MedWorm: Carpal Tunnel Syndrome

A Holistic Evaluation of Risk Factors for Work-Related Musculoskeletal Distress Among Asymptomatic Sonographers Performing Neurosonology: A Pilot Study

Journal of Diagnostic Medical Sonography — Tue, 16 Mar 2010 18:01:47 +0100

A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonograp...

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Correlates of Upper Extremity Disability in Medical Transcriptionists

Journal of Occupational Rehabilitation — Sun, 14 Mar 2010 12:27:22 +0100

Conclusions Prior upper extremity musculoskeletal symptoms requiring treatment or ergonomic assessment, high perceived stress and a history of smoking are associated with self-reported disability. Diabetics have significantly higher levels of upper extremity disability than non-diabetics. Prospective studies are needed to see if interventions addressing these factors will prevent future work disability. Content Type Journal ArticleDOI 10.1007/s10926-010-9235-7Authors Russell Gelfman, College of Medicine, Mayo Clinic Department of Physical Medicine and Rehabilitation 200 First Street SW Rochester MN 55905 USATimothy J. Beebe, College of Medicine, Mayo Clinic Health Sciences Research 200 First Street SW Rochester MN 55905 USAPeter C. Amadio, College of Medicine, Mayo Clinic Departm...

Prevalent involvement of thenar motor fibres in vineyard workers with carpal tunnel syndrome.

Clinical Neurophysiology — Sat, 13 Mar 2010 00:00:00 +0100

CONCLUSIONS: The vineyard workers showed a different pattern of CTS than the other patients: thenar motor fibres were more affected, presumably due to chronic compression on the thenar branch. This suggests an association between "common" CTS and thenar mononeuropathy. SIGNIFICANCE: Occupational physiologists should clarify the mechanisms of neuromuscular engagement in particular jobs and ergonomists design suitable working tools, because many "individual" risk factors are difficult to change, but workplace-related risk factors can be modified. PMID: 20231111 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

Median nerve deformation and displacement in the carpal tunnel during index finger and thumb motion

Journal of Orthopaedic Research — Thu, 11 Mar 2010 00:00:00 +0100

The purpose of this study was to investigate the deformation and displacement of the normal median nerve in the carpal tunnel during index finger and thumb motion, using ultrasound. Thirty wrists from 15 asymptomatic volunteers were evaluated. Cross-sectional images during motion from full extension to flexion of the index finger and thumb were recorded. On the initial and final frames, the median nerve, flexor pollicis longus (FPL), and index finger flexor digitorum superficialis (FDS) tendons were outlined. Coordinate data were recorded and median nerve cross-sectional area, perimeter, aspect ratio of the minimal-enclosing rectangle, and circularity in extension and flexion positions were calculated. During index finger flexion, the tendon moves volarly while the nerve moves radially. Wi...

Current concepts in carpal tunnel syndrome: a review of the literature

European Journal of Orthopaedic Surgery & Traumatology — Wed, 10 Mar 2010 16:22:56 +0100

This article reviews the history, diagnosis and current management of this frequently encountered condition. Content Type Journal ArticleCategory General ReviewDOI 10.1007/s00590-010-0585-9Authors C. Lewis, Solihull Hospital Birmingham Heart of England NHS Trust Lode Lane, 456 Warwick Road Solihull B91 2JL UKC. Mauffrey, Solihull Hospital Birmingham Heart of England NHS Trust Lode Lane, 456 Warwick Road Solihull B91 2JL UKS. Newman, Solihull Hospital Birmingham Heart of England NHS Trust Lode Lane, 456 Warwick Road Solihull B91 2JL UKA. Lambert, Solihull Hospital Birmingham Heart of England NHS Trust Lode Lane, 456 Warwick Road Solihull B91 2JL UKP. Hull, Solihull Hospital Birmingham Heart of England NHS Trust Lode Lane, 456 Warwick Road Solihull B91 2JL UK Journal European ...

“Dropping objects”: a potential index of severe carpal tunnel syndrome

Neurological Sciences — Wed, 10 Mar 2010 15:26:49 +0100

Abstract Patients affected by carpal tunnel syndrome (CTS) often report finding themselves “dropping objects”. This symptom is perceived as a severe and frustrating problem. We investigated the occurrence of “dropping objects” in a sample of 532 patients affected by CTS, studied with a multidimensional protocol (clinical, neurophysiological, and patient-oriented). To ensure that the definition of “dropping objects” was index of abnormality, we evaluated a control group interviewing 200 subjects. In order to evaluate if “dropping objects” was an index of more severe CTS impairment, we compared the severity measures between the patients with and without this condition. Severity of CTS multidimensionally assessed was significantly greater in patients with a hi...

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Bilateral carpal tunnel syndrome in a child with type 1 diabetes mellitus

Neurology India — Tue, 09 Mar 2010 15:01:56 +0100

Duru Nilgun Selcuk, Acar Hurtan, Ayta Semih, Elevli MuratNeurology India 2010 58(1):136-137 (Source: Neurology India)

Percutaneous Carpal Tunnel Release Compared With Mini-Open Release Using Ultrasonographic Guidance for Both Techniques

The Journal of Hand Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: The PCTR provides the same neurologic recovery as does the mini-OCTR. The former leads to less postoperative morbidity and earlier functional return and achievement of satisfaction.Type of study/level of evidence: Therapeutic III. (Source: The Journal of Hand Surgery)

Low-Level Laser Treatment

The Journal of Hand Surgery — Mon, 01 Mar 2010 00:00:00 +0100

A 55-year-old, right-handed man presents with numbness and pain in his right thumb, index, and long fingers that wakes him from sleep. Electrodiagnostic studies are consistent with carpal tunnel syndrome (CTS) with a motor latency greater than 7 ms. He received transient relief from a steroid injection. The wrist brace that prevented night symptoms for years is no longer helpful. The patient prefers to avoid surgery and requests low-level laser therapy (LLLT), which he read about on the Internet. (Source: The Journal of Hand Surgery)

Judge Rules Carpal Tunnel Is Not An 'Accidental Injury' Per Disability Policy

LexisNexis® Mealey's™ Disability Insurance Legal News — Tue, 23 Feb 2010 14:44:56 +0100

SANTA ANA, Calif. - Determining that an insured's carpal tunnel syndrome (CTS) was not the result of an accident, a California federal judge on Jan. 25 found that his insurer was not guilty of breach of contract or bad faith by declining coverage under the "accidental injury" provision of his disability insurance policies (Zaven Bilezikjian v. Unum Life Insurance Company of America, et al., No. 07-1438, C.D. Calif.; 2010 U.S. Dist. LEXIS 6666). Full story on lexis.com (Source: LexisNexis® Mealey's™ Disability Insurance Legal News)

Bilateral carpal tunnel syndrome in a 7-year-old girl with Hurler’s syndrome

European Journal of Plastic Surgery — Tue, 23 Feb 2010 07:17:37 +0100

Abstract This is a case report of bilateral carpal tunnel syndrome in a 7-year-old girl with Hurler’s syndrome successfully managed with standard carpal tunnel releases. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00238-010-0403-yAuthors Amy J. Greenwood, Frenchay Hospital Department of Plastic and Reconstructive Surgery Bristol UKJacqueline E. Rees-Lee, Frenchay Hospital Department of Plastic and Reconstructive Surgery Bristol UKSimon Lee, Frenchay Hospital Department of Plastic and Reconstructive Surgery Bristol UK Journal European Journal of Plastic SurgeryOnline ISSN 1435-0130Print ISSN 0930-343X (Source: European Journal of Plastic Surgery)

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A new clinical scale to grade the impairment of median nerve in carpal tunnel syndrome.

Clinical Neurophysiology — Tue, 23 Feb 2010 00:00:00 +0100

CONCLUSIONS: The Hi-Ob-Db is a clinical scale which correlates with the neurophysiological impairment of the median nerve and with patient-oriented findings in patients with CTS. SIGNIFICANCE: The new scale may be useful in routine examination and for scientific purposes. PMID: 20185361 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

MR Imaging-related Electrical Thermal Injury Complicated by Acute Carpal Tunnel and Compartment Syndrome: Case Report [MUSCULOSKELETAL IMAGING]

Radiology — Mon, 22 Feb 2010 20:50:31 +0100

Identification bracelets may need to be removed or padded to prevent direct contact with the patient’s skin during MR imaging for patients unable to communicate, such those requiring sedation or general anesthesia. (Source: Radiology)

Endogenous glucocorticoids improve myelination via Schwann cells after peripheral nerve injury: An in vivo study using a crush injury model

Glia — Thu, 18 Feb 2010 00:00:00 +0100

In this study, an adrenalectomy (ADX) was performed, and followed by a daily injection of either low dose (1 mg/kg) or high dose (10 mg/kg) corticosterone (CORT). We then simulated a crush injury of the sciatic nerves. A sham ADX operation, followed by a simulated crush injury, was conducted as a control. Immunohistochemistry showed that the nuclei of in vivo Schwann cells expressed GR and that glucocorticoids impacted the GR immunoreactivity of the Schwann cells. The mRNA and protein expression of myelin basic protein was significantly lower in the animals given ADX with vehicle than in the sham operation group. However, the expression was restored in the low-dose CORT replacement group. Morphological analyses showed that the ADX with vehicle group had a significantly lower myelin thickne...

Dynamic imaging in patients with carpal tunnel syndrome

Clinical Anatomy — Thu, 18 Feb 2010 00:00:00 +0100

No absrtact. (Source: Clinical Anatomy)

Management of Carpal Tunnel Syndrome

Medscape Today Headlines — Wed, 17 Feb 2010 12:04:43 +0100

Learn more about this painful hand condition that so many suffer from. U.S. Pharmacist (Source: Medscape Today Headlines)

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Peripheral neuropathy in patients with primary antiphospholipid (Hughes') syndrome.

Lupus — Mon, 15 Feb 2010 00:00:00 +0100

In conclusion, peripheral neuropathy is a common asymptomatic abnormality in patients with PAPS. The routine performance of NCS may be considered when evaluating such patients. PMID: 20156929 [PubMed - as supplied by publisher] (Source: Lupus)

Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation

Journal of Orthopaedic Science — Fri, 12 Feb 2010 07:23:58 +0100

Abstract The current concepts of carpal tunnel syndrome (CTS) with respect to its pathophysiology, treatment, and evaluation are discussed. With regard to the pathophysiology of idiopathic CTS, biomechanical studies to determine the kinematics of the flexor tendon, and the median nerve inside the carpal tunnel may provide valuable insights. Different degrees of excursion between the flexor tendons and the median nerve could cause strain and microdamage to the synovial tissue; this has been microscopically observed. A biomechanical approach for elucidating the events that trigger the development of CTS seems interesting; however, there are limitations to its applications. Endoscopic carpal tunnel release (ECTR) is a useful technique for achieving median nerve decompression....

Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review

Neurological Sciences — Tue, 09 Feb 2010 17:45:13 +0100

Abstract The carpal tunnel syndrome is a compressive neuropathy with high incidence rates, and its correct diagnosis, treatment and follow-up may lead to significant benefits in healthcare, social and economic terms. In this review, based on systematic review databases and guidelines, we summarise the appropriate indications for the diagnosis, treatment and follow-up, accompanied, whenever possible, by the levels of evidence and strength of recommendations. Content Type Journal ArticleCategory Review ArticleDOI 10.1007/s10072-009-0213-9Authors Calogero Alfonso, Azienda Ospedaliera di Bologna Policlinico S. Orsola-Malpighi U.O. Ortopedia e Traumatologia Via Albertoni, 15 40141 Bologna ItalyStefano Jann, A.O. Ospedale Maggiore Niguarda U.O. Neurologia Piazza Ospedale Maggi...

The perioperative use of oral anticoagulants during surgical procedures for carpal tunnel syndrome. A preliminary study

Acta Neurochirurgica — Sun, 07 Feb 2010 06:56:33 +0100

Conclusion Continuation of anticoagulant treatment is safe for OCTR. The adverse effects of stopping treatment for surgery can be severe. As a result of this study, we have changed our surgery protocol for OCTR and continue anticoagulant treatment perioperatively. Content Type Journal ArticleCategory Clinical ArticleDOI 10.1007/s00701-010-0603-zAuthors R. D. S. Nandoe Tewarie, Radboud University Nijmegen Medical Center Department of Neurosurgery Reinier Postlaan 4 6500HB Nijmegen The NetherlandsR. H. M. A. Bartels, Radboud University Nijmegen Medical Center Department of Neurosurgery Reinier Postlaan 4 6500HB Nijmegen The Netherlands Journal Acta NeurochirurgicaOnline ISSN 0942-0940Print ISSN 0001-6268 (Source: Acta Neurochirurgica)

What Can I Get You Today?

Psychology Today Work Center — Fri, 05 Feb 2010 00:47:06 +0100

The coffee-shop waitress is a classic American icon -- for a reason. Coffeepot in hand, she is a surrogate mother or girlfriend or confidante, servile yet wise and eternal. Sometimes we even see her as a sage. Buzzing hither and yon, bearing sustenance to strangers and regulars, she soothes us -- as if her very presence proves that some things in the world, at least, will never change. But as she dashes and delivers, providing refills, what is she thinking and how does she feel?Candacy Taylor wanted to know. Having waitressed as a grad student several years ago, Taylor -- whom I interviewed recently -- "found the job physically and emotionally draining and couldn't imagine doing it for fifty years," as many career waitresses have done. She assumed that they felt depressed, hopeless and stu...

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Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies

Occupational and Environmental Medicine — Thu, 04 Feb 2010 16:47:12 +0100

Conclusion Our study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first-level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings. (Source: Occupational and Environmental Medicine)

[Carpal tunnel syndrome - modern diagnostic and management.]

Praxis — Wed, 03 Feb 2010 00:00:00 +0100

Authors: Gautschi OP, Land M, Hoederath P, Fournier JY, Hildebrandt G, Cadosch D The carpal tunnel syndrome is the most common entrapment neuropathy (about 3% of the adults are affected). It is characterized by pain and paresthesia along the distribution of the median nerve. Thenar muscle atrophy with corresponding muscle weakness is a late manifestation of advanced disease. Electrophysiological tests are helpful in suggesting the diagnosis. An imaging with a magnetic resonance tomography may be used in the diagnosis of atypical cases. Ergonomic manoeuvres, oral steroids and steroidal injections may alleviate symptoms in mild cases. Surgical decompression of the carpal tunnel is the classical treatment of severe cases as well as for those who do not respond to conservative treatment. A...

Re: Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: Correlation with nerve conduction studies

Journal of Clinical Ultrasound — Tue, 02 Feb 2010 00:00:00 +0100

No abstract. (Source: Journal of Clinical Ultrasound)

Botox Therapy for Ischemic Digits

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: Botox appears to provide improvement in digital perfusion and pain reduction in patients with Raynaud's syndrome when conservative management fails. Summary: Digital ulceration associated with Raynaud's syndrome is painful, difficult to treat, and frequently results in patient debilitation and chronic depression. Reports by Sycha and Van Beek have indicated potential benefit for patients with ischemic digits with local injection of botulinum toxin (Euro J Clin Invest 2004;34:312-3; Plast Reconstr Surg 2007;119:217-26). This was a retrospective observational study on outcomes of 19 patients with Raynaud's syndrome treated with botulinum toxin. All patients had chronic ischemic hand pain, and vascular studies had ruled out proximal occlusive disease and underlying disorders, inc...

Ultrasonographic and functional changes of the ulnar nerve at Guyon’s canal after carpal tunnel release

Clinical Neurophysiology — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: CTR has a significant effect not only on the anatomical geometry of Guyon’s canal, but also on the morphology and function of the ulnar nerve.Significance: In CTS, high pressure in the carpal tunnel may result in anatomical changes of ulnar nerve, thus causing functional impairment to the ulnar fibres. CTR appears to reverse some of this damage. (Source: Clinical Neurophysiology)

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Rate of Infection After Carpal Tunnel Release Surgery and Effect of Antibiotic Prophylaxis

The Journal of Hand Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: The overall infection rate after carpal tunnel release surgery is low. In addition, the deep (organ/space) infection rate is much lower than previously reported. Antibiotic use did not decrease the risk of infection in this study population, including patients with diabetes. The routine use of antibiotic prophylaxis in carpal tunnel release surgery is not indicated. Surgeons should carefully consider the risks and benefits of routinely using prophylactic antibiotics in carpal tunnel release surgery.Type of study/level of evidence: Therapeutic III. (Source: The Journal of Hand Surgery)

Single-Incision Extensile Volar Approach to the Distal Radius and Concurrent Carpal Tunnel Release: Cadaveric Study

The Journal of Hand Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: Carpal tunnel pressure is safely reduced and the distal radius is adequately exposed for fixation with the extensile volar approach. (Source: The Journal of Hand Surgery)

Survey Developed Here at the School of Medicine Finds Surgeons Suffer Occupational Injuries From Minimally Invasive Techniques

University of Maryland School of Medicine News Headlines — Mon, 01 Feb 2010 00:00:00 +0100

University of Maryland survey asked about physical symptoms, discomfort among surgeons Surgeons who engage in minimally invasive, laparoscopic surgery are providing great benefits to their patients, but possibly to their own detriment. That’s the finding of the largest survey ever conducted of surgeons in North America who perform laparoscopic procedures. The survey, developed at the University of Maryland School of Medicine in Baltimore, found that 87 percent of laparoscopic surgeons have experienced physical symptoms or discomfort. This was especially true among those with high case volumes. Previous surveys had found only a 20-30 percent incidence of occupational injury among these surgeons. Results of the survey will appear in the March 2010 Journal of the American College of Surg...

Referring Physicians’ Knowledge of Hand Surgery

Hand — Wed, 27 Jan 2010 19:59:22 +0100

This study evaluates the referring physicians’ knowledge and perceptions of basic hand problems and their treatment. This study also evaluates the impact of a brief lecture on our referring physicians’ understanding of hand issues. A survey instrument was administered to referring physicians. The instrument addressed general hand knowledge and perceptions toward hand surgery. The physicians also attended a lecture on general hand problems and their treatments. The survey was repeated 2 weeks post-lecture. Subjects had a pre-lecture knowledge score of 65% correct and post-lecture a score of 85%, p < 0.05. The participants were knowledgeable about common hand problems, such as carpal tunnel syndrome. Knowledge gaps did exist, for example, only 37% recognized the symptoms of ...

Intraneural blood flow analysis during an intraoperative Phalen's test in carpal tunnel syndrome

Journal of Orthopaedic Research — Wed, 27 Jan 2010 00:00:00 +0100

This study demonstrated that the blood flow in the median nerve is reduced when Phalen's test is performed in vivo. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res (Source: Journal of Orthopaedic Research)

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Acute ophthalmoparesis associated with human parvovirus B19 infection.

European Journal of Ophthalmology — Tue, 26 Jan 2010 00:00:00 +0100

Conclusions. Clinicians should be aware of this possible clinical presentation. PMID: 20155703 [PubMed - as supplied by publisher] (Source: European Journal of Ophthalmology)

Opponensplasty using palmaris longus tendon and flexor retinaculum pulley in patients with severe carpal tunnel syndrome

Archives of Orthopaedic and Trauma Surgery — Fri, 22 Jan 2010 10:08:52 +0100

Conclusion Modified Camitz opponensplasty is a simple procedure that provides immediate improvement of thenar function. Palmar flexion and pronation can be further improved by addition of a pulley. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1053-zAuthors Il-Jung Park, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaHyoung-Min Kim, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaSang-Uk Lee, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaJoo-Yup Lee, Catholic University o...

MR Imaging-related Electrical Thermal Injury Complicated by Acute Carpal Tunnel and Compartment Syndrome: Case Report [MUSCULOSKELETAL IMAGING]

Continuous Publishing articles — Wed, 20 Jan 2010 15:37:29 +0100

Health Tip: Reduce Your Risk of Carpal Tunnel Syndrome

MedlinePlus Health News — Wed, 20 Jan 2010 14:00:00 +0100

Help protect your wrists Source: HealthDay Related MedlinePlus Topic: Carpal Tunnel Syndrome (Source: MedlinePlus Health News)

A rare cause of carpal tunnel syndrome in childhood: Benign recurrent intrahepatic cholestasis

Central European Journal of Medicine — Tue, 19 Jan 2010 17:47:46 +0100

In conclusion, benign recurrent intrahepatic cholestasis can be a rare cause of carpal tunnel syndrome in childhood. We also advocate treating the underlying disease as an appropriate conservative treatment before surgery. Content Type Journal ArticleCategory Case ReportDOI 10.2478/s11536-009-0142-2Authors Necati Balamtekin, Hacettepe University Faculty of Medicine, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition 06100 Ankara TurkeyNuray Uslu, Hacettepe University Faculty of Medicine, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition 06100 Ankara TurkeyCagri Temucin, Hacettepe University Faculty of Medicine, Department of Neurology 06100 Ankara TurkeyHulya Demir, Hacettepe University Faculty of Medicine, Department of Pedi...

