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OBJECTIVES: The aim was to examine exposure-response relations between occupational hand exposures and carpal tunnel syndrome (CTS) and to compare the relation between surgery-treated and non-surgery-treated CTS. The secondary aim was to study sex-specific differences in exposure-response relations. METHODS: We conducted a nationwide register-based cohort study of all persons born in Denmark (1945-1994). During follow-up (2010-2013), we identified first-time events of CTS. Occupational hand exposure estimates the year before each follow-up year were obtained by linking individual occupational codes with a job exposure matrix. We used multivariable logistic regression equivalent to discrete survival analysis based on sex and surgery. The excess fraction of cases was calculated. RESULTS: For both sexes, exposure-response relations were found for all occupational hand exposures. Among men, we found ORadj of 3.6 (95% CI 3.2 to 3.8) for hand-related force, 2.9 (95% CI 2.5 to 3.2) for repetitive hand movements, 3.8 (95% CI 2.7 to 5.2) for non-neutral hand posture and 2.5 (95% CI 2.2 to 2.7) for hand-arm vibration in the highest exposure groups. For combined exposure (hand load), ORadj was 3.5 (95% CI 3.1 to 4.0). Slightly higher ORsadj were generally found for surgery-treated CTS compared with non-surgery-treated CTS for both sexes. When comparing sex, somewhat higher ORsadj were found among men. The excess fraction was 42%. CONCLUSIONS: Occupational hand exposures carried a 3-5-fold increased risk of CTS with slightly higher risks for surgery-treated compared with non-surgery-treated CTS. Even though CTS occurs more frequently among women, somewhat higher exposure-response relations were found for men compared with women. In the general working population, a substantial fraction of first-time CTS could be related to occupational hand exposures.
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Síndrome del Túnel Carpiano , Mano , Enfermedades Profesionales , Exposición Profesional , Humanos , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Dinamarca/epidemiología , Masculino , Femenino , Exposición Profesional/efectos adversos , Exposición Profesional/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Adulto , Persona de Mediana Edad , Estudios de Cohortes , Factores Sexuales , Modelos Logísticos , Factores de Riesgo , Sistema de Registros , Vibración/efectos adversos , Trastornos de Traumas Acumulados/epidemiología , Trastornos de Traumas Acumulados/etiología , Postura , Síndrome por Vibración de la Mano y el Brazo/epidemiología , Síndrome por Vibración de la Mano y el Brazo/etiología , AncianoRESUMEN
BACKGROUND: Carpal tunnel syndrome (CTS) is a very common clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the carpal tunnel in the wrist. Direct and indirect costs of CTS are substantial, with estimated costs of two billion US dollars for CTS surgery in the USA alone. Local corticosteroid injection has been used as a non-surgical treatment for CTS for many years, but its effectiveness is still debated. OBJECTIVES: To evaluate the benefits and harms of corticosteroids injected in or around the carpal tunnel for the treatment of carpal tunnel syndrome (CTS) compared to surgery. SEARCH METHODS: We used standard, extensive Cochrane search methods. We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and WHO ICTRP. The latest search was 26 May 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) or quasi-randomised trials of adults with CTS that included at least one comparison group of local corticosteroid injection (LCI) into the wrist and one group of any surgical intervention. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcome was 1. improvement in symptoms at up to three months of follow-up. Our secondary outcomes were 2. functional improvement, 3. improvement in symptoms at greater than three months of follow-up, 4. improvement in neurophysiological parameters, 5. improvement in imaging parameters, 6. improvement in quality of life and 7. ADVERSE EVENTS: We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included seven studies involving 569 'hands' (although two studies had unusable data for quantitative analyses). All studies used a one-time LCI as a comparator, using several different types and doses of corticosteroids. In every study, for both surgery and LCI groups, all our primary and secondary outcomes showed improvement from pre- to post-treatment. However, evidence from the combined analysis was too uncertain for us to draw reliable conclusions for the comparison of surgical treatment versus LCI with