Clinical features of 1039 patients with neurophysiological diagnosis of carpal tunnel syndrome

2004 ◽  
Vol 107 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Daniel B. Nora ◽  
Jefferson Becker ◽  
João Arthur Ehlers ◽  
Irênio Gomes
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Tunnel Syndrome

scholarly journals Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome

Symmetry ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1042
Author(s):  
Oscar J. Pellicer-Valero ◽  
José D. Martín-Guerrero ◽  
César Fernández-de-las-Peñas ◽  
Ana I. De-la-Llave-Rincón ◽  
Jorge Rodríguez-Jiménez ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Spectral Clustering ◽  
Grip Force ◽  
The Other ◽  
Pressure Pain ◽  
Thermal Pain ◽  
Pressure Pain Thresholds ◽  
Tunnel Syndrome

Identification of subgroups of patients with chronic pain provides meaningful insights into the characteristics of a specific population, helping to identify individuals at risk of chronification and to determine appropriate therapeutic strategies. This paper proposes the use of spectral clustering (SC) to distinguish subgroups (clusters) of individuals with carpal tunnel syndrome (CTS), making use of the obtained patient profiling to argue about potential management implications. SC is a powerful algorithm that builds a similarity graph among the data points (the patients), and tries to find the subsets of points that are strongly connected among themselves, but weakly connected to others. It was chosen due to its advantages with respect to other simpler clustering techniques, such as k-means, and the fact that it has been successfully applied to similar problems. Clinical (age, duration of symptoms, pain intensity, function, and symptom severity), psycho-physical (pressure pain thresholds—PPTs—over the three main nerve trunks of the upper extremity, cervical spine, carpal tunnel, and tibialis anterior), psychological (depressive levels), and motor (pinch tip grip force) variables were collected in 208 women with clinical/electromyographic diagnosis of CTS, whose symptoms usually started unilaterally but eventually evolved into bilateral symmetry. SC was used to identify clusters of patients without any previous assumptions, yielding three clusters. Patients in cluster 1 exhibited worse clinical features, higher widespread pressure pain hyperalgesia, higher depressive levels, and lower pinch tip grip force than the other two. Patients in cluster 2 showed higher generalized thermal pain hyperalgesia than the other two. Cluster 0 showed less hypersensitivity to pressure and thermal pain, less severe clinical features, and more normal motor output (tip grip force). The presence of subgroups of individuals with different altered nociceptive processing (one group being more sensitive to pressure pain and another group more sensitive to thermal pain) could lead to different therapeutic programs.

Carpal tunnel decompression in patients with normal nerve conduction studies

2019 ◽  
Vol 45 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Samuel P. Mackenzie ◽  
Oliver D. Stone ◽  
Paul J. Jenkins ◽  
Nicholas D. Clement ◽  
Iain R. Murray ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Study Groups ◽  
Nerve Conduction Studies ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
Normal Nerve Conduction

Some patients present with typical clinical features of carpal tunnel syndrome despite normal nerve conduction studies. This study compared the preoperative and 1-year postoperative QuickDASH scores in patients with normal and abnormal nerve conduction studies, who underwent carpal tunnel decompression. Of the 637 patients included in the study, 19 had clinical features of carpal tunnel syndrome but normal nerve conduction studies, and underwent decompression after failure of conservative management. Preoperative QuickDASH scores were comparable in both groups (58 vs 54.8). However, there were significant differences between the normal and abnormal nerve conduction study groups in the QuickDASH at 1 year (34.9 vs 21.5) and change in QuickDASH postoperatively (23.1 vs 33.4). Patients with normal nerve conduction studies had comparable preoperative disability scores compared with those with abnormal studies. Although they had a significant improvement in QuickDASH at 1 year, this was significantly less than those with abnormal nerve conduction studies. Level of evidence: III

Carpal tunnel syndrome: clinical features, diagnosis, and management

2016 ◽  
Vol 15 (12) ◽  
pp. 1273-1284 ◽  
Author(s):  
Luca Padua ◽  
Daniele Coraci ◽  
Carmen Erra ◽  
Costanza Pazzaglia ◽  
Ilaria Paolasso ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Diagnosis And Management ◽  
Tunnel Syndrome

scholarly journals Surgical profile and management of carpal tunnel syndrome among sample of Iraqi patients attending a teaching hospital

2019 ◽  
Vol 6 (5) ◽  
pp. 1477
Author(s):  
Amir Naif Kadum Al-Imari ◽  
Amine Mohammed Bakkour ◽  
Mohammed Hillu Surriah ◽  
Ayaad Makki Saaid
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Surgical Management ◽  
Teaching Hospital ◽  
Carpal Tunnel ◽  
Common Condition ◽  
Associated Diseases ◽  
Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is a common condition that causes pain, numbness, and weakness in the hands and wrist. CTS affecting female more than male, and diagnosed by EMG and NCS. The aim of this study was to describe the profile and surgical management among sample of Iraqi patients.Methods: Sixty-two patients collected from the neuro-surgical departments of the specialized surgical hospital from June 2015 till June 2018, all patients studied thoroughly regarding age, sex, associated diseases, clinical features, EMG studies, surgery and out come and follow up for at least one year.Results: There was around 2:1 female: male, with age predominant between 40-60 years. All the patients had pain (aching) and most of them numbness, and tingling and only 1/3 had atrophy of muscle of the hand all diagnosed by EMG and NCS, treated surgically results were good compared with other studies regarding complications and final outcome.Conclusions: Surgery for CTS is safe and successful surgery under meticulus procedure and appropriate choice of patients.

scholarly journals Electrodiagnostic, Sonographic, and Clinical Features of Carpal Tunnel Syndrome with Bifid Median Nerve

2021 ◽  
Vol Volume 14 ◽  
pp. 1259-1269
Author(s):  
Dougho Park ◽  
Byung Hee Kim ◽  
Sang-Eok Lee ◽  
Dong Young Kim ◽  
Yoon Sik Eom ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Tunnel Syndrome

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

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