scholarly journals Change to movement and morphology of the median nerve resulting from steroid injection in patients with mild carpal tunnel syndrome

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyunseok Moon ◽  
Byung Joo Lee ◽  
Donghwi Park
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Aspect Ratio ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Significant Difference ◽  
Before And After ◽  
Tunnel Syndrome

Abstract There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Fourteen hands from 14 healthy participants and 24 hands from 24 participants with mild CTS were examined. Dynamic movement and morphology of the median nerve before and after steroid injection were measured. There was no significant difference in the normalized maximal distance of the median nerve, which reflects the degree of fibrosis in the SSCT indirectly, during finger and wrist movements before and after the injection among patients with CTS (p > 0.05). Among the parameters that indirectly reflects the degree of median nerve compression, such as normalized maximal change in the aspect ratio of the minimum-enclosing rectangle (MER), maximal change in the median nerve perimeter, and maximal value of the median nerve cross-sectional area (CSA), statistically significant differences were not observed between values of the normalized maximal change in the aspect ratio of the MER and maximal change in the median nerve perimeter, during finger and wrist movements recorded before and after the injection in patients with CTS (p > 0.05). However, multivariate logistic regression analysis revealed that the change in the normalized maximal value of the median nerve CSA, according to finger and wrist movement was correlated with the administration of the steroid injection (p < 0.05). In conclusion, compared to that noted before steroid injection, the median nerve CSA noted during finger and wrist movements changed significantly after injection in patients with mild CTS. Given the improvement in median nerve swelling after steroid injection, but no improvement in the movement of the median nerve during finger and wrist movements, median nerve swelling due to compression (rather than fibrosis of the SSCT may be the initial pathogenesis of early-stage (mild) CTS, and the fibrous changes around the median nerves (SSCT) may be indicative of secondary pathology after median nerve compression. Further studies are required to validate the findings of our study and confirm the pathogenesis of CTS.

What symptoms are truly caused by median nerve compression in carpal tunnel syndrome?

2005 ◽  
Vol 116 (2) ◽  
pp. 275-283 ◽  
Author(s):  
Daniel Bocchese Nora ◽  
Jefferson Becker ◽  
João Arthur Ehlers ◽  
Irenio Gomes
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Tunnel Syndrome

scholarly journals Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

2014 ◽  
Vol 41 (6) ◽  
pp. 426-433 ◽  
Author(s):  
Adham do Amaral e Castro ◽  
Thelma Larocca Skare ◽  
Paulo Afonso Nunes Nassif ◽  
Alexandre Kaue Sakuma ◽  
Bruno Luiz Ariede ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Clinical Tests ◽  
Ultrasound Evaluation ◽  
Significant Difference ◽  
Before And After ◽  
Tunnel Syndrome

Objective:To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods:We studiedthree groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results:We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p<0.00001). There were lowe levels of paresthesias (p=0.0002) and median nerve area (p=0.04) in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work.Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

Use of the Palmaris Brevis Flap for Preventing Recurrent Median Nerve Compression in Mucolipidosis

1999 ◽  
Vol 24 (3) ◽  
pp. 300-302 ◽  
Author(s):  
M. B. H. KELLY ◽  
L. BOSMANS ◽  
D. GAULT
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Internal Neurolysis ◽  
Tunnel Syndrome ◽  
Bilateral Carpal Tunnel Syndrome

In a patient with severe, recurrent bilateral carpal tunnel syndrome secondary to mucolipidosis, the ‘turnover’ palmaris brevis flap was used in conjunction with internal neurolysis. The procedure was effective in alleviating symptoms of recurrent carpal tunnel compression in both hands.

scholarly journals The Association Between Concomitant Ulnar Nerve Compression at the Elbow and Carpal Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 335-340 ◽  
Author(s):  
Brandon Shulman ◽  
Jonathan Bekisz ◽  
Christopher Lopez ◽  
Samantha Maliha ◽  
Siddharth Mahure ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Nerve Compression ◽  
Concomitant Treatment ◽  
Ulnar Nerve Compression ◽  
Median Nerve Compression ◽  
Number Of Patients ◽  
Tunnel Syndrome