respect to our primary outcome of symptom relief at up to three months' follow-up (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) -0.61 to 1.88; I2 = 95%; 5 trials, 305 participants; very low-certainty evidence). Findings with respect to secondary outcome measures of symptom relief at greater than three months' follow-up (SMD 0.94, 95% CI -0.31 to 2.19; I2 = 93%; 4 trials, 235 participants), functional improvement at up to three months' follow-up (SMD -0.11, 95% CI -0.94 to 0.72; I2 = 84%; 3 trials, 215 participants) and functional improvement at greater than three months' follow-up (SMD 0.19, 95% CI -1.22 to 1.59; I2 = 93%; 3 trials, 185 participants) were also uncertain (very low-certainty evidence) and showed no clear advantage for surgery or LCI. Surgery may improve neurophysiology (median nerve distal motor latency) more than LCI (mean difference (MD) 0.87 ms, 95% CI 0.32 to 1.42; I2 = 72%; 3 trials, 162 participants; low-certainty evidence). Evidence for quality of life and adverse events was also uncertain; quality of life (EuroQol-5D-3L) may be slightly improved after LCI than after surgery (the difference may not be clinically important) (MD 0.07, 95% CI 0.02 to 0.12; 1 trial, 38 participants; very low-certainty evidence) and there may be fewer adverse events with LCI than with surgery (risk ratio (RR) 0.34, 95% CI 0.04 to 3.26; 3 trials, 112 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: The evidence comparing LCI to surgery for CTS, either in the short term or up to 12 months' follow-up, is too uncertain for any reliable conclusions to be drawn.
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Corticoesteroides , Sesgo , Síndrome del Túnel Carpiano , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/tratamiento farmacológico , Corticoesteroides/administración & dosificación , Calidad de Vida , Adulto , Fuerza de la Mano , Glucocorticoides/administración & dosificación , Resultado del TratamientoRESUMEN
BACKGROUND: Early diagnosis of cardiac amyloidosis (CA) is crucial due to the promising effect of disease-modifying treatment. This calls for screening strategies to identify CA patients with so-called "red flags", such as carpal tunnel syndrome (CTS). OBJECTIVES: This study aims to assess Troponin-T (TnT) and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) as predictors for CA in patients with a history of surgery for bilateral carpal tunnel syndrome, a population suitable for systematic screening. METHODS: Subjects with a history of surgery for bilateral CTS 5-15 years prior, identified using national registries were investigated for CA as per international recommendations. Sensitivity, specificity, positive and negative predictive values were assessed, and receiver operating curves were generated using logistic regression. RESULTS: Among the 250 participants, 12 were diagnosed with CA, all with wild-type transthyretin amyloidosis. Elevated TnT levels (≥13 ng/L) were found in all CA patients and 25.6% (±2.8) of non-CA patients. The negative predictive value (NPV) of TnT <13 ng/L was 100%. For NT-ProBNP the NPV was 99.1% when age dependent cutoff levels were used. A combination of both biomarkers yielded an NPV of 99.1% and sensitivity of 99.7%. Early disease (Mayo or NAC stage 1) was found in 83% of identified patients with CA. CONCLUSION: This study demonstrates the utility of TnT and NT-ProBNP as negative predictors to exclude CA in a screening population with a history of surgery for CTS.
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Biomarcadores , Síndrome del Túnel Carpiano , Péptido Natriurético Encefálico , Fragmentos de Péptidos , Humanos , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/sangre , Síndrome del Túnel Carpiano/diagnóstico , Péptido Natriurético Encefálico/sangre , Femenino , Masculino , Fragmentos de Péptidos/sangre , Anciano , Persona de Mediana Edad , Biomarcadores/sangre , Amiloidosis/sangre , Amiloidosis/diagnóstico , Amiloidosis/cirugía , Amiloidosis/complicaciones , Troponina T/sangre , Cardiomiopatías/sangre , Cardiomiopatías/diagnóstico , Tamizaje Masivo/métodos , Anciano de 80 o más AñosRESUMEN
INTRODUCTION: The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease. PATIENT CONCERNS: A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand. DIAGNOSES: Left-sided infected wrist arthritis complicating ACTS. INTERVENTIONS: The child received emergency surgery and anti-infective treatment combined with regular rehabilitation. OUTCOMES: During the treatment period, the child's wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited. CONCLUSION: In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.
