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Karimzadeh A, Esmaily H, Raeissadat SA, Esmaelzade M, Aghamiri SH, Bolandnazar NS. Comparison of the Effect of Intracarpal Injection of Ketorolac With Triamcinolone in Carpal Tunnel Syndrome: A Randomized Controlled Trial. Ann Pharmacother 2024; 58:205-213. [PMID: 37278013 DOI: 10.1177/10600280231175146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The most prevalent entrapment neuropathy is carpal tunnel syndrome (CTS). Although nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal disorders, oral NSAIDs do not provide any additional benefits for CTS. Nevertheless, the use of NSAID phonophoresis has shown significant improvement, possibly due to increased concentration in the target tissue. The effects of intracarpal injection of NSAIDs on CTS have not been studied. OBJECTIVE We conducted a controlled trial to compare the efficacy of ketorolac and triamcinolone in treating CTS. METHODS Mild to moderate CTS patients were randomly assigned to receive either a local injection of 30 mg ketorolac or 40 mg triamcinolone. Patients were evaluated using visual analog scale (VAS) for pain, severity, function, electrodiagnostic findings, patient satisfaction, and any complications at the injection site, at baseline and 12 weeks after the procedures. RESULTS Fifty patients participated, and 43 completed the study. Both groups showed significant improvement in the VAS, severity, function, and electrodiagnostic scores at 3 months compared with the baseline. A comparison of the groups showed significant differences in VAS, severity, and function, with the improvement being significantly higher in the triamcinolone group. CONCLUSION AND RELEVANCE The present study showed that injection of triamcinolone or ketorolac into the carpal tunnel relieved pain, increased function, and improved electrodiagnostic findings in patients with mild to moderate CTS. It also showed that triamcinolone was superior to ketorolac in terms of analgesic effect and resulted in greater improvement in symptom severity and function.
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Affiliation(s)
- Afshin Karimzadeh
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Esmaily
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Clinical Research Development Center, Shahid Modarres Hospital, Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaelzade
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Aghamiri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Sadat Bolandnazar
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Akdağ MA, Menekşeoğlu AK, Seğmen H, Gözek B, Korkmaz MD, Güçlü B. Measuring tactile sensitivity and mixed-reality-assisted exercise for carpal tunnel syndrome by ultrasound mid-air haptics. Front Neurosci 2024; 18:1319965. [PMID: 38312930 PMCID: PMC10835795 DOI: 10.3389/fnins.2024.1319965] [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] [Received: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation. Methods Twenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program. Results Thresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature. Discussion The results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS.
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Affiliation(s)
- Mehmet Akif Akdağ
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Türkiye
| | - Ahmet Kıvanç Menekşeoğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
| | - Hatice Seğmen
- Department of Neurology, University of Health Sciences, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
| | - Berk Gözek
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Türkiye
| | - Merve Damla Korkmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
| | - Burak Güçlü
- Institute of Biomedical Engineering, Boğaziçi University, İstanbul, Türkiye
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Anagnostou E, Xirou S, Aristeidou S, Koutsoudaki P, Kokotis P, Karandreas N, Zambelis T. The Rise Slope of the Compound Sensory Nerve Action Potential in Normal and Pathological Human Nerves. Neurodiagn J 2023; 63:190-204. [PMID: 37549426 DOI: 10.1080/21646821.2023.2235956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
In spite of the diagnostic importance of the early phase of the sensory nerve action potential (SNAP), reliable electrodiagnostic metrics for this part of the recorded waveform are lacking. The average rise slope of the SNAP appreciates the steepness of the initial negative deflection of the waveform, which might be a useful metric for the first part of the potential. Sural nerve sensory neurography was performed in patients with various axonal neuropathies, and median nerve sensory studies were carried out in patients with carpal tunnel syndrome. Age-matched healthy individuals served as controls. The rise slope was compared to conventional SNAP parameters such as conduction velocity, latency, duration, and rise time. Overall, 537 sensory studies were prospectively analyzed. The rise slope of the sural SNAP demonstrated superior classification performance in terms of sensitivity (92.5%), specificity (97%), and area under the receiver operating characteristic curve (0.986), as compared to conventional SNAP parameters. Its diagnostic power was similarly excellent in median nerve studies, whereas here a slightly better classification performance was obtained by SNAP latency and conduction velocity. The average rise slope appears to do justice to the tight interplay between amplitude and rise time of the initial negative spike deflection, outperforming many conventional measures. This composite metric proved high diagnostic potency in particular with regard to axonal sensory nerve dysfunction.
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Affiliation(s)
- Evangelos Anagnostou
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Sophia Xirou
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Stavroula Aristeidou
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Pinelopi Koutsoudaki
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Panagiotis Kokotis
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Nikos Karandreas
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Thomas Zambelis
- Department of Neurology National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
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Lyu S, Zhang M, Zhang B, Yu J, Zhu J, Gao L, Yang L, Zhang Y. Application of ultrasound images-based radiomics in carpal tunnel syndrome: Without measuring the median nerve cross-sectional area. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1198-1204. [PMID: 37313858 DOI: 10.1002/jcu.23505] [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: 04/18/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE By constructing a prediction model of carpal tunnel syndrome (CTS) based on ultrasound images, it can automatically and accurately diagnose CTS without measuring the median nerve cross-sectional area (CSA). METHODS A total of 268 wrists ultrasound images of 101 patients diagnosed with CTS and 76 controls in Ningbo NO.2 Hospital from December 2021 to August 2022 were retrospectively analyzed. The radiomics method was used to construct the Logistic model through the steps of feature extraction, feature screening, reduction, and modeling. The area under the receiver operating characteristic curve was calculated to evaluate the performance of the model, and the diagnostic efficiency of the radiomics model was compared with two radiologists with different experience. RESULTS The 134 wrists in the CTS group included 65 mild CTS, 42 moderate CTS, and 17 severe CTS. In the CTS group, 28 wrists median nerve CSA were less than the cut-off value, 17 wrists were missed by Dr. A, 26 wrists by Dr. B, and only 6 wrists were missed by radiomics model. A total of 335 radiomics features were extracted from each MN, of which 10 features were significantly different between compressed and normal nerves, and were used to construct the model. The area under curve (AUC) value, sensitivity, specificity, and accuracy of the radiomics model in the training set and testing set were 0.939, 86.17%, 87.10%, 86.63%, and 0.891, 87.50%, 80.49%, and 83.95%, respectively. The AUC value, sensitivity, specificity, and accuracy of the two doctors in the diagnosis of CTS were 0.746, 75.37%, 73.88%, 74.63% and 0.679, 68.66%, 67.16%, and 67.91%, respectively. The radiomics model was superior to the two-radiologist diagnosis, especially when there was no significant change in CSA. CONCLUSION Radiomics based on ultrasound images can quantitatively analyze the subtle changes in the median nerve, and can automatically and accurately diagnose CTS without measuring CSA, especially when there was no significant change in CSA, which was better than radiologists.
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Affiliation(s)
- Shuyi Lyu
- Department of Interventional Therapy, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
- Department of Ultrasound, Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, People's Republic of China
| | - Meiwu Zhang
- Department of Interventional Therapy, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
| | - Baisong Zhang
- Department of Interventional Therapy, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
| | - Jianjun Yu
- Department of Neuroelectrophysiology, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
| | - Jiazhen Zhu
- Department of Multi-Disciplinary Diagnosis and Treatment, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
| | - Libo Gao
- Department of Interventional Therapy, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
| | - Liu Yang
- Department of Interventional Therapy, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
| | - Yan Zhang
- Department of Interventional Therapy, Ningbo NO.2 Hospital, Ningbo, People's Republic of China
- Department of Ultrasound, Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, People's Republic of China
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Matur Z, Zengin T, Bolu NE, Oge AE. Prevalence of Carpal Tunnel Syndrome Symptoms Among Young Dentists. Cureus 2023; 15:e43358. [PMID: 37700967 PMCID: PMC10493822 DOI: 10.7759/cureus.43358] [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: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Although age is a risk factor, carpal tunnel syndrome (CTS) can also affect younger individuals, particularly those involved in activities or occupations that require repetitive hand movements, forceful gripping, or prolonged wrist flexion/extension. This case-control study aimed to examine the prevalence of CTS symptoms and frequent object dropping among a group of young dentists who are exposed to CTS risk factors. Additionally, other reported risk factors for CTS, such as sex, obesity, and square wrist sign, were also investigated. Methods A total of 74 dentists (48 women, mean age 28.5 years), who are working at Istanbul Faculty of Dentistry, the largest dental school in Istanbul, which is the biggest city in Turkey, were included in the study. Additionally, 61 age- and sex-matched controls (38 women, mean age 27.9 years) were also recruited. The Edinburgh Hand Preference Questionnaire, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), a questionnaire for object dropping and occupational hand usage, anthropometric measurements of the hands, clinical neurologic examination, and electromyography intended for the detection of CTS were performed. Results The dentists had a higher total weekly hand usage duration compared to the controls (66.3 vs 44.8 hours, p<0.001). BCTQ scores and the frequency of object dropping were also significantly higher in dentists compared to controls (respective p values: 0.011, 0.003). Positive correlations were found between BCTQ scores, hand usage durations, and object dropping (respective p values: 0.001, <0.001). BCTQ scores were higher in women than in men (p=0.027). Electrophysiologic evidence of CTS was found in one dentist. Conclusions Symptoms of CTS may manifest in individuals at a younger age than predicted, primarily influenced by their occupation and the duration of hand usage. Dentists, in particular, report a higher incidence of complaints related to object dropping, which can be attributed to their frequent use of specialized tools and engagement in delicate tasks, resulting in heightened awareness. However, it can also potentially serve as an indicator of CTS.
