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Assmus H, Antoniadis G, Heinen C, Kneser U, Bahm J. ["Nerve Surgery" In German-Speaking Countries - Starting With The Nerve Club Up To A Certificate]. HANDCHIR MIKROCHIR P 2024; 56:7-10. [PMID: 38508202 DOI: 10.1055/a-2241-2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
We present the Nerve Club, a community of colleagues originating from german-speaking countries and dedicated to those working in or outside surgery with interest in the peripheral nerve. This article reviews the club´s history and specific characteristics and activities, and highlights the concept of a certificate in nerve surgery. We have annual club meetings and organize every two years a plexus symposium. Also exists a scientific publication award and cooperation with an online based journal dedicated to medical publications in the field of nerve surgery.
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Affiliation(s)
| | | | - Christian Heinen
- Medizinisches Versorgungszentrum am Christlichen Krankenhaus Fachbereich Neurochirurgie, Quakenbrück
| | - Ulrich Kneser
- Hand-, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen
| | - Jörg Bahm
- Klinik für Plastische, Hand und Verbrennungschirurgie am Universitätsklinikum der RWTH Aachen, Aachen
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2
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M Pothmann CE, Besmens IS, Rothenfluh E, Guidi M, Calcagni M, Frueh FS. [Neuropathic Pain - Differential Diagnosis and Treatment from the Hand Surgeon's Perspective]. PRAXIS 2021; 110:673-680. [PMID: 34521273 DOI: 10.1024/1661-8157/a003734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Neuropathic Pain - Differential Diagnosis and Treatment from the Hand Surgeon's Perspective Abstract. Neuropathic pain of the wrist and hand can be caused by a multitude of pathologies, such as trauma, iatrogenic damage, local peripheral nerve compression, nerve tumors and systemic diseases. Neuropathic pain can lead to chronification and disability, severely affecting the patients' quality of life and the ability to work. A precise diagnosis is the key to an adequate therapy with satisfactory functional results. An interdisciplinary and multimodal approach is a prerequisite when treating neuropathic pain. This review article provides an insight into the diagnosis and therapy of pathologies associated with neuropathic pain of the wrist and hand.
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Affiliation(s)
- Carina E M Pothmann
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Inga S Besmens
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Esin Rothenfluh
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Marco Guidi
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Maurizio Calcagni
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
| | - Florian S Frueh
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich, Zürich
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Froschauer SM, Raher W, Holzbauer M, Brett E, Kwasny O, Duscher D. Seasonal impact on surgical site infections and wound healing disturbance in carpal tunnel surgery: A retrospective cohort study. Int Wound J 2021; 18:708-715. [PMID: 33939266 PMCID: PMC8450797 DOI: 10.1111/iwj.13573] [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: 12/30/2020] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Abstract
Carpal tunnel syndrome is the most common entrapment syndrome of a peripheral nerve. The gold standard treatment is open carpal tunnel release which has a high success rate, a low complication rate, and predictable postoperative results. However, it has not been analysed yet if there is a seasonal influence on complications for carpal tunnel release, a highly elective procedure. In this retrospective study, we determine whether there is a seasonal impact on surgical site infections (SSI) and wound healing disorders (WHD) in primary carpal tunnel syndrome surgery. Between 2014 and 2018, we have assessed 1385 patients (65% female, 35% male) at a mean age of 61.9 (SD 15.3) years, which underwent open carpal tunnel release because of primary carpal tunnel syndrome. The seasonal data such as the warm season (defined as the period from 1st of June until 15th of September), the average daily and monthly temperature, and the average relative humidity were analysed. Patient demographics were examined including body mass index, alcohol and nicotine abuse, the use of anticoagulants and antiplatelet drugs as well as comorbidities. These data were correlated regarding their influence to the rate of surgical site infections and wound healing disorders in our study collective. A postoperative SSI rate of 2.4% and a WHD rate of 7% were detected. Our data confirms the warm season, the average monthly temperature, and male sex as risk factors for increasing rates of WHDs. Serious SSIs with subsequent revision surgery could be correlated with higher age and higher relative humidity. However there is no seasonal impact on SSIs. We therefore advise considering the timing of this elective surgery with scheduling older male patients preferably during the cold season to prevent postoperative WHDs.
