Unilateral Carpal Tunnel Syndrome Research Articles

Evaluation of smartphone-assisted infrared thermal imaging efficiency in carpal tunnel syndrome

BackgroundThermography is an industrial method for surface temperature measurements, and although it is medically safe and non-invasive, its place in daily practice has been limited. With the development of technology, thermal cameras have become more accessible and practical via adaptation to mobile phones. Among patients evaluated with bilateral nerve conduction studies (NCS) for suspected carpal tunnel syndrome (CTS), those with electrophysiological findings consistent with mild-to-moderate unilateral CTS were accepted for this prospective study. The hands with positive NCS findings were the study group, and the unaffected hands were the control group. The images were evaluated with the thermal analysis software (FLIR Tools ver. 6.4, Windows 10) and compared with NCS for statistical significance. In addition, thermal images were examined by three orthopaedic surgeons, and interobserver correlation was analyzed. Our study aims to evaluate the mobile phone-assisted thermal camera (FLIR One Pro, FLIR Systems, Wilsonville, OR, USA) as a suitable tool to diagnose CTS.Results48 patients, 35 women and 13 men were included in the study. Bilaterally, a total of 96 hands were evaluated. 18 patients had mild, and 30 patients had moderate NCS stages unilaterally. The mean temperature difference at the region of interest in the palm, first and third fingers were statistically significant between the study and control groups (p < 0.05). NCS values and stages were correlated with the temperature difference in the third finger (p = 0.002). The inter-observer reliability was high (ICC = 0.858) while detecting temperature differences.ConclusionsSince smartphone-assisted thermal cameras are easy and convenient to use, we think they are helpful in the daily practice of diagnosing mild-to-moderate carpal tunnel syndrome.

Carpal tunnel syndrome caused by an interosseous ganglion of the lunate.

We present a case of a 29-year-old woman with diffuse, unilateral wrist pain and carpal tunnel syndrome secondary to an interosseous ganglion of the lunate and aim to highlight uncommon aetiologies when assessing patients with atypical carpal tunnel symptoms.

Effects of mirror therapy on pain, sensitivity and functionality in patients with unilateral carpal tunnel syndrome. Randomised control trial

Purpose To investigate the effects of mirror therapy (MT) and therapeutic exercise (TE) with the unaffected hand, on pain, sensitivity and functionality in individuals with unilateral carpal tunnel syndrome (CTS). Material and methods A randomized controlled trial was carried out. Thirty-nine adults with unilateral CTS were included and randomly allocated to a six-week training programme based on MT (n = 20) or TE (n = 19). Visual Analogue Scale, Semmes-Weinstein monofilament test, Two-point discrimination (2PD), Disabilities of the Arm, Shoulder and Hand (DASH) and Boston Carpal Tunnel Questionnaire (BCTQ) were assessed before (T0) and after the intervention (T1), and at one-month follow-up (T2). Results At T1, MT and TE showed significant improvements in pain (p = 0.001 and p = 0.03, respectively), however, only MT maintained the achieved effects at T2 (p = 0.01). In addition, 2PD significantly improved in MT in the first (p = 0.04) and fourth fingers (p = 0.02) at T1. The DASH score decreased at T1 in MT (p < 0.001) and TE (p = 0.01). Additionally, the BCTQ score improved in MT (p < 0.001), and TE (p < 0.001) at T1. The effects were maintained at T2 for DASH and BCTQ scores. Conclusions Training of the unaffected hand resulted in a significant improvement of the affected hand in both groups; nevertheless, MT achieved a longer duration of the effects.

Motor Imagery and Pain Processing in Patients With Entrapment Neuropathies: A Cross-sectional Study.

