Signs Of Carpal Tunnel Syndrome Research Articles

Diagnostic Relevance of Electromyographic Values and their Role in Forecasting the Conservative Treatment in Patients with Carpal Tunnel Syndrome

Summary. Instrumental investigation and electromyography (EMG), one of the most widespread and informative of its methods, still remains widely used for differentiated diagnostics with any other disorder, compressive-ishemic focal neuropathy (CIFN) of the median nerve (MN) ) at the level of the carpal tunnel (CT) diagnosis verification and determination of the severity of damage to the MN. The clinical diagnosis of this pathologyis better know as carpal tunnel syndrome (CTS). Objective: To study the diagnostic relevance of electromyographic values in the Ukrainian population of CTS patients and their role in forecasting the efficiency of conservative treatment of this disorder.
 Materials and methods: 128 patients (204 extremities) with the clinical signs of CTS, who formed the Main Group (MG) underwent electromyography (EMG). The mean age of the patients was 58.2±12.5 years old; among them were 105 (82 %) women and 23 (18 %) men; 77 persons with a bilateral and 51 with a unilateral process. The control group (CG) included 30 volunteers (54 extremities) without any claims and signs of neurological symptoms. The mean age was 45.1±7.8 years old; among them were 23 (77.6%) women and 7 (23,3%) men. To determine the EMG predictors of the effectiveness of clinical outcomes after paraneural corticosteroid injection (PCI) 58 extremities MG were examined.For the EMG examination, we used the «Viking Quest» machine by Nicollet, the USA. Applying relevant methods, we investigated the following: median motor distal latency (DMLm) and CMAP of M. abductor pollicis brevis (APB); median sensory distal onset (MOL-D2), median sensory distal peak latency (MPL-D2), median SNAP amplitude digit 2, median sensory conduction velocity between wrist and digit 2 (mSNCV); difference in median sensory onset latency (digit 1) (MSL-D1) to radial sensory onset latency (digit 1) (RSL-D1) – MD1-RD1; difference in median nerve distal motor latency (2nd lumbrical)to the ulnar nerve distal motor latency (2nd interossei) – 2LI-DML; interrelation of the amplitudes of CMAP APB obtained by the stimulation of the MN on the level of the lower third of forearm to the amplitude of CMAP APB – on the level of the lower third of a palm (wrist to palm amplitude ratio); the sensory ulnar nerve conduction velocity (uSNCV).
 Results: The analysis of mean values of the core EMG values has demonstrated the significant differences between MG and CG, with different directions of changes, typical of the CTS. Relying on the data collected while studying people from the CG (the discovered referential and abnormal values) and the ROC analysis, we have established the sensitivity and specificity of EMG values: DMLm – 73.5% and 96.3%; MPL-D2 – 81.9% and 100%; mSNCV– 93.9% and 100%; MD1-RD1 – 62.5% and 100%; MSL-D1– 83.3% and 96.9%; 2LI-DML – 88.2% and 100%, respectively (AUC=0,91-0.96). Based on the results of the ROC analysis, determined that the most prognostically significant EMG predictor of clinical outcome after PCI was median SNAP amplitude digit 2 (sensitivity 90,9% and specificity 92%, AUC=0,95.
 Conclusions: The EMG is the objective and informative method to diagnose CIFN of the MN at the level of the CT, severity of nerve damage in CTS patients and predicting of clinical outcome after PCI.

