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Folia Morphologica 2022Carpal tunnel syndrome is the most common peripheral nerve entrapment encountered worldwide. The aetiology can be related to repetitive exposure to vibrations or...
Carpal tunnel syndrome is the most common peripheral nerve entrapment encountered worldwide. The aetiology can be related to repetitive exposure to vibrations or forceful angular motions, genetic predisposition, injury and specific conditions, such as diabetes, pregnancy and morbid obesity. This entity is observed with increased frequency in females and the elderly. The diagnosis is largely clinical and suspected when patients present with typical symptoms such as numbness, tingling, nocturnal paraesthesia and/or neuritic "pins-and-needles" pain in the radial 3.5 digits. Certain provocative manoeuvres can be employed to evoke the symptoms of the disease to guide the diagnosis. Further testing such as electrodiagnostic studies, ultrasound or magnetic resonance imaging is required in the case of diagnostic uncertainty or if there is a need for objective evaluation whether or not more invasive surgical intervention is required. If the presenting symptoms are mild and discontinuous, non-surgical measures are indicated. However, if the symptoms are moderate to severe, further testing modalities such as nerve conduction studies or needle electromyography are used to determine whether carpal tunnel syndrome is acute or chronic. If significant evidence of axonal injury is identified, surgical treatment may be indicated. Surgical release of the carpal tunnel has evolved over time to become the most common hand surgery procedure.
Topics: Female; Humans; Aged; Carpal Tunnel Syndrome; Wrist; Ultrasonography; Magnetic Resonance Imaging; Median Nerve
PubMed: 34783004
DOI: 10.5603/FM.a2021.0121 -
Journal of Hand Therapy : Official... 2020Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome worldwide. There are limited studies on the effectiveness of carpal ligament stretching on... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome worldwide. There are limited studies on the effectiveness of carpal ligament stretching on symptomatic and electrophysiologic outcomes.
PURPOSE OF THE STUDY
The purpose of this study was to evaluate the effect of self-myofascial stretching of the carpal ligament on symptom outcomes and nerve conduction findings in persons with CTS.
STUDY DESIGN
This is a prospective, double-blinded, randomized, placebo-controlled trial.
METHODS
Eighty-three participants diagnosed with median mononeuropathy across the wrist by nerve conduction study were randomized 1:1 to sham treatment or self-carpal ligament stretching. Participants were instructed to perform the self-treatment four times a day for six weeks. Seventeen participants in the sham treatment group and 19 participants in the carpal ligament stretching group completed the study. Pre- and post-treatment outcome measures included subjective complaints, strength, nerve conduction findings, and functional scores.
RESULTS
Groups were balanced on age, sex, hand dominance, symptom duration, length of treatment, presence of nocturnal symptoms, and compliance with treatment. Even though the ANOVA analyses were inconclusive about group differences, explorative post hoc analyses revealed significant improvements in numbness (P = .011, Cohen's d = .53), tingling (P = .007, Cohen's d = .60), pinch strength (P = .007, Cohen's d = -.58), and symptom severity scale (P = .007, Cohen's d = .69) for the treatment group only.
CONCLUSIONS
The myofascial stretching of the carpal ligament showed statistically significant symptom improvement in persons with CTS. Larger comparative studies that include other modalities such as splinting should be performed to confirm the effectiveness of this treatment option.
Topics: Adult; Aged; Carpal Tunnel Syndrome; Double-Blind Method; Female; Hand Strength; Humans; Ligaments, Articular; Male; Median Nerve; Middle Aged; Muscle Stretching Exercises; Neural Conduction; Prospective Studies; Self Care; Symptom Assessment; Treatment Outcome
PubMed: 32362377
DOI: 10.1016/j.jht.2019.12.002 -
BioMed Research International 2022Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce.
OBJECTIVE
To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status.
METHODS
A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3 and 6 weeks.
RESULTS
Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group.
CONCLUSIONS
The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.
Topics: Carpal Tunnel Syndrome; Humans; Median Nerve; Pain; Physical Therapy Modalities; Surveys and Questionnaires
PubMed: 35782066
DOI: 10.1155/2022/2155765 -
Intensive Care Medicine Jun 2023Severe traumatic brain injury (TBI) leads to acute coma and may result in prolonged disorder of consciousness (pDOC). We aimed to determine whether right median nerve... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Severe traumatic brain injury (TBI) leads to acute coma and may result in prolonged disorder of consciousness (pDOC). We aimed to determine whether right median nerve electrical stimulation is a safe and effective treatment for accelerating emergence from coma after TBI.