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Affiliation(s)
- Zeliha Matur
- Department of Neurology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TUR
| | - Tunahan Zengin
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TUR
- Department of Internal Medicine, Trakya University, Faculty of Medicine, Edirne, TUR
| | - Naci Emre Bolu
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TUR
- Department of Neurology, Maltepe University, Faculty of Medicine, Istanbul, TUR
| | - Ali Emre Oge
- Departments of Neurology and Clinical Neurophysiolgy, Istanbul University, Istanbul Faculty of Medicine, Istanbul, TUR
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Lyu S, Zhang Y, Zhang M, Zhu J, Yu J, Zhang B, Gao L, Wei H. The Application of Ultrasound Image-Based Radiomics in the Diagnosis of Mild Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1499-1508. [PMID: 36565451 DOI: 10.1002/jum.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The ultrasound diagnosis of mild carpal tunnel syndrome (CTS) is challenging. Radiomics can identify image information that the human eye cannot recognize. The purpose of our study was to explore the value of ultrasound image-based radiomics in the diagnosis of mild CTS. METHODS This retrospective study included 126 wrists in the CTS group and 88 wrists in the control group. The radiomics features were extracted from the cross-sectional ultrasound images at the entrance of median nerve carpal tunnel, and the modeling was based on robust features. Two radiologists with different experiences diagnosed CTS according to two guidelines. The area under receiver (AUC) operating characteristic curve, sensitivity, specificity, and accuracy were used to evaluate the diagnostic efficacy of the two radiologists and the radiomics model. RESULTS According to guideline one, the AUC values of the two radiologists for CTS were 0.72 and 0.67, respectively; according to guideline two, the AUC were 0.73 and 0.68, respectively. The radiomics model achieved the best accuracy when 16 important robust features were selected. The AUC values of training set and test set were 0.92 and 0.90, respectively. CONCLUSIONS The radiomics label based on ultrasound images had excellent diagnostic efficacy for mild CTS. It is expected to help radiologists to identify early CTS patients as soon as possible, especially for inexperienced doctors.
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Affiliation(s)
- Shuyi Lyu
- Department of Interventional Therapy, Ningbo No. 2 Hospital, Zhejiang, China
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
| | - Yan Zhang
- Department of Interventional Therapy, Ningbo No. 2 Hospital, Zhejiang, China
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
| | - Meiwu Zhang
- Department of Interventional Therapy, Ningbo No. 2 Hospital, Zhejiang, China
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
| | - Jiazhen Zhu
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
- Multi-disciplinary Diagnosis and Treatment Department, Ningbo No. 2 Hospital, Zhejiang, China
| | - Jianjun Yu
- Department of Neuroelectrophysiology, Ningbo No. 2 Hospital, Zhejiang, China
| | - Baisong Zhang
- Department of Interventional Therapy, Ningbo No. 2 Hospital, Zhejiang, China
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
| | - Libo Gao
- Department of Interventional Therapy, Ningbo No. 2 Hospital, Zhejiang, China
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
| | - Huilin Wei
- Department of Interventional Therapy, Ningbo No. 2 Hospital, Zhejiang, China
- Ningbo Clinical Research Center for Medical Imaging, Zhejiang, China
- Provincial and Municipal Co-construction Key Discipline for Medical Imaging, Zhejiang, China
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Kim SW, Kim S, Shin D, Choi JH, Sim JS, Baek S, Yoon JS. Feasibility of artificial intelligence assisted quantitative muscle ultrasound in carpal tunnel syndrome. BMC Musculoskelet Disord 2023; 24:524. [PMID: 37370076 DOI: 10.1186/s12891-023-06623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND In case of focal neuropathy, the muscle fibers innervated by the corresponding nerves are replaced with fat or fibrous tissue due to denervation, which results in increased echo intensity (EI) on ultrasonography. EI analysis can be conducted quantitatively using gray scale analysis. Mean value of pixel brightness of muscle image defined as EI. However, the accuracy achieved by using this parameter alone to differentiate between normal and abnormal muscles is limited. Recently, attempts have been made to increase the accuracy using artificial intelligence (AI) in the analysis of muscle ultrasound images. CTS is the most common disease among focal neuropathy. In this study, we aimed to verify the utility of AI assisted quantitative analysis of muscle ultrasound in CTS. METHODS This is retrospective study that used data from adult who underwent ultrasonographic examination of hand muscles. The patient with CTS confirmed by electromyography and subjects without CTS were included. Ultrasound images of the unaffected hands of patients or subjects without CTS were used as controls. Ultrasonography was performed by one physician in same sonographic settings. Both conventional quantitative grayscale analysis and machine learning (ML) analysis were performed for comparison. RESULTS A total of 47 hands with CTS and 27 control hands were analyzed. On conventional quantitative analysis, mean EI ratio (i.e. mean thenar EI/mean hypothenar EI ratio) were significantly higher in the patient group than in the control group, and the AUC was 0.76 in ROC analysis. In the analysis using machine learning, the AUC was the highest for the linear support vector classifier (AUC = 0.86). When recursive feature elimination was applied to the classifier, the AUC value improved to 0.89. CONCLUSION This study showed a significant increase in diagnostic accuracy when AI was used for quantitative analysis of muscle ultrasonography. If an analysis protocol using machine learning can be established and mounted on an ultrasound machine, a noninvasive and non-time-consuming muscle ultrasound examination can be conducted as an ancillary tool for diagnosis.
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Affiliation(s)
- Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sunwoo Kim
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea
| | - Dongik Shin
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea
| | - Jae Hyeong Choi
- Department of Physical and Rehabilitation Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung Sub Sim
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea
| | - Seungjun Baek
- Department of Computer Science and Engineering, Korea University, 145, Anam-ro, Seoul, 02841, Republic of Korea.
| | - Joon Shik Yoon
- Department of Physical and Rehabilitation Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Chen J, Fowler JR. Comparison of Diagnostic Accuracy of Electrodiagnostic Testing and Ultrasonography for Carpal Tunnel Syndrome. Hand (N Y) 2023; 18:407-412. [PMID: 34431727 PMCID: PMC10152524 DOI: 10.1177/15589447211038701] [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: 11/16/2022]
Abstract
BACKGROUND Confirmatory methods such as electrodiagnostic testing (EDX) and ultrasonography (US) are currently used to support a clinical diagnosis of carpal tunnel syndrome (CTS). Scientific consensus long has preferred nerve conduction studies (NCS); however, recent studies have advocated for a diagnostic niche for ultrasound examination. This study seeks to compare diagnostic accuracies, sensitivity, and specificity between these 2 diagnostic tools. METHODS An institutional database was retrospectively analyzed to reveal 402 upper extremity cases (265 patients) with potential for CTS diagnosis. Demographics, NCS results, and US findings were determined for each patient case. Sensitivity and specificity values were determined for each diagnostic modality using Carpal Tunnel Syndrome 6 (CTS-6), a validated clinical CTS scoring system, as the reference standard. Demographic and diagnostic values were compared between positive and negative CTS groups using the 2-tailed t test and χ2 test. RESULTS Electrodiagnostic testing resulted in a sensitivity of 87% and a specificity of 27%, whereas US produced a sensitivity of 76% and a specificity of 51%. No statistical difference was found in CTS-6 scores between NCS-positive and NCS-negative patient hands, whereas CTS-6 scores were significantly greater in US-positive CTS cases than US-negative cases (15.2 and 13.1, respectively, P < .001). CONCLUSIONS Electrodiagnostic testing yields a greater sensitivity for CTS than US examination. However, US testing aligns more closely with CTS-6 scores and results in a greater specificity and positive predictive value. These findings suggest that US holds a non-trivial niche in CTS diagnosis and that EDX is not clearly preferable for all CTS diagnoses and cases.
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De Souza JM, Trevisan TJ, Sepresse SR, Londe AC, França Júnior MC, Appenzeller S. Peripheral Neuropathy in Systemic Autoimmune Rheumatic Diseases-Diagnosis and Treatment. Pharmaceuticals (Basel) 2023; 16:ph16040587. [PMID: 37111344 PMCID: PMC10141986 DOI: 10.3390/ph16040587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Peripheral neuropathy (PN) is frequently observed in systemic rheumatic diseases and is a challenge in clinical practice. We aimed to review the evidence on the subject and proposed a comprehensive approach to these patients, facilitating diagnosis and management. We searched the MEDLINE database for the terms (and its respective Medical Subject Headings (MeSH) terms): "peripheral neuropathy" AND "rheumatic diseases" OR "systemic lupus erythematosus", "rheumatoid arthritis", "Sjogren syndrome", and "vasculitis" from 2000 to 2023. This literature review focuses on the diagnostic workup of PNs related to systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, and systemic vasculitis. For every type of PN, we provide a pragmatic flowchart for diagnosis and also describe evidence-based strategies of treatment.