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Affiliation(s)
- Stefan Mathias Froschauer
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Linz, Austria.,Johannes Kepler University Linz, Faculty of Medicine, Linz, Austria
| | - Wolfgang Raher
- Johannes Kepler University Linz, Faculty of Medicine, Linz, Austria
| | | | - Elizabeth Brett
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Oskar Kwasny
- Department for Trauma Surgery and Sport Traumatology, Kepler University Hospital Linz, Linz, Austria.,Johannes Kepler University Linz, Faculty of Medicine, Linz, Austria
| | - Dominik Duscher
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, Tübingen, Germany
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van der Molen HF, Visser S, Alfonso JH, Curti S, Mattioli S, Rempel D, Roquelaure Y, Kuijer PPFM, Tamminga SJ. Diagnostic criteria for musculoskeletal disorders for use in occupational healthcare or research: a scoping review of consensus- and synthesised-based case definitions. BMC Musculoskelet Disord 2021; 22:169. [PMID: 33573616 PMCID: PMC7879660 DOI: 10.1186/s12891-021-04031-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to identify case definitions of diagnostic criteria for specific musculoskeletal disorders (MSDs) for use in occupational healthcare, surveillance or research. Methods A scoping review was performed in Medline and Web of Science from 2000 to 2020 by an international team of researchers and clinicians, using the Arksey and O’Malley framework to identify case definitions based on expert consensus or a synthesis of the literature. Seven MSDs were considered: non-specific low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral or medial elbow tendinopathy, and knee and hip osteoarthritis (OA). Case definitions for occupational healthcare or research were charted according to symptoms, signs and instrumental assessment of signs, and if reported, on work-related exposure criteria. Results In total, 2404 studies were identified of which 39 were included. Fifteen studies (38%) reported on non-specific LBP, followed by knee OA (n = 8;21%) and CTS (n = 8;21%). For non-specific LBP, studies agreed in general on which symptoms (i.e., pain in lower back) and signs (i.e., absence of red flags) constituted a case definition while for the other MSDs considerable heterogeneity was found. Only two studies (5%), describing case definitions for LBP, CTS, and SAPS and lateral and medial elbow tendinopathy respectively, included work-related exposure criteria in their clinical assessment. Conclusion We found that studies on non-specific LBP agreed in general on which symptoms and signs constitute a case definition, while considerable heterogeneity was found for the other MSDs. For prevention of work-related MSDs, these MSD case definitions should preferably include work-related exposure criteria. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04031-z.
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Affiliation(s)
- Henk F van der Molen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Steven Visser
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jose Hernán Alfonso
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-49000, Angers, France
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sietske J Tamminga
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Ayache A, Unglaub F, Tsolakidis S, Schmidhammer R, Löw S, Langer MF, Spies CK. [Revision surgery for carpal and cubital tunnel syndrome]. DER ORTHOPADE 2020; 49:751-761. [PMID: 32857166 DOI: 10.1007/s00132-020-03969-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carpal tunnel syndrome, a compressive neuropathy of the median nerve at the wrist and cubital tunnel syndrome, a compressive neuropathy of the ulnar nerve at the elbow, are the two most common peripheral nerve compression syndromes. Chronic compressive neuropathy of peripheral nerves causes pain, paraesthesia and paresis. Treatment strategies include conservative options, but only surgical decompression can resolve the mechanical entrapment of the nerve with proven good clinical results. However, revision rates for persistent or recurrent carpal tunnel syndrome is estimated at around 5% and for refractory cubital tunnel syndrome at around 19%. Common causes for failure include incomplete release of the entrapment and postoperative perineural scarring. THERAPY Precise diagnostic work-up is obligatory before revision surgery. The strategy of revision surgery is first complete decompression of the affected nerve and then providing a healthy, vascularized perineural environment to allow nerve gliding and nerve healing and to avoid recurrent scarring. Various surgical options may be considered in revision surgery, including neurolysis, nerve wrapping and nerve repair. In addition, flaps may provide a well vascularized nerve coverage in the case of recurrent carpal tunnel syndrome. In the case of recurrent cubital tunnel syndrome, anterior transposition of the ulnar nerve is mostly performed for this purpose. RESULTS In general, revision surgery leads to improvement of symptoms, although the outcome of revision surgery is less favourable than after primary surgery and complete resolution of symptoms is unlikely.
