MedWorm: Carpal Tunnel Syndrome

Guide: Carpal Tunnel Syndrome

About.com Eating Disorders — Mon, 06 Feb 2012 05:00:00 +0100

Physicians use specific tests to try to produce the symptoms of carpal tunnel syndrome. (Source: About.com Eating Disorders)

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Epidemiology, Clinical Manifestations, and Long-Term Outcomes of a Major Outbreak of Chikungunya in a Hamlet in Sri Lanka, in 2007: A Longitudinal Cohort Study

Clinical and Developmental Immunology — Thu, 02 Feb 2012 11:21:45 +0100

Chikungunya outbreaks occurred in the central province, Sri Lanka in 2006. This community-based study reports the epidemiology and the natural history of the infection from an affected village. Of the 199 families and 1001 individuals in the village, 159 (80%) and 513 (51%) were affected, respectively, comprising 237 (46%) males with peak incidence at 40–50 years. The acute illness caused polyarthritis in 233 (46%), and of them 230 (98%) progressed to chronic arthritic disability (CAD). Of the CAD patients, 102 (44%) had recovered in 141 days (range 30–210 days) from the disability state whilst 128 (56%) had persisting disability which lasted 12, 24, and 36 months in 41 (17.8%), 22 (9.5%), and 14 (6.1%) individuals, respectively. Carpal ...

Impact of carpal tunnel syndrome on the expectant woman's life

Asia Pacific Family Medicine — Mon, 30 Jan 2012 05:00:00 +0100

Conclusion: This study shows that even though CTS in third trimester pregnancy is prevalent, generally it would be mild. However, function can still be affected especially if patients complain of pain. (Source: Asia Pacific Family Medicine)

Drug 'increases risk' of carpel tunnel syndrome for cancer patients

Nursing Times Breaking News — Sun, 29 Jan 2012 00:00:00 +0100

Risk of carpal tunnel syndrome is higher in breast cancer patients given the drug exemestane than in those treated with tamoxifen, according to an international study in the Lancet Oncology. (Source: Nursing Times Breaking News)

Objective Structured Assessment of Technical Skill in Upper Extremity Surgery

The Journal of Hand Surgery — Fri, 27 Jan 2012 11:25:00 +0100

Conclusions: This study reports that a surgeon's ability to release a trigger finger does not correlate specifically to his or her ability to perform a carpal tunnel release or to perform plate fixation of a radius fracture. The results of this study would indicate that, for 3 different surgical simulations representing procedures of varying complexity, assessments by a single assessment tool is not adequate. To completely understand a resident's abilities, assessment by checklist (understanding the steps of the surgery), global rating scales (assessment of basic surgical skills in light of lesser or greater complexity surgeries), and pass/fail assessment (examination of adverse events) are all necessary components. Type of study/level of evidence: Therapeutic II. (Source: The Journal o...

Therapeutic ultrasound for carpal tunnel syndrome.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: There is only poor quality evidence from very limited data to suggest that therapeutic ultrasound may be more effective than placebo for either short- or long-term symptom improvement in people with CTS. There is insufficient evidence to support the greater benefit of one type of therapeutic ultrasound regimen over another or to support the use of therapeutic ultrasound as a treatment with greater efficacy compared to other non-surgical interventions for CTS, such as splinting, exercises, and oral drugs. More methodologically rigorous studies are needed to determine the effectiveness and safety of this intervention for CTS. PMID: 22259004 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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Ergonomic positioning or equipment for treating carpal tunnel syndrome.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: There is insufficient evidence from randomised controlled trials to determine whether ergonomic positioning or equipment is beneficial or harmful for treating carpal tunnel syndrome. PMID: 22259003 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Morphologic Characterization of Intraneural Flow Associated With Median Nerve Pathology

Journal of Diagnostic Medical Sonography — Wed, 25 Jan 2012 05:00:00 +0100

A prospective cohort of 47 symptomatic patients who reported for nerve conduction studies and 44 asymptomatic controls was examined with sonography to evaluate the median nerve. Doppler studies of the median nerve were collected with handheld sonography equipment and a 12-MHz linear broadband transducer. Strict inclusion criteria were established for assessing 435 waveforms from 166 wrists. Two sonographers agreed that 245 waveforms met the a priori criteria and analyzed the corresponding data. Spectral Doppler waveforms provided direct quantitative and qualitative data for comparison with indirect provocative testing results. These Doppler data were compared between the recruitment groups. No statistical difference existed in waveforms between the groups (P < .05). Trending of the over...

Unusual formation of the median nerve associated with the third head of biceps brachii

Clinical Anatomy — Mon, 23 Jan 2012 05:00:00 +0100

AbstractUnilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30‐year‐old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side, the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with m...

Carpal tunnel syndrome and musculoskeletal symptoms after exemestane or tamoxifen following 2 to 3 years of tamoxifen: retrospective analysis of Intergroup Exemestane Study

NeLM - News — Fri, 20 Jan 2012 05:00:00 +0100

Source: Lancet Oncology Area: News Aromatase inhibitors are more effective than tamoxifen in preventing breast-cancer recurrence, but are associated with increased musculoskeletal side-effects, such as carpal tunnel syndrome. Researchers conducted a retrospective analysis of the Intergroup Exemestane Study to assess risk factors and the prognostic value of musculoskeletal symptoms during treatment with exemestane or with tamoxifen after 2 to 3 years of tamoxifen in postmenopausal women with early invasive breast cancer. The primary endpoint for of the retrospective analysis was occurrence of carpal tunnel syndrome and any musculoskeletal events, analysed in the safety population, which consisted of all patients who had received any trial treatment. As well as case-report forms,...

Carpal tunnel syndrome and its relationship to occupation: a meta-analysis

Rheumatology — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion. Occupational exposure to excess vibration, increased hand force and repetition increase the risk of developing CTS. Workplace strategies to avoid overexposure to these risk factors should be implemented. (Source: Rheumatology)

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Corticosteroid injection for carpal tunnel syndrome: a 5-year survivorship analysis

Hand — Thu, 19 Jan 2012 07:00:06 +0100

Conclusions Steroid injection is an appropriate treatment in carefully selected patients. Those who are female, diabetic and have neurophysiological confirmation of diagnosis have the highest risk of relapse. These results may be used to guide initial treatment and counsel patients about the risk relapse. Content Type Journal ArticleCategory Surgery ArticlesPages 1-6DOI 10.1007/s11552-012-9390-8Authors Paul J. Jenkins, Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU, UKAndrew D. Duckworth, Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU, UKAdam C. Watts, Department of Orthopaedic Surgery, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife KY12 0SU...

Surgical options for recalcitrant carpal tunnel syndrome with perineural fibrosis

Hand — Thu, 19 Jan 2012 07:00:05 +0100

Abstract Surgical release of the transverse carpal ligament for the treatment of carpal tunnel syndrome (CTS) is, in general, a very successful procedure. Some patients, however, fail this standard release and have persistent or recurrent symptoms. Such recalcitrance may relate to incomplete release but more often relates to perineural or intraneural fibrosis of the median nerve. While there is no good treatment for intraneural fibrosis, numerous procedures have evolved in an attempt to treat perineural fibrosis which restricts nerve gliding. These include procedures to isolate the nerve from scar as well as procedures to bring neovascularization to the median nerve. This review describes the various surgical treatment options for recalcitrant CTS as well as their reported ...

Correlation Between the Severity of Carpal Tunnel Syndrome and Color Doppler Sonography Findings

American Journal of Roentgenology — Thu, 19 Jan 2012 05:00:00 +0100

CONCLUSION. Our study suggests that the severity of CTS strongly correlates with color Doppler sonography findings, and this technique may represent a reliable complementary tool in CTS examination. (Source: American Journal of Roentgenology)

Median nerve neuropathy in the forearm due to recurrence of anterior wrist ganglion that originates from the scaphotrapezial joint: a case report

Journal of Brachial Plexus and Peripheral Nerve Injury — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions: A typical median nerve compression was caused by incomplete resection of an anterior wrist ganglion, which may have induced widening of the cyst. Cases with anterior wrist ganglion have high recurrence rates and require extra attention in their treatment. (Source: Journal of Brachial Plexus and Peripheral Nerve Injury)

Tactile roughness discrimination of the finger pad relies primarily on vibration sensitive afferents not necessarily located in the hand.

Behavioural Brain Research — Tue, 17 Jan 2012 05:00:00 +0100

This study aims to investigate the relative contribution of remote mechanoreceptors to perception of roughness and spatial acuity. We examined two unilateral pathological conditions affecting differently innervation of the index finger: unilateral carpal tunnel syndrome (n=12) and surgically repaired complete traumatic median nerve section at the wrist following surgical repair (n=4). We employed a control condition consisting of ring-block anesthesia of the entire index in 10 healthy subjects to model pathological denervation of the fingertip. Spatial acuity and the ability to discern roughness were assessed using a grating orientation task and a roughness discrimination task, respectively. In patients with carpal tunnel syndrome, we observed a significant reduction of spatial resolution ...

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Carpal tunnel syndrome: Clinical, electrophysiological, and ultrasonographic ratio after surgery

Muscle and Nerve — Sun, 15 Jan 2012 03:11:44 +0100

Conclusions: Symptoms improved more rapidly than function after surgery. Measurement of the ultrasonographic CSA ratio may provide clinicians with a useful assessment tool after surgery. Muscle Nerve, 2012 (Source: Muscle and Nerve)

Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms

Journal of Orthopaedic Research — Mon, 09 Jan 2012 05:00:00 +0100

AbstractSplinting and nerve and tendon gliding exercises are commonly used to treat carpal tunnel syndrome (CTS). It has been postulated that both modalities reduce intraneural edema. To test this hypothesis, 20 patients with mild to moderate CTS were randomly allocated to either night splinting or a home program of nerve and tendon gliding exercises. Magnetic resonance images of the wrist were taken at baseline, immediately after 10 min of splinting or exercise, and following 1 week of intervention. Primary outcome measures were signal intensity of the median nerve at the wrist as a measure of intraneural edema and palmar bowing of the carpal ligament. Secondary outcome measures were changes in symptom severity and function. Following 1 week of intervention, but not immediately after 10...

