scholarly journals Prevalence and predictive factors for bilateral carpal tunnel syndrome by electrodiagnosis: A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260578
Author(s):  
Apiradee Singjam ◽  
Kanchana Charoentanyarak ◽  
Jittima Saengsuwan
Keyword(s):  
Logistic Regression ◽  
Carpal Tunnel Syndrome ◽  
Muscle Weakness ◽  
Predictive Factors ◽  
Carpal Tunnel ◽  
Cutoff Point ◽  
Receiver Operating Curve ◽  
Thenar Muscle ◽  
Duration Of Symptoms ◽  
Tunnel Syndrome

Introduction Carpal tunnel syndrome (CTS) is the most common compressive neuropathy. Patients who have unilateral symptoms are frequently found to have bilateral CTS by electrodiagnostic (EDx) study. We aimed to (a) study the prevalence and identify the predictive factors for bilateral CTS diagnosed by EDx; and (b) develop a model to predict bilateral CTS. Methods The retrospective clinical and EDx data of patients with CTS were collected and analyzed using the Chi-squared test and multiple logistic regression analysis. A model was fitted, and the best cutoff point determined. Calibration and discrimination performance of the model were performed. Results A total of 327 patients with a mean age of 50.0 years were enrolled. Most were women (82.6%), and the most common presenting symptom was hand numbness (93.6%). The median duration of symptoms was 60 days. The prevalence of bilateral CTS was 80.7%. In the multivariate analysis, the predictive factors for bilateral CTS were the presence of bilateral symptoms (AOR 6.7 [95%CI 3.1–14.3]), thenar muscle weakness (AOR 3.9 [95%CI 1.3–11.6]), and age ≥ 45 years (AOR 2.5 [95%CI 1.3–4.6]). The logistic regression model was fitted, and the best cutoff point determined. The area under the receiver operating curve (AUC) was 0.76. The respective optimism-corrected C index and Somers’ D was 0.762 and 0.524. Conclusion The prevalence of bilateral CTS was 80.7%. Our findings suggest bilateral CTS was predicted with adequate diagnostic accuracy by bilateral symptoms, age ≥ 45 years, and thenar muscle weakness.

scholarly journals When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

2021 ◽  
Vol 67 (4) ◽  
pp. 518-525
Author(s):  
Zuhal Özişler ◽  
Müfit Akyüz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Spontaneous Activity ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Sensory Nerve ◽  
Symptom Duration ◽  
Thenar Muscle ◽  
Distal Motor Latency ◽  
Motor Latency ◽  
Tunnel Syndrome

Objectives: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). Patients and methods: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. Results: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). Conclusion: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

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.

Incidence of Bilateral Symptoms in Carpal Tunnel Syndrome

1998 ◽  
Vol 23 (5) ◽  
pp. 603-606 ◽  
Author(s):  
L. PADUA ◽  
R. PADUA ◽  
M. NAZZARO ◽  
P. TONALI
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Significant Positive Correlation ◽  
Duration Of Symptoms ◽  
Positive Correlation ◽  
Tunnel Syndrome ◽  
Contralateral Symptoms ◽  
Bilateral Impairment

We prospectively studied 266 hands in 133 patients with carpal tunnel syndrome (CTS) in order to evaluate: the incidence of bilateral CTS symptoms; correlation between severity, duration of symptoms and bilateral occurrence of CTS; agreement of clinical and neurophysiological findings; and the neurophysiological findings in asymptomatic hands in unilateral CTS, The incidence of bilateral clinical CTS in our population was 87%. Neurophysiological impairment of median nerve was observed in about half of the asymptomatic hands. Follow-up of patients with unilateral CTS showed that contralateral symptoms developed in most cases. We found a significant positive correlation of bilateral CTS with the duration of symptoms, whereas there was no correlation with the severity of symptoms. Our data suggest that bilateral impairment of median nerve is the rule in patients with CTS and probably it has been underestimated in previous studies.