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Affiliation(s)
- Jean Marcos De Souza
- Department of Internal Medicine, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | - Thiago Junqueira Trevisan
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13084971, Brazil
| | - Samara Rosa Sepresse
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | - Ana Carolina Londe
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
- Post-Graduate Program in Physiopathology, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | | | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13084971, Brazil
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
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Lyu S, Zhang Y, Zhang M, Jiang M, Yu J, Zhu J, Zhang B. Ultrasound-based radiomics in the diagnosis of carpal tunnel syndrome: The influence of regions of interest delineation method on mode. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:498-506. [PMID: 36341718 DOI: 10.1002/jcu.23387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In the recent years, artificial intelligence (AI) algorithms have been used to accurately diagnose musculoskeletal diseases. However, it is not known whether the particular regions of interest (ROI) delineation method would affect the performance of the AI algorithm. PURPOSE The purpose of this study was to investigate the influence of ROI delineation methods on model performance and observer consistency. METHODS In this retrospective analysis, ultrasound (US) measures of median nerves affected with carpal tunnel syndrome (CTS) were compared to median nerves in a control group without CTS. Two methods were used for delineation of the ROI: (1) the ROI along the hyperechoic medial edge of the median nerve but not including the epineurium (MN) (ROI1); and (2) the ROI including the hyperechoic epineurium (ROI2), respectively. The intra group correlation coefficient (ICC) was used to compare the observer consistency of ROI features (i.e. the corresponding radiomics parameters). Parameters α1 and α2 were obtained based on the ICC of ROI1 features and ROI2 features. The ROC analysis was used to determine the area under the curve (AUC) and evaluate the performance of the radiologists and network. In addition, four indices, namely sensitivity, specificity, positive prediction and negative prediction were analyzed too. RESULTS A total of 136 wrists of 77 CTS group and 136 wrists of 74 control group were included in the study. Control group was matched to CTS group according to the age and sex. The observer consistency of ROI features delineated by the two schemes was different, and the consistency of ROI1 features was higher (α1 ˃ α2). The intra-observer consistency was higher than the inter-observer consistency regardless of the scheme, and the intra-observer consistency was higher when chose scheme one. The performances of models based on the two ROI features were different, although the AUC of each model was greater than 0.8.The model performed better when the MN epineurium was included in the ROI. Among five artificial intelligence algorithms, the Forest models (model1 achieved an AUC of 0.921 in training datasets and 0.830 in testing datasets; model2 achieved an AUC of 0.967 in training datasets and 0.872 in testing datasets.) obtained the highest performance, followed by the support vector machine (SVM) models and the Logistic models. The performances of the models were significantly better than the inexperienced radiologist (Dr. B. Z. achieved an AUC of 0.702). CONCLUSION Different ROI delineation methods may affect the performance of the model and the consistency of observers. Model performance was better when the ROI contained the MN epineurium, and observer consistency was higher when the ROI was delineated along the hyperechoic medial border of the MN.
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Affiliation(s)
- Shuyi Lyu
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, China
| | - Yan Zhang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, China
| | - Meiwu Zhang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, China
| | - Maoqing Jiang
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, China
- Department of PET-CT and Nuclear Medicine, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Jianjun Yu
- Department of Neuroelectrophysiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Jiazhen Zhu
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, China
- Multi-disciplinary diagnosis and treatment department, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Baisong Zhang
- Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, China
- Provinicial and Municipal Co-construction Key Discipline for Medical Imaging, Ningbo, China
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Vo NQ, Nguyen DD, Hoang NT, Ngo DHA, Nguyen THD, Trong BL, Le NTN, Thanh TN. Magnetic resonance imaging as a first-choice imaging modality in carpal tunnel syndrome: new evidence. Acta Radiol 2023; 64:675-683. [PMID: 35437022 DOI: 10.1177/02841851221094227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common type of peripheral nerve compression. Magnetic resonance imaging (MRI) is becoming more popular in practice in the evaluation of CTS. PURPOSE To evaluate the diagnostic value of MRI in CTS. MATERIAL AND METHODS A cross-sectional study of 39 wrists was conducted. Clinical and nerve conduction study findings were evaluated and graded according to the Boston Carpal Tunnel Questionnaire (BCTQ) and the American Association of Neuromuscular and Electrodiagnostic Medicine. MRI was performed using a 1.5-T scanner. MRI parameters included cross-sectional area (CSA) of the median nerve and the ratio change in CSA at four levels: distal radioulnar joint (DRUJ-CSA); pisiform (p-CSA); middle of the carpal tunnel (i-CSA); and hook of hamate. The ratio change in CSA was expressed as p-CSA/DRUJ-CSA and ΔCSA (difference between iCSA and DRUJ-CSA), the flattening ratio of the median nerve, the thickness of the flexor retinaculum, flexor retinaculum bowing ratio, signal intensity ratio of the median, nerve and hypothenar muscle signal intensity. RESULTS With a cutoff point of 10.9 mm2 of the p-CSA, MRI had a sensitivity and specificity of 97.4% and 80% for diagnosis of CTS, respectively. There was a significant association between the clinical and electrophysiological stage with MRI findings (P < 0.001). There was a positive correlation between the BCTQ score and MRI parameters (0.5 < r < 0.7, P < 0.01). CONCLUSION MRI has good diagnostic value in evaluating CTS. We recommend using p-CSA ≥10.9 mm2 and ΔCSA ≥2.3 mm2 as MRI diagnostic criteria of CTS.
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Affiliation(s)
- Nhu Quynh Vo
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Duy Duan Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Ngoc Thanh Hoang
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Dac Hong An Ngo
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Thi Hieu Dung Nguyen
- Department of Physiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Binh Le Trong
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Nghi Thanh Nhan Le
- Department of Surgery, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
| | - Thao Nguyen Thanh
- Department of Radiology, University of Medicine and Pharmacy, 95414Hue University, Hue, Vietnam
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Vo NQ, Hoang NT, Nguyen DD, Nguyen THD, Le TB, Le NTN, Nguyen TT. Quantitative parameters of diffusion tensor imaging in the evaluation of carpal tunnel syndrome. Quant Imaging Med Surg 2022; 12:3379-3390. [PMID: 35655836 PMCID: PMC9131322 DOI: 10.21037/qims-21-910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/16/2022] [Indexed: 11/30/2023]
Abstract
BACKGROUND To explore the value of diffusion tensor imaging (DTI)-derived metrics in quantitative evaluation of carpal tunnel syndrome (CTS). METHODS This prospective cross-sectional study included 39 wrists from 24 symptomatic CTS patients, who underwent clinical, electrophysiological, and magnetic resonance imaging (MRI) evaluations. In addition, 10 wrists of 6 healthy participants were included as controls. Clinical and nerve conduction study (NCS) findings were evaluated and graded according to the Boston Carpal Tunnel Questionnaire (BCTQ) and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM), respectively. We performed MRI using a 1.5 Tesla scanner. Mean diffusivity (MD), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) of the median nerve at the distal radioulnar joint (DRUJ) (d), the inlet of the carpal tunnel (CT) at the pisiform level (i), the middle of the CT (m) and the outlet of the CT at the level of the hook of hamate (o), cross-sectional area at the inlet of the CT (iCSA), and the difference between MD and FA of the DRUJ and the outlet of CT (Delta MD and Delta FA) were measured. RESULTS The CTS patients had significantly lower FA [for example, oFA: mean difference 0.09, 95% confidence interval (CI): 0.05 to 0.12] and significantly higher MD than healthy participants (for example, iMD: mean difference 0.3, 95% CI: 0.03 to 0.57). There was a negative correlation between iCSA with iFA and between mFA and oFA (-0.5 CONCLUSIONS The DTI-derived quantitative metrics add potential value to the evaluation of CTS. Alterations in the FA of the median nerve along the CT are the most significant features of CTS and reflect the degree of median nerve compression and clinical deficit. With a cutoff value of 0.45, FA at the carpal outlet has a sensitivity and specificity of 87.5% and 85.7% in the diagnosis of CTS, respectively.
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Affiliation(s)
- Nhu Quynh Vo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Ngoc Thanh Hoang
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Duy Duan Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thi Hieu Dung Nguyen
- Department of Physiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Trong Binh Le
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nghi Thanh Nhan Le
- Department of Surgery, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thanh Thao Nguyen
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Singla M, Sharma MK, Khurana D, Lal V. Role of High Frequency Ultrasound in Diagnosing Carpal Tunnel Syndrome as Compared with Conventional Nerve Conduction Studies. Ann Indian Acad Neurol 2021; 23:649-655. [PMID: 33623266 PMCID: PMC7887507 DOI: 10.4103/aian.aian_469_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/13/2019] [Accepted: 11/08/2019] [Indexed: 11/05/2022] Open
Abstract
Objective: Our aim was to evaluate High Frequency Ultrasonography as a tool for diagnosis in patients withcarpal tunnel syndrome in comparison with electrophysiological study. Methods: Thirty- one patients [56 hands] with CTS and twenty-five asymptomatic controls [50 hands] were assessed and underwent ultrasonography of the wrists and electrophysiological testing. Data from the patient and the control groups was compared for both the investigations to determine the CTS and the grade of severity. Results: There was a high degree of correlation between the conduction abnormalities of the median nerve as detected by electrodiagnostic tests, historic and objective scale [Hi-Ob] and the measurement of the cross-sectional area of the nerve by US (P < 0.05). A cut-off point of 0.88 mm2 for the mean cross-sectional area of the median nerve was found to be the upper limit for normal values. Compared to Ultrasonography which found one hand negative, six hands (10%) were negative on the electrophysiological tests. Using critical CSA value of 1.0 mm2 in these CTS cases by US with sensitivity and specificity of 100% and 88%. Based on the results of this study, ultrasonography of wrist is another useful tool along with nerve conduction studies as per sensitivity and specificity patterns found in our study in diagnosis of carpal tunnel syndrome. Conclusion: High-frequency US examination of the median nerve and measurement of its cross-sectional area can be strongly considered as useful diagnostic diagnostic modality for the evaluation of CTS along with nerve conduction studies. In addition to its high diagnostic accuracy it is able to define the cause of nerve compression, aids treatment planning and provides a reliable method to follow response to therapy.