(1) To assess the ability to generate both kinesthetic and visual motor imagery in participants with carpal tunnel syndrome (CTS), compared with asymptomatic participants. (2) To assess the influence of psychophysiological and functional variables in the motor imagery process. Twenty patients with unilateral CTS and 18 pain-free individuals were recruited. An observational case-control study with a nonprobability sample was conducted to assess visual and kinesthetic movement imagery ability and psychophysiological variables in patients with CTS compared with asymptomatic participants in a control group. The trial was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. CTS patients have more difficulties in generating visual motor images compared with asymptomatic individuals ( t =-2.099; P <0.05; d=0.70). They need more time to complete the mental tasks (visual t =-2.424; P <0.05 and kinesthetic t =-2.200; P <0.05). A negative correlation was found between the ability to imagine and functional deficits ( r =-0.569; P =0.021) for the kinesthetic subscale and temporal summation ( r =-0.515; P <0.5). A positive correlation was found between pain pressure threshold homolateral (homolateral) and time to generate the visual mental images ( r =0.537; P <0.05). CTS patients have greater difficulty generating motor images than asymptomatic individuals. Patients also spend more time during mental tasks. CTS patients present a relationship between temporal summation and the capacity to generate kinesthetic images. In addition, the CST patients presented a correlation between chronometry mental tasking and mechanical hyperalgesia.

The effectiveness of combining ultrasound therapy with splinting and exercise therapy for patients with carpal tunnel syndrome

Background: Carpal tunnel syndrome (CTS) can cause patients to experience negative symptoms that can significantly affect their ability to use their hands to perform daily activities. This study aimed to compare the effectiveness of a combination of splinting and exercise therapy with or without ultrasound therapy in improving CTS symptoms and the functional status of patients.&#x0D; Methods: This randomized pre and post-test control group design study was conducted in private physiotherapy practices in the Denpasar area from August to September 2022. Twenty-four subjects with unilateral CTS were randomly divided into an Intervention Group (n=12; splinting, exercise therapy, and ultrasound therapy) and a Control Group (n=12; splinting and exercise therapy only). Splinting was used all day and night for four weeks. Exercise therapy was given three times per week for four weeks. Ultrasound therapy was given once a day, three times per week, for four weeks. The subject's symptoms and functional status before and after treatment were evaluated using the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), which consists of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS).&#x0D; Results: Significant improvements were found in SSS and FSS in Group 1 (SSS: p=0.000; FSS: p=0.000) and Group 2 (SSS: p=0.000; FSS: p=0.000), and a significant between-group difference was found in SSS (p=0.000) and FSS (p=0.001).&#x0D; Conclusion: The addition of ultrasound therapy to splinting and exercise therapy is more effective than that in improving the symptoms and functional status of patients with CTS.

Idiopathic carpal tunnel syndrome in male patients

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;The carpal tunnel syndrome (CTS) in male patients, due to anatomical characteristics and the perception of CTS-related symptoms, remains undetected for a long time. Men respond less well to CTS treatment, and early detection enables conservative treatment of mild and moderate CTS. The aim of this paper was to examine the average age, the frequency of bilateral CTS and its correlation with the age, and to determine the grade of electrophysiological damage of the median nerve in male patients with idiopathic CTS diagnosed by electromyoneurography. &amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The retrospective study included 83 male patients, aged from 32 to 81 years, with complaints of unilateral CTS on the right, dominant hand. All patients underwent EMNG for confirmation of CTS and the degree of median nerve damage. Statistical analysis was performed by methods of descriptive statistics, t-test, Wilcoxon signed rank test, and Pearson&amp;amp;rsquo;s correlation coefficient. The value of p &amp;amp;lt; 0.05 was considered statistically significant.&amp;lt;strong&amp;gt; Results.&amp;lt;/strong&amp;gt; The average age of patients was 55.84 years. The bilateral CTS was confirmed in 88.4%, most often of a moderate degree and more pronounced on the right, dominant hand (p=0.001). In cases of bilateral CTS, age did not correlate with the grade of CTS changes in both hands. The changes in the dominant hand were more pronounced in patients older than 51 years.&amp;lt;strong&amp;gt; Conclusion.&amp;lt;/strong&amp;gt; Male patients with idiopathic CTS usually have bilateral CTS, with more pronounced changes on dominant hand. Bilaterality of CTS and the degree of median nerve damage are not connected with age.&amp;lt;/p&amp;gt;

Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity.