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Artritis Infecciosa , Síndrome del Túnel Carpiano , Articulación de la Muñeca , Humanos , Masculino , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Niño , Artritis Infecciosa/complicaciones , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Artritis Infecciosa/diagnóstico , Antibacterianos/uso terapéutico , Enfermedad AgudaRESUMEN
OBJECTIVES: To test the hypothesis that weight loss following bariatric surgery is associated with a reduced risk of developing carpal tunnel syndrome (CTS) compared with obese patients who do not undergo bariatric surgery. METHODS: We performed a cohort study using data from the Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery from 2006 to 2019 were propensity score (PS)-matched to up to 2 obese bariatric surgery-free patients ("unexposed patients"). Cox proportional hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CIs) to compare the incidence of CTS among bariatric surgery patients to obese unexposed patients both overall and divided by subgroups of age, sex, bariatric surgery type, and duration of follow-up. RESULTS: In total, 40,619 bariatric surgery patients were PS-matched to 63,540 obese unexposed patients who did not undergo surgery. Bariatric surgery was not associated overall with CTS (HR 0.98, 95% CI 0.91-1.05). There was a 23% decreased risk of CTS incidence observed within >1-3 years after bariatric surgery (HR 0.77, 95% CI 0.68-0.88). Decreased CTS risks were observed among bariatric surgery patients aged 18-34 years (HR 0.87, 95% CI 0.74-1.01) and those who underwent sleeve gastrectomy (HR 0.81, 95% CI 0.63-1.03), but these risks did not reach significance level compared with obese unexposed patients. However, there was a 20% increased CTS risk after 6 years (HR 1.20, 95% CI 1.05-1.36). CONCLUSION: Our results suggest that marked weight does not have a lasting impact on the reduction of CTS incidence.
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Cirugía Bariátrica , Síndrome del Túnel Carpiano , Puntaje de Propensión , Humanos , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/estadística & datos numéricos , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Adulto , Persona de Mediana Edad , Femenino , Masculino , Suecia/epidemiología , Incidencia , Adolescente , Anciano , Adulto Joven , Estudios de Cohortes , Obesidad/epidemiología , Obesidad/complicaciones , Sistema de Registros , Pérdida de Peso , Factores de RiesgoRESUMEN
The prevalence of N. medianus compression neuropathies remains high in clinical practice. The objective was to evaluate modalities of conservative treatments for carpal tunnel syndrome (CTS) focusing on the role of acetylcholinesterase inhibitors. This observational study involved 51 adult outpatients diagnosed with CTS. Patients were observed during routine clinical protocols and we compared two groups of 25 and 26 individuals, with the first group receiving basic therapy for CTS and 20 mg of ipidacrine (Neiromidin®) two or three times a day per os, while the second group received only basic therapy. The condition of all patients was assessed twice, with at least a one-month interval. The parameters evaluated included the Boston Carpal Tunnel Questionnaire (BCTQ); the Disabilities of the Arm, Shoulder, and Hand scale (DASH); and pain intensity on the Numeric Rating Scale (NRS). The mean reduction in DASH score was 12.3 (SD 7.7) in Group 1 and 7.1 (SD 6.3) in Group 2 (p < 0.01). Also, other scores showed statistically significant differences between the two groups: -2.3 vs. -1.0 for NRS, -0.89 vs. -0.44 for SSS, and -0.68 vs. -0.31 for FSS, respectively (p < 0.01). Moreover, these findings correlated positively with the global improvement (CGI-I) between the groups. The addition of ipidacrine to basic therapy led to improved recovery in patients with CTSs of varying severity.