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Affiliation(s)
- Monika Singla
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Mukesh K Sharma
- Consultant Neurologist, Apollo International Hospitals, Gandhi Nagar, Ahmedabad, Gujarat, India
| | - Dheraj Khurana
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Faeghi F, Ardakani AA, Acharya UR, Mirza-Aghazadeh-Attari M, Abolghasemi J, Ejtehadifar S, Mohammadi A. Accurate automated diagnosis of carpal tunnel syndrome using radiomics features with ultrasound images: A comparison with radiologists' assessment. Eur J Radiol 2021; 136:109518. [PMID: 33434859 DOI: 10.1016/j.ejrad.2020.109518] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Ultrasonography is the most common imaging modality used to diagnose carpal tunnel syndrome (CTS). Recently artificial intelligence algorithms have been used to diagnose musculoskeletal diseases accurately without human errors using medical images. In this work, a computer-aided diagnosis (CAD) system is developed using radiomics features extracted from median nerves (MN) to diagnose CTS accurately. METHOD This study is performed on 228 wrists from 65 patients and 57 controls, with an equal number of control and CTS wrists. Nerve conduction study (NCS) is considered as the gold standard in this study. Two radiologists used two guides to evaluate and categorize the pattern and echogenicity of MNs. Radiomics features are extracted from B-mode ultrasound images (Ultrasomics), and the robust features are fed into support vector machine classifier for automated classification. The diagnostic performances of two radiologists and the CAD system are evaluated using ROC analysis. RESULTS The agreement of two radiologists was excellent for both guide 1 and 2. The honey-comb pattern clearly appeared in control wrists (based on guide 1). In addition, CTS wrists indicated significantly lower number of fascicles in MNs (based on guide 2). The area under ROC curve (AUC) of the radiologist 1 and 2 are 0.658 and 0.667 based on guide 1 and 0.736 and 0.721 based on guide 2, respectively. The CAD system indicated higher performance than two radiologists with AUC of 0.926. CONCLUSION The proposed CAD system shows the benefit of using ultrasomics features and can assist radiologists to diagnose CTS accurately.
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Affiliation(s)
- Fariborz Faeghi
- Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Abbasian Ardakani
- Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - U Rajendra Acharya
- School of Engineering, Ngee Ann Polytechnic, Singapore; Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan; Department of Biomedical Engineering, Singapore University of Social Sciences, Singapore.
| | | | - Jamileh Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Sajjad Ejtehadifar
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran.
| | - Afshin Mohammadi
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran.
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15
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Mansfield M, Thacker M, Sandford F. Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review. Hand (N Y) 2018; 13:501-508. [PMID: 29078710 PMCID: PMC6109903 DOI: 10.1177/1558944717736398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Research has shown that associative factors for CTS include occupational and biomechanical elements, sex, and age. To date, no systematic review has been undertaken to determine specifically whether there are any psychosocial risk factors in developing CTS. The objective is to determine whether psychosocial factors are associated with and/or predict the development of CTS. METHODS A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE, and CINAHL from inception to May 30, 2017. Quantitative studies must have investigated a minimum of 1 or more psychosocial factors-cognitive, affective, behavioral, vocational, or interpersonal processes (eg, social support)-and include a point or risk estimate. One reviewer conducted the search and 2 reviewers independently assessed eligibility and completed methodological quality assessment using a modified Downs and Black checklist. Data were analyzed narratively. RESULTS Six moderate- to high-quality studies were included in the final review. Five studies reported a positive association between psychosocial factors and CTS, where psychosocial factors were more in those who reported CTS. One study reported no positive or negative association with CTS development. Four studies reported a negative association between psychosocial factors and CTS, where psychosocial factors were less in those who reported CTS. CONCLUSIONS There is limited evidence for a positive association between psychosocial factors and CTS. However, this was not a consistent finding across all included studies. Further research is indicated in standardizing CTS diagnostic criteria and investigating other working environments.
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Affiliation(s)
- Michael Mansfield
- London South Bank University, UK,Michael Mansfield, Division of Allied Health Sciences, School of Health and Social Care, London South Bank University, London SE1 0AA, UK.
| | - Michael Thacker
- London South Bank University, UK,University of South Australia, Adelaide, Australia
| | - Fiona Sandford
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
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Motomiya M, Funakoshi T, Ishizaka K, Nishida M, Matsui Y, Iwasaki N. Blood Flow Changes in Subsynovial Connective Tissue on Contrast-Enhanced Ultrasonography in Patients With Carpal Tunnel Syndrome Before and After Surgical Decompression. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1597-1604. [PMID: 29171083 DOI: 10.1002/jum.14500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/20/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Although qualitative alteration of the subsynovial connective tissue in the carpal tunnel is considered to be one of the most important factors in the pathophysiologic mechanisms of carpal tunnel syndrome (CTS), little information is available about the microcirculation in the subsynovial connective tissue in patients with CTS. The aims of this study were to use contrast-enhanced ultrasonography (US) to evaluate blood flow in the subsynovial connective tissue proximal to the carpal tunnel in patients with CTS before and after carpal tunnel release. METHODS The study included 15 volunteers and 12 patients with CTS. The blood flow in the subsynovial connective tissue and the median nerve was evaluated preoperatively and at 1, 2, and 3 months postoperatively using contrast-enhanced US. RESULTS The blood flow in the subsynovial connective tissue was higher in the patients with CTS than in the volunteers. In the patients with CTS, there was a significant correlation between the blood flow in the subsynovial connective tissue and the median nerve (P = .01). The blood flow in both the subsynovial connective tissue and the median nerve increased markedly after carpal tunnel release. CONCLUSIONS Our results suggest that increased blood flow in the subsynovial connective tissue may play a role in the alteration of the microcirculation within the median nerve related to the pathophysiologic mechanisms of CTS. The increase in the blood flow in the subsynovial connective tissue during the early postoperative period may contribute to the changes in intraneural circulation, and these changes may lead to neural recovery.
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Affiliation(s)
- Makoto Motomiya
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Orthopedic Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Tadanao Funakoshi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiologic Technology, Hokkaido University Hospital, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine , Hokkaido University Hospital, Sapporo, Japan
| | - Yuichiro Matsui
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Are the Sensory Fibers of the Ulnar Nerve Affected in Carpal Tunnel Syndrome? J Clin Neurophysiol 2018; 34:502-507. [PMID: 28914658 DOI: 10.1097/wnp.0000000000000410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Distribution of paresthesia throughout the skin area without median nerve innervation is frequently seen in carpal tunnel syndrome (CTS). However, its pathophysiologic mechanisms are still unclear. We aimed to research whether a dysfunction in sensory fibers of the ulnar nerve (UN) was present or not in hands with CTS. METHODS Totally, upper extremity nerve conduction study recordings of 508 patients were considered. After exclusions, 331 upper extremity recordings of 277 patients were included. We compared the results of sensory conduction studies of median nerve and UN between normal hands and hands with CTS. RESULTS The mean distal sensory latency of the median nerve was longer, the mean conduction velocity was slower, and mean nerve action potential amplitude was higher in the hands with CTS than in normal hands (P < 0.001 for all comparisons). There was no statistically significant difference on any sensory conduction parameters of UN recorded on digit IV or digit V between the disease and control groups (P > 0.05 for all comparisons). The rates of conduction abnormalities of the UN sensory fibers were also similar in hands with CTS and in normal hands (P > 0.05 for all comparisons). CONCLUSIONS The hands with CTS do not have an increased rate of conduction abnormalities of UN sensory fibers compared with the normal hands in our study population. Therefore, our study did not confirm the distortion of UN sensory fibers as a mechanism underlying the spread of paresthesia throughout the skin area without median nerve innervation in CTS.
