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Balogh D, Kociolek AM. The Median Nerve Displays Adaptive Characteristics When Exposed to Repeated Pinch Grip Efforts of Varying Rates of Force Development: An Ultrasonic Investigation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2025; 44:727-738. [PMID: 39692085 PMCID: PMC11892086 DOI: 10.1002/jum.16634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 11/14/2024] [Accepted: 12/03/2024] [Indexed: 12/19/2024]
Abstract
OBJECTIVES Repeated gripping with high grip forces and high rates of grip force development are risk factors for carpal tunnel syndrome. As the nerve's adaptive ability is crucial to prevent disease progression, we investigated how these risk factors influence median nerve deformation and displacement over the time course of a repeated pinch grip task. METHODS Seventeen healthy participants performed a repeated grip task against a load cell while their carpal tunnel was scanned with ultrasound. The grip task involved pulp-pinching three consecutive times from 0 to 40% maximal voluntary exertion (MVE), performed at three different rates of force development (RFD): 40% MVE/1 second; 2 seconds; and 5 seconds. Ultrasound images were analyzed at 10% MVE intervals. Nerve circularity, width, height, and cross-sectional area were measured to assess deformation. Median nerve displacement was assessed by its change in position relative to the flexor digitorum superficialis tendon of the third digit (FD) in both radioulnar and palmodorsal axes. RESULTS Linear mixed modeling indicated that median nerve deformation increased, becoming more circular, with each repeated pulp-pinch (P < .01) and with grip force magnitude (P < .01). However, a faster RFD decreased nerve deformation (P < .01). Furthermore, the nerve displaced ulnarly during pulp-pinching, with greater displacement during the fastest (ie, 40% MVE/1 second) RFD (P < .01). CONCLUSIONS The median nerve deformed and displaced in response to pulp-pinching; however, faster rates of force development hindered this adaptive response. This likely reflects the viscoelastic properties of the healthy nerve and subsynovial connective tissue, highlighting the importance of tissue compliance in preventing nerve compression.
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Affiliation(s)
- Denise Balogh
- Canadian Center for Rural and Agricultural HealthUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Aaron M. Kociolek
- School of Physical and Health EducationNipissing UniversityNorth BayOntarioCanada
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Khired Z, Shawish AM, Mojiri ME, Albarrati AM, Hobani AH, Madkhali HA, Hakami AJ, Adawi KA, Hakami SM, Hakami LB, Muqri KY, Awaji AY, Ageeli FE, Sayegh AA. Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Jazan: A Cross-Sectional Study. Cureus 2024; 16:e68458. [PMID: 39360059 PMCID: PMC11446227 DOI: 10.7759/cureus.68458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 10/04/2024] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a common musculoskeletal condition of the hand and wrist frequently associated with repetitive hand motion and environmental considerations. Teachers are more likely to acquire CTS because of their lengthy writing and computer use. This study aimed to determine the prevalence of CTS symptoms and related variables among schoolteachers in Jazan, Saudi Arabia. Methods This study was conducted as a cross-sectional survey of teachers in Jazan, utilizing an online platform for data collection. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was the primary tool used to determine symptom intensity and functional status. The data were rigorously analyzed using a range of statistical methods, including descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman's correlation, the chi-square test, Fisher's exact test, and binary logistic regression, ensuring the robustness of the findings. Results The study comprised 336 schoolteachers with a mean age of 43.3 ± 6.5 years, of whom 58.0% were female and 42.0% were male. About 8.0% of instructors reported CTS symptoms. Female gender (median Symptom Severity Scale (SSS): 15.0 vs. 12.0, p < 0.001; median Functional Status Scale (FSS): 8.0 vs. 8.0, p < 0.001), increased time spent writing (r = 0.237, p < 0.001 for SSS; r = 0.217, p < 0.001 for FSS), and presence of comorbidities such as diabetes (median SSS: 16.0, p = 0.002; median FSS: 8.0, p = 0.001) had a negative correlation with symptom severity (r = -0.174, p = 0.002) and functional impairment (r = -0.141, p = 0.011). Surgical therapy (median SSS: 32.0; median FSS: 24.0; p<0.001) and post-treatment symptom recurrence (median SSS: 28.0; median FSS: 22.0; p<0.001) were associated with increased severity and disability. According to binary logistic regression, increased writing time significantly predicted CTS diagnosis (OR = 1.151, 95% CI: 1.024-1.295, p = 0.018). Conclusion CTS symptoms are common among Jazan teachers, and various sociodemographic, vocational, and clinical variables influence their intensity and functional status. Ergonomic treatment, early identification, and suitable management measures are critical for preventing and mitigating the effects of CTS among teachers. Additional research is required to develop focused therapies and enhance the results of this occupational group.
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Affiliation(s)
- Zenat Khired
- Department of Surgery, Jazan University, Jazan, SAU
| | | | | | | | | | | | - Ali J Hakami
- College of Medicine, Jazan University, Jazan, SAU
| | | | | | - Layla B Hakami
- College of Applied Medical Sciences, Jazan University, Jazan, SAU
| | - Khalid Y Muqri
- Department of Orthopedic Surgery, King Fahad Central Hospital, Jazan, SAU
| | - Alyazid Y Awaji
- Department of Plastic and Reconstructive Surgery, King Fahad Central Hospital, Jazan, SAU
| | - Fatimah E Ageeli
- Department of General Surgery, King Fahad Central Hospital, Jazan, SAU
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Roy U, Srivastava AK, Cartwright MS, Panwar A, Shahil P. A Case of Suspected Carpal Tunnel Syndrome: Ultrasonography Prior to the Scalpel. Cureus 2024; 16:e65823. [PMID: 39228896 PMCID: PMC11370708 DOI: 10.7759/cureus.65823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
Carpal tunnel syndrome (CTS) is the most prevalent focal mononeuropathy worldwide and is traditionally diagnosed based on clinical history, examination, and nerve conduction studies. Surgical release is the gold standard in cases where conservative management fails; however, it is prudent to obtain imaging before planning such intervention. We present the case of a 47-year-old woman who presented with typical symptoms of CTS, which was confirmed with nerve conduction studies and was being considered for carpal tunnel release surgery. Her history and laboratory studies revealed rheumatoid arthritis and subsequent ultrasonography showed swelling of the median nerve just proximal to the transverse carpal ligament at the level of pronator quadratus muscle. The possibility of a nerve sheath tumour or tenosynovitis with edematous fascicles of the median nerve was considered, and a decision was taken to give a short course of prednisolone 1 mg/kg, to which she clinically responded and the repeat ultrasonography showed near complete resolution of the focal nerve enlargement. This case emphasizes the role of point-of-care neuromuscular ultrasound (NMUS) in identifying the underlying cause of CTS and validates NMUS as a powerful tool in reaching a comprehensive diagnosis in entrapment neuropathies and it should be incorporated into the routine protocol of diagnosis of these disorders.
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Affiliation(s)
- Ujjawal Roy
- Department of Neurology, Roy Neurocare Centre, Ranchi, IND
- Department of Neurology, Pulse Super Speciality Hospital, Ranchi, IND
| | | | - Michael S Cartwright
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ajay Panwar
- Neurology, Rotary Ambala Cancer and General Hospital, Amballa Cantt., IND
| | - Pratik Shahil
- Department of Neurology, Pulse Super Speciality Hospital, Ranchi, IND
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Rocks MC, Donnelly MR, Li A, Glickel SZ, Catalano LW, Posner M, Hacquebord JH. Demographics of Common Compressive Neuropathies in the Upper Extremity. Hand (N Y) 2024; 19:217-223. [PMID: 35815639 PMCID: PMC10953515 DOI: 10.1177/15589447221107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The purpose of this study was to compare the demographic differences of the most common peripheral nerve compressions in the upper extremity-carpal tunnel syndrome (CTS), ulnar nerve compression (UNC) at the elbow, combined CTS and UNC, radial tunnel syndrome (RTS), and posterior interosseous nerve syndrome (PINS)-as a means to better understand the etiologies of each. METHODS A retrospective chart review was performed of all patients over the age of 18 years seen at our institution in the 2018 calendar year. International Classification of Diseases, Tenth Revision codes were used to identify patients with diagnoses of upper extremity peripheral nerve compressions. Demographic details and relevant comorbidities were recorded for each patient and compared with controls, who were seen the same calendar year with no neuropathies. χ2 analyses, independent-samples t tests, and multivariate logistic regressions were performed (P < .05). RESULTS A total of 7448 patients were identified. Those with CTS were mainly women, former smokers, and diabetic (all P < .001) and with a greater average body mass index (BMI) (P = .006) than controls. Patients with UNC were more often men and younger when compared with controls (both P < .001). A history of smoking, diabetes, and average BMI were similar between patients with UNC and controls (all P > .05). Those patients with combined CTS/UNC were mainly men, former smokers, and diabetic (all P < .001) when compared with controls. Patients with RTS/PINS were also mostly men (P = .007), diabetic (P = .042), and were more often current smokers (P < .001). CONCLUSIONS The demographics of patients with various compressive neuropathies were not homogeneous, suggesting different etiologies.
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Lnu S, Biswas A. A Comparative Study of Effectiveness of Splinting and Splinting Plus Local Corticosteroid Injection in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial. Cureus 2024; 16:e52868. [PMID: 38406125 PMCID: PMC10890796 DOI: 10.7759/cureus.52868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Corticosteroid injection and wrist-hand splint are two of the most commonly used conservative options for the management of carpal tunnel syndrome (CTS). This study compares the effectiveness of splinting and splinting plus local steroid injection in improving clinical and nerve conduction findings of patients with CTS. Methods A total of 44 patients with CTS were randomized into two groups. Group A used a full-time neutral wrist splint and group B was injected with 20 mg of triamcinolone acetonide and was given a full-time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients were evaluated at baseline, 4 and 12 weeks after interventions. The chi-square test was used to test the association of different study variables. Z-test was used to test the significant difference between the two proportions. The means were compared by t-test. ANOVA was used to compare more than two mean values. Results The mean difference of the Boston Carpal Tunnel Questionnaire and median nerve latency at baseline and 12th week after treatment was significantly higher in group B than in group A (p<0.05). In intragroup comparison, there was significant improvement in the patient satisfaction, and clinical and nerve conduction values between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P < 0.01). However, the inter-group comparisons were not significant. Conclusion Both of the management methods (splinting plus corticosteroid injection and splinting) have significant effects on the improvement of symptoms, and functional and nerve conduction status. It seems that splinting plus corticosteroid injection has a little edge over splinting alone during the follow-up periods.
