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Search Results for : Carpal Tunnel Syndrome
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Carpal tunnel syndrome due to lipofibromatous hamartoma of the median nerve.
Author(s): Afshar, A
Journal: Arch Iran Med 2010 Mar 10; Vol. 13, Issue 1; Page(s) 45-7
[Medline ID - 20039769]

This report describes a rare case of secondary carpal tunnel syndrome due to a lipofibromatous hamartoma of the median nerve. Excision of the fibrofatty tissue between the nerve fascicles without risking damage to the fascicles was impossible. The transverse carpal ligament was incised and an epineurotomy was performed. Within six months, the 25-year-old female patient's symptoms were much improved.

Screening for gastrointestinal, hepatic/biliary, and renal/urologic disease.
Author(s): Goodman, CC
Journal: J Hand Ther 2010 Jul 23; Vol. 23, Issue 2; Page(s) 140-56; quiz 157
[Medline ID - 20036512]

NARRATIVE REVIEW: Many organ systems in the body can demonstrate signs and symptoms of impairment that mimic integumentary, musculoskeletal, and/or neuromuscular conditions commonly evaluated and treated by the hand therapist. In this review, diseases and disorders affecting the gastrointestinal (GI), hepatic/biliary, and renal/urologic systems capable of referring pain and other symptoms to the upper quadrant are presented. Specifically, these organ systems can refer pain to the sternum, neck, shoulder, scapulae, and subscapular and interscapular regions. Symptom referral from the viscera to the elbow and hand is extremely rare. Symptoms of carpal tunnel syndrome/paresthesias can occur in renal disorders and with hepatic/biliary problems. Following the screening model proposed by Goodman and Snyder, potential origins from the GI, hepatic/biliary, and renal/urologic systems are discussed. The goal is to identify patients with referred pain patterns and associated signs and symptoms of conditions that require referral to a physician or other appropriate health care professional. The alert hand therapist will recognize red flag histories, clinical presentation, and risk factors suggesting the need for a more thorough examination to ensure that the patient/client has a condition requiring intervention that is within the scope of the therapist's practice. Screening principles and tips for physician referral are offered. LEVEL OF EVIDENCE: 5.

Carpal tunnel syndrome: associations between risk factors and laterality.
Author(s): Zambelis, T; Tsivgoulis, G; Karandreas, N
Journal: Eur Neurol 2010 Mar 17; Vol. 63, Issue 1; Page(s) 43-7
[Medline ID - 20029215]

AIMS: The investigation of the association between known risk factors and laterality in patients with carpal tunnel syndrome (CTS). Patients and METHODS: 130 consecutive subjects with CTS only, or mainly, in the left hand were compared with 130 consecutive subjects with CTS only, or mainly, in the right hand. The following parameters were recorded: age, sex, job, handedness, hand mainly used in daily activities, BMI, diabetes mellitus, thyroid dysfunction, wrist trauma and connective tissue diseases. RESULTS: A left dominant hand was independently associated with 13-fold higher odds for left-hand CTS, while a right dominant hand had 5-fold higher odds for right-hand CTS. Right-hand CTS was more frequent in younger subjects and females. CONCLUSION: Older age, higher BMI and diabetes mellitus were more prevalent in patients with bilateral CTS. Age and BMI were independently associated with bilateral CTS.

Endoscopically assisted release of the ulnar nerve for cubital tunnel syndrome.
Author(s): Flores, LP
Journal: Acta Neurochir (Wien) 2010 Jun 19; Vol. 152, Issue 4; Page(s) 619-25
[Medline ID - 20024689]

PURPOSE: Recently, the simple decompression of the ulnar nerve has been advocated as the best surgical approach for the treatment of the cubital tunnel syndrome. Encouraged by the positive results observed with the use of the endoscopic approach for the treatment of the carpal tunnel syndrome, there have been reports about the use of endoscopes for decompression of the ulnar nerve at the level of the elbow since 1999. The objective of this study was to demonstrate the surgical results obtained with a simple and replicable technique employed for endoscopic release of the ulnar nerve in cases of cubital tunnel syndrome. METHODS: It was retrospectively studied thirteen patients who presented signs and symptoms of cubital tunnel syndrome and who were operated on by an endoscopically assisted technique, from 2007 to 2009. The approach included the use of a 0 degrees lens neuroendoscope usually employed for ventricular endoscopy. Preoperative clinical and electrophysiological data were collected and compared to those observed 6 months after the surgery. The Dellon's scale was used for rating the severity of the lesions, and the postoperative outcome was assessed based on the Bishop rating system. RESULTS: All procedures were completed successfully via the endoscopically assisted approach, and no surgery had to be converted to an open operation. Postoperatively, 76.9% of the cases were completely free of signs and symptoms (8 and 9 points on the Bishop scale), 15.3% presented with light complaints (7 points), and only one subject (7.6%) reached 5 points on the outcome scale. Complete normalization of the electrophysiological studies was also observed in seven patients, most of whom were classified preoperatively as Dellon's grades I and II, but three of whom were classified as grade III. Normalization of the sensory conduction studies was observed in ten cases, normalization of the motor conduction studies in six subjects, and in four patients, there was improvement in electromyographic parameters. CONCLUSIONS: The endoscopically assisted approach for decompression of the ulnar nerve at the level of the elbow is a minimally invasive technique that demonstrated surgical results similar to those reported via the open approach. It may have additional advantages such as the reduction of soft tissue manipulation, faster mobilization of the arm, and quicker re turn of the patients to their daily activities.

Local corticosteroid treatment for carpal tunnel syndrome: a 6-month clinical and electrophysiological follow-up study.
Author(s): Milo, R; Kalichman, L; Volchek, L; Reitblat, T
Journal: J Back Musculoskelet Rehabil 2010 Apr 7; Vol. 22, Issue 2; Page(s) 59-64
[Medline ID - 20023332]

OBJECTIVE: To evaluate the clinical and electrophysiological effects of local depo-methylprednisolone injection in patients with carpal tunnel syndrome (CTS) over a 6-months period. METHODS: Twenty one patients, of whom 7 were lost for follow-up (mean age 57.9 +/- 8.4) with clinical and electrophysiological evidence of CTS were treated by injection of depo-methylprednisolone 40 mg proximal to the carpal tunnel. Severity of pain (VAS), rates of numbness/paresthesias and nocturnal awakening, motor and sensory nerve conduction studies were used as outcomes. All tests were performed before, 1, 3 and 6 months after the injection. RESULTS: Severity of pain was significantly reduced at all follow-up time points (p < 0.001). Prior to injection all patients complained of night pain and awakening. On the first, third and sixth months, 0(0%), 4 (29%) and 7 (50%) of the patients, respectively, had night awakening. All patients complained of numbness before the treatment. This symptom disappeared in 81% of the patients after one month and reappeared in all after three months. Significant improvement was shown in the mean distal motor latency (DML) of the median nerve: 5.2 +/- 0.9 msec. before, 4.6 +/- 0.6 msec. and 4.7 +/- 0.6 msec. 1 and 3 months after the injection, respectively (p < 0.05). Mean values of motor muscle potential amplitudes, sensory latency and sensory amplitude did not change significantly after the treatment. CONCLUSIONS: Local corticosteroid injection for the treatment of CTS provides significant symptom improvement for three months. No electrophysiological parameters were improved after injection, except the improvement in distal motor latency of the median nerve.

Carpal tunnel syndrome: ultrasonographic imaging and pathologic mechanisms of median nerve compression.
Author(s): Sucher, BM
Journal: J Am Osteopath Assoc 2009 Dec 22; Vol. 109, Issue 12; Page(s) 641-7
[Medline ID - 20023220]

Median nerve compression is a well-known cause of carpal tunnel syndrome (CTS). Yet, reasons why the most common idiopathic form of CTS develops in certain individuals are not well understood. To further understand the compressive mechanisms at work in CTS development, the authors used ultrasonographic imaging of the median nerve to evaluate 2 patients with CTS. Findings were compared to those of 2 control subjects who did not have CTS. In the patients who had CTS, the transverse carpal ligament was pulled taut by thenar muscle contraction as the flexor tendons tightened, compressing the median nerve between the ligament and tendons. No such compression was observed with the control subjects. Thus, a pathologic mechanism of median nerve compression was confirmed in the patients with CTS. Demonstration of such pathologic mechanisms during prehensile hand movement may improve understanding of how to treat patients with CTS and prevent nerve injury.

Dynamics of intracarpal tunnel pressure in patients with carpal tunnel syndrome.
Author(s): Goss, BC; Agee, JM
Journal: J Hand Surg Am 2010 May 21; Vol. 35, Issue 2; Page(s) 197-206
[Medline ID - 20022712]

PURPOSE: To measure pressure within the carpal tunnel (intracarpal tunnel pressures) in patients with carpal tunnel syndrome and determine the effect of quantified active hand use on both the magnitude and location of peak pressures, before and after division of the transverse carpal ligament. METHODS: We measured intracarpal tunnel pressures intraoperatively in 12 patients with carpal tunnel syndrome at 5 standardized locations based on the distance between each patient's proximal pisiform and hook of hamate (HH) before endoscopic division of the ligament, using a semiconductor gauge pressure sensor inserted from proximal to distal into the tunnel under fluoroscopic control. At each location, pressure was recorded with fingers extended, fingers flexed, and 50% maximum grip using a grip dynamometer. Additional hand use activities, including maximum key and pulp pinch using a pinch dynamometer, 25% maximum grip, and maximum grip, were performed by a subset of these patients. After ligament division, we measured pressures during the same hand activities at a single location, HH. We analyzed the effect of hand activity, measurement location, and ligament division using repeated measures analysis of variance. RESULTS: Compared with fingers extended (mean pressure, 56 mm Hg), all pinch and grip activities caused significant increases in pressure at HH, with a mean peak pressure of 1151 mm Hg during maximum gr ip. After endoscopic release, pressures decreased significantly at HH for all hand activities. CONCLUSIONS: In patients with carpal tunnel syndrome, intracarpal tunnel pressures during active hand use are substantially greater than previously reported. Peak pressures occur at the HH, where the tunnel is most constricted and the median nerve is most compressed in carpal tunnel syndrome. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Nerve compression activates selective nociceptive pathways and upregulates peripheral sodium channel expression in Schwann cells.
Author(s): Frieboes, LR; Palispis, WA; Gupta, R
Journal: J Orthop Res 2010 May 5; Vol. 28, Issue 6; Page(s) 753-61
[Medline ID - 20014316]

Chronic nerve compression (CNC) injuries, such as carpal tunnel syndrome, are common musculoskeletal conditions that affect patients with debilitating loss of sensory function and pain. Although early detection and treatment are important, our understanding of pain-related molecular mechanisms remains largely unclear. Here we investigate these mechanisms using an animal model for CNC injury. To confirm that CNC injury induces pain, we assessed expression of c-fos, a gene that is rapidly expressed in spinal sensory afferents in response to painful peripheral stimuli, and TNF-alpha and IL-6, two proinflammatory cytokines that are crucial to development of inflammatory-mediated pain. Results show c-fos upregulation 1-2 weeks postinjury in the absence of TNF-alpha or IL-6 expression, indicating increased neural sensitivity without an inflammatory response. This is consistent with previous studies that showed no morphologic evidence of inflammation in the CNC model. Surprisingly, we also found de novo expression of Na(V)1.8, a sodium channel linked to the development of neuropathic pain, in endoneurial Schwann cells following injury. Until now, Na(V)1.8 expression was thought to be restricted to sensory neurons. CNC injury appears to be a unique model of noninflammatory neuropathic pain. Further investigation of the underlying molecular basis could yield promising targets for early diagnosis and treatment.

ğ and colleagues.
Author(s): Pazzaglia, C; Padua, L
Journal: Rheumatol Int 2009 Dec 17
[Medline ID - 20012867]

ABSTRACT NOT AVAILABLE

Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions.
Author(s): Valen, PA; Foxworth, J
Journal: Curr Opin Rheumatol 2010 Apr 20; Vol. 22, Issue 2; Page(s) 194-204
[Medline ID - 20010297]

PURPOSE OF REVIEW: To evaluate recent trials and reviews of physical modalities and conservative treatments for selected upper extremity musculoskeletal conditions for evidence supporting their use. RECENT FINDINGS: Recent evidence suggests that many localized tendinopathies are related more to degenerative than inflammatory processes. With this realization, there is increased emphasis on finding new modalities to treat tendinopathies and other localized musculoskeletal conditions that rely on other than anti-inflammatory mechanisms. Although there is good evidence to support the short-term benefits of corticosteroid injections, convincing evidence in support of other conservative treatments and modalities is generally lacking. Extracorpal shock wave therapy may have significant clinical benefit for calcific tendinitis; however, it requires intravenous sedation in most cases and does not appear to be effective in lateral epicondylitis. The most consistent positive treatment effects for rotator cuff tendinitis were achieved by ultrasound-guided subacromial corticosteroid injection as well as manual therapy in conjunction with therapeutic exercise. SUMMARY: Although there is evidence supporting the use of several different physical modalities and conservative treatments for upper extremity musculoskeletal conditions, there is a strong need for larger, higher quality randomized controlled trials. Although most studies are able to demonstrate short-term benefits, there is a lack of high-quality data demonstrating that these conservative treatments have long-term benefits, particularly, with regard to functional outcomes.
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