The occurrence of carpal tunnel syndrome in chronic inflammatory demyelinating polyneuropathy

2005 ◽  
Vol 116 (9) ◽  
pp. 2251-2252 ◽  
Author(s):  
D. Cocito ◽  
P. Ciaramitaro ◽  
A. Tavella ◽  
F. Poglio ◽  
I. Paolasso ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Demyelinating Polyneuropathy ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
Tunnel Syndrome

scholarly journals Typical Carpal Tunnel Syndrome or Something More? A Plastic Surgeon’s Experience With Chronic Inflammatory Demyelinating Polyneuropathy

2017 ◽  
Vol 3 ◽  
pp. 2513826X1771645
Author(s):  
Mark K. Hewitt ◽  
Shane K. F. Seal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Demyelinating Polyneuropathy ◽  
Neurological Deficits ◽  
Clear Cut ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
History Of ◽  
Tunnel Syndrome ◽  
Peripheral Motor

Chronic inflammatory demyelinating polyneuropathy (CIDP) typically presents with widespread peripheral motor and sensory deficits that progress over a 2- to 3-month period. In this article, the authors report a case involving a 32-year-old pregnant woman presenting to hand clinic after a 3-month history of bilateral median nerve compression consistent with carpal tunnel syndrome. Carpal tunnel syndrome is a common complaint resulting from pregnancy-associated edema and is typically treated conservatively. However, upon follow-up, this patient displayed new signs of widespread peripheral neurological deficits, prompting a diagnosis of CIDP. In addition to this highly atypical presentation of CIDP, the patient’s symptoms spontaneously remitted throughout the pregnancy requiring no further treatment. This case highlights the heterogeneous nature of neurological disease presentation and the importance in considering alternative diagnosis in what may appear as clear-cut plastic surgery case.

scholarly journals Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

2021 ◽  
Author(s):  
Emanuele Spina ◽  
Pietro Emiliano Doneddu ◽  
Giuseppe Liberatore ◽  
Dario Cocito ◽  
Raffaella Fazio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
Tunnel Syndrome ◽  
Median Neuropathy

AbstractCompression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS demyelinating criteria for chronic inflammatory demyelinating polyneuropathy (CIDP). Accordingly, being carpal tunnel syndrome (CTS) common in the general population, the EFNS/PNS guidelines recommend excluding the DML of the median nerve when DML prolongation may be consistent with median neuropathy at the wrist from CTS. The main aims of this study were to verify whether the inclusion of DML of the median nerve (when consistent with CTS) could improve electrophysiological diagnostic accuracy for CIDP and if the median nerve at the carpal tunnel was more prone to demyelination. We analyzed electrophysiological data from 499 patients included consecutively into the Italian CIDP Database. According to the EFNS/PNS criteria, 352 patients had a definite, 10 a probable, and 57 a possible diagnosis of CIDP, while 80 were not fulfilling the diagnostic criteria. The inclusion of DML prolongation of median nerve did not improve significantly the diagnostic accuracy for CIDP; overall diagnostic class changed in 6 out of 499 patients (1.2%) and electrodiagnostic class of CIDP changed from not fulfilling to possible in only 2 patients (2.5% of not-fulfilling patients). In conclusion, we can infer that excluding DML prolongation of median nerve does not increase the risk of missing a diagnosis of CIDP thus corroborating the current EFNS/PNS criteria.

scholarly journals Multifocal acquired demyelinating sensory and motor neuropathy misdiagnosed as carpal tunnel syndrome: a case report

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199889
Author(s):  
Soyoung Kwak ◽  
Mathieu Boudier-Revéret ◽  
Hee Kyung Cho ◽  
Min Cheol Chang
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Peripheral Nerves ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Motor Neuropathy ◽  
Motor Weakness ◽  
Left Hand ◽  
Sensory Deficits ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), a subtype of chronic inflammatory demyelinating polyneuropathy, is a non-compressive peripheral nerve disorder. Symptoms of MADSAM include asymmetrical weakness and sensory deficits in the distribution of individual peripheral nerves, which are frequently noted in the distal portion of peripheral nerves. MADSAM can be easily misdiagnosed as any of the various compressive peripheral neuropathies. Here, we present a case of MADSAM misdiagnosed as carpal tunnel syndrome (CTS). A 53-year-old woman had bilateral asymmetrical hand weakness (left hand: significant weakness, right hand: slight motor weakness) and a slight weakness of her bilateral lower extremities. Sensory deficit was found on the volar side of her left hand. She had visited many clinics previously and was diagnosed with CTS. However, an electrodiagnostic study performed in our hospital did not identify CTS but indicated a demyelinating peripheral neuropathy in all limbs. On the basis of the patient’s clinical symptoms and laboratory findings, she was diagnosed with MADSAM. When patients exhibit progressive aggravating motor weakness and sensory deficits in more than one distal limb without a specific finding of compressive neuropathy in electrodiagnostic studies, clinicians should consider the possibility of MADSAM.

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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