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 A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study

10.2196/26320 ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. e26320
Author(s):  
Takafumi Koyama ◽  
Shusuke Sato ◽  
Madoka Toriumi ◽  
Takuro Watanabe ◽  
Akimoto Nimura ◽  
...  
Keyword(s):  
Machine Learning ◽  
Carpal Tunnel Syndrome ◽  
Data Collection ◽  
Anomaly Detection ◽  
Carpal Tunnel ◽  
Medical Condition ◽  
Screening Method ◽  
Detection Algorithm ◽  
Thenar Muscle ◽  
Tunnel Syndrome

Background Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on a CTS-screening app that uses a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. Objective To make data collection for machine learning easier and more available, we developed a screening app for CTS using a smartphone and an anomaly detection algorithm, aiming to examine our system as a useful screening tool for CTS. Methods In total, 36 participants were recruited, comprising 36 hands with CTS and 27 hands without CTS. Participants controlled the character in our app using their thumbs. We recorded the position of the thumbs and time; generated screening models that classified CTS and non-CTS using anomaly detection and an autoencoder; and calculated the sensitivity, specificity, and area under the curve (AUC). Results Participants with and without CTS were classified with 94% sensitivity, 67% specificity, and an AUC of 0.86. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92% sensitivity, and 100% specificity. Conclusions Our app could reveal the difficulty of thumb opposition for patients with CTS and screen for CTS with high sensitivity and specificity. The app is highly accessible because of the use of smartphones and can be easily enhanced by anomaly detection.

Pregnancy-Related Carpal Tunnel Syndrome

1998 ◽  
Vol 23 (1) ◽  
pp. 98-101 ◽  
Author(s):  
P. SEROR
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
De Novo ◽  
Post Partum ◽  
Nerve Lesion ◽  
Second Trimester ◽  
Third Trimester ◽  
Duration Of Symptoms ◽  
Tunnel Syndrome ◽  
First Time

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.

scholarly journals Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle

2016 ◽  
Vol 74 (3) ◽  
pp. 207-211 ◽  
Author(s):  
Nermin Tanik ◽  
Umit Sarp ◽  
Mehmet Ucar ◽  
Asuman Celikbilek ◽  
Ozlem Balbaloglu ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Diabetic Patient ◽  
Patient Group ◽  
Carpal Tunnel ◽  
Diabetic Patients ◽  
Vicious Cycle ◽  
Duration Of Symptoms ◽  
Tunnel Syndrome

ABSTRACT Carpal tunnel syndrome (CTS) is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) and depression using the Beck Depression Inventory (BDI). The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4) questionnaire and a visual analogue scale (VAS). Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

scholarly journals Screening Method by Anomaly Detection for Patients with Carpal Tunnel Syndrome Using a Smartphone: Diagnostic Case-Control Study (Preprint)

2020 ◽  
Author(s):  
Takafumi Koyama ◽  
Shusuke Sato ◽  
Madoka Toriumi ◽  
Takuro Watanabe ◽  
Akimoto Nimura ◽  
...  
Keyword(s):  
Machine Learning ◽  
Carpal Tunnel Syndrome ◽  
Data Collection ◽  
Anomaly Detection ◽  
Carpal Tunnel ◽  
Medical Condition ◽  
Screening Method ◽  
Detection Algorithm ◽  
Thenar Muscle ◽  
Tunnel Syndrome

BACKGROUND Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on the application for screening CTS using a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. OBJECTIVE To make data collection for machine learning easier and more available, we developed a screening application for CTS using a smartphone and an anomaly detection algorithm, and aimed to examine our system as a useful screening tool for CTS. METHODS In total, 36 CTS hands and 27 non-CTS hands were recruited. Participants controlled the character in our application using their thumbs. We recorded the position of the thumbs and time, and generated screening models that classify CTS and non-CTS using anomaly detection and an autoencoder and calculated the sensitivity, specificity, and area under the curve (AUC). RESULTS CTS and non-CTS participants were classified with 93% sensitivity, 69% specificity, and 0.86 AUC. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92% sensitivity, and 100% specificity. CONCLUSIONS Our application could reveal the difficulty of thumb opposition for CTS patients and screen for CTS with high sensitivity and specificity. The application is highly accessible because of the use of smartphones and can easily enhance machine learning using anomaly detection.

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