Clinical efficacy of electroacupuncture-like magnetic therapy compared to conventional transcutaneous electrical nerve stimulation in individuals with carpal tunnel syndrome

This study aimed to evaluate the clinical efficacy of an electroacupuncture-like magnetic therapy (ELMT) and conventional transcutaneous electrical nerve stimulation (TENS) in patients with carpal tunnel syndrome (CTS). A prospective randomized controlled trial in single-centre was conducted. Thirty-four CTS patients confirmed by electrodiagnostic study were randomized into TENS or ELMT group and completed a six-week treatment program. TENS or ELMT treatment was applied on acupuncture point PC-6 (Neiguan) and one selected hand acupoint. Therapeutic exercises were also included after the electrophysical modality. Their physical signs, motor and sensory performances, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and results of electrodiagnostic study were evaluated. After treatments, both groups demonstrated significantly decreased BCTQ scores and positive rate of Tinel’s sign in the major symptomatic side, which indicated improvements in the symptom severity and physical functions. Significant increases in distal sensory amplitude and nerve conduction velocity of the median nerve were only found in the ELMT group. Our study found either conventional TENS or ELMT plus therapeutic exercises could improve the symptomatology and physical provocation sign of CTS. The ELMT has additional improvement in the nerve conduction in patients with CTS.

P11.43.B HIGH-RESOLUTION NERVE ULTRASOUND IN NEUROFIBROMATOSIS TYPE 1

Abstract BACKGROUND Patients with neurofibromatosis type 1 (NF1) can develop plexiform neurofibromas (PN). PN are peripheral nerve sheath tumors that can cause pain, neurological deficit and can transform into malignant peripheral nerve sheath tumors (MPNST). High-resolution ultrasound (HRUS) is suggested as a quick and cost-effective technique, as compared to whole-body MRI, for screening NF1 patients for PN. Our aim is to describe the variety of HRUS nerve abnormalities in NF1 patients and to study the link between nerve morphology and nerve function. MATERIAL AND METHODS We selected patients with a clinical diagnosis of NF1, with or without symptoms related to the peripheral nervous system (PNS) such as pain, sensory disturbances or loss of strength. Patients were invited for a study visit including neurological examination, nerve conduction studies (NCS) and HRUS. One-sided NCS were performed of the median and ulnar nerve (motor and sensory), peroneal and tibial nerve (motor) and sural nerve according to standard protocol. We visualised the brachial plexus, median-, radial-, ulnar-, peroneal-, tibial-, and sural nerves on both sides using HRUS. The cross-sectional area (CSA) of the nerve was measured at predefined anatomical sites, and additional sites in case of focal nerve enlargement. RESULTS We enrolled 60 NF1 patients, of which 57% had PNS-related symptoms. One third of our patients had neurological deficits during physical examination. We found nerve enlargement with HRUS in 48 out of 60 patients (80%), this was not significantly different between patients with PNS symptoms or without PNS symptoms (82% vs 77% respectively, p=0.602). In 82% of the patients with PNS symptoms, their symptoms were likely to be related to one or more nerve enlargements. Nine of these patients had clinical and neurophysiological signs of carpal tunnel syndrome. Different patterns of nerve enlargement were identified. 46% had isolated nerve enlargements, 25% had diffusely enlarged nerves and 29% had a mixture of diffusely enlarged nerves with isolated nerve enlargements. The majority of the patients with nerve enlargement on HRUS had no abnormalities on NCS (65%). CONCLUSION The majority of NF1 patients have nerve enlargements as seen by HRUS, however we have shown that nerve enlargements can often be asymptomatic and do not always lead to impaired nerve function. To determine whether patients have PN cannot be based solely on clinical evaluation of symptoms. HRUS might have an application as a screening tool for NF1 patients in clinical practice. However, further research is needed to describe growth of nerve enlargements, the impact of intra- and interobserver variability on CSA measurements and to improve our knowledge on the link between nerve morphology and nerve function in NF1.

