The Use of Ultrasonography in Detection of Synovitis in Carpal Tunnel Syndrome

1993 ◽  
Vol 18 (2) ◽  
pp. 176-179 ◽  
Author(s):  
K. NAKAMICHI ◽  
S. TACHIBANA
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Lymphocytic Infiltration ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Group 3 ◽  
Group 2 ◽  
Inflammation Group ◽  
Group 1

The findings of pre-operative ultrasonography of the carpal tunnel were compared with synovial histology in 50 surgically treated wrists with carpal tunnel syndrome. Eight wrists with a massive hypoechoic area (group 3) had synovitis. 28 with a minimal hypoechoic area (group 1) had no evidence of inflammation. 14 with a moderately increased hypoechoic area (group 2) consisted of three with synovitis, four with lymphocytic infiltration and seven without inflammation. Group 3 strongly indicates synovitis, in which case one should consider aetiology other than the idiopathic cause. Bilateral synovial thickening suggests carpal tunnel syndrome as the initial clinical picture of rheumatoid arthritis, and group 1 indicates idiopathic carpal tunnel syndrome provided that there are no primary causes.

scholarly journals Efficacy of Hyalase Hydrodissection in the Treatment of Carpal Tunnel Syndrome: A Randomized, Double-Blind, Controlled, Clinical Trial

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. E175-E183
Author(s):  
Emad Zarief Kamel
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Saline Solution ◽  
Controlled Clinical Trial ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Group 1

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. Objectives: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. Study Design: A randomized, double-blinded trial. Setting: Anesthesia, pain, and rheumatology clinics in a university hospital. Methods: Patients: 60 patients with CTS (> 6 months’ duration). Intervention: patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). Measurements: assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well. Results: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up. Limitation: We suggest a longer period could be reasonable. Conclusions: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration. Key words: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection

Idiopathic Carpal Tunnel Syndrome and Trigger Finger: Is There an Association?

2008 ◽  
Vol 34 (1) ◽  
pp. 58-59 ◽  
Author(s):  
P. KUMAR ◽  
I. CHAKRABARTI
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Trigger Finger ◽  
Study Group ◽  
Population Prevalence ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
A Prospective Study ◽  
Hospital Outpatients

Carpal tunnel syndrome (CTS) and trigger finger are known to occur together in association with conditions such as diabetes mellitus, rheumatoid arthritis and hypothyroidism. Although most cases that present to a hand clinic have no obvious predisposing cause, the two conditions often appear together in the same patient. We performed a prospective study of the prevalence of CTS in hospital outpatients presenting with trigger finger. Six hundred and eighty-one patients with CTS, trigger finger or both conditions were recruited prospectively. Diagnosis of both disorders was made on clinical grounds. The study group comprised 551 patients with no obvious predisposing cause. Of 211 patients with trigger finger, 91 (43%) also had CTS. This prevalence is substantially higher than the population prevalence of CTS of approximately 4%. Our data support an association between idiopathic CTS and idiopathic trigger finger and lend support to common pathophysiological factors.

Single versus repetitive injection of lignocaine in the management of carpal tunnel syndrome – a randomized controlled trial

2014 ◽  
Vol 40 (2) ◽  
pp. 179-183 ◽  
Author(s):  
S. Akarsu ◽  
Ö. Karadaş ◽  
F. Tok ◽  
H. Levent Gül ◽  
E. Eroğlu
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Controlled Trial ◽  
Post Treatment ◽  
Randomized Controlled ◽  
Electrophysiological Findings ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Single Versus ◽  
Group 1

The aim of this study was to determine the efficacy of single versus repetitive injection of lignocaine into the carpal tunnel for the management of carpal tunnel syndrome. The 42 patients included were randomly assigned to two Groups: group 1 was injected with 4 mL of 1% lignocaine once and Group 2 was injected with 4 mL of 1% lignocaine twice a week for 2 weeks. Clinical and electrophysiological evaluations were performed at the study onset, and at 6 and 12 weeks following the final injection. Initially, the groups were similar with respect to clinical and electrophysiological findings. All parameters in Group 2 improved 6 weeks post treatment ( p < 0.05), and these improvements persisted at 12 weeks post treatment ( p < 0.05). Repetitive local lignocaine injection was effective in reducing the symptoms of carpal tunnel syndrome and improving electrophysiological findings.