High-impact articles in hand surgery

Hand — Fri, 06 Jan 2012 16:44:42 +0100

Conclusions The top 50 highly cited articles in hand surgery reflect the most common clinical, scientific, and educational efforts of the field. Content Type Journal ArticleCategory Surgery ArticlesPages 1-6DOI 10.1007/s11552-011-9388-7Authors Kyle R. Eberlin, Department of Plastic and Oral Surgery, Children’s Hospital of Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USABrian I. Labow, Department of Plastic and Oral Surgery, Children’s Hospital of Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USAJoseph Upton, Department of Plastic and Oral Surgery, Children’s Hospital of Boston, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USAAmir H. Taghinia, Department of Plastic and Oral Surgery, Children’s Hosp...

The Nerve/Tunnel Index: A New Diagnostic Standard for Carpal Tunnel Syndrome Using Sonography: A Pilot Study

Journal of Ultrasound in Medicine — Tue, 03 Jan 2012 05:00:00 +0100

Conclusions— The nerve/tunnel index is unaffected by body indices or sex and thus may be a useful and objective standard for diagnosing carpal tunnel syndrome. (Source: Journal of Ultrasound in Medicine)

Sonographic Measurements of Subsynovial Connective Tissue Thickness in Patients With Carpal Tunnel Syndrome

Journal of Ultrasound in Medicine — Tue, 03 Jan 2012 05:00:00 +0100

Conclusions— With this study, we have shown that it is possible to measure subsynovial connective tissue thickness with sonography, and the tissue is thicker in patients with carpal tunnel syndrome than in healthy controls. (Source: Journal of Ultrasound in Medicine)

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Carpal Tunnel Syndrome, Low Back Pain, Chronic Fatigue Syndrome, Preventing Preeclampsia, Preventing Complex Regional Pain Syndrome

Explore — Sun, 01 Jan 2012 05:00:00 +0100

Level 2 (mid-level) evidence Reference: J Pain 2011;12:307 (Source: Explore)

Title: Hand‐held nerve conduction device in carpal tunnel syndrome – A prospective study

Muscle and Nerve — Sun, 01 Jan 2012 05:00:00 +0100

Discussion:The Mediracer should only be used in patients with typical CTS symptoms and signs and no muscle wasting who have had careful neurological assessment. © 2012 Wiley‐Liss, Inc. (Source: Muscle and Nerve)

A blinded placebo-controlled randomized trial on the use of astaxanthin as an adjunct to splinting in the treatment of carpal tunnel syndrome

Hand — Fri, 30 Dec 2011 07:11:11 +0100

Conclusion At present, the role for astaxanthin as an adjunct in conservative management of CTS has not been established. Content Type Journal ArticleCategory Therapy ArticlesPages 1-9DOI 10.1007/s11552-011-9381-1Authors Joy C. MacDermid, School of Rehabilitation Science, McMaster University, Hamilton, ON, CanadaJoshua I. Vincent, Health and Rehabilitation Sciences, University of Western Ontario, London, ON, CanadaBing S. Gan, Department of Surgery, University of Western Ontario, London, ON, CanadaRuby Grewal, Hand and Upper Limb Center, St. Joseph’s Health Center, Division of Orthopedics, University of Western Ontario, 268 Grosvenor Street, London, ON, Canada Journal HandOnline ISSN 1558-9455Print ISSN 1558-9447 (Source: Hand)

Immediate and long-term effects of selected physiotherapy methods in patients with carpal tunnel syndrome.

Ortopedia, Traumatologia, Rehabilitacja — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: Ultrasound therapy combined with massage and kinesiotherapy brings the expected, long-term effects in patients with carpal tunnel syndrome. PMID: 22248460 [PubMed - in process] (Source: Ortopedia, Traumatologia, Rehabilitacja)

Neurosurgery at Queen Square

Journal of Pakistan Medical Students — Thu, 29 Dec 2011 05:00:00 +0100

This article has been peer reviewed. Article Submitted on: 9th October 2011 Article Accepted on: 28th November 2011 Funding sources: None declared Correspondence to:Hamza Tariq Medical student Address:King Edward Medical University, Lahore, Pakistan. Email: hamxatariq@yahoo.com Download PDF Elective Report The day I finished studying the anatomy of brain, I knew that I wanted to pursue neurosurgery as a career speciality. A medical student getting fascinated by the mysterious workings of the human brain is not something unusual. Here, in a mere 3 pounds of living tissue, lies the complexity sufficient to incarnate and store the record of a lifetime of the richest human experience. Our brains contain the secrets of ourselves. Its mystery lies in the fact that it con...

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Commentary on “Duration of Postoperative Dressing After Mini-Open Carpal Tunnel Release: A Prospective, Randomized Trial”

The Journal of Hand Surgery — Thu, 29 Dec 2011 03:44:44 +0100

The authors have designed a prospective randomized trial to determine whether there is a benefit to maintaining a postoperative dressing for 2 weeks in an effort to decrease the perceived higher rate of wound complications and infections with early dressing removal. Anyone who has tried to design and execute a prospective randomized clinical trial understands the challenges that exist with this type of study, and the authors have demonstrated the ability to design a study and answer a clinical question. (Source: The Journal of Hand Surgery)

The Comparative Effectiveness of Combined Lumbrical Muscle Splints and Stretches on Symptoms and Function in Carpal Tunnel Syndrome

Archives of Physical Medicine and Rehabilitation — Thu, 29 Dec 2011 01:24:28 +0100

Conclusions: A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline. Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment. (Source: Archives of Physical Medicine and Rehabilitation)

QuickStats: Percentage of Employed Adults* Aged 18–64 Years with Current Asthma,† Skin Condition,§ or Carpal Tunnel Syndrome¶ Who Were Told Their Condition Was Work-Related,** by Sex — National Health Interview Survey, 2010††

CDC Morbidity and Mortality Weekly Report — Sat, 24 Dec 2011 04:36:28 +0100

(Source: CDC Morbidity and Mortality Weekly Report)

Carpal tunnel syndrome diagnosed by general practitioners: an observational study

Neurological Sciences — Fri, 23 Dec 2011 16:51:24 +0100

Abstract The aim of this study was to investigate the results of both clinical testing and standardised nerve conduction studies performed on patients with Carpal tunnel syndrome (CTS) complaints, who had been referred to the neurologist by their general practitioners. Analysis of the data of neurological examination and electrodiagnostic tests (EDX) were performed on patients that had been referred by general practitioners. A total of 232 patients with clinically defined CTS, who had been referred by general practitioners, were seen by a neurologist and subsequently underwent electrodiagnostic testing. The diagnosis of CTS made by general practitioners was clinically confirmed by the neurologist in 187 of 232 (81%) patients. In these 187 patients, EDX confirmed CTS clinica...

Predicting the Outcome of Revision Carpal Tunnel Release

The Journal of Hand Surgery — Thu, 22 Dec 2011 05:00:00 +0100

Conclusions: In a small group of patients with recurrent carpal tunnel syndrome, cortisone injection into the carpal tunnel was not, by itself, a statistically significant predictor of successful revision surgery. However, relief from injection as a diagnostic test for predicting successful revision CTR was found to have both a high sensitivity and a positive predictive value. Coupled with the components of the physical examination, injection provides a good screening test to establish surgical success with revision CTR. Type of study/level of evidence: Therapeutic III. (Source: The Journal of Hand Surgery)

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Ultrasonographic median nerve cross-section areas measured by 8-point "inching test" for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms

BMC Medical Imaging - Latest articles — Wed, 21 Dec 2011 05:00:00 +0100

Conclusions: Using the 8-point measurement of the median nerve CSA from inlet to outlet similar to the "inching test" has positive correlations with NCS severity and duration of CTS clinical symptoms, and can provide more information on anatomic changes. Combined NCS and US studies using the 8-point measurement may have a higher positive rate than NCS alone for diagnosing CTS. (Source: BMC Medical Imaging - Latest articles)

Neurosurgery at Queen Square

Journal of Pakistan Medical Students — Sat, 17 Dec 2011 05:00:00 +0100

Using item response theory improved responsiveness of patient-reported outcomes measures in carpal tunnel syndrome

Journal of Clinical Epidemiology — Fri, 16 Dec 2011 05:00:00 +0100

Conclusion: IRT-based scoring showed high responsiveness for the QuickDASH and CTS-6, and the ES were larger than those estimated using conventional scoring. (Source: Journal of Clinical Epidemiology)

QuickStats: Percentage of Employed Adults* Aged 18–64 Years Who Had Carpal Tunnel Syndrome† in the Past 12 Months, by Sex and Age Group — National Health Interview Survey, 2010§

CDC Morbidity and Mortality Weekly Report — Fri, 16 Dec 2011 00:19:32 +0100

(Source: CDC Morbidity and Mortality Weekly Report)

Bilateral carpal tunnel syndrome and multiple trigger fingers in a child with mucolipidosis Type III disease

Indian Journal of Plastic Surgery — Thu, 15 Dec 2011 05:00:00 +0100

This report presents a five-year-old girl with mucolipidosis Type III disease who had bilateral carpal tunnel syndrome and eight trigger fingers. Bilateral open carpal tunnel release was performed. The trigger fingers were treated with A1 and A3 pulleys release and the ulnar slips of the flexor digitorum superficialis tendons were removed. (Source: Indian Journal of Plastic Surgery)

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Carpal Tunnel Syndrome: Work and Individual Risk Factors Carpal Tunnel Syndrome: Work and Individual Risk Factors

