scholarly journals Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is there a Case for Causation?

Hand ◽  
2007 ◽  
Vol 2 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Steven J. McCabe ◽  
Anna L. Uebele ◽  
Vasyl Pihur ◽  
Roberto S. Rosales ◽  
Isam Atroshi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Sleep Disturbances ◽  
Lateral Position ◽  
Causal Mechanism ◽  
Causative Mechanism ◽  
Increased Risk ◽  
Tunnel Syndrome ◽  
Relationship Of

Introduction Carpal tunnel syndrome (CTS) is thought to be due to compression of the median nerve in the carpal tunnel. It is known that carpal tunnel pressures are elevated in wrist postures of flexion and extension and in those patients with CTS. Classic symptoms of CTS include night waking with pain, tingling, and numbness. These classic symptoms stimulated our interest in the relationship of sleep to the development of CTS. Method We reviewed the literature surrounding the epidemiology of CTS and the literature regarding sleep disturbances. Through careful distillation of these studies and a process of reasoning, we have developed a hypothesis for a causal mechanism of CTS. Results Epidemiologically, it has been shown that CTS is associated with age, gender, increased body mass index (BMI), diabetes, pregnancy, and is more common in some populations. The same associations noted above for CTS are strongly associated with sleep disturbances. Sleep disturbances due to age, gender, BMI, pregnancy, and population variations are all associated with sleeping in the lateral position supporting the hypothesis that a common causative mechanism of CTS is sleeping in a lateral position. Discussion We believe that the epidemiologic associations with CTS act through a common causative mechanism, increased sleeping in the lateral position which puts the wrist at increased risk of flexion or extension, compressing the median nerve in the carpal tunnel. This hypothesis is simple and explains the connection between a previously unconnected group of epidemiologic associations. This realization has real clinical significance in that it focuses our attention on the early disorder when it is completely reversible. It clarifies previously confused clinical circumstances, creates research questions that can be tested, and it invites us to change our clinical perspective in this most common form of nerve compression.

The Relationship of Vitamin B6 Status to Median Nerve Function and Carpal Tunnel Syndrome Among Active Industrial Workers

1996 ◽  
Vol 38 (5) ◽  
pp. 485-491 ◽  
Author(s):  
Alfred Franzblau ◽  
Cheryl L. Rock ◽  
Robert A. Werner ◽  
James W. Albers ◽  
Matthew P. Kelly ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Vitamin B6 ◽  
Nerve Function ◽  
Industrial Workers ◽  
Tunnel Syndrome ◽  
Relationship Of ◽  
The Relationship

P104 The relationship of median nerve F-wave parameters with severity and subtypes of carpal tunnel syndrome

2008 ◽  
Vol 119 ◽  
pp. S98
Author(s):  
Recep Aygül ◽  
Dilcan Kotan ◽  
Hizir Ulvi ◽  
Mutlu Kuyucu ◽  
Gökhan Özdemir
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Wave Parameters ◽  
Tunnel Syndrome ◽  
F Wave ◽  
Relationship Of ◽  
The Relationship

Carpal tunnel syndrome – Occupationally Related or Not?

2009 ◽  
Vol 14 (3) ◽  
pp. 1-2
Author(s):  
Craig Uejo
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Perceived Risk ◽  
Occupational Injury ◽  
The United States ◽  
Work Related ◽  
Tunnel Syndrome ◽  
Relationship Of

Abstract Carpal tunnel syndrome (CTS), the most common peripheral entrapment neuropathy, is caused by compression of the median nerve at the wrist, and annual costs of CTS treatment in the United States total $2 billion. Although CTS often is attributed to repetitive motions at work, recent reports have questioned the relationship of CTS and occupational activities. This article reviews recent publications and provides insights into the causation of this common problem. Despite ergonomic workplace modifications aimed at reducing perceived risk factors, rates of imputedly work-related musculoskeletal disorders such as CTS have not decreased during the past ten years. One study found a prevalence of electrodiagnostically confirmed CTS of 3.5% in frequent computer users, but the authors also note that affected and unaffected employees had similar occupations, years using a computer, and usage rates. Another group concluded that computer use does not pose a severe occupational hazard for developing symptoms of CTS. Recent publications have suggested other risk factors such as age, obesity, hand dominance, reduced physical fitness, lifetime alcohol intake, and smoking; others have correlated weight and body mass index with prolonged median nerve latency. A relatively small number of jobs may be associated with CTS, primarily those that involve high force and repetition. The etiology of CTS usually is multifactorial, and risk factors include genetics, age, female sex, and obesity; its relationship with occupational injury is questioned.

scholarly journals POS0584 ULTRASONOGRAPHY OF THE MEDIAN NERVE IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER SUSPICION OF CARPAL TUNNEL SYNDROME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 525.1-525
Author(s):  
S. Tsiami ◽  
E. Ntasiou ◽  
C. Krogias ◽  
R. Gold ◽  
J. Braun ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Sectional Area ◽  
Cross Sectional ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Tunnel Syndrome

Background:Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome and a common extra-articular manifestation of rheumatoid arthritis (RA). Different causes of CTS are known, among them inflammatory and non-inflammatory pathologies. Electroneurography (ENG) of the median nerve, the method of choice to diagnose CTS, measures impairment of nerve conduction velocity without explaining its underlying cause. However, because the electrical stimulation is often not well tolerated, ENG results may come out inconclusive. Using greyscale ultrasonography (GS-US) provides anatomic information including a structural representation of the carpal tunnel.Objectives:To investigate the performance of nerve GS-US in the diagnosis of CTS in patients with RA.Methods:Consecutive patients with active RA under suspicion of CTS presenting to a large rheumatologic center were included. Both hands were examined by an experienced neurologist including ENG and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG (1), and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm2, moderate: 0,14-0,15 cm2, severe: > 0,15 cm2 CTS (2)] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms (3).Results:Both hands of 58 patients with active RA (n=116) and clinical suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.There was a good correlation of the cross-sectional area (CSA) as well as the CSA-ratio to the ENG findings: the larger the CSA, the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these 19 patients, clinical complains were more severely present than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007).Conclusion:In patients with active RA and clinical complains of CTS, ultrasound examinations provide additional information about inflammation which is helpful for a diagnosis of CTS. Thus, ENG and nerve GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.References:[1]Padua L et al. Acta Neurol Scand 1997; 96:211–217[2]El Miedany et al., Rheumatology (Oxford). 2004 Jul; 43(7):887-895[3]Levine DW et al. J Bone Joint Surg Am 1993; 75: 1585-1592Figure 1.BCTSQ scores in patients with diagnosis of CTS and absence or presence of RA-related tenosynovial hypertrophyDisclosure of Interests:None declared

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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