Study Of Carpal Tunnel Syndrome Research Articles

Proximal and Distal Nerve Conduction Studies in Carpal Tunnel Syndrome

Introduction/Aims: The exact reason for the decrease in median nerve motor conduction velocity (MMCV) in the forearm in carpal tunnel syndrome (CTS) is debatable. However, some studies support the hypothesis of blockage of large, myelinated fibers in the carpal tunnel, and/or retrograde axonal degeneration. We aimed to determine the decrease in the MMCV of the second lumbrical (FMMCVL) and abductor pollicis brevis (APB) muscles recorded in the forearm (FMMCVAPB) in patients with CTS compared with a control group and also to compare the MMCV among CTS subgroups with different severity. Methods: The study included data on the hands of 51 patients and 20 volunteer controls. Patients were divided into four groups according to the severity of the involvement, minimal, mild, moderate, and severe. Routine median, ulnar, and comparative conduction studies were performed. By stimulating the median nerve at the palm, wrist, and elbow, responses were recorded over the APB and second lumbrical muscles. MMCV was assessed in the transcarpal segment (TCMMCV) and forearm. Results: The mean FMMCVAPB and FMMCVL in patients were 53.8 ± 4.2 m/s and 54.3 ± 5.6 m/s, respectively, and were significantly slower than in the controls (P < 0.001 and P = 0.012, respectively). The FMMCVL was significantly decreased in the severe group compared with the other three groups (P < 0.001). FMMCVL and FMMCVAPB relatively decreased as CTS severity increased. Conclusion: In this study, FMMCVAPB and FMMCVL were found significantly slower. Slowing of FMMCVL in the forearm is related to the severity of CTS. The decrease in MMCV in the forearm did not parallel the decrease in TCMMCV. This suggests that retrograde axonal degeneration may be the contributing factor to forearm slowing. There is also an association between axonal degeneration and disease severity.

Wrist & Hand

The December 2023 Wrist & Hand Roundup360 looks at: Volar locking plate for distal radius fractures with patient-reported outcomes in older adults; Total joint replacement or trapeziectomy?; Replantation better than revision amputation in traumatic amputation?; What factors are associated with revision cubital tunnel release within three years?; Use of nerve conduction studies in carpal tunnel syndrome; Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis; Association between radiological and clinical outcomes following distal radial fractures; Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study.

Use of nerve conduction studies in carpal tunnel syndrome.

This review article examines the use of nerve conduction studies in the management of carpal tunnel syndrome. These studies should be understood not as a test that determines the diagnosis but as a measure of impaired nerve function. They are sensitive indicators of local demyelination and axonal loss that can detect and quantify these changes before the appearance of clinical signs, providing information that cannot be obtained with the unaided senses of the physician, nor by any other investigation. They are the best available indicator of overall disease severity, correlating with symptoms and anatomical change in the median nerve. They have some prognostic value for surgical outcome and are sufficiently sensitive to change for the evaluation of treatment response. When surgery does not yield the expected improvement in symptoms, they can help to establish whether decompression has been achieved provided preoperative results are available for comparison.

Correlation of Ultrasonography and MRI with Electrodiagnostic Studies in Carpal Tunnel Syndrome.

Background: One controversial question in Carpal Tunnel Syndrome (CTS) diagnosis is whether magnetic resonance imaging (MRI) and Ultrasound (US) imaging tools have any relationship with electrodiagnostic (EDX) study. The objective of this study is to determine the possible correlation between MRI and US measurements with EDX parameters. Methods: Both US and MRI of the median nerve were simultaneously performed in 12 confirmed CTS wrists, at two levels of forearm distal fold (proximal) and the hook of the hamate (distal), to measure various anatomic parameters of the nerve. EDX parameters of median motor distal latency (DL) and median sensory proximal latency (PL) were evaluated in milliseconds. Results: Nerve cross-sectional area (CSA), measured by MRI, correlated with sensory PL at distal level (p = 0.015). At proximal level MRI, nerve width and width to height ratio also correlated with motor DL (p = 0.033 and 0.021, respectively). Median nerve CSA proximal to distal ratio correlated with sensory PL (p = 0.028) at MRI. No correlation was found between US and EDX measurements. Conclusions: Median nerve MRI measurement of nerve CSA at hook of the hamate (distal) level or CSA proximal to distal ratio correlated with EDX parameter of sensory PL. On the other hand, nerve MRI width and width to height ratio at distal level correlated with motor DL in EDX. Level of Evidence: Level III (Diagnostic).