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Five-Year Follow-Up of Carpal Tunnel Release in Patients Over Age 65

The Journal of Hand Surgery — Mon, 11 Jan 2010 00:00:00 +0100

Conclusions: Patients who were 65 years of age or older at the time of surgery maintained their clinical improvement for at least 5 years after surgery.Type of study/level of evidence: Therapeutic IV. (Source: The Journal of Hand Surgery)

Course: Carpal Tunnel Syndrome and other causes of hand pain

NHS Evidence - Neurological conditions - Events — Sat, 09 Jan 2010 14:34:57 +0100

(Source: NHS Evidence - Neurological conditions - Events)

Unstable Distal Radius Fractures in the Elderly Patient-Volar Fixed-Angle Plate Osteosynthesis Prevents Secondary Loss of Reduction.

Hand Surgery — Fri, 08 Jan 2010 00:00:00 +0100

CONCLUSION:: Fixed-angle plate osteosynthesis at the distal radius in the elderly patient signifies a significant improvement in the treatment of distal radial fractures in terms of restoration of the shape and function of the wrist associated with a low complication rate. This technique with its simple palmar access, allows exact anatomic reduction of the fracture, allows early return to function, and minimizes morbidity in the elderly patient. Secondary correction loss can be prevented by this procedure. PMID: 20065876 [PubMed - as supplied by publisher] (Source: Hand Surgery)

Celiac Disease Increases Risk of Neurological and Psychiatric Disorders

Medscape Today Headlines — Thu, 07 Jan 2010 23:08:10 +0100

A new study shows that migraine and carpal tunnel syndrome are common among celiac patients and 35% had a history of psychiatric problems. Medscape Medical News (Source: Medscape Today Headlines)

Carpal and Cubital Tunnel Syndrome: Who Gets Surgery?

Clinical Orthopaedics and Related Research — Tue, 05 Jan 2010 00:00:00 +0100

CONCLUSION: Patient age was the most important predictor of surgical release, and among those with multiple neuropathies, male patients were more likely to have surgery than female patients. Patients with Workers Compensation may experience long wait times to surgery. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 20049568 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

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American Academy of Orthopaedic Surgeons Clinical Practice Guideline on The Treatment of Carpal Tunnel Syndrome

JBJS [Am] — Mon, 04 Jan 2010 18:02:21 +0100

(Source: JBJS [Am])

Stonefish envenomation with acute carpal tunnel syndrome. - Ling SK, Cheng SC, Yen CH.

SafetyLit: All (Unduplicated) — Sun, 03 Jan 2010 15:15:30 +0100

Stonefish envenomation is a common marine sting. Although stonefish injuries are commonly sustained during maritime activities, this local delicacy can also be considered a regional occupational hazard for chefs. The availability and consumption of stonefi... (Source: SafetyLit: All (Unduplicated))

Carpal Tunnel Syndrome due to Lipofibromatous Hamartoma of the Median Nerve.

Archives of Iranian Medicine — Fri, 01 Jan 2010 00:00:00 +0100

This report describes a rare case of secondary carpal tunnel syndrome due to a lipofibromatous hamartoma of the median nerve. Excision of the fibrofatty tissue between the nerve fascicles without risking damage to the fascicles was impossible. The transverse carpal ligament was incised and an epineurotomy was performed. Within six months, the 25-year-old female patient's symptoms were much improved. PMID: 20039769 [PubMed - in process] (Source: Archives of Iranian Medicine)

[Correspondence] Surgery versus non-surgical therapy for carpal tunnel syndrome

LANCET — Fri, 01 Jan 2010 00:00:00 +0100

We read the Article by Jeffrey Jarvik and colleagues (Sept 26, p 1074) with great interest. In reference to our randomised controlled trial comparing surgery with steroid injection, Jarvik and colleagues state that outcomes were better with local injections. We would like to comment that, although in our trial patients who had steroid injections did better than those who had surgery at 3 months' follow-up, both types of treatment were equally effective at 6 and 12 months' follow-up. (Source: LANCET)

[Correspondence] Surgery versus non-surgical therapy for carpal tunnel syndrome

LANCET — Fri, 01 Jan 2010 00:00:00 +0100

Jeffrey Jarvik and colleagues provide evidence to support the priority of surgery over medical treatment in patients with carpal tunnel syndrome (CTS). We want to highlight a concern. (Source: LANCET)

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[Correspondence] Surgery versus non-surgical therapy for carpal tunnel syndrome – Authors' reply

LANCET — Fri, 01 Jan 2010 00:00:00 +0100

José-Luis Andréu and Domingo Ly-Pen are correct that patients will differ depending on the referral source. As they point out, our patients were from a mixture of both primary care and specialists. Because we used different measures to assess symptoms and functional status, direct comparison between our patients is difficult. Nonetheless, we can attempt to compare the baseline value of nocturnal paraesthesias, as measured by one of the items in the CTSAQ-symptom scale, to their measure of nocturnal paraesthesias using a visual analogue scale of 0–100. Our mean nocturnal paraesthesia score (four items of the 11-item CTSAQ-symptom scale) was similar (3·0 on a 5-point scale) to the average of their surgery and local steroid injection scores (56·88/100). (Source: LANCET)

American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome.

The Journal of Bone and Joint Surgery. American volume — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Keith MW, Masear V, Chung KC, Amadio PC, Andary M, Barth RW, Maupin K, Graham B, Watters WC, Turkelson CM, Haralson RH, Wies JL, McGowan R, PMID: 20048116 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Suicide inquiry in primary care: creating context, inquiring, and following up.

Annals of Family Medicine — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSION: Although most suicide inquiries by primary care physicians are sensitive, clear, and supportive, some language is used that may inhibit suicide disclosure. Some physician responses may unintentionally reinforce patients for remaining silent about their risk. This study will inform future research in the development of quality improvement interventions to support primary care physicians in making clear, appropriate, and sensitive inquires about suicide. PMID: 20065276 [PubMed - in process] (Source: Annals of Family Medicine)

Management of patients with carpal tunnel syndrome.

Nursing Standard — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Walker JA Carpal tunnel syndrome is an upper limb entrapment neuropathy that can result in motor and sensory disturbance of the median nerve, affecting the hands. Treatment strategies may include the use of night splints, corticosteroid injections or surgical decompression. The aim of this article is to familiarise readers with carpal tunnel syndrome in relation to the relevant anatomy, signs, symptoms and management. PMID: 20175360 [PubMed - in process] (Source: Nursing Standard)

Carpal Tunnel Syndrome

The Journal of Hand Surgery — Mon, 28 Dec 2009 15:18:52 +0100

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the upper extremity. The condition is responsible for substantial annual costs to society, both in terms of lost productivity and the costs of treatment. Accurate diagnostic criteria, the selection of treatment strategies based on high-level evidence, and outcomes data have been inconsistent despite the prevalence of the condition. The increased awareness of the need for evidence-based practice guidelines has, however, yielded important data to guide treatment of CTS. Evidence-based guidelines for diagnosis and treatment have been developed and should direct the treatment of CTS. (Source: The Journal of Hand Surgery)

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Perioperative Antibiotics for Carpal Tunnel Surgery

The Journal of Hand Surgery — Mon, 28 Dec 2009 15:18:47 +0100

A 47-year-old diabetic secretary presents for treatment of numbness, tingling, and nocturnal paresthesias in her right dominant hand that have been present for 3 years. An evaluation including a positive result in a nerve compression test, a positive result in Phalen's test, and decreased sensibility in the median nerve distribution along with electrodiagnostic studies identified carpal tunnel syndrome. Her diabetes is well controlled with diet, and she has no other medical problems. She agrees to your recommendation for right carpal tunnel release. (Source: The Journal of Hand Surgery)

Carpal Tunnel Syndrome: Associations between Risk Factors and Laterality

European Neurology — Tue, 22 Dec 2009 23:00:00 +0100

Eur Neurol 2010;63:43-47 (DOI:10.1159/000268165) (Source: European Neurology)

Health Tip: Risk Factors for Carpal Tunnel Syndrome

Forbes.com Health News — Tue, 22 Dec 2009 14:00:00 +0100

Typical symptoms include pain in the wrist and hand (Source: Forbes.com Health News)

Health Tip: Risk Factors for Carpal Tunnel Syndrome

MedlinePlus Health News — Tue, 22 Dec 2009 14:00:00 +0100

Typical symptoms include pain in the wrist and hand Source: HealthDay Related MedlinePlus Topic: Carpal Tunnel Syndrome (Source: MedlinePlus Health News)

Health Tip: Risk Factors for Carpal Tunnel Syndrome

MedicineNet Chronic Pain General — Tue, 22 Dec 2009 07:00:00 +0100

Title: Health Tip: Risk Factors for Carpal Tunnel SyndromeCategory: Health NewsCreated: 12/22/2009 8:10:00 AMLast Editorial Review: 12/22/2009 (Source: MedicineNet Chronic Pain General)

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Health Tip: Risk Factors for Carpal Tunnel Syndrome

MedicineNet Diabetes General — Tue, 22 Dec 2009 07:00:00 +0100

Title: Health Tip: Risk Factors for Carpal Tunnel SyndromeCategory: Health NewsCreated: 12/22/2009 8:10:00 AMLast Editorial Review: 12/22/2009 (Source: MedicineNet Diabetes General)

Health Tip: Risk Factors for Carpal Tunnel Syndrome

MedicineNet Thyroid General — Tue, 22 Dec 2009 07:00:00 +0100

Title: Health Tip: Risk Factors for Carpal Tunnel SyndromeCategory: Health NewsCreated: 12/22/2009 8:10:00 AMLast Editorial Review: 12/22/2009 (Source: MedicineNet Thyroid General)

Health Tip: Risk Factors for Carpal Tunnel Syndrome

MedicineNet Senior Health General — Tue, 22 Dec 2009 07:00:00 +0100

Title: Health Tip: Risk Factors for Carpal Tunnel SyndromeCategory: Health NewsCreated: 12/22/2009 8:10:00 AMLast Editorial Review: 12/22/2009 (Source: MedicineNet Senior Health General)

Health Tip: Risk Factors for Carpal Tunnel Syndrome

MedicineNet Arthritis General — Tue, 22 Dec 2009 07:00:00 +0100

Title: Health Tip: Risk Factors for Carpal Tunnel SyndromeCategory: Health NewsCreated: 12/22/2009 8:10:00 AMLast Editorial Review: 12/22/2009 (Source: MedicineNet Arthritis General)

MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance

Surgical and Radiologic Anatomy — Mon, 21 Dec 2009 22:59:15 +0100

Conclusion There was a high prevalence of bifid median nerve (19%) and PMA (11%) within the tunnel regardless of gender or age. The PMA was more frequent on the left side. Content Type Journal ArticleCategory Anatomic VariationsDOI 10.1007/s00276-009-0600-1Authors Claude Pierre-Jerome, Emory University School of Medicine Radiology Department, Musculoskeletal Division Atlanta GA USARobert D. Smitson, Emory University School of Medicine Radiology Department, Musculoskeletal Division Atlanta GA USARaj K. Shah, George Washington University School of Medicine Washington DC USAValeria Moncayo, Emory University School of Medicine Radiology Department, Musculoskeletal Division Atlanta GA USAMichael Abdelnoor, Oslo University Hospital Oslo NorwayMichael R. Terk, Emory Universit...