Complex trigger wrist associated with carpal tunnel syndrome: a case report

BackgroundThere are few reports of trigger wrist in the literature, as it is a rare pathology. Furthermore, various authors report that it is also hard to diagnose. It manifests with neurological symptoms at the affected wrist, which are usually induced by wrist movement, and can lead to partial or full loss of wrist function and sensitivity. The reason for reporting this specific case is that it was hard to differentiate between trigger finger and trigger wrist by clinical symptoms; no pathology was palpable or clearly seen on magnetic resonance imaging scan of the wrist. We propose a new diagnostic statement relative to this pathology.Case presentationA case of a 45-year-old white slavic man with trigger wrist associated with carpal tunnel syndrome, caused by a fibroma of the flexor tendon sheath, is reported. Despite careful clinical examination, it was not possible to differentiate between trigger finger and trigger wrist. Magnetic resonance imaging was performed to arrive at the right diagnosis but did not reveal any pathology in the wrist area. Carpal tunnel release was performed with a fibroma identified and excised. Wrist function was maintained well; no signs of carpal tunnel syndrome were seen at last follow-up.ConclusionsTrigger wrist can be misdiagnosed as trigger finger even if adequate clinical evaluation is performed, and this can lead to inadequate treatment. We state that, when clinical symptoms of both trigger wrist and trigger finger are present, except painful palpation of the A-1 pulley region, the case should be referred to as trigger wrist.

Electrodiagnostic signs of carpal tunnel syndrome in ocular pseudoexfoliation syndrome

To assess the occurrence and severity of electrodiagnostic signs of carpal tunnel syndrome (ED-CTS) in patients with ocular pseudoexfoliation (PEX) and compare them with normal subjects. A cross-sectional study with comparison group was designed and 60 patients with PEX were recruited from May 2019 to February 2021, and the findings were compared with 59 healthy subjects. All patients underwent complete ophthalmologic examination and nerve conduction velocity test at the median nerve was used to assess the occurrence and severity of ED-CTS in both hands. The mean age of participants was 59.8 ± 4.5years. Occurrence of ED-CTS was 38.3% in PEX patients and 20.3% in control subjects (P = 0.025). There was also a significant difference in the severityand presence of asymptomatic CTS (P < 0.05). Adjusting other variables, including; age and sex, having severe ED-CTS showed a 3.07fold higher chance in the PEX group (P = 0.005). According to our finding, it seems there is a direct association between PEX and the occurrence, as well as severity of ED-CTS.

Minimally Invasive Carpal Tunnel Release: A Technical Note and a 20-Year Retrospective Series.

IntroductionThe surgical treatment of carpal tunnel syndrome (CTS) has been enriched, during the last years, by different minimally invasive techniques to decompress the median nerve at the wrist as the endoscopic approaches or modified open technique. However, controversy remains about their safety and complication rate. We present the results of our minimally-invasive technique to median nerve release at the wrist. We will discuss the instrumental preoperative assessment, surgical steps, post-operative management, and complications.MethodsWe retrospectively reviewed clinical and neurophysiological data of all patients admitted at our institution between January 2001 and December 2020 for CTS surgery. The technique, performed under local anesthesia, is based on a single, small, linear transverse incision proximal to the wrist fold. After unsharpened dissection of subcutaneous tissues, a grooved guide is inserted in a slightly medial direction towards the fourth finger; this strategy prevents possible damages of nerve branches that could originate at this level. A second small incision over the guide’s tip allows a wide corridor in the context of the ligament. The carpalotome is then inserted into the guide; the two minor wounds are closed with 5-0 prolene sutures. The final result is a wide release of the nerve.ResultsA total of 1568 operations on 1371 patients were performed using the described technique at our institution. The patients’ cohort showed a higher prevalence of women (68%), with a mean age of 56.4 years (range 24-88 years). Paresthesia and numbness of the first three fingers were the most frequent signs and symptoms. All patients were submitted to a preoperative electrophysiological evaluation, which revealed the typical signs of CTS in most patients. The US evaluation of the median nerve at the wrist was a more recent introduction, dating from 2018. In 47 patients, despite an electromyography (EMG) not showing marked neurophysiological signs of severe CTS, the ultrasonographic evaluation was strongly consistent with the clinical diagnosis. In such patients, carpal tunnel release determined the resolution of symptoms. In 99.8% of total cases, we obtained a complete symptoms remission, with the disappearance of acroparesthesia and numbness.ConclusionThe use of this technique has become widespread at our institution due to fewer local complications, a very low rate of recurrence, faster functional recovery, and reduced surgical time if compared to traditional open surgery and to endoscopic release too.

