Carpal tunnel syndrome: clinical features, diagnosis, and management

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.

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Diagnosis of carpal tunnel syndrome in perspective of clinical features, neurophysiological studies and high resolution ultrasound

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2020.6.3.0182 ◽

2020 ◽

Vol 6 (3) ◽

pp. 086-096

Author(s):

Aziz Nusrat

Keyword(s):

High Resolution ◽

Carpal Tunnel Syndrome ◽

Clinical Features ◽

Carpal Tunnel ◽

Neurophysiological Studies ◽

Tunnel Syndrome

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Carpal tunnel decompression in patients with normal nerve conduction studies

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419866646 ◽

2019 ◽

Vol 45 (3) ◽

pp. 260-264 ◽

Cited By ~ 1

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

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

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2004.08.003 ◽

2004 ◽

Vol 107 (1) ◽

pp. 64-69 ◽

Cited By ~ 60

Author(s):

Daniel B. Nora ◽

Jefferson Becker ◽

João Arthur Ehlers ◽

Irênio Gomes

Keyword(s):

Carpal Tunnel Syndrome ◽

Clinical Features ◽

Carpal Tunnel ◽

Tunnel Syndrome

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

International Surgery Journal ◽

10.18203/2349-2902.isj20191510 ◽

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.

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