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Síndrome del Túnel Carpiano , Inhibidores de la Colinesterasa , Humanos , Síndrome del Túnel Carpiano/tratamiento farmacológico , Femenino , Masculino , Persona de Mediana Edad , Inhibidores de la Colinesterasa/uso terapéutico , Anciano , Encuestas y Cuestionarios , Adulto , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: Osteoarthritis (OA) is a prevalent degenerative joint disease that significantly impacts quality of life, particularly when affecting the hands. However, whether patients with OA are associated with higher risk of developing upper limb disorders, specifically trigger finger (TF) and carpal tunnel syndrome (CTS), remains unclear. This study aimed to evaluate the risk of upper limb disease in OA patients. PATIENTS AND METHODS: Using the US Collaborative Network, a subset of the TriNetX research network, we identified patients diagnosed with OA and matched them 1:1 with non-OA controls based on propensity scores. Matching covariates included age, sex, race, and comorbidities. The cohort consisted of 1,554,182 patients in each group. The hazard ratio of TF and CTS, as well as related surgical interventions, was assessed over a 5-year follow-up period. RESULTS: Patients with OA had a 1.30-fold increased risk of TF [95% confidence interval (CI)=1.27-1.33] and a 1.50-fold increased risk of CTS (95%CI=1.48-1.53) compared to controls. The hazard ratios for undergoing surgical interventions were 1.61 for TF (95%CI=1.51-1.71) and 1.97 for CTS (95%CI=1.78-2.19). These risks remained significant across various sensitivity analyses and stratifications according to age and sex. CONCLUSION: OA significantly increases the risk of TF and CTS. These findings highlight the need for vigilant monitoring and management of upper limb disorders in OA patients to improve overall patient care and outcomes. Future research is warranted to focus on pathological mechanisms of OA and their impact on upper limb health to develop targeted interventions.
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Síndrome del Túnel Carpiano , Osteoartritis , Puntaje de Propensión , Extremidad Superior , Humanos , Femenino , Masculino , Osteoartritis/epidemiología , Osteoartritis/complicaciones , Osteoartritis/etiología , Persona de Mediana Edad , Anciano , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Extremidad Superior/patología , Estudios de Cohortes , Factores de Riesgo , Trastorno del Dedo en Gatillo/epidemiología , Trastorno del Dedo en Gatillo/etiologíaRESUMEN
An 87-year-old man was referred to our department for evaluation of his dystrophic left fingernails that developed progressively for the past 2 years. His past medical history included hemodialysis for 10 years for chronic renal failure. Examination of his nails revealed xanthonychia, onycholysis, Beau's lines, and marked hyperkeratosis of the nail plate involving all of his left fingernails. However, his right fingernails were not affected (Figure 1). He also had edema of the left hand associated with puffy fingers but without trophic disorders (Figure 2). Mycologic exam-ination with direct microscopy and culture of his affected nails were negative. Antinuclear antibodies (ANAs), Scl-70 (anti-topoisomerase) antibodies, anti-centromere antibodies, and anti-RNA polymerase III antibodies were all negative. Capillaroscopy showed no abnormalities. An X-ray of his left hand showed no bony abnormalities. For the past 5 years, the patient had suffered from paresthesia and numbness on the left hand in the area of the median nerve. Paresthesia, pain, burning, and tingling involved mainly the thumb, plus the index and middle fingers, but not the little finger. Carpal tunnel syndrome (CTS) was suspected. Neurologic examination and electromyography (EMG) confirmed the diagnosis of CTS of the left hand explaining his unilateral onychodystrophy. The patient was then referred to a hand surgeon for his CTS.
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Síndrome del Túnel Carpiano , Dedos , Humanos , Masculino , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/etiología , Anciano de 80 o más Años , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/etiología , Enfermedades de la Uña/patología , Uñas Malformadas/diagnóstico , Uñas Malformadas/etiologíaRESUMEN
Neste episódio da série Por dentro dos HDs, vamos conhecer a Rosenete Gonçalves. Em 16 de maio, ela passou por uma cirurgia de mão no Hospital Dia (HD) Itaim Paulista para tratar uma dor crônica, a síndrome do túnel do carpo.