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Affiliation(s)
- Shikha Lnu
- Physical Medicine and Rehabilitation, Patna Medical College and Hospital, Patna, IND
| | - Anurug Biswas
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Patna, Patna, IND
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Yang J, Mo Z, Zhang Y, Ji R, Tao C, Fan Y. The effects of walking aids on shoulder joint kinematics in older persons: an initial study. BMC Geriatr 2023; 23:743. [PMID: 37964210 PMCID: PMC10648336 DOI: 10.1186/s12877-023-04439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Many older persons with degenerative physical functions use walking aids to improve their ambulation ability. The aim of this study was to investigate the effects of walking aids with different configurations on shoulder joint motion in older persons. METHODS The 3D motion capture system VICON was applied to collect data on gait parameters and shoulder motion characteristics of 6 older persons walking either independently or with the assistance of a footed walking frame and a wheeled walking frame. The different effects of walking aids on gait parameters and the shoulder joint motion of older individuals were quantitatively analyzed. RESULTS The gait parameters of the older individuals changed significantly when they used walking frames to assist walking. Compared to independent walking, the range of motion of the shoulder joint was reduced by 79.92% in flexion when walking with a wheeled walking frame. Meanwhile, the range of motion in flexion, extension, and external rotation increased by 76.04%, 85.55%, and 110.99%, respectively, when walking with a footed walking frame. CONCLUSION The motion characteristics of shoulder joints in older persons were significantly affected by using different walking aids. These changes in shoulder joint motion characteristics will lead to potential diseases related to the shoulder musculoskeletal system. These findings are beneficial to determine a walking aid for older people.
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Affiliation(s)
- Jiemeng Yang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Zhongjun Mo
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Yanyu Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Run Ji
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Chunjing Tao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China.
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100191, China.
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Rothman A, Samineni AV, Sing DC, Zhang JY, Stein AB. Carpal Tunnel Release Performed during Distal Radius Fracture Surgery. J Wrist Surg 2023; 12:211-217. [PMID: 37223388 PMCID: PMC10202570 DOI: 10.1055/s-0042-1756501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/30/2022] [Indexed: 11/11/2022]
Abstract
Background Carpal tunnel release (CTR) may be concomitantly performed along with distal radius fracture open reduction internal fixation (DRF ORIF) to prevent carpal tunnel syndrome; however, there is little to no literature investigating the rate, risk factors, and complications associated with CTR. Questions/Purposes The purpose was to determine (1) the rate of CTR performed at time of DRF ORIF, (2) factors associated with CTR, and (3) whether CTR was associated with any complications. Patients and Methods In this case-control study, adult patients who underwent DRF ORIF from 2014 to 2018 were identified from a national surgical database. Two cohorts were analyzed, (1) patients with CTR and (2) patients without CTR. Preoperative characteristics and postoperative complications were compared with determine factors associated with CTR. Results Of the 18,466 patients, 769 (4.2%) had CTR. Rates of CTR in patients with intra-articular fractures with two or three fragments were significantly higher than the rate of CTR for patients with extra-articular fractures. Underweight patients underwent CTR at a significantly lower rate compared with overweight and obese patients. The American Society of Anesthesiologists ≥3 was associated with a higher rate of CTR. Male and older patients were less likely to have CTR. Conclusion The rate of CTR at time of DRF ORIF was 4.2%. Intra-articular fractures with multiple fragments were strongly associated with CTR at time of DRF ORIF, while being underweight, elderly, and male were associated with lower rates of CTR. These findings should be considered when developing clinical guidelines to assess the need for CTR in patients undergoing DRF ORIF. This is a retrospective case control study and reflects level of evidence III.
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Affiliation(s)
- Alyssa Rothman
- Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts
| | | | - David C. Sing
- Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts
| | - Joanne Y. Zhang
- Department of Hand and Upper Extremity Surgery, University of Chicago, Chicago, Illinois
| | - Andrew B. Stein
- Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts
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AlHussain AH, Alshahir AA, AlNaqa FH, Alsaygh EF, Alquwaiz IA, Alqahtani MS. Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Riyadh: A Cross-Sectional Study. Cureus 2023; 15:e35040. [PMID: 36942171 PMCID: PMC10023996 DOI: 10.7759/cureus.35040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a musculoskeletal disorder (MSD) afflicting the upper limbs with a prevalence of approximately 14.4% in the general population. Previous studies have noted the increasing prevalence of MSDs among teachers but have not investigated in depth the prevalence and predictors of CTS symptoms in this population. The aim of this study was to help fill this gap in the literature by investigating teachers working in Riyadh, Saudi Arabia. Methods We conducted this cross-sectional study in Riyadh using an online survey. We distributed the Boston carpal tunnel questionnaire (BCTQ) to schoolteachers in the city through the social media applications Twitter, WhatsApp, and Telegram. We assessed the respondents' symptoms using Univariate association analyses with a Wilcoxon rank sum test for the continuous variables and Fisher's exact test and Pearson's chi-squared test for the categorical variables. We assessed the independent risk factors for CTS by constructing multivariate binary logistic regression models and expressed the results using the odds ratio (OR) and 95% confidence intervals (95% CIs), with p < 0.05 indicating statistical significance. Results The sample for this study included 490 teachers. Among them, the prevalence of moderate to severe CTS symptoms was 40.0%, and self-reported CTS was 9.1%. The teachers who were female, relatively old, left-handed, retired, and spent significant time using a pen, keyboard, and/or blackboard were more likely than those who were male, relatively young, right-handed, and did not spend significant time using a pen, keyboard, and/or blackboard to self-report CTS and exhibit moderate to severe symptoms. Conclusions We found a relatively high percentage (40.0%) of CTS symptoms among teachers working in Riyadh. This finding suggests that any sign of CTS symptoms should be checked to ensure early diagnosis and treatment, which contribute to positive outcomes, particularly given the recent increase in such risk factors for CTS as diabetes, hypothyroidism, and high BMI in populations worldwide.
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Affiliation(s)
- Ahmed H AlHussain
- Orthopaedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Medical Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Alwaleed A Alshahir
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Medical Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Faisal H AlNaqa
- Orthopaedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | | | - Ibrahim A Alquwaiz
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-kharj, SAU
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The Effects of Pedestrian Environment on Ambulation with a Walking Frame in Elderly Individuals: A Survey and Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159327. [PMID: 35954684 PMCID: PMC9368263 DOI: 10.3390/ijerph19159327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023]
Abstract
Understanding the effects of sloped roads in the pedestrian environment on the body during ambulation with a walking frame can help design friendlier living environments for elderly individuals. A survey of the characteristics of walking frames used in different pedestrian environments was investigated in five communities, and a controlled study of the effects of a sloped road on a subject with different walking frames was carried out as foundational research in the laboratory. A synchronous acquisition system consisting of a wireless motion capture module and a physiological information recording module was applied to collect data on the motion of the shoulder joint and skin conductance response (SCR) of fingers in one participant. Force data were collected from sensors placed on the four legs of the walking frame. The experimental data obtained during different tasks were quantitatively analyzed. Compared to flat ground, the shoulder joint rotated in the opposite direction in horizontal and internal/external planes when using a wheeled walking frame on an uphill road, and the supportive force decreased on both uphill and downhill roads. The range of motion of the shoulder joint reduced and the direction of the shoulder joint motion changed when using a footed walking frame on both uphill and downhill roads. Additionally, the peak value of the supportive force on the uphill road appeared in the first 50% of the gait cycle, which was earlier than in the other cases. In addition, walking on the uphill road with a walking frame had a maximum SCR value, which means a greater impact of psychological arousal. Biomechanics of the shoulder joint and psychological arousal are closely related to the ease of walking on a sloped road with a walking frame. These findings are beneficial for designing more appropriate environments for elderly individuals who walk with aids.
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Local Corticosteroid Injections versus Surgical Carpal Tunnel Release for Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:life12040533. [PMID: 35455023 PMCID: PMC9026554 DOI: 10.3390/life12040533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. This meta-analysis compared local steroid injections (LSIs) versus carpal tunnel release (CTR) for the management of CTS. Neurophysiological parameters, patient-reported outcome measures (PROMs), and the complication rate were investigated. We hypothesized that LSIs may represent an effective and safe alternative to surgical management. Methods: This systematic review was conducted according to the 2020 PRISMA statement. All the clinical investigations comparing LSIs versus CTR for carpal tunnel syndrome were accessed. In March 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, and Embase. No time constrains were used for the search. The risk of bias and statistical analyses were conducted using the Review Manager Software 5.3 (The Nordic Cochrane Collaboration, Copenhagen). Results: Data from 1096 procedures were retrieved. The mean follow-up was 12.3 (1 to 58) months. The mean age of the patients was 51.1 ± 4.6. Nocturnal paraesthesia (p < 0.0001) and visual analogue scale (p < 0.0001) were greater in the LSIs cohort. No difference was found in the functional (p = 0.2) and symptom (p = 0.4) subscales of the Boston Carpal Tunnel Questionnaire (BCTQ), median nerve distal motor latency (p = 0.9), median nerve motor amplitude (p = 0.7), median nerve sensory conduction velocity (p = 0.4), or median nerve sensory amplitude (p = 0.3). No difference was found in terms of minor complications (p = 0.9). No major complications were observed within the duration of follow-up. Conclusion: Both CTR and LSIs were effective and feasible in reducing symptoms of carpal tunnel syndrome. Though LSIs led to greater pain relief, this superiority was not permanent. Irrespective of the severity of the symptoms, current evidence suggests that a cycle of LSIs may be considered in patients with CTS. However, patients must be aware that LSIs may not be the definitive therapy, and CTR should be recommended.