Investigating the effects of volar wrist cock-up splint and dorsal lock wrist hand orthosis in reducing signs of carpal tunnel syndrome.

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy presenting with sharp pain, parenthesis, dysfunction of the hand in coordination and gripping. Splinting is the most common conservative intervention to improve pain and enological symptom of this Syndrome (CTS). With regard to the importance of these interventions and controversies about different designs of splints, the aim of this study was to compare the therapeutic effects of volar wrist cock-up orthosis and dorsal lock wrist hand orthosis on pain, sensory and motor latency in carpal tunnel syndrome. Methods: In this Randomized controlled trial study, 30 patients diagnosed with mild to moderate CTS were recruited. The subjects were randomly divided into two equal groups. Both groups received one form of splints for three weeks. Before receiving the splints, Electromyography (EMG) and Visual analog scale (VAS) were performed. Then, two different designs of splints were used for a period of three weeks. After that, EMG and Numerical Rating Scale (NRS-11) were repeated to reveal the effects of splints on reducing pain, sensory and motor latency in CTS. Independent t and paired t-tests were done uding SPSS software version 19.0. P-value was set at 0.05. Results: All the variables in both groups showed significant improvement. The NRS-11 test was significantly improved in the dorsal lock wrist hand orthosis group (p<0.05). Conclusion: This study showed that the use of the dorsal lock wrist hand orthosis for about three weeks was significantly improved pain and neurological symptoms of patients with CTS because of maintaining the wrist in the neutral position. Knowing this fact helps us to design and make a less cumbersome and restrictive splint with an accurate position for the wrist and distal joints.

Investigating the effects of volar wrist cock-up splint and dorsal lock wrist hand orthosis in reducing signs of carpal tunnel syndrome

Investigating the effects of volar wrist cock-up splint and dorsal lock wrist hand orthosis in reducing signs of carpal tunnel syndrome

Carpal and cubital tunnel syndromes as the most common variants of upper extremity compression neuropathies

Upper and lower extremity tunnel neuropathies are classified as the peripheral nervous system disorders and are quite common in clinical practice. The development of tunnel syndrome is associated with compression, entrapment of the nerve in the narrow anatomical spaces (anatomical tunnel). Sensory, motor, and trophic disorders are the main clinical manifestations of the nerve compression syndromes. The article describes the main upper extremity tunnel neuropathies, their names and affected nerves. The main common upper extremity tunnel neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome are considered in depth. The carpal tunnel syndrome is currently recognized as the most common peripheral neuropathy. Risk factors, gender and age characteristics, prevalence, incidence of carpal tunnel syndrome and cubital canal syndrome are presented. A scope of specialized skills comprising certain motions that can contribute to the development of carpal tunnel syndrome is presented. The clinical manifestations of these tunnel syndromes are described. Sensory, motor, and trophic disorders are the main clinical manifestations of nerve compression syndromes. The course and signs of carpal tunnel syndrome that can be divided into three stages are provided. The main diagnostic methods for the syndrome examination are shown. The article provides the main conservative and surgical methods for the treatment of these tunnel syndromes. It was noted that the cubital canal syndrome requires surgical treatment more often. The issue of using thiamine, pyridoxine, cyanocobalamin and their combination for the treatment of tunnel neuropathies is considered in more depth. A clinical case of effective conservative treatment for the carpal tunnel syndrome is discussed.

Recurrent blistering of the fingers as a sign of carpal tunnel syndrome: a first report from Japan

Recurrent blistering of the fingers as a sign of carpal tunnel syndrome: a first report from Japan

Carpal Tunnel Syndrome: A Review of Literature.

Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most frequently reported forms of median nerve compression. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation. The diagnosis of CTS is conducted through medical assessments and electrophysiological testing, although idiopathic CTS is the most typical method of diagnosis for patients suffering from these symptoms. The pathophysiology of CTS involves a combination of mechanical trauma, increased pressure, and ischemic damage to the median nerve within the carpal tunnel. The diagnosis of CTS patients requires the respective medical professional to develop a case history associated with the characteristic signs of CTS. In addition, the doctor may question whether the patients use vibratory objects for their tasks, the parts of the arm where the sensations are felt, or if the patient may already have predisposing factors for CTS incidence. During the diagnosis of CTS, it is essential to note that other conditions may also provide similar symptoms to CTS, thus requiring vigorous diagnosis to assert the medical condition of the patients. Doctors use both non-surgical and surgical treatments when addressing CTS. Non-surgical treatments include wrist splinting, change of working position, medications, and the use of alternative non-vibrating equipment at work. On the other hand, surgical methods include open release and endoscopic surgeries. This review of literature has provided an overview of CTS with an emphasis on anatomy, epidemiology, risk factors, pathophysiology, stages of CTS, diagnosis, and management options.

P82-F Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a widely distributed upper limb nerve compression. CTS is relatively easy to recognise with timely diagnosis of sympto. The elimination of risks and professional conservative therapy can prevent the radical interventions. In our study we worked with 8 patients, 7 of them had signs of CTS in both hands. The diagnosis was based on history, physical examinations and an electroneurographia test (ENG). All of the patients completed a questionnaire about their subjective symptoms before the objective physical examinations. The used physiotherapy was modified for the severity of the sympto. Advice on workplace task modification was given to all patients. Main symptoms are tingling, numbness, nocturnal pain and weakness in the distribution of the median nerve in the hand. Objective results represented a decrease in the range of motion, waste of force in the hand and thenar atrophy. After the treatment the waste of the abductor pollicis has disappeared at all patients, weakness and deficits of motion were found in one person. We recognised a significant improvement in the specific tests. Occupational factors, overstrain of the hands are important causes of CTS. Loss of sensory feedback and pain is more often presented than motor function loss. After the treatment the symptoms of patients were reduced or disappeared. CTS can be often effectively treated with complex physiotherapy and workplace task modifications, but there isn’t a complete recovery in all cases.

Carpal Tunnel Syndrome: Treating Hand Pain and Numbness.

Pain and a loss of feeling in your thumb, index finger, middle finger, and part of your ring finger may be a sign of carpal tunnel syndrome. This syndrome and the pain, numbness, tingling, and weakness in your hand that result from it are caused by pressure on the median nerve as it travels through the carpal tunnel. Guidelines published in the May 2019 issue of JOSPT make recommendations, based on best practices from the published literature, for evaluating, diagnosing, and treating carpal tunnel syndrome. For you as a patient, these guidelines outline the best rehabilitation treatment options based on the scientific research. Ultimately, the best care is a combination of the leading science, the clinical expertise of your health care provider, and your input as the patient. These guidelines help inform the first step in that process. J Orthop Sports Phys Ther 2019;49(5):361. doi:10.2519/jospt.2019.0502.

Peripheral neuropathy in hereditary spastic paraplegia caused by REEP1 variants.

SPG31 is a hereditary spastic paraplegia (HSP) caused by pathogenic variants in the REEP1 gene. The phenotype (SPG31) has occasionally been described with peripheral nervous system involvement, in additional to the gradually progressing lower limb spasticity that characterizes HSP. The objective of this study was to characterize patients with pathogenic REEP1 variants and neurophysiologically assess the extent of peripheral nerve involvement in this patient group. Thirty-eight index cases were molecular-genetically tested, yielding two previously reported pathogenic REEP1 variants and a novel missense variant, in a total of four index patients. Three of four probands and five additional family members underwent nerve conduction studies, electromyography, quantitative sensory testing, and examination of the autonomic nervous system. None of the examined patients had completely unremarkable results of peripheral nerve studies. Most showed electrophysiological signs of carpal tunnel syndrome, and one patient demonstrated a multifocal compression neuropathy. Autonomic testing revealed no severe dysfunction, and findings were limited to adrenergic function. HSP caused by pathogenic REEP1 variants may be accompanied by a generally mild and subclinical polyneuropathy with a predisposition to compression neuropathy, and should be considered in such cases.