It remains unclear whether physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index on CTS severity is not well characterized. Unilateral and bilateral CTS patients were seen from October of 2014 to February of 2021. Obese and nonobese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), and six-item Carpal Tunnel Symptom Score (CTS-6) measures were obtained. Nerve conduction studies recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used Wilcoxon signed rank testing for paired continuous variables, Mann-Whitney U testing for nonpaired continuous variables, and chi-square testing for continuous variables, with a significance level of P < 0.05. A total of 109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score ( P < 0.0001), CTS-6 score ( P < 0.0001), DML ( P < 0.0001), and DSL ( P < 0.01). Bilateral patients also had higher symptom severity scale ( P < 0.01) and DSL ( P < 0.001) outcomes compared with unilateral patients. Obese patients had higher median nerve CSA ( P < 0.01), prolonged DML, and prolonged DSL ( P < 0.0001) values despite similar CTS severity (BCTSQ and CTS-6). Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS and BCTSQ). Obesity increases median nerve CSA and prolongs nerve conduction studies without influencing CTS severity. This information can be used when considering which diagnostic test to order for CTS.

Potential Relationships between the Median Nerve Cross-Sectional Area and Physical Characteristics in Unilateral Symptomatic Carpal Tunnel Syndrome Patients

The present study investigated the relationships between the median nerve cross-sectional area (CSA) and physical characteristics in patients with unilateral symptomatic carpal tunnel syndrome (CTS). Height, weight, body mass index (BMI), disease duration, results of electrodiagnostic testing (EDX), and median nerve CSA at the level of the wrist crease were recorded in 81 patients with CTS who presented with symptoms on only one side. Correlation coefficients between median nerve CSA and physical characteristics, disease duration, and results of EDX were analyzed. Median nerve CSA at the wrist crease (mm2) was significantly larger on the symptomatic side (14.1 ± 3.8) than on the asymptomatic side (11.5 ± 2.9). Median nerve CSA correlated with body weight (correlation coefficient = 0.39) and BMI (correlation coefficient = 0.44) on the asymptomatic side, but not on the symptomatic side. These correlations were slightly stronger in females (correlation coefficient = 0.46) than in males (correlation coefficient = 0.40). No correlations between median nerve CSA and disease duration and the results of EDX were observed in both sides. In patients with unilateral symptomatic CTS, median nerve CSA correlated with BMI only on the asymptomatic side. The present results suggest that the relationship between median nerve CSA and BMI in CTS is significant until symptom onset but may be masked by edema and pseudoneuroma after its onset. A higher BMI is associated with a larger CSA of the median nerve, which may be a risk factor for the development of CTS.

Infrared thermographic changes after decompression surgery in patients with carpal tunnel syndrome

BackgroundDigital infrared thermal imaging (DITI), which detects infrared rays emitted from body surface to create a body heat map, has been utilized at various musculocutaneous conditions. Notably, DITI can demonstrate autonomic vasomotor activity in the nerve-innervated area, and thus may be of use in carpal tunnel syndrome (CTS). In this study, we compared DITI findings before and after carpal tunnel release (CTR) surgery in patients with unilateral CTS to investigate the corresponding neurophysiological changes.MethodsIn this retrospective cohort study, DITI parameters such as the temperature differences between the median and ulnar nerve territories and median nerve-innervated digital anisometry were measured. Subjective symptom duration, pain scale, and ultrasonographic findings were also compared before and after CTR. Patients were evaluated before and 6 weeks after CTR, respectively.ResultsA total of 27 patients aged 59.0 ± 11.2 years were finally included. After CTR, median nerve-innervated thermal anisometry was improved (2.55 ± 0.96 °C to 1.64 ± 1.34 °C; p = 0.003). The temperature differences between the median and ulnar nerve territories were not significantly changed. Subjective pain, the Simovic Weinberg Clinical Scale, and palmar bowing of the flexor retinaculum were also significantly improved (p < 0.001 for all comparisons).ConclusionsOur results demonstrated that DITI findings could reflect an improvement in autonomic function after CTR. Therefore, DITI can be an objective method to assess pre- and post-operative neurophysiologic changes in CTS.

Clinical Relevance of Ultrasonographic and Electrophysiological Findings of the Median Nerve in Unilateral Carpal Tunnel Syndrome Patients.