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Seronegative arthritis mimicking intratendinous synovial sarcoma: a review of imaging aids. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01949-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bekele A, Abebe G, Hailu T, Fekadu T, Gebremickael A, Getachew T, Churko C, Alelign D, Wassihun B, Teshome D, Bukala Z. Prevalence and Associated Factors of Carpal Tunnel Syndrome Among Diabetic Patients in Arba Minch General Hospital, South West Ethiopia, 2021. Diabetes Metab Syndr Obes 2022; 15:983-993. [PMID: 35386587 PMCID: PMC8979567 DOI: 10.2147/dmso.s356484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/12/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE OF THE STUDY This study aimed to assess the prevalence of carpal tunnel syndrome and associated factors among diabetic patients in Arba Minch General Hospital, Southwest Ethiopia. Carpal tunnel syndrome (CTS) is the second most common cause of absence from work which causes functional loss of the hands and leads to disability. However, it is understudied among diabetic patients in Ethiopia. PATIENTS AND MATERIALS An institution-based cross-sectional study was conducted from May 1 to October 1, 2021. Systematic random sampling method was used to select 353 study participants. CTS-6 Evaluation tool was applied to assess carpal tunnel syndrome. The data was coded and entered into Epi-Data version 3.1 statistical packages and exported to SPSS version 25 for analysis. Binary logistic regression model was applied to assess the association between outcome variable and independent variables. Odds ratio (OR) with 95% CI and p-values <0.05 were used to identify significantly associated factors with an outcome variable. RESULTS The study was conducted among 353 diabetic patients. The cumulative prevalence of carpal tunnel syndrome among diabetes was 3.1%. CTS was statistically significantly associated with high body mass index; AOR=0.34 (0.12, 0.97, 95% CI) (p=0.04. Majority of participants 322 (91.2%) had type 2 DM. Mean fasting blood sugar level ± standard error of study participants was 157.52 ± 1.91 mg/dl. CONCLUSION The prevalence of carpal tunnel syndrome was relatively low. High body mass index (BMI) was significantly but negatively associated with carpal tunnel syndrome compared to diabetic patients with normal BMI. Diabetic patients with normal BMI should be screened for CTS for early management of the disease and prevention of further complications. Further investigations are recommended.
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Affiliation(s)
- Alehegn Bekele
- Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Alehegn Bekele, Department of Anatomy, Arba Minch University, P.O Box: 21, Arba Minch, Southern Nations, Nationalities and Peoples, Ethiopia, Tel +251921575427, Email
| | - Getachew Abebe
- Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tadiwos Hailu
- Department of Internal Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Teshale Fekadu
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abinet Gebremickael
- Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tamiru Getachew
- Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Chuchu Churko
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dagninet Alelign
- Department of Medical Laboratory, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biresaw Wassihun
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Daniel Teshome
- Department of Anatomy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zekarias Bukala
- Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Falcon S, Everist B, Brubacher J. Anomalous Flexor Digitorum Profundus Muscle Bellies as a Cause of Snapping Wrist and Carpal Tunnel Syndrome: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00027. [PMID: 34714785 DOI: 10.2106/jbjs.cc.21.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 20-year-old right hand dominant woman presented with an audible and painful snapping wrist occurring with finger flexion. This bothersome mechanical finding and concomitant carpal tunnel syndrome (CTS) did not resolve with conservative measures. Dynamic magnetic resonance imaging revealed anomalous flexor digitorum profundus (FDP) muscle bellies as the cause of the mechanical snapping and irritation of the median nerve. Carpal tunnel release and excision of anomalous muscle within the carpal tunnel and distal forearm provided complete resolution of symptoms. CONCLUSION Anomalous muscle bellies of the FDP is a rare cause of a volar snapping wrist and CTS.
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Affiliation(s)
- Spencer Falcon
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Brian Everist
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jacob Brubacher
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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14
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Carpal Tunnel Syndrome in Autoimmune Rheumatic Diseases and Inflammatory Bowel Diseases: Retrospective Population Cohort Study. Am J Phys Med Rehabil 2021; 100:760-765. [PMID: 33065575 DOI: 10.1097/phm.0000000000001627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The relationship between autoimmune rheumatic diseases, inflammatory bowel diseases, and carpal tunnel syndrome is unclear. We aimed to survey the occurrence and characteristics of carpal tunnel syndrome in autoimmune rheumatic diseases and inflammatory bowel diseases, compared with the general population. METHODS We used the Longitudinal Health Insurance Database 2015 from Taiwan's National Health Insurance Research Database. Patients diagnosed with autoimmune rheumatic diseases/inflammatory bowel diseases were identified. The incidence rates and surgical rates of carpal tunnel syndrome among individual diseases were calculated. The hazard ratios when compared with age and sex matched, and 1:1 ratio control groups were surveyed. RESULTS A total of 2591 women and 701 men were identified. The incidence rate of carpal tunnel syndrome was highest in Crohn disease (1001 per 100,000 person-years, 95% confidence interval = 0-2747), followed by scleroderma and Sjögren syndrome. The incidence rate in the control group was 571 per 100,000 person-years (95% confidence interval = 314-829). Significantly increased adjusted hazard ratios were seen in Sjögren syndrome (1.44, 95% confidence interval = 1.09-1.90) and rheumatic arthritis (1.33, 95% confidence interval = 1.05-1.70). The overall surgical rate was 0.2% in patients with autoimmune rheumatic diseases/inflammatory bowel diseases and 0.3% in the control group, without a significant difference (P = 0.85). CONCLUSIONS Patients with Sjögren syndrome and rheumatic arthritis are susceptible to carpal tunnel syndrome. Patients with autoimmune rheumatic diseases/inflammatory bowel diseases have similar surgical rates as general population.
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Chen L, Chen Z, Xu Z, Feng W, Yang X, Qi Z. Polydatin protects Schwann cells from methylglyoxal induced cytotoxicity and promotes crushed sciatic nerves regeneration of diabetic rats. Phytother Res 2021; 35:4592-4604. [PMID: 34089208 DOI: 10.1002/ptr.7177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/25/2021] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Abstract
Oxidative stress plays the main role in the pathogenesis of diabetes mellitus and peripheral neuropathy. Polydatin (PD) has been shown to exhibit strong antioxidative and antiinflammatory effects. At present, no research has focused on the possible effects of PD on Schwann cells and impaired peripheral nerves in diabetic models. Here, we used an in vitro Schwann cell damage model induced by methylglyoxal and an in vivo diabetic sciatic nerve crush model to study problems in such an area. In our experiment, we demonstrated that PD potently alleviated the decrease of cellular viability, prevented reactive oxygen species generation, and suppressed mitochondrial depolarization as well as cellular apoptosis in damaged Schwann cells. Moreover, we found that PD could upregulate Nrf2 and Glyoxalase 1 (GLO1) expression and inhibit Keap1 and receptor of AGEs (RAGE) expression of damaged Schwann cells. Finally, our in vivo experiment showed that PD could promote sciatic nerves repair of diabetic rats. Our results revealed that PD exhibited prominent neuroprotective effects on Schwann cells and sciatic nerves in diabetic models. The molecular mechanisms were associated with activating Nfr2 and GLO1 and inhibiting Keap1 and RAGE.
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Affiliation(s)
- Lulu Chen
- Department No.16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zixiang Chen
- Department No.16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuqiu Xu
- Department No.16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weifeng Feng
- Department No.16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaonan Yang
- Department No.16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zuoliang Qi
- Department No.16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Peeters S, Decramer A, Cain SA, Houpt P, Verstreken F, Noyez J, Hermans C, Jacobs W, Lammens M, Fransen E, Kumar AA, Vandeweyer G, Loeys B, Van Hul W, Baldock C, Boudin E, Mortier G. Delineation of a new fibrillino-2-pathy with evidence for a role of FBN2 in the pathogenesis of carpal tunnel syndrome. J Med Genet 2020; 58:778-782. [PMID: 32900841 DOI: 10.1136/jmedgenet-2020-107085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy, its pathogenesis remains largely unknown. An estimated heritability index of 0.46 and an increased familial occurrence indicate that genetic factors must play a role in the pathogenesis. METHODS AND RESULTS We report on a family in which CTS occurred in subsequent generations at an unusually young age. Additional clinical features included brachydactyly and short Achilles tendons resulting in toe walking in childhood. Using exome sequencing, we identified a heterozygous variant (c.5009T>G; p.Phe1670Cys) in the fibrillin-2 (FBN2) gene that co-segregated with the phenotype in the family. Functional assays showed that the missense variant impaired integrin-mediated cell adhesion and migration. Moreover, we observed an increased transforming growth factor-β signalling and fibrosis in the carpal tissues of affected individuals. A variant burden test in a large cohort of patients with CTS revealed a significantly increased frequency of rare (6.7% vs 2.5%-3.4%, p<0.001) and high-impact (6.9% vs 2.7%, p<0.001) FBN2 variants in patient alleles compared with controls. CONCLUSION The identification of a novel FBN2 variant (p.Phe1670Cys) in a unique family with early onset CTS, together with the observed increased frequency of rare and high-impact FBN2 variants in patients with sporadic CTS, strongly suggest a role of FBN2 in the pathogenesis of CTS.