Carpal tunnel syndrome among milking parlor workers in Northern Italy: a comparison of screening approaches.

Background:Occupational tasks characterized by repetitive, awkward and forceful movements of the hand and wrist may heighten the risk of carpal tunnel syndrome (CTS) among dairy parlor workers. Median nerve impairment can be investigated with ultrasonography (US) and nerve conduction studies (NCS) but a structured questionnaire may help identify early symptoms.Objectives:Our objectives were to: a) compare the sensitivity of US investigations and NCS to detect early signs of CTS; b) explore the correlation of the results of these two tests with CTS symptoms obtained from the administration of a targeted questionnaire.Methods:Forty male milking parlor workers were recruited. The study protocol included: 1) the identification of characteristic CTS symptoms through a targeted questionnaire; 2) US imaging of the carpal tunnel inlet (using a portable ultrasound device; 3) NCS of the distal median nerve.Results:The symptom questionnaire was considered positive if at least one CTS symptom was present within two weeks prior to the examination. The symptom questionnaire showed a high level of specificity (92,6%) and sensitivity (61%) when compared with NCS results. Ultrasound results revealed a prevalence of median neuropathy of 55%, but when compared to NCS, the ultrasound showed quite low predictive values (NPV of 37% and PPV of 38%).Discussion:The symptom questionnaire was associated with the median nerve pathology often seen in CTS. Moreover, the study results have shown the questionnaire to be the most effective screening method when compared to ultrasound.

The diagnostic accuracy of high-resolution ultrasound in screening for carpal tunnel syndrome and grading its severity is moderated by age

ObjectiveTo assess the effect of age on the accuracy of high-resolution ultrasound (HRUS) in the diagnosis and grading of carpal tunnel syndrome (CTS). MethodsPatients with symptoms and signs of CTS (N = 527 wrists) were evaluated using electrodiagnostic studies (EDx) for CTS diagnosis and grading. Median nerve cross-sectional areas at carpal tunnel inlet (CSA) and at forearm level were measured by HRUS and the ratio of these values was calculated (WFR). Healthy controls underwent identical testing (N = 122 wrists). HRUS accuracy was assessed against the EDx standard by Receiver Operator Characteristic (ROC) curve analysis. ResultsIn patients >65 y with moderate and severe CTS, disease-related increases in CSA and WFR were negatively correlated with increasing age. Subjects were grouped by age into younger (<65 y) and older (≥65 y). The c-statistics for CSA and WFR respectively were: For CTS diagnosis, younger group: 0.94 and 0.96 (excellent); older group: 0.85 and 0.86 (satisfactory). For CTS grading, younger group: differentiating mild CTS from controls: 0.90 and 0.92 (excellent); mild from moderate: 0.79 and 0.74 (satisfactory); moderate from severe: 0.82 and 0.78 (satisfactory). For CTS grading, older group: differentiating mild CTS from controls: 0.83 and 0.83 (satisfactory); mild from moderate: 0.53 and 0.61 (poor); moderate from severe: 0.65 and 0.53 (poor). ConclusionsFor subjects aged <65 y, HRUS accuracy is excellent in CTS diagnosis and satisfactory in grading. For older subjects, accuracy is satisfactory in diagnosis but not in grading. SignificanceHRUS for CTS has diagnostic limitations selectively in older individuals.

