ultrasonographic visualization of these inflammatory and anomalous variations enables early detection of CTS and highlights the possibility of non-arthritic-related causes. Using the 7-joint ultrasound (US7) score for assessment of synovitis, tenosynovitis, and erosions in rheumatoid arthritis patients is of valuable role in reflecting inflammation and its relation to the development of CTS in RA patients.

Electrophysiological Evaluation in Carpal Tunnel Syndrome

IntroductionCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy in society. Based on the data obtained from basic conventional CTS studies, patients can be staged, and the changes in CTS severity can be followed according to the electrophysiological parameters derived from the data. This study aimed to assess the electrophysiological findings of CTS patients using the Bland and Padua grading systems and median terminal latency index (mTLI) and to evaluate the findings that may indicate the transition to the advanced stage.Material and methodsThe study included 822 patients. After electrophysiological examination, both hands of the patients were staged according to the grading systems proposed by Padua and Bland. Additionally, mTLI was calculated for each hand.ResultsWith the increase in stages, a significant decrease was found in mTLI, median sensory nerve conduction velocity (mSNCV), median sensory amplitude (mSA), median motor nerve conduction velocity (mMNCV), and median motor amplitude (mMA), whereas a significant increase was observed in median sensory distal latency (mSDL) and median motor distal latency (mMDL) (p&lt;0.001) The parameter with the highest sensitivity regarding the indication of transition between stages was mSNCV, the sensitivity increased with the progression of stage, and a cut-off value of 40.5 m/s showed a sensitivity of 94.2% and a specificity of 90% regarding the indication of transition to the advanced stage.ConclusionsOur results showed that with a cut-off value of 40.5 m/s, mSNCV is an accurate sensitive and specific parameter regarding the indication of transition to the advanced stage.

The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome in Bangladeshi Population

Introduction: The CTS is one of the clinical syndromes, it was experienced by the patients from numbness, tingling, burning and or pain associated with localized compression of the median nerve at the wrist. Median nerve with the carpel tunnel (CTS) is localized and it was compressed in median nerve, resulting in mechanical compression and local ischemia has been associated with age and sex matched control. Objective: To assess The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome in Bangladesh Population. Methods: A prospective study was conducted at Department of Neurology, Uttara Adhunik Medical College Hospital (UAMCH), Uttara, and Dhaka, Bangladesh from January to December 2021. A total 100 case were prospectively observed for the period of six months 50 patients’ with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined. Based on clinical assessment, the study patients were divided into 03 groups with mild CTS, moderate CTS and severe CTS respectively as per Mackinnsons classification. The relationship between the clinical severity grade and various nerve conduction study parameters were correlated. The study was correlated with age and gender matched control intervention and we extrapolate the any significant correlation between the clinical grades and various attributes of study traits. All the traits were carefully assessed by using logistic regression analysis and Fisher F- test statistics. Results: Out of 50 patients with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined. The Left hand was involved in 11patients; right hand in 19 patients &amp; 20 patients had involvement of both hands. Numbness and tingling of hand and first three fingers was the most common presenting symptom. Phalens test was positive 30 (60.0%) of our patients. 7(14.0%) pts had hypothyroidism, 10(20%) patients showed raised DM and 4(8.0%) patients showed lipid profile abnormalities. Both male and female sex ratio was 1:3. All cases were considered for the study. The distal motor latency was significantly correlated with different age group of the population and CMAP and conduction velocity not shows any significant relation with clinical severity of CTS. Since, the median sensory latency and nerve conduction velocity seen in study population and well apprehension with clinical different grading of CTS. Conclusion: Summing of the results concludes that, the sensory conduction appears to be more sensitive (95%) AUC 0.89 and significantly correlated when compared to motor conduction attributes, the correlation besides with clinical severity of CTS apart from gender and age matched cases.

3D volumetric evaluation of the diagnosis and severity of carpal tunnel syndrome using MRI