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Síndrome del Túnel Carpiano , Procedimientos OrtopédicosRESUMEN
BACKGROUND: Reduced longitudinal median nerve gliding is a new promising diagnostic feature in carpal tunnel syndrome (CTS). However, the complexity of existing ultrasound analysis protocols undermines the application in routine clinical practice. AIM: To provide a simple method for assessing longitudinal gliding with ultrasound, without the need for post-hoc image analysis. DESIGN: 1) Retrospective cohort study, validation by external blinded reviewers; 2) proof of concept in body donors. SETTING: 1) Outpatient clinic; 2) anatomy department. POPULATION: The population included 48 patients with idiopathic CTS diagnosed by electrodiagnostic testing and ultrasound, as well as 15 healthy controls. Twelve, non-frozen, non-embalmed body donors were enrolled. METHODS: Longitudinal gliding of the median nerve in the carpal tunnel was visualized in all patients with idiopathic CTS and healthy controls. All ultrasound videos were pseudonymized, equipped with a scale, and randomized. Videos were analyzed by four independent radiologists, all blinded to clinical characteristics. The endpoint was gliding rated as millimeters. Validity of the technique was tested by using speckle tracking software, and in body donors, directly measuring nerve excursion in situ, simultaneously to ultrasound. RESULTS: Gliding differed significantly between controls and patients with CTS, decreasing with incremental CTS severity. A cut-off value of 3.5 mm to identify patients with CTS, yielded 93.8% sensitivity and 93.3% specificity. Intraclass correlation coefficient among senior author and raters was 0.798 (95% CI 0.513 to 0.900, P<0.001), indicating good reliability. Speckle tracking and especially direct validation in body donors correlated well with ultrasound findings. CONCLUSIONS: First, longitudinal median nerve gliding can reliably be assessed using this simple technique without the need for complicated procedures. Second, a decrease in gliding was found with progressive severity of CTS. Reproducibility for measured distances is good among raters. CLINICAL REHABILITATION IMPACT: An easy to apply sonography parameter would bolster the diagnostic ability of specialists in physical medicine and rehabilitation in daily routine.
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Síndrome del Túnel Carpiano , Nervio Mediano , Ultrasonografía , Humanos , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/fisiopatología , Femenino , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Cadáver , Voluntarios Sanos , Reproducibilidad de los ResultadosRESUMEN
INTRODUCTION: Sjögren's syndrome (SS) is a chronic autoimmune disease characterized by lymphocytic infiltrates in the exocrine glands. Carpal tunnel syndrome (CTS) is suggested to be more frequent among SS patients than in the general population. The aim of this study was to seek associations between the CTS and the laboratory and clinical findings of SS patients. METHODS: Fifty patients diagnosed with primary SS (pSS) were examined. Clinical evaluation by a rheumatologist and electrophysiological studies were conducted. Data on laboratory tests results was collected. Control group consisted of 50 sex and age-matched individuals with osteoarthritis (OA). RESULTS: Out of 50 patients in the study group 27 (54%) were diagnosed with CTS. The prevalence of CTS among 50 individuals in the control group was 8%. Among pSS patients with CTS the joint involvement was not more common than in those from the non-CTS group [15 vs. 13 (p = 0.945)]. There was an expected difference in sleep disorders [18 vs. 9 (p = 0.012)] and paresthesia [23 vs. 13 (p = 0.024)]. The major finding was a significant difference in elevated beta2-microglobulin (B2MG) [23 vs. 13 (p = 0.024)]. Other studied factors, suggested in the literature as significant in the pSS-related neuropathy, were not statistically different between the groups. CONCLUSION: Our study confirms that CTS is more prevalent among pSS patients than in the general population and suggests that a new approach is required towards the pathogenesis of this phenomenon. We hypothesize that CTS is more associated with an overall disease activity than joint involvement as such.
