[Carpal tunnel syndrome in chronic hemodialysis patients]

Association between low serum prealbumin levels and carpal tunnel syndrome in maintenance hemodialysis patients

Aims

Carpal tunnel syndrome (CTS) and low serum prealbumin concentration are common in maintenance hemodialysis patients. In this study, we focused on the association between low serum prealbumin levels and carpal tunnel syndrome in maintenance hemodialysis (MHD) patients using low-flux dialysis reuse.

Materials and methods

Serum prealbumin levels were assessed to determine the association between low serum prealbumin levels and CTS in 373 prevalent MHD patients (the mean age was 45 years old, hemodialysis duration was 46 months). The patients were divided into 2 groups: the CTS group with 44 patients and the non-CTS group with 329 patients.

Results

The prevalence of CTS was 11.8%. Serum prealbumin showed a good prognostic value to predict CTS in MHD patients using low-flux dialysis reuse (the Area Under the Curve = 0.841, p < .001; cutoff value: 26.5 mg/dL with sensitivity = 72.7% and specificity = 79.9%).

Conclusions

Serum prealbumin was a good prognostic biomarker of CTS in MHD patients using low-flux dialysis reuse.

Early detection and treatment of complications in the fingers and hand after arthroscopic rotator cuff repair

Background

Complications in the fingers and hand after arthroscopic rotator cuff repair (ARCR) have been reported to include carpal tunnel syndrome (CTS), flexor tenosynovitis (TS), and complex regional pain syndrome. These studies were conducted retrospectively; however, the reported complications have not been examined prospectively. The aim of this study was to evaluate the outcomes of early detection and treatment of the complications after ARCR.

Methods

Forty-six patients (48 shoulders) who underwent ARCR were prospectively examined to investigate complications in the fingers and hand after ARCR. We attempted to immediately detect and proactively treat these complications. We evaluated the outcomes of the early detection and treatment of the complications.

Results

Complications were observed in 17 hands (35%) and occurred an average of 1.5 months after ARCR. The symptoms in 3 hands resolved spontaneously, 2 hands were diagnosed with CTS, and 12 hands were diagnosed with TS. Of the 12 hands with TS, 11 exhibited no triggering of the fingers. Among the 14 hands diagnosed with CTS or TS, 13 hands (CTS: 2 hands, TS: 11 hands) were treated with corticosteroid injections; the mean interval between treatment initiation and symptom resolution was 1.0 months (0.5-3.0 months). None exhibited complex regional pain syndrome.

Conclusions

When symptoms occur in the fingers and hand after ARCR, CTS or TS should be primarily suspected. The diagnosis of TS must be made carefully because most patients with TS have no triggering. For patients with CTS or TS after ARCR, rapid corticosteroid injection administration can lead to improvement in these symptoms.

Case-control study on individual risk factors of carpal tunnel syndrome

This study was conducted to observe the characteristics of the risk factors of carpal tunnel syndrome (CTS) in Chinese population. CTS of 1,512 outpatients aged 41–70 years were without any other diseases which could cause numbness as a case group, and 4,536 non-CTS outpatients as a control group were involved in the study in 2013–2014. Both groups received a questionnaire and the case group received another electrical physiological examination. The results showed the odds ratio (OR) of age is 0.990 (95% CI, 0.984–0.996). The OR of BMI is 1.096 (95% CI, 1.077–1.115). The OR of smoking is 4.862 (95% CI, 3.991–5.925). The OR of wrist injury is 1.313 (95% CI, 1.019–1.691). The OR of diabetes mellitus is 1.837 (95% CI, 1.557–2.168). The OR of hypertension is 0.805 (95% CI, 0.688–0.942). The OR of hypothyroidism is 1.385 (95% CI, 1.119–1.715). The OR of rheumatic disease is 4.450 (95% CI, 3.712–5.215). The results showed that sex, age, smoking, wrist injury, diabetes mellitus, hypothyroidism and wrist working are all risk factors of CTS. Hypertension could be a protection factor of CTS in early phase but will increase the risk in a long-term high blood pressure. Smoking, alcohol and diabetes mellitus can be predictors of moderate and severe CTS.