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Affiliation(s)
- A Ayache
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - S Tsolakidis
- Millesi Center, Nervenchirurgie und Rekonstruktive Chirurgie, Wien, Österreich
| | - R Schmidhammer
- Millesi Center, Nervenchirurgie und Rekonstruktive Chirurgie, Wien, Österreich
| | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland
| | - M F Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
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6
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[Surgical treatment of carpal tunnel syndrome: open release of the flexor retinaculum and hypothenar fat flap for revision surgery]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:219-235. [PMID: 32524170 DOI: 10.1007/s00064-020-00662-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Decompression of the median nerve by complete release of the flexor retinaculum and the distal antebrachial fascia. In the case of revision surgery providing of a scar-free covering of the median nerve, if necessary. INDICATIONS Carpal tunnel release is indicated for symptomatic patients with painful paraesthesia or neurological deficits after adequate diagnostic evaluation. The hypothenar fat flap is indicated in revision surgery if a sufficient nerve bed of the median nerve is needed and to restore nerve gliding. CONTRAINDICATIONS General operative limitations. The hypothenar fat flap is not indicated in revision surgery if median nerve irritation is not caused by surrounding scaring but other reasons like tendonitis. SURGICAL TECHNIQUE Proximal longitudinal incision of the palm. Subcutaneous dissection and incision of the palmar aponeurosis. Careful ulnar incision of the transverse carpal ligament. Considerate release of the distal and proximal parts of the retinaculum as well as the distal part of the antebrachial fascia. Exploration of the median nerve and palpation of the carpal tunnel and resection of compressive structures, if necessary. In case of revision surgery, if required, the hypothenar fat flap is raised. The fat flap is transposed without tension palmar to the median nerve and fixed to the radial side of the carpal tunnel. POSTOPERATIVE MANAGEMENT Early functional mobilization. Immobilization for a short period is optional. After revision surgery and hypothenar fat flap, splinting for one week is recommended.
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Marschall A, Ficjian A, Stradner MH, Husic R, Zauner D, Seel W, Simmet NE, Klammer A, Heizer P, Brickmann K, Gretler J, Fürst-Moazedi FC, Thonhofer R, Hermann J, Graninger WB, Quasthoff S, Dejaco C. The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study. PLoS One 2016; 11:e0162288. [PMID: 27662617 PMCID: PMC5035047 DOI: 10.1371/journal.pone.0162288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/20/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives To investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS). Methods Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models. Results Short-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes. Conclusions Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.