BackgroundCarpal tunnel syndrome (CTS) is the most common nerve compression syndrome. The usage of clinical tests and nerve conduction studies (NCS), as well as ultrasonography and magnetic resonance images (MRI), have recently become widespread to diagnose CTS. This study aims to determine the alteration of the carpal tunnel volume based on disease seriousness by MIMICS 19.0 which is a three-dimensional modeling software. Materials and methodIn this study, 80 wrists of 63 (47 female and 16 male) patients with MRI and NCS results among 1252 patients who applied to our hospital with wrist pain and neuropathic complaints between January 2019 and August 2020 were included in our study. The patients were classified into four groups according to their NCS results as normal, mild CTS, moderate CTS, and severe CTS. Carpal tunnel volumes of the groups were measured with MIMICS 19.0 program using MRI. Three-dimensional carpal tunnel volume averages were statistically compared between the groups. Then, all statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 23) software. ResultsThe results demonstrate the mean carpal tunnel volume values for normal, mild CTS, moderate CTS, and severe CTS are 5.51 cm3 ± 0.20, 5.27 cm3 ± 0.16, 4.86 cm3 ± 0.20, and 4.43 cm3 ± 0.24, respectively. Carpal tunnel volumes were found to be lower in all groups which have CTS compared to the normal group. As the groups with CTS were compared among themselves, a significant difference was found between the groups in terms of carpal tunnel volumes (p < 0.001). ConclusionsIn this study, a significant relationship between 3-dimensional measurements of carpal tunnel volume and the severity of CTS was observed. Therefore, MRI is an applicable method to diagnose and determine the severity of CTS.

Diagnostic value of median nerve shear wave ultrasound elastography in diagnosis and differentiation of carpal tunnel syndrome severity

BackgroundCarpal tunnel syndrome (CTS) is the commonest type of peripheral nerve entrapment syndromes. The study aimed at evaluation of diagnostic value of median nerve stiffness measured by shear wave ultrasound elastography for diagnosis and differentiation of CTS severity, correlated to electrophysiological studies. This case–control study involved 40 patients (56 wrists) with CTS of different severity and 40 controls (40 wrists). All participants underwent electrophysiological study to assess the CTS severity, high-resolution conventional B-mode ultrasound to assess cross-sectional area “CSA” of median nerve at carpal tunnel, ratio of median nerve CSA at carpal tunnel and forearm, and shear wave ultrasound elastography with measurement of median nerve mean stiffness and correlation to electrophysiological results as the reference standard.ResultsMean median nerve stiffness by shear wave US elastography was increased in patients with CTS compared to controls and across the different CTS severity groups (P value < 0.001 & 0.001, respectively). The cutoff value by ROC curve analysis for median nerve stiffness to differentiate between patients with CTS and control group was 65.4 kPa (P value < 0.001, 94.6% sensitivity, 97.3% specificity). Higher diagnostic accuracy was noted with the combination of shear wave elastography and conventional B-mode US with improved AUC (B-mode + shear wave; 0.962, P value < 0.001).ConclusionsShear wave ultrasound elastography of median nerve was able to discriminate different severity subgroups of CTS with high sensitivity, while conventional US couldn’t. The diagnostic accuracy of CTS was improved when combined high-resolution conventional B-mode US and complementary shear wave ultrasound elastography.

On the Severity of Carpal Tunnel Syndrome: Metabolic Syndrome or Obesity

AIM: This study aimed to determine the relationship between CTS, metabolic syndrome and obesity and to compare the severity of CTS between patients with or without metabolic syndrome (MS) and patients with or without obesity.&#x0D; METHODS: In this prospective study, patients with clinical and electrophysiological confirmed diagnosis of CTS were included. The waist circumference, blood pressure, fasting blood glucose, fasting triglycerides and high/low density lipoprotein cholesterol levels were recorded. Patients were categorized having metabolic syndrome according to Adult Treatment Panel III definition, while body mass index was used to identify obesity.&#x0D; RESULTS: A total of 65 patients with a mean age of 58.91 ± 12.49 years were included. MS was found in 39 (60%) patients and obesity in 27 (41.5%) patients. The CTS was described as mild, moderate and severe in 8, 12 and 19 hands of those with MS and in 2, 6, and 18 of those without MS respectively (p = 0.207). There were no statistically significant results observed between BMI and the severity of CTS (p &gt; 0.05). The mean waist circumference was 94.75 ± 7.36, 98.78 ± 9.64, 106.42 ± 10.78, 86.41 ± 6.77 for patients with MS+_O–, MS–O+_, MS+_O+_ _and MS–O– _respectively (p &lt; 0.002). &#x0D; CONCLUSION: CTS appears to be more severe in patients with MS than in patients with obesity. Central obesity is one of the well-known risk factors for CTS, but components of MS may have a greater effect on the severity of CTS.

Predictive Value of Markers of Adiposity in Carpal Tunnel Syndrome: A Clinical and Electrophysiological Evaluation.

