A PRACTICAL ELECTROPHYSIOLOGICAL GUIDE FOR NON-SURGICAL AND SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME

2008 ◽  
Vol 33 (1) ◽  
pp. 32-37 ◽  
Author(s):  
C. -W. CHANG ◽  
Y. -C. WANG ◽  
K. -F. CHANG
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Electrophysiological Tests ◽  
Severity Scores ◽  
Functional Scores ◽  
Electrophysiological Studies ◽  
Severe Group ◽  
Tunnel Syndrome

In the present study, we illustrate the use of an electrophysiological classification as a guide to the treatment of carpal tunnel syndrome (CTS). A total of 113 CTS patients were assessed with symptom severity scores, hand functional scores and electrophysiological studies. By setting criteria of electrophysiological tests, 179 hands in 113 patients were classified into mild, moderate and severe degrees of CTS. Of these, the 41 hands with severe CTS were referred for surgery. The 58 hands with moderate CTS and 80 hands with mild CTS received conservative treatment. The improvement ratios in the severe group were greater than that in the moderate and mild groups, both at 6 months and at 1 year. Eighteen hands with moderate or mild CTS returned to normal electrophysiology with the conservative treatments. No patient recovered to normal electrophysiology in the severe group. This electrophysiological classification is objective and it may serve as a useful guide for non-surgical and surgical treatment of CTS.

An analysis of patient’s and disease related factors predictive of the outcomes of surgery for carpal tunnel syndrome

2020 ◽  
Vol 52 (01) ◽  
pp. 11-17
Author(s):  
Andrzej Zyluk ◽  
Paulina Zyluk-Gadowska ◽  
Lukasz Kolodziej ◽  
Zbigniew Szlosser
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Clinical Severity ◽  
Related Factors ◽  
Minimally Clinically Important Difference ◽  
Duration Of Symptoms ◽  
Younger Age ◽  
Severity Scores ◽  
Tunnel Syndrome

Abstract Purpose Outcomes of surgery for carpal tunnel syndrome may differ in relation to certain factors like age, duration of symptoms, clinical and electrophysiological severity. The objective of this study was an investigation into the hypothesis that several factors are predictive of results of surgical treatment of the condition. Methods The pre- and postoperative records of 1,117 patients: 909 women (81 %) and 208 men (19 %) with a mean age of 63 years were analysed. Outcomes recorded in the sensory and functional severity scores of the Levine questionnaire were dichotomized into achieving or not-achieving a minimally clinically important difference. The effect of selected variables: sex, age, duration of symptoms, clinical and electrophysiological severity of and presence of comorbidities on outcomes of surgery at 6 months was investigated. Results Univariate and multivariate analysis of covariates based on sex, age, duration of the disease and its clinical severity showed female gender and worse baseline symptom severity scores to be significant predictors for an improvement following carpal tunnel syndrome surgery. It showed also younger age, shorter duration of symptoms and higher baseline symptom severity scores to be predictive of a greater improvement of total grip strength, and younger age to be predictive of a greater pain cessation following surgery. Conclusion Of all considered patient’s and disease related factors, the baseline clinical severity expressed in the Levine symptom severity scores had appeared to be the strongest predictor of better outcomes of surgery for carpal tunnel syndrome.

scholarly journals Intralesional steroid and ultrasound therapy in patients with carpal tunnel syndrome

2019 ◽  
Vol 12 (4) ◽  
pp. 177-181
Author(s):  
Md. Israt Hasan ◽  
Syed Mozaffar Ahmed
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Naproxen Sodium ◽  
Ultrasound Therapy ◽  
Severity Scores ◽  
Intralesional Steroid ◽  
Tunnel Syndrome ◽  
Wrist Splint