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Síndrome del Túnel Carpiano , Síndrome de Sjögren , Microglobulina beta-2 , Humanos , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/epidemiología , Femenino , Microglobulina beta-2/sangre , Persona de Mediana Edad , Masculino , Estudios Prospectivos , Anciano , Adulto , Biomarcadores/sangre , Prevalencia , Estudios de Casos y ControlesRESUMEN
Hydrodissection is becoming increasingly recognized as a treatment for nerve entrapment syndromes in the orthopedic and rehabilitation world. Carpal Tunnel Syndrome (CTS) is the most prevalent nerve entrapment neuropathy, characterized by compression of the median nerve as it passes through the carpal tunnel. Initial management includes NSAIDs and wrist splints, but surgical intervention is often necessary when these measures fail. Ultrasound-guided hydrodissection of the median nerve is both safe and effective and presents a minimally invasive option when first-line treatments fail to provide adequate symptom relief. This case report demonstrates the potential for an alternative approach to analgesia in the Emergency Department (ED) for patients presenting with pain related to CTS. Here we discuss a case of a 26-year-old female presenting with CTS symptoms and her successful treatment with ultrasound-guided hydrodissection in the ED.
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Síndrome del Túnel Carpiano , Servicio de Urgencia en Hospital , Nervio Mediano , Ultrasonografía Intervencional , Humanos , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/terapia , Femenino , Adulto , Ultrasonografía Intervencional/métodos , Nervio Mediano/diagnóstico por imagenRESUMEN
BACKGROUND: Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model. METHODS: Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL. RESULTS: SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R2 = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R2 = 0.996). CONCLUSION: The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction of tunnel pressure and diagnosis of carpal tunnel syndrome.
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Cadáver , Síndrome del Túnel Carpiano , Diagnóstico por Imagen de Elasticidad , Ligamentos Articulares , Presión , Humanos , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/fisiopatología , Diagnóstico por Imagen de Elasticidad/métodos , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , AncianoRESUMEN
OBJECTIVES: In this study, we evaluated the amount of public funds spent on the operative treatment of carpal tunnel syndrome (CTS) in Finland in 2011-2015. DESIGN: A registry-based cost burden study. SETTING: The data were collected in primary and secondary care in both private and public hospitals, covering the whole population of Finland. PARTICIPANTS: We collected the total number of patients with new CTS diagnoses and the total number of patients undergoing surgery from the Care Register for Health Care, Finland's national register. INTERVENTIONS: Open carpal tunnel release (OCTR). OUTCOME MEASURES: We collected the costs of the OCTR procedure from diagnosis-related group prices. The Social Insurance Institution of Finland provided the total amount of euros reimbursed for sick leaves. We then combined the average amount of reimbursed sick leave with our estimated cost of the treatment chain to approximate the average cost per patient. RESULTS: The average amount of public funds used for diagnosing and surgically treating new CTS in 2011-2015 in Finland, including reimbursements for sick leaves, was 2759 per patient in 2015 currency. The average direct procedure cost was 1020. We found no clear trend in total cost per patient, but the proportion of surgically treated patients rose from 63.14% to 73.09%. The total annual cost of these treatments was between 18 128 420 and 22 569 973. CONCLUSIONS: The average amount of public funds used to surgically treat one patient with new CTS in 2011-2015 in Finland was 2759, making the total annual burden 20.7 million.
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Síndrome del Túnel Carpiano , Sistema de Registros , Ausencia por Enfermedad , Humanos , Finlandia , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/economía , Ausencia por Enfermedad/economía , Ausencia por Enfermedad/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Masculino , Femenino , Persona de Mediana EdadRESUMEN
CONTEXT: Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel into the wrist. It is the most common peripheral mononeuropathy and accounts for a large proportion of occupational upper extremity disorders. Teaching is an occupation associated with musculoskeletal disorders. AIMS: This study aimed to investigate the prevalence of CTS symptoms and related risk factors among schoolteachers in Al-Ahsa. SETTINGS AND DESIGN: A cross-sectional study was conducted on schoolteachers in Al-Ahsa, Saudi Arabia, during 2023. SUBJECTS AND METHODS: We distributed the Boston Carpal Tunnel Questionnaire to the teachers' groups through social media in the form of an online questionnaire, and we visited schools to encourage participation. STATISTICAL ANALYSIS USED: Data were analyzed using the Statistical Package for the Social Sciences. P < 0.05 was considered statistically significant. RESULTS: Our study included 619 schoolteachers. The syndrome symptoms were present in 71.1% of individuals, and functional disruption was present in 52.7%. The likelihood of exhibiting the symptoms is increased by being female, not participating in sports, having a chronic illness, writing for more than 4 h, and having symptoms in both hands. CONCLUSIONS: We found a comparatively high percentage (71.1%) of the syndrome symptoms among schoolteachers working in Al-Ahsa, Saudi Arabia, which suggests that any signs of CTS in schoolteachers should be evaluated to ensure proper diagnosis and treatment.