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Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome

Acta Neurochirurgica — Mon, 21 Dec 2009 06:44:31 +0100

Conclusions The endoscopically assisted approach for decompression of the ulnar nerve at the level of the elbow is a minimally invasive technique that demonstrated surgical results similar to those reported via the open approach. It may have additional advantages such as the reduction of soft tissue manipulation, faster mobilization of the arm, and quicker return of the patients to their daily activities. Content Type Journal ArticleCategory Clinical ArticleDOI 10.1007/s00701-009-0578-9Authors Leandro Pretto Flores, Hospital de Base do Distrito Federal Unit of Neurosurgery SQN 208 Bloco F Apartamento 604, Asa Norte Brasília 70853-060 Distrito Federal Brazil Journal Acta NeurochirurgicaOnline ISSN 0942-0940Print ISSN 0001-6268 (Source: Acta Neurochirurgica)

Integrated Approach Assesses Residents' Surgical Ability

Modern Medicine — Mon, 21 Dec 2009 00:00:00 +0100

An integrated approach can effectively assess orthopedic residents' competence in the performance of carpal tunnel release surgery, according to a study in the Dec. 1 issue of the Journal of Bone & Joint Surgery. (Source: Modern Medicine)

Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

The Journal of Hand Surgery — Mon, 21 Dec 2009 00:00:00 +0100

Conclusions: In patients with carpal tunnel syndrome, intracarpal tunnel pressures during active hand use are substantially greater than previously reported. Peak pressures occur at the HH, where the tunnel is most constricted and the median nerve is most compressed in carpal tunnel syndrome.Type of study/level of evidence: Therapeutic IV. (Source: The Journal of Hand Surgery)

Video: Viewers' Medical Questions

Health News: CBSNews.com — Wed, 16 Dec 2009 15:29:01 +0100

Dr. Jennifer Ashton answers viewers' questions about losing weight with nutritional supplements and carpal tunnel syndrome. (Source: Health News: CBSNews.com)

Nerve compression activates selective nociceptive pathways and upregulates peripheral sodium channel expression in Schwann cells

Journal of Orthopaedic Research — Mon, 14 Dec 2009 00:00:00 +0100

Chronic nerve compression (CNC) injuries, such as carpal tunnel syndrome, are common musculoskeletal conditions that affect patients with debilitating loss of sensory function and pain. Although early detection and treatment are important, our understanding of pain-related molecular mechanisms remains largely unclear. Here we investigate these mechanisms using an animal model for CNC injury. To confirm that CNC injury induces pain, we assessed expression of c-fos, a gene that is rapidly expressed in spinal sensory afferents in response to painful peripheral stimuli, and TNF-[alpha] and IL-6, two proinflammatory cytokines that are crucial to development of inflammatory-mediated pain. Results show c-fos upregulation 1-2 weeks postinjury in the absence of TNF-[alpha] or IL-6 expression, indic...

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Severity of carpal tunnel syndrome assessed with high frequency ultrasonography: reply to Karadağ and colleagues

Rheumatology International — Sun, 13 Dec 2009 06:41:23 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00296-009-1298-4Authors Costanza Pazzaglia, Università Cattolica del Sacro Cuore Institute of Neurology L.go F. Vito 1 00168 Rome ItalyLuca Padua, Università Cattolica del Sacro Cuore Institute of Neurology L.go F. Vito 1 00168 Rome Italy Journal Rheumatology InternationalOnline ISSN 1437-160XPrint ISSN 0172-8172 (Source: Rheumatology International)

Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms

Pain — Wed, 09 Dec 2009 00:00:00 +0100

Abstract: Extraterritorial spread of sensory symptoms is frequent in carpal tunnel syndrome (CTS). Animal models suggest that this phenomenon may depend on central sensitization. We sought to obtain psychophysical evidence of sensitization in CTS with extraterritorial symptoms spread. We recruited 100 unilateral CTS patients. After selection to rule out concomitant upper-limb causes of pain, 48 patients were included. The hand symptoms distribution was graded with a diagram into median and extramedian pattern. Patients were asked on proximal pain. Quantitative sensory testing (QST) was performed in the territory of injured median nerve and in extramedian territories to document signs of sensitization (hyperalgesia, allodynia, wind-up). Extramedian pattern and proximal pain were found in 33...

Endoscopic Versus Open Carpal Tunnel Release

Arthroscopy — Mon, 07 Dec 2009 00:00:00 +0100

Conclusions: Endoscopic carpal tunnel release provides a faster recovery to operated patients for the first 2 weeks, with faster relief of pain and faster improvement in functional abilities. Paresthesia and numbness subside in an identical manner with the 2 techniques. At 1 year postoperatively, both open and endoscopic techniques seem to be equivalently efficient.Level of Evidence: Level II, prospective comparative study. (Source: Arthroscopy)

The carpal tunnel.

British Journal of Hospital Medicine — Mon, 07 Dec 2009 00:00:00 +0100

Authors: Ellis H The carpal bones are deeply convex anteriorly. This bony gutter is converted by the flexor retinaculum into a tube - the carpal tunnel, which conveys the median nerve, together with the long flexor tendons of the fingers and thumb, into the hand. It is of special interest to the surgeon because it is the site of a common nerve entrapment, the carpal tunnel syndrome. PMID: 20081627 [PubMed - as supplied by publisher] (Source: British Journal of Hospital Medicine)

Validity and Responsiveness of the Jebsen–Taylor Hand Function Test

The Journal of Hand Surgery — Thu, 03 Dec 2009 00:00:00 +0100

Conclusions: We found poor correlation between the change in JTT and absolute JTT scores after surgery compared with change in MHQ and absolute MHQ scores. In addition, the JTT had poor discriminant validity based on the MHQ as a reference. This study showed that the time to complete activities does not correlate well with patient-reported outcomes. We conclude that the JTT should not be used as a measure of disability or clinical change after surgical intervention.Type of study/level of evidence: Diagnostic III. (Source: The Journal of Hand Surgery)

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Ultrasound Assessment of the Displacement and Deformation of the Median Nerve in the Human Carpal Tunnel with Active Finger Motion

JBJS [Am] — Tue, 01 Dec 2009 18:02:03 +0100

Conclusions: This report presents a method with which to assess displacement and deformation of the median nerve on a cross-sectional ultrasound image during different finger motions. This method may be useful to assess pathological changes within the carpal tunnel, and we plan to perform a similar study of patients with carpal tunnel syndrome on the basis of these preliminary data. Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

Assessment of Technical Skills of Orthopaedic Surgery Residents Performing Open Carpal Tunnel Release Surgery

JBJS [Am] — Tue, 01 Dec 2009 18:02:02 +0100

Conclusions: The results of the present study suggest that both knowledge and cadaver testing discriminate between novice and accomplished residents. However, although failure of the knowledge test can predict failure on technical skills testing, the presence of knowledge does not necessarily ensure successful performance of technical skills, as cognitive testing and technical skills testing are separate domains. (Source: JBJS [Am])

Ultrasound imaging of the carpal tunnel during median nerve compression

Current Reviews in Musculoskeletal Medicine — Tue, 01 Dec 2009 08:43:51 +0100

Abstract Median nerve (MN) compression is a recognized component of carpal tunnel syndrome (CTS). In order to document compressive changes in the MN during hand activity, the carpal tunnel was imaged with neuromuscular ultrasound (NMUS). Ten patients with CTS and five normal controls underwent NMUS of the MN at rest and during dynamic stress testing (DST). DST maneuvers involve sustained isometric flexion of the distal phalanges of the first three digits. During DST in the CTS patients, NMUS demonstrated MN compression between the contracting thenar muscles ventrally and the taut flexor tendons dorsally. The mean MN diameter decreased nearly 40%, with focal narrowing in the mid-distal carpal canal. Normal controls demonstrated no MN compression and a tendency towards MN en...

Ultrasound assessment of the displacement and deformation of the median nerve in the human carpal tunnel with active finger motion.

The Journal of Bone and Joint Surgery. American volume — Tue, 01 Dec 2009 00:00:00 +0100

CONCLUSIONS: This report presents a method with which to assess displacement and deformation of the median nerve on a cross-sectional ultrasound image during different finger motions. This method may be useful to assess pathological changes within the carpal tunnel, and we plan to perform a similar study of patients with carpal tunnel syndrome on the basis of these preliminary data. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence. PMID: 19952256 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Assessment of technical skills of orthopaedic surgery residents performing open carpal tunnel release surgery.

The Journal of Bone and Joint Surgery. American volume — Tue, 01 Dec 2009 00:00:00 +0100

CONCLUSIONS: The results of the present study suggest that both knowledge and cadaver testing discriminate between novice and accomplished residents. However, although failure of the knowledge test can predict failure on technical skills testing, the presence of knowledge does not necessarily ensure successful performance of technical skills, as cognitive testing and technical skills testing are separate domains. PMID: 19952242 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

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Effect of Hand Warming on Electrodiagnostic Testing Results and Diagnosis in Patients With Suspected Carpal Tunnel Syndrome

Archives of Physical Medicine and Rehabilitation — Tue, 01 Dec 2009 00:00:00 +0100

Conclusions: Hand warming using a heating pad for 20 minutes increases median nerve transcarpal tunnel conduction velocity and reduces amplitude. These phenomena introduce potential sources of diagnostic error, particularly in borderline cases. Generally, within hand, between nerve, and within nerve comparison techniques are less susceptible to the conduction velocity effects of warming. (Source: Archives of Physical Medicine and Rehabilitation)

Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

The Journal of Hand Surgery — Tue, 01 Dec 2009 00:00:00 +0100

Peripheral compression neuropathies are familiar to the hand surgeon. Although compression neuropathies of the forearm are far less common than those of the wrist (namely, carpal tunnel syndrome), for the patient suffering from one of these neuropathies, a missed diagnosis has far-reaching consequences. In this 2-part review (I: Radial Nerve; II: Median Nerve), several compression neuropathies of the forearm are examined. We will first discuss compression neuropathies affecting the radial nerve: (1) posterior interosseous nerve syndrome, (2) radial tunnel syndrome, and (3) superficial radial nerve compression (Wartenberg's syndrome). (Source: The Journal of Hand Surgery)

Unusual Compression Neuropathies of the Forearm, Part II: Median Nerve

The Journal of Hand Surgery — Tue, 01 Dec 2009 00:00:00 +0100

We have previously discussed compression neuropathies of the radial nerve in the forearm. In the second half of this 2-part review, we will now turn our attention to 2 compression neuropathies affecting the proximal median nerve, before its entry through the carpal tunnel: (1) pronator syndrome and (2) anterior interosseous nerve syndrome. (Source: The Journal of Hand Surgery)

Stonefish envenomation with acute carpal tunnel syndrome.