Study of carpal tunnel syndrome in diabetic polyneuropathy with comparison of inching method and second lumbrical-interossei test.

Background: Since diabetic generalized neuropathy affects peripheral nerves, the diagnosis of carpal tunnel syndrome (CTS) with conventional electrodiagnostic techniques (EDX) [onset latency of median sensory nerve action potential (SNAP) or distal latency of median compound muscle action potential (CMAP)] is controversial. The aim of this study is to investigate the diagnostic values of two other techniques including inching method and second lumbrical-interossei test in patients with diabetic polyneuropathy (DPN) as well as signs or symptoms of CTS. Methods: Fifteen patients (30 hands) with definite diagnosis of generalized peripheral neuropathy secondary to diabetes who developed signs and symptoms of CTS were participated. For diagnosis of CTS, sensory and motor median distal latencies were considered by nerve conduction study. In the next step, inching method and second lumbrical-interossei test were performed for all hands. Finally, sensitivity and specificity of two tests were calculated. Results: Mean age of participants was 53.87 ± 11.53 years. The sensitivity and specificity of inching method in this study were 95.65% and 85.71%, respectively, and for the second lumbrical-interossei test, they were 73.91% and 71.42%, respectively. Conclusion: Inching method was more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS among patients with diabetic peripheral neuropathy. Moreover, the sensitivity of inching method was greater than specificity.

Value of soft tissue mobilization versus medical therapy in carpal tunnel syndrome treatment

Objectives: detect effectiveness of soft tissue mobilization (STM) in reliving manifestations, improving function and electrophysiological studies of carpal tunnel syndrome (CTS) compared to medical treatment. This single-blind randomized-control study included sixty CTS-patients; 40 treated by STM and 20 received medical treatment only. STM was applied three-times weekly for six weeks (total of 18-treatments). Patients were assessed clinically, functionally using Boston-Carpal-Tunnel-Questionnaire (SSS (Symptom-Severity-Scale) and FSS (Functional-Status-Scale)) and electrophysiologically for the median nerve. Assessment was done at the base-line and at the end of treatment. Results: Difference was significantly detected within groups and between both groups treated with STM and medically at the end of treatment regarding tingling, extensionf sensory-amplitude, distal-latency and conduction velocity (p≤0.0001), the motor-amplitude and distal-latency (p=0.008,p=0.004) and changing CTS grade (p=0.01). Patients received medical treatment showed significant difference only in sensory amplitude (p=0.04). Significant difference between both groups regarding changing CTS grade (p=0.03). Conclusion: Clinical, functional and electrophysiological changes in post-STM treated CTS patients have been detected better than medical therapy alone; thereby offering a satisfactory evidence to justify the usage of manual therapy as a conservative treatment of CTS.

An epidemiological study of carpal tunnel syndrome among pregnant women at Al-Wahda hospital Derna

Carpal tunnel syndrome (CTS) the most common and the most widely known entrapment neuropathy. It is occurs when pressure is exerted on the median nerve that runs from the forearm into the palm of the hand. This leads to progressive pain, numbness and weakness in the palm associated with problems in fine movement and pain on the hand when tapping over the median nerve at wrist. To detect the ecological factors, determine adequate management of CTS among pregnant woman and to recommend suitable preventable measures of CTS.This descriptive case series study was done among pregnant women admitted to antenatal ward or coming for antenatal visits were evaluated for carpal tunnel syndrome. Carpal tunnel syndrome was diagnosed based on symptomatology and clinical examination.Among the 74 pregnant ladies diagnosed with carpal tunnel syndrome, the majority of cases were at age of 28-32 years (33.8%), 51.3% were housewives and 17.6% had hypertension. We observed in this study that the majority of cases were in their third trimester 56.8%, 29.7% in blood group A, 31.1% were primigravidae. However, no case underwent surgery.