Résumé Contexte:Le syndrome du canal carpien (CTS) est causé par la compression du nerf médian lorsqu'il traverse le canal carpien jusqu'au poignet. Il s'agit de la mononeuropathie périphérique la plus courante et représente une grande proportion des troubles professionnels des membres supérieurs. L'enseignement est une profession associée aux troubles musculo-squelettiques.Objectifs:Dans une étude récente menée à Riyad, il y avait un pourcentage relativement élevé (40,0 %) de symptômes du syndrome chez les enseignants.Paramètres et conception:une étude transversale a été menée auprès d'enseignants à Al-Ahsa, en Arabie Saoudite, en 2023.Sujets et méthodes:nous avons distribué le questionnaire du canal carpien de Boston aux groupes d'enseignants via les médias sociaux sous la forme d'un questionnaire en ligne., et nous avons visité les écoles pour encourager la participation.Analyse statistique utilisée:Les données ont été analysées à l'aide du progiciel statistique pour les sciences sociales. P < 0,05 était considéré comme statistiquement significatif.Résultats:Notre étude a porté sur 619 enseignants. Les symptômes du syndrome étaient présents chez 71,1 % des individus et des troubles fonctionnels étaient présents chez 52,7 %. La probabilité de présenter ces symptômes est augmentée par le fait d'être une femme, de ne pas faire de sport, d'avoir une maladie chronique, d'écrire pendant plus de 4 heures et d'avoir des symptômes dans les deux mains.Conclusions:Nous avons trouvé un pourcentage relativement élevé (71,1 %) de symptômes du syndrome chez les enseignants travaillant à Al-Ahsa, en Arabie Saoudite, ce qui suggère que tout signe de SCC chez les enseignants doit être évalué pour garantir un diagnostic et un traitement appropriés.
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Síndrome del Túnel Carpiano , Enfermedades Profesionales , Maestros , Humanos , Síndrome del Túnel Carpiano/epidemiología , Arabia Saudita/epidemiología , Estudios Transversales , Femenino , Masculino , Factores de Riesgo , Maestros/estadística & datos numéricos , Adulto , Prevalencia , Enfermedades Profesionales/epidemiología , Encuestas y Cuestionarios , Persona de Mediana EdadRESUMEN
BACKGROUND: Physiotherapeutic management is the first-line intervention for patients with entrapment neuropathies such as carpal tunnel syndrome (CTS). As part of physiotherapy, neurodynamic interventions are often used to treat people with peripheral nerve involvement, but their mechanisms of action are yet to be fully understood. The MONET (mechanisms of neurodynamic treatment) study aims to investigate the mechanisms of action of neurodynamic exercise intervention on nerve structure, and function. METHODS: This mechanistic, randomised, single-blind, controlled trial will include 78 people with electrodiagnostically confirmed mild or moderate CTS and 30 healthy participants (N = 108). Patients will be randomly assigned into (1) a 6-week progressive home-based neurodynamic exercise intervention (n = 26), (2) a steroid injection (= 26), or (3) advice (n = 26) group. The primary outcome measure is fractional anisotropy of the median nerve at the wrist using advanced magnetic resonance neuroimaging. Secondary outcome measures include neuroimaging markers at the wrist, quantitative sensory testing, electrodiagnostics, and patient reported outcome measures. Exploratory outcomes include neuroimaging markers at the cervical spine, inflammatory and axonal integrity markers in serial blood samples and biopsies of median nerve innervated skin. We will evaluate outcome measures at baseline and at the end of the 6-week intervention period. We will repeat questionnaires at 6-months. Two-way repeated measures ANCOVAs, followed by posthoc testing will be performed to identify differences in outcome measures among groups and over time. DISCUSSION: This study will advance our understanding of the mechanisms of action underpinning neurodynamic exercises, which will ultimately help clinicians to better target these treatments to those patients who may benefit from them. The inclusion of a positive control group (steroid injection) and a negative control group (advice) will strengthen the interpretation of our results. TRIAL REGISTRATION: NCT05859412, 20/4/2023.
