The Impact of Sensory, Motor and Pain Impairments on Patient- Reported and Performance Based Function in Carpal Tunnel Syndrome

Background: Research has suggested that persistent sensory and motor impairments predominate the symptoms experienced by patients with carpal tunnel syndrome (CTS); with intermittent pain symptoms, being less predominant. Objective: The study aims to determine the relative contribution of sensory, motor and pain impairments as contributors to patient-report or performance-based hand function. Methods: Fifty participants with a diagnosis of CTS confirmed by a hand surgeon and electrodiagnosis were evaluated on a single occasion. Impairments were measured for sensibility, pain and motor performance. A staged regression analysis was performed. In the first step, variables with each of the 3 impairment categories were regressed on the Symptom Severity Scale (SSS) to identify the key variables from this domain. Models were created for both self report (Quick Disabilities of arm, shoulder and hand- Quick DASH) and performance based (Dexterity) functional outcomes. Backward regression modelling was performed for SSS and then, to allow comparability of the importance of different impairments across models, the 7 significant variables from the SSS model were forced into the models. Results: Variables: age, touch threshold and vibration threshold of the little finger of unaffected hand, median-ulnar vibration threshold ratio of affected hand, mean pain tolerance of unaffected hand, grip strength and pinch strength of affected hand, explained 31%, 36% and 63% of the variance in SSS, Quick DASH and dexterity scores, respectively. Conclusion: Hand function in patients with CTS is described by variables that reflect sensory status of the median and ulnar nerves, the persons pain threshold, grip and pinch strength impairments and age.

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The Impact of Disease Severity in Carpal Tunnel Syndrome on Grip Strength, Pinch Strength, Fine Motor Skill and Depression

Journal of Physical Therapy Science ◽

10.1589/jpts.23.115 ◽

2011 ◽

Vol 23 (1) ◽

pp. 115-118 ◽

Cited By ~ 6

Author(s):

Nilgun Simsir Atalay ◽

Ayse Sarsan ◽

Nuray Akkaya ◽

Necmettin Yildiz ◽

Oya Topuz

Keyword(s):

Carpal Tunnel Syndrome ◽

Grip Strength ◽

Disease Severity ◽

Carpal Tunnel ◽

Motor Skill ◽

Fine Motor ◽

Pinch Strength ◽

Fine Motor Skill ◽

Tunnel Syndrome ◽

The Impact

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Associations between hand function and electrophysiological measurements in hand osteoarthritis patients of different ages with or without carpal tunnel syndrome

Scientific Reports ◽

10.1038/s41598-020-74795-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Young Hoon Kim ◽

Eun Young Han ◽

Jinseok Kim ◽

Kyu-Bum Seo ◽

Young Tae Jeon ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Hand Function ◽

Sensory Nerve ◽

Male Gender ◽

Pinch Strength ◽

Hand Osteoarthritis ◽

Hand Grip ◽

Tunnel Syndrome

Abstract Osteoarthritis is a common degenerative disease that most frequently involves the hand. The objective was to compare clinical functional outcome measures including hand grip, pinch strength, and dexterity with various electrophysiological measures in patients of different ages with hand osteoarthritis with or without the presence of carpal tunnel syndrome (CTS). Patients with hand osteoarthritis (208 patients, 404 hands) who underwent hand-function tests and motor and sensory nerve conduction studies (NCS) between June 2015 and June 2016 were enrolled. The patients’ hands were assigned to carpal tunnel syndrome (CTS) (206 hands; mean age, 56.37 ± 10.52; male:female, 46:160) or control groups (198 hands; mean age, 57.88 ± 9.68; male:female, 55:143). The strength of hand grip and lateral pinch, the time required to complete the nine-hole pegboard test (9HPT), and motor and sensory nerve conduction parameters were measured and compared across age groups and between hands with or without CTS. The CTS group showed significantly lower hand grip and lateral pinch strength, and a longer time to complete the 9HPT in comparison with the control group. Female patients showed significantly lower hand grip and lateral pinch strength than male patients. However, there was no difference in the 9HPT completion time between genders. Multivariate regression analysis identified the amplitude of the median compound muscle action potential (CMAP), age, and male gender as independent predictors of grip strength (adjusted R2 = 0.679), and amplitude of median CMAP and male gender as independent predictors of KP strength (adjusted R2 = 0.603). Velocity of median CMAP, amplitude of median sensory nerve action potential, and age were identified as independent predictors of 9HPT time (adjusted R2 = 0.329). Nerve conduction measurements were significantly related to hand-function test results, and CTS induced significant deficits in strength and performance of the affected hand.

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Carpal Tunnel Syndrome and Hand Function

Canadian Journal of Plastic Surgery ◽

10.1177/229255039300100103 ◽

1993 ◽

Vol 1 (1) ◽

pp. 44-46

Author(s):

G Allan Taylor

Keyword(s):

Informed Consent ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Hand Function ◽

Pinch Strength ◽

High Incidence ◽

Tunnel Syndrome ◽

Loss Of Strength ◽

Age And Sex

GA Taylor. Carpal tunnel syndrome and hand function. Can J Plast Surg 1993; 1 (1):44-46. A prospective review of 78 hands in 58 patients with carpal tunnel syndrome is presented. The author's technique for carpal tunnel release under local anesthesia is described. Comparison of the patients in the series with age- and sex-matched controls revealed a high incidence of preoperative weakness of grip and pinch strength. Postoperatively, many patients experienced further loss of strength persisting six months or more. Some had not regained preoperative strength by six months. Explanations for diminished hand strength in patients with carpal tunnel syndrome both pre- and postoperatively are advanced and recommendations made for improved informed consent for patients undergoing carpal tunnel release.

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Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.julaug02 ◽

2003 ◽

Vol 8 (4) ◽

pp. 4-5

Author(s):

Christopher R. Brigham ◽

James B. Talmage

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Proper Time ◽

Carpal Tunnel Release ◽

Hand Function ◽

Factors Affecting ◽

Early Results ◽

Medical Evaluation ◽

Nerve Recovery ◽

Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

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Author Correction: Associations between hand function and electrophysiological measurements in hand osteoarthritis patients of different ages with or without carpal tunnel syndrome

Scientific Reports ◽

10.1038/s41598-021-82090-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Young Hoon Kim ◽

Eun Young Han ◽

Jinseok Kim ◽

Kyu‑Bum Seo ◽

Young Tae Jeon ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Hand Function ◽

Hand Osteoarthritis ◽

Different Ages ◽

Electrophysiological Measurements ◽

Tunnel Syndrome

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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The impact of gender on personal, health and workplace psychosocial risk factors for carpal tunnel syndrome

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931213571504 ◽

2013 ◽

Vol 57 (1) ◽

pp. 2167-2170

Author(s):

Carisa Harris-Adamson ◽

Ellen A Eisen ◽

Ann Marie Dale ◽

Bradley Evanoff ◽

Kurt T. Hegmann ◽

...

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Psychosocial Risk Factors ◽

Psychosocial Risk ◽

Personal Health ◽

Tunnel Syndrome ◽

The Impact

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

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00237-5 ◽

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.

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