Value of soft tissue mobilization versus medical therapy in carpal tunnel syndrome treatment

The forearm, hand, and wrist is a functionally vital part of the musculoskeletal system and in consequence, is highly sophisticated and complex in its anatomical development. Frequently, the hand and wrist may be the site of onset of symptoms of a polyarthropathy such as rheumatoid arthritis or of osteoarthritis, so that the physician should always seek to screen for such conditions before making a local diagnosis. Tenosynovitis, de Quervain’s disease, trigger digit, Dupuytren’s, and carpal tunnel syndrome are local soft tissue pathologies which can usually be discriminated on clinical grounds with or without the use of simple diagnostic tests and are satisfying to treat for the most part. Non-specific forearm pain is more complex, with much controversy surrounding not only its aetiopathogenesis but also its existence. It can be difficult to diagnose and difficult to treat.

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Synovial Angioma of the FDP Flexor Sheath: A Rare Cause of Carpal Tunnel Syndrome

The Open Orthopaedics Journal ◽

10.2174/1874325001307010072 ◽

2013 ◽

Vol 7 (1) ◽

pp. 72-74 ◽

Cited By ~ 3

Author(s):

Robert George ◽

Kenneth Lee

Keyword(s):

Carpal Tunnel Syndrome ◽

Soft Tissue ◽

Carpal Tunnel ◽

Ring Finger ◽

Dominant Male ◽

Tumour Resection ◽

Tissue Mass ◽

Surgical Exploration ◽

Compressive Neuropathy ◽

Tunnel Syndrome

It has been previously noted that synovial haemangiomas in the hand and wrist are very rare pathological entities. We report the case of a 34-year-old right hand dominant male who presented to his general practitioner with an enlarging left volar wrist/ palmar mass, who further developed symptoms consistent with carpal tunnel syndrome. An MRI scan subsequently confirmed a large, complex mass with area of necrosis and peripheral enhancement. The rate of mass growth and radiological features raised the possibility of a soft tissue malignancy, and the gentleman was urgently referred to our unit for surgical exploration and removal of tumour. Surgical exploration demonstrated a tan-coloured soft tissue mass on the ulnar aspect of the median nerve. It appeared to arise from, and marginally infiltrated, the tendon sheath of the FDP tendon to the ring finger and the lumbrical muscle of the fourth ray; the distal and proximal extent of the tumour was difficult to define due to the diffuse growth of the tumour. Resection was achieved with macroscopic margins, with excellent functional recovery immediately and at 6 month follow-up. Histological analysis was consistent with a synovial haemangioma, comprising of numerous thin-walled blood vessels with a central cystic cavity containing blood and fibrin. Our case further demonstrates the diagnostic challenges posed by compressive neuropathy due to soft tissue masses, even with thorough clinical and radiological assessment. In the context of a rapidly growing tumour, malignancy must always be suspected and might highlight a role for pre-operative biopsy.

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Clinical and Electrophysiological Comparison of Different Methods of Soft Tissue Coverage of the Median Nerve in Recurrent Carpal Tunnel Syndrome

Neurosurgery ◽

10.1227/01.neu.0000342792.61944.24 ◽

2009 ◽

Vol 64 (3) ◽

pp. E577-E577

Author(s):

Nicolas Stütz ◽

Alexander Novotny ◽

Andreas Gohritz

Keyword(s):

Carpal Tunnel Syndrome ◽

Soft Tissue ◽

Median Nerve ◽

Carpal Tunnel ◽

Soft Tissue Coverage ◽

Tunnel Syndrome

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Concurrent musculoskeletal and soft tissue pain in the upper extremity can affect the treatment and prognosis of carpal tunnel syndrome: redefining a common condition

Journal of Pain Research ◽

10.2147/jpr.s142153 ◽

2017 ◽

Vol Volume 10 ◽

pp. 2497-2502

Author(s):

Reynaldo P Lazaro ◽

Thomas Eagan

Keyword(s):

Carpal Tunnel Syndrome ◽

Soft Tissue ◽

Upper Extremity ◽

Carpal Tunnel ◽

Common Condition ◽

Tunnel Syndrome

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Recurrent Carpal Tunnel Syndrome – Analysis of the Origin in 204 Cases and Comparison of Different Soft-Tissue Coverage for the Median Nerve