Hong Kong Med J — Tue, 01 Dec 2009 00:00:00 +0100

Authors: Ling SK, Cheng SC, Yen CH Stonefish envenomation is a common marine sting. Although stonefish injuries are commonly sustained during maritime activities, this local delicacy can also be considered a regional occupational hazard for chefs. The availability and consumption of stonefish in local restaurants has increased the risk of acute carpal tunnel syndrome after a stonefish injury. This case report describes acute carpal tunnel syndrome following stonefish envenomation. An excellent recovery was achieved after surgical decompression of the carpal tunnel syndrome. Standard management of stonefish injuries should therefore take into account the possibility that this orthopaedic emergency may complicate the injury. PMID: 19966353 [PubMed - in process] (Source: Hong Kong Med...

Ultrasonographic and functional changes of the ulnar nerve at Guyon's canal after carpal tunnel release.

Clinical Neurophysiology — Sat, 28 Nov 2009 00:00:00 +0100

CONCLUSIONS: CTR has a significant effect not only on the anatomical geometry of Guyon's canal, but also on the morphology and function of the ulnar nerve. SIGNIFICANCE: In CTS, high pressure in the carpal tunnel may result in anatomical changes of ulnar nerve, thus causing functional impairment to the ulnar fibres. CTR appears to reverse some of this damage. PMID: 19948426 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

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Correlation between the combined sensory index and clinical outcome after carpal tunnel decompression: A retrospective review

Muscle and Nerve — Wed, 25 Nov 2009 00:00:00 +0100

The objective of this study was to examine the association between the CSI and symptom relief from pain and parasthesiae following surgical intervention. Retrospective chart review was performed on 272 patients, diagnosed with carpal tunnel syndrome by electrodiagnostic criteria, who proceeded to undergo open or endoscopic carpal tunnel release with postoperative follow-up at an academic medical center between 1996 and 2006. The CSI demonstrated statistical significance (P = 0.03) for correlation with resolution of pain and parasthesiae following carpal tunnel decompression. Patients with a CSI of 2.5-4.6 had the best prognosis for resolution of pain and parasthesiae following surgical intervention. Median compound muscle action potential (CMAP) amplitude and median motor latency were also...

A prospective study of prognostic factors for duration of sick leave after endoscopic carpal tunnel release

BioMed Central — Sun, 22 Nov 2009 00:00:00 +0100

Conclusion: Preoperative sick leave, blaming oneself for the hand problem, and a preoperative distal nerve conduction motor latency were prognostic factors for postoperative work absence of more than 21 days. Other factors may be important (clinical, demographic, economic, and workplace) in explaining the great variance in the results of sick leave after carpal tunnel release between studies from different countries. (Source: BioMed Central)

Gabapentin in carpal tunnel patients: A consideration

Neurology India — Fri, 20 Nov 2009 14:36:08 +0100

Wiwanitkit VirojNeurology India 2009 57(5):690-690 (Source: Neurology India)

Genes and Jobs

Psychology Today Work Center — Tue, 17 Nov 2009 20:49:36 +0100

The Genetic Non-Discrimination Act (GINA) comes into full effect this Saturday, November 21st. Employers need to take note, and employees should be aware of their rights.Congress passed GINA almost unanimously, and President Bush signed it on May 21, 2008. Described by the late Senator Ted Kennedy as "the first civil rights bill of the new century of the life sciences," GINA protects individuals from genetic information discrimination in health insurance and employment. A detailed description can be found here.Even some well-informed commentators seem to have missed this landmark piece of legislation. So have some employers. The University of Akron (UA), for example, adopted a policy as recently as August that could require any candidate for employment to submit a DNA sam...

Comparative study of carpal tunnel compliance in the human, dog, rabbit, and rat

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

The purpose of this study was to measure the compliance of the carpal tunnel in candidate animal models of carpal tunnel syndrome (CTS), by measuring the resistance when passing a tapered metal rod through the carpal tunnel. Forepaws from 10 dogs, 10 rabbits, and 10 rats with intact carpal tunnels, and 10 fresh frozen human wrist cadavers were used. The slopes of the linear part of the force-displacement curve (a measure of stiffness), normal force, and increasing area ratio (InAR) were significantly different among the four species (p < 0.05). Post hoc analysis indicated that the mean slopes for the human carpal tunnel were the largest, indicating the least compliance, whereas those of the rat were the least (p < 0.05). The features of the compliance for the dog carpal tunnel were closest...

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The illusion of severe carpal tunnel syndrome (CTS)

Muscle and Nerve — Fri, 13 Nov 2009 00:00:00 +0100

In this report we present a young woman with mild bilateral CTS, based on electrophysiological studies, in whom marked thenar atrophy was on a congenital basis related to the VATER association (vertebral anomalies, anal atresia, tracheoesophageal fistula, and radial or renal abnormalities). Muscle Nerve, 2010 (Source: Muscle and Nerve)

Ischaemic sensitivity of axons in carpal tunnel syndrome

Journal of the Peripheral Nervous System — Tue, 10 Nov 2009 00:00:00 +0100

Although carpal tunnel syndrome (CTS) is the most common human entrapment neuropathy characterized by paraesthesiae and numbness with nocturnal exacerbation, the mechanisms underlying the generation of these symptoms remain unclear. Consequently, the aim of the present study was to investigate the relationship between changes in axonal excitability and the development of neurological symptoms in response to an ischaemic insult in CTS patients. Sensory and motor excitability were measured in 10 CTS patients and compared with 10 healthy controls, with participants asked to report symptom generation and intensity during the development of limb ischaemia. To induce ischaemia, a sphygmomanometer was inflated above the elbow and maintained at 200 mmHg for 10 min. During ischaemia there were decr...

Hand Syndromes Associated with Diabetes: Impairments and Obesity Predict Disability.

J Rheumatol — Mon, 02 Nov 2009 00:00:00 +0100

CONCLUSION: In adults with hand syndromes associated with diabetes, disability was related to impaired muscle function and carpal tunnel syndrome. Obesity and overall physical functioning influenced hand disability, particularly in women. PMID: 19884270 [PubMed - as supplied by publisher] (Source: J Rheumatol)

Original paper Comparison of the diagnostic value of ultrasonography and neurography in carpal tunnel syndrome

Fri, 30 Oct 2009 14:29:32 +0100

Conclusions: Ultrasonographic findings correlate well with electrophysiological tests in CTS patients. Cross-sectional area equal to 0.1 cm2 is important in CTS diagnostics. Median nerve oedema, revealed in the early stage of CTS without any electrophysiological changes, might be an important factor in occurrence of subjective complaints. Radial slide of median nerve phenomenon is a common ultrasonographic finding in CTS. (Source: Articles of Polish Journal of Neurology and Neurosurgery - TERMEDIA publishing house)

Unusual Charcot-Marie-Tooth phenotype due to a mutation within the intracellular domain of myelin protein zero

Muscle and Nerve — Fri, 30 Oct 2009 00:00:00 +0100

We report a family with a missense mutation, c.700G>T p.Asp234Tyr (deviant nomenclature: c.670G>T, p.Asp224Tyr), within the intracellular domain of myelin protein zero, who has distal sensorimotor symptoms, cramps, restless legs syndrome, neuropathic pain, and carpal tunnel syndrome. The index patient responded to intravenous immunoglobulin and immunosuppression, so there may be a possible secondary autoimmune process, probably triggered by altered antigen presentation due to mutated MPZ protein. Muscle Nerve, 2009 (Source: Muscle and Nerve)

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[Carpal tunnel release: avoiding complications.]

Revista de Neurologia — Thu, 29 Oct 2009 21:08:43 +0100

Authors: Arrotegui I PMID: 19859882 [PubMed - in process] (Source: Revista de Neurologia)

Weight Loss Improves Carpal Tunnel Syndrome in Obese Patients

Medscape Medical News Headlines — Thu, 29 Oct 2009 15:58:16 +0100

Obesity has been linked to an increased prevalence of carpal tunnel syndrome, and now new findings indicate that massive weight loss can improve symptoms in affected patients. Reuters Health Information (Source: Medscape Medical News Headlines)

Work-related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost work

American Journal of Industrial Medicine — Wed, 28 Oct 2009 00:00:00 +0100

Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability.This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n = 8,224) filed during 1990-1994 (followed through 2000) and receiving lost-work compensation.Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P < 0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS condit...

Weight Loss Can Shed Pounds And Carpal Tunnel

ScienceDaily Headlines — Tue, 27 Oct 2009 00:00:00 +0100

A new study investigating the relationship between obesity and carpal tunnel suggests that massive weight loss alone may provide a cure for the syndrome. (Source: ScienceDaily Headlines)

Digital ulcers as the first manifestation of carpal tunnel syndrome

Rheumatology International — Fri, 23 Oct 2009 18:53:02 +0100

We report of a case of severe bilateral medial nerve palsy, presented to us for diagnosis of chronic digital ulcers which had been suspected to be rheumatologic in origin. Careful examination revealed an unusual case of CTS in an advanced stage, which presented itself with skin changes only, lacking all the typical neurologic symptoms or rheumatologic background. Our case stresses the importance for rheumatologists to be aware of the ulcerative form of CTS as one of the etiologic differential diagnostic options of digital ulcers. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00296-009-1229-4Authors Katja Perdan-Pirkmajer, University Medical Centre Department of Rheumatology Vodnikova 62 1000 Ljubljana SloveniaSonja Praprotnik, University Medical Centre Department of...

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Limited economic evaluation to assess the effectiveness of a university-wide office ergonomics program.

