scholarly journals Typical Carpal Tunnel Syndrome or Something More? A Plastic Surgeon’s Experience With Chronic Inflammatory Demyelinating Polyneuropathy

2017 ◽  
Vol 3 ◽  
pp. 2513826X1771645
Author(s):  
Mark K. Hewitt ◽  
Shane K. F. Seal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Demyelinating Polyneuropathy ◽  
Neurological Deficits ◽  
Clear Cut ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
History Of ◽  
Tunnel Syndrome ◽  
Peripheral Motor

Chronic inflammatory demyelinating polyneuropathy (CIDP) typically presents with widespread peripheral motor and sensory deficits that progress over a 2- to 3-month period. In this article, the authors report a case involving a 32-year-old pregnant woman presenting to hand clinic after a 3-month history of bilateral median nerve compression consistent with carpal tunnel syndrome. Carpal tunnel syndrome is a common complaint resulting from pregnancy-associated edema and is typically treated conservatively. However, upon follow-up, this patient displayed new signs of widespread peripheral neurological deficits, prompting a diagnosis of CIDP. In addition to this highly atypical presentation of CIDP, the patient’s symptoms spontaneously remitted throughout the pregnancy requiring no further treatment. This case highlights the heterogeneous nature of neurological disease presentation and the importance in considering alternative diagnosis in what may appear as clear-cut plastic surgery case.

scholarly journals Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

2021 ◽  
Author(s):  
Emanuele Spina ◽  
Pietro Emiliano Doneddu ◽  
Giuseppe Liberatore ◽  
Dario Cocito ◽  
Raffaella Fazio ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Diagnostic Accuracy ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Inflammatory Demyelinating Polyneuropathy ◽  
Tunnel Syndrome ◽  
Median Neuropathy

AbstractCompression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS demyelinating criteria for chronic inflammatory demyelinating polyneuropathy (CIDP). Accordingly, being carpal tunnel syndrome (CTS) common in the general population, the EFNS/PNS guidelines recommend excluding the DML of the median nerve when DML prolongation may be consistent with median neuropathy at the wrist from CTS. The main aims of this study were to verify whether the inclusion of DML of the median nerve (when consistent with CTS) could improve electrophysiological diagnostic accuracy for CIDP and if the median nerve at the carpal tunnel was more prone to demyelination. We analyzed electrophysiological data from 499 patients included consecutively into the Italian CIDP Database. According to the EFNS/PNS criteria, 352 patients had a definite, 10 a probable, and 57 a possible diagnosis of CIDP, while 80 were not fulfilling the diagnostic criteria. The inclusion of DML prolongation of median nerve did not improve significantly the diagnostic accuracy for CIDP; overall diagnostic class changed in 6 out of 499 patients (1.2%) and electrodiagnostic class of CIDP changed from not fulfilling to possible in only 2 patients (2.5% of not-fulfilling patients). In conclusion, we can infer that excluding DML prolongation of median nerve does not increase the risk of missing a diagnosis of CIDP thus corroborating the current EFNS/PNS criteria.

Von Willebrand’s Disease presenting as Acute Carpal Tunnel Syndrome

1998 ◽  
Vol 23 (1) ◽  
pp. 114-114 ◽  
Author(s):  
D. G. PARTHENIS ◽  
C. B. KARAGKEVREKIS ◽  
M. A. WALDRAM
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Spontaneous Bleeding ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
History Of ◽  
Tunnel Syndrome ◽  
Acute Carpal Tunnel Syndrome

We describe a patient who developed acute carpal tunnel syndrome due to spontaneous bleeding without a history of injury. Immediate decompression relieved the symptoms. Further haematological investigations revealed that the patient was suffering from von Willebrand’s disease.

scholarly journals The Natural History of Carpal Tunnel Syndrome in Lactation

1989 ◽  
Vol 82 (6) ◽  
pp. 349-350 ◽  
Author(s):  
J S Wand
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Natural History ◽  
Carpal Tunnel ◽  
Surgical Decompression ◽  
Steroid Injections ◽  
History Of ◽  
Tunnel Syndrome ◽  
Inflammatory Drugs ◽  
One Year ◽  
Primiparous Women