METHODS
This randomised controlled trial was performed in 22 centres in China. Participants with acute coma at 7-14 days after TBI were randomly assigned (1:1) to either routine therapy and right median nerve electrical stimulation (RMNS group) or routine treatment (control group). The RMNS group received 20 mA, 300 μs, 40 Hz stimulation pulses, lasting 20 s per minutes, 8 h per day, for 2 weeks. The primary outcome was the proportion of patients who regained consciousness 6 months post-injury. The secondary endpoints were Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness scale (FOUR), Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE) scores reported as medians on day 28, 3 months and 6 months after injury, and GCS and FOUR scores on day 1 and day 7 during stimulation. Primary analyses were based on the intention-to-treat set.
RESULTS
Between March 26, 2016, and October 18, 2020, 329 participants were recruited, of whom 167 were randomised to the RMNS group and 162 to the control group. At 6 months post-injury, a higher proportion of patients in the RMNS group regained consciousness compared with the control group (72.5%, n = 121, 95% confidence interval (CI) 65.2-78.7% vs. 56.8%, n = 92, 95% CI 49.1-64.2%, p = 0.004). GOSE at 3 months and 6 months (5 [interquartile range (IQR) 3-7] vs. 4 [IQR 2-6], p = 0.002; 6 [IQR 3-7] vs. 4 [IQR 2-7], p = 0.0005) and FOUR at 28 days (15 [IQR 13-16] vs. 13 [interquartile range (IQR) 11-16], p = 0.002) were significantly increased in the RMNS group compared with the control group. Trajectory analysis showed that significantly more patients in the RMNS group had faster GCS, CRS-R and DRS improvement (p = 0.01, 0.004 and 0.04, respectively). Adverse events were similar in both groups. No serious adverse events were associated with the stimulation device.
CONCLUSION
Right median nerve electrical stimulation is a possible effective treatment for patients with acute traumatic coma, that will require validation in a confirmatory trial.
Topics: Humans; Coma, Post-Head Injury; Coma; Median Nerve; Brain Injuries, Traumatic; Glasgow Coma Scale; Electric Stimulation
PubMed: 37178149
DOI: 10.1007/s00134-023-07072-1 -
Journal of Ultrasound Sep 2020Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of peripheral nerves, with an incidence of 1-3 patients in 1000. CTS typically occurs between 45... (Review)
Review
Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of peripheral nerves, with an incidence of 1-3 patients in 1000. CTS typically occurs between 45 and 60 years of age, and it is more frequent in women than in men. The main cause of CTS is chronic compression of the median nerve and ischemic suffering secondary to increased pressure in the carpal tunnel. There are many possible causes of CTS, which can be differentiated into idiopathic causes, which include most cases, and secondary causes. Classical CTS diagnosis is based on the patient's clinical examination and electrophysiological tests, such as electromyography and nerve conduction studies. The latter are helpful for determining the site of nerve compression, assessing its severity, monitoring the course of the disease after therapy, and excluding other causes of median nerve pain, such as cervical radiculopathies, brachial plexopathies, polyneuropathy, or other forms of mononeuropathies. However, clinical examination and electrophysiological tests are not able to differentiate idiopathic forms from secondary forms of CTS, and discrepancies are possible between clinical examination and electrophysiological tests (false negatives). Ultrasound examination is able to recognize most of the secondary forms of CTS. It can evaluate the morphological alterations of the nerve and correlate them with the severity of nerve suffering in all cases, even idiopathic ones, with a sensitivity and specificity equal to those of electrophysiological tests. It can also highlight some anatomical predisposing variants or conditions that may represent contraindications to minimally invasive treatments. Ultrasound examination also plays a fundamental role in evaluating patients with an unfavorable outcome after surgical treatment.
Topics: Carpal Tunnel Syndrome; Humans; Median Nerve; Ultrasonography
PubMed: 32323256
DOI: 10.1007/s40477-020-00460-z -
Journal of the Belgian Society of... Sep 2020The Kiloh-Nevin Syndrome is a rare entrapment syndrome of the median nerve, with a distinct muscle edema pattern of the forearm.