Assessment of the diagnostic accuracy of nerve conduction study and the correlation between severity of symptoms and nerve conduction studies in carpal tunnel syndrome

<p class="abstract"><strong>Background:</strong> This study was done to assess the diagnostic accuracy of nerve conduction study in carpal tunnel syndrome and comparability of nerve conduction measures before and after carpal tunnel release.</p><p class="abstract"><strong>Methods:</strong> 31 patients (30 females and 1 male) with carpal tunnel syndrome were subjected to nerve conduction study and Boston symptom severity scores before surgery and at 3 months post-operative period and nerve conduction values compared. The effect of duration of symptoms on nerve conduction values was studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Nerve conduction studies were found to be reliable in diagnosing carpal tunnel syndrome. 61.30% patients showed a right-handed involvement, or right side getting affected first in a bilateral case. 60-80% patients had Boston symptom severity scores which were comparable to the nerve conduction grades ascertaining the relationship between them. Only 58.8% patients with extreme and severe NCS grades preoperatively showed improvement post-surgical release. In patients with symptoms for more than 12 months, only 33.33% had improved nerve conduction grades post-surgical release at 3 months, validating the need for early surgical release.</p><p class="abstract"><strong>Conclusions:</strong> Nerve conduction study was found to be a reliable diagnostic modality for diagnosis of carpal tunnel syndrome and nerve conduction study values correlated with the Boston symptom severity score. The post-operative nerve conduction values revealed definite neurological improvement in patients who underwent early surgical management. Hence, we recommend early release for carpal tunnel syndrome patients for speedy recovery from the condition.</p>

Study of carpal tunnel syndrome in peripheral neuropathy with comparison of two methods: Inching method and second lumbrical-interossei test

Diabetes mellitus is the most common metabolic disease. The carpal tunnel syndrome (CTS) occurs frequently in this disease. In diabetes mellitus due to effects of generalized neuropathy on peripheral nerves, the diagnosis of CTS with conventional EDX criteria (onset latency of median SNAP or distal latency of median CMAP) is challenged, so another methods such as 2nd lumbrical-interossei test is used. On the other hand Inching method is a technique in which used for diagnosis and determining the site of compression in carpal tunnel. The purpose of the present study is to evaluate diagnostic value of the inching method and 2nd lumbrical-interossei test in patients with diabetic peripheral neuropathy and signs or symptoms of carpal tunnel syndrome. Thirty hands with history of diabetes mellitus and signs and symptoms of CTS that confirmed diagnosis of peripheral neuropathy with conventional electro-diagnosis were evaluated. Then for diagnosis of CTS, sensory and motor median distal latencies were measured by nerve conduction study. In the next step, inching method and second lumbrical-interossei test was performed for all hands and sensitivity and specificity of two tests was calculated. Mean age of participants was 53.87 ± 11.53 years (range 26 to 70 years). Ten participants were female and 6 participants were male. The sensitivity and specificity of inching method in this study were 95.65 and 85.71, respectively and the results for second lumbrica-interossei test 73.91 and 71.42 were calculated. In this study, we showed the inching method is more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS in diabetic peripheral neuropathy with sensitivity and specificity 95.65 and 85.71, respectively and also the sensitivity of inching method was greater than specificity.

Effect of Gabapentin on nerve conduction studies in carpal tunnel syndrome

Background: The most common type of neuropathy in adults is carpal tunnel syndrome (CTS) which is caused by compression of the median nerve at the wrist.
 Methods: This quasi-experimental study was conducted to determine the efficacy of gabapentin on nerve conduction studies in patients with mild CTS. The patients with mild CTS were randomly allocated into two groups. Group A received naproxen alone (500 mg/day, orally) while group B received both gabapentin (100-300 mg) and naproxen (500 mg/day, orally) for two months. Sensory nerve conduction velocity (SNCV) and distal motor latency (DML) were performed at baseline and two months after treatment.
 Results: There were no significant differences between the two groups with regards to the outcome parameters before initiation of intervention. The SNCV and DML showed no significant improvements in group A (p>0.05), whereas for group B the SNCV and DML of the median nerve were significantly improved at two months after treatment (p<0.001).
 Conclusion: Gabapentin was found to be effective for SNCV and DML in patients with mild CTS over a two-month period.