Medscape Today Headlines — Mon, 12 Dec 2011 04:00:00 +0100

Could certain jobs more likely predispose someone to the development of carpal tunnel syndrome? Occupational and Environmental Medicine (Source: Medscape Today Headlines)

Prevalence of carpal tunnel syndrome among dairy workers

American Journal of Industrial Medicine — Wed, 07 Dec 2011 05:00:00 +0100

ConclusionsThe results of this study indicate that CTS is a significant challenge for dairy parlor workers. The prevalence of CTS was found to be significantly higher among dairy workers performing tasks in the milking parlor as opposed to workers performing tasks in other areas of the dairy farm. The results emphasize the need for administrative and engineering controls to limit the exposure to physical risk factors that are associated with upper limb disorders such as CTS. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc. (Source: American Journal of Industrial Medicine)

Determinants of Return to Work After Carpal Tunnel Release

The Journal of Hand Surgery — Mon, 05 Dec 2011 05:00:00 +0100

Conclusions: The most important determinant of return to full duty work after limited incision open carpal tunnel release is job type, but psychological factors such as patient expectations, catastrophic thinking, and anxiety in response to pain also have a role. Type of study/level of evidence: Prognostic II. (Source: The Journal of Hand Surgery)

Surface electromyography features in manual workers affected by carpal tunnel syndrome

Muscle and Nerve — Fri, 02 Dec 2011 05:00:00 +0100

Neuropathic pain in post‐burn hypertrophic scars: A psychophysical and neurophysiological study

Muscle and Nerve — Fri, 02 Dec 2011 05:00:00 +0100

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Black Friday Violence: Where It Comes From and What We Can Do about It

Psychology Today Anxiety Center — Thu, 01 Dec 2011 15:54:16 +0100

The violence that we saw last week gave new meaning to the term “Black Friday.” This madness and mayhem was not simply a product of the actions of a few misguided souls, but the reflection of a deeper problem that lives inside of all of us. Primary Topic: Happiness read more (Source: Psychology Today Anxiety Center)

Impact of Diabetes on Outcomes in Hand Surgery

The Journal of Hand Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Diabetes mellitus is associated with the development of several pathologic conditions of the hand, including carpal tunnel syndrome, Dupuytren disease, trigger digits, and limited joint mobility or cheiroarthropathy. In recent years, across a variety of surgical disciplines, increased emphasis has been placed on the impact of diabetes on treatment outcomes. This review provides an overview of the current literature regarding the effect of diabetes on outcomes of hand surgery for these common diabetes-related conditions. Taken as a whole, the best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondia...

Concurrent palmar lunate dislocation and posterior elbow dislocation: a case report.

Journal of Orthopaedic Surgery — Thu, 01 Dec 2011 05:00:00 +0100

We report a rare case of concurrent palmar lunate dislocation of the left wrist combined with a posterior dislocation of the left elbow joint in a 40-year-old man. He sustained both injuries after falling onto his outstretched left hand. The elbow was reduced by the closed method. The wrist was treated with open reduction with carpal tunnel decompression and fixation with a Kirschner wire through the volar approach. Both the scapholunate and radioscaphocapitate ligaments were also repaired. At month 3, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a porter. PMID: 22184173 [PubMed - in process] (Source: Journal of Orthopaedic Surgery)

Duration of Postoperative Dressing After Mini-Open Carpal Tunnel Release: A Prospective, Randomized Trial

The Journal of Hand Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Removal of a bulky dressing after mini-open CTR and replacement with an adhesive strip at 48 to 72 hours causes no wound complications and results in equal short-term clinical and subjective outcome measures compared with using a bulky dressing for 2 weeks. Type of study/level of evidence: Therapeutic I. (Source: The Journal of Hand Surgery)

Screening for Carpal Tunnel Syndrome Using Sonography

Journal of Ultrasound in Medicine — Mon, 28 Nov 2011 05:00:00 +0100

Conclusions— Measurement of swelling through a ratio or absolute change had similar diagnostic accuracy as individual measurement of the cross-sectional area within the carpal tunnel. These measures may be useful for improving accuracy in more diverse clinical populations. Further refinement of protocols to identify the largest cross-sectional area within the carpal tunnel region and statistical methods to analyze clustered, multilevel outcome data are recommended to improve diagnostics. (Source: Journal of Ultrasound in Medicine)

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Variable disease progression after successful stem cell transplantation: Prospective follow‐up investigations in eight patients with Hurler syndrome

Pediatric Transplantation — Sat, 26 Nov 2011 13:45:34 +0100

We report the results of a prospective, standardized follow‐up programme of eight children (median age at SCT 1.2 yr) with mucopolysaccharidosis (MPS1H, M. Hurler) transplanted using a fludarabine‐based SCT. SCT resulted in stable engraftment without transplant‐related mortality. All patients are alive, engrafted and in ambulatory care. During follow‐up (median five yr, 1.9–8 yr), six of eight showed developmental delay (two severe, two mild/no), all eight had spinal deformities and one received hip surgery for acetabular dysplasia. Hand surgery for carpal tunnel release and trigger digits was required in five of the patients. The cranio‐cervical junction was narrowed in four patients, one child having already received surgery. CC was present in all patients prior to SCT....

An unusual cause of carpal tunnel syndrome.

Practical Neurology — Sat, 26 Nov 2011 13:14:10 +0100

Authors: Kowalewska-Zietek J, Dawson TP, Damodaran D, Gillmore JD PMID: 22100945 [PubMed - in process] (Source: Practical Neurology)

[Tolerance and efficacy of peripheral nerve blocks for carpal tunnel release.]

Annales Francaises d'Anesthesie et de Reanimation — Fri, 25 Nov 2011 05:00:00 +0100

DISCUSSION: Wrist blocks are less tolerated than brachial canal blocks. The musculocutaneous nerve might often participate in the palm sensitive innervation. For open carpal tunnel release, median, ulnar and musculocutaneous nerves blocks at the brachial canal should be preferred. PMID: 22118874 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Carpal Tunnel Syndrome [JAMA Patient Page]

JAMA — Tue, 22 Nov 2011 05:00:00 +0100

(Source: JAMA)

Carpal tunnel syndrome caused by a ganglion in the carpal tunnel with an atypical type of palsy: a case report.

Hand Surgery — Tue, 22 Nov 2011 02:06:03 +0100

We report a case which presented with a rapidly progressive onset of symptoms and subsequent thenar palsy. PMID: 22072471 [PubMed - in process] (Source: Hand Surgery)

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High definition ultrasound as diagnostic adjunct for incomplete carpal tunnel release.

Hand Surgery — Tue, 22 Nov 2011 02:06:03 +0100

We present our experience in utilizing high definition ultrasound to reliably and accurately localize the anatomical cause to aid focused revision CTR. PMID: 22072462 [PubMed - in process] (Source: Hand Surgery)

Macromastia: a risk factor for carpal tunnel syndrome?

Hand Surgery — Tue, 22 Nov 2011 02:06:03 +0100

Conclusion: Age, breast size, but not body mass index, have a positive correlation with the CTS. PMID: 22072461 [PubMed - in process] (Source: Hand Surgery)

Ultrasonographic assessment of longitudinal median nerve and hand flexor tendon dynamics in carpal tunnel syndrome

Muscle and Nerve — Fri, 18 Nov 2011 05:00:00 +0100

Conclusion:The altered hand dynamics in CTS patients may have implications for the pathophysiology and clinical evaluation of CTS, and ultrasound‐based classification models may further support the diagnosis of CTS. © 2011 Wiley‐Liss, Inc. (Source: Muscle and Nerve)

Characteristics of sleep disturbance in patients with carpal tunnel syndrome

Hand — Mon, 14 Nov 2011 16:58:59 +0100

Conclusion Sleep disturbance in CTS patients is characterized by a broad array of physical symptoms that have a significant impact on quality of life. Content Type Journal ArticleCategory Surgery ArticlesPages 1-4DOI 10.1007/s11552-011-9373-1Authors Jay N. Patel, University of Louisville, School of Medicine, 323 E. Chestnut St, Louisville, KY 40202, USASteven J. McCabe, University of Louisville, School of Medicine, 323 E. Chestnut St, Louisville, KY 40202, USAJohn Myers, Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 Gray Street, Louisville, KY 40202, USA Journal HandOnline ISSN 1558-9455Print ISSN 1558-9447 (Source: Hand)

Carpal Tunnel Syndrome: The Disease You Thought You Knew

UK College of Medicine News — Fri, 11 Nov 2011 00:41:29 +0100

The following column appeared in the Lexington Herald-Leader on Sunday, Nov. 6 (Source: UK College of Medicine News)

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Painless Ulcers on the Fingers: An Unusual Presentation of Severe Bilateral Carpal Tunnel Syndrome.

Actas Dermo-Sifiliograficas — Thu, 10 Nov 2011 05:00:00 +0100

Authors: Ormaechea-Pérez N, Arregui-Murua MA, Zubizarreta-Salvador J, Tuneu-Valls A PMID: 22078142 [PubMed - as supplied by publisher] (Source: Actas Dermo-Sifiliograficas)

An evidence-based review of the most current treatment options and trends for carpal tunnel syndrome (CTS)

Rheumatology International — Wed, 09 Nov 2011 07:03:18 +0100

Abstract In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS) published a guideline for treatment of carpal tunnel syndrome (CTS) in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen r...