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Affiliation(s)
- Alexander Marschall
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Anja Ficjian
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Martin H. Stradner
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Rusmir Husic
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Dorothea Zauner
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Werner Seel
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Nicole E. Simmet
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Alexander Klammer
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Petra Heizer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Kerstin Brickmann
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Judith Gretler
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | | | - Rene Thonhofer
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Josef Hermann
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Winfried B. Graninger
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
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Age delays the recovery of distal motor latency after carpal tunnel syndrome surgery. Acta Neurochir (Wien) 2014; 156:1335-9. [PMID: 24691974 DOI: 10.1007/s00701-014-2065-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies have shown slow healing of peripheral nerve injury in elderly patients. Carpal tunnel syndrome (CTS) is the most frequent compressive mononeuropathy, affecting mostly older people and females. Few studies have assessed electrophysiological differences between younger and older patients. We aimed to evaluate age-dependent differences in electrophysiological parameters preoperatively and postoperatively over a 100-day postoperative period. METHOD This retrospective study included 258 hands of patients who underwent conventional open-technique carpal tunnel syndrome surgery. Patients with paresthesia in the median nerve distribution or with impaired sensation or abnormal findings in sensory and motor median nerve conduction studies were enrolled. The age dependence of the preoperative values of distal motor latency, amplitude of the compound motor action potential and sensory conduction velocity was estimated using regression analysis. RESULTS Statistically significant age dependence was found for the preoperative distal motor latency, compound motor action potential, amplitude and sensory conduction velocity. The repair of segmental demyelination was nearly twice as slow in the older group, at a 5 % significance level, even when comparing groups with the same preoperative distal motor latency. CONCLUSIONS Analysis of preoperative nerve conduction parameters indicates that surgery for carpal tunnel syndrome is performed later in older patients.
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Dahlin LB, Sandén H, Dahlin E, Zimmerman M, Thomsen N, Björkman A. Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy. J Occup Med Toxicol 2014; 9:7. [PMID: 24606755 PMCID: PMC3974023 DOI: 10.1186/1745-6673-9-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/03/2014] [Indexed: 11/16/2022] Open
Abstract
Prolonged exposure to hand-held vibrating tools may cause a hand-arm vibration syndrome (HAVS), sometimes with individual susceptibility. The neurological symptoms seen in HAVS are similar to symptoms seen in patients with carpal tunnel syndrome (CTS) and there is a strong relationship between CTS and the use of vibrating tools. Vibration exposure to the hand is known to induce demyelination of nerve fibres and to reduce the density of myelinated nerve fibres in the nerve trunks. In view of current knowledge regarding the clinical effects of low nerve-fibre density in patients with neuropathies of varying aetiologies, such as diabetes, and that such a low density may lead to nerve entrapment symptoms, a reduction in myelinated nerve fibres may be a key factor behind the symptoms also seen in patients with HAVS and CTS. Furthermore, a reduced nerve-fibre density may result in a changed afferent signal pattern, resulting in turn in alterations in the brain, further prompting the symptoms seen in patients with HAVS and CTS. We conclude that a low nerve-fibre density lead to symptoms associated with nerve entrapment, such as CTS, in some patients with HAVS.
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Affiliation(s)
- Lars B Dahlin
- Department of Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
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Gupta S, Tewari AK, Nair V, Gupta A. Reliability of motor parameters for follow-up after local steroid injection in carpal tunnel syndrome. J Neurosci Rural Pract 2013; 4:392-6. [PMID: 24347943 PMCID: PMC3858755 DOI: 10.4103/0976-3147.120233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Local steroid injection is one of the treatment modalities for carpal tunnel syndrome (CTS). Symptomatic and electrophysiological improvement has been previously documented. The electrophysiological parameter, which represents the most consistent change after local steroid injection, is not well-known. OBJECTIVE The objective of this study was to evaluate the changes in electrophysiological parameters 1 month after local steroid injection and to determine the parameter that is able to depict improvement across the severity spectrum of CTS. MATERIALS AND METHODS Forty-seven patients (27 with bilateral disease, 74 hands totally) were included. The electrophysiological parameters studied at baseline included sensory onset latency, sensory nerve action potential amplitude, sensory conduction velocity (CV), distal motor latency, compound muscle action potential amplitude and motor CV. All patients were injected with 40 mg triamcinalone at the wrist. After 1 month, symptomatic improvement from baseline was documented using visual analog score of 100. Electrophysiology was repeated. Paired t tests were done between baseline electrophysiology parameters and those obtained 1 month after steroid injection for significant improvement. Subgroup analyses were performed in hands with mild to moderate (Grade 3 or less by Bland's classification) and severe disease (Grades 4 and 5). RESULTS All patients showed a symptomatic improvement. Distal motor latency showed most consistent improvement irrespective of the severity of CTS. In mild to moderate CTS (Grade 3 or less of the classification given by Bland) sensory parameters were recordable and showed significant improvement in addition to distal motor latency. In the subcategory of severe CTS (Grades 4 and 5 of Bland) where sensory parameters are not recordable distal motor latency and the motor CV showed a significant improvement. CONCLUSION One month after local steroid injection among the electrophysiological parameters studied distal motor latencies showed most consistent and recordable improvement across the severity spectrum of CTS. This can be used as a single objective parameter to follow-up patients after a local steroid injection to document improvement or relapse. They can also be considered as objective parameter to follow-up patients after surgery.