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Wolny T, Linek P, Saulicz E. Overall health status in patients with mild to moderate carpal tunnel syndrome: A case-control study. J Hand Ther 2017; 30:293-298. [PMID: 28233620 DOI: 10.1016/j.jht.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/24/2016] [Accepted: 10/12/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN A case-control study. INTRODUCTION There are no reports in the literature that evaluate the overall health status (OHS) of patients with mild to moderate forms of carpal tunnel syndrome (CTS) using 36-Item Short Form Health Survey (SF-36). PURPOSE OF THE STUDY To assess OHS in patients with mild to moderate CTS, in comparison with healthy subjects. METHODS The study involved 273 healthy people and 140 people diagnosed with CTS. The CTS diagnosis was made on the basis of clinical examinations and nerve conduction studies. OHS was assessed using the SF-36. RESULTS In the assessment of physical components of OHS, in the CTS group (compared with healthy subjects), the results show significantly lower values in physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions by 7.44, 23.2, 18.9, and 4.1, respectively. Mental components were lower (in CTS group) only in relation to vitality and social functioning by 4.1 and 5.5, respectively. In the assessment of physical component summary (PCS) and mental component summary (MCS), the results show significantly lower values of PCS (by 13 in CTS group) and no significant differences in the assessment of MCS between patients with CTS and healthy subjects. DISCUSSION The perception of the OHS in CTS patients is diminished. Hence, when evaluating the effects of the therapy, not only disease-specific scales should be used, but also the OHS. This will allow an assessment of the impact of CTS on OHS and the impact of applied therapy, not only in terms of a reduction in the main symptoms of the condition. CONCLUSIONS Mild and moderate forms of CTS significantly affected the PCS of the OHS and all its subcomponents (physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions) but did not affect the MCS of OHS evaluated as a whole. There were significant differences in the mental component in the evaluation of vitality and social functioning. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tomasz Wolny
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland
| | - Pawel Linek
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
| | - Edward Saulicz
- Department of Kinesiotherapy and Special Methods in Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland; Department of Physiotherapy, The Academy of Business, Dąbrowa Górnicza, Poland
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Willis FB, Fowler B. Longitudinal Outcomes Following a Randomized Controlled Trial of Dynamic Splint Stretching for Carpal Tunnel Syndrome. Hand (N Y) 2016; 11:290-294. [PMID: 27698630 PMCID: PMC5030854 DOI: 10.1177/1558944715626925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The incidence of carpal tunnel syndrome (CTS) is 48 million patients in the United States. The purpose of this longitudinal study was to determine whether Dynasplint stretching (immediately after diagnosis) had an effect on a patient's decision to seek surgical treatment for CTS. Methods: Fifty patients (10 men, 40 women, mean age 51.2 ± 12 years) were recruited for this randomized, controlled, longitudinal trial. Patients were diagnosed with CTS by physical examination and nerve conduction studies. The intervention used was Dynasplint stretching that delivered a prolonged duration of low load stretching. Patients who were randomly chosen for the Experimental category wore the device for two 30-minute sessions per day with regular increases in splint tension for 60 days. Control patients received nonsteroidal anti-inflammatory medication plus instructions on daily home stretching. Results: The final, longitudinal outcome showed a 72% reduction in surgery chosen by the experimental group (n = 25), compared with 38% reduction for control patients (n = 25). Conclusions: Immediate treatment with Dynasplint stretching showed a 2 to 1 reduction in surgery, with abundant financial savings.
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Affiliation(s)
- F. Buck Willis
- Galveston Clinical Research, TX, USA,Paul Quinn College, Dallas, TX, USA,F. Buck Willis, Galveston Clinical Research, P.O. Box 1582, Galveston, TX 77553, USA.
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Gürsoy AE, Bilgen HR, Dürüyen H, Altıntaş Ö, Kolukisa M, Asil T. The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci 2016; 37:1055-61. [PMID: 26939675 DOI: 10.1007/s10072-016-2530-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/22/2016] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP- group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP- group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP- groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP- group was lower than EP+ group, statistically difference was not significant between EP+ and EP- groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP- groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results.
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Affiliation(s)
- Azize Esra Gürsoy
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey.
| | - Halide Rengin Bilgen
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Hümeyra Dürüyen
- Department of Neurology, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Özge Altıntaş
- Department of Neurology, Niğde-Bor State Hospital, Niğde, Turkey
| | - Mehmet Kolukisa
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Talip Asil
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
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Al-Hashel JY, Rashad HM, Nouh MR, Amro HA, Khuraibet AJ, Shamov T, Tzvetanov P, Rousseff RT. Sonography in carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 2015; 51:592-7. [DOI: 10.1002/mus.24425] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Jasem Y. Al-Hashel
- Department of Neurology; Ibn Sina Hospital; POB 25427 Safat 13115 Kuwait
| | - Hanaa M. Rashad
- Department of Neurology; Ibn Sina Hospital; POB 25427 Safat 13115 Kuwait
- Clinical Neurophysiology Department; Kasr El Aini Hospital, Cairo University; Cairo Egypt
| | - Mohamed R. Nouh
- Department of Radiology; Faculty of Medicine; Alexandria University; Alexandria Egypt
| | - Hanan A. Amro
- Department of Radiology; Al-Razi Orthopedic Hospital; Sulaibikhat Kuwait
| | - Adnan J. Khuraibet
- Department of Neurology; Ibn Sina Hospital; POB 25427 Safat 13115 Kuwait
| | - Todor Shamov
- Department of Orthopedics; Jaber-Al-Sabah Armed Forces Hospital; Subhan Kuwait
| | - Plamen Tzvetanov
- Department of Neurosciences; University Hospitals, Coventry and Warwickshire NHS Trust; Coventry UK
| | - Rossen T. Rousseff
- Department of Neurology; Ibn Sina Hospital; POB 25427 Safat 13115 Kuwait
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Abstract
BACKGROUND F waves are late electrophysiological responses to antidromic activation of motor neurons and are used to evaluate the conduction along the whole length of peripheral nerves. We aimed to determine the diagnostic efficacies of minimum median nerve F-wave latency (FWL) and median-to-ulnar nerve F-wave latency difference (FWLD) on carpal tunnel syndrome (CTS). MATERIALS AND METHODS The electrophysiological studies consisted of sensory and motor nerve conduction and F-wave studies of the median and ulnar nerves. The best cut-off points of minimum median nerve FWL and FWLD for the diagnosis of CTS were detected for the whole study group and for different height subgroups (Group 1: 150-159 cm, Group 2: 160-169 cm, and Group 3: over 170 cm). The diagnostic efficacies of minimum median nerve FWL and FWLD were calculated for the whole CTS group and for the mild CTS group, separately. RESULTS The best cut-off point of minimum median nerve FWL on the diagnosis of CTS was determined as 24.60 ms for the whole group. It was 23.90 ms for Group 1, 24.80 ms for Group 2, and 28.40 ms for Group 3. The usage of these stratified cut-off points yielded a higher total diagnostic efficacy rate than single cut-off point usage (79.9% vs 69%, respectively; P=0.02). The best cut-off point of FWLD on the diagnosis of CTS was 0.80 ms for the whole group. It was 0.55 ms for Group 1, 0.30 ms for Group 2, and 0.85 ms for Group 3. Both the single cutoff point usage and the stratified chart usage for FWLD had equal diagnostic efficacy (85.1%). In the mild CTS group, diagnostic efficacy was 55.5% for minimum median nerve FWL and 78.8% for FWLD (P=0.0001). CONCLUSION Median-to-ulnar nerve FWLD yields a higher diagnostic efficacy than minimum median nerve FWL on the diagnosis of CTS. However, the sensitivities of both parameters are not satisfactory for the extremities with mild CTS, which compose the main group having diagnostic challenge.
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Affiliation(s)
- Murat Alemdar
- Sakarya University Education and Research Hospital, Sakarya, Turkey
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25
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Effects of gender and age on median and ulnar nerve sensory responses over ring finger. J Electromyogr Kinesiol 2014; 24:52-7. [DOI: 10.1016/j.jelekin.2013.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 09/14/2013] [Accepted: 12/03/2013] [Indexed: 01/05/2023] Open
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Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-Resolution Magnetic Resonance Neurography in Upper Extremity Neuropathy. Neuroimaging Clin N Am 2014; 24:109-25. [DOI: 10.1016/j.nic.2013.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Paliwal PR, Therimadasamy AK, Chan YC, Wilder-Smith EP. Does measuring the median nerve at the carpal tunnel outlet improve ultrasound CTS diagnosis? J Neurol Sci 2014; 339:47-51. [PMID: 24485910 DOI: 10.1016/j.jns.2014.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/08/2014] [Accepted: 01/13/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Nerve conduction is often regarded as more sensitive than ultrasonography (US) for diagnosing carpal tunnel syndrome (CTS). The diagnostic value of US derives from median nerve enlargement occurring at both ends of the carpal tunnel resulting in a dumbbell-like swelling from carpal tunnel pressure. An important reason for the inferior sensitivity of US may be because measurements are restricted to the carpal tunnel inlet. We investigate the value of including median nerve enlargement at the carpal tunnel outlet for diagnosing CTS. METHODS Retrospective cohort study of nerve conduction verified CTS, determining sensitivity, specificity, and positive and negative predictive values of carpal tunnel inlet and outlet median nerve cross sectional area as determined by US for the diagnosis of CTS. Nerve conduction graded CTS severity. RESULTS 127 hands from 77 patients with CTS and 35 control healthy hands were assessed. US sensitivity for diagnosing CTS increased from 65% to 84% by including outlet enlargement of the median nerve. Specificity changed from 94% to 86%, positive predictive value from 98% to 96% and the negative predictive value from 43% to 60%. 25 hands out of the 127 from CTS patients showed enlargement restricted to the outlet and mainly occurred in moderate CTS. CONCLUSION In our population, the use of carpal tunnel outlet median nerve enlargement in addition to inlet median nerve size increases sensitivity for diagnosing CTS by 19%.
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Affiliation(s)
- P R Paliwal
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | | | - Y C Chan
- National University Hospital, Singapore
| | - E P Wilder-Smith
- Yong Loo Lin School of Medicine, National University, Singapore.
