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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
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
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
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
OBJECTIVES: The occurrence of hand and forearm disorders related to vibration exposure, adjusted for relevant background factors, is scarcely reported. We analysed the prevalence of such conditions in a large population cohort, stratified by sex, and associations with exposure to vibrating hand-held tools. DESIGN: This is a retrospective cohort study. SETTING: Individuals in the Malmö Diet and Cancer Study cohort (MDCS; inclusion 1991-1996; followed until 2018) were asked, 'does your work involve working with vibrating hand-held tools?' (response: 'not at all', 'some' and 'much'). Data were cross-linked with national registers to identify treatment for carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), Dupuytren's disease, trigger finger or first carpometacarpal joint (CMC-1) osteoarthritis (OA). Cox regression models, unadjusted and adjusted (age, sex, prevalent diabetes, smoking, hypertension and alcohol consumption), were performed to analyse the effects of reported vibration exposure. PARTICIPANTS: Individuals in the MDCS who had answered the questionnaire on vibration exposure (14 342 out of the originally 30 446 individuals in MDCS) were included in the study. RESULTS: In total, 12 220/14 342 individuals (76%) reported 'no' exposure, 1392/14 342 (9%) 'some' and 730/14 342 (5%) 'much' exposure to vibrating hand-held tools. In men, 'much' exposure was independently associated with CTS (HR 1.71 (95% CI 1.11 to 2.62)) and UNE (HR 2.42 (95% CI 1.15 to 5.07)). 'Some' exposure was independently associated with UNE in men (HR 2.10 (95% CI 1.12 to 3.95)). 'Much' exposure was independently associated with trigger finger in women (HR 2.73 (95% CI 1.49 to 4.99)). We found no effect of vibration exposure on Dupuytren's disease or CMC-1 OA. 'Much' vibration exposure predicted any hand and forearm diagnosis in men (HR 1.44 (95% CI 1.08 to 1.80)), but not in women. CONCLUSIONS: Vibration exposure by hand-held tools increases the risk of developing CTS and UNE and any common hand and forearm conditions in men, whereas women only risk trigger finger and CMC-1 OA. Adjustment for relevant confounders in vibration exposure is crucial.
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Síndrome del Túnel Carpiano , Exposición Profesional , Vibración , Humanos , Masculino , Femenino , Estudios Retrospectivos , Suecia/epidemiología , Persona de Mediana Edad , Vibración/efectos adversos , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Anciano , Exposición Profesional/efectos adversos , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Trastorno del Dedo en Gatillo/epidemiología , Contractura de Dupuytren/epidemiología , Mano , Prevalencia , Factores de Riesgo , Síndromes de Compresión del Nervio Cubital/epidemiología , Síndromes de Compresión del Nervio Cubital/etiología , Adulto , Modelos de Riesgos ProporcionalesRESUMEN
INTRODUCTION: Transthyretin-related amyloidosis (ATTRv) is a progressive multisystem disorder, predominantly involving the peripheral nerve system (PNS) and heart. Quantification of small fiber damage may help guide treatment decisions, as amyloid deposits frequently affect those fibers early in disease course. Corneal confocal microscopy (CCