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American Family Physician Dec 2016Carpal tunnel syndrome, the most common entrapment neuropathy of the upper extremity, is caused by compression of the median nerve as it travels through the carpal... (Review)
Review
Carpal tunnel syndrome, the most common entrapment neuropathy of the upper extremity, is caused by compression of the median nerve as it travels through the carpal tunnel. Classically, patients with the condition experience pain and paresthesias in the distribution of the median nerve, which includes the palmar aspect of the thumb, index and middle fingers, and radial half of the ring finger. Additional clues include positive physical examination findings, such as the flick sign, Phalen maneuver, and median nerve compression test. Although patients with typical symptoms and signs of carpal tunnel syndrome do not need additional testing, ultrasonography and electrodiagnostic studies are useful to confirm the diagnosis in atypical cases and rule out other causes. If surgical decompression is planned, electrodiagnostic studies should be obtained to determine severity and surgical prognosis. Conservative treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome. Options include splinting, corticosteroids, physical therapy, therapeutic ultrasound, and yoga. Nonsteroidal anti-inflammatory drugs, diuretics, and vitamin B6 are not effective therapies. Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year. Patients with severe carpal tunnel syndrome or whose symptoms have not improved after four to six months of conservative therapy should be offered surgical decompression. Endoscopic and open techniques are equally effective, but patients return to work an average of one week earlier with endoscopic repair.
Topics: Adrenal Cortex Hormones; Carpal Tunnel Syndrome; Decompression, Surgical; Disease Management; Humans; Immobilization; Injections; Neural Conduction; Physical Examination; Physical Therapy Modalities; Splints; Ultrasonic Therapy; Ultrasonography
PubMed: 28075090
DOI: No ID Found -
Best Practice & Research. Clinical... Jun 2015Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance'... (Review)
Review
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance' symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed.
Topics: Carpal Tunnel Syndrome; Humans; Occupational Diseases; Occupational Exposure; Risk Factors; Work Capacity Evaluation
PubMed: 26612240
DOI: 10.1016/j.berh.2015.04.026 -
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 -
Clinics in Orthopedic Surgery Sep 2014With advancement in biomechanical and biological research on idiopathic carpal tunnel syndrome, the insight on the pathophysiology of carpal tunnel syndrome has gained... (Review)
Review
With advancement in biomechanical and biological research on idiopathic carpal tunnel syndrome, the insight on the pathophysiology of carpal tunnel syndrome has gained much clinical relevance. Open carpal tunnel release is still a gold standard procedure for carpal tunnel syndrome, which has evolved into mini-open procedure with development of new devices. Endoscopic carpal tunnel release has become popular in recent practice of hand surgery with an advantage of early recovery of hand function with minimal morbidity. However, endoscopic carpal tunnel release has its own limitation such as long learning curve with obvious surgical risk reported in the literature. In this review article, various treatment protocols for idiopathic carpal tunnel syndrome are presented with special highlight on endoscopic carpal tunnel release, which is gaining popularity in current practice.
Topics: Carpal Tunnel Syndrome; Endoscopy; Humans; Treatment Outcome
PubMed: 25177448
DOI: 10.4055/cios.2014.6.3.253 -
Neurosciences (Riyadh, Saudi Arabia) Jan 2015Carpal tunnel syndrome (CTS) is the most common median nerve neuropathy, accounting for 90% of all neuropathies. Carpal tunnel syndrome presents in 3.8% of the general... (Review)
Review
Carpal tunnel syndrome (CTS) is the most common median nerve neuropathy, accounting for 90% of all neuropathies. Carpal tunnel syndrome presents in 3.8% of the general population, with a higher prevalence among women. There are several risk factors associated with CTS, including both medical and non medical factors. The pathophysiologic mechanisms involved in the median nerve compression and traction are thought to be complex, and as yet are not fully understood. The present review aimed to provide an overview of the pathophysiology of median nerve neuropathy in the carpal tunnel, and subsequent development of CTS.
Topics: Carpal Tunnel Syndrome; Humans; Median Nerve; Neural Conduction; Peripheral Nerve Injuries; Prevalence; Sex Factors
PubMed: 25630774
DOI: No ID Found -
The Ulster Medical Journal Jan 2008Carpal tunnel syndrome is one of the most common peripheral neuropathies. It affects mainly middle aged women. In the majority of patients the exact cause and... (Review)
Review
Carpal tunnel syndrome is one of the most common peripheral neuropathies. It affects mainly middle aged women. In the majority of patients the exact cause and pathogenesis of CTS is unclear. Although several occupations have been linked to increased incidence and prevalence of CTS the evidence is not clear. Occupational CTS is uncommon and it is essential to exclude all other causes particularly the intrinsic factors such as obesity before attributing it to occupation. The risk of CTS is high in occupations involving exposure to high pressure, high force, repetitive work, and vibrating tools. The classic symptoms of CTS include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand. There are several physical examination tests that will help in the diagnosis of CTS but none of these tests are diagnostic on their own. The gold standard test is nerve conduction studies. However, they are also associated with false positive and false negative results. The diagnosis of CTS should be based on history, physical examination and results of electrophysiological studies. The patient with mild symptoms of CTS can be managed with conservative treatment, particularly local injection of steroids. However, in moderate to severe cases, surgery is the only treatment that provides cure. The basic principle of surgery is to increase the volume of the carpal tunnel by dividing transverse carpal ligament to release the pressure on the median nerve. Apart from early recovery and return to work there is no significant difference in terms of early and late complications and long-term pain relief between endoscopic and open carpal tunnel surgery.
Topics: Adrenal Cortex Hormones; Carpal Tunnel Syndrome; Humans; Median Nerve; Neural Conduction; Occupational Diseases; Pain; Paresthesia; Risk Factors
PubMed: 18269111
DOI: No ID Found -
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 -
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 -
Joint Bone Spine Oct 2018Carpal tunnel syndrome is the most common nerve entrapment syndrome. The majority of cases are due to compression or irritation of the median nerve in the carpal canal.... (Review)
Review
Carpal tunnel syndrome is the most common nerve entrapment syndrome. The majority of cases are due to compression or irritation of the median nerve in the carpal canal. It is diagnosed clinically, often being confirmed by an electromyogram, while ultrasonography criteria have become increasingly useful for the diagnosis. Ultrasonography is better tolerated, less expensive, yet just as effective as other diagnostic methods. It provides a good indication of the severity of the condition and it allows anatomical variants to be discerned. In light of this, for a number of medical professionals it is the first-line examination. In terms of therapeutic use, ultrasound can be used to guide infiltrations. In case medical treatment is unsuccessful, release by transection of the flexor retinaculum is generally done surgically as an open procedure or by endoscopy. A new minimally invasive percutaneous treatment to release the nerve based on ultrasonography guided or ultrasound surgery appears to be a promising alternative, however, to conventional open surgery or endoscopic treatments.
Topics: Carpal Tunnel Syndrome; Decompression, Surgical; Electromyography; Female; Humans; Male; Prognosis; Recovery of Function; Severity of Illness Index; Surgery, Computer-Assisted; Treatment Outcome; Ultrasonography, Interventional
PubMed: 29154980
DOI: 10.1016/j.jbspin.2017.11.003 -
The Israel Medical Association Journal... Jul 2023
Topics: Humans; Carpal Tunnel Syndrome
PubMed: 37461179
DOI: No ID Found