Applied Ergonomics — Fri, 23 Oct 2009 00:00:00 +0100

The objective of this research was to evaluate the effectiveness and provide a limited economic evaluation of an office ergonomics program at a major university from 1995 to 2007. The relationship between office-related recordable injuries, reported lost time, severity of these injuries, and the Workers' Compensation (WC) paid was analyzed and the corresponding incident cost was calculated. Two major datasets analyzed were OSHA 200/300 logs (1991-2007) and WC claims paid (1999-2007). Since the beginning of the office ergonomics program in 1995 and through 2007 (13-year period), the number of office cumulative trauma disorder (CTD) cases decreased by 53%. Since the official start (in 1999) of a 50-50 cost share agreement for office equipment purchases between the university's Safety and Hea...

Joint contractures in the absence of inflammation may indicate mucopolysaccharidosis

Pediatric Rheumatology — Thu, 22 Oct 2009 23:00:00 +0100

Background: Undiagnosed patients with the attenuated form of mucopolysaccharidosis (MPS) type I often have joint symptoms in childhood that prompt referral to a rheumatologist. A survey conducted by Genzyme Corporation of 60 European and Canadian rheumatologists and pediatric rheumatologists demonstrated that < 20% recognized signs and symptoms of MPS I or could identify appropriate diagnosis tests. These results prompted formation of an international working group of rheumatologists, pediatric rheumatologists, and experts on MPS I to formulate a rheumatology-based diagnostic algorithm. The resulting algorithm applies to all MPS disorders with musculoskeletal manifestations.Bone and joint manifestations are prominent among most patients with MPS disorders. These life-threatening lysosomal ...

Koilonychia in carpal-tunnel syndrome

Clinical And Experimental Dermatology — Thu, 22 Oct 2009 23:00:00 +0100

(Source: Clinical And Experimental Dermatology)

Inter- and Intraobserver Reliability of Predefined Diagnostic Levels in High-Resolution Sonography of the Carpal Tunnel Syndrome - a Validation Study on Healthy Volunteers.

Ultraschall in der Medizin — Tue, 20 Oct 2009 23:00:00 +0100

CONCLUSION: To use high-resolution ultrasound for the diagnosis of carpal tunnel syndrome, the reproducibility of this method has to be evaluated. Our study confirms examiner-independent reproducibility of two predefined diagnostic cross-sectional areas resulting in good alpha values. PMID: 19847740 [PubMed - as supplied by publisher] (Source: Ultraschall in der Medizin)

Neurological symptoms in patients with biopsy proven celiac disease

Movement Disorders — Mon, 19 Oct 2009 23:00:00 +0100

In celiac disease (CD), the gut is the typical manifestation site but atypical neurological presentations are thought to occur in 6 to 10% with cerebellar ataxia being the most frequent symptom. Most studies in this field are focused on patients under primary neurological care. To exclude such an observation bias, patients with biopsy proven celiac disease were screened for neurological disease. A total of 72 patients with biopsy proven celiac disease (CD) (mean age 51 ± 15 years, mean disease duration 8 ± 11 years) were recruited through advertisements. All participants adhered to a gluten-free diet. Patients were interviewed following a standard questionnaire and examined clinically for neurological symptoms. Medical history revealed neurological disorders such as migraine (28%), carpa...

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Sonographic and Electrodiagnostic Evaluations in Patients With Aromatase Inhibitor-Related Arthralgia [Breast Cancer]

Journal of Clinical Oncology — Fri, 16 Oct 2009 22:02:50 +0100

Conclusion Patients with AI-related arthralgia often show tenosynovial changes suggesting tenosynovitis, exerting local problems but lacking a systemic inflammatory component. Our finding of increased CTS frequency also supports this hypothesis. (Source: Journal of Clinical Oncology)

Aromatase Inhibitor-Induced Carpal Tunnel Syndrome: Results From the ATAC Trial [Breast Cancer]

Journal of Clinical Oncology — Fri, 16 Oct 2009 22:02:50 +0100

Conclusion Although the use of anastrozole is associated with a greater incidence of CTS, it is rare, and most cases were of mild to moderate intensity and short duration. CTS has little impact on the overall risk-to-benefit ratio for the use of anastrozole in postmenopausal women with early breast cancer. (Source: Journal of Clinical Oncology)

Management of Neuropathic Pain in Dialysis Patients: An Effective Approach with Gabapentin

Dialysis and Transplantation — Thu, 15 Oct 2009 23:00:00 +0100

In this study, we administered gabapentin, a novel antiepileptic drug which is excreted at 98% unaltered by the kidneys, to 7 hemodialysis patients (4 female, 3 male) from 65 to 75 years of age and at 65 to 70 kg of body weight who suffered from restless legs syndrome (4 patients), pruritus (1 patient), neuralgia (1 patient), and carpal tunnel syndrome (1 patient). Recommended dosing with adjustments for the degree of kidney failure provoked severe somnolence and dizziness affecting all patients. On an "observe and treat" basis, we determined the optimum dose was 50% lower than the suggested dose. Patients responded rapidly with significant improvement on the lower dose schedule. A follow-up period of 8 to 32 months confirmed the good outcome. We determine that administration of gabapentin...

Speckle Tracking Ultrasound for Assessment of the Relative Motion of Flexor Tendon and Subsynovial Connective Tissue in the Human Carpal Tunnel

Ultrasound in Medicine and Biology — Thu, 15 Oct 2009 00:00:00 +0100

The objective of this study was to compare tissue Doppler imaging and speckle tracking ultrasound to assess the relative motion of flexor tendon and surrounding subsynovial connective tissue (SSCT). Twenty normal human wrists were imaged with an ultrasound scanner. The two ultrasound methods measured the excursion and maximum velocity of the tendon and SSCT while subjects gripped three different sized acrylic tubes and these were correlated with tendon excursions estimated from finger joint angle changes. The maximum velocity ratio (=SSCT/tendon velocity) and the shear index (=[(Tendon excursion–SSCT excursion)/Tendon excursion]×100%) were calculated. The intraclass correlation coefficient was higher for joint angle/speckle tracking tendon excursion (0.642) than for joint angle/tissue D...

[Median nerve compression neuropathies: Struthers ligament and carpal tunnel.]

Anales de Pediatria — Tue, 13 Oct 2009 23:00:00 +0100

Authors: Escámez Pérez A, Salcedo Cánovas C, Alarcón Zamora A, Martínez Herrada J PMID: 19836320 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

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Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes.

European Journal of Internal Medicine — Tue, 13 Oct 2009 20:02:11 +0100

CONCLUSION: Upper limb locomotor abnormalities are very common in diabetes and are associated with worse glycaemic control and more diabetic complications. Assessment of upper limb locomotor disease in diabetes should include an estimate of glycaemic control and a search for other complications. PMID: 19818294 [PubMed - as supplied by publisher] (Source: European Journal of Internal Medicine)

Surgery for Carpal Tunnel Syndrome Modestly Better Than Nonsurgical Management

AccessMedicine Updates — Fri, 09 Oct 2009 03:30:01 +0100

(Source: AccessMedicine Updates)

Are You At Risk For Carpal Tunnel Syndrome?

ScienceDaily Headlines — Wed, 07 Oct 2009 15:00:00 +0100

If you are experiencing pain in your arms, based on individual risk factors, there may be an increased likelihood you are suffering from carpal tunnel syndrome. According to researchers, certain factors can play a role in your prevalence to developing this painful syndrome. (Source: ScienceDaily Headlines)

The Clinical Application of Kaplan’s Cardinal Line as a Surface Marker for the Superficial Palmar Arch

Hand — Tue, 06 Oct 2009 12:50:45 +0100

Abstract We feel the original description of Kaplan’s cardinal line provides a more accurate reference point to the superficial palmar arterial arch. We sought to anatomically correlate the relationship of Kaplan’s cardinal line to the superficial palmar arch. Sixty hands (30 cadavers) were dissected after Kaplan’s original description was drawn on each hand. Measurements we made from Kaplan’s cardinal line to the superficial palmar arch at both the radial and ulnar borders of the ring finger. The superficial palmar arterial arch was an average of 10.4 and 11.8 mm from the radial and ulnar borders of the ring finger with standard deviations of roughly 4 mm for each measurement. Clinically, Kaplan’s cardinal line is a more predictable landmark for the su...

Carpal Tunnel Syndrome Shows Improvement Following Bariatric Surgery

Health News from Medical News Today — Tue, 06 Oct 2009 07:00:00 +0100

As bariatric surgical procedures (BSPs), or weight loss surgeries, have become increasingly common, so have their associated neurological complications. However, for patients with a pre-surgical diagnosis of carpal tunnel syndrome (CTS), the benefits of the bariatric surgery may actually help improve the painful symptoms of CTS. (Source: Health News from Medical News Today)

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Are You At Risk For Carpal Tunnel Syndrome?

Health News from Medical News Today — Tue, 06 Oct 2009 07:00:00 +0100

If you are experiencing pain in your arms, based on individual risk factors, there may be an increased likelihood you are suffering from carpal tunnel syndrome (CTS). According to a team of researchers, certain factors can play a role in your prevalence to developing this painful syndrome. (Source: Health News from Medical News Today)

Clinical Reasoning: A 54-year-old woman with hand dysesthesia: Many dimensions to a common problem

Neurology — Mon, 05 Oct 2009 20:01:33 +0100

(Source: Neurology)

Ulnar nerve paresis secondary to lunate dislocation

European Journal of Plastic Surgery — Sat, 03 Oct 2009 06:36:30 +0100

We present the second reported case of ulnar nerve paresis secondary to lunate dislocation resulting from a wrist hyperextension injury. Early open reduction and screw fixation lead to rapid resolution of symptoms. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00238-009-0360-5Authors Zakir Shariff, Pinderfield General Hospital Wakefield EnglandChika Edward Uzoigwe, Pinderfield General Hospital Wakefield EnglandFulvio Urso-Baiarda, Pinderfield General Hospital Wakefield EnglandAjit Shetty, Pinderfield General Hospital Wakefield England Journal European Journal of Plastic SurgeryOnline ISSN 1435-0130Print ISSN 0930-343X (Source: European Journal of Plastic Surgery)

Surgery Provides Modest Benefit for Carpal Tunnel Syndrome

Medscape Today Headlines — Fri, 02 Oct 2009 18:23:17 +0100

A new trial shows that surgery can be useful for patients with carpal tunnel syndrome and no denervation. Medscape Medical News (Source: Medscape Today Headlines)

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on. Diagnosis of Carpal Tunnel Syndrome

JBJS [Am] — Thu, 01 Oct 2009 17:01:57 +0100

(Source: JBJS [Am])

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Quadrature radio frequency coil for magnetic resonance imaging of the wrist at 4T

Concepts in Magnetic Resonance Part B: Magnetic Resonance Engineering — Thu, 01 Oct 2009 00:00:00 +0100

A magnetic resonance imaging (MRI) quadrature transmit/receive radio frequency (RF) coil for the purpose of imaging the human wrist in high resolution is outlined. The proposed design is used in a nonconventional manner within the bore of the MRI scanner. Due to restrictions of field linearity, space, and patient comfort, it was deemed necessary to design a coil that can be placed above the head with the arm aligned in the transverse plane of the magnet. This configuration allows the placement of the coil to be near the isocenter of the magnet, away from static field impurities. The RF wrist coil was built and a phantom study was conducted to establish signal-to-noise (SNR) performance and coil uniformity. Our design resulted in a peak SNR of 150 and sufficient uniformity for our applicati...