To determine the association of total and segmental body composition adiposity indices with electrophysiological indicators of CTS. Observational cross-sectional study. Departments of Medicine and Clinical Physiology at King Saud University Medical City, King Saud University, Riyadh from August 2018 to December 2019. Total and segmental body composition analyses were performed by a bio-impedance body composition analyser. All the patients were grouped according to body mass index [BMI], total body fat % [TBF%], total fat mass [TFM], arm fat % [AF%], arm fat mass [AFM], and visceral fat rating [VFR] scores. Nerve conduction studies (NCS) were performed according to the standard protocols. CTS clinical severity score and CTS by NCS correlated significantly with BMI, TBF%, TFM, VFR, AF% and AFM. In ROC analysis, it was revealed that adiposity indices including BMI, TFM, VFR and AFM were significant predictors of abnormal NCS with area under the curve (AUC) of 0.824, 0.795, 0.795, and 0.803, respectively. VFR was a significant independent predictor of CTS severity (β coefficient=0.613, p<0.001) and delayed median nerve latency (β coefficient=0.317, p=0.017). Total and segmental body composition adiposity indicators are significantly associated with clinical severity of CTS and electrophysiological markers; especially, visceral adiposity. Large scale studies are required to explore the true predictive value of body composition in CTS. Key Words: Body mass index, Body composition, Adipose tissue, Body fat distribution, Carpal tunnel syndrome, Nerveconduction, Mediannerveentrapment, Visceralfat, Bioelectricalimpedance, ROCanalysis.

Comparisons of electrophysiological and clinical findings between young and elderly patients with Carpal Tunnel Syndrome

BackgroundFew studies have been published on differences between young and old patients with Carpal Tunnel Syndrome regarding clinical and electrophysiological findings. We compared the findings in participants of two age ranges. MethodsFor one year from August 2016, we performed a two-group cross-sectional study in an outpatient clinic of physical medicine and rehabilitation at a University Hospital. Two samples of young and old women with a diagnosis of the syndrome without known risk factors affecting electrophysiological findings were selected. We measured sensory and motor amplitudes and latencies, the conduction velocity of the median nerve, severity, and recurrence of the manifestations, weakness, atrophy, and severity of the syndrome. ResultsWe had two groups of 24 young (<35 years) and 24 old (>65 years) patients with CTS. Severity of symptoms was higher in young participants [Mean (SD) 3.0(0.6) vs. 2.0(0.8), P<0.001]. Muscular weakness was not different [young 2.6(0.88) vs. old 1.9(1.6), P=0.541]. Five young and nine old participants showed thenar wasting (P=0.104). The severity of CTS was similar (P=0.129). For the group young patients, mean sensory amplitude was higher [14.07(10.98) vs. 7.58(5.08), P=0.012], while mean latency was lower [3.86(0.57) vs. 5.15(1.17), P<0.001]. In motor studies, mean latency was more prolonged in the group old patients [3.86(0.57) vs. 5.15(1.17), P<0.001]. ConclusionClinical symptoms are more severe among young people, while the pathophysiological process is more intense in the elderly. Patients should not be clinically judged merely by subjective manifestations. Both diagnostic workup and treatment should be designed holistically with all the evidence taken into consideration.

Diagnostic potential of ultrasound in carpal tunnel syndrome with different etiologies: correlation of sonographic median nerve measures with electrodiagnostic severity

BackgroundCarpal tunnel syndrome (CTS) is the commonest entrapment neuropathy. The aim of this study was to assess the accuracy and validity of high resolution musculoskeletal ultrasound (US) in the diagnosis of CTS in the Saudi population.MethodsSixty patients were diagnosed clinically to have CTS involving 89 wrists that were confirmed by neurophysiologic studies. Each affected wrist was characterized as idiopathic or associated with either diabetes mellitus or hypothyroidism and were assigned a severity grade based on results of neurophysiologic studies. Seventy-six healthy wrists from fifty age, sex and BMI matched healthy subjects were included in the control group. High resolution ultrasound (US) was performed to assess median nerve cross sectional area distal (CSAd) at the entry to the carpal tunnel and proximally (CSAp) at the level of pronator quadratus muscle with a further calculation of their difference (ΔCSA) and their mean average or CSAd+CSAp/2 (CSApd).ResultsThere was a significant difference between both groups regarding mean ± SD of CSAd, CSAp, ∆CSA, and CSApd (p = 0.0001). A positive significant correlation was also found between the CSAd, ∆ CSA and the CSApd measurements with neurophysiologic severity grade of CTS (P = 0.001). A ∆CSA threshold of 2.5 mm2 showed the highest sensitivity and specificity to diagnose CTS in Saudis.ConclusionHigh resolution ultrasound is a valid and accurate diagnostic modality in carpal tunnel syndrome and correlated to CTS severity. A ∆CSA greater than 2.5 mm2 is considered a valid diagnostic value for CTS in our Saudi population. CTS in our patients with diabetes tend to have greater median nerve US measurement values.