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Outcomes and cost-effectiveness of carpal tunnel injections using sonographic needle guidance. Clin Rheumatol 2013; 33:849-58. [PMID: 24277115 DOI: 10.1007/s10067-013-2438-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 01/13/2023]
Abstract
This randomized controlled study addressed whether sonographic needle guidance affected the outcomes of corticosteroid injection for symptomatic carpal tunnel syndrome. Seventy-seven symptomatic carpal tunnels were randomized to injection by either (1) conventional anatomic landmark palpation-guided injection or (2) sonographic image-guided injection, each using a two-step technique where 3 ml of 1% lidocaine was first injected to hydrodissect and hydrodisplace critical intra-carpal tunnel structures followed by injection with 80 mg of triamcinolone acetonide (2 ml). Baseline pain, procedural pain, pain at outcome (2 weeks and 6 months), responders, therapeutic duration, total cost, and cost per responder were determined. There were no complications in either treatment group. Relative to conventional anatomic landmark palpation-guided methods, sonographic guidance for injection of the carpal tunnel resulted in 77.1% reduction in injection pain (p<0.01), a 63.3% reduction in pain scores at outcome (p<0.014), 93.5% increase in the responder rate (p<0.001), 84.6% reduction in the non-responder rate (p<0.001), a 71.0% increase in therapeutic duration (p<0.001), and a 59.3% ($150) reduction in cost/responder/year for a hospital outpatient (p<0.001). However, despite improved outcomes, cost per patient per year was significantly increased for an outpatient in a physician's office and was neutral for a hospital outpatient. Sonographic needle guidance significantly improves the performance and clinical outcomes of injection of the carpal tunnel and is cost-effective for a hospital-based practice, but based on current reimbursements, it significantly increases overall costs for medical care delivered in a non-hospital-based physician practice.
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Younes TB, Elattar EA. Electrophysiological assessment of hand elevation test in the diagnosis of carpal tunnel syndrome. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2013. [DOI: 10.4103/1110-161x.123808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ntani G, Palmer KT, Linaker C, Harris EC, Van der Star R, Cooper C, Coggon D. Symptoms, signs and nerve conduction velocities in patients with suspected carpal tunnel syndrome. BMC Musculoskelet Disord 2013; 14:242. [PMID: 23947775 PMCID: PMC3765787 DOI: 10.1186/1471-2474-14-242] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/09/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To inform the clinical management of patients with suspected carpal tunnel syndrome (CTS) and case definition for CTS in epidemiological research, we explored the relation of symptoms and signs to sensory nerve conduction (SNC) measurements. METHODS Patients aged 20-64 years who were referred to a neurophysiology service for investigation of suspected CTS, completed a symptom questionnaire (including hand diagrams) and physical examination (including Tinel's and Phalen's tests). Differences in SNC velocity between the little and index finger were compared according to the anatomical distribution of symptoms in the hand and findings on physical examination. RESULTS Analysis was based on 1806 hands in 908 patients (response rate 73%). In hands with numbness or tingling but negative on both Tinel's and Phalen's tests, the mean difference in SNC velocities was no higher than in hands with no numbness or tingling. The largest differences in SNC velocities occurred in hands with extensive numbness or tingling in the median nerve sensory distribution and both Tinel's and Phalen's tests positive (mean 13.8, 95% confidence interval (CI) 12.6-15.0 m/s). Hand pain and thumb weakness were unrelated to SNC velocity. CONCLUSIONS Our findings suggest that in the absence of other objective evidence of median nerve dysfunction, there is little value in referring patients of working age with suspected CTS for nerve conduction studies if they are negative on both Tinel's and Phalen's tests. Alternative case definitions for CTS in epidemiological research are proposed according to the extent of diagnostic information available and the relative importance of sensitivity and specificity.
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Affiliation(s)
- Georgia Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK.
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Chen Y, Kumar N, Lim JWW, Smith EW. High-resolution sonography detects extraforaminal nerve pathology in patients initially diagnosed with cervical disc disease: a case series. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:46-54. [PMID: 22006670 DOI: 10.1002/jcu.20876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
In patients presenting with neck and upper limb complaints, MRI changes suggestive of cervical disc disease do not exclude concomitant extraforaminal pathology, as shown in the series of three cases presented here. High-resolution ultrasound of the brachial plexus and peripheral nerves may be useful in identifying an extraforaminal pathology when (1) symptoms and signs are disproportionate to MRI findings of cervical disc disease; (2) there is obvious discordance between MRI and nerve conduction findings; (3) an entrapment neuropathy is suspected but the site of nerve lesion is unidentifiable on the basis of available investigations and clinical findings.
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Dejaco C, Stradner M, Zauner D, Seel W, Simmet NE, Klammer A, Heitzer P, Brickmann K, Gretler J, Fürst-Moazedi FC, Thonhofer R, Husic R, Hermann J, Graninger WB, Quasthoff S. Ultrasound for diagnosis of carpal tunnel syndrome: comparison of different methods to determine median nerve volume and value of power Doppler sonography. Ann Rheum Dis 2012; 72:1934-9. [PMID: 23212030 DOI: 10.1136/annrheumdis-2012-202328] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare ultrasound measurement of median nerve cross-sectional area (CSA) at different anatomical landmarks and to assess the value of power Doppler signals within the median nerve for diagnosis of carpal tunnel syndrome (CTS). METHODS A prospective study of 135 consecutive patients with suspected CTS undergoing two visits within 3 months. A final diagnosis of CTS was established by clinical and electrophysiological findings. CSA was sonographically measured at five different levels at forearm and wrist; and CSA wrist to forearm ratios or differences were calculated. Intraneural power Doppler signals were semiquantitatively graded. Diagnostic values of different ultrasound methods were compared by receiver operating characteristic curves using SPSS. RESULTS CTS was diagnosed in 111 (45.5%) wrists; 84 (34.4%) had no CTS and 49 (20.1%) were possible CTS cases. Diagnostic values were comparable for all sonographic methods to determine median nerve swelling, with area under the curves ranging from 0.75 to 0.85. Thresholds of 9.8 and 13.8 mm(2) for the largest CSA of the median nerve yielded a sensitivity of 92% and a specificity of 92%. A power Doppler score of 2 or greater had a specificity of 90% for the diagnosis of CTS. Sonographic median nerve volumetry revealed a good reliability with an intraclass correlation coefficient of 0.90 (95% CI 0.79 to 0.95). CONCLUSIONS Sonographic assessment of median nerve swelling and vascularity allows for a reliable diagnosis of CTS. Determination of CSA at its maximal shape offers an easily reproducible tool for CTS classification in daily clinical practice.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology and Immunology, Medical University Graz, , Graz, Austria
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Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ng ES, Ng KW, Wilder-Smith EP. Provocation tests in doppler ultrasonography for carpal tunnel syndrome. Muscle Nerve 2012. [PMID: 23180630 DOI: 10.1002/mus.23637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Doppler ultrasonography (DU) has recently been shown to be useful in imaging carpal tunnel syndrome (CTS). In this study, we aim to characterize the changes seen after exercise and electrical stimulation. METHODS Five patients with CTS were recruited with 5 age-matched subjects. DU was used to visualize the median nerve, flexor tendon, and bone at base line and after 1 minute of: (a) median nerve motor stimulation, (b) median nerve sensory stimulation, (c) abductor pollicis brevis contraction, and (d) adductor digiti minimi contraction. RESULTS Blood flow in the median nerve was greater after APB exercise. Furthermore, blood flow in the median nerve was greater in cases than controls after APB exercise. At baseline, blood flow in the flexor tendon was greater in cases than controls. CONCLUSIONS While limited by sample size, this study demonstrates that exercise of median innervated muscles may be useful in enhancing diagnostic utility of DU for CTS.
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Affiliation(s)
- Esther S Ng
- Department of Medicine, National University Health System, Heidelberg, Germany
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Povlsen B, Raymond AC. Gp Diagnostics and Splint Treatment of Carpal Tunnel Syndrome and Trapeziometacarpal Arthritis. ACTA ACUST UNITED AC 2012. [DOI: 10.1308/147363512x13311314197978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Carpal tunnel syndrome (CTS) and trapeziometacarpal joint osteoarthritis (TMCJ OA) are common problems in the UK. Given the current financial climate, it is particularly important to improve cost effectiveness and avoid unnecessary patient referrals to the more expensive secondary care services. This could be achieved by initial management of these conditions in the primary care setting. For this to be possible, GPs must be able to make a reliable clinical diagnosis for these conditions. To our knowledge there are no studies that evaluate the reliability of GPs when making clinical diagnoses of CTS and TMCJ OA.
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Affiliation(s)
- B Povlsen
- Consultant Orthopaedic Surgeon, Guy's and St Thomas' NHS Foundation Trust
| | - AC Raymond
- Anatomy Demonstrator, King's College London
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Tan SV, Sandford F, Stevenson M, Probert S, Sanders S, Mills KR, Koutroumanidis M. Hand-held nerve conduction device in carpal tunnel syndrome: a prospective study. Muscle Nerve 2012; 45:635-41. [PMID: 22499088 DOI: 10.1002/mus.23279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION We assessed the clinical impact of replacing standard neurophysiologic testing with a hand-held device (Mediracer) for diagnosis of carpal tunnel syndrome (CTS). METHODS One hundred patients (200 hands) with suspected CTS were studied by blinded assessors [Hand-therapist (HT)1 and Consultant Neurophysiologist] using the Mediracer, followed by standard neurophysiologic testing. To simulate testing by personnel without neurological training, Mediracer recordings were analyzed separately by an assessor who had not seen the patients (HT2). RESULTS Correlation of the CTS grades was 0.94 for the results obtained by HT1, and 0.87 for HT2. The sensitivity and specificity of the Mediracer was 0.85 and 0.9, respectively, by HT1, and 0.84 and 0.89 for HT2. Nine patients had conditions other than CTS, and 35 patients were judged to require further investigation. CONCLUSIONS The Mediracer should only be used in patients with typical CTS symptoms and signs and no muscle wasting who have had careful neurological assessment.
