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Carpal Tunnel Syndrome (carpal + tunnel_syndrome)
Selected AbstractsPyridoxine Hydrochloride Treatment of Carpal Tunnel Syndrome: A ReviewNUTRITION REVIEWS, Issue 3 2004Elaine Aufiero M.D. It has been hypothesized that idiopathic carpal tunnel syndrome (CTS) is a manifestation of vitamin B6 deficiency. Some claim that B6 supplementation can alleviate symptoms. Others argue that pain relief occurs because of vitamin B6's anti-nociceptive properties or because B6 supplementation addresses an unrecognized peripheral neuropathy. Few studies on CTS and B6 employed electrodiagnostic techniques in diagnosis, and few showed a correlation between symptoms and improved electrodiagnostic parameters with supplementation. Other studies failed to measure or estimate B6 levels. Nevertheless, it appears reasonable to recommend vitamin B6 supplementation to people with CTS. Some patients will improve symptomatically with low risks of toxicity in recommended doses. [source] Carpal tunnel syndrome among apprentice construction workers,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2002John C. Rosecrance PT Abstract Background In terms of lost-work time and restricted workdays, surgery, and rehabilitation, one of the most costly occupational musculoskeletal disorders is carpal tunnel syndrome (CTS). The purpose of this study was to determine the prevalence of CTS among apprentice construction workers. Methods This cross-sectional study included apprentices from four construction trades. Apprentices completed a self-administered questionnaire and received electrophysiologic studies assessing median nerve function across the carpal tunnel. A surveillance case definition for CTS was based on characteristic hand symptoms and the presence of median mononeuropathy across the carpal tunnel. Results Of the 1,325 eligible apprentices, 1,142 (86.2%) participated in the study. The prevalence of CTS among apprentices was 8.2%; sheet metal workers had the highest rate (9.2%). In operating engineers, the prevalence of CTS was significantly higher (OR,=,6.9; 95% CI,=,2.6,18.2) among the heavy equipment mechanics than the drivers of those vehicles. Body mass index, age, and self-reports of working overhead were associated with prevalent CTS. Less than 15% of the apprentices with CTS sought medical attention for their disorder. Conclusions Many construction workers begin developing CTS before or during their apprenticeship. Few apprentices seek medical attention for hand symptoms characteristic of CTS. The results of this study indicate a public health need for the implementation of prevention strategies for CTS in the construction industry. Am. J. Ind. Med. 42:107,116, 2002. © 2002 Wiley-Liss, Inc. [source] Can the outcome of open carpal tunnel release be predicted?: a review of the literatureANZ JOURNAL OF SURGERY, Issue 1-2 2010Alexandra Turner Abstract Carpal tunnel syndrome is a common condition affecting 1% of the population. Open carpal tunnel release is the most commonly performed procedure for this condition. About 70,90% of patients have good to excellent long-term outcomes with open carpal tunnel release. The remainder have poor outcomes. An understanding of factors which predict a poor outcome following open carpal tunnel release would be of benefit during preoperative counselling, and provides more accurate expectations of outcomes after surgery. We reviewed the published literature in the English language over the last 20 years in an attempt to ascertain predictors of poor outcomes following open carpal tunnel release. Patient factors such as age, sex and weight were not found to be predictors of a poor outcome following open carpal tunnel release. Similarly, physical examination had little usefulness, save for abductor pollicis wasting, for predicting post-surgical functional limitations, symptoms or satisfaction. Co-morbid conditions such as diabetes, poor health status, thoracic outlet syndrome, double crush, alcohol and smoking have a worse prognosis. Normal nerve conduction studies preoperatively, direct nerve surgery such as neurolysis, abductor pollicis brevis muscle wasting and workers' compensation cases which involve lawyers preoperatively are all associated with worse outcomes. Postoperative physiotherapy may accelerate recovery but neither modifies functional recovery or reduces symptom occurrence. [source] When exactly can carpal tunnel syndrome be considered work-related?ANZ JOURNAL OF SURGERY, Issue 3 2002Sonja Falkiner Background: Carpal tunnel syndrome (CTS), compression of the median nerve at the wrist, is the most frequently encountered peripheral entrapment neuropathy. Whilst rates of all other work-related conditions have declined, the number of work-related musculoskeletal disorders (which include CTS) has not changed for the past 9 years in the USA. Median days off work are also highest for CTS: 27 compared to 20 for fractures and 18 for amputations. This results in enormous Workers Compensation and other costs to the community. Awareness of CTS as a disorder associated with repeated trauma at work is now so widespread amongst workers that many have diagnosed themselves before being medically assessed, often by means of the Internet. Surprisingly, however, a definite causal relationship has not yet been established for most occupations. Although the quality of research in this area is generally poor, CTS research studies are being used as the basis for acceptance of Workers Compensation claims, substantial expensive ergonomic workplace change and even workplace closures. The fact that the incidence of work-related musculoskeletal disorders has not changed despite these latter measures would suggest that a causal relationship is not proven and that some resources are being misdirected in CTS prevention and treatment. Method: A literature review of 64 articles on CTS was conducted. This included those articles most frequently cited as demonstrating the relationship between CTS and work. Results: Primary risk factors in the development of CTS are: being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake. In most cases, work acts as the ,last straw' in CTS causation. Conclusion: Except in the case of work that involves very cold temperatures (possibly in conjunction with load and repetition) such as butchery, work is less likely than demographic and disease-related variables to cause CTS. To label other types of work as having caused CTS, therefore, would result in inappropriate allocation of resources. It would also relieve individuals of the responsibility of addressing correctable lifestyle factors and treatable illnesses such as obesity, diabetes, smoking and increased alcohol intake which may have contributed to their CTS more that their work. This results in both avoidable long-term health effects and ongoing costs to the community. [source] Critical reappraisal of referrals to electromyography and nerve conduction studies,EUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2005S. Podnar A large number of examinees referred to electromyographic (EMG) laboratories do not have symptoms or signs suggestive of a peripheral nervous system disorder, and the aim of the present study was to check this. All examinees evaluated by the author in a ,general' EMG laboratory in the first 4 months of 2002 were included. Data on examinees, referral physicians and diagnoses, clinical symptoms and signs, and electrodiagnostic findings were statistically evaluated. Three hundred examinees, 42% men, were included. A neurological diagnosis was provided in 55% of referrals. Electrodiagnostic abnormalities were found in 45% of examinees. Using multivariate statistics, a positive effect of neurological referral diagnosis, history of paraesthesias and of weakness and sensory loss on examination, and a negative effect of history of pain on pathological electrodiagnostic findings were found. Except 20 patients with carpal tunnel syndrome, no patient with normal clinical examination had abnormal electrodiagnostic findings. Our study confirmed the inappropriateness of referrals to electrodiagnostic examination to screen patients for peripheral nervous disorders. We propose electrodiagnostic examination mainly of patients with unequivocal clinical signs of a peripheral nervous system lesion and of patients with typical symptoms of the carpal tunnel syndrome. [source] Comparison of three conservative treatment protocols in carpal tunnel syndromeINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2006O. Baysal Summary The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon- and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS. [source] Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndromeJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2009D. Pastare MD Abstract Purpose. To compare the diagnostic value of high-resolution ultrasound (US) with nerve conduction studies (NCS) in patients with clinically defined carpal tunnel syndrome (CTS). Methods. A prospective study was conducted on 66 consecutive patients investigated for sensory hand symptoms. The gold standard was the clinical diagnosis of CTS. Results. NCS showed greater diagnostic sensitivity (82%) than US (62%) in supporting a diagnosis of CTS. With increasing neurophysiologic severity of median neuropathy, there was increasing convergence of the two test methods. Abnormal US as the only diagnostic supportive evidence of CTS was rare. However, the positive predictive value of US for CTS was 100%. Conclusion. NCS show better sensitivity than US in supporting a diagnosis of CTS. However, because of its high positive predictive value, one may consider using US as a screening test, eliminating the need for NCS in the majority of clinical suspicion of CTS and reserving NCS for cases in which US is negative. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009 [source] Ultrasonographic Reference Values for Assessing the Normal Median Nerve in AdultsJOURNAL OF NEUROIMAGING, Issue 1 2009Michael S. Cartwright MD ABSTRACT BACKGROUND AND PURPOSE Several studies have evaluated the cross-sectional area of the median nerve at the wrist, but none have examined other sites along the median nerve. Nerve enlargement has been demonstrated in entrapment, hereditary and acquired neuropathies, as well as with intraneural masses, and cross-sectional area reference values at sites along the nerve will help in the evaluation of these conditions. In addition, muscle intrusion into the carpal tunnel has been implicated in carpal tunnel syndrome, but the normal amount of muscle intrusion has not been quantified. METHODS Fifty asymptomatic volunteers (100 arms) were evaluated to determine the mean cross-sectional area of the median nerve at 6 sites and the mean amount of muscle intruding into the carpal tunnel. RESULTS The cross-sectional area of the nerve was consistent along its course (7.5 to 9.8 mm2). The amount of muscle within the carpal tunnel varied greatly, with the mean area of flexor digitorum being 15.5 mm2 and lumbricals 13.5 mm2. CONCLUSIONS These reference