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 A Survey of the Use of Ultrasound by Upper Extremity Surgeons

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 31-38 ◽  
Author(s):  
William L. Wang ◽  
Kevin Kruse ◽  
John R. Fowler
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Upper Extremity ◽  
Carpal Tunnel ◽  
Imaging Modality ◽  
Practice Setting ◽  
Chi Square ◽  
Ultrasound Machine ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Chi Square Analysis

Background: Ultrasound is a versatile imaging modality that can be used by upper extremity surgeons for diagnostic purposes and guided injections. The perceptions of ultrasound for diagnosis and treatment among upper extremity surgeons and its barriers for adoption have not been formally surveyed. The purpose of this study is to determine the current usage of musculoskeletal ultrasound for diagnostic purposes and guided injections by upper extremity surgeons and their reasons for using it or not using it in practice. Methods: A 22-question survey was distributed to the American Society for Surgery of the Hand (ASSH). The survey questions consisted of respondent characteristic questions and questions pertaining to the use of ultrasound. Chi-square analysis was performed to assess for a difference in ultrasound usage across respondent characteristics. Results: Three hundred four (43%) answered that they have an ultrasound machine in their office; Fifty-one percent (362) of the respondents use ultrasound for diagnostic purposes. Fifty-five (8%) of the survey respondents use ultrasound to diagnose carpal tunnel syndrome; 168 (23.5%) respondents reported that they use ultrasound for guided injections. There was a statistically significant difference between access to an ultrasound machine in the office by practice setting and use of ultrasound for diagnostic purposes by practice setting. Conclusions: The use of ultrasound by upper extremity surgeons is split for diagnostic purposes, with fewer surgeons using ultrasound to diagnose carpal tunnel syndrome and guided injections. Ultrasound machine availability and the use of ultrasound for diagnosis appear to be influenced by practice setting.

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.

scholarly journals Gabapentin as an adjuvant therapy to splinting in carpal tunnel syndrome (CTS): a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Ahmed M. Ahmed ◽  
Osama G. Hassan ◽  
Ahmed A. Khalifa
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Pinch Strength ◽  
Symptom Severity Scale ◽  
Significant Difference ◽  
Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is a common upper limb entrapment neuropathy; severe cases are treated surgically and mild to moderate can be managed conservatively. The purpose of this systematic review and meta-analysis was to define the efficacy of gabapentin as an adjuvant to splinting in the treatment of mild to moderate CTS. Methods A systematic search through 13 databases, randomized clinical trials (RCTs) reporting the use of gabapentin with splinting in CTS were included and analyzed. Results Three RCTs including 170 patients were eligible. There was no significant difference between gabapentin plus splinting and splinting alone in 5 measured parameters: (1) Symptom Severity Scale (SSS) [MD (95% CI) = − 0.76 (− 2.46–0.93), p = 0.378], (2) Functional Status Scale (FSS) [MD (95% CI) = − 0.23 (− 1.40–0.94), p = 0.701], (3) visual analogue scale (VAS) to assess pain [MD (95% CI) = − 0.6 (− 1.47–0.27), p = 0.174], (4) Grip strength [MD (95% CI) = − 0.11 (− 0.70–0.48), p = 0.718], and (5) pinch strength [MD (95% CI) = 0.72 (− 0.10–1.54), p = 0.083]. Conclusion This review provides low-quality evidence that gabapentin plus nocturnal splinting is not superior to splinting alone. More high-quality trials are needed to determine the role of this drug as an adjuvant in the management of CTS.

scholarly journals Body mass index and carpal tunnel syndrome

2000 ◽  
Vol 58 (2A) ◽  
pp. 252-256 ◽  
Author(s):  
JOAO ARIS KOUYOUMDJIAN ◽  
MARIA DA PENHA ANANIAS MORITA ◽  
PAULO RICARDO FERNANDO ROCHA ◽  
RAFAEL CARLOS MIRANDA ◽  
GUSTAVO MACIEL GOUVEIA
Keyword(s):  
Body Mass Index ◽  
Carpal Tunnel Syndrome ◽  
Body Mass ◽  
Carpal Tunnel ◽  
Ring Finger ◽  
Additional Increase ◽  
Significant Difference ◽  
Tunnel Syndrome ◽  
Increasing Risk ◽  
Sensory Latency