Few studies have compared the unaffected and affected sides in the same carpal tunnel syndrome (CTS) patients using ultrasonography and electrophysiological tests. We focused on unilateral idiopathic CTS patients to investigate whether clinical test results differ between the unaffected and affected sides. The bilateral wrist joints of 61 unilateral idiopathic CTS patients were evaluated. The median nerve cross-sectional area of ultrasound image, and latencies of the compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) were measured. The values obtained were compared between the affected and unaffected sides. The diagnostic accuracies of each parameter were assessed, and cut-off values were defined. Significant differences were observed in all parameters between the affected and unaffected sides (p &lt; 0.01). Area under the curve (AUC) values were 0.74, 0.88, and 0.73 for the cross-sectional area, CMAP distal latency, and SNAP distal latency, respectively. Cut-off values were 11.9 mm2, 5.1 ms, and 3.1 ms for the cross-sectional area, CMAP distal latency, and SNAP distal latency, respectively. The most reliable parameter that reflected clinical symptoms was the distal latency of CMAP. Cut-off values for each parameter are considered to be an index for the onset of the clinical symptoms of CTS.

ARE JOINT POSITION SENSE, TWO-POINT DISCRIMINATION, FINE MOTOR CONTROL, GRIP STRENGTH, LIGHT TOUCH SENSATION, PAIN, AND FUNCTIONALITY AFFECTED BILATERALLY IN UNILATERAL CARPAL TUNNEL SYNDROME?

Objective: This study aimed to evaluate joint position sense, two-point discrimination, fine motor control, grip strength, light touch sensation, pain, and functionality in patients with unilateral carpal tunnel syndrome and to determine whether these variables change in the unaffected hands of patients with unilateral carpal tunnel syndrome. Materials and Methods: The study was planned as a single-blind, cross-sectional case-control study. Individuals between the ages of 20-65 who were diagnosed with carpal tunnel syndrome (n=22) and healthy (n=22) were included. The device was designed for the study of measurements; discriminator; 9-hole peg test, dynamometer, and pinch meter, Semmens Weinstein monofilament test; The visual analog scale was evaluated bilaterally with the Boston questionnaire. Results: There was a significant difference between all measurements in the affected and unaffected hands between the CTS group and the control group (p&lt;0.05). There was no significant difference between the joint position sense, two-point discrimination, fine motor control, grip strength, light touch sense, and functionality between the affected and unaffected hand in the CTS group (p&gt;0.05). Conclusion: This is the first study evaluating joint position sense in the wrist, metacarpophalangeal joints, and interphalangeal joints in unilateral CTS syndrome. It was noteworthy that patients&nbsp;with unilateral carpal tunnel syndrome had deficiencies in joint position sense, fine motor control, two-point discrimination, light touch sense, and grip strength compared to the healthy control group, as well as deficiencies in the unaffected sides.

Significance of Early Diagnostic of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. The conservative treatment remains the first therapeutic choice in the treatment of mild and moderate CTS. The aim of this paper was to examine the average age of female patients with CTS diagnosed by EMNG, the frequency of bilateral CTS and its correlation with the age, and to determine the grade of electrophysiological damage of the nerve when the CTS diagnosis is confirmed for the first time. The retrospective examination included 187 female patients, aged from 27 to 79, with complains on unilateral CTS. All patients underwent EMNG for confirmation of CTS and the degree of damage to median nerve. Statistical analysis was performed by methods of descriptive statistics, Kruskal-Wallis test, and the Student t-test. The value of p 0.05 was considered statistically significant. The average age of the female examinees was 54.53 years. The bilateral CTS was confirmed in 67.9 %, most often of a moderate degree and more often on the right hand. No statistically significant difference was found in grades of CTS between the analysed age groups of patients that had the bilateral CTS (p = 0.206), nor there was a difference in years of life between the patients with unilateral and bilateral CTS (p = 0.638). Bilaterality of CTS, as well as the degree of the damage are not connected with age. The patients report timely for the first examination and diagnostics of CTS when there is still a possibility of the conservative treatment.

Is the left/right judgment task performance altered in unilateral carpal tunnel syndrome: And associated with symptom severity?