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Affiliation(s)
- Salil Gupta
- Department of Neurology, Armed Forces Medical College, Pune, Maharashtra, India
| | - A K Tewari
- Department of Neurology, Command Hospital, Pune, Maharashtra, India
| | - Velu Nair
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Aditya Gupta
- Department of Neurology, Command Hospital, Pune, Maharashtra, India
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11
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Postoperative care and rehabilitation after open carpal tunnel surgery. Eur Surg 2013. [DOI: 10.1007/s10353-013-0210-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ott F, Mattiassich G, Kaulfersch C, Ortmaier R. Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome. BMJ Case Rep 2013; 2013:bcr-2013-009062. [PMID: 23513027 DOI: 10.1136/bcr-2013-009062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient was admitted reporting tingling pain and numbness in the right hand. Neurological examination--including nerve conduction studies--diagnosed carpal tunnel syndrome. Operative carpal tunnel release was performed without complications. Four months postoperatively the otherwise healthy patient presented again due to persistent complaints, although preoperative symptoms had improved. On this occasion, the patient reported loss of strength accompanied by rigidity in the wrist. Clinical examination showed some swelling adjacent to the operation wound. A postoperative ganglion cyst was suspected and a conservative treatment option--splinting the wrist--was chosen. Four weeks later the patient presented again with further swelling and increasing rigidity of the wrist. Surgical intervention was planned. Preoperative plain radiographs of the wrist revealed chronic palmar dislocation of the lunate to be the cause of the symptoms in our patient. Radiological signs of scapholunate advanced collapse arthritis (SLAC wrist) were also observed.
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Affiliation(s)
- Florian Ott
- Department of Trauma Surgery, Diakonissen Hospital Schladming, Schladming, Austria
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13
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Todnem K, Sand T. [Neurography for diagnosing carpal tunnel syndrome]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:170-3. [PMID: 23344602 DOI: 10.4045/tidsskr.12.0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND A number of evidence-based guidelines now recommend that a nerve conduction study should be used to confirm the existence of carpal tunnel syndrome before any surgery takes place. METHOD The article is based on a search in PubMed, a personal literature archive (1980-2011) and long clinical experience of neurological and neurophysiological diagnostics. RESULTS Both motor and sensory nerve fascicles must be tested after adequate warming up. An extended nerve conduction study with supplementary tests to compare velocities and latencies in median and ulnar nerves, increases the diagnostic precision. Given normal or mild findings, surgery can usually be avoided as the first choice of treatment, because many patients with mild carpal tunnel syndrome recover spontaneously. INTERPRETATION The gold standard for diagnosis of carpal tunnel syndrome should be a combination of a clinical examination and a nerve conduction study.
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Affiliation(s)
- Kari Todnem
- Avdeling for nevrologi og klinisk nevrofysiologi, St. Olavs hospital, Norway
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14
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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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Differenzialdiagnostik manualmedizinischer Syndrome der oberen Extremität. MANUELLE MEDIZIN 2010. [DOI: 10.1007/s00337-010-0762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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