The study aimed to compare the effects of intralesional steroid injection and ultrasound therapy for the treatment of carpal tunnel syndrome. A total 130 patients divided into 2 groups: a) One group (n=65) received intralesional corticosteroid injection along with wrist splint, exercise, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=65) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with  Wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks. The patients were followed-up 2 weekly for 4 weeks. The visual analogue score, symptom severity scores and functional status scores were significantly improved within each group at week 2 (p<0.05) and week 4 (p<0.05) except for the symptom severity score at (p>0.05). The improvement in symptom severity scores and functional status scores in the intralesional steroid group was more than in the ultrasound therapy group after 4 weeks.

scholarly journals Assessment of the diagnostic accuracy of nerve conduction study and the correlation between severity of symptoms and nerve conduction studies in carpal tunnel syndrome

2019 ◽  
Vol 5 (4) ◽  
pp. 559
Author(s):  
Benjamin Alex ◽  
Mithun Joy Kattoor ◽  
Samson Samuel Edayalamuriyil
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Symptom Severity ◽  
Nerve Conduction ◽  
Nerve Conduction Studies ◽  
Severity Scores ◽  
Tunnel Syndrome ◽  
Surgical Release

<p class="abstract"><strong>Background:</strong> This study was done to assess the diagnostic accuracy of nerve conduction study in carpal tunnel syndrome and comparability of nerve conduction measures before and after carpal tunnel release.</p><p class="abstract"><strong>Methods:</strong> 31 patients (30 females and 1 male) with carpal tunnel syndrome were subjected to nerve conduction study and Boston symptom severity scores before surgery and at 3 months post-operative period and nerve conduction values compared. The effect of duration of symptoms on nerve conduction values was studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Nerve conduction studies were found to be reliable in diagnosing carpal tunnel syndrome. 61.30% patients showed a right-handed involvement, or right side getting affected first in a bilateral case. 60-80% patients had Boston symptom severity scores which were comparable to the nerve conduction grades ascertaining the relationship between them. Only 58.8% patients with extreme and severe NCS grades preoperatively showed improvement post-surgical release. In patients with symptoms for more than 12 months, only 33.33% had improved nerve conduction grades post-surgical release at 3 months, validating the need for early surgical release.</p><p class="abstract"><strong>Conclusions:</strong> Nerve conduction study was found to be a reliable diagnostic modality for diagnosis of carpal tunnel syndrome and nerve conduction study values correlated with the Boston symptom severity score. The post-operative nerve conduction values revealed definite neurological improvement in patients who underwent early surgical management. Hence, we recommend early release for carpal tunnel syndrome patients for speedy recovery from the condition.</p>

scholarly journals Us and Mri Neurography Assessment of Diagnostic Criteria in Patients With Carpal Tunnel Syndrome Using Electrophysiological Tests as Gold Standard: A Prospective Study

2022 ◽  
Author(s):  
Mona Gamalludin AlKaphoury ◽  
Eman Farouk Dola
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Imaging Modality ◽  
Dynamic Assessment ◽  
Diagnostic Modality ◽  
Electrophysiological Tests ◽  
Flexor Retinaculum ◽  
Significant Difference ◽  
Electrophysiological Studies ◽  
Tunnel Syndrome