values are necessary for advancing the field of neuromuscular ultrasound, because they facilitate studies of the median nerve in conditions such as entrapment, hereditary neuropathy, acquired neuropathy, and intraneural masses. [source] Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndromeJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 7 2007Michel W. Coppieters Abstract Nerve and tendon gliding exercises are advocated in the conservative and postoperative management of carpal tunnel syndrome (CTS). However, traditionally advocated exercises elongate the nerve bedding substantially, which may induce a potentially deleterious strain in the median nerve with the risk of symptom exacerbation in some patients and reduced benefits from nerve gliding. This study aimed to evaluate various nerve gliding exercises, including novel techniques that aim to slide the nerve through the carpal tunnel while minimizing strain ("sliding techniques"). With these sliding techniques, it is assumed that an increase in nerve strain due to nerve bed elongation at one joint (e.g., wrist extension) is simultaneously counterbalanced by a decrease in nerve bed length at an adjacent joint (e.g., elbow flexion). Excursion and strain in the median nerve at the wrist were measured with a digital calliper and miniature strain gauge in six human cadavers during six mobilization techniques. The sliding technique resulted in an excursion of 12.4 mm, which was 30% larger than any other technique (p,,,0.0002). Strain also differed between techniques (p,,,0.00001), with minimal peak values for the sliding technique. Nerve gliding associated with wrist movements can be considerably increased and nerve strain substantially reduced by simultaneously moving neighboring joints. These novel nerve sliding techniques are biologically plausible exercises for CTS that deserve further clinical evaluation. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:972,980, 2007 [source] Towards development of a nonhuman primate model of carpal tunnel syndrome: Performance of a voluntary, repetitive pinching task induces median mononeuropathy in Macaca fascicularisJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2007Carolyn M. Sommerich Abstract This study investigated changes in median sensory nerve conduction velocity (SNCV) over several weeks of exposure to a voluntary, moderately forceful, repetitive pinching task performed for food rewards by a small sample of young adult female monkeys (Macaca fascicularis). SNCV, derived from peak latency, decreased significantly in the working hands of three of the four subjects. The overall decline in NCV was 25%,31% from baseline. There was no decrease in SNCV in the contralateral, nonworking hands. Several weeks after being removed from the task, SNCV returned to within 87%,100% of baseline. MRI showed enlargement of the affected nerves near the proximal end of the carpal tunnel, at the time of maximal SNCV slowing. This new animal model demonstrates a temporally unambiguous relationship between exposure to a moderately forceful, repetitive manual task and development of median mononeuropathy at the wrist, and recovery of SNCV following termination of task exposure. This study contributes to the pattern of evidence of a causal relationship between manual work, median mononeuropathy, and carpal tunnel syndrome in humans. In the future, this new animal model could be used to characterize dose,response relationships between risk factors and carpal tunnel syndrome. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25: 713,724, 2007 [source] Treating nerves: a call to armsJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2008Richard A. C. Hughes Abstract The process of proving that new treatments for peripheral nerve diseases work has often been slow and inefficient. The lack of adequate evidence for some existing treatments has been highlighted by Cochrane systematic reviews. This article uses four different conditions to illustrate the need for more research. Both corticosteroid injections and surgical decompression of the median nerve are efficacious in carpal tunnel syndrome, but whether corticosteroid injections avoid the need for operation needs to be discovered. Corticosteroids are efficacious for Bell's palsy, but the role of antiviral agents needs clarification, which should come from ongoing trials. Intravenous immunoglobulin (IVIg) and plasma exchange are both efficacious in Guillain-Barré syndrome, but corticosteroids are not. More trials are needed to discover the best dose of IVIg in severe cases and whether mild cases need treatment. In chronic inflammatory demyelinating polyradiculoneuropathy, corticosteroids, IVIg and plasma exchange are all efficacious, at least in the short term, but trials are needed to discover whether and which other immunosuppressive agents help. The Peripheral Nerve Society has formed a standing committee, the Inflammatory Neuropathy Consortium (http://pns.ucsd.edu/INC.htm), to facilitate the trials needed to answer the remaining questions in the inflammatory neuropathies. [source] Charcot-Marie-Tooth disease type 1A: clinicopathological correlations in 24 patientsJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2005Alzira A. S. Carvalho Abstract We examined nerve biopsies from 24 patients with Charcot-Marie-Tooth disease type 1A (CMT1A) and proven 17p11.2-12 duplication. There were seven males and 17 females with a mean age of 27.85 ± 18.95 years at the time of nerve biopsy. A family history consistent with dominant inheritance was