The Six-Item CTS Symptoms Scale and Palmar Pain Scale in Carpal Tunnel Syndrome

Introduction. Carpal tunnel syndrome (CTS) is a neurological disease associated with tunnel mononeuropathies. There are various proven treatment regimens for patients with the use of conservative and surgical methods of treatment. Studies devoted to a comparative analysis of the effectiveness of methods of conservative therapy in patients with CTS are not enough to choose a treatment strategy.Purpose of the study. To study the therapeutic efficacy of wearing a wrist orthosis with and without the use of NSAIDs in the treatment of patients with CTS.Materials and methods. The study involved 40 patients (the average age of the participants was 32.8 ± 4.3 years) with a primary diagnosis of CTS, who were admitted to the neurological department of of the St Petersburg State Budgetary Healthcare Institution “Elizavetinskaya Hospital”, the Department of Medical Rehabilitation of St. Petersburg State Budgetary Healthcare Institution “St. Luke’s Clinical Hospital” in the period from 2017 to 2021. Patients were randomized into two comparable groups for complex conservative treatment and observation for 2 months of the dynamics of neurological symptoms, pain scale, QuickDASH questionnaire and neurophysiological parameters. The first group of patients received NSAIDs (Nimesil), 1 sachet (100 mg of nimesulide) twice a day after meals for 4 weeks, and the second group – NSAIDs with the imposition of a wrist orthosis for 4 weeks.Results. The study involved 40 patients. The average age of the participants was 32.8 ± 4.3 years (range from 20 to 48 years). Neurophysiological indicators in the studied groups at the screening stage were comparable: distal latency of the M-response (DLMO), ms; the amplitude of the negative peak of the M-response, mV; sensory latency (SL), ms and sensory impulse conduction velocity (SSPI), m / s: 5.7, 5.3, 3.5 and 31.8 in the first group and 5.4, 5.5, 3.8 and 32.4 in the second group (p > 0.05 when comparing the corresponding parameters). After the course of treatment, significant changes in the analyzed parameters were revealed (p < 0.05).Conclusions. In patients who received nimesulide and wore a wrist brace, the effectiveness of treatment was higher.

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

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.

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

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.novdec02 ◽

2007 ◽

Vol 12 (6) ◽

pp. 5-8 ◽

Cited By ~ 3

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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