scholarly journals Effectiveness of neural mobilization and ultrasound therapy on pain severity in carpal tunnel syndrome

2018 ◽  
Vol 5 (4) ◽  
pp. 2187-2193
Author(s):  
Mehboob Alam ◽  
Muhammad Khan ◽  
Syed Imran Ahmed ◽  
Syed Shahzad Ali
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Successful Treatment ◽  
Carpal Tunnel ◽  
Severe Pain ◽  
Pain Severity ◽  
Ultrasound Therapy ◽  
Mild Pain ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Group 1

Objective: To compare the effectiveness of neural mobilization and ultrasound therapy on pain severity in carpal tunnel syndrome (CTS). Methods: This randomized controlled trial was conducted on 48 CTS patients at the Physiotherapy Department IPM&R, DUHS between 23rd January 2017 and 22nd July 2017. The CTS patients were randomly allocated into 2 equal groups by simple randomization method. Group 1 received neural mobilisation; Group 2 received ultrasound therapy with a predetermined intensity. A total of 12 sessions were given over a period of 4 weeks. Pre and post intervention data were collected from both groups on Visual Analogue Scale (VAS) to measure pain. SPSS version 20 was used for data analysis. Comparisons between post test results of both groups were done by using paired sample t-test with a p-value < 0.05 considered as significant. Results: It was found that the 79% (19 cases) and 21% (5 cases) in Group 1 (Neural Mobilization), who prior to the treatment had faced moderate and severe pain, respectively, all experienced successful treatment. Indeed, after treatment 100% (24) of the cases only experienced mild pain, indicating successful treatment. For Group 2 (Ultrasound Therapy), 54% (13) and 46% (11) of cases were with moderate and severe pain before treatment; after administering the treatment 20% (5 cases) had mild pain and 80% (19 cases) had moderate pain. Conclusion: Neural mobilization for median nerve is more beneficial than ultrasound therapy in reducing pain intensity and functional limitations due to CTS.

scholarly journals Limited mid palmar versus extended incision in surgical treatment of carpal tunnel syndrome: Clinical analysis

2020 ◽  
Vol 24 (3) ◽  
pp. 360-366
Author(s):  
Jagar Doski ◽  
Reber Sindy ◽  
Farhad Hamzani ◽  
Hishyar Omar
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Operative Time ◽  
Daily Life ◽  
Daily Life Activities ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Group 1

Background and objective: There are different methods and incisions to release the transverse carpal ligament in carpal tunnel syndrome. This study aimed to compare the surgical outcome of the conventional extended incision with the limited mid palmar one. Methods: The study was a prospective comparative one. Patients with carpal tunnel syndrome were divided into two groups: Group 1 was patients operated on by the conventional extended incision, Group 2 with a limited mid palmar incision. Results: The patients included were 79 with 89 hands. The age mean was 41 years. Group 1 included 47, and Group 2 included 42 hands. The differences between both groups were statistically significant regarding the operative data (the incision length and the operative time) and the post-operative data (the duration of analgesia needed, the date of starting to use the hand in daily life activities, and return to work). However, the date of improvement of the sensory symptoms from the fingers showed no significant differences. The sum of the overall complications that occurred for the cases of Group 2 was about a third of that occurred for Group 1. The highly significant difference was in the scar tenderness in the third month of the post-operative period. Conclusion: The limited mid palmar incision to release the entrapment of median nerve in carpal tunnel syndrome offers a shorter operative time, less analgesia needed post-operatively, less complication rate, less scar tenderness, earlier use of the hand in daily life activities, and return to work in a shorter period. Keywords: Carpal tunnel syndrome; Surgical treatment; Incision.

scholarly journals Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome

2020 ◽  
Author(s):  
Gianluca Smerilli ◽  
Andrea Di Matteo ◽  
Edoardo Cipolletta ◽  
Sergio Carloni ◽  
Antonella Incorvaia ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Ultrasound Assessment ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

scholarly journals Carpal tunnel syndrome: elastosonographic strain ratio andcross-sectional area evaluation for the diagnosis and disease severity.