BackgroundLeft/right judgment task performance (LRJT) is impaired in severe neuropathic pain conditions. However, comparison of LRJT performance in patients with carpal tunnel syndrome (CTS) with a control group with similar cognitive functions has not been investigated. ObjectiveThe aim of the study was to compare the LRJT performance of CTS patients with healthy controls and the unaffected side. MethodsSeventy-five CTS patients with dominant, right-hand involvement and 75 control subjects were included in the study. The Recognize® tablet application was used for LRJT performance. Tactile acuity (Two-point discrimination) and handgrip strength; pain severity (Visual Analog Scale) and neuropathic component of pain (Pain Detect Questionnaire); symptom severity and functional impact of CTS (Boston CTS Assessment Test) were evaluated. Mixed-design ANOVAs and correlation analyses were used for data analysis. DesignCross-sectional study. ResultsAnalysis of variance showed that there was no significant effect of side (affected versus unaffected) or group (CTS versus control group) on recognition accuracy or time. Significant group*site interactions were found for the two-point discrimination F (1,148) = 6.388, p = 0.013; and for handgrip strength F (1,148) = 17.552, p < 0.01. A statistically significant negative correlation was found between recognition accuracy and symptom duration and a significant positive correlation was found between recognition accuracy and handgrip strength in CTS patients (r = −0.267, p = 0.020; r = 0.290, p = 0.012). ConclusionCTS patients recognize the affected side as accurately and quickly as the unaffected side and control group. Further research is needed to clarify the relationship between LRJT performance in the severely affected CTS group. ClinicalTrials.gov registration numberNCT04967144 ClinicalTrials.gov registration date19 July 2021

Extra-Cardiac Manifestations In Patients With Valine 122 Isoleucine Hereditary Transthyretin Cardiac Amyloidosis Undergoing Orthotopic Heart Transplant

Introduction : Hereditary transthyretin cardiac amyloidosis (hATTR CA) is a systemic disease associated with a rapidly progressive cardiomyopathy as well as extra-cardiac manifestations including polyneuropathy, spinal stenosis, and carpal tunnel syndrome. The Valine 122 Isoleucine (V122I) mutation is the most prevalent hereditary variant in the United States, affecting 3.4% of Black Americans. Orthotopic heart transplant (OHT) has been performed on V122I patients with end-stage cardiomyopathy; however, this therapy does not address extra-cardiac manifestations. New transthyretin (TTR) targeted therapies (Tafamidis, Patisiran) are now FDA approved in hATTR CA and hATTR polyneuropathy respectively, but their role in post-transplant management is unclear. Methods : We conducted a retrospective chart review of patients enrolled in Emory University's Cardiac Amyloidosis Clinic who underwent OHT between January 2014 and April 2021. Extra-cardiac manifestations were recorded at hATTR CA diagnosis and followed post-OHT. Results : Ten patients with V122I hATTR CA underwent OHT. All patients were Black males, with an average age of 63 ± 4 years. Mean ejection fraction was 21 ± 8% and mean left ventricular mass index was 200 ± 85 g/m2 at time of transplant. Survival to date is 80% with a median follow-up time of 4.1 years (3.6 - 6.4). Pre-OHT, seven (70%) patients had extra-cardiac manifestations. All seven had carpal tunnel syndrome (CTS) - five with unilateral and two with bilateral involvement. Three patients (30%) had additional extra-cardiac manifestations; including polyneuropathy, spinal stenosis, and/or gastroparesis. Post-OHT, one patient with bilateral CTS developed severe gastroparesis necessitating gastric tube placement and peroral endoscopic myotomy, as well as worsening polyneuropathy with autonomic dysfunction. Another patient with unilateral CTS and polyneuropathy pre-OHT developed spinal stenosis necessitating laminectomy as well as worsening polyneuropathy. Patisiran was initiated in both of these patients after worsening neuropathy was documented. Finally, a third patient progressed from unilateral to bilateral CTS necessitating bilateral release. Conclusions : OHT outcomes in patients with V122I hATTR CA are overall favorable in terms of cardiac function and survival. However, progression and/or development of extra-cardiac manifestations can significantly affect quality of life post-OHT. Annual neurologic and orthopedic evaluations should be incorporated into routine post-transplant care. Despite the advent of safe and effective TTR targeted therapies, these medications do not currently carry an indication for prophylactic use post-OHT. More data is needed to develop clinical best practices, including guidelines for use of targeted TTR therapies, in V122I patients undergoing OHT. : Hereditary transthyretin cardiac amyloidosis (hATTR CA) is a systemic disease associated with a rapidly progressive cardiomyopathy as well as extra-cardiac manifestations including polyneuropathy, spinal stenosis, and carpal tunnel syndrome. The Valine 122 Isoleucine (V122I) mutation is the most prevalent hereditary variant in the United States, affecting 3.4% of Black Americans. Orthotopic heart transplant (OHT) has been performed on V122I patients with end-stage cardiomyopathy; however, this therapy does not address extra-cardiac manifestations. New transthyretin (TTR) targeted therapies (Tafamidis, Patisiran) are now FDA approved in hATTR CA and hATTR polyneuropathy respectively, but their role in post-transplant management is unclear. : We conducted a retrospective chart review of patients enrolled in Emory University's Cardiac Amyloidosis Clinic who underwent OHT between January 2014 and April 2021. Extra-cardiac manifestations were recorded at hATTR CA diagnosis and followed post-OHT. : Ten patients with V122I hATTR CA underwent OHT. All patients were Black males, with an average age of 63 ± 4 years. Mean ejection fraction was 21 ± 8% and mean left ventricular mass index was 200 ± 85 g/m2 at time of transplant. Survival to date is 80% with a median follow-up time of 4.1 years (3.6 - 6.4). Pre-OHT, seven (70%) patients had extra-cardiac manifestations. All seven had carpal tunnel syndrome (CTS) - five with unilateral and two with bilateral involvement. Three patients (30%) had additional extra-cardiac manifestations; including polyneuropathy, spinal stenosis, and/or gastroparesis. Post-OHT, one patient with bilateral CTS developed severe gastroparesis necessitating gastric tube placement and peroral endoscopic myotomy, as well as worsening polyneuropathy with autonomic dysfunction. Another patient with unilateral CTS and polyneuropathy pre-OHT developed spinal stenosis necessitating laminectomy as well as worsening polyneuropathy. Patisiran was initiated in both of these patients after worsening neuropathy was documented. Finally, a third patient progressed from unilateral to bilateral CTS necessitating bilateral release. : OHT outcomes in patients with V122I hATTR CA are overall favorable in terms of cardiac function and survival. However, progression and/or development of extra-cardiac manifestations can significantly affect quality of life post-OHT. Annual neurologic and orthopedic evaluations should be incorporated into routine post-transplant care. Despite the advent of safe and effective TTR targeted therapies, these medications do not currently carry an indication for prophylactic use post-OHT. More data is needed to develop clinical best practices, including guidelines for use of targeted TTR therapies, in V122I patients undergoing OHT.