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Affiliation(s)
- S Veronica Tan
- Department of Neurology and Clinical Neurophysiology, St Thomas' Hospital, Guy's and St Thomas' Foundation NHS Trust, Lambeth Palace Road, London, United Kingdom.
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Lo YL, Lim SH, Fook-Chong S, Lum SY, Teoh LC, Yong FC. Outcome prediction value of nerve conduction studies for endoscopic carpal tunnel surgery. J Clin Neuromuscul Dis 2012; 13:153-158. [PMID: 22538311 DOI: 10.1097/cnd.0b013e31822b19a5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Carpal tunnel syndrome is the most common entrapment neuropathy. We explore the clinical use of nerve conduction study in the outcome prediction and preoperative selection for endoscopic carpal tunnel syndrome surgery. METHODS Sixty-seven patients with carpal tunnel syndrome were prospectively enrolled. Each patient's clinical symptomatic score at baseline and 3 months postsurgery was compared with nerve conduction study parameters of distal motor latency, motor amplitude, motor conduction velocity, distal sensory latency, sensory amplitude, and sensory conduction velocity. A statistical logistic regression model was used to ascertain outcomes. RESULTS Endoscopic surgery resulted in significant improvement for all four major symptoms pain, numbness, paresthesia, and weakness. From multivariate logistic regression, a shorter distal sensory latency is associated with a higher likelihood of a good outcome (P = 0.058; odds ratio, 0.912; 95% confidence interval, 0.828-1.0) only for paresthesia. The other factors were not found to be significant (all P > 0.10). The area under the curve (AUC) was 0.69 (95% confidence interval for AUC, 0.50-0.88). A cutoff of 6.0 ms or lower for sensory latency predicts for good outcome (in terms of paresthesia score) with the sensitivity/certainty of 84.6% and positive predictive value of 86.8%. A receiver operating characteristic analysis of baseline paresthesia score for good outcome of the paraesthesia domain showed that the AUC was 0.967 (95% confidence interval for AUC, 0-1.0). At a cutoff of baseline paraesthesia score of 4 or above, prediction for good outcome achieved a sensitivity of 87.2% and positive predictive value of 97.1%. CONCLUSIONS A shorter distal sensory latency is associated with a higher likelihood of a good outcome for paraesthesia. In addition, patients with baseline of 4 or above had correlated with better surgical outcome than those with less severe symptoms. Our data thus suggest that surgical benefit is best seen in patients with moderate symptoms, in combination with electrophysiological evidence of early demyelination, as a possible therapeutic window.
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Affiliation(s)
- Yew-Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore.
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Mohammadi A, Ghasemi-Rad M, Mladkova-Suchy N, Ansari S. Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings. AJR Am J Roentgenol 2012; 198:W181-4. [PMID: 22268209 DOI: 10.2214/ajr.11.7012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Carpal tunnel syndrome (CTS) represents one of the most prevalent peripheral entrapment mononeuropathies. The purpose of our study was to assess the potential correlation between intraneural hypervascularization, flexor retinaculum bowing, and median nerve cross-sectional area and the severity of CTS in cases confirmed by nerve conduction study. SUBJECTS AND METHODS Sixty consecutive patients with classic or probable symptoms of CTS were enrolled in the study. A control group consisting of 27 healthy volunteers who were never diagnosed with CTS or had any symptoms of CTS was recruited among institution employees. All symptomatic patients were initially examined by a hand surgeon and subsequently referred for sonographic and electrophysiologic examinations. RESULTS A total of 90 wrists (in 60 patients) were included in the study. Twenty-eight (31.1%) had mild CTS, 33 had moderate disease, and 29 had severe disease. We detected significant correlation between median nerve hypervascularization and the severity of CTS (p = 0.01, logistic regression) for moderate CTS and (p = 0.04) for severe disease. We also detected a significant correlation in flexor retinaculum bowing and median nerve cross-sectional area with increase in the severity of CTS (p < 0.001 and < 0.008; chi-square test and analysis of variance, respectively). CONCLUSION Our study suggests that the severity of CTS strongly correlates with color Doppler sonography findings, and this technique may represent a reliable complementary tool in CTS examination.
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Affiliation(s)
- Afshin Mohammadi
- Department of Radiology, Urmia University of Medical Sciences, Urmia, West-Azerbaijan, Iran
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Joy V, Therimadasamy AK, Chan YC, Wilder-Smith EP. Combined Doppler and B-mode sonography in carpal tunnel syndrome. J Neurol Sci 2011; 308:16-20. [PMID: 21764405 DOI: 10.1016/j.jns.2011.06.042] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/07/2011] [Accepted: 06/22/2011] [Indexed: 12/20/2022]
Abstract
An intraoperatively enlarged engorged median nerve has been described as typical of patients with carpal tunnel syndrome (CTS). Although many studies of CTS have addressed median nerve enlargement, little is known about the usefulness of Doppler methods in detecting median nerve engorgement combined with nerve cross-sectional area (CSA). In a retrospective study of hands referred for evaluation of possible CTS, patients were clinically graded into Highly-likely or Indeterminate CTS. Nerve conduction studies (NCS), CSA, and Doppler analysis were compared. Median nerve blood flow was detected in 29 of 30 Highly-likely CTS hands (mean 13.3m/s (8.2) SD) and in 25 of 30 with Indeterminate CTS (mean 8.5m/s (4.5) SD). These were significantly higher than our laboratory normal values (mean 1.9 m/s (2.8) SD). Raised intraneural blood flow showed the highest test sensitivity in diagnosing Highly-likely carpal tunnel syndrome (83%) and combined with CSA reached 90%. NCS sensitivity was 83%. In the group of Indeterminate CTS, combined blood flow and CSA showed abnormality in 77% and NCS 47%. All nerve conduction parameters and median nerve cross sectional area showed linear correlation to intraneural blood flow velocity (P<0.05; Spearman's r=0.362 to 0.264). This study suggests that adding measures of intraneural blood flow to CSA further improves the sonographic evaluation of CTS and may be of particular use in patients with negative NCS.
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Affiliation(s)
- Vijayan Joy
- Neurodiagnostic Laboratory, National University Hospital, Singapore
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DeLea SL, Chavez-Chiang NR, Poole JL, Norton HE, Sibbitt WL, Bankhurst AD. Sonographically guided hydrodissection and corticosteroid injection for scleroderma hand. Clin Rheumatol 2011; 30:805-13. [PMID: 21234632 DOI: 10.1007/s10067-010-1653-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 08/28/2010] [Accepted: 12/06/2010] [Indexed: 11/30/2022]
Abstract
Scleroderma is associated with intractable hand pain from vasospasm, digital ischemia, tenosynovitis, and nerve entrapment. This study investigated the effect of hydrodissection of the carpal tunnel followed by corticosteroid injection for the painful scleroderma hand. Twenty-six consecutive subjects [12 with painful scleroderma hand and 14 with rheumatoid arthritis and carpal tunnel syndrome (RA/CTS)] underwent sonographically observed carpal tunnel hydrodissection with 3 ml of 1% lidocaine administered with a 25-gauge 1-in. needle on a 3-ml RPD mechanical syringe (reciprocating procedure device). After hydrodissection, a syringe exchange was performed, and 80 mg of triamcinolone acetonide was injected. Baseline pain, procedural pain, pain at outcome, responders, therapeutic duration, and reinjection interval were determined. Hydrodissection and injection with corticosteroid significantly reduced pain scores by 67% in scleroderma (p < 0.001) and by 47% in RA/CT (p < 0.001). Scleroderma and RA/CTS were similar in outcome measures: injection pain (p = 0.47), pain scores at outcome (p = 0.13), responders (scleroderma, 83.3%; RA/CTS, 57.1%, p = 0.15), pain at 6 months (p = 0.15), and therapeutic duration (p = 0.07). Scleroderma patients responded better in time to next injection (scleroderma, 8.5 ± 3.0 months; RA/CTS, 5.2 ± 3.1 months, p = 0.03). Reduced Raynaud's attacks and healing of digital ulcers occurred in 83% of subjects. There were no complications. Hydrodissection with lidocaine followed by injection of triamcinolone reduces pain and vasomotor changes in the scleroderma hand. The mechanism may be a combination of hydrodissection-mediated mechanical freeing of entrapped arteries, nerves, and tendinous structures and corticosteroid-induced reduction of inflammatory vasospasm.