2016 ◽  
Vol 18 (3) ◽  
pp. 305 ◽  
Author(s):  
Idil Gunes Tatar ◽  
Aydin Kurt ◽  
NeseGungor Yavasoglu ◽  
Baki Hekimoglu
Keyword(s):  
Carpal Tunnel ◽  
Strain Ratio ◽  
Change Score ◽  
Ratio Score ◽  
Sectional Area ◽  
Tunnel Syndrome ◽  
Group 3 ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Aim: To evaluate the role of gray scale ultrasonography (US) and real time elastosonography (RTE) incarpal tunnel syndrome (CTS). Materials and methods: Both wrists of 18 healthy volunteers (n=36) formed the control group (Group 1) and 19 symptomatic outpatients of the neurology clinic constituted the patient group. According to nerve conduction study results, cases with mild CTS (n=15) formed Group 2; cases with moderate to severe CTS (n=20) formed Group 3. Cross sectional area (CSA) and strain ratio (SR) were measured at carpal tunnel inlet (CTI) and 4 cm proximal to the distal end of the radius (P). CSA and SR change score (CSACTI-CSAP; SRCTI-SRP), CSA and SR ratio score (CSACTI / CSAP; SRCTI / SRP) were calculated. Results: The median nerve was significantly stiffer in Group 2 compared to Group 1; also in Group 3 compared to Group 1 (p=0.000). For CSACTI, the difference was significant between Group 1 and Group 3 (p=0.000), also between Group 2 and Group 3 (p=0.001). For CSA change scores the difference was only significant between Group 1 and Group 3 (p=0.015). In the diagnosis of CTS the best cut-off value for CSACTI was 10.8 (p=0.001), 2.3 for SRCTI(p=0.000), 4.9 for the CSA change score (p=0.005), 0.05 for the SR change score (p=0.000), 1.3 for the the CSA ratio score (p=0.015) and 1.1 for the SR ratio score (p=0.000). Conclusion: SR measurements do not  exclude patients even with mild CTS but cannot categorize disease severity. CSA measurements on the other hand can categorize disease severity.Therefore, the combined use of US and RTE is suggested.

scholarly journals AB1181 ULTRASOUND PATHOLOGICAL PATTERNS AT CARPAL TUNNEL LEVEL IN RHEUMATOID ARTHRITIS AND IDIOPATHIC CARPAL TUNNEL SYNDROME

2019 ◽  
Author(s):  
Gianluca Smerilli ◽  
Emilio Filippucci ◽  
Andrea DI Matteo ◽  
Antonella Draghessi ◽  
Stefania Gasparini ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome

scholarly journals Minimally invasive modified Camitz opponensplasty for severe carpal tunnel syndrome

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877091
Author(s):  
Mitsuhiko Nanno ◽  
Norie Kodera ◽  
Yuji Tomori ◽  
Shinro Takai
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Modified Technique ◽  
Abductor Pollicis Brevis ◽  
Thenar Muscle ◽  
Painful Wrist ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Group 1

Purpose: We aimed to compare the clinical results and the complications between the minimally invasive modified Camitz opponensplasty and the conventional Camitz opponensplasty for severe carpal tunnel syndrome (CTS), and to evaluate the efficacy of the modified technique for CTS. Methods: Twenty-eight hands in 24 patients with severe CTS who had disorder of the thumb opposition with thenar muscle atrophy (group 1) were treated by minimally invasive modified Camitz opponensplasty, passing the transferred palmaris longus (PL) tendon under the abductor pollicis brevis (APB) fascia using only palm and thumb incision, and no incision to either wrist crease or forearm. Ten hands in 10 patients (group 2) were treated by the conventional Camitz opponensplasty. Clinical evaluation was made by comparing the results before and after surgery for the angle of the thumb palmar abduction, pinch power, and grip strength. Results: All clinical findings significantly improved after surgery compared with before surgery in all patients. In group 1, there were no complications including transferred tendon bowstring, painful wrist scar, or injury to the palmar cutaneous branch of the median nerve in all hands. Conversely, patients in group 2 had four painful wrist scars and nine bowstrings of the transferred tendon. Conclusions: Several complications have been considered to attribute to the long incision and an extensive dissection crossing the wrist crease from the palm to the wrist in the conventional Camitz procedure. The current modified Camitz opponensplasty by minimally invasive incision without straddling the wrist crease is a simple and effective procedure that can decrease the risk of painful scar around the wrist crease in severe CTS patients with disorder of thumb opposition. Additionally, this technique, by passing the transferred PL tendon under the APB fascia, is useful in restoring the thumb opposition immediately, and in preventing the bowstringing of the transferred tendon.

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