Risk of de novo severe carpal tunnel syndrome after bilateral oophorectomy

Clinical and electrophysiological features were studied in 52 cases of carpal tunnel syndrome (CTS) associated with 30 pregnancies. The duration of symptoms was less than 3 months before electrodiagnosis was performed. This study revealed a higher incidence of persistent, painful diurnal symptoms in pregnancy-related CTS (PRCTS) than in idiopathic CTS. PRCTS usually occurs for the first time (de novo) (24/30 cases), in primigravidas (15 cases) as well as multigravidas. The onset of symptoms was in the first or second trimester in 11 women, the third trimester in 12 women, or the post-partum period in seven women. Nerve conduction studies demonstrated evidence of an acute median nerve lesion at the wrist with motor and/or sensory conduction blocks in 20/30 women and severe denervation signs in five women.

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Development of carpal tunnel syndrome in association with checkpoint inhibitors

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220950430 ◽

2020 ◽

pp. 107815522095043

Author(s):

Lauren Eisenbud ◽

Samuel Ejadi ◽

Nataliya Mar

Keyword(s):

Carpal Tunnel Syndrome ◽

General Population ◽

Carpal Tunnel ◽

De Novo ◽

Checkpoint Inhibitors ◽

Autoimmune Encephalitis ◽

Prior History ◽

History Of ◽

Tunnel Syndrome ◽

High Index Of Suspicion

Introduction The incidence of neuropathy with checkpoint inhibitors is 0.3–1%, typically occurring 2–12 weeks after treatment initiation. Common neuropathy phenotypes include inflammatory myopathies, myasthenia gravis, acute and chronic demyelinating polyradiculopathies, vasculitic neuropathies, isolated cranial neuropathies, aseptic meningitis, autoimmune encephalitis, multiple sclerosis and hypophysitis. Carpal tunnel syndrome is the most common entrapment neuropathy in the general population; however, the association of carpal tunnel syndrome with checkpoint inhibitors is exceedingly rare. Case Report We report two cases of patients with no prior history of carpal tunnel syndrome treated with checkpoint inhibitors that developed de novo bilateral carpal tunnel syndrome. Management & Outcome: For both patients, the neurologic symptoms improved with cessation of the checkpoint inhibitor and initiation of corticosteroids. Discussion Given the prevalence of carpal tunnel syndrome in the general population, a high index of suspicion for carpal tunnel in patients receiving checkpoint inhibitors and prompt treatment with corticosteroids is essential.

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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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