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Affiliation(s)
- Silke Peeters
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Arne Decramer
- Department of Orthopaedics and Traumatology, AZ Delta, Roeselare, Belgium
| | - Stuart Alan Cain
- Division of Cell-Matrix Biology and Regenerative Medicine, Wellcome Centre for Cell-Matrix Research, The University of Manchester, Manchester, UK
| | - Peter Houpt
- Department of Plastic Surgery, Isala Clinic Zwolle, Zwolle, The Netherlands
| | | | - Jan Noyez
- Department of Orthopaedics and Traumatology, AZ Delta, Roeselare, Belgium
| | - Christophe Hermans
- Center for Oncological Research Antwerp (CORE), University of Antwerp, Edegem, Belgium
| | - Werner Jacobs
- Department of Forensic Medicine and Pathology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Martin Lammens
- Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium
| | - Erik Fransen
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Ajay Anand Kumar
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
- Department of Paediatrics, Wellcome-MRC Cambridge Stem Cell Institute Cambridge, Cambridge University, Cambridge, UK
| | - Geert Vandeweyer
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
- Biomedical Informatics Research Network Antwerp (Biomina), University of Antwerp, Edegem, Belgium
| | - Bart Loeys
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Wim Van Hul
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Clair Baldock
- Division of Cell-Matrix Biology and Regenerative Medicine, Wellcome Centre for Cell-Matrix Research, The University of Manchester, Manchester, UK
| | - Eveline Boudin
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Geert Mortier
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
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Lee G, Bae GY, Son JH, Lee S, Kim SW, Kim D, Lee SG, Cho K. User-Interactive Thermotherapeutic Electronic Skin Based on Stretchable Thermochromic Strain Sensor. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:2001184. [PMID: 32999818 PMCID: PMC7507701 DOI: 10.1002/advs.202001184] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 05/20/2023]
Abstract
User-interactive electronic skin (e-skin) with a distinguishable output has enormous potential for human-machine interfaces and healthcare applications. Despite advances in user-interactive e-skins, advances in visual user-interactive therapeutic e-skins remain rare. Here, a user-interactive thermotherapeutic device is reported that is fabricated by combining thermochromic composites and stretchable strain sensors consisting of strain-responsive silver nanowire networks on surface energy-patterned microwrinkles. Both the color and heat of the device are easily controlled through electrical resistance variation induced by applied mechanical strain. The resulting monolithic device exhibits substantial changes in optical reflectance and temperature with durability, rapid response, high stretchability, and linear sensitivity. The approach enables a low-expertise route to fabricating dynamic interactive thermotherapeutic e-skins that can be used to effectively rehabilitate injured connective tissues as well as to prevent skin burns by simultaneously accommodating stretching, providing heat, and exhibiting a color change.
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Affiliation(s)
- Giwon Lee
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
| | - Geun Yeol Bae
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
| | - Jong Hyun Son
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
| | - Siyoung Lee
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
| | - Seong Won Kim
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
| | - Daegun Kim
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
| | - Seung Goo Lee
- Department of ChemistryUniversity of UlsanUlsan44610Korea
| | - Kilwon Cho
- Department of Chemical EngineeringPohang University of Science and TechnologyPohang37673Korea
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Cunningham DJ, Baumgartner RE, Federer AE, Richard MJ, Mithani SK. Elevated Preoperative Hemoglobin A1c Associated with Increased Wound Complications in Diabetic Patients Undergoing Primary, Open Carpal Tunnel Release. Plast Reconstr Surg 2019; 144:632e-638e. [PMID: 31568301 DOI: 10.1097/prs.0000000000006023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increased rate of complications has been demonstrated with increasing hemoglobin A1c value for a variety of orthopedic procedures, including arthroplasty and spine surgery. The authors investigated the effects of elevated hemoglobin A1c value on postoperative complications at the time of carpal tunnel release. METHODS This retrospective, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value within 90 days of primary, open carpal tunnel release at a single academic institution within the past 10 years. Binary hemoglobin A1c thresholds were tested for association with outcomes of superficial or deep infection, delayed wound healing, and persistent symptoms using chi-square analysis. Multivariable models with adjustment for baseline and operative factors were then constructed. Odds ratios and 95 percent confidence intervals were displayed. RESULTS Hemoglobin A1c value greater than or equal to 7.8 percent was most strongly associated with an increased risk of all-cause wound healing complications (p = 0.049) at an odds ratio of 4.2 (95 percent CI, 1.0 to 17.7) in adjusted analyses. Six patients (4 percent) experienced delayed wound healing and five patients (4 percent) developed a superficial infection. Six patients (4 percent) reported persistent carpal tunnel syndrome symptoms. CONCLUSIONS Diabetic patients undergoing open, primary carpal tunnel release with a hemoglobin A1c value of 7.8 percent or higher had a higher rate of postoperative wound complications compared to diabetic patients with improved preoperative glucose control. Diabetics with poor glycemic control should be counseled that their risk of postoperative complication is higher. Further work is needed to determine whether delaying surgery to optimize glucose control could result in a reduction of wound healing complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
| | - Rita E Baumgartner
- From the Department of Orthopaedic Surgery, Duke University Medical Center
| | - Andrew E Federer
- From the Department of Orthopaedic Surgery, Duke University Medical Center
| | - Marc J Richard
- From the Department of Orthopaedic Surgery, Duke University Medical Center
| | - Suhail K Mithani
- From the Department of Orthopaedic Surgery, Duke University Medical Center
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Short N, Blair M, Crowell C, Loewenstein A, Lynch A, Nakum R, Warner A. Mobile technology and cumulative trauma symptomology among millennials. HAND THERAPY 2019. [DOI: 10.1177/1758998319871075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Technology use among the millennial population is increasing and related postural compromise may lead to cumulative trauma disorder symptomology. The aim of this study was to explore trends of hand-held mobile technology use and upper extremity cumulative trauma disorder symptomology among a sample of millennials. Methods A convenience sample of graduate students ( n = 42) was used for the study. Demographic and technology use information was obtained through self-report using the smartphone screen time tracking feature. Cumulative trauma disorder symptomology was assessed through administration of various orthopedic special tests. Results On average, participants spent 2 h and 23 min per day using hand-held mobile devices. Out of 42 participants, 54.8% tested positive for at least one orthopedic special test. The symptomatic group spent 2 h and 29 min using hand-held mobile devices, while the asymptomatic group spent 2 h and 4 min. The most common positive orthopedic special tests were Finkelstein’s test ( n = 19; 36%), hyperabduction (Wright’s) test ( n = 13; 25%), and the elbow flexion test ( n = 10; 18.9%), indicating symptoms associated with De Quervain’s tenosynovitis, thoracic outlet syndrome, and cubital tunnel syndrome, respectively. Discussion Results were consistent with prior research on time spent using hand-held mobile technology and cumulative trauma disorder among millennials. Additionally, a difference in mean time spent using mobile technology between the asymptomatic and symptomatic groups was found, suggesting a relationship which warrants further research.
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Affiliation(s)
- Nathan Short
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
| | - Madison Blair
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
| | - Chloe Crowell
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
| | - Abby Loewenstein
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
| | - Annie Lynch
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
| | - Ravina Nakum
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
| | - Allyson Warner
- Occupational Therapy Program, Huntington University, Fort Wayne, IN, USA
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20
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Huang JI, Thayer MK, Paczas M, Lacey SH, Cooperman DR. Variations in Hook of Hamate Morphology: A Cadaveric Analysis. J Hand Surg Am 2019; 44:611.e1-611.e5. [PMID: 30287099 DOI: 10.1016/j.jhsa.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/05/2018] [Accepted: 08/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The hook of the hamate is an anatomical structure that separates the ulnar border of the carpal tunnel from Guyon's canal and serves as a landmark for surgeons. The hook of the hamate is also subject to fracture from injury. We hypothesize that there are variations in the hook of the hamate in the general population. METHODS One thousand pairs of hamates (2,000 hamates) from the Hamann-Todd Collection at the Cleveland Natural History Museum were analyzed. The height of the hook of the hamate and the total height of the hamate bone were measured using digital calipers. The hook height ratio was defined as the hook height divided by the total height of the hamate. Statistical analysis was performed using unpaired Student's t test to determine differences in sex and race. RESULTS The mean hook height was 9.8 ± 1.4 mm (range, 2.5-15.9 mm), whereas the mean hook height ratio was 0.42 ± 0.04 (range, 0.15-0.56). There was a 3.1% (62/2,000) incidence of abnormally small hooks, which we classified as hypoplastic and aplastic. Of the hypoplastic hooks, 55% (24/44) were bilateral, whereas 44% (8/18) of the aplastic hooks were bilateral. The incidence of variation in size in the hook of the hamate was highest in white females (9.3%) and lowest in black males (1.4%). CONCLUSIONS Abnormalities in hook of hamate anatomy are common in the general population, especially in white females. CLINICAL RELEVANCE Knowledge of anatomic variation in the hook of the hamate may provide additional insight into surgeons' palpation of bony anatomy, interpretation of imaging studies, and use of the hook as a landmark during surgery.
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Affiliation(s)
- Jerry I Huang
- University Hospitals Case Medical Center, Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, OH; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
| | - Mary Kate Thayer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | - Michael Paczas
- University Hospitals Case Medical Center, Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, OH; TriHealth Hand Surgery Specialists, Cincinnati, OH
| | - Stephen H Lacey
- University Hospitals Case Medical Center, Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, OH
| | - Daniel R Cooperman
- University Hospitals Case Medical Center, Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, OH; Yale Medicine Orthopaedics, New Haven, CT
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Omura D, Obika M, Iwamuro M, Nagao S, Nada T, Matsuzaki T, Kondo Y, Otsuka F. Anterior Cutaneous Nerve Entrapment Syndrome Possibly Triggered by Oral Contraceptives. Intern Med 2019; 58:1507-1509. [PMID: 30713291 PMCID: PMC6548911 DOI: 10.2169/internalmedicine.1361-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/30/2018] [Indexed: 12/31/2022] Open
Abstract
We herein report a teenage girl who had been taking oral contraceptive pills for three months and complained of left lower abdominal pain that had continued for two months. A physical examination indicated anterior cutaneous nerve entrapment syndrome (ACNES), although no abnormality was found in various biochemical and imaging examinations. The pain was only transiently ameliorated by trigger-point injection, and neurectomy surgery was eventually effective. Sex steroids can be involved in the progress of local tissue edema causing ACNES. ACNES should be considered in cases of abdominal pain in patients taking oral contraceptives.