Study of Carpal tunnel syndrome in Adult Females of Maharashtra

Study of Carpal tunnel syndrome in Adult Females of Maharashtra

Diagnostic Utility of MRI versus Nerve Conduction Studies in Carpal Tunnel Syndrome

Diagnostic Utility of MRI versus Nerve Conduction Studies in Carpal Tunnel Syndrome

Characteristics of nerve conduction studies in carpal tunnel syndrome

Nerve conduction studies are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivityand specificity reported for each tests in clinical studies. The aim of this study was to compare the diagnostic accuracy ofvarious nerve conduction tests and determine the properties of the most accurate test. Forty patients with clinically confirmedCTS and 40 healthy controls were included in the study. All patients and controls underwent various nerve conduction studyprotocols for CTS. The mean age was 53±11.6 years and the female to male ratio was 2:1. The mean duration of disease was1.25±0.61 years. The median nerve motor latency was 4.35±0.63ms while the sensory latency was 3.47±0.58ms. The mediannerve orthodromic sensory latency was found to be 2.51±0.32 ms. The conduction velocity across the palm and wrist was28.7 m/s. The sensitivity was the highest in the inching method (89.6%) and lowest for the conventional median motor andsensory latencies. Addition of a single test of median and ulnar sensory latency, the median and radial sensory latency or theinching method, in routine protocol will improve the sensitivity for the diagnosis of CTS in all patients.

Reliability of neuroconduction studies in carpal tunnel syndrome

To determine the reliability of neuroconduction studies by comparing two observers and detecting minimum changes when diagnosing carpal tunnel syndrome. Sixty-nine patients referred for electrophysiological study due to suspected carpal tunnel syndrome were studied. The patients underwent two examinations, performed by two evaluators, on two different days. Sensory and motor latencies of the median and ulnar nerves were evaluated; all were classified as negative, incipient, mild, moderate, severe or extreme. Relative interval variation, intraclass correlation coefficient, kappa index, limit of agreement and minimum detectable change were estimated. The relative variation of motor nerve latency of the median nerve was -6.8% to 15.9%, with intraclass correlation coefficient of 0.98 for the difference of median-ulnar nerve latency. The minimum detected change was 0.4ms, while the relative interval variation of sensory latency of the median nerve was -5.0% to 11%, with intraclass correlation coefficient of 0.95 for difference with the ulnar nerve. The minimum detectable change was 0.2ms. Electrophysiological classification agreed in 93% of the cases, with a kappa index of 0.89. Sensory and motor latencies of the median nerve, as well as the difference between them and the ulnar nerve, are reliable measures. The minimum detectable change obtained in our study helps clinicians to establish whether changes in latencies in consecutive or post-treatment studies are significant.

Study of Carpal Tunnel Syndrome in the Adult Females of Rajasthan Population

Study of Carpal Tunnel Syndrome in the Adult Females of Rajasthan Population

Characteristics of nerve conduction studies in carpal tunnel syndrome.

Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivity and specificity reported for each test in clinical studies. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests and determine the properties of the most accurate test. A prospective observational case control study. Eighty patients with clinically confirmed CTS and 80 asymptomatic healthy controls were included in the study. All patients underwent the routine hematological investigations as per the protocol. All cases and controls were subjected to various nerve conduction study protocols for CTS. Results were analyzed statistically. The two-tailed Student's t-test was used for the comparative statistical analysis. The sensitivity of each test was calculated as (the number of hands with an abnormal study result/the number of CTS hands) × 100. Comparison between percentages was performed by the McNemar test. The mean age was 38.19 ± 10.13 years and the female:male ratio was 1.5:1. The mean duration of disease was 0.89 ± 0.61 years. Hypothyroidism was present in 21 (26.25%) patients, whereas 13 (16.25%) and 4 (5%) patients had diabetes mellitus and rheumatoid arthritis, respectively. The median nerve motor latency was 4.73 ± 0.83 ms while the sensory latency was 3.44 ± 0.56 ms. The median nerve orthodomic sensory latency was found to be 2.57 ± 0.31 ms. The conduction velocity across the palm and wrist was 41.37 ± 0.67 ms. The sensitivity was the highest in the inching method (86.25%) and lowest for the conventional median motor and sensory latencies (56.25% and 45%, respectively). Addition of a single test of median and ulnar sensory latency, the median and radial sensory latency or the inching method, in routine protocol will improve the sensitivity for the diagnosis of CTS in all patients.