Abstract BackgroundPeripheral neuropathy evaluation depends mainly on physical examination, patient history, electrophysiological studies, with evoked potential abnormalities. High-resolution US has the advantage of being fast, non-invasive modality with nerve dynamic assessment allowing examination of long part of nerve. MR imaging serve better in examination of deeper nerves with higher contrast resolution. It shows great benefit in patient with atypical presentation, Equivocal diagnosis and suspicious of secondary cause and post-surgical relapse.MethodsThis study was conducted prospectively on 32 patients, presented with carpal tunnel syndrome diagnosed by electrophysiological tests. Superficial US of the wrist joint was done to all participants followed by MRI within 1 weeks of the US.We aimed to assess the measurements & criteria of both US & MRN in diagnosis of CTS, depending mainly on the three-measurement assessed by Buchberger et al., then to find the agreement between US & MR Neurography (MRN)ResultsUs proved to have higher rate of CTS prediction, the three main parameters CSA measurement, distal nerve flattening and flexor retinaculum bowing indices showed positive occurrence of 93.7%,59.4% &59.4% respectively. While we found that decreased nerve echotexture was positive in 90.6% of patients.Regarding MRI it showed less diagnostic ability when using CSA measurement as it was positive in 81.2% of patients, also distal tunnel nerve increased flattening and bowed flexor retinaculum positive results were slightly decreased to 56.2% for each. In contrast to high T2 signal of median nerve which was positive in 90.6% of patients.In agreement study, we found statically significant difference supporting US as the primary diagnostic modality of CTS depending mainly on the three measurement CSA, Flattening and bowing indices. Yet, for cases of secondary CTS and detection of underlying entrapping cause as well as innervated muscle early abnormality detection and better tissue characterization, MRI was better diagnostic modality with statistically significant difference. ConclusionsOur results proved that ultrasound examination can be used as first imaging modality after physician evaluation with comparable results to electrophysiological studies in evaluating CTS and try to find the cause. MRN examination came as second step in patients with suspected muscle denervation changes that could not be elicited by US or equivocal cases for detection of secondary cause in clinically suspected patient.

scholarly journals Clinical Study of Surgical Treatment of Carpal Tunnel Syndrome: Open versus Endoscopic Technique

2000 ◽  
Vol 8 (2) ◽  
pp. 19-25 ◽  
Author(s):  
Masato Okada ◽  
Osamu Tsubata ◽  
Sadayuki Yasumoto ◽  
Norihiko Toda ◽  
Tadami Matsumoto
Keyword(s):  
Clinical Study ◽  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Endoscopic Technique ◽  
Tunnel Syndrome ◽  
Open Versus

scholarly journals Clinical Utility of the 6-Item CTS, Boston-CTS, and Hand-Diagram for Carpal Tunnel Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Gregor Schulze ◽  
Kristian Bernhard Nilsen ◽  
Rikke Munk Killingmo ◽  
John Anker Zwart ◽  
Margreth Grotle
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Construct Validity ◽  
Internal Consistency ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Clinical Utility ◽  
Severity Assessment ◽  
Discriminative Ability ◽  
Tunnel Syndrome ◽  
Severity Levels

Background: Self-reported measures are often used in research and clinical practice to diagnose carpal tunnel syndrome (CTS) and guide therapeutic choices. We aimed to assess the clinical utility of the Norwegian versions of two self-reported outcome measures for symptom severity assessment, the 6-item CTS (CTS-6), and Boston-CTS (BCTQ), and of one diagnostic measure, the hand-diagram, by evaluating measurement properties including discriminative ability for severity assessment (CTS-6, BCTQ), and diagnosis of CTS (hand-diagram).Methods: We performed forward and backward translation and cultural adaptation of the Norwegian CTS-6 and BCTQ. Following COSMIN guidelines, we investigated internal consistency, reliability, construct validity, and discriminative ability for distinguishing between severity levels of CTS in patients with confirmed CTS for the CTS-6 and BCTQ and reliability and discriminative ability for diagnosing CTS for the hand-diagram.Results: Two hundred and fifty-one patients referred for diagnostic work-up for CTS with nerve conduction studies (NCS) participated. The CTS-6 and BCTQ had acceptable internal consistency (Crohnbach's α = 0.82 and 0.86, respectively), reliability (ICC = 0.86 and 0.90; SEM = 0.24 and 0.20; SDC95% = 0.68 and 0.55, respectively), construct validity (all eight pre-defined hypotheses confirmed) and discriminative ability to distinguish between severity levels of CTS [Area under the curve (AUC) = 0.75, 95% CI 0.64–0.85]. The hand-diagram had acceptable reliability (Cohen's kappa = 0.69) and discriminative ability to diagnose CTS (sensitivity = 0.72, specificity = 0.90).Conclusion: Our findings support the clinical utility of the CTS-6 and BCTQ for symptom severity assessment and of the hand-diagram for diagnostic screening.

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