Workplace and individual risk factors for carpal tunnel syndrome

Occupational and Environmental Medicine — Wed, 09 Nov 2011 05:00:00 +0100

Conclusions Quantitative and ratings-based job exposure measures were each associated with CTS. Obesity increased the association between frequency of exertion and CTS. (Source: Occupational and Environmental Medicine)

Chronic sciatic nerve injury impairs the local cutaneous neurovascular interaction in rats

Pain — Fri, 04 Nov 2011 04:00:00 +0100

Summary: The assessment of neurovascular interaction in skin innervated by the compressed nerve is well adapted to detect the severity of surrounding tissue damage.Abstract: Most studies of chronic nerve compression focus on large nerve function in painful conditions, and only few studies have assessed potential changes in the function of small nerve fibers during chronic nerve compression and recovery from compression. Cutaneous pressure-induced vasodilation is a neurovascular phenomenon that relies on small neuropeptidergic fibers controlling the cutaneous microvasculature. We aimed to characterize potential changes in function of these small fibers and/or in cutaneous microvascular function following short-term (1-month) and long-term (6-month) nerve compression and after release of com...

Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy.

Annals of the Royal College of Surgeons of England — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS: A highly efficient clinical service involving both diagnostics and treatment can be delivered at a single hospital visit while maintaining optimal outcomes and high patient satisfaction. PMID: 22041242 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)

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Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

Orthopedics — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Hernández-Cortés P, Caba M, Gómez-Sánchez R, Gómez-Morales M Abstract The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and...

Biomechanical properties of the transverse carpal ligament under biaxial strain

Journal of Orthopaedic Research — Mon, 31 Oct 2011 04:00:00 +0100

AbstractThe transverse carpal ligament (TCL) influences carpal stability and carpal tunnel mechanics, yet little is known about its mechanical properties. We investigated the tissue properties of TCLs extracted from eight cadaver arms and divided into six tissue samples from the distal radial, distal middle, distal ulnar, proximal radial, proximal middle, and proximal ulnar regions. The 5% and 15% strains were applied biaxially to each sample at rates of 0.1, 0.25, 0.5, and 1%/s. Ligament thickness ranged from 1.22 to 2.90 mm. Samples from the middle of the TCL were thicker proximally than distally (p < 0.013). Tissue location significantly affected elastic modulus (p < 0.001). Modulus was greatest in the proximal radial samples (mean 2.8 MPa), which were 64% and 44% grea...

Relationship Between Interpretation and Accuracy of the Upper Limb Neurodynamic Test 1 in Carpal Tunnel Syndrome

Journal of Manipulative and Physiological Therapeutics — Mon, 31 Oct 2011 04:00:00 +0100

Conclusion: Our investigation suggests that the reproduction of symptoms in the thumb or lateral 2 fingers of the affected arm during ULNT1 has weak diagnostic accuracy for carpal tunnel syndrome. (Source: Journal of Manipulative and Physiological Therapeutics)

The efficacy of phonophoresis on electrophysiological studies of the patients with carpal tunnel syndrome

Rheumatology International — Sat, 29 Oct 2011 05:50:25 +0100

Abstract To investigate the efficacy of phonophoresis with nonsteroid anti-inflammatory drugs (P-NSAID) and corticosteroids (P-CS) in the treatment for carpal tunnel syndrome (CTS) and to compare the efficacy of phonophoresis with local CS injection (LCSI) and splinting with a 3-month follow-up. 84 hands of 51 patients with CTS were treated by applying LCSI, P-CS, P-NSAID, and wrist splinting. Electrophysiological studies, grip strength, hand dexterity, and sensory recovery of the first three digits were assessed. Duruöz hand index (DHI) was used to assess the functional hand disability. For clinical evaluation, we used Phalen and Tinnel signs. Pain intensity was evaluated by visual analog scale. The LCIS group showed a significant improvement in pain relief and DHI, but ...

Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes

Rheumatology International — Sat, 29 Oct 2011 05:50:23 +0100

Conclusion: The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00296-011-2173-7Authors Feray Soyupek, Suleyman Demirel University, Isparta, TurkeyAhmet Yesildag, Suleyman Demirel University, Isparta, TurkeySuleyman Kutluhan, Suleyman Demirel University, Isparta, TurkeyAyhan Askin, Suleyman Demirel University, Isparta, TurkeyAhmet Ozden, Suleyman Demirel University, Isparta, TurkeyGokcen Ay Uslusoy, Suleyman Demirel University, Isparta, Tu...

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Comparison of the long - term effectiveness of physiotherapy programs with low - level laser therapy and pulsed magnetic field in patients with carpal tunnel syndrome.

Advances in Medical Sciences — Sat, 29 Oct 2011 04:00:00 +0100

Conclusions: Although after LLL as well as PMF therapy clinical improvement was observed, the most significant differences were registered after the second series and persisted for up to 6 months in both groups. PMID: 22037175 [PubMed - as supplied by publisher] (Source: Advances in Medical Sciences)

Neoplasm Mimics of Rheumatologic Presentations: Sialadenitis, Ocular Masquerade Syndromes, Retroperitoneal Fibrosis, and Regional Pain Syndromes

Rheumatic Disease Clinics of North America — Fri, 28 Oct 2011 04:00:00 +0100

This article reviews a group of miscellaneous malignant conditions that may mimic rheumatologic diseases. Primary salivary gland cancer as well as lymphoproliferative conditions such as lymphoma and IgG4 related syndromes should be considered when evaluating a patient with sialadenosis. Primary intraocular lymphoma and melanoma in adults as well as leukemia and retinoblastoma in children may present as idiopathic ocular inflammation and require a high index of suspicion. Retroperitoneal fibrosis may mimic lymphoma or a solid malignancy and poses diagnostic challenges. Regional pain syndromes, such as complex regional pain and carpal tunnel syndromes, may be a manifestation of cancer and amyloidosis respectively. Awareness of these rare mimics may serve in guiding diagnostic investigations....

Factors Affecting Return to Work After Carpal Tunnel Syndrome Surgery in a Large French Cohort

Archives of Physical Medicine and Rehabilitation — Thu, 27 Oct 2011 09:20:35 +0100

Conclusion: This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients. (Source: Archives of Physical Medicine and Rehabilitation)

The responsiveness of sensibility and strength tests in patients undergoing carpal tunnel decompression

BMC Musculoskeletal Disorders — Thu, 27 Oct 2011 04:00:00 +0100

Conclusions: For clinical assessment of sensibility touch threshold assessed by monofilaments (WEST) and tactile gnosis measured with the STITM test are the most responsive tests and are recommended for future studies. The use of handheld myometry (RIHM) for manual muscle testing, despite more specifically targeting thenar muscles, was less responsive than grip or tripod pinch testing using the digital grip analyser (MIE). When assessing power and pinch strength the effect of other concomitant conditions such as degenerative joint disease on strength needs to be considered. (Source: BMC Musculoskeletal Disorders)

Bilateral Ulnar Neuropathy Secondary to Volar Displacement of Flexor Tendons Following Open Carpal Tunnel Release: Case Report

The Journal of Hand Surgery — Mon, 24 Oct 2011 04:00:00 +0100

We report a case of bilateral ulnar neuropathy after bilateral open carpal tunnel release. Displacement of the flexor tendons anterior to the hook of hamate caused impingement on the ulnar nerve. Symptoms resolved after hook of hamate resection. (Source: The Journal of Hand Surgery)

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Dynamic Doppler Evaluation of the Radial and Ulnar Arteries in Patients With Carpal Tunnel Syndrome

American Journal of Roentgenology — Fri, 21 Oct 2011 04:00:00 +0100

CONCLUSION. Blood flow in the hands of CTS patients differs from that of healthy individuals both at rest and during certain hand movements. Future studies, also with simultaneous monitoring of sympathetic innervation, could be beneficial to confirm the association between blood flow and the sympathetic nerves of the hand. (Source: American Journal of Roentgenology)

Usefulness of assessing repeater F‐waves in routine studies

Muscle and Nerve — Fri, 21 Oct 2011 04:00:00 +0100

Discussion:The findings based on the presented material and recording condition suggest that repeater F‐waves differentiate between health and disease but not between different types of pathology of motor neurons or their axons. Even in routinely recorded samples of 20 traces, the index of repeater to all F‐waves could be used as a sign of nerve pathology. © 2011 Wiley‐Liss, Inc. (Source: Muscle and Nerve)

[Musculoskeletal Ultrasound II - «Why are Bats Better Than Physicians»].

Praxis — Wed, 19 Oct 2011 04:00:00 +0100

This article reviews the aspects which were discussed at the SGUM congress in Davos in the talk «why are bats better than physicians». The talk focussed on modern aspects of Ultrasound (US) diagnostics at the locomotor system. High frequency US probes allow accurate diagnosis, initial assessment and follow up in Rheumatoid Arthritis and Osteo-Arthritis. Basic pathologic features in these pathologic conditions in form of synovitis, erosion and cartilage damage are described. In case of entrapment neuropathies - first of all in carpal tunnel syndrome - pathognomonic sonomorphologic changes can be detected and allow to confirm a clinical suspicion. The correct indication for diagnostic or therapeutic interventions at the musculoskeletal system can be critically verified and if necessary rev...

Color and Power Doppler US for Diagnosing Carpal Tunnel Syndrome and Determining Its Severity: A Quantitative Image Processing Method [Musculoskeletal Imaging]

Radiology — Wed, 19 Oct 2011 04:00:00 +0100

Conclusion: Color Doppler US can be used to accurately diagnose CTS. By processing the recorded power Doppler images and determining the number of pixels in the intraneural vascular area, the severity of CTS can be assessed. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110150/-/DC1 (Source: Radiology)

Performance on a manual tracking task differentiates individuals at risk of developing carpal tunnel syndrome from those not at risk

Journal of Electromyography and Kinesiology — Wed, 19 Oct 2011 04:00:00 +0100

Conclusion: These results suggest that manual tracking tasks may be useful in the identification of those individuals at risk of developing CTS before they develop any measurable sensorimotor impairment. (Source: Journal of Electromyography and Kinesiology)

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Subsynovial connective tissue is sensitive to surgical interventions in a rabbit model of carpal tunnel syndrome

Journal of Orthopaedic Research — Wed, 19 Oct 2011 02:49:00 +0100

AbstractThe most common histological finding in carpal tunnel syndrome (CTS) is non‐inflammatory fibrosis and thickening of the subsynovial connective tissue (SSCT) in the tunnel. While the cause of SSCT fibrosis and the relationship of SSCT fibrosis and CTS are unknown, one hypothesis is that SSCT injury causes fibrosis, and that the fibrosis then leads to CTS. We investigated the sensitivity of the SSCT to injuries. Two types of surgical interventions were performed in a rabbit model: A skin incision with tendon laceration and SSCT stretching sufficient to damage the SSCT, and skin incision alone. Twelve weeks after surgery, the rabbit carpal tunnel tissues were studied with immunochemistry for TGF‐β receptors 1, 2, and 3, collagen III, and collagen VI. All TGF‐β receptors were e...