Neurofibroma of the Median Nerve Managed With Ultrasound Guided Nerve Block: A Case Report

Background: Median nerve neurofibroma can mimic carpal tunnel syndrome. In unilateral carpal tunnel syndrome, wrist imaging is suggested to exclude tumors. Diagnosis and management of peripheral nerve sheath tumors can be challenging.&#x0D; Case: This is a case report of 42-year-old female with median nerve neurofibroma who presented with excruciating pain as the main symptom. Though surgical excision is the preferred treatment, it is associated with the risk of functional deficit. In this case, patient was unwilling for surgery. This report highlights the evaluation of neurofibroma and the role of median nerve block in the symptomatic as well as functional improvement.&#x0D; Conclusion: Nerve block can be effective if neurofibroma presents with pain as the main symptom without any impairment of motor function or daily activities.

Signs Indicative of Central Sensitization Are Present but Not Associated with the Central Sensitization Inventory in Patients with Focal Nerve Injury.

Objective: Carpal tunnel syndrome (CTS) is the most common focal nerve injury. People with CTS may show alterations in central processing of nociceptive information. It remains unclear whether the central sensitization inventory (CSI) is capable of detecting such altered central pain processing. Methods: Thirty healthy volunteers were matched with 30 people with unilateral CTS from the orthopaedic waitlist. Changes to central pain processing were established through psychophysical sensory testing (bilateral pressure pain thresholds (PPT), conditioned pain modulation, temporal summation) and pain distribution on body charts. Patients also completed pain severity and function questionnaires, psychological questionnaires and the CSI. Results: Compared to healthy volunteers, patients with CTS have lower PPTs over the carpal tunnel bilaterally (t = −4.06, p < 0.0001 ipsilateral and t = −4.58, p < 0.0001 contralateral) and reduced conditioned pain modulation efficacy (t = −7.31, p <0.0001) but no differences in temporal summation (t = 0.52, p = 0.60). The CSI was not associated with psychophysical measures or pain distributions indicative of altered central pain processing. However, there was a correlation of the CSI with the Beck Depression Inventory (r = 0.426; p = 0.019). Conclusion: Patients with CTS show signs of altered central pain mechanisms. The CSI seems unsuitable to detect changes in central pain processing but is rather associated with psychological factors in people with focal nerve injuries.