present in 17 patients. Clinical features were classical in 16 patients and were atypical in the other eight: one had calf hypertrophy; two had Roussy,Levy syndrome; one had had a subacute inflammatory demyelinating polyneuropathy 11 years earlier and presented a relapse on the form of a chronic inflammatory demyelinating polyneuropathy; one had carpal tunnel syndrome; one had a recent painful neuropathy in both legs; and two had chronic inflammatory demyelinating polyneuropathy. Onion bulb formations (OMFs) were present in every case and most of them were characteristic, whereas burnt-out or cluster-associated OMFs were less common. Depletion of myelinated fibers was severe in 20 cases (169,2927/mm2) and varied from 5187 to 3725/mm2 in three children (4,9 years old). In addition, features of macrophage-associated demyelination were observed in the last four atypical cases. Known for more than 20 years, inflammatory demyelination superimposed in the course of CMT1A has been reported in a few cases in the past few years, mainly concerning asymptomatic or atypical patients. Such an association deserves to be better known because corticotherapy improves weakness in most of these patients. [source] Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 62JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2003C Briani Thalidomide seems to be effective in the treatment of cutaneous forms of lupus erythematosus refractory to other therapies. Peripheral neuropathy is the most severe side effect, but the incidence of neuropathy and its relation to thalidomide doses are still unclear. We prospectively monitored 12 patients treated with thalidomide for cutaneous lupus erythematosus in order to estimate the occurrence of side effects, particularly peripheral neuropathy. A total of 12 female patients, median age 38,6 years (range 26,56), with subacute or chronic cutaneous lupus erythematosus were considered. The patients were treated with low dose thalidomide (starting dose 100 mg, tapered to 50 mg/day or 50 mg alternative day) for up to 18 months. The average follow-up period was 8,6 months (range 2,18). Prior to, and regularly during treatment patients underwent neurological evaluation and electrophysiological study of at least 8 nerves in the 4 arms (ulnar, median, sural, peroneal nerves). At recruitment, one patient presented a sensory-motor peripheral neuropathy. Of the remaining 11 patients, six did not present electrophysiological evidence of neuropathy, one had a carpal tunnel syndrome and four showed slowing of ulnar nerve velocity at elbow. No patients developed neuropathy neither worsening of electrophysiological parameters during thalidomide treatment. The most common side effect was tremor, always reversible after withdrawing or reducing thalidomide. Paresthesias, somnolence, amenhorrea, constipation were also present. Only one patient had to stop the therapy for the occurrence, 10 days after taking 50 mg of thalidomide, of a severe, stabbing, "zoster-like" thoracic pain, which disappeared upon withdrawal of the drug. Started again on thalidomide, the symptoms reappeared and the patient definitely interrupted the therapy with benefit. All the 11 patients who continued on the therapy presented a significant improvement or remission of the cutaneous alterations. These preliminary data seem to indicate that low dose thalidomide is efficacious and tolerable for cutaneous lupus erythematosus. Peripheral neuropathy seems not to be a major side effect. A longer follow-up and the study of more patients are needed to confirm the results. [source] ELECTROPHYSIOLOGICAL ABNORMALITIES IN DIABETIC PATIENTSJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2000B. Lanzillo We studied 476 patients affected by diabetes: 166 male (mean age 61.6 ± 10 years, range 27,91) and 310 female (mean age 61.5 ± 8.4 years, range 25,82). Mean disease duration was 11.3 ± 7.6 years, range 0.3,37). All patients underwent surface motor and sensory nerve conduction along median, popliteal, and sural nerve. Results. Median nerve: in 3.1% of subjects sensory action potentials (SAP) was absent; sensory nerve conduction velocity (SNCV) was reduced in 41.8% in distal segment and in 27.5% in the proximal segment. Motor nerve conduction (MNCV) was reduced in 29.9% of the subjects. Sural nerve: SAP was absent in 24.4% and SNCV was reduced in 32.7%. Popliteal nerve: MNCV was abnormal in 30.4% of the subjects. Combining electrophysiological data we observed that: 1. 28.6% of the subjects resulted normal 2. 12.8% were affected by a lower limbs sensory neuropathy 3. 0.2% had a lower limbs motor neuropathy 4. 5.9% had a lower limbs sensory-motor neuropathy 5. 6.1% had a diffused sensory neuropathy 6. 30.2% had a diffused sensory-motor neuropathy 7. 