Health Tip: When Symptoms Indicate Carpal Tunnel Syndrome

The Doctors Lounge - Neurology — Thu, 13 Oct 2011 12:00:00 +0100

Here are common warning signs (Source: The Doctors Lounge - Neurology)

Systemic but asymptomatic transthyretin amyloidosis 8 years after domino liver transplantation

Journal of Neurology, Neurosurgery and Psychiatry — Thu, 06 Oct 2011 04:00:00 +0100

As familial amyloid polyneuropathy (FAP) is an adult-onset disease, a long period is expected between domino liver transplantation (DLT) and the occurrence of amyloidosis in recipients of a FAP liver. However, as time passes, and increased numbers of patients have undergone DLT, patients with symptoms suggesting amyloidosis have been reported. The authors describe, for the first time, pathological findings in an autopsy case of a recipient of a FAP liver. A male patient with primary sclerosing cholangitis received a liver graft from a FAP patient with the transthyretin (TTR) Tyr114Cys mutation when he was 30 years old. Although a recurrence of primary sclerosing cholangitis was detected at age 34, he had no symptoms indicating amyloidosis. He died from Burkitt's lymphoma at 38 ye...

[Value of the cutaneous-plantar reflex in the diagnosis of idiopathic carpal tunnel syndrome].

Revista de Neurologia — Wed, 05 Oct 2011 22:26:47 +0100

CONCLUSION. Studying the CPR can provide complementary data in the evaluation of CTS. PMID: 21960386 [PubMed - in process] (Source: Revista de Neurologia)

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The Journal of Hand Surgery — Wed, 05 Oct 2011 04:00:00 +0100

Designed as a quick reference for orthopedic residents and general orthopedic surgeons who may not encounter upper extremity problems on a regular basis, this book succinctly covers 15 common disorders of the upper extremity (from finger to shoulder). Specifically, the topics covered are: trigger finger, de Quervain, carpal tunnel syndrome, ganglion cysts, distal radius fractures, both-bone fractures, lateral epicondylitis, cubital tunnel syndrome, distal biceps tendon rupture, proximal humerus fractures, acromioclavicular joint disorders, shoulder impingement, rotator cuff tears, adhesive capsulitis, and shoulder instability. (Source: The Journal of Hand Surgery)

Performance of Simplified Scoring Systems for Hand Diagrams in Carpal Tunnel Syndrome Screening

The Journal of Hand Surgery — Wed, 05 Oct 2011 04:00:00 +0100

Conclusions: Symptoms diagrammed within the median nerve distribution are associated with abnormal nerve conduction among workers. The median nerve digit score and the long finger score offer increased ease of use compared to the Katz method, while maintaining similar performance characteristics. The long finger appears best suited for isolated digit scoring to predict abnormal median nerve conduction in a working population. Type of study/level of evidence: Diagnostic II. (Source: The Journal of Hand Surgery)

Carpal tunnel and transverse carpal ligament stiffness with changes in wrist posture and indenter size.

Cell Research — Tue, 04 Oct 2011 10:16:39 +0100

This study investigated the effects of loading and posture on mechanical properties of the transverse carpal ligament (TCL). Ten fresh-frozen cadaver arms were dissected to expose the TCL and positioned in the load frame of a servo-hydraulic testing machine, equipped with a load cell and custom made indenters. Four cylindrical indenters (5, 10, 20, and 35 mm) loaded the TCL in three wrist postures (30° extension, neutral and 30° flexion). Three loading cycles with a peak force of 50 N were applied at 5 N/s for each condition. The flexed wrist posture had significantly greater TCL stiffness (40.0 ± 3.3 N/mm) than the neutral (35.9 ± 3.5 N/mm, p = 0.045) and extended postures (34.9 ± 2.8 N/mm, p = 0.025). TCL stiffness using the 10 and 20 mm indenters w...

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Modified Phalen's Test as an aid in diagnosing carpal tunnel syndrome

Arthritis Care and Research — Mon, 03 Oct 2011 04:00:00 +0100

Conclusion:The MPT is a highly useful screening diagnostic tool for CTS. The MPT demonstrates greater accuracy than the TPT for predicting CTS. The MPT also demonstrates a greater sensitivity than the TPT in predicting a positive electrodiagnostic test for carpal tunnel syndrome. © 2011 by the American College of Rheumatology (Source: Arthritis Care and Research)

Painful numb hands.

Med J Aust — Mon, 03 Oct 2011 04:00:00 +0100

Authors: Simpson MA, Day B Abstract Carpal tunnel syndrome, resulting from median nerve compression at the wrist, is a common and often disabling mononeuropathy. Risk factors include female sex, family history, repetitive hand use, obesity, pregnancy and a variety of medical comorbidities including diabetes mellitus, rheumatoid arthritis, and other connective tissue diseases. In many cases, an accurate diagnosis can be reached on the basis of clinical history and supportive examination findings alone. Neurophysiological investigations are essential for confirming the diagnosis, assessing severity and excluding more generalised neuropathies, as well as providing a baseline preoperative index of median nerve function. Wrist splinting and local corticosteroid injection are effective t...

It's All About Money

Rheumatology News — Sat, 01 Oct 2011 04:00:00 +0100

DR. GREENBAUM is a rheumatologist who practices in Greenwood, Ind. I sent one of my middle-aged patients with psoriatic arthritis for electromyography, suspecting that the numbness and tingling he described in his hands was due to carpal tunnel syndrome. A few days later I got a report back from the neurologist that read, “moderate median nerve entrapment in both wrists,” confirming my clinical suspicion. I told the nurse to ask him to try sleeping with resting wrist splints. (Source: Rheumatology News)

The Validity of Sensory Threshold Measures and Functional Measures in Patients with Carpal Tunnel Syndrome

Journal of Hand Therapy — Sat, 01 Oct 2011 04:00:00 +0100

The first objective of this study is to evaluate the validity of two sensory threshold tools (NK PSSD and vibrometer) in relation to self reported measures of symptom severity, function, and dexterity. The second objective of the study is to compare the responsiveness of the NK PSSD and vibrometer. (Source: Journal of Hand Therapy)

Carpal Tunnel Injection: With or Without Ultrasound Guidance?

PM and R — Sat, 01 Oct 2011 04:00:00 +0100

A.H. is a 44-year-old woman with a 2-year history of numbness and tingling in her dominant right hand. She reports that the symptoms are primarily in her third digit but also into her thumb and index finger. She works as a secretary and notes that she occasionally drops things, although she is not sure if this is because of true weakness or difficulty feeling things in her hand. She was diagnosed by her primary care physician with carpal tunnel syndrome and had a course of hand therapy with some improvement, but she still has persistent symptoms. She wears a custom splint made by her therapist, which does help with night pain, but she is frustrated with her symptoms at work. She has had electrodiagnostic testing, which demonstrated moderate median mononeuropathy at the wrist, with prolonge...

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Median nerve deformation in differential finger motions: Ultrasonographic comparison of carpal tunnel syndrome patients and healthy controls

Journal of Orthopaedic Research — Thu, 29 Sep 2011 17:26:44 +0100

AbstractWe investigated the median nerve deformation in the carpal tunnel in patients with carpal tunnel syndrome and controls during thumb, index finger, middle finger, and a four finger motion, using ultrasound. Both wrists of 29 asymptomatic volunteers and 29 patients with idiopathic carpal tunnel syndrome were evaluated by ultrasound. Cross‐sectional images during motion from full extension to flexion were recorded. Median nerve cross‐sectional area, perimeter, aspect ratio of the minimal enclosing rectangle, and circularity in extension and flexion positions were calculated. Additionally, a deformation index was calculated. We also calculated the intra‐rater reliability. In both controls and patients, the median nerve cross‐sectional area became significantly smaller from exte...

Diffusion tensor imaging in carpal tunnel syndrome.

Diagnostic and Interventional Radiology : The Turkish Society of Radiology — Thu, 29 Sep 2011 04:00:00 +0100

CONCLUSION: Diffusion tensor imaging may contribute to the diagnosis of carpal tunnel syndrome on the basis of fractional anisotropy measurements. PMID: 21960133 [PubMed - as supplied by publisher] (Source: Diagnostic and Interventional Radiology : The Turkish Society of Radiology)

Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome

Rheumatology International — Wed, 28 Sep 2011 05:48:26 +0100

Abstract We aimed to bring a more understandable and applicable technique to the literature instead of “massage therapy” in CTS. We compared our new technique with the splint wear, of which the efficacy in CTS has been proven with many studies. Eighty-four patients between 31 and 65 years of age were included in the study. The patients were divided into two equal groups. In the first group, splint and “Madenci” hand massage technique were applied, and in the second group only splint was applied. A splint was provided for all patients with tendon and nerve gliding exercises, and also when needed analgesic drugs were given. When the pretreatment and posttreatment parameters were compared via repetitive measurement analysis, it was found that PGA and MDPGA were si...