Same same, but different? The neurological presentation of wildtype transthyretin (ATTRwt) amyloidosis

Background Both hereditary transthyretin (ATTRv) amyloidosis and wildtype transthyretin (ATTRwt) amyloidosis can be associated with neurological diseases such as carpal tunnel syndrome and polyneuropathy. While ATTRv amyloidosis has been extensively studied, to date little is known about neurological complications of ATTRwt amyloidosis. In particular, the prevalence, pattern and extent of polyneuropathy and autonomic dysfunction has not been adequately investigated in the context of ATTRwt amyloidosis. To tackle this issue, we aimed to characterise the neurological presentation of ATTRwt amyloidosis and to compare between the presentations of ATTRv and ATTRwt amyloidoses. Patients and methods Between November 2019 and September 2020, we included 50 patients with ATTRwt amyloidosis in this cohort study. All patients presented to the amyloidosis centre in Berlin, Germany and underwent neurological, cardiological and radiological work-up including neurological examination, laboratory testing, nerve conduction studies (NCS), echocardiography and scintigraphy. Patients were screened for symptoms of autonomic dysregulation and a subgroup of patients underwent tilt-table testing for orthostatic dysregulation. Results The cohort included 46 men and 4 women; the mean age of the study participants was 80.6 (standard deviation [SD] ± 5.0) years. All patients showed signs of cardiomyopathy on echocardiography. Neurological examination revealed peripheral, symmetric and length-depended predominately sensory polyneuropathy in 74% (n = 37) of patients. Neuropathy impairment scores (NIS) ranged from 0 to 50 with an average score of 8.4 (SD ± 10.1) indicating mild to moderate impairment. 90% and 92% of patients were classified as FAP stage I and PND stage I, respectively. Unilateral or bilateral carpal tunnel syndrome (CTS) was present in 70% (n = 35) and spinal stenosis was seen in 11% (n = 5) of patients. We detected a low rate of autonomic symptoms with a median COMPASS-31 total score of 18.4 points (IQR 32.4 points). Additional tilt-table testing of a subgroup of 8 patients yielded negative results for orthostatic intolerance. Conclusion Distal-symmetric, predominantly sensory polyneuropathy is a common neurological complication in ATTRwt amyloidosis besides carpal tunnel syndrome and spinal stenosis, further substantiating the systemic character of the disease. Compared to ATTRv amyloidosis, the severity of polyneuropathy in ATTRwt amyloidosis is milder and without relevant motor involvement. Symptoms of autonomic dysfunction were not common in this cohort. Nevertheless, ATTRwt amyloidosis is a treatable disease and should be included in the differential diagnosis of sensory polyneuropathy in the elderly.

Clinical and Electrophysiological Profile of Carpal Tunnel Syndrome: A Study in a Tertiary Care Hospital

Introduction: Carpal tunnel syndrome (CTS) is a clinical syndrome that results from compression of median nerve within the carpal tunnel at the wrist. The aim of this study was to review the clinical and demographic characteristics and electrophysiological patterns of CTS patients who presented to a tertiary care hospital in Bangladesh.&#x0D; Methodology; A descriptive cross-sectional study was conducted on 150 CTS patients at the neurology department, Dhaka Medical College Hospital between January, 2019 to March , 2020 . All the subjects had clinical evaluation and standardized nerve conduction studies of upper limbs (300 limbs) using the same protocol.&#x0D; Results: 228 hands were found to have clinical and electrophysiological features consistent with CTS. There was female predominance (90%) and the highest occurrence of CTS was in the 45-55 years age group. Bilateral CTS was found in the majority of cases ie 78 (52%) and the rest had unilateral CTS. Among those with unilateral CTS, right hand was affected more (41, 57%) than left hand (31, 43%). Most of the cases were idiopathic. Neurophysiological studies showed most patients had mild CTS (121 hands, 53%). Most of the cases were idiopathic (102, 68%). Where a risk factor was found diabetes was commonest one (32) followed by hypothyroidism (12) and pregnancy (4).&#x0D; Conclusion: There was marked female predominance and the 45-55 years age group was predominantly affected. Majority of cases had mild CTS. Bilateral involvement was more common. Right hand was more affected than the left hand.&#x0D; J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 96-99

Hereditary Transthyretin Amyloidosis- Clinical and Genetic Characteristics of a Multiracial South-East Asian Cohort in Singapore.