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Affiliation(s)
- Daisuke Omura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mikako Obika
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Satoko Nagao
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takahiro Nada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takashi Matsuzaki
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Deng X, Chau LHP, Chiu SY, Leung KP, Hu Y, Ip WY. Prognostic Value of Ultrasonography in Predicting Therapeutic Outcome for Carpal Tunnel Syndrome after Conservative Treatment: A Retrospective Long-term Follow-up Study. J Med Ultrasound 2019; 27:192-197. [PMID: 31867193 PMCID: PMC6905255 DOI: 10.4103/jmu.jmu_13_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/06/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose This study aimed at investigating prognostic values of different ultrasound variables in predicting therapeutic outcome of the patients with carpal tunnel syndrome (CTS) after conservative treatment in a long-term follow-up data. Materials and Methods One hundred and three participants with 162 affected hands were enrolled in this retrospective study. Records of baseline clinical information, nerve conduction studies (NCSs), and ultrasound assessment were retrieved. A structured telephone interview was conducted for acquiring patients' response to recovery after treatment. Multinomial logistic regression analysis was used to estimate the odds ratio and 95% confidence interval of individual ultrasound variable, adjusted for age, gender, and other confounding factors. Results Perimeter at wrist (W-P), ratio of cross-sectional area of wrist over one-third distal forearm (R-CSA), changes of CSA from wrist to the one-third distal forearm (△CSA), and changes of perimeter from wrist to one-third distal forearm (△P) were negatively and significantly associated with "improved" and "no change" categories relative to reference category ("deteriorated" category). After adjustment for age, gender, affected hand side, surgical history, and comorbidity, for one unit increase of W-P/△CSA/△P, the odds of "improved" category versus "deteriorated" category decreased by 89.1%/56%/95.2%, whereas the odds of "no change" relative to "deteriorated" category decreased by 77.8%/54.6%/84.9% should one unit increase in the correspondent individual ultrasound variable. Conclusion Ultrasound variables can significantly predict therapeutic outcome in CTS after conservative management in a long-term follow-up. Further studies may be required to assess whether a combination of clinical, NCS, and ultrasound variables can better predict the therapeutic outcome.
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Affiliation(s)
- Xue Deng
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Suk-Yee Chiu
- Clinical Neurodiagnostic Unit, Tung Wah Hospital, Sheung Wan, Hong Kong
| | - Kwok-Pui Leung
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yong Hu
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wing-Yuk Ip
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
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23
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Wessel LE, Marshall DC, Stepan JGH, Sacks HA, Nwawka OK, Miller TT, Fufa DT. Sonographic Findings Associated With Carpal Tunnel Syndrome. J Hand Surg Am 2019; 44:374-381. [PMID: 30241975 DOI: 10.1016/j.jhsa.2018.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to identify associations between the clinical manifestations of carpal tunnel syndrome (CTS) and the sonographic measurements of the median nerve in the carpal tunnel. We hypothesized that sonographic changes in the median nerve from proximal to distal along the carpal tunnel would be associated with symptom severity scores. METHODS We report on 38 patients with clinical signs and symptoms of CTS in a prospective investigation. Subjects underwent sonographic evaluation with measurement of median nerve cross-sectional area (CSA) at 3 locations: the level of the pronator quadratus, pisiform, and hamate. In addition, we measured dimensions of the carpal tunnel at the levels of the pisiform (inlet) and hamate (outlet). Finally, we recorded maximal thickness of the transverse carpal ligament (TCL). Patients underwent routine clinical evaluation and 31 patients had electrodiagnostic examination. Patients completed the Levine Katz Questionnaire (LKQ) to characterize severity of clinical symptoms. Each clinician was blinded to symptom severity scores. Pearson correlation coefficients were calculated to measure the relationship between LKQ score and sonographic measures. RESULTS Median nerve CSA decreased over the course of the carpal tunnel from proximal to distal in 30 of 38 wrists. A greater absolute change in CSA of the median nerve over the course of the carpal tunnel between the pisiform and the hamate as well as between the pronator quadratus and the hamate correlated with increased severity of clinical symptoms. Increased thickening of the TCL also correlated with greater symptom severity scores. CONCLUSIONS Changes in CSA of the median nerve as well as thickening of the TCL correlate with CTS severity. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
| | | | | | - Hayley Anne Sacks
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York
| | | | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York
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Abstract
The Academy of Orthopaedic Physical Therapy and the Academy of Hand and Upper Extremity Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on hand pain and sensory deficits in carpal tunnel syndrome. J Orthop Sports Phys Ther 2019;49(5):CPG1-CPG85. doi:10.2519/jospt.2019.0301.
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25
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Nazish S, Zafar A, Shahid R, Al Sulaiman A, Alabdali M, Aljaafari D, Alkhamis FA, Alkhamis FA, Yasawy ZM, Ishaque N, Soltan NM, Vohra EA. Electrophysiologic severity of carpal tunnel syndrome in diabetic patients of the Saudi population. ACTA ACUST UNITED AC 2019; 24:22-28. [PMID: 30842396 PMCID: PMC8015540 DOI: 10.17712/nsj.2019.1.20180217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: To study the frequency of multiple vascular risk factors and electrophysiological severity of carpal tunnel syndrome (CTS) in Saudi diabetic patients. Methods: This retrospective cross-sectional study was conducted in Neurology Department, King Fahd Hospital of University, Al-Khobar, Kingdom of Saudi Arabia from April 2017 to March 2018 and included 200 patients with CTS. Body parameters, such as blood pressure (BP), weight, height, and body mass index (BMI), along with laboratory and median nerve electrophysiological parameters, of diabetic and non-diabetic patients were compared, and a p-value<0.05 was considered significant. Results: Frequency of hypertension (HTN) and obesity was significantly higher in diabetic patients (p<0.05). Mean median nerve sensory amplitude (MNSA) was lower in diabetic patients (p<0.05).Non-recordable nerves, as well as bilateral and extremely severe CTS (p<0.05), were more frequently seen in diabetic patients. Age, BMI, systolic BP, low serum high density lipoprotein (HDL), high triglycerides, high fasting blood sugar, and high glycated hemoglobin (Hba1c) levels, known to affect the electrophysiological severity of CTS, had a statistically significant association with diabetes. Conclusion: Diabetes mellitus (DM) and obesity are the most commonly identified risk factors of CTS. Dyslipidemia, HTN and obesity are more frequently seen in diabetic patients with CTS. These concurrent risk factors are confounding the electrophysiological severity of CTS in these patients. Further larger-scale studies with the control of confounding factors are recommended.
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Affiliation(s)
- Saima Nazish
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia. E-mail:
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Abstract
Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities.
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Affiliation(s)
- Christopher T Doughty
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Michael P Bowley
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, WACC 739B, Boston, MA 02114, USA.
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The Economic Effect of Chronic Comorbidities in Carpal Tunnel Syndrome Workers’ Compensation Claimants, Washington State. J Occup Environ Med 2018; 60:1128-1135. [DOI: 10.1097/jom.0000000000001451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kwon DR, Chae S, Moon YS, Woo IH. Carpal tunnel syndrome caused by synovial osteochondromatosis of the finger flexor tendon: A case report. Medicine (Baltimore) 2018; 97:e13943. [PMID: 30593214 PMCID: PMC6314781 DOI: 10.1097/md.0000000000013943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Carpal tunnel syndrome (CTS) is the most common peripheral nerve neuropathy resulting from compression of the median nerve as it traverses the carpal tunnel. The pathophysiology of this condition is multifactorial, and majority of cases of CTS are idiopathic. We report cases of CTS caused by synovial osteochondromatosis (SOC), which has rarely been reported. PATIENT CONCERNS A 45-year-old female was admitted to the clinic due to right hand tingling sensation for 4 months. On physical examination, the patient's symptoms and signs corresponded to the median nerve entrapment at wrist. However, there is mild swelling and tenderness around the second metacarpal bone. Pain was aggravated during wrist and finger flexion. DIAGNOSES An electrodiagnostic study revealed CTS. She was advised to begin splinting the hand using a wrist brace and to undergo physiotherapy. After 2 weeks, the tingling sensation decreased slightly. However mild swelling and tenderness around the second metacarpal bone did not improve. Ultrasonography showed multiple echogenic foci. Magnetic resonance imaging (MRI) revealed a nodule at the proximal metacarpal level with synovial thickening, enhancement, and a calcified shadow close to the flexor tendon. After confirming the presence of an osseous nodule with synovial thickening, the patient underwent surgery INTERVENTIONS:: Carpal tunnel release and mass excision with synovectomy of the adjacent structures were performed. Histologically, the lesion was compatible with a diagnosis of SOC. OUTCOME The symptoms have improved. LESSONS CTS due to SOC on finger flexor tendon is rare but should be considered for possible etiology. Appropriate clinical examination, plain radiography, ultrasonography, and MRI will help physicians to diagnose this condition. In this paper, we report the successful diagnosis and treatment of CTS caused by SOC within the finger flexor tendon.
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Affiliation(s)
| | | | - Yong Suk Moon
- Department of Anatomy, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - In Ho Woo
- Department of Rehabilitation Medicine
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Eroğlu A, Sarı E, Topuz AK, Şimşek H, Pusat S. Recurrent carpal tunnel syndrome: Evaluation and treatment of the possible causes. World J Clin Cases 2018; 6:365-372. [PMID: 30283799 PMCID: PMC6163139 DOI: 10.12998/wjcc.v6.i10.365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/03/2018] [Accepted: 08/11/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the causes of the recurrent carpal tunnel syndrome (CTS) and implemented surgical interventions.