Correlation of clinical grading, physical tests and nerve conduction study in carpal tunnel syndrome.

Background and aims Carpal tunnel syndrome (CTS) is a common debilitating condition. As the reliability of CTS-specific physical tests and its clinical grading remain a matter of debate, we determined the correlations between these assessments with nerve conduction study (NCS). Methods In this cross-sectional study, patients with uni or bilateral CTS, which was confirmed in electrodiagnosis, were enrolled. Clinical grading was based on the modified criteria of the Italian CTS Study Group. Numeric Pain Rating Scale (NPRS) and Boston Questionnaire (BQ) were used. Physical tests [Phalen's, reverse Phalen's, Tinel's and manual carpal compression test (mCCT)] were performed by a single blinded neurologist. A p-value<0.05 was considered statistically significant. Results A total of 100 patients (age=47.48±11.44 years; 85% female) with 181 involved hands were studied. The majority of hands (59.7%) were classified as grade 2 of clinical grading. On NCS, hands with mild (64%), moderate (27%) and severe (9%) CTS were identified. Sensory (velocity, latency and amplitude) and motor parameters (latency and amplitude) were significantly correlated with clinical grades (p-value<0.001). The correlation of NPRS (p-value=0.009) and BQ (p-value<0.001) scores with NCS was significant. None of the physical tests were significantly correlated with NCS in terms of result or duration (p-value>0.05). Conclusions We found that physical tests are not a reliable screening method for evaluation of CTS severity. However, the BQ and clinical grading can be more valuable due to their significant correlation with NCS. Implications Physicians might benefit from employing clinical grading and BQ in practice for better assessment of CTS severity.

T111. Median nerve area in diabetic carpal tunnel syndrome patients: a retrospective review of 1030 cases

Association of CTS and diabetes mellitus (DM) is very common. DM is a known risk factor for CTS, but the impact of DM on the median nerve cross-sectional area augmentation remains uncertain. This is a retrospective review of patients presenting to the Duke Electromyography (EMG) Laboratory during 2013–2014 with a final diagnosis of CTS. US diagnosis of CTS was based upon median nerve cross-sectional area of >9 mm2 and/or wrist-to-forearm ratio of >1.4. EDx studies were the gold standard for diagnosis. The objective of this study is to determine if median nerve CSA is higher in diabetic CTS patients as compared to non-diabetic CTS patients. A total of this is a retrospective review of 1030 consecutive patients presenting to the Duke EMG Laboratory during 2013–2014 with a final EDX diagnosis of CTS were examined. Median nerve CSA at the wrist We analyzed wrist-CSA (W-CSA) and, forearm (F-CSA) were measured-CSA and a wrist-forearm ratio (WFR) calculated. Statistical analysis was performed in diabetic and non-diabetic CTS patients with ANCOVA test and Bonferroni correction using as covariates: age, gender, pregnancy, handedness, and body mass index (BMI). The mean age was 56 ± 14.0 (range from 20 to 90 years). 263 were men (36.8%) and 451 were women (63.2%, 10 women were pregnant). 41.9% of patients were diabetic. 521 were Caucasians, 162 African-Americans and 31 other ethnicities (Asians, Indians, Hispanic). 539 were right-handed, 174 left-handed and 1 was ambidextrous. The mean body mass index (BMI) was 32.2 ± 8.0 (range from 15.5 to 112.1), and the patients were classified in groups I-V following international classification (underweight + normal weight, preobese, obese, severely obese and morbidly obese).The CSA of the median nerve in diabetic patients: (1) At the wrist was 12.8 ± 4.7 mm2 on the right and 11.7 ± 4.8 mm2 on the left. (2) At the forearm, median nerve CSA was 6.5 ± 2.2 mm2 on the right, and 6.1 ± 2.3 mm2 on the left. (3) Mean WFR was 2.1 ± 0.9 on the right and 2.0 ± 0.8 on the left. We had 43 bifid median nerves, and 3 with persistent median artery. There was no difference between wrist CSA (W-CSA) of non-diabetic and diabetic patients (right W-CSA p = 0.992, left W-CSA p = 0.253), and the same was observed with forearm-CSA (right forearm-CSA p = 0.498, left forearm-CSAp = 0.181) and WFR (right-WFR p = 0.706, left WFR p = 0.444 mean = 2.0 ± 0.8), and Bonferroni-correction p-values were also non-significant (value = 1) for all the analysis. There was no difference in CSA or WFR considering the severity of CTS between non-diabetic and diabetic patients (right hand p = 0.237 and left hand p = 0.458). There is no correlation between higher median nerve CSA and diabetes in patients with CTS.