16.2% had a carpal tunnel syndrome. Patients were divided in 2 groups: patients with and patients without neuropahy: the latter showed a significantly shorter disease duration (12.7 ± 8.1 vs 9.0 ± 6.3; p < 0.0001). In addition, we observed a significant correlation between disease duration and distal latency, median and popliteal MNCV, and SNCV in median and sural nerve (Regression test; p < 0.0001). Patients on insulin showed a longer disease duration and more severe electrophysiological abnormalities. [source] Frequency-dependent conduction block in carpal tunnel syndromeMUSCLE AND NERVE, Issue 5 2006DScArticle first published online: 31 MAR 200, David Burke MD No abstract is available for this article. [source] Simplified orthodromic inching test in mild carpal tunnel syndromeMUSCLE AND NERVE, Issue 12 2001Paul Seror MD Abstract This prospective study was undertaken to determine the clinical relevance, reliability, sensitivity, and specificity of the orthodromic inching test with 2-cm incremental study of the median nerve over the four intracarpal centimeters in 50 control and 50 successive (unselected) patient wrists with mild carpal tunnel syndrome (CTS). In controls, the mean maximum conduction delay per 2 cm (CD/2cm) was 0.445 ± 0.04 ms, and abnormality was defined as at least one CD/2cm exceeding the mean + 2.5 SD of the normal CD/2cm. This yielded a specificity of 98%. In patients with mild unselected CTS, this simplified orthodromic inching test (SOIT) detected the median nerve lesion at the wrist in 47 cases (sensitivity = 94%). The SOIT detected 15 more CTS cases than did the orthodromic median-ulnar latency difference of the 4th digit (Chi square = 13; P = .002). Thus, the SOIT was as effective as an incremental study every centimeter over 10 cm, and the time required for the test allows its routine use when other electrodiagnostic tests fail to reveal any median nerve impairment. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1595,1600, 2001 [source] When to use the combined sensory index,MUSCLE AND NERVE, Issue 8 2001Matthew P. Kaul MD Abstract A recently developed electrodiagnostic technique, the combined sensory index (CSI), has been recommended for its greater sensitivity in diagnosing carpal tunnel syndrome (CTS). The CSI requires a greater number of procedures and therefore involves greater time, cost, and patient discomfort than does conventional electrodiagnostic testing. The CSI is composed of three commonly used electrodiagnostic techniques. There is a close correlation between the components of the CSI, and in most cases, all three components of the CSI are in agreement. We performed a study to develop and validate an algorithm that could be used to identify subsets of patients with CTS in whom CSI testing is particularly useful. Subjects were consecutive outpatient veterans referred by a heterogeneous group of specialists and generalists for electrodiagnostic evaluation of paresthesias in a median distribution with nocturnal exacerbation of symptoms. The CSI served as our gold standard. Using our simple algorithm, we found that in approximately 95% of cases, it was unnecessary to perform the CSI. This management strategy improves patient comfort and reduces electrodiagnostic cost while identifying the minority of patients for whom the CSI is indicated. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1078,1082, 2001 [source] The de Quervain's screening tool: Validity and reliability of a measure to support clinical diagnosis and managementMUSCULOSKELETAL CARE, Issue 3 2008DipCOT, Rachel Batteson PhD Abstract Background:,Studies into the effectiveness of interventions for upper limb soft tissue disorders have been hampered by a lack of consistently used diagnostic criteria, meaning that comparison of research results is a problem. To aid homogeneous recruitment into a study of de Quervain's disease, a de Quervain's screening tool (DQST) was developed. This could also be used to facilitate clinical diagnosis and management in practice. Aims:,To provide evidence for the content and construct validity and test,retest and inter-rater reliability of the DQST. Method:,The study was conducted in an acute care, outpatient hand unit in a district general hospital. Three convenience samples of: 59 people with de Quervain's disease; 18 with carpal tunnel syndrome (CTS) and 16 with osteoarthritis (OA) of the carpometacarpal (CMC) joint were recruited. The DQST diagnostic criteria were initially generated from a literature review. Content validity was then established by expert doctors with an interest in upper limb musculoskeletal disorders (n = 7) rating the relevance of the seven items included. The DQST was then tested in people either already diagnosed with, or reported as having some of the symptoms of, de Quervain's disease. Construct validity was tested with people with CTS or OA of the CMC joint. Results:,The median DQST score was 5 (Interquartile range IQR = 4,6) out of a possible seven diagnostic criteria. Inter-rater reliability was excellent (Intra-class coefficient [ICC] = 0.85; 95% confidence interval [CI] = 0.75, 0.91). Test retest reliability was good (ICC = 0.64; 95% CI = 0.20, 0.87). Sensitivity (Se) and specificity (Sp) testing (Se = 1.00; Sp = 1.00) demonstrated that the DQST discriminated between people with de Quervain's disease, CTS or OA of the CMC joint. Conclusions:,The DQST is a valid, reliable tool which could be of assistance in aiding correct diagnosis for recruitment to clinical trials and in clinical practice. Future research is recommended to further examine retest reliability with a larger sample size and to identify the commonest diagnostic criteria required for inclusion. Copyright © 2008 John Wiley & Sons, Ltd. [source] Ultrasound assessment of large joint amyloidosis in haemodialysisNEPHROLOGY, Issue 1-2 2000Marc Lanteri SUMMARY: Dialysis-related amyloidosis (DRA), associated with beta-2 microglobulin deposition, is a common cause of morbidity in patients with renal failure undergoing chronic dialysis. The non-invasive diagnosis of DRA in its early stages is difficult. High resolution ultrasound (US) was used to examine the shoulder, hip and knee joints of 25 chronic haemodialysis patients, and features distinctive of DRA were determined. Distinctive US features were associated with increased total