Functional outcome of surgery done for carpal tunnel syndrome

<p class="abstract"><strong>Background:</strong> Carpal tunnel syndrome is a common, chronic and disabling condition afflicting many people. The common age at onset is 40 to 50, although a person of any age may be affected. The diagnosis of carpal tunnel syndrome is often based on clinical findings alone. Electro-diagnostic studies of carpal tunnel syndrome were first established in 1956 by demonstrating focal slowing of median nerve conduction at wrist. This study is meant to evaluate the functional outcome of carpal tunnel release surgery done in Al Azhar Medical College from 2012-2014.</p><p class="abstract"><strong>Methods:</strong> 50 cases (5 cases being bilateral) of carpal tunnel syndrome were operated between 2012 to 2014. All cases were done under local anesthesia. Patients were retrospectively evaluated and interviewed for 2 months follow up after the surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 50 patients who had undergone surgery, 44 patients (88%) had symptomatic relief in the first 10 days. Remaining patients had symptomatic relief in 2 months time.</p><p><strong>Conclusions:</strong> Surgery is always the preferred treatment for carpal tunnel syndrome. In my study, 6 patients (12%) had long standing carpal tunnel syndrome, hence it took 2 months for symptomatic relief. Remaining patients had symptomatic relief in the first 10 days. </p>

The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

Objective. The aim of the study was to examine the relation between clinical findings, neurological examination and electrophysiological studies in diagnosing carpal tunnel syndrome (CTS) and share our institutional experience in patients with CTS. Methods. Patients presenting with complaints of pain, paresthesia, and weakness in hands who diagnosed CTS between 2014 and 2015 were examined retrospectively. Demographic characteristics, clinical and neurological examination findings and electrodiagnostic evaluations were analyzed. Results. A total of 348 patients were included to the study. Weight and height measurements were significantly higher in patients with CTS on the right side ( p =0.05 and p =0.04, respectively). Right hand side was the most dominant lateralization in patients with CTS ( p =0.001) but there was no significant correlation for left side ( p >0.05). The score of visual analogue scale was positively correlated with the severity of CTS ( p =0.001). Thenar atrophy, hypoesthesia, positivity of Tinel and Phalen tests were also related to bilateral CTS ( p =0.001 for each). Conclusion. We agree that clinical features, neurological examination findings and electrophysiological studies are effective diagnostic means in patients with CTS.

Biomechanical and psychosocial exposures are independent risk factors for carpal tunnel syndrome: assessment of confounding using causal diagrams

BackgroundBetween 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure–response relationships.ObjectiveThis analysis examined the...

Evaluation of Radiographic Instability of the Trapeziometacarpal Joint in Women With Carpal Tunnel Syndrome

To determine whether median nerve dysfunction measured by electrophysiologic studies in carpal tunnel syndrome (CTS) is associated with thumb trapeziometacarpal (TMC) joint instability. We evaluated 71 women with CTS and 31 asymptomatic control women. Patients with generalized laxity or TMC joint osteoarthritis were excluded. We classified the electrophysiologic severity of CTS based on nerve conduction time and amplitude and assessed radiographic instability of the TMC joint based on TMC joint stress radiographs. We compared subluxation ratio between patients with CTS and controls and performed correlation analysis of the relationship between the electrophysiologic grade and subluxation ratio. Thirty-one patients were categorized into the mild CTS subgroup and 41 into the severe CTS subgroup. There was no significant difference in subluxation ratio between the control group and CTS patients or between the control group and CTS subgroup patients. Furthermore, there was no significant correlation between electrophysiologic grade and subluxation ratio. This study demonstrated that patients with CTS did not have greater radiographic TMC joint instability compared with controls, and suggests that TMC joint stability is not affected by impaired median nerve function. Further studies could investigate how to better evaluate proprioceptive function of TMC joint and whether other nerves have effects on TMC joint motor/proprioceptive function, to elucidate the relationship between neuromuscular control of the TMC joint, its stability, and its progression to osteoarthritis. Diagnostic II.