Background: Many patients treated for ulnar nerve compression at the elbow (UNE) are concomitantly treated for carpal tunnel syndrome (CTS). We sought to investigate the association between the conditions. Methods: The Statewide Planning and Research Cooperative System (SPARCS) database was used to determine the number of patients with UNE concomitantly treated for CTS in New York State from 2003 to 2014. We then retrospectively reviewed each patient who received surgical treatment for UNE (n = 222 patients) or CTS (n = 1063 patients) at our tertiary care institution in 2014 and 2015 to assess concomitant treatment. Results: In the SPARCS database, the percentage of patients surgically treated for concomitant UNE and CTS steadily increased from 23% in 2003 to 45% in 2014. At our institution, 50 of 222 patients (23%) surgically treated for UNE underwent concomitant carpal tunnel releases. For concomitantly treated patients, 94% had examinations consistent with UNE and CTS, 87% of patients had median nerve compression on electrodiagnostic tests, and 72% of patients had UNE on electrodiagnostic tests. Conclusions: Most patients concomitantly treated for UNE and CTS have objective findings of both conditions. At least one-fourth of patients indicated for operative ulnar nerve release also require a carpal tunnel release—far beyond the prevalence of CTS in the general population. A diagnosis of UNE merits a comprehensive workup by the treating surgeon and a high suspicion for concomitant median nerve compression.

Bifid Median Nerve Compression due to a Musculotendinous Anomaly of FDS to the Middle Finger

1994 ◽  
Vol 19 (5) ◽  
pp. 616-617 ◽  
Author(s):  
S. FERNANDEZ-GARCIA ◽  
J. PI-FOLGUERA ◽  
F. ESTALLO-MATINO
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Muscle Contraction ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Middle Finger ◽  
The Other ◽  
Nerve Compression ◽  
Musculotendinous Junction ◽  
Median Nerve Compression ◽  
Tunnel Syndrome

A case is presented of a bifid median nerve whose longest portion had a normal course while the other portion passed through a hole in the FDS tendon of the middle finger, at its musculotendinous junction. This caused nerve compression during muscle contraction, producing pain and dysaesthesia in the middle finger suggesting carpal tunnel syndrome.

TWO CASES OF ENDOSCOPIC MANAGEMENT OF CARPAL TUNNEL SYNDROME IN MACRODACTYLY PATIENTS

Hand Surgery ◽  
2007 ◽  
Vol 12 (01) ◽  
pp. 41-46 ◽  
Author(s):  
A. Yoshida ◽  
I. Okutsu ◽  
I. Hamanaka ◽  
S. Morimoto
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Muscle Power ◽  
Nerve Compression ◽  
Endoscopic Management ◽  
Decompression Surgery ◽  
Median Nerve Compression ◽  
Flexor Retinaculum ◽  
Tunnel Syndrome

Some cases of carpal tunnel syndrome in macrodactyly patients have been reported. We performed endoscopic carpal canal release on two unilateral macrodactyly patients suffering from bilateral carpal tunnel syndrome. We measured carpal canal pressure before performing endoscopic surgery using the Universal Subcutaneous Endoscope system to confirm median nerve compression. We diagnosed median nerve compression in each patient due to the high preoperative carpal canal pressure. Carpal canal pressure immediately decreased to within normal range following release of both the flexor retinaculum and the distal holdfast fibres of the flexor retinaculum. One patient recovered to within normal in terms of sensory disturbances and abductor pollicis brevis muscle strength. The other patient showed improvement in terms of sensory disturbance, however, muscle power did not recover because this patient had suffered from carpal tunnel syndrome for ten years. Endoscopic carpal canal release and decompression surgery was effective for carpal tunnel syndrome in both macrodactyly patients.

Fracture Of The Hook Of The Hamate Presenting As Carpal Tunnel Syndrome

HAND ◽  
1978 ◽  
Vol os-10 (2) ◽  
pp. 181-183 ◽  
Author(s):  
Paul R. Manske
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Physical Examination ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Tunnel Syndrome ◽  
High Degree ◽  
Careful Physical Examination

summary This case report of a fracture of the hook of the hamate presenting as carpal tunnel syndrome emphasizes the importance of a careful physical examination, the necessity for a carpal tunnel roentgenogram and a high degree of suspicion by the surgeon in patients with symptoms of median nerve compression following trauma to the wrist.

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