METHODS Four hundred and eighty-seven patients, who were diagnosed with CTS and underwent surgical intervention between October 2016 and September 2007, were evaluated in this retrospective study. The age, gender, physical evaluation findings, electrophysiological examination reports and implemented surgical treatment methods were analyzed.
RESULTS Thirty-nine of the cases were operated due to recurrent CTS. Further examination of the patients with recurrent CTS revealed that ten cases had diabetic polyneuropathy, three cases had hypothyroidism, two cases had rheumatoid arthritis and one case had systemic amyloidosis. Postoperative electromyography confirmed the neuropathy was due to systemic diseases. The remaining 23 patients with recurrent CTS did not have any systemic disease and all of them had applied previously to another health center.
CONCLUSION We concluded that the recurrence rates in CTS might be decreased with exploration and incision of the entire transverse ligament. Damage to the motor and sensory branches of the median nerve could be avoided with an incision on the ulnar side.
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Affiliation(s)
- Ahmet Eroğlu
- Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul 34000, Turkey
| | - Enes Sarı
- Department of Orthopaedics and Traumatology, Near East University Hospital, Lefkoşa 99010, Cyprus
| | - Ali Kıvanç Topuz
- Department of Neurosurgery, Baypark Hospital, Istanbul 34000, Turkey
| | - Hakan Şimşek
- Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul 34000, Turkey
| | - Serhat Pusat
- Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul 34000, Turkey
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Musolin KM, Ramsey JG. Carpal tunnel syndrome prevalence: an evaluation of workers at a raw poultry processing plant. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2018; 23:282-290. [PMID: 29873286 DOI: 10.1080/10773525.2018.1474420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Evaluate the prevalence of carpal tunnel syndrome (CTS) among workers at a raw poultry processing plant and categorize jobs on the basis of hand activity and force. METHODS A cross-sectional survey among 191 workers assessed CTS defined by self-reported CTS symptoms, a hand symptom diagram, and measurements of nerve conduction parameters. We categorized jobs based on American Conference of Governmental Industrial Hygienists' (ACGIH®) limits for hand activity and force, and examined the relationships with CTS occurrence. RESULTS A total of 64 workers (34%) had CTS after adjusting for non-occupational factors. Overall, 81% of jobs were above the ACGIH action limit; 59% were above the ACGIH threshold limit value®. CTS prevalence did not differ significantly between exposure groups (PR = 0.82, p = 0.35). CONCLUSIONS These findings suggest that poultry processing jobs continue to be hazardous with workers at risk for CTS. Recommendations for the study population were provided to reduce exposure and CTS risk among workers.
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Affiliation(s)
- Kristin M Musolin
- a National Institute for Occupational Safety and Health , Cincinnati , OH , USA
| | - Jessica G Ramsey
- a National Institute for Occupational Safety and Health , Cincinnati , OH , USA
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Vahed LK, Arianpur A, Gharedaghi M, Rezaei H. Ultrasound as a diagnostic tool in the investigation of patients with carpal tunnel syndrome. Eur J Transl Myol 2018; 28:7380. [PMID: 29991986 PMCID: PMC6036310 DOI: 10.4081/ejtm.2018.7406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/23/2018] [Indexed: 12/21/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is reveled to be the most common peripheral nerve entrapment syndrome, estimating for 90% of all compressive. The diagnosis of CTS is based on the use of clinical criteria and imaging technique tests such as ultrasonography (US) and magnetic resonance imaging (MRI). US is a time-saving method in the diagnosis of CTS, which induces less discomfort to the patient and may be a more cost-effective approach to confirm clinical suspicion of this syndrome .The current study was aimed to evaluate the value of US and physical examinations in the diagnosis of CTS. This cross-sectional and cross-sectional prospective case study was conducted to evaluate the usefulness of wrist ultrasonography in diagnosing CTS. Twenty one patients (21 wrists) were invited to participate in the study along with an age- and sex-matched group of participant controls. Physical examination included Phalen, Tinel, Durkan, Tourniquet test. Anteroposterior and mediolateral dimension of carpal tunnel, and the median nerve area at the tunnel were also measured. All the patients underwent the open surgical release of the flexor retinaculum. There was a significant statistical relationship (p=0.05) between anteroposterior diameter of the carpal tunnel and clinical and electro physiologic nerve involvement. Furthermore, some qualitative findings was achieved such as median nerve splitting, hypo echogenicity of the involved nerve, thickening of flexor retinaculum and disappearance of median nerve areas (especially mediolateral direction). In conclusion, ultrasonographic examination of the wrists in the patients with suspected clinical symptoms can improve the diagnostic ability of CTS, especially by improving technology and experience. US can be applied for the median nerve area (MNA) measurement as a first line technique in patients with CTS.
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Affiliation(s)
- Leila Kanafi Vahed
- Department of Community Medicine, Gilan University of Medical Sciences, Gilan, Iran
| | - Afshin Arianpur
- Department of Orthopedics, Shohada Hospital, Lahijan, Gilan University of Medical Sciences, Gilan, Iran
| | | | - Hosein Rezaei
- Mashhad University of Medical Sciences, Mashhad, Iran
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Desai GJ, Dowling DJ, Harbaugh JW. Carpal Tunnel Syndrome. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Investigation of Nerve Conduction Studies of Carpal Tunnel Syndrome Cases With Different Risk Factors: An Electrodiagnostic Study. J Clin Neurophysiol 2017; 34:139-143. [PMID: 27753734 DOI: 10.1097/wnp.0000000000000352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to determine whether there are electrodiagnostic differences between carpal tunnel syndrome (CTS) patients with diabetes mellitus, CTS + hypothyroidism (HT), CTS + fibromyalgia syndrome, CTS + rheumatoid arthritis (RA), and idiopathic CTS cases, by comparing nerve conduction studies. METHODS This research examined electrophysiologic studies of 47 untreated HT + CTS, 47 diabetes mellitus + CTS, 49 RA + CTS, 52 fibromyalgia syndrome + CTS, 50 idiopathic CTS cases, and a healthy control group of 50 individuals (a total of 293 patients and 433 hands with CTS). RESULTS There were no significant differences between the groups in terms of sex and age. There was no significant difference between the CTS groups-in terms of numbers-with mild, moderate, and severe CTS. When the CTS groups were compared with the control group, in all CTS groups on both left and right hands, there was a significant prolongation in median motor latency and median sensory latency (in the 3rd finger); also a significant decrease in median sensory velocity in the 3rd finger. In diabetes mellitus, HT, and RA groups, the median motor amplitudes in both hands were significantly decreased compared with the idiopathic group. There was a moderate significant negative correlation between disease duration and median motor amplitudes (of both right and left sides) in RA (right; P = 0.028, r = 0.761, left; P = 0.041, r = 0.694) and HT groups (right; P = 0.035, r = 0.637, left; P = 0.049, r = 0.697). CONCLUSIONS Electrodiagnostic results showed both demyelinating injury and axonal damage in diabetes mellitus, HT, and RA patients with CTS, in these patients during treatment for CTS. Early treatment planning should include the risk factor diseases.
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Medical Problems During Pregnancy. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Roshanzamir S, Mortazavi S, Dabbaghmanesh A. Does Hypothyroidism Affect Post-Operative Outcome of Patients Undergoing Carpal Tunnel Release? Electron Physician 2016; 8:2977-2981. [PMID: 27790353 PMCID: PMC5074759 DOI: 10.19082/2977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/22/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction Risk factors associated with Carpal Tunnel Syndrome include repetitive use of hand and wrist, advanced age, obesity, pregnancy, diabetes mellitus and thyroid disease. Decompression of the median nerve is the last treatment of choice usually indicated when negative results to conservative treatments remain for three months. In this study, we aimed to find out whether hypothyroid patients would respond to CTS surgical decompression differently in comparison to healthy individuals. Methods This case control study was conducted on patients with CTS in need of surgical release who were refered to Shahid Faghihi hospital, International Branch of Shiraz University of Medical Sciences, Shiraz, Iran from January 2013 to January 2015. Twenty-five hypothyroid and 22 euthyroid patients were recruited. Hypothyroidism was diagnosed based on clinical symptoms and serum TSH level. All patients were followed for three weeks after surgery and a Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was completed for them pre and post operation. An electrophysiological study was performed during the same follow up period. Statistical analysis was performed using SPSS version 16. Results The CTS grade reported by electrophysiological study, decreased significantly 3 weeks after operation in comparison with preoperative grades (p<0.001). A significant decrease was observed in the immediate postoperative BCTQ scores compared to preoperative (p<0.001). Also a decrease was detected in the three weeks of postoperative follow up compared to immediate postoperative BCTQ scores (p<0.001) and preoperative BCTQ scores (p<0.001). Postoperative BCTQ scores of euthyroid patients decreased more in comparison to hypothyroid patients (p<0.001). Conclusion It seems that, hypothyroidism has an effect on postoperative outcome of carpal tunnel release.