Carpal tunnel syndrome (CTS) has been correlated to body mass index (BMI) increase. The present study was done in a Brazilian population to compare BMI values in the following groups: first, CTS vs. controls subjects, and, second CTS groups of increasing median sensory latency (MSL). According to MSL > or = 3.7 ms (wrist-index finger, 14 cm), median/ulnar sensory latency difference > or = 0.5 ms (ring finger, 14 cm) or median palm-to-wrist (8 cm) latency > or = 2.3 ms (all peak-measured), 141 cases (238 hands) had CTS confirmation. All were symptomatic; previous surgery and polyneuropathy were excluded; mean age 50.3; 90.8% female. Controls subjects (n=243; mean age 43.0; 96.7% female) and CTS cases had BMI calculated (kg/m²). Controls subjects had a mean BMI of 25.43±4.80 versus 28.38±4.69 of all CTS cases, a statistically significant difference (p < 0.001). The CTS groups of increasing MSL severity do not show additional increase in BMI (28.44 for incipient, 28.27 for mild, 28.75 for moderate and 29.0 for severe). We conclude that CTS cases have a significant correlation with higher BMI when compared to controls subjects; however, higher BMI do not represent a statistically significant increasing risk for more severe MSL.

Are Carpal Tunnel Syndrome and Regional Degenerative Osteoarthritis Linked? Results of a Case-Control Study

2018 ◽  
Vol 23 (01) ◽  
pp. 41-46 ◽  
Author(s):  
Guillaume Bacle ◽  
Emilie Marteau ◽  
Philippe Corcia ◽  
Pascal Garaud ◽  
Jacky Laulan
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Case Control Study ◽  
Causal Relation ◽  
Case Control ◽  
Degenerative Osteoarthritis ◽  
Significant Difference ◽  
Osteoarthritis Of The Wrist ◽  
Tunnel Syndrome ◽  
Control Study

Background: Causality has not been formally demonstrated between carpal tunnel syndrome and osteoarthritis of the wrist or at the base of the thumb. The purpose of this study was to assess the relationship between carpal tunnel syndrome and concomitant degenerative osteoarthritis of the wrist or basal thumb joint. We hypothesised that wrist osteoarthritis by reducing the free volume of the carpal tunnel would be associated with carpal tunnel syndrome, while basal thumb osteoarthritis would show no direct correlation with carpal tunnel syndrome. Methods: A case-control study including 95 cases and 99 control subjects, has been carried out. Sixty-eight per group were matched for age and sex. Posterior-anterior and lateral plain wrist radiographs for the two matched groups were analysed. Results: Except for scaphotrapeziotrapezoid location, degenerative osteoarthritis of the wrist was significantly linked with carpal tunnel syndrome, whereas there was no significant difference between case and control groups for prevalence of basal osteoarthritis of the thumb. Conclusions: These results suggest that basal osteoarthritis of the thumb is not a causal factor in carpal tunnel syndrome. In contrast, degenerative osteoarthritis of the wrist was strongly associated with carpal tunnel syndrome, suggesting a causal relation.

The Sensitivity and Specificity of Tests for Carpal Tunnel Syndrome Vary with the Comparison Subjects

1998 ◽  
Vol 23 (2) ◽  
pp. 151-155 ◽  
Author(s):  
F. GERR ◽  
R. LETZ
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Diagnostic Tests ◽  
Normal Subjects ◽  
Clinical Test ◽  
Test Results ◽  
Electrophysiological Tests ◽  
Tunnel Syndrome ◽  
Electrophysiological Test ◽  
Hand Symptoms

The performance of a variety of common office-based clinical tests for detection of carpal tunnel syndrome (CTS) was assessed in 119 subjects with and without electrophysiological evidence of CTS. Symptoms compatible with CTS and electrophysiological tests positive for median mononeuropathy at the wrist were observed in 57 hands, symptoms compatible with CTS and normal electrophysiological test results were observed in 58 hands, and no symptoms compatible with CTS and normal electrophysiological test results were observed in 123 hands. For all the diagnostic tests studied, the proportion of subjects who had a false positive clinical test result was much higher in the electrophysiologically normal subjects who had CTS compatible hand symptoms than in the electrophysiologically normal subjects who were asymptomatic. These results suggest that many studies that have evaluated diagnostic tests for CTS have produced falsely optimistic estimates of the test’s performance because of their use of asymptomatic comparison subjects.