Cubital Tunnel Syndrome-Surgical Treatment Techniques

Operative Techniques in Orthopaedics — Thu, 01 Oct 2009 00:00:00 +0100

Cubital tunnel syndrome is the second most common nerve compression in the upper extremity after carpal tunnel syndrome (CTS). There are multiple surgical options to treat cubital tunnel syndrome with no one treatment proving superior. The options include in situ decompression with or without medial epicondylectomy, endoscopic decompression, and subcutaneous, intramuscular, or submuscular transposition. The surgical techniques as well as specific pearls and pitfalls, relevant anatomy, diagnosis, and conservative treatment will be reviewed. (Source: Operative Techniques in Orthopaedics)

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on diagnosis of carpal tunnel syndrome.

The Journal of Bone and Joint Surgery. American volume — Wed, 30 Sep 2009 23:00:00 +0100

Authors: Keith MW, Masear V, Chung KC, Maupin K, Andary M, Amadio PC, Watters WC, Goldberg MJ, Haralson RH, Turkelson CM, Wies JL, McGowan R PMID: 19797585 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

A randomized sham-controlled trial of a neurodynamic technique in the treatment of carpal tunnel syndrome.

Physical Therapy — Wed, 30 Sep 2009 23:00:00 +0100

CONCLUSION: The sham intervention was successful in blinding the participants. Immediate changes in pain sensitivity and intensity and 3-week changes in clinical pain intensity and upper extremity disability associated with NDT were equivalent to a sham intervention to which the participants were adequately blinded. Conversely, reduction of temporal summation was only observed in participants receiving the NDT, suggesting the potential of a favorable neurophysiological effect. LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2009;39(10):709-723. doi:10.2519/jospt.2009.3117. PMID: 19801812 [PubMed - in process] (Source: Physical Therapy)

Unilateral carpal tunnel syndrome caused by an occult palmar lipoma.

Orthopedics — Wed, 30 Sep 2009 23:00:00 +0100

This article presents 2 cases of patients with occult deep palmar lipomas compressing the median nerve and causing unilateral symptoms of carpal tunnel syndrome. We stress the importance of imaging studies in patients with unilateral symptoms that are usually not used in carpal tunnel syndrome. While both patients' symptomatic hands showed severe neurophysiologic impairment, the contralateral hands were totally intact, which is contradictory with a long history. The reported patients were evaluated and magnetic resonance images revealed intra-tunnel lesions. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. Since the thick palmar fascia is strong, a deep lipoma may not be recognized although nerve compression symptoms m...

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Surgeon bias in the medical record.

Orthopedics — Wed, 30 Sep 2009 23:00:00 +0100

This study was designed to determine if hand surgeons introduce selective bias into the medical record. Fifty consecutive new patients were referred to a hand surgery practice for presumed carpal tunnel syndrome. Forty-four patients were diagnosed with carpal tunnel syndrome and were eligible for study inclusion. Prior to evaluation, all patients wrote in free-response fashion and diagrammed their symptom quality and location. Surgeon dictations from these visits were then evaluated against the patients' self-reported symptomatology. Statistical analysis was performed to determine if specific symptom types and locations were preferentially omitted from medical records. The surgeons' records most closely replicated patients' self-reported diminished sensibility in the thumb, index, and midd...

Double- versus single-incision technique for open carpal tunnel release.

Orthopedics — Wed, 30 Sep 2009 23:00:00 +0100

Authors: Hamed AR, Makki D, Chari R, Packer G A prospective, randomized, controlled trial was performed comparing the double incision technique to the conventional open method used in carpal tunnel decompression surgery, with pillar pain, scar sensitivity, and recovery of grip strength each assessed independently. Forty patients (40 hands) were operated on, 21 hands with the standard single-incision technique and 19 hands with the double-incision technique. Patients were assessed throughout 6 months of follow-up. The results showed that the double-incision technique caused less pillar pain and scar sensitivity compared to the single-incision technique. No difference in recovery of grip strength was noted between the 2 techniques. The limited open technique using the double incision in ...

Scratch Collapse Test for the Evaluation of Carpal and Cubital Tunnel Syndrome

Journal of Hand Therapy — Wed, 30 Sep 2009 23:00:00 +0100

In this study, the positive predictive value for all tests was high for CTS, with the SCT having the highest value (99%) followed by wrist flexion/nerve compression (98%) and Tinel's (96%). Negative predictive values were highest for the SCT (73%) followed by wrist flexion/nerve compression (65%) and Tinel's (59%). For CuTS, the SCT had the highest positive predictive value (99%), followed by Tinel's (98%), and elbow flexion/nerve compression (96%). Negative value, however, was highest for Tinel's (98%), followed by the SCT (86%) and elbow flexion/nerve compression (78%).Data analysis showed that the SCT was reproducible, with excellent inter-rater reliability, and had higher sensitivity than the other tests performed, for both CTS and CuTS. The accuracy rate was 82% for diagnosing CTS an...

A Randomized Sham-Controlled Trial of a Neurodynamic Technique in the Treatment of Carpal Tunnel Syndrome

The Journal of Orthopaedic and Sports Physical Therapy — Wed, 30 Sep 2009 05:00:00 +0100

CONCLUSION: The sham intervention was successful in blinding the participants. Immediate changes in pain sensitivity and intensity and 3-week changes in clinical pain intensity and upper extremity disability associated with NDT were equivalent to a sham intervention to which the participants were adequately blinded. Conversely, reduction of temporal summation was only observed in participants receiving the NDT, suggesting the potential of a favorable neurophysiological effect. LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2009;39(10):709-723. doi:10.2519/jospt.2009.3117 KEY WORDS: central sensitization, manual therapy, musculoskeletal pain, placebo (Source: The Journal of Orthopaedic and Sports Physical Therapy)

Brief Post Surgical Electrical Stimulation Accelerates Axon Regeneration and Muscle Reinnervation Without Affecting the Functional Measures in Carpal Tunnel Syndrome Patients.

Experimental Neurology — Tue, 29 Sep 2009 23:00:00 +0100

Authors: Gordon T, Amirjani N, Edwards DC, Chan KM Electrical stimulation (ES) of injured peripheral nerves accelerates axonal regeneration in laboratory animals. However, clinical applicability of this intervention has never been investigated in human subjects. The aim of this pilot study was to determine the effect of ES on axonal regeneration after surgery in patients with median nerve compression in the carpal tunnel causing marked motor axonal loss. A randomized control trial was conducted to provide proof of principle for ES-induced acceleration of axon regeneration in human patients. Carpel tunnel release surgery (CTRS) was performed and in the stimulation group of patients, stainless steel electrode wires placed alongside the median nerve proximal to the surgical decompression ...

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Surgery Modestly Better Than Nonsurgical Treatments for Carpal Tunnel Syndrome

Physician's First Watch current issue — Sun, 27 Sep 2009 23:00:00 +0100

(Source: Physician's First Watch current issue)

WATCH: A Look at Carpel Tunnel

ABC News: Health — Sat, 26 Sep 2009 01:41:50 +0100

(Source: ABC News: Health)

Surgery provides modest benefit over non-surgical treatment for patients with carpal tunnel syndrome

uwnews.org | Health and Medicine — Fri, 25 Sep 2009 15:04:08 +0100

While surgery for carpal tunnel syndrome in patients without an indication of severe nerve damage (denervation) provides better outcomes than non-surgical treatment, the clinical relevance of this difference is modest. The findings of this comparative effectiveness research are reported in this week's Surgery Special Issue of The Lancet, written by Dr. Jeffrey Jarvik, professor of radiology and neurosurgery at the University of Washington and director of the Comparative Effectiveness, Cost and Outcomes Research Center at UW. (Source: uwnews.org | Health and Medicine)

Carpal Tunnel Syndrome: Modest Benefit Of Surgery Compared To Non-Surgical Treatment

Health News from Medical News Today — Fri, 25 Sep 2009 07:00:00 +0100

An article in this week's Surgery Special Issue of The Lancet reports that surgery for carpal tunnel syndrome in patients (without an indication of severe nerve damage known as denervation) provides better outcomes than non-surgical treatment. However, the clinical relevance of this difference is modest. (Source: Health News from Medical News Today)

Minimally invasive carpal tunnel release.

The Orthopedic Clinics of North America — Thu, 24 Sep 2009 23:44:43 +0100

Authors: Cellocco P, Rossi C, El Boustany S, Di Tanna GL, Costanzo G We prospectively compared the safety and effectiveness of mini-incision (group A) and a limited open technique (group B) for carpal tunnel release (CTR) in 185 consecutive patients operated between November 1999 and May 2001, with a 5-year minimum follow-up. Patients in Group A had a minimally invasive approach (<2 cm incision), performed using the KnifeLight (Stryker, Kalamazoo, Michigan) instrument. Patients in Group B had a limited longitudinal incision (3-4 cm). Patient status was evaluated with an Italian modified version of the Boston Carpal Tunnel questionnaire, administered preoperatively and at 19, 30, and 60 postoperative months. Mini-incision CTR showed advantages over standard technique in early recover...