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Síndrome del Túnel Carpiano , Nervio Mediano , Humanos , Síndrome del Túnel Carpiano/terapia , Síndrome del Túnel Carpiano/fisiopatología , Síndrome del Túnel Carpiano/diagnóstico , Método Simple Ciego , Masculino , Nervio Mediano/fisiopatología , Femenino , Resultado del Tratamiento , Adulto , Persona de Mediana Edad , Terapia por Ejercicio/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Imagen por Resonancia Magnética , AncianoRESUMEN
California's Controlled Substance Utilization Review and Evaluation System (CURES) was mandated in 2018 to monitor and limit opiate prescriptions. This study evaluated the effects of this legislation on postoperative opioid prescriptions of patients undergoing soft tissue hand surgery. Patients receiving carpal tunnel release, trigger finger release, and ganglion excisions 18 months prior to and 18 months after CURES were selected. The primary outcome was milligram morphine equivalent (MME) prescribed at the surgical encounter and at first postoperative visit. There were 758 patients in the pre-CURES cohort and 701 patients in the post-CURES cohort. In the pre-CURES cohort, there was 116.9 ± 123.8 MME prescribed post op and 10.2 ± 70.8 at first follow-up, whereas post-CURES had 58.8 ± 68.4 MME and 1.1 ± 14.1 for post-op and first follow-up respectively. Findings of this study indicate state regulations may play a role in reducing narcotic consumption following soft tissue hand surgery. (Journal of Surgical Orthopaedic Advances 33(2):122-124, 2024).
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Analgésicos Opioides , Mano , Dolor Postoperatorio , Humanos , Masculino , Dolor Postoperatorio/tratamiento farmacológico , Persona de Mediana Edad , Femenino , Mano/cirugía , Analgésicos Opioides/uso terapéutico , Anciano , Síndrome del Túnel Carpiano/cirugía , Adulto , Estudios Retrospectivos , Trastorno del Dedo en Gatillo/cirugía , Trastorno del Dedo en Gatillo/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricosRESUMEN
PURPOSE: To evaluate the current evidence comparing low level to high level laser therapy to reveal any superiorities in the treatment of musculoskeletal disorders. METHODS: Five databases were searched till September 2022 to obtain relevant RCTs comparing high intensity and low-level laser therapies in the management of musculoskeletal disorders. Two authors assessed the methodological quality of the included studies using the Physiotherapy Evidence Database scale and meta-analysis was conducted for studies that showed homogeneity. RESULTS: Twelve articles were included in this systematic review with a total population of 704 participants across various musculoskeletal pathologies including tennis elbow, carpal tunnel syndrome, chronic non-specific low back pain, knee arthritis, plantar fasciitis, and subacromial impingement. There were no statistical differences between the two interventions in pain, electrophysiological parameters, level of disability, quality of life, postural sway or pressure algometer, however, Low level laser therapy showed superiority in increasing grip strength compared to high intensity laser therapy while results were significant in favour of high intensity laser therapy regarding long head of biceps diameter and cross sectional area, supraspinatus thickness and echogenicity and acromio-humeral distance. CONCLUSION: The current literature suggests no superiority of both types of laser therapy in musculoskeletal disorders, however, more RCTs with larger sample size are required to reach a definitive conclusion regarding the superiority of either form of laser therapy in musculoskeletal disorders.