Journal of Reconstructive Microsurgery ◽

10.1055/s-2006-947929 ◽

2006 ◽

Vol 22 (03) ◽

Author(s):

Nicolas Stütz ◽

Andreas Gohritz ◽

Jörg Schoonhoven ◽

Ulrich Lanz

Keyword(s):

Carpal Tunnel Syndrome ◽

Soft Tissue ◽

Median Nerve ◽

Carpal Tunnel ◽

Soft Tissue Coverage ◽

Tunnel Syndrome ◽

Syndrome Analysis

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Carpal Tunnel Syndrome in a Melorheostotic Limb

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(85)80031-0 ◽

1985 ◽

Vol 10 (1) ◽

pp. 101-102 ◽

Cited By ~ 13

Author(s):

O. M. BÖSTMAN ◽

G. E. BAKALIM

Keyword(s):

Carpal Tunnel Syndrome ◽

Soft Tissue ◽

Upper Limb ◽

Carpal Tunnel ◽

Middle Aged ◽

Soft Tissue Lesions ◽

Aged Woman ◽

Middle Aged Woman ◽

Tunnel Syndrome ◽

The Right

Melorheostosis can be associated with various soft tissue lesions of the affected limb. A case is presented in which a severe carpal tunnel syndrome developed in a middle-aged woman with melorheostosis of the right upper limb since childhood.

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The SToICAL trial: study protocol for the soft tissue injection of corticosteroid and local anaesthetic trial—a single site, non-inferiority randomised control trial evaluating pain after soft tissue corticosteroid injections with and without local anaesthetic

Trials ◽

10.1186/s13063-021-05627-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

M. Jones ◽

J. Evans ◽

S. Fullilove ◽

E. Doyle ◽

C. Gozzard

Keyword(s):

Carpal Tunnel Syndrome ◽

Soft Tissue ◽

Clinical Diagnosis ◽

Carpal Tunnel ◽

Local Anaesthetic ◽

Corticosteroid Injection ◽

Randomised Control Trial ◽

Tunnel Syndrome ◽

Vas Scores ◽

Corticosteroid Injections

Abstract Background Corticosteroid injections are used in the treatment of hand and wrist conditions. The co-administration of a local anaesthetic and corticosteroid aims to reduce pain after the injection, although no studies have directly compared this with using corticosteroid alone. The aim is to determine whether pain experienced during the 24 h after a corticosteroid injection to the hand and wrist is no worse than (not inferior to) the pain experienced after a corticosteroid and local anaesthetic injection. Methods A single-site, patient- and assessor-blinded, non-inferiority randomised control trial recording pain visual analogue scale (VAS) scores in patients with a clinical diagnosis of trigger finger, de Quervains tenosynovitis or carpal tunnel syndrome, treated with a 1-ml triamcinolone (40 mg/1 ml) injection co-administered with or without 1 ml of 1% lidocaine. The primary aim is to investigate a difference in pain VAS scores at 1 h after the injection using a mean change score. A 95% power calculation was made using a minimally clinical important difference of 20 mm as the clinically admissible margin of non-inferiority and an assumed standard deviation of 25 mm, from previous studies. Including a 20% fall out rate, 100 patients are required. Discussion Patients with a clinical diagnosis of trigger finger, de Quervains and carpal tunnel syndrome, are over the age 18 years old and who are able to give written informed consent will be included. Patients will be excluded if they have had previous surgery or corticosteroid injection for the condition being treated at the site considered for injection. Patients will be electronically randomised and injections delivered during their clinic appointment. Pain is assessed using a 100-mm VAS score taken, before and at the time of injection and at 5 min, 1 h, 2 h, 3 h and 24 h after the injection. The secondary outcomes are to determine a difference in pain VAS score at the time of injection and during the 24 h after. Trial registration This study is registered on the IRAS (259336) on November 11, 2019, and EudraCT database on October 31, 2019 (2019-003742-32). REC/HRA approval was given in January 2020, and Clinical Trial Authorisation from the MHRA was given in December 2019. The study is registered on ClinicalTrials.gov (NCT04253457) on February 5, 2020.

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