The Kiloh-Nevin Syndrome is a rare entrapment syndrome of the median nerve, with a distinct muscle edema pattern of the forearm.
PubMed: 32964190
DOI: 10.5334/jbsr.2183 -
Ugeskrift For Laeger Dec 2023This is a case report of a four-year-old boy who suffered a forearm fracture managed with closed reduction and casting for six weeks. Postoperatively, the patient showed...
This is a case report of a four-year-old boy who suffered a forearm fracture managed with closed reduction and casting for six weeks. Postoperatively, the patient showed symptoms of median nerve affection which was misinterpreted as neuropraxia. Ultrasonography of the forearm revealed that the median nerve was trapped in the radius fracture site. The patient underwent a second operation with neurolysis and nerve grafting. This case report highlights the use of ultrasonography in the diagnostics of nerve entrapment neuropathy.
Topics: Male; Child; Humans; Child, Preschool; Forearm; Ulna Fractures; Median Neuropathy; Radius Fractures; Nerve Compression Syndromes
PubMed: 38105734
DOI: No ID Found -
Hawai'i Journal of Health & Social... Nov 2019Carpal tunnel syndrome costs the United States billions of dollars each year. The majority of patients are industrial workers, females, and the elderly who first present...
Carpal tunnel syndrome costs the United States billions of dollars each year. The majority of patients are industrial workers, females, and the elderly who first present to their primary care physicians. Therefore, it is essential that the primary care physician understand this syndrome in order to diagnose and direct treatment. Here we present a review of the anatomy, pathophysiology, diagnosis, and current treatment of carpal tunnel syndrome that is relevant for the treating primary care physician. In addition, we discuss the role of the primary care physician in the diagnosis, management, and treatment of carpal tunnel syndrome. The aim of this review is to improve the integrated care of those patients suffering from carpal tunnel syndrome.
Topics: Age Factors; Carpal Tunnel Syndrome; Female; Humans; Male; Median Nerve; Middle Aged; Physicians, Primary Care; Practice Guidelines as Topic; Sex Factors; United States
PubMed: 31773104
DOI: No ID Found -
JPMA. the Journal of the Pakistan... Feb 2020To evaluate the effectiveness of a home exercise programme in pregnant patients with carpal tunnel syndrome. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effectiveness of a home exercise programme in pregnant patients with carpal tunnel syndrome.
METHODS
The randomised, single-blind, controlled clinical study was conducted at Vakif University School of Medicine, Istanbul, Turkey, From December 2017 to June 2018 and comprised pregnant women with carpal tunnel syndrome (CTS) . Clinical evaluation of each patient was performed by a blind researcher and (EMG) Electromyography measurements were performed by another blind researcher. Patients were divided into two groups with normal and (mild or moderate) CTS based on EMG results and clinical examination. Patients with symptoms, clinical signs and CTS in EMG were included in group 1, while patients whose symptoms and clinical evaluation (such as Tinel, Phalen, Reverse Phalen and Durkan's test) were positive but not CTS in EMG were included in group 2. Exercise forms were given to both groups and they were asked to perform the exercises stated in the form in 3 sets each day and 10 repetitions in each set. The Sick Boston Carpal Tunnel Syndrome Questionnaire was administered face-to-face to collect data which was analysed using SPSS 22.
RESULTS
Of the 33 subjects, 19(57.6%) were in patient group 1 and 14(42.4%) in control group 2. The overall mean age of the sample was 28.84±3.62 years. There were no significant differences between the groups in terms of symptoms and clinical tests (p>0.05). The symptom severity scale between the groups was significantly high in group 1 (p<0.05). Patients receiving treatment showed a decrease in symptom severity and functional capacity, but only the former showed a significant decrease in group 2 (p>0.05).
CONCLUSIONS
Nerve and tendon slip exercises for patients with mild to moderate carpal tunnel syndrome symptoms were found to be simple and reliable methods that could be applied to patients to increase their functionality and to reduce the severity of the disease.
Topics: Adult; Carpal Tunnel Syndrome; Electrodiagnosis; Electromyography; Exercise Therapy; Female; Humans; Median Nerve; Neural Conduction; Pregnancy; Pregnancy Complications; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Turkey; Young Adult
PubMed: 32063607
DOI: 10.5455/JPMA.1846