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BMJ Online First — Wed, 28 Sep 2011 04:00:00 +0100

Sensory disturbance—measured electrophysiologically or subjectively—does not provide a good yardstick by which to assess potential carpal tunnel syndrome. A study of 64 patients showed that objective... (Source: BMJ Online First)

Wide-awake trapeziectomy: video detailing local anesthetic injection and surgery

Hand — Sat, 24 Sep 2011 05:42:33 +0100

Abstract The use of local anesthesia with epinephrine and no tourniquet/no sedation is becoming an excellent alternative for hand surgeries. This wide-awake approach is the most commonly used method of anesthesia for carpal tunnel release in Canada. The purpose of this paper is to provide a video detailing this technique for trapeziectomy for trapeziometacarpal joint osteoarthritis. Content Type Journal ArticleCategory Multimedia ArticlesPages 1-2DOI 10.1007/s11552-011-9367-zAuthors Hana Farhangkhoee, Division of Plastic and Reconstructive Surgery, Dalhousie University, Hilyard Place, 600 Main Street, Suite C204, Saint John, NB E2K 1J5, CanadaJan Lalonde, Division of Plastic and Reconstructive Surgery, Dalhousie University, Hilyard Place, 600 Main Street, Suite C204, Sa...

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Compressive neuropathy in the upper limb

Indian Journal of Plastic Surgery — Sat, 24 Sep 2011 04:00:00 +0100

This article seeks to review comprehensively the pathophysiology, Anatomy and treatment of these conditions in a way that is intended for the practicing Hand Surgeon as well as postgraduates in training. It is generally a rewarding exercise to treat these conditions because they generally do well after corrective surgery. Diagnostic guidelines, treatment protocols and surgical technique has been discussed. (Source: Indian Journal of Plastic Surgery)

Quantitative processing method boosts carpal tunnel diagnosis

AuntMinnie.com Headlines — Wed, 21 Sep 2011 18:27:29 +0100

Color Doppler ultrasound can be reliably used to diagnose carpal tunnel syndrome, (more) (Source: AuntMinnie.com Headlines)

Short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate carpal tunnel syndrome: a double blind randomized sham-controlled trial.

Clinical Rehabilitation — Wed, 21 Sep 2011 04:00:00 +0100

CONCLUSION: Hyperthermia provides short-term improvements in pain and function in patients with mild to moderate carpal tunnel syndrome. PMID: 21937521 [PubMed - as supplied by publisher] (Source: Clinical Rehabilitation)

Health Tip: At Risk of Carpal Tunnel Syndrome?

The Doctors Lounge - Neurology — Tue, 20 Sep 2011 12:00:00 +0100

Here are potential causes (Source: The Doctors Lounge - Neurology)

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Peripheral neuropathy in HIV patients: Treatment by decompression of peripheral nerves

Microsurgery — Wed, 14 Sep 2011 04:00:00 +0100

AbstractPeripheral neuropathy is the most common nerve disorder in human immunodeficiency virus (HIV) patients. Distal symmetrical sensory polyneuropathy (DSP) affects roughly one third of HIV patients. With the introduction of antiretrovirals, more patients are surviving longer, and chronic complications are surfacing. Three consecutive patients with at least a 5‐year history of HIV presented during the period from 2007 to 2009. All three patients were on antiretrovirals and had no other comorbid conditions such as spinal pathology or diabetes. All patients had symptoms of pain, numbness, and weakness. Quantitative sensory testing and/or electromyography/nerve conduction testing (EMG/NCT) were performed preoperatively and correlated with the presence of Tinel signs. Targeted nerve relea...

RSNA: Ultrasound accurately diagnoses carpal tunnel syndrome

CMIO.net: The News Weekly for Health IT Executives — Mon, 12 Sep 2011 12:11:15 +0100

Color Doppler ultrasonography (US) can be used as a noninvasive alternative to electrodiagnostic testing (EDT) to accurately diagnose carpal tunnel syndrome (CTS), according to a study published online in Radiology Sept. 7. (Source: CMIO.net: The News Weekly for Health IT Executives)

Radiology: Ultrasound bests EDT for carpal tunnel syndrome diagnosis

CMIO.net: The News Weekly for Health IT Executives — Mon, 12 Sep 2011 12:11:15 +0100

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Ultrasonography in severe carpal tunnel syndrome

Muscle and Nerve — Mon, 12 Sep 2011 04:00:00 +0100

DiscussionAtrophy of the median nerve in severe CTS does not explain negative ultrasonographic test results. Instead, the CSA of the median nerve is enlarged in most patients with severe CTS. © 2011 Wiley‐Liss, Inc. (Source: Muscle and Nerve)

Prevalence and pattern of hand soft-tissue changes in type 2 diabetes mellitus.

Diabetes and Metabolism — Mon, 12 Sep 2011 04:00:00 +0100

CONCLUSION: Hand changes are more prevalent and severe in patients with T2DM, and are correlated with age, duration of diabetes and microvascular complications. PMID: 21917496 [PubMed - as supplied by publisher] (Source: Diabetes and Metabolism)

Workstation: An Ergonomics Challenge in New Electronic Devices

NYT Health — Sat, 10 Sep 2011 17:30:51 +0100

As people communicate on more electronic devices in more situations, they may be putting themselves at greater risk of injury, ergonomics experts say. (Source: NYT Health)

Tendon injury produces changes in SSCT and nerve physiology similar to carpal tunnel syndrome in an in vivo rabbit model

Hand — Sat, 10 Sep 2011 06:02:14 +0100

Conclusions Our findings are similar to those seen in patients with carpal tunnel syndrome and suggest that the tendon injury procedure may be the basis of a new animal model of SSCT injury and, possibly, CTS. Content Type Journal ArticleCategory Surgery ArticlesPages 1-9DOI 10.1007/s11552-011-9356-2Authors Tamami Moriya, Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAChunfeng Zhao, Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAStephen S. Cha, Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USAJames D. Schmelzer, Department of Neurology, Mayo Clinic,...

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Color and Power Doppler US for Diagnosing Carpal Tunnel Syndrome and Determining Its Severity: A Quantitative Image Processing Method [Musculoskeletal Imaging]

Continuous Publishing articles — Tue, 06 Sep 2011 23:00:00 +0100

We used color Doppler US to diagnose carpal tunnel syndrome. We introduced an image processing method that determines the number of pixels in the intraneural vascular area on power Doppler images and can be useful for noninvasive assessment of the severity of carpal tunnel syndrome. (Source: Continuous Publishing articles)

The association of Raynaud’s syndrome with carpal tunnel syndrome: a meta-analysis

Rheumatology International — Tue, 06 Sep 2011 15:50:13 +0100

The objective of this paper was to assess the prevalence of RS in patients with CTS—a meta-analysis of published data was performed. The PubMed database of the National Library of Medicine and ISI Web of Knowledge was used for studies dealing with RS and CTS. The studies provided sufficient data to estimate the prevalence of RS in patients of CTS. A forest plot was determined by the revealed prevalence. Statistical analysis was based on methods for a random effects meta-analysis and a finite mixture model for proportions. Publication bias was investigated with the linear regression test (Egger’s method). A meta-regression was conducted by the year of publication. Eight eligible studies, contributing data on 675 subjects, were included in this meta-analysis. For CTS, a pooled prev...

SerratioPeptidase is a potent anti-inflammatory enzyme

NaturalNews.com — Sun, 04 Sep 2011 07:00:00 +0100

(NaturalNews) Proteolytic enzymes are specific enzymes that metabolize protein. These enzymes are naturally produced by the human body and other living organisms and help carry out essential functions. Supplementing with these enzymes has shown to have a favorable anti-inflammatory effect on the tissues of the body. A unique enzyme named serratiopeptidase is now emerging as one of the most potent anti-inflammatory supplements.Serratiopeptidase is an enzyme isolated from a non-pathogenic bacteria called enterobacteria Serratia E15. This enzyme makes its inhabitants in the intestine of the silkworm. Silkworms go through a transformational process within a cocoon that turns them into moths. It is this specific enzyme that is used by the silkworm to dissolve the cocoon and reemerge as a moth.S...

The response of the rabbit subsynovial connective tissue to a stress‐relaxation test

Journal of Orthopaedic Research — Sat, 03 Sep 2011 19:20:27 +0100

AbstractThe subsynovial connective tissue (SSCT) in the carpal tunnel may play a role in the etiology of carpal tunnel syndrome (CTS), yet the material properties of the SSCT remain unclear. Thus, we investigated the mechanical response of the SSCT in a rabbit model. Twenty‐four rabbit cadaver paws were used for mechanical testing; two paws were used for scanning electron microscopy (SEM) imaging. After testing normal tendon excursion, the divided third digit flexor digitorum superficialis (FDS) tendon was pulled to displacements of 2, 3.5, 5, or 8 mm, maintained at that position until force decay, and then the process was repeated. Normal excursion of the FDS averaged 4.8 mm. The ratio of the second peak force to the first peak force in the 2 mm group was 0.98 (SD = 0.16), whi...

Often atypical? The distribution of sensory disturbance in carpal tunnel syndrome.

Annals of the Royal College of Surgeons of England — Thu, 01 Sep 2011 04:00:00 +0100

This study aimed to examine the disturbance of hand sensation in patients with carpal tunnel syndrome (CTS) and assess the usefulness of objective and subjective measures. The study included 64 patients with CTS confirmed by electrophysiological testing. Sensory assessment was made by objective (pressure aesthesiometry) and subjective (hand symptom diagram) measures in different anatomical areas. The results of the subjective and objective testing were correlated with nerve conduction studies by a kappa analysis. Sensory disturbance occurred more frequently in areas innervated by the median nerve (index finger, 94%) but also with great frequency in other areas (little finger, 39%). Pain occurred frequently in anticipated areas (wrist crease, 33%) but also in other areas (little finger, 11%...