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Affiliation(s)
- Suzanne L DeLea
- Division of Rheumatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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Povlsen B, Aggelakis K, Koutroumanidis M. Effect of age on subjective complaints and objective severity of carpal tunnel syndrome: prospective study. JRSM SHORT REPORTS 2010; 1:62. [PMID: 21234134 PMCID: PMC3014786 DOI: 10.1258/shorts.2010.010088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Older patients with carpal tunnel syndrome who are resistant to conservative treatment often have a less than satisfactory outcome after surgery. We therefore investigated whether the age of the patient affects the subjective complaints or the objective severity of the nerve entrapment prior to surgery in patients younger than 40 years compared with those above 70 years of age. DESIGN Prospective study. SETTING NHS specialist neurophysiology department. PARTICIPANTS One hundred and six splint-resistant patients scored their subjective complaints and scores were then compared with the neurophysiology results. MAIN OUTCOME MEASURES Nerve conduction speeds and subjective visual analogue score of pain, sensation and motor function. RESULTS Conduction speeds were significantly more affected in patients over 70 years of age than in those under 40 years. Older patients scored their subjective complaints lower than younger patients. CONCLUSIONS Older patients' subjective complaints misrepresent the severity of the nerve entrapment. Clinicians should have a lower threshold for objective investigation of patients older than 70 years of age to minimize development of irreversible nerve damage.
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Affiliation(s)
- B Povlsen
- Department of Orthopaedics, Guy's, St Thomas' NHS Foundation Trust , London , UK
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Tamburin S, Cacciatori C, Praitano ML, Cazzarolli C, Foscato C, Fiaschi A, Zanette G. Median nerve small- and large-fiber damage in carpal tunnel syndrome: a quantitative sensory testing study. THE JOURNAL OF PAIN 2010; 12:205-12. [PMID: 20797919 DOI: 10.1016/j.jpain.2010.06.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 05/31/2010] [Accepted: 06/25/2010] [Indexed: 12/21/2022]
Abstract
UNLABELLED We explored the contribution of median nerve small (Aδ, C)-and large (Aβ)-fiber damage to the severity and topographic distribution of sensory symptoms in carpal tunnel syndrome (CTS) and the timing of fiber damage across CTS stages. We recruited 106 CTS patients. After selection, 49 patients were included. They underwent electrodiagnostic and quantitative sensory testing (QST) study and were asked on the severity of Boston Carpal Tunnel Questionnaire (BCTQ) Symptoms Severity Scale, daytime pain (DP), night pain and paresthesia, on the distribution of hand symptoms, and the presence of proximal symptoms. BCTQ Symptoms Severity Scale and DP severity was significantly correlated with Aδ-fiber damage. Small-fiber QST measures were impaired in electrodiagnostic-negative CTS patients and did not change across CTS neurographic stages. QST findings were not correlated to the topographical distribution of symptoms. Aδ-fiber damage contributes to CTS symptoms and in particular to DP. Night pain and paresthesia might be ascribed to ectopic fiber discharges secondary to median nerve enhanced mechanosensitivity. Small-fiber damage takes place earlier than large fiber. Median nerve fiber involvement does not directly contribute to extraterritorial symptoms spread. Our data may help understanding CTS pathophysiology and explain the well-known discrepancy between CTS symptoms and electrodiagnostic findings. PERSPECTIVE We explored the involvement of median nerve small and large fibers in carpal tunnel syndrome (CTS). We found a significant correlation between Aδ-fiber function and CTS symptoms. Small-fiber involvement took place in milder disease stages. These findings could help reconcile the discrepancy between CTS symptoms and electrodiagnostic data.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
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Pastare D, Therimadasamy AK, Lee E, Wilder-Smith EP. Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:389-393. [PMID: 19479718 DOI: 10.1002/jcu.20601] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To compare the diagnostic value of high-resolution ultrasound (US) with nerve conduction studies (NCS) in patients with clinically defined carpal tunnel syndrome (CTS). METHODS A prospective study was conducted on 66 consecutive patients investigated for sensory hand symptoms. The gold standard was the clinical diagnosis of CTS. RESULTS NCS showed greater diagnostic sensitivity (82%) than US (62%) in supporting a diagnosis of CTS. With increasing neurophysiologic severity of median neuropathy, there was increasing convergence of the two test methods. Abnormal US as the only diagnostic supportive evidence of CTS was rare. However, the positive predictive value of US for CTS was 100%. CONCLUSION NCS show better sensitivity than US in supporting a diagnosis of CTS. However, because of its high positive predictive value, one may consider using US as a screening test, eliminating the need for NCS in the majority of clinical suspicion of CTS and reserving NCS for cases in which US is negative.
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Affiliation(s)
- D Pastare
- Neurology, National University Health Systems, 5 Lower Kent Ridge Road, 119074, Singapore
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Stein D, Neufeld A, Pasternak O, Graif M, Patish H, Schwimmer E, Ziv E, Assaf Y. Diffusion tensor imaging of the median nerve in healthy and carpal tunnel syndrome subjects. J Magn Reson Imaging 2009; 29:657-62. [DOI: 10.1002/jmri.21553] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Wilder-Smith EP, Ng ES, Chan YH, Therimadasamy AK. Sensory distribution indicates severity of median nerve damage in carpal tunnel syndrome. Clin Neurophysiol 2008; 119:1619-25. [PMID: 18467170 DOI: 10.1016/j.clinph.2008.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 03/18/2008] [Accepted: 03/25/2008] [Indexed: 12/16/2022]
Affiliation(s)
- E P Wilder-Smith
- Neurology, Yong Loo Lin School of Medicine, National University, 5 Lower Kent Ridge Road, Singapore, Singapore.
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Lowe W. Suggested variations on standard carpal tunnel syndrome assessment tests. J Bodyw Mov Ther 2008; 12:151-7. [DOI: 10.1016/j.jbmt.2007.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 04/07/2007] [Accepted: 04/10/2007] [Indexed: 11/16/2022]
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Effects of perineural steroid injections on median nerve conduction during the carpal tunnel release. VOJNOSANIT PREGL 2008; 65:825-9. [DOI: 10.2298/vsp0811825s] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background/Aim. The treatment outcome of the median nerve compressive neuropathy in the carpal zone due to carpal tunnel syndrome (CTS) is represented by recovering the nerves sensibility, conductivity, condition and strength. Perineural application of betamethasone during the surgical decompression might result in faster recovery of compressed median nerve's conduction speed. Methods. In this study 40 patients with CTS were randomly divided in the two groups. In the first group (n = 20) we performed the surgical decompression of the median nerve by the open release of the carpal tunnel, and in the second group (n = 20) we applicated a perineural injection of 1 ml of betamethason immediately after the surgical decompression. We performed the electrodiagnostic (ED) examinations 7, 30 and 90 days after the surgery, and measured the conduction speed of the median nerve in the carpal tunnel zone and the sensitivity conduction speed of the median nerve. Results. Significant differences in examined ED respective variable values in different time intervals were obtained. At the final measurements, 90 days after the surgical procedure, both groups evidenced a full recovery of the conduction speed in the carpal tunnel with statistically significant better results in the second group of the patients (t = -2.116; p = 0.043). Conclusion. Intraoperative application of the corticosteroid injection during the surgical decompression results in faster regaining of conduction speed of the median nerve.
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Wilder Smith EPV, Chan YH, Kannan TA. Medial thenar recording in normal subjects and carpal tunnel syndrome. Clin Neurophysiol 2007; 118:757-61. [PMID: 17307031 DOI: 10.1016/j.clinph.2006.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2006] [Revised: 11/09/2006] [Accepted: 12/05/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Since little is known about the involvement of median nerve fibres to the medial thenar eminence in CTS, we determine the consistency of a motor response derived from a medial thenar motor (MTM) site. We then compare sensitivity and specificity of this novel site with other nerve conduction parameters in supporting a diagnosis of CTS. METHODS The motor responses over the MTM with ulnar and median stimulation were determined in healthy subjects and patients with CTS. Sensitivity and specificity of 4 motor techniques (Abductor Pollicis Brevis (APB) and median MTM latency, 2nd Lumbricales to Interossei latency difference (2-LINT), APB to Adductor Digiti Minimi (ADM) latency difference, median MTM to ulnar MTM latency difference) and the median sensory distal latency in confirming CTS were calculated using the ROC method. RESULTS 132 hands (68 CTS, 64 controls) were examined. All but one median and ulnar nerve stimulation (both in patients with CTS) resulted in negative MTM compound muscle action potentials. Sensitivity and specificity in diagnosing CTS were 79/97% (APB) 90/98% (median MTM latency), 88/97% (2-LINT), 85/97% (APB to ADM latency difference) and 75/95% (median MTM to ulnar MTM latency difference). Median sensory latency showed 89% sensitivity and 97% specificity. CONCLUSIONS Median and ulnar stimulation results in consistent motor responses at the medial thenar site. Median distal motor latency to MTM is frequently abnormal in CTS showing similar sensitivity and specificity to 2-LINT and median distal sensory latency. SIGNIFICANCE The MTM site shows consistent responses to both median and ulnar stimulation. MTM distal latency can be considered a useful site for supporting a diagnosis of CTS.
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Abstract
PURPOSE To provide a comprehensive review of the management of carpal tunnel syndrome. METHODS AND RESULTS A systematic literature review is provided of the history, anatomy, pathophysiology, epidemiology, diagnostic criteria, investigative surgical techniques, results and complications for carpal tunnel syndrome. CONCLUSION Surgery for carpal tunnel syndrome requires meticulous attention to history-taking, investigation, counseling, training and surgical technique if unsatisfactory results and complications are to be avoided.
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Affiliation(s)
- J Haase
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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