In a retrospective postal study of 27 women who have developed carpal tunnel syndrome (CTS) in the puerperium, the condition was found to affect predominantly elderly primiparous women (mean age 31.5 years). The condition was associated with breastfeeding in 24 women. The three who did not breastfeed had less severe symptoms which resolved within one month of onset. The symptoms developed a mean of 3.5 weeks following delivery, lasted 6.5 months and started to resolve within 14 days of weaning. Symptomatic treatments with either splint-age, diuretics, non-steroidal anti-inflammatory drugs or steroid injections provided some benefit. Two patients required surgical decompression. All patients were symptom-free by one year.

Progression from Injection to Surgery for Trigger Finger: A Statistical Analysis

2017 ◽  
Vol 22 (02) ◽  
pp. 194-199 ◽  
Author(s):  
Hideyuki Ota ◽  
Katsuyuki Iwatsuki ◽  
Shigeru Kurimoto ◽  
Koji Iida ◽  
Hitoshi Hirata
Keyword(s):  
Logistic Regression ◽  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Clinical Severity ◽  
Trigger Finger ◽  
Injection Treatment ◽  
History Of ◽  
Tunnel Syndrome

Background: The purpose of this study was to identify predictive factors of poor response to intra-flexoral sheath corticosteroid injection, as well as to identify factors associated with patients’ decisions to undergo surgical treatment. Methods: Data from 112 patients who received steroid injection treatment for trigger finger were reviewed retrospectively. Logistic regression was used to assess the prognostic value of factors assumed to affect prognosis (age, sex, underlying disease, history of illness, presence of carpal tunnel syndrome, multiple digit involvement, and pre- and post-operative disability scores). Results: Multiple digits were affected in 42 patients. Associated and underlying conditions were carpal tunnel syndrome (n = 36), hypertension (n = 23), hyperlipidemia (n = 14), and history of malignant tumor (n = 10). Logistic regression analysis showed that multiple digit involvement and Froimson clinical severity score were factors significantly associated with surgical treatment after intra-flexoral sheath corticosteroid injection treatment. These two factors were also found to be associated with the patients’ decisions to undergo surgical treatment. Conclusions: Although local corticosteroid injection is useful in most cases, providers need to counsel patients with multiple digit involvement and/or severe cases about the possibility of requiring additional surgical treatment.

scholarly journals Mini-open Carpal Tunnel Release

2018 ◽  
Vol 19 (4) ◽  
pp. 21-27
Author(s):  
Paulo Henrique Pires De Aguiar ◽  
Carlos Alexandre Martins Zicarelli ◽  
Fabio V. C. Sparapani ◽  
Pedro Augusto De Santana Jr ◽  
Alexandros Theodoros Panagoupolos ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Neurological Deficits ◽  
Motor Branch ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Nerve Entrapment Syndrome ◽  
Mini Open

Introduction: Median nerve compression is the most common nerve entrapment syndrome. After carpal tunnel release, patients often complain about the scar cosmetic appearance. Objective: The aim of our study was to evaluate the clinical outcome, surgical technique and complications of mini-open carpal release. Methods: We reviewed data from 48 surgical procedures for Carpal Tunnel Syndrome in 32 patients at the Pinheiros Neurologicaland Neurosurgical Clinic in the period of 2000 and 2008. The mean age was 49 years-old. We used a 2 cm incision and microscopic technique to obtain meticulous access of the palmar hand anatomy with special attention to both the recurrent motor branch and palmar cutaneous nerve. Results: Twenty-two patients had total resolution of symptoms. Two patients had no change of neurological symptoms. During the follow up no infection or neurological deficits were observed. Conclusion: Mini-open is a safe and effective approach for carpal tunnel syndrome release. However detailed palmar hand anatomy is mandatory to prevent lesion of branching palmar nerve. The use of microscope is desirable to help identify important structures and avoid complications.

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