Studies of hereditary transthyretin amyloidosis (ATTRv amyloidosis) in South-East Asia are underrepresented in the literature. We report the unique phenotypic and genetic characteristics of this disorder in a multiracial South-East Asian cohort. Patients with genetically proven ATTRv amyloidosis were identified over a 13-year period (2007-2020) at the National Neuroscience Institute, Singapore. Clinical, laboratory, genotypic and electrophysiological features were retrospectively reviewed. 29 patients comprising Chinese, Malay, Burmese, Vietnamese and Indonesians with ATTRv amyloidosis were identified. Somatic neuropathy was the most common initial presentation, followed by carpal tunnel syndrome, autonomic dysfunction and cardiac dysfunction. ATTR-A97S (p.Ala117Ser) was the most common variant found in 14 patients, constituting 66.7%of ethnic Chinese patients and 48.3%of the entire cohort. Five patients had early-onset disease (age < 50 years) with the following variants: ATTR-V30M (p.Val50Met), ATTR-G47A (p.Gly67Ala), ATTR-S50I (p.Ser70Ile) and ATTR-A97S (p.Ala117Ser); one patient with ATTR-A97S (p.Ala117Ser) had isolated unilateral carpal tunnel syndrome with amyloid deposits identified on histological examination of the transverse carpal ligament. All early-onset patients had a positive parental history; two patients, with ATTR-S50I (p.Ser70Ile) and ATTR-Ala97Ser (p.Ala117Ser) respectively, demonstrated anticipation with mother-to-daughter inheritance. Amongst the 24 patients with late-onset disease (age≥50 years), two patients had novel variants, ATTR-G66D (p.Glu86Asp) and ATTR-A81V (p.Ala101Val) that were confirmed to be pathogenic based on the histological identification of transthyretin amyloid. Other identified variants included ATTR-V30M (p.Val50Met), ATTR-R34T (p.Arg54Thr), ATTR-S50I (p.Ser70Ile), ATTR-H88R (p.His108Arg) and ATTR-A97S (p.Ala117Ser). Our study further expands the genotypic and phenotypic knowledge regarding ATTRv amyloidosis.

Effect of extracorporeal shock wave therapy on different severities of carpal tunnel syndrome

BackgroundCarpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome worldwide.ObjectiveThe current work aimed at determining the effect of extracorporeal shock wave therapy (ESWT) on different severities of carpal tunnel syndrome.Subjects and methodsSixty patients with unilateral carpal tunnel syndrome were participated in this study. They were divided into three equal groups according to severity (mild, moderate, and severe). All patients received shock wave therapy one session per week, for 6 weeks. Nerve conduction studies (NCs) were done for the median nerve. Pinch dynamometer was used to measure the degree of lateral pinch power, and Visual Analogue Scale (VAS) was used to assess degree of pain and Ultrasonography analysis measured cross-sectional area (CSA) of median nerve for all patients at the beginning and at the end of the study.ResultsThere was significant improvement (P < 0.05) in sensory conduction parameters, CSA, lateral pinch power, and VAS after shock wave therapy in all groups. Also, there was significant improvement in motor latency, motor, and sensory amplitudes after shock wave therapy in mild and moderate groups only (P < 0.05). In all group samples, results revealed a highly significant correlations (p < 0.001) between peak sensory latency (PSL) with VAS, CSA with motor latency (ML), CSA with PSL, CSA with VAS, CSA with lateral pinch, and ML with lateral pinch.ConclusionIt is recommended to use ESWT as a conservative treatment in patients with different severities of CTS, except patients with severe motor affection.Trial registrationPACTR201804003293116. Registered on 26 April 2018 as retrospective registration in the pan African clinical trial registry (www.pactr.org).