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Affiliation(s)
- Sharareh Roshanzamir
- M.D., Physiatrist, Assistant Professor, Shiraz Burn Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahameddin Mortazavi
- M.D., Student Research Committee, International Branch, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Dabbaghmanesh
- M.D, Internist, Assistant Professor, Shiraz Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk Factors in Carpal Tunnel Syndrome. ACTA ACUST UNITED AC 2016; 29:315-20. [PMID: 15234492 DOI: 10.1016/j.jhsb.2004.02.009] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 02/02/2004] [Indexed: 01/01/2023]
Abstract
We have undertaken a large case–control study using the UK General Practice Research Database to quantify the relative contributions of the common risk factors for carpal tunnel syndrome (CTS) in the community. Cases were patients with a diagnosis of CTS and, for each, four controls were individually matched by age, sex and general practice. Our dataset included 3,391 cases, of which 2,444 (72%) were women, with a mean age at diagnosis of 46 (range 16–96) years. Multivariate analysis showed that the risk factors associated with CTS were previous wrist fracture (OR = 2.29), rheumatoid arthritis (OR = 2.23), osteoarthritis of the wrist and carpus (OR = 1.89), obesity (OR = 2.06), diabetes (OR = 1.51), and the use of insulin (OR = 1.52), sulphonylureas (OR = 1.45), metformin (OR = 1.20) and thyroxine (OR = 1.36). Smoking, hormone replacement therapy, the combined oral contraceptive pill and oral corticosteroids were not associated with CTS. The results were similar when cases were restricted to those who had undergone carpal tunnel decompression.
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Affiliation(s)
- J M Geoghegan
- Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, Derby, UK.
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Abstract
Women with type 1 diabetes (T1DM) have unique needs during the preconception, pregnancy, and postpartum periods. Preconception counseling is essential for women with T1DM to minimize pregnancy risks. The goals of preconception care should be tight glycemic control with a hemoglobin A1c (A1C) < 7 % and as close to 6 % as possible, without significant hypoglycemia. This will lower risks of congenital malformations, preeclampsia, and perinatal mortality. The safety of medications should be assessed prior to conception. Optimal control of retinopathy, hypertension, and nephropathy should be achieved. During pregnancy, the goal A1C is near-normal at <6 %, without excessive hypoglycemia. There is no clear evidence that continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) is superior in achieving the desired tight glycemic control of T1DM during pregnancy. Data regarding continuous glucose monitoring (CGM) in pregnant women with T1DM is conflicting regarding improved glycemic control. However, a recent CGM study does provide some distinct patterns of glucose levels associated with large for gestational age infants. Frequent eye exams during pregnancy are essential due to risk of progression of retinopathy during pregnancy. Chronic hypertension treatment goals are systolic blood pressure 110-129 mmHg and diastolic blood pressure 65-79 mmHg. Labor and delivery target plasma glucose levels are 80-110 mg/dl, and an insulin drip is recommended to achieve these targets during active labor. Postpartum, insulin doses must be reduced and glucoses closely monitored in women with T1DM because of the enhanced insulin sensitivity after delivery. Breastfeeding is recommended and should be highly encouraged due to maternal benefits including increased insulin sensitivity and weight loss and infant and childhood benefits including reduced prevalence of overweight. In this article, we discuss the care of pregnant patients with T1DM.
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Affiliation(s)
- Anna Z Feldman
- Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02115, USA
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Simultaneous Median-Radial Nerve Electrical Stimulation Revisited: An Accurate Approach to Carpal Tunnel Syndrome Diagnosis and Severity. J Clin Neurophysiol 2016; 33:554-559. [PMID: 27258600 DOI: 10.1097/wnp.0000000000000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To assess the accuracy of an unusual test for CTS investigation and correlate it with clinical symptoms. METHODS Initially, we applied a visual analog scale for CTS discomfort (CTS-VAS) and performed a standard electrophysiologic test for CTS diagnosis (median-ulnar velocity comparison). Posteriorly, a blinded neurophysiologist performed the orthodromic simultaneous median-radial nerve stimulation (SMRS) at the thumb, with recording of both action potentials over the lateral aspect of the wrist. RESULTS All hands (106) showed median-radial action potential splitting using the SMRS technique, in which was possible to measure the interpeak latencies (IPLs) between action potentials. The IPL and median nerve conduction velocity were different according to CTS intensity (Bonferroni; P < 0.001). There was significant correlation between IPL and median nerve conduction velocity (Spearman; r = -0.51; P < 0.01). In the same way, there was a significant correlation between IPL and median nerve conduction velocity with CTS-VAS (r = 0.6 and r = -0.3, respectively). The duration and unpleasantness of the SMRS procedure were lower when compared with standard approach (t Student < 0.001 for both comparisons). Twenty-nine symptomatic patients (39 hands) who did not fulfill criteria for CTS based on standard approach showed abnormal IPLs. CONCLUSIONS The SMRS technique is a simple, sensitive, and tolerable approach for CTS diagnosis. Apart from that, the data from SMRS correlated better with clinical impact of CTS in comparison with the standard approach. Therefore, this method might be useful as adjunct to standard electrophysiologic approaches in clinical practice.
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Riches PL, Elherik FK, Dolan S, Unglaub F, Breusch SJ. Patient rated outcomes study into the surgical interventions available for the rheumatoid hand and wrist. Arch Orthop Trauma Surg 2016; 136:563-70. [PMID: 26864307 DOI: 10.1007/s00402-016-2412-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION A multitude of surgical interventions are recognised for the treatment of the rheumatoid hand and wrist, however there seems to be a distinct lack of patient rated outcome measures (PROMs) studies reporting on the efficacy of these procedures. The aim of this study was to assess the PROMs related to hand and wrist surgery in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS A single surgeon series identified 94 patients (133 hands) with RA who had undergone one of eight surgical procedures (Swanson's arthroplasty, finger joint or wrist arthrodesis, carpal tunnel decompression, posterior interosseous nerve denervation, RA nodule excision, synovectomy/tenosynovectomy and tendon repair/release) with a mean follow-up period of 3 years. The primary outcome measures were the same for all patients and comprised the validated modified score for the assessment and quantification of chronic rheumatoid affections of the hand (M-SACRAH) and a separate satisfaction questionnaire. RESULTS Highly significant improvements in both function and pain scores are reported across the cohort as a whole following hand surgery, with this pattern replicated within all of the operative subgroups. In keeping with these favourable results very high levels of overall satisfaction were reported with 93 % of patients reporting themselves to be very or fairly satisfied with their procedure. CONCLUSIONS Overall, patient reported outcomes in functional, stiffness and pain domains of the M-SACRAH questionnaire appear very favourable across the range of surgical procedures that can be performed in the rheumatoid hand. We believe this data supports the use of all the procedures explored, and will be helpful in patient guidance.
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Affiliation(s)
- Philip L Riches
- Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Firas K Elherik
- Department of Orthopaedic Surgery, New Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK
| | - Sean Dolan
- University of Dundee Medical School, Ninewells Hospital, Dundee, DD2 1UB, UK
| | - Frank Unglaub
- Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, Germany
| | - Steffen J Breusch
- Department of Orthopaedic Surgery, New Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SU, UK.
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Affiliation(s)
- R Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
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Yian EH, Dillon M, Sodl J, Dionysian E, Navarro R, Singh A. Incidence of symptomatic compressive peripheral neuropathy after shoulder replacement. Hand (N Y) 2015; 10:243-7. [PMID: 26034438 PMCID: PMC4447685 DOI: 10.1007/s11552-014-9701-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The incidence of post-operative compressive peripheral neuropathy (CPN) after shoulder arthroplasty is not known. We hypothesized that the likelihood following shoulder arthroplasty would be higher compared to a non-operative cohort. METHODS Retrospective study compared the incidence of symptomatic CPN after shoulder replacement to a 1:1 age- and gender-matched non-operative control group with shoulder arthritis. Six hundred six consecutive shoulder replacements from a regional shoulder arthroplasty registry were analyzed. This included 319 primary total shoulder arthroplasties (TSR), 168 hemiarthroplasties (HA), 31 humeral resurfacings (HHR), 71 reverse arthroplasties (RTSA), and 17 revision arthroplasties. Diagnosis of post-operative CPN was obtained by documented clinical examination by a physician consistent with CPN based on patient complaints, positive nerve study results, and/or nerve decompression. Age, gender, body mass index, diabetes status, thyroid abnormalities, operative side, and anesthesiology (ASA) score were examined. RESULTS The surgery group had 15 cases (2.5 %) of post-operative CPN (ten carpal tunnel syndrome, five cubital tunnel syndrome). This included seven TSR, six HA, one revision TSR, and one RTSA. Diagnoses included ten osteoarthritis, four rotator cuff arthropathies, and one chondrolysis. Control group had eight cases (1.3 %) of CPN (seven carpal tunnel syndrome, one cubital tunnel syndrome). In univariate analysis, age, gender, body mass index, ASA score, operative side, thyroid status, and diabetes were not predictors of post-operative CPN. CPN incidence between surgical and control groups was not statistically significant. CONCLUSION The 1-year incidence rate of new onset clinical post-operative CPN symptoms was 2.5 %. There was no significant difference of CPN rates between surgical and non-operative groups.