duration of dialysis (15 ± 5 vs 4 ± 2 years), carpal tunnel syndrome (9/10 cases) and shoulder joint discomfort (19 vs three joints). These features include altered rotator cuff echogenicity (hyperechoic and hypoechoic areas; 20/48 joints), hypoechoic material in the biceps sheath (16/48), erosions of bone (15/48) and reduced biceps tendon fibril echogenicity (12/48). These changes are unique in the experience of the current authors, but histological proof that they are definitely the result of DRA has not yet been possible. Tears of the rotator cuff tendons (14/50) were not consistently associated with symptoms (7/14). Tendon thickness was also increased (as has been described previously). The hip capsule thickness was increased in patients with signs of DRA in the shoulder, but no specific changes in texture were seen. Asymptomatic knee joint effusions were present in 40/50 joints (80%). These features detectable on high resolution US allow the non-invasive early detection of DRA and are useful in the diagnosis and management of this condition. [source] Pyridoxine Hydrochloride Treatment of Carpal Tunnel Syndrome: A ReviewNUTRITION REVIEWS, Issue 3 2004Elaine Aufiero M.D. It has been hypothesized that idiopathic carpal tunnel syndrome (CTS) is a manifestation of vitamin B6 deficiency. Some claim that B6 supplementation can alleviate symptoms. Others argue that pain relief occurs because of vitamin B6's anti-nociceptive properties or because B6 supplementation addresses an unrecognized peripheral neuropathy. Few studies on CTS and B6 employed electrodiagnostic techniques in diagnosis, and few showed a correlation between symptoms and improved electrodiagnostic parameters with supplementation. Other studies failed to measure or estimate B6 levels. Nevertheless, it appears reasonable to recommend vitamin B6 supplementation to people with CTS. Some patients will improve symptomatically with low risks of toxicity in recommended doses. [source] Axillary brachial plexus block with patient controlled analgesia for complex regional pain syndrome type I: a case report. (National Cheng Kung University, Tainan, Taiwan) Reg Anesth Pain Med 2001;26:68,71.PAIN PRACTICE, Issue 4 2001Li-Kai Wang A 32-year-old man who suffered from complex regional pain syndrome type I (CRPS I) of the right upper limb after surgical release of carpal tunnel syndrome of the right hand is the subject of this case report. Symptoms and signs over the right hand were alleviated under rehabilitation and conventional pharmacological management, but severe painful swelling of the right wrist persisted. Axillary brachial plexus block (BPB) with patient controlled analgesia (PCA) was performed on the 32nd postoperative day, which soon resulted in significant reduction of pain with gradual improvement of function of the right wrist. Conclude that axillary BPB with PCA may provide patients with CRPS I of the upper limb a feasible and effective treatment. [source] Work-related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost workAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009William E. Daniell MD Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability. Methods This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n,=,8,224) filed during 1990,1994 (followed through 2000) and receiving lost-work compensation. Results Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P,<,0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery. Conclusions There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution. Am. J. Ind. Med. 52:931,942, 2009. © 2009 Wiley-Liss, Inc. [source] Variations in diagnostic criteria for carpal tunnel syndrome among Ontario specialists,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2006Brent Graham MD, FRCSC Abstract Background Variations in diagnostic criteria for carpal tunnel syndrome (CTS) may result in differing reports of disease prevalence, errors in diagnosis, and variable results of treatment. The objective of this study was to determine how consistent specialists are in their ratings of the importance of clinical criteria for the diagnosis of CTS. Methods Three hundred specialist physicians and surgeons received a questionnaire containing 57 clinical criteria for the diagnosis of CTS. A visual analog scale (VAS) was used to rate the importance of each criterion in the diagnosis of CTS. Results The overall consistency both across and within specialties was poor (intraclass correlation coefficient across specialties (ICC),=,0.28; ICC range within specialties 0.27,0.37). Conclusions Specialists are relatively inconsistent in the importance they assign to clinical criteria for the diagnosis of CTS. This inconsistency may be an important source of variation in the reported prevalence and treatment of CTS. Am. J. Ind. Med. 49:8,13, 2006. © 2005 Wiley-Liss, Inc. [source] Work-related carpal tunnel syndrome in Washington State workers' compensation: Temporal trends, clinical practices, and disabilityAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2005William E. Daniell MD Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of disability. There is a need for information about temporal trends, clinical practices, and treatment outcomes. Methods A population based, retrospective cohort study of Washington State workers' compensation claims for CTS was initiated focusing on claims filed during 1990,1994, followed through 2000 (n,=,16,710). Results Half of the claims were filed for conditions other than CTS, but were eventually identified to be or include CTS. The first CTS diagnosis