THE PREVALENCE OF CARPAL TUNNEL SYNDROME AMONG FEMALE DAIRY MILKERS

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

Factors Affecting the Outcomes of Carpal Tunnel Surgery: A Review

Ziel der vorliegenden Arbeit war es, unter Berücksichtigung der in Pubmed und Medline veröffentlichten Ergebnisse nach Eingriffen am Karpalkanal zu ermitteln, inwieweit ausgewählte Faktoren wie das Patientenalter, die Dauer der Symptome, die Ausprägung der klinischen und elektrophysiologischen Befunde, das Vorliegen von Begleiterkrankungen und medikolegale Momente die Ergebnisse beeinflussen. Letztlich konnte für keinen der zahlreichen untersuchten Faktoren ein signifikanter Einfluss auf das Langzeitergebnis nachgewiesen werden. Bestehen die Beschwerden länger, sind die klinischen und elektrophysiologischen Befunde ausgeprägter und liegen Begleiterkrankungen vor, so fallen die Ergebnisse weniger gut aus, was darauf hindeutet, dass die betroffenen Patienten etwas weniger von der Operation profitieren. Nur bei Vorliegen von medikolegalen Faktoren wie Rechtsstreit oder Schadenersatzansprüchen lässt sich definitiv ein schlechtes Ergebnis voraussagen.

Carpal tunnel syndrome and prediabetes: Is there a true association?

BackgroundCarpal tunnel syndrome (CTS) is probably associated with diabetes mellitus, but its link to prediabetes (PD) is unknown. ObjectiveTo determine prevalence of PD and others risk factors in CTS. MethodsA cross-sectional study including 115 idiopathic CTS patients and 115 age-, gender-and body mass index (BMI)-matched controls was performed. Clinical, laboratory and neurophysiological evaluations were conducted in all subjects to confirm CTS diagnosis. CTS severity was graded on a standardized neurophysiological scale. PD was defined using strict criteria. ResultsThe prevalence of PD was similar in CTS and control groups (27% vs. 21.7%, respectively P=0.44). Nocturnal symptoms (91.3%) and moderate CTS (58.3%) were most frequently observed in CTS patients. In logistic regression analysis, PD was significantly correlated with age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01–1.09; P=0.006) and BMI (OR 1.08. 95% CI 1.01–1.16; P=0.026), but not with CTS (OR 0.82, 95% CI 0.43–1.53; P=0.537). CTS patients with PD had a significantly higher mean age compared to those without PD (53.8±10.2 vs. 49.5±8.6 years, respectively P=0.027). The frequency of age >60 years was significantly higher in CTS with PD than in CTS without PD (29.0% vs. 8.3%, respectively P=0.04) as was BMI >30kg/m2 (64.5% vs. 33.3%, respectively P=0.03). No significant differences were observed between the two CTS groups with respect to gender, BMI, symptoms, and neurophysiological severity of CTS. ConclusionsOur findings indicated that CTS is not associated with PD, but that PD is closely linked to age and overweight.

Application of ultrasound elastography for determining carpal tunnel syndrome severity.

To evaluate grey-scale and elastography ultrasound imaging findings in patients with CTS compared to nerve conductive studies. Sixty median nerves of 31 cases with confirmed CTS and 44 median nerves in 22 controls (healthy volunteers) who had no clinical evidence of CTS were evaluated. An expert radiologist performed all US evaluations. The RGB image is a three-dimensional matrix. A colour image RGB is an M × N × 3 array of colour pixels. The total pixels, total blue and red pixels, and blue and red indexes were compared between cases and controls. Of the 60 nerves in the cases, 17 (16.3%) were mildly affected, 30 (28.8%) were moderately affected, and 13 (12.5%) were severely affected. Mean CSA, total blue pixels and blue indexes were significantly different between controls and cases with different levels of disease severity. The best cut-off point in the blue index to differentiate patients from controls was 0.1486, with a sensitivity and specificity of 80 and 70% (AUC = 0.79, P < 0.001), respectively. The best cut-off point for the red index to differentiate patients from controls was 0.1896, with a sensitivity and specificity of 70 and 55% (AUC = 0.64, P = 0.01), respectively. Sono-elastography could be a useful diagnostic method for evaluating CTS severity in affected cases.