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Affiliation(s)
- Edward H. Yian
- />Kaiser Permanente Southern California Orange County Kraemer Medical Offices, 3460 E. La Palma Avenue, Anaheim, CA 92806 USA
| | - Mark Dillon
- />Kaiser Permanente Northern California Sacramento Medical Center and Medical Offices, 2025 Morse Avenue, Sacramento, CA 95825 USA
| | - Jeff Sodl
- />Kaiser Permanente Southern California Orange County Medical Office Building, 200 North Lewis Avenue, Orange, CA 92807 USA
| | - Emil Dionysian
- />Kaiser Permanente Southern California Orange County Medical Office Building, 411 North Lakeview Avenue, Anaheim, CA 92807 USA
| | - Ronald Navarro
- />Kaiser Permanente Southern California South Bay Medical Center, 25825 Vermont Avenue, Harbor City, CA 90710 USA
| | - Anshuman Singh
- />Kaiser Permanente Southern California Orthopedics-Regular Clinic, Garfield Specialty Center, 5893 Copley Drive, San Diego, CA 92111 USA
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Oktayoglu P, Nas K, Kilinç F, Tasdemir N, Bozkurt M, Yildiz I. Assessment of the Presence of Carpal Tunnel Syndrome in Patients with Diabetes Mellitus, Hypothyroidism and Acromegaly. J Clin Diagn Res 2015; 9:OC14-8. [PMID: 26266148 DOI: 10.7860/jcdr/2015/13149.6101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/12/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies of the upper limbs. It results from compromised median nerve function of the wrist that is caused by increased pressure in the carpal tunnel. Repetitive use of the hand and wrist, obesity, pregnancy, rheumatoid diseases, trauma and endocrinopathies are some of the risk factors for CTS. AIM The purpose of this study was to find out whether patients with diabetes mellitus (DM), hypothyroidism and acromegaly have an increased incidence of carpal tunnel syndrome compared to each other and normal population. MATERIALS AND METHODS Patients were assigned into three groups as follows: patients with type II DM n: 100, patients with hypothyroidism n:48 and patients with acromegaly n:36. In addition, 50 healthy individuals were included in the study as control subjects. Patients were asked if they had any pain, symptoms of paraesthesia and numbness. Patients with peripheral neuropathy were excluded from the study. Boston Symptom Severity Scale and Functional Capacity Scale were used to assess symptom severity and functional capacity. CTS was investigated by performing electrophysiological study for both hands. RESULTS The incidence of CTS was significantly higher in all three groups compared to the control group (p>0.05). In addition, the incidence of CTS was significantly higher in the DM group compared to the hypothyroid and acromegaly groups (p<0.001). The incidence of bilateral CTS in the DM group was significantly higher compared to both hypothyroid and acromegaly groups and the control group (p<0.001). CONCLUSION CTS has a higher incidence in DM, hypothyroid and acromegaly patients compared to healthy individuals. Clinicians should be careful about development of CTS in DM, hypothyroidism and acromegaly. They should adopt a multidisciplinary approach and co-operate with the psychiatrist.
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Affiliation(s)
- Pelin Oktayoglu
- Faculty, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University , Diyarbakir, Turkey
| | - Kemal Nas
- Faculty, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sakarya University , Sakarya, Turkey
| | - Faruk Kilinç
- Faculty, Department of Endocrinology, Faculty of Medicine, Dicle University , Diyarbakir, Turkey
| | - Nebahat Tasdemir
- Faculty, Department of Neurology, Faculty of Medicine, Dicle University , Diyarbakir, Turkey
| | - Mehtap Bozkurt
- Faculty, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University , Diyarbakir, Turkey
| | - Ismail Yildiz
- Faculty, Department of Biostatistics, Faculty of Medicine, Dicle University , Diyarbakir, Turkey
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Petit A, Ha C, Bodin J, Rigouin P, Descatha A, Brunet R, Goldberg M, Roquelaure Y. Risk factors for carpal tunnel syndrome related to the work organization: a prospective surveillance study in a large working population. APPLIED ERGONOMICS 2015; 47:1-10. [PMID: 25479968 DOI: 10.1016/j.apergo.2014.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 06/25/2014] [Accepted: 08/04/2014] [Indexed: 06/04/2023]
Abstract
The study aimed to determine the risk factors for incident carpal tunnel syndrome (CTS) in a large working population, with a special focus on factors related to work organization. In 2002-2005, 3710 workers were assessed and, in 2007-2010, 1611 were re-examined. At baseline all completed a self-administered questionnaire about personal/medical factors and work exposure. CTS symptoms and physical examination signs were assessed by a standardized medical examination at baseline and follow-up. The risk of "symptomatic CTS" was higher for women (OR = 2.9 [1.7-5.2]) and increased linearly with age (OR = 1.04 [1.00-1.07] for 1-year increment). Two work organizational factors remained in the multivariate risk model after adjustment for the personal/medical and biomechanical factors: payment on a piecework basis (OR = 2.0, 95% CI 1.1-3.5) and work pace dependent on automatic rate (OR = 1.9, 95% CI 0.9-4.1). Several factors related to work organization were associated with incident CTS after adjustment for potential confounders.
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Affiliation(s)
- Audrey Petit
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France.
| | - Catherine Ha
- Département santé travail, Institut de veille sanitaire (DST-InVS), Saint-Maurice, France
| | - Julie Bodin
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
| | - Pascal Rigouin
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
| | - Alexis Descatha
- INSERM, Université de Versailles St-Quentin, UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - René Brunet
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
| | - Marcel Goldberg
- INSERM, Université de Versailles St-Quentin, UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Yves Roquelaure
- LUNAM Université, Université d'Angers, Laboratoire d'ergonomie et d'épidémiologie en santé au travail (LEEST), Angers, France
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Kazamel M, Dyck PJ. Sensory manifestations of diabetic neuropathies: anatomical and clinical correlations. Prosthet Orthot Int 2015; 39:7-16. [PMID: 25614497 DOI: 10.1177/0309364614536764] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Diabetes mellitus is among the most common causes of peripheral neuropathy worldwide. Sensory impairment in diabetics is a major risk factor of plantar ulcers and neurogenic arthropathy (Charcot joints) causing severe morbidity and high health-care costs. OBJECTIVE To discuss the different patterns of sensory alterations in diabetic neuropathies and their anatomical basis. STUDY DESIGN Literature review. METHODS Review of the literature discussing different patterns of sensory impairment in diabetic neuropathies. RESULTS The different varieties of diabetic neuropathies include typical sensorimotor polyneuropathy (lower extremity predominant, length-dependent, symmetric, sensorimotor polyneuropathy presumably related to chronic hyperglycemic exposure, and related metabolic events), entrapment mononeuropathies, radiculoplexus neuropathies related to immune inflammatory ischemic events, cranial neuropathies, and treatment-related neuropathies (e.g. insulin neuritis). None of these patterns are unique for diabetes, and they can occur in nondiabetics. Sensory alterations are different among these prototypic varieties and are vital in diagnosis, following course, treatment options, and follow-up of treatment effects. CONCLUSIONS Diabetic neuropathies can involve any segment of peripheral nerves from nerve roots to the nerve endings giving different patterns of abnormal sensation. It is the involvement of small fibers that causes positive sensory symptoms like pain early during the course of disease, bringing subjects to physician's care. CLINICAL RELEVANCE This article emphasizes on the fact that diabetic neuropathies are not a single entity. They are rather different varieties of conditions with more or less separate pathophysiological mechanisms and anatomical localization. Clinicians should keep this in mind when assessing patients with diabetes on the first visit or follow-up.
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Affiliation(s)
- Mohamed Kazamel
- Neuromuscular Pathology Laboratories, Department of Neurology, Mayo Clinic, Rochester, USA
| | - Peter J Dyck
- Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, Rochester, USA
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Diagnosis and Prognosis of Carpal Tunnel Syndrome. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Medical Problems During Pregnancy. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_12-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Myofibroma in the palm presenting with median nerve compression symptoms. Plast Reconstr Surg Glob Open 2014; 2:e204. [PMID: 25426387 PMCID: PMC4236365 DOI: 10.1097/gox.0000000000000153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/11/2014] [Indexed: 12/31/2022]
Abstract
SUMMARY A myofibroma is a benign proliferation of myofibroblasts in the connective tissue. Solitary myofibromas are a rare finding especially in an adult. We report a case of a 23-year-old man presenting with an enlarging mass over his right palm. The patient is an active weight lifter. He reported numbness and tingling in the median nerve distribution. Nerve conduction studies and magnetic resonance imaging scans suggested a tumor involving or compressing the median nerve. The final diagnosis of myofibroma was made only after the histopathological diagnosis.
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Dale AM, Gardner BT, Zeringue A, Strickland J, Descatha A, Franzblau A, Evanoff BA. Self-reported physical work exposures and incident carpal tunnel syndrome. Am J Ind Med 2014; 57:1246-54. [PMID: 25223617 DOI: 10.1002/ajim.22359] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND To prospectively evaluate associations between self-reported physical work exposures and incident carpal tunnel syndrome (CTS). METHODS Newly employed workers (n = 1,107) underwent repeated nerve conduction studies (NCS), and periodic surveys on hand symptoms and physical work exposures including average daily duration of wrist bending, forearm rotation, finger pinching, using vibrating tools, finger/thumb pressing, forceful gripping, and lifting >2 pounds. Multiple logistic regression models examined relationships between peak, most recent, and time-weighted average exposures and incident CTS, adjusting for age, gender, and body mass index. RESULTS 710 subjects (64.1%) completed follow-up NCS; 31 incident cases of CTS occurred over 3-year follow-up. All models describing lifting or forceful gripping exposures predicted future CTS. Vibrating tool use was predictive in some models. CONCLUSIONS Self-reported exposures showed consistent risks across different exposure models in this prospective study. Workers' self-reported job demands can provide useful information for targeting work interventions.
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Affiliation(s)
- Ann Marie Dale
- Division of General Medical Sciences; Washington University School of Medicine; St. Louis Missouri
| | - Bethany T. Gardner
- Division of General Medical Sciences; Washington University School of Medicine; St. Louis Missouri
| | - Angelique Zeringue
- Division of General Medical Sciences; Washington University School of Medicine; St. Louis Missouri
- Department of Biostatistics; School of Public Health; St. Louis University; St. Louis Missouri
| | - Jaime Strickland
- Division of General Medical Sciences; Washington University School of Medicine; St. Louis Missouri
| | - Alexis Descatha
- Inserm U1018-AP-HP; Occupational Health Unit, F92380; Garches France
| | - Alfred Franzblau
- Department of Environmental Health Sciences; University of Michigan School of Public Health; Ann Arbor Michigan
| | - Bradley A. Evanoff
- Division of General Medical Sciences; Washington University School of Medicine; St. Louis Missouri
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50
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Shiri R. Hypothyroidism and carpal tunnel syndrome: A meta-analysis. Muscle Nerve 2014; 50:879-83. [DOI: 10.1002/mus.24453] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Rahman Shiri
- Centre of Expertise for Health and Work Ability, and Disability Prevention Centre; Finnish Institute of Occupational Health; Topeliuksenkatu 41 a A FI-00250 Helsinki Finland
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