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.

Return-to-Work Interval and Surgery for Carpal Tunnel Syndrome. Results of a Prospective Series of 233 Patients

2004 ◽  
Vol 29 (6) ◽  
pp. 568-570 ◽  
Author(s):  
F. CHAISE ◽  
P. BELLEMÈRE ◽  
J. P. FRIL ◽  
E. GAISNE ◽  
P. POIRIER ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Social Security ◽  
Private Sector ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Civil Servants ◽  
Workers Compensation ◽  
Full Time ◽  
Significant Difference ◽  
Tunnel Syndrome

Aim of the study To evaluate the connection between the type of patient insurance and the time taken to return to work after carpal tunnel surgery. Patients and methods Two hundred and thirty-three patients in full-time work were operated on for carpal tunnel syndrome between 1 January and 30 June 1998. They were divided into three groups: independent workers ( n=87), wage earners in the private sector ( n=90) and civil servants ( n=56). Four categories were defined: manual workers, non-manual workers, patients with social security insurance and patients with workers compensation. The average return-to-work interval after surgery for each of the groups was evaluated and compared group by group. Results For independent workers the average time off work is 17 days, for those in the private sector it is 35 days, and for civil servants it is 56 days. Patients with social security insurance were off work for 32 days and those with workers compensation for 49 days. Discussion The comparison shows significant differences with regard to social security insurance: the return-to-work interval in civil servants is larger than for private sector workers, and this is higher than in independent workers. The difference between patients with workers compensation and those with social security insurance is 17 days and significant. There is a significant difference between manual and non-manual workers in independent and private sector workers. There is no significant difference between the sub-groups in the civil servants. These cross references enable us to work out the influence that social security status has on the return-to-work time following surgery.

scholarly journals Influence of temperature on sonographic images of the median nerve for the diagnosis of carpal tunnel syndrome: a case control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Wei Chang ◽  
Chii-Jen Chen ◽  
You-Wei Wang ◽  
Valeria Chiu ◽  
Shinn-Kuang Lin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carpal Tunnel Syndrome ◽  
Skin Temperature ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Power Doppler ◽  
Power Doppler Ultrasonography ◽  
Local Skin ◽  
Significant Difference ◽  
Tunnel Syndrome

Abstract Background In addition to nerve conduction studies (NCSs), ultrasonography has been widely used as an alternative tool for diagnosing carpal tunnel syndrome (CTS). Although the results of NCSs are influenced by local skin temperature, few studies have explored the effects of skin temperature on ultrasonography of the median nerve. Since swelling and intraneural blood flow of the median nerve might be influenced by local temperature changes, the aim of this study was to evaluate the cross-sectional area (CSA) and intraneural blood flow of the median nerve under three skin temperatures (30 °C, 32 °C, 34 °C). Methods Fifty patients with CTS and 50 healthy volunteers were consecutively recruited from a community hospital. Each participant received physical examinations and NCSs and underwent ultrasonography, including power Doppler, to evaluate intraneural vascularity. Results The CSA of the median nerve in the CTS patients was significantly larger than that in the healthy controls at all three temperatures. However, significant differences in the power Doppler signals of the median nerve between the two studied groups were observed only at 30 and 32 °C, not at 34 °C. Conclusion The significant difference in the intraneural vascularity of the median nerve between the patients with CTS and the healthy subjects was lost at higher temperatures (34 °C). Therefore, the results of power Doppler ultrasonography in diagnosing CTS should be cautiously interpreted in patients with a high skin temperature or those who reside in warm environments.

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