occurred more than 3 months after claim filing in 20% of claims. The longer that the CTS diagnosis occurred after claim filing, the more likely that CTS was accompanied by other problems, and disability tended to be longer. Conclusions Making an accurate diagnosis of CTS and initiating appropriate actions earlier than might otherwise occur could reduce the disability and costs in a large fraction of claims that are ultimately determined to involve CTS. © 2005 Wiley-Liss, Inc. [source] Work-related carpal tunnel syndrome (WR-CTS) in Massachusetts, 1992,1997: Source of WR-CTS, outcomes, and employer intervention practices,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2004Helen Wellman MS Abstract Background The Massachusetts Sentinel Event Notification System for Occupational Risks (MASS SENSOR) receives reports of work-related carpal tunnel syndrome (WR-CTS) cases from (1) workers' compensation (WC) disability claims for 5 or more lost work days; and (2) physician reports (PR). Methods From 1992 through 1997, 1,330 WC cases and 571 PR cases completed follow-back surveys to provide information on industry, occupation, attributed source of WR-CTS, outcomes, and employer intervention practices. Results Sixty-four percent of the respondents had bilateral CTS and 61% had surgery, both of which were proportionally more frequent among WC cases. Office and business machinery was the leading source of WR-CTS (42% of classifiable sources) in every economic sector except construction, followed by hand tools (20%). Managers and professional specialty workers were the most likely to report employers' interventions and were up to four times more likely to report equipment or work environment changes than higher risk groups. Conclusions State-based surveillance data on the source of WR-CTS provided valuable information on how and where to implement interventions. New occurrences of WR-CTS are likely, especially in the highest risk industries where very few cases reported primary prevention measures (e.g., changes to equipment or work environment) implemented by their employers. Am. J. Ind. Med. 45:139,152, 2004. © 2004 Wiley-Liss, Inc. [source] Carpal tunnel syndrome among apprentice construction workers,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2002John C. Rosecrance PT Abstract Background In terms of lost-work time and restricted workdays, surgery, and rehabilitation, one of the most costly occupational musculoskeletal disorders is carpal tunnel syndrome (CTS). The purpose of this study was to determine the prevalence of CTS among apprentice construction workers. Methods This cross-sectional study included apprentices from four construction trades. Apprentices completed a self-administered questionnaire and received electrophysiologic studies assessing median nerve function across the carpal tunnel. A surveillance case definition for CTS was based on characteristic hand symptoms and the presence of median mononeuropathy across the carpal tunnel. Results Of the 1,325 eligible apprentices, 1,142 (86.2%) participated in the study. The prevalence of CTS among apprentices was 8.2%; sheet metal workers had the highest rate (9.2%). In operating engineers, the prevalence of CTS was significantly higher (OR,=,6.9; 95% CI,=,2.6,18.2) among the heavy equipment mechanics than the drivers of those vehicles. Body mass index, age, and self-reports of working overhead were associated with prevalent CTS. Less than 15% of the apprentices with CTS sought medical attention for their disorder. Conclusions Many construction workers begin developing CTS before or during their apprenticeship. Few apprentices seek medical attention for hand symptoms characteristic of CTS. The results of this study indicate a public health need for the implementation of prevention strategies for CTS in the construction industry. Am. J. Ind. Med. 42:107,116, 2002. © 2002 Wiley-Liss, Inc. [source] When exactly can carpal tunnel syndrome be considered work-related?ANZ JOURNAL OF SURGERY, Issue 3 2002Sonja Falkiner Background: Carpal tunnel syndrome (CTS), compression of the median nerve at the wrist, is the most frequently encountered peripheral entrapment neuropathy. Whilst rates of all other work-related conditions have declined, the number of work-related musculoskeletal disorders (which include CTS) has not changed for the past 9 years in the USA. Median days off work are also highest for CTS: 27 compared to 20 for fractures and 18 for amputations. This results in enormous Workers Compensation and other costs to the community. Awareness of CTS as a disorder associated with repeated trauma at work is now so widespread amongst workers that many have diagnosed themselves before being medically assessed, often by means of the Internet. Surprisingly, however, a definite causal relationship has not yet been established for most occupations. Although the quality of research in this area is generally poor, CTS research studies are being used as the basis for acceptance of Workers Compensation claims, substantial expensive ergonomic workplace change and even workplace closures. The fact that the incidence of work-related musculoskeletal disorders has not changed despite these latter measures would suggest that a causal relationship is not proven and that some resources are being misdirected in CTS prevention and treatment. Method: A literature review of 64 articles on CTS was conducted. This included those articles most frequently cited as demonstrating the relationship between CTS and work. Results: Primary risk factors in