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Surgery Best for Carpal Tunnel Syndrome

MedlinePlus Health News — Thu, 24 Sep 2009 23:00:00 +0100

Operation has modest advantage over non-surgical therapies, researchers say Source: HealthDay Related MedlinePlus Topic: Carpal Tunnel Syndrome (Source: MedlinePlus Health News)

[Editorial] Surgical research: the reality and the IDEAL

LANCET — Thu, 24 Sep 2009 23:00:00 +0100

The Lancet today is about surgery, but it is not just for surgeons. The issue addresses quality, innovation, and evaluation. These themes are taken up in a three-part Series from the Balliol Colloquia that introduces a framework for advancing surgical knowledge by translating innovations into practice. The need for standardised definitions and metrics is discussed by The Safe Surgery Saves Lives Measurement and Study Group. Two studies show the value of randomised controlled trials (RCTs) to inform surgical practice. Jeffrey Jarvik and colleagues compare complex non-surgical and surgical interventions for carpal tunnel syndrome, and Thomas Santarius and co-workers shine new light on one of the oldest surgical procedures—trephining. (Source: LANCET)

[Comment] Non-surgical treatment in carpal tunnel syndrome

LANCET — Thu, 24 Sep 2009 23:00:00 +0100

Carpal tunnel syndrome is a common cause of disabling hand symptoms. Patients seeking treatment are offered surgery or various non-surgical therapies. In the UK, 31% of patients newly presenting in primary care with carpal tunnel syndrome in 2000 were treated surgically. In a US population, the annual incidence of carpal tunnel syndrome (2001–05) was 424 per 100 000 and, for carpal tunnel release surgery, 134 per 100 000. It is generally accepted that severe carpal tunnel syndrome, manifested by thenar muscle atrophy, severe sensory loss, or both, requires surgery. Similarly, surgeons do not usually encourage surgery in patients with only mild symptoms or functional limitation and no neurological deficit. Between these levels of severity, the decision about the best initial treatment i...

[Articles] Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial

LANCET — Thu, 24 Sep 2009 23:00:00 +0100

A previous randomised controlled trial reported greater efficacy of surgery than of splinting for patients with carpal tunnel syndrome. Our aim was to compare surgical versus multi-modality, non-surgical treatment for patients with carpal tunnel syndrome without denervation. We hypothesised that surgery would result in improved functional and symptom outcomes. (Source: LANCET)

Surgery May Be Better Than Other Carpal Tunnel Therapies

Modern Medicine — Thu, 24 Sep 2009 23:00:00 +0100

Surgery for carpal tunnel syndrome produced better outcomes than non-surgical therapies, but the clinical advantage was modest, according to a study in the Sept. 26 issue of The Lancet. (Source: Modern Medicine)

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Surgery has 'modest' effect on carpal tunnel syndrome

Arthritis Research Campaign — Thu, 24 Sep 2009 23:00:00 +0100

New research suggests that surgery for carpal tunnel syndrome has a 'modest' effect on hand function and other symptoms of the wrist condition. (Source: Arthritis Research Campaign)

Surgery Modestly Better than Splint for Carpal Tunnel (CME/CE)

MedPage Today Surgery — Thu, 24 Sep 2009 22:30:00 +0100

Surgery was more effective than splinting for treating carpal tunnel syndrome, but the improvements in function and symptoms were only modestly better, a new study found. (Source: MedPage Today Surgery)

Minimally Invasive Carpal Tunnel Release

Orthopedic Clinics of North America — Fri, 18 Sep 2009 16:58:29 +0100

We prospectively compared the safety and effectiveness of mini-incision (group A) and a limited open technique (group B) for carpal tunnel release (CTR) in 185 consecutive patients operated between November 1999 and May 2001, with a 5-year minimum follow-up. Patients in Group A had a minimally invasive approach ( (Source: Orthopedic Clinics of North America)

Morphological Analysis of the Carpal Tunnel

Hand — Thu, 17 Sep 2009 12:42:18 +0100

Abstract Although carpal tunnel release is one of the most commonly performed procedures in the USA, the morphology of the carpal tunnel as determined previously in the literature has been questioned. Previous methodology has been questioned for accuracy by recent studies. The purpose of this study was to perform a morphological analysis of the carpal tunnel and correlate carpal tunnel and hand dimensions. The carpal tunnels of ten cadaveric specimens were emptied of their contents and a silicone cast of the carpal tunnel was then created. This cast was then digitized, and the dimensions of the carpal tunnel were calculated. These dimensions were compared with the measured hand dimensions of the specimens. The width, depth, tilt angle, length, cross-sectional area, and vol...

Familial primary carpal tunnel syndrome with possible skipped generation

European Journal of Pediatrics — Wed, 16 Sep 2009 19:02:56 +0100

We report the occurrence of carpal tunnel syndrome in two generations of a family in which the index case was a 6-year-old boy with bilateral hand pain and paresthesias. Our report demonstrates an interesting inheritance pattern of carpal tunnel syndrome in a family transmitted by an autosomal dominant gene with variable expressivity and reduced penetrance. To our knowledge, it is the first report of familial bilateral carpal tunnel syndrome in a family with possible skipped generation. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00431-009-1055-4Authors Saliha Senel, Dr. Sami Ulus Children’s Health and Diseases Training and Research Hospital Department of Pediatrics Ankara TurkeyGulay Ceylaner, Intergen Genetics Centre Department of Genetics Ankara TurkeyDeni...

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Risk factors for operated carpal tunnel syndrome: a multicenter population-based case-control study

BMC Public Health - Latest articles — Tue, 15 Sep 2009 23:00:00 +0100

Conclusions: This study strongly underlines the relevance of biomechanical exposures in both non-industrial and industrial work as risk factors for surgically treated CTS. (Source: BMC Public Health - Latest articles)

Anastrozole increases risk of carpal tunnel syndrome?

NeLM - Oncology — Tue, 15 Sep 2009 23:00:00 +0100

Source: JCO Area: News An analysis of follow up data from the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial in postmenopausal women with early breast cancer, has found that although the use of anastrozole is associated with a greater incidence of carpal tunnel syndrome (CTS) , it is rare, and most cases were of mild to moderate intensity and short duration. This post-hoc analysis was based on the 100-month median follow-up data in the two monotherapy arms (anastrozole, n = 3,092; tamoxifen, n = 3,094). After 100 months of follow-up when all patients had completed five years of treatment: . 80 cases (2.6%) of CTS were reported in the anastrozole arm, compared with 23 cases (0.7%) in the tamoxifen arm (P < 0.0001). . The majority of CTS...

Cancer Drug May Increase Risk of Carpal Tunnel Syndrome

Modern Medicine — Tue, 15 Sep 2009 23:00:00 +0100

Treatment of postmenopausal breast cancer with an aromatase inhibitor increases the risk of developing carpal tunnel syndrome, although cases are mild to moderate and do not lead to patients stopping treatment, according to a study published online Sept. 14 in the Journal of Clinical Oncology. (Source: Modern Medicine)

Joint Pain Can Accompany Aromatase Therapy

Modern Medicine — Mon, 14 Sep 2009 23:00:00 +0100

Postmenopausal breast cancer patients receiving aromatase inhibitors adjunctively can experience joint pain, marked by fluid buildup in joints, localized inflammation of tendon sheaths, and carpal tunnel syndrome, according to a study published online Sept. 14 in the Journal of Clinical Oncology. (Source: Modern Medicine)

Management of carpal tunnel syndrome

Neurological Conditions Specialist Library — Mon, 14 Sep 2009 11:02:57 +0100

Review article from the Drug and Therapeutics Bulletin. Bottom-line conclusion: Carpal tunnel syndrome results from compression of the median nerve in the wrist and has a prevalence of around 2%. About 30% of patients have transient symptoms that recover completely after a few weeks or months without treatment, while some patients have progressive and eventually permanent median nerve deficit. The diagnosis can usually be made clinically, but should be confirmed with nerve conduction tests if diagnosis is in doubt or surgery is being considered. In mild cases, initial treatment should include the use of wrist splints. If this fails, then a local corticosteroid injection is appropriate, but it is not clear what the best regimen is to use. Patients with severe or persistent impairment, or sy...

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Exposure-dependent increases in IL-1[beta], substance P, CTGF, and tendinosis in flexor digitorum tendons with upper extremity repetitive strain injury

Journal of Orthopaedic Research — Wed, 09 Sep 2009 23:00:00 +0100

Upper extremity tendinopathies are associated with performance of forceful repetitive tasks. We used our rat model of repetitive strain injury to study changes induced in forelimb flexor digitorum tendons. Rats were trained to perform a high repetition high force (HRHF) handle-pulling task (12 reaches/min at 60 ± 5% maximum pulling force [MPF]), or a low repetition negligible force (LRNF) reaching and food retrieval task (three reaches/min at 5 ± 5% MPF), for 2 h/day in 30 min sessions, 3 days/week for 3-12 weeks. Forelimb grip strength was tested. Flexor digitorum tendons were examined at midtendon at the level of the carpal tunnel for interleukin (IL)-1[beta], neutrophil, and macrophage influx, Substance P, connective tissue growth factor (CTGF), and periostin-like factor (PLF) immunoe...

[Electrophysiological exploration of tunnel syndromes.]

Neuro-Chirurgie — Wed, 09 Sep 2009 23:00:00 +0100

Authors: Dumas P The compressive neuropathies often lead to segmental demyelination injury. These injuries can be detected using speed motor conduction and sensitivity conduction. The corresponding abnormalities are localized conduction abnormalities, presenting as deceleration or as a conductive block. Segmentary deceleration is perfectly well observed, such as in cases of carpal tunnel syndrome. The detection examination, recording motor unit potentials, can distinguish between a peripheral injury and a central injury as well as between a neurogenic injury and a myogenous injury. The precise study of the sensitivity potentials makes it possible to distinguish between a radicular injury, in which the sensitivity potentials are normal, and a plexus injury, in which the sensitivity pote...

Myoepithelioma within the carpal tunnel: a case report and review of the literature

International Seminars in Surgical Oncology — Tue, 08 Sep 2009 23:00:00 +0100

Myoepitheliomas of the extremity are rare and usually benign, while a minority display malignant features. This case demonstrates the diagnosis and management of myoepithelioma within the carpal tunnel. Clinical and radiological tumour features were evaluated. Hematoxylin and eosin stained tumour sections were examined, and immunohistochemistry was performed. Histology revealed a nodular mass of epithelioid cells in clusters within a myxoid/chondroid stroma. No mitoses were noted. Cytokeratins, neuron-specific enolase, synaptophysin, glial fibrillary acidic protein, and S100 were positive on immunohistochemistry. A literature review revealed very few prior reports of myoepithelioma in the wrist, and limited data concerning any relationship between recurrence and quality of surgical margins...

Suction helps carpal tunnel pain

OrlandoSentinel: Medical Research — Sat, 05 Sep 2009 23:00:00 +0100

If you suffer from carpal tunnel syndrome, how far would you go to get rid of the pain? Would you let someone puncture your skin and use suction cups to draw blood through the surface? German researchers from Immanuel Hospital Berlin suggest that a... (Source: OrlandoSentinel: Medical Research)