Sonographic Measurement of Cross-sectional Area of the Median Nerve in Academic Dentists Without Symptoms or Signs of Carpal Tunnel Syndrome

The objective was to evaluate the distribution of the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve (MN) in asymptomatic academic dentists using ultrasonography (US). Fifty academic dentists underwent US of the MN in transverse section at the pisiform bone level and the CSA (mm2) and FR were measured bilaterally. A CSA of &lt;10 mm2 was considered normal. Paired t-test showed no statistical significance between either hand for CSA and FR ( P&gt; .05). Two independent t-tests showed significant statistical differences ( P= .023) between males and females in the right dominant hand for CSA. Linear correlation analysis showed no significant correlation between CSA and FR for number of years of experience or number of working hours per day in either hand ( P&gt;.05). The CSA was abnormal in the right dominant hand in 20 (40%) of the subjects. These male academic dentists were at increased risk of having an enlarged MN without symptoms.

Frequency of Carpal Tunnel Syndrome in Patients Having Diabetes Mellitus with Neuropathy in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 240-245

Emphysematous Pyelonephritis: Experience of Managing 15 Consecutive Cases in a Tertiary Care Hospital of Bangladesh

Background: Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. CTS and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy.Methods: This study was a hospital based descriptive cross sectional study done in a tertiary care hospital, Dhaka between July, 2015 and June, 2016. The initial clinical diagnosis of diabetic peripheral neuropathy was made from history and examination. It was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Collected data were checked, verified for consistency and edited for final results. Data cleaning, validation and analysis were performed using Statistical Package for the Social Sciences (Version 20.0).Results: A total of 354 cases were finally analyzed with 153 (43.2) patients being symptomatic for CTS and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Majority (38.4%) of patients belonged to the age group of 51-60 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). One hundred and ninety two (54.2%) patients were housewives, 57 (16.1%) were garment workers, 45 (12.7%) patients were businessmen and 60 (16.9%) patients were service holders. Study subjects with CTS had significantly higher body mass index, higher fasting blood glucose and higher HemoglobinA1c in comparison to patients without CTS. Examination of upper limb sensory nerves showed that nerve conduction velocity was significantly decreased and distal latency was found to be significantly increased in patients with CTS on median nerve examination. The mean compound motor action potential was not significantly different between patients with and without CTS.Conclusion: Symptoms and signs of CTS are mostly masked by the symptoms of DPN and patients presenting with such symptoms in the upper limbs should be evaluated for CTS as a separate entity to DPN. The finding of a frequency of CTS of 26% in subjects with diabetes with varying degrees of DPN is remarkably high. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions be made carefully after nerve conduction study and proper diagnosis.Birdem Med J 2018; 8(3): 246-250

ELECTRODIAGNOSTIC CRITERIA FOR DIAGNOSING CARPAL TUNNEL SYNDROME NEED TO BE REVISED IN HYPOTHYROID PATIENTS

Background: Previous studies do not agree with each other on the association between electrodiagnostic findings and clinical symptoms of Carpal tunnel syndrome (CTS). In most of these studies, many variables such as age, sex, obesity and hypothyroidism have not been taken into account. Material &amp; methods: About 62 patients with hypothyroidism and 62 patients without hypothyroidism with sign and symptoms of CTS were included in this study. Electrodiagnostic tests were done for all patients. And relationship of the severity of CTS signs and symptoms with electrodiagnostic parameters was examined statistically in each group. Results: This study showed that distal motor latency in control group (without hypothyroidism) is significantly more prolonged than hypothyroid patients. Also there was significant correlation between clinical symptoms and electrodiagnostic findings in control group, but there was not such correlation in hypothyroid patients. In 62% of hypothyroid patients with clinical signs and symptoms of CTS, electrodiagnostic findings were normal and only in 38% of cases, electrodiagnostic findings were suggestive of CTS. Conclusion: Relationship of the severity of CTS signs and symptoms with electrodiagnostic parameters is very weak in hypothyroid patients. Many hypothyroid patients with clinical signs and symptoms of CTS have normal electrodiagnostic findings; so we need more studies for revising the para-clinic criteria of labeling patients having CTS in hypothyroid patients.