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The Effect of Symptoms of Carpal Tunnel Syndrome on Ultrasonographic Median Nerve Measures Before and After Wheelchair Propulsion

PM and R — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions: We found several median nerve responses to wheelchair propulsion associated with symptoms of CTS. These responses occurred even though no baseline ultrasound difference was found based on symptoms. Future research is necessary to determine how propulsion characteristics (ie, force, repetition, and posture) affect the median nerve response. (Source: PM and R)

Carpal tunnel syndrome and peripheral polyneuropathy in patients with end stage kidney disease.

J Korean Med Sci — Thu, 01 Sep 2011 04:00:00 +0100

This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb...

Insulin resistance increases risk of carpal tunnel syndrome: a case‐control study

Journal of the Peripheral Nervous System — Thu, 01 Sep 2011 04:00:00 +0100

In this study, we focused on evidence that pre‐diabetes may represent a risk factor for CTS. We proposed to determine IR as a rule in all patients with idiopathic CTS. (Source: Journal of the Peripheral Nervous System)

T267 prevalence and severity of carpal tunnel syndrome in over 15 years old women 2010

European Journal of Pain Supplements — Thu, 01 Sep 2011 04:00:00 +0100

(Source: European Journal of Pain Supplements)

[Evaluation of the Sentinel Surveillance Program in Occupational Health in Navarra (1998-2007).]

Anales del Sistema Sanitario de Navarra — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions. The Sentinel Surveillance Program in Occupational Health in Navarra is a good experience in obtaining an information system that connects the public health system and the occupational compensation system in Spain, but it requires close monitoring and coordination. PMID: 22233845 [PubMed - as supplied by publisher] (Source: Anales del Sistema Sanitario de Navarra)

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Chronic nerve compression alters Schwann cell myelin architecture in a murine model

Muscle and Nerve — Mon, 29 Aug 2011 23:00:00 +0100

Discussion:Chronic entrapment injuries like carpal tunnel syndrome are primarily mediated by the Schwann cell response, wherein decreases in internodal length and myelin thickness disrupt the efficiency of impulse propagation. Restitution of Cajal bands is not sufficient for remyelination post‐CNC injury. © 2011 Wiley‐Liss, Inc. (Source: Muscle and Nerve)

Polymethylmethacrylate membrane with a series of serendipity.

Contributions to Nephrology — Mon, 29 Aug 2011 01:56:07 +0100

This article reviews its history and explains its longevity. The membrane was developed through application of a stereocomplex phenomenon that is observed upon mixture of isotactic and syndiotactic PMMA polymers. Filtryzer(TM) B1 and B2 were approved in Japan in 1977. B1 was the pioneer high-performance membrane model and B2 was a model that simulated a low-flux cellulosic membrane. The development of B1 led to the development of the dialysis machine with an ultrafiltration rate (UFR)-controlling function because the UFR of B1 was too high to control using transmembrane pressure control. B1 was used not only as a dialyzer but also as a hemodiafilter by combination with a UFR controller. Biocompatibility of the dialysis membrane, complement activation and/or transient leukopenia was studied...

Proteasome Modulator 9 SNPs are linked to Hypertension in Type 2 Diabetes Families

Cardiovascular Diabetology — Sat, 27 Aug 2011 23:00:00 +0100

Conclusions: We conclude that the PSMD9 gene and/or any variant in linkage disequilibrium with the SNPs studied contribute to the linkage to hypertension within our family dataset. This is the first report of PSMD9 linkage to hypertension within the 12q24 locus. (Source: Cardiovascular Diabetology)

Nerve compression, membrane excitability, and symptoms of carpal tunnel syndrome

Muscle and Nerve — Thu, 25 Aug 2011 00:19:30 +0100

Conclusions: Axonal responses to compression are impaired in CTS. This may suggest a greater reliance on axonal membrane Na+/K+‐ATPase function. Muscle Nerve 44: 402–409, 2011 (Source: Muscle and Nerve)

Fiber orientation of the transverse carpal ligament

Clinical Anatomy — Wed, 24 Aug 2011 23:00:00 +0100

AbstractThe transverse carpal ligament is the volar roof of the carpal tunnel. Gross observation shows that the ligament appears to have fibers that roughly orient in the transverse direction. A closer anatomical examination shows that the ligament also has oblique fibers. Knowledge of the fiber orientation of the transverse carpal ligament is valuable for further understanding the ligament's role in regulating the structural function of the carpal tunnel. The purpose of this study is to quantify collagen fiber orientation within the transverse carpal ligament using the small angle light scattering technique. Eight transverse carpal ligament samples from cadaver hands were used in this study. Individual 20‐μm sections were cut evenly along the thickness of the transverse carpal ligament...

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Combination of high resolution and color Doppler ultrasound in diagnosis of carpal tunnel syndrome.

Acta Radiologica — Tue, 23 Aug 2011 15:44:07 +0100

Authors: Wilder-Smith EP PMID: 21852439 [PubMed - in process] (Source: Acta Radiologica)

Med Sci Monit 2011; 17(9):CR505-509 "Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation – incidence, risk factors and results of surgical treatment "

Medical Science Monitor — Mon, 22 Aug 2011 10:16:00 +0100

Conclusions: Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS. (Source: Medical Science Monitor)

Extracorporeal Shock Wave Therapy in Pillar Pain After Carpal Tunnel Release: A Preliminary Study

Ultrasound in Medicine and Biology — Mon, 22 Aug 2011 04:00:00 +0100

Abstract: “Pillar pain” is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density–focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for...

Proteasome modulator 9 and carpal tunnel syndrome

Diabetes Research and Clinical Practice — Mon, 22 Aug 2011 04:00:00 +0100

Abstract: Proteasome modulator 9 (PSMD9) is linked to type 2 diabetes (T2D).The author studied whether PSMD9 IVS3+nt460 A>G, IVS3+nt437 T>C and E197 are linked to carpal tunnel syndrome in T2D Italian families.Non-parametric linkage, linkage disequilibrium-based and independent SNPs-based linkage analyses were performed. The PSMD9 SNPs show linkage to carpal tunnel syndrome. (Source: Diabetes Research and Clinical Practice)

Ulnar Nerve Entrapment in Guyon's Canal Due to Recurrent Carpal Tunnel Syndrome: Case Report.

Turkish Neurosurgery — Fri, 19 Aug 2011 22:22:03 +0100

Authors: Ozdemir O, Calisaneller T, Gulsen S, Caner H Abstract Guyon's canal syndrome is a compression neuropathy of the ulnar nerve entrapment at the wrist. Compression of the ulnar nerve at the wrist by a ganglion, lipomas, diseases of the ulnar artery, fractures of the hamate and trauma are common etiologcal factors. Unlike Guyon's canal syndrome, carpal tunnel syndrome (CTS) is the most common nerve entrapment of the upper extremity. Although, open (OCTR) or endoscopic carpal tunnel release (ECTR) is highly effective in relieving pain, failure with carpal tunnel release is seldom seen. In this paper, we presented a patient with ulnar nerve entrapment associated with recurrent CTS and discussed the possible pathomechanism with a review of current literature. PMID: 21845587 [...

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Anatomic variations of the median nerve in the carpal tunnel: a brief review of the literature.

Turkish Neurosurgery — Fri, 19 Aug 2011 22:22:03 +0100

Authors: Demircay E, Civelek E, Cansever T, Kabatas S, Yilmaz C Abstract Carpal tunnel syndrome (CTS) is a common focal peripheral neuropathy. Increased pressure in the carpal tunnel results in median nerve compression and impaired nerve perfusion, leading to discomfort and paresthesia in the affected hand. Surgical division of the transverse carpal ligament is preferred in severe cases of CTS and should be considered when conservative measures fail. A through knowledge of the normal and variant anatomy of the median nerve in the wrist is fundamental in avoiding complications during carpal tunnel release. This paper aims to briefly review the anatomic variations of the median nerve in the carpal tunnel and its implications in carpal tunnel surgery. PMID: 21845577 [PubMed - in p...

Cubital Tunnel Syndrome Caused by Amyloid Elbow Arthropathy in Long-term Hemodialysis Patients: Report of 4 Cases

The Journal of Hand Surgery — Thu, 18 Aug 2011 04:00:00 +0100

Carpal tunnel syndrome occurs frequently in long-term hemodialysis patients. However, the literature contains few detailed reports of other nerve entrapment syndromes of the upper extremity in these patients. We encountered 4 cases in which cubital tunnel syndrome occurred in long-term hemodialysis patients. In all cases, a hypertrophic synovial mass projecting from the humeroulnar joint compressed the ulnar nerve, and Congo red staining revealed that the mass contained amyloid deposition. Synovial proliferation resulting from amyloid arthropathy of the elbow joint appears to be the primary cause of this disease. (Source: The Journal of Hand Surgery)

The gliding characteristics of the flexor pollicis longus tendon in the carpal tunnel: Potential implications for manual pipette users

Journal of Orthopaedic Research — Wed, 17 Aug 2011 23:00:00 +0100

AbstractTo understand the potential mechanism for hand and wrist complaints in pipette users, whose motion is characterized by repetitive thumb motion in certain wrist positions, the peak (PGR) and mean (MGR) gliding resistance of the flexor pollicis longus (FPL) tendon were measured in nine human cadaver wrists. The PGR with the wrist in 30° ulnar deviation and in the neutral position were significantly lower than the PGR with the wrist in 60° flexion. The MGR with the wrist in 30° ulnar deviation was significantly lower than the MGR with the wrist in 60° flexion, 60° extension, or 20° radial deviation with 40° extension. Based on these data, we believe that a manual pipette designed to be used in neutral to ulnar deviated wrist position could have ergonomic advantages. © 2011 Ort...