the development of CTS are: being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake. In most cases, work acts as the ,last straw' in CTS causation. Conclusion: Except in the case of work that involves very cold temperatures (possibly in conjunction with load and repetition) such as butchery, work is less likely than demographic and disease-related variables to cause CTS. To label other types of work as having caused CTS, therefore, would result in inappropriate allocation of resources. It would also relieve individuals of the responsibility of addressing correctable lifestyle factors and treatable illnesses such as obesity, diabetes, smoking and increased alcohol intake which may have contributed to their CTS more that their work. This results in both avoidable long-term health effects and ongoing costs to the community. [source] The significance of second lumbrical-interosseous latency comparison in the diagnosis of carpal tunnel syndromeACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009A. A. Argyriou Aim,,, To assess the significance of the second lumbrical-interosseous latency (2LI-DML) comparison in the diagnosis of carpal tunnel syndrome (CTS). Patients and methods,,, We examined 150 consecutive hands of patients referred with suspected CTS, using the 2LI-DML test and other standard measures of median nerve function. Correlations of the 2LI-DML test with standard tests were computed. Results,,, Hundred and four hands were electrophysiologically confirmed to have CTS. The 2LI-DML test was abnormal in 99/104 (95.2%) hands with CTS with a mean value of 1.54 ± 1.12 ms. Among the other measures, the orthodromic median,ulnar palmar velocity comparison was the most frequently abnormal test (95/104 hands, 91.3%), followed by the double-peak morphology of orthodromic sensory action potential from digit 4 (94/104, 90.4%). The 2LI-DML test significantly correlated, either positively or negatively, with all other standard tests. Conclusion,,, The 2LI-DML comparison is highly sensitive in diagnosing CTS, even in mild cases in which standard tests fail to detect abnormalities. [source] Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled studyACTA NEUROLOGICA SCANDINAVICA, Issue 1 2009M. V. De Angelis Objective,,, To examine, in a randomized, controlled, single blinded trial, the efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome (CTS). Methods,,, We randomized 120 patients with CTS into a group wearing the soft hand brace MANU® and into another group wearing the wrist splint CAMP TIELLE® at night for 3 months. We re-evaluated the patients after 3 (T1) and 9 months (T2). The primary efficacy measures were changes in scores of Boston Carpal Tunnel Questionnaire (BCTQ) and in Visual Analogical Scale (VAS) for pain and paresthesias. Results,,, At T1, both groups showed a significant reduction in symptomatic and functional BCTQ (T0,T1 differences: MANU® BCTQ sympt: 0.88 (0.68,1.08), funct: 0.45 (0.19,0.72); TIELLE® BCTQ sympt: 0.78 (0.55,1.01), funct: 0.41 (0.22,0.59). At T2, a less evident benefit on symptoms persisted in both groups, except for pain VAS score that was significantly reduced only in the CAMP TIELLE® group. No significant functional benefits persisted in either group. There were no differences in BCTQ and VAS scores between the two groups at T1 and T2 compared with that at baseline. Conclusions,,, A 3-month treatment with either the hand brace or the wrist splint induces a symptomatic and functional benefit in patients with CTS. [source] A prospective study of aromatase inhibitor-associated musculoskeletal symptoms and abnormalities on serial high-resolution wrist ultrasonographyCANCER, Issue 18 2010N. Lynn Henry MD Abstract BACKGROUND: Nearly half of women treated with aromatase inhibitors (AI) develop AI-associated musculoskeletal symptoms (AIMSS) such as arthralgias, but to the authors' knowledge the etiology is unclear. The upper extremities are frequently affected, especially the wrists, hands, and fingers. AI use may also increase the risk of developing carpal tunnel syndrome. Tendon sheath fluid and tenosynovial changes have been demonstrated by imaging symptomatic patients who were treated with AIs. The authors hypothesized that these abnormalities are correlated with AIMSS. METHODS: Thirty consecutive patients in whom adjuvant therapy with letrozole or exemestane was initiated on a prospective clinical trial enrolled in a pilot study evaluating tendon and joint abnormalities at baseline and after 3 months of AI therapy. Patients underwent high-resolution ultrasonography of the wrists bilaterally and completed the Health Assessment Questionnaire (HAQ) and pain Visual Analog Scale (VAS). AIMSS were defined as an increase in the HAQ or VAS score during AI therapy that exceeded a predefined cutoff. RESULTS: Twenty-five patients completed both the baseline and 3-month assessments. During the first 12 months of AI therapy, 15 patients developed AIMSS, and 13 discontinued therapy because of musculoskeletal symptoms. There was a trend toward an association between the presence of tendon sheath abnormalities on wrist ultrasound at baseline and the development of AIMSS (P = .06). CONCLUSIONS: Clinically relevant musculoskeletal symptoms develop in women treated with AIs, leading to treatment discontinuation in a substantial percentage of these patients. However, in the current study, patient-reported symptoms were not found to be associated with changes visible on wrist ultrasonography. Cancer 2010. © 2010 American Cancer Society. [source] | |||||||||||||