Carpal Tunnel Syndrome Patients Prefer to Share Decision-Making with Their Physicians

MedlinePlus Health News — Thu, 11 Aug 2011 05:08:56 +0100

Source: American Academy of Orthopaedic Surgeons Related MedlinePlus Page: Carpal Tunnel Syndrome (Source: MedlinePlus Health News)

Carpal tunnel syndrome: Clinical, electrophysiological and ultrasonographic ratio after surgery

Muscle and Nerve — Wed, 10 Aug 2011 23:00:00 +0100

Conclusion:Symptoms improved more rapidly than function following surgery. Measurement of the ultrasonographic CSA ratio may provide clinicians with an assessment tool after surgery. (Source: Muscle and Nerve)

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CTS Was Not 'Injury' Under Policy, 9th Circuit Holds

LexisNexis® Mealey's™ Disability Insurance Legal News — Wed, 10 Aug 2011 21:53:57 +0100

SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on July 14 in an unpublished decision upheld a grant of summary judgment to a disability insurer that found that an insured's carpal tunnel syndrome did not fall under the policy's "injury" provision. Classification of the disability as an "injury" would entitle the insured to lifetime disability benefits under the policy, the appeals court said (Zaven Bilezikjian v. Unum Life Insurance Company of America, et al., No. 10-55249, 9th Cir.; 2011 U.S. App. LEXIS 14664). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Administrator's Reliance On Record Reviews, IME Was Reasonable, Judge Says

LexisNexis® Mealey's™ Disability Insurance Legal News — Wed, 10 Aug 2011 21:53:57 +0100

BROWNSVILLE, Texas - A plan administrator that relied on record reviews and an independent medical exam (IME) in its decision to terminate benefits to a claimant with carpal tunnel syndrome (CTS) acted reasonably, a Texas federal judge ruled July 25 (Charlene Curley v. Sedgwick Claims Management Services Inc., No. H-10-117, S.D. Texas; 2011 U.S. Dist. LEXIS 81391). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Carpal Tunnel Syndrome Patients Prefer To Share Decision-Making With Their Physicians

Health News from Medical News Today — Wed, 10 Aug 2011 07:00:00 +0100

Patients receiving treatment for carpal tunnel syndrome (CTS) prefer to play a more collaborative role when it comes to making decisions about their medical or surgical care, according to the findings of an August 3rd issue of the Journal of Bone and Joint Surgery (JBJS)... (Source: Health News from Medical News Today)

Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients

Diabetes Research and Clinical Practice — Wed, 10 Aug 2011 04:00:00 +0100

Abstract: Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia with various complications including diabetic hand syndrome (DHS); a condition characterized by association of distinct entities; limited joint mobility (LJM), Dupuytren's disease (DD), flexor tenosynovitis (FTS) and carpal tunnel syndrome (CTS) resulting in significant morbidity and mortality. The aim of this study was to evaluate the prevalence of these changes and their association to diabetes duration. We studied 142 type 2 and 45 type 1 DM patients and investigated the presence of these hand changes and peripheral neuropathy (PNP).The prevalence of LJM was 29.4%, DD was 17.6%, FTS was 10.7% and CTS 41.7% in all diabetics. The prevalence of CTS was more in type 2 DM (83.3%) as compared to type 1 DM (24...

Carpal tunnel syndrome patients prefer to share decision-making with their physicians

EurekAlert! - Medicine and Health — Mon, 08 Aug 2011 04:00:00 +0100

In this study, 78 patients who underwent carpal tunnel release for CTS were requested to indicate their preferred level of involvement preoperatively and to assess their actual levels of involvement postoperatively, using a scale containing five levels ranging from fully active to fully passive. (Source: EurekAlert! - Medicine and Health)

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Diagnostic Accuracy of Ultrasonography VS. Electromyography in Carpal Tunnel Syndrome: A Systematic Review of Literature

Ultrasound in Medicine and Biology — Mon, 08 Aug 2011 04:00:00 +0100

Abstract: A plethora of research investigates sonography vs. electrodiagnostic testing (EDX) for diagnosis of carpal tunnel syndrome (CTS). Through database searches, hand searches and communication with authors, 582 abstracts published from 1999 to 2009 were identified. A comprehensive systematic review process resulted in inclusion of 23 studies. Significant methodologic discrepancies among the studies limited the ability to complete a meta-analysis to identify specific diagnostic thresholds. Instead, the data were reviewed to provide implications for clinical utility of sonography as a screening tool as a compliment to EDX and to suggest continued and future research. The largest cross-sectional area of the median nerve within the carpal tunnel region has high potential for clinical scr...

Obsessive‐compulsive symptoms in primary focal dystonia: A controlled study

Movement Disorders — Sun, 31 Jul 2011 23:00:00 +0100

AbstractPrimary focal dystonia is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology probably involves the basal ganglia and cortical‐basal pathways. Primary dystonia appears to be associated with significant obsessive‐compulsive symptoms, but evidence remains scarce and contradictory. We addressed the following research questions: (1) Do primary dystonia patients have high obsessive‐compulsive symptom scores? (2) Are these symptoms more severe in dystonia than in controls with equivalent peripheral neurological disorders? and (3) Is psychopathology different in botulinum toxin‐treated and ‐untreated dystonia patients? This work was a cross‐sectional, descriptive, controlled study comprising 45 consecutive patients with primary focal...

Sonographic assessment of a bifid median nerve and median artery in carpal tunnel syndrome.

J Rheumatol — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Checa A, Hussain H PMID: 21807786 [PubMed - in process] (Source: J Rheumatol)

Immediate and delayed postoperative morbidity in functional and non-functioning pituitary adenomas

Pituitary — Thu, 21 Jul 2011 18:06:32 +0100

Abstract Neurosurgery is the most widely used definite treatment for pituitary tumors, while medical treatments are a good option to improve symptoms, which tend to recur when drugs are stopped. The aim of this study was to assess postsurgical morbidity of secreting pituitary adenomas (adrenocorticotropin hormone –ACTH- and growth hormone –GH- secreting) and non-functioning (NF) adenomas, operated between January 2002 and May 2009. We retrospectively reviewed the data of 94 patients who were operated by the same neurosurgeons and compared the immediate (1st month) and delayed (1st year) complications between the three groups of adenomas. Forty had immediate post-operative complications (42% of NF, 37% of GH-secreting and 48% of ACTH-secreting adenomas). The most freque...

The Effect of Dividing Muscles Superficial to the Transverse Carpal Ligament on Carpal Tunnel Release Outcomes

The Journal of Hand Surgery — Wed, 20 Jul 2011 23:00:00 +0100

Conclusions: Division of the muscles overlying or within the TCL in line with the third web space incision does not affect postoperative outcomes after carpal tunnel release in terms of the Boston and DASH scores, grip and pinch powers, and scar pain.Type of study/level of evidence: Prognostic I. (Source: The Journal of Hand Surgery)

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Heightened pain sensitivity in individuals with signs and symptoms of carpal tunnel syndrome and the relationship to clinical outcomes following a manual therapy intervention

Manual Therapy — Mon, 18 Jul 2011 04:00:00 +0100

Abstract: Neurophysiological responses related to lessening of pain sensitivity are a suggested mechanism of manual therapy. Prior studies have observed generalized lower pain thresholds associated with carpal tunnel syndrome (CTS) in comparison to healthy controls. The present study sought to determine whether similar findings were present in suprathreshold measures and measures specific to central integration of pain (temporal summation and after sensations). Additionally, we wished to determine whether measures of pain sensitivity were related to clinical outcomes in participants with signs and symptoms of CTS receiving a manual therapy intervention. Individuals with signs and symptoms of CTS reported greater pain sensitivity to suprathreshold measures of mechanical pain, temporal summa...

Combined Doppler and B-mode sonography in carpal tunnel syndrome

Journal of the Neurological Sciences — Sun, 17 Jul 2011 23:00:00 +0100

Abstract: An intraoperatively enlarged engorged median nerve has been described as typical of patients with carpal tunnel syndrome (CTS). Although many studies of CTS have addressed median nerve enlargement, little is known about the usefulness of Doppler methods in detecting median nerve engorgement combined with nerve cross-sectional area (CSA). In a retrospective study of hands referred for evaluation of possible CTS, patients were clinically graded into Highly-likely or Indeterminate CTS. Nerve conduction studies (NCS), CSA, and Doppler analysis were compared.Median nerve blood flow was detected in 29 of 30 Highly-likely CTS hands (mean 13.3m/s (8.2) SD) and in 25 of 30 with Indeterminate CTS (mean 8.5m/s (4.5) SD). These were significantly higher than our laboratory normal values (mea...

The secret history of Monsanto, Agent Orange and the mutilation of innocent Vietnamese

NaturalNews.com — Wed, 13 Jul 2011 07:00:00 +0100

(NaturalNews) We still find it difficult to completely forget one of the uglier and far-reaching atrocities of the Vietnam War - the dissemination of a deadly herbicide, Agent Orange. But where we only have movies like Apocalypse Now and a host of war novels to remind us of the majority of the unpalatable actions that took place in the 60s, the repercussions of Agent Orange are still rising and expanding - through the world and media.No matter how difficult it is to stop and listen to the stories of US military veterans who served in Vietnam, we cannot discount the myriad of first-person accounts of the damage that was caused and the cover-ups that have taken place since.One recent story was unveiled earlier this year by KPHO, a news station in Phoenix, which showcased a number of Vietnam ...

A Randomized Trial of Conventional Chest Physical Therapy Versus High Frequency Chest Wall Oscillation in Intubated and Non-Intubated Adults.

Respiratory Care — Mon, 11 Jul 2011 23:00:00 +0100

CONCLUSIONS: This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential use of HFCWO or CCPT for intubated and non-intubated adult patients. HFCWO was associated with statistically better comfort scores. PMID: 21762564 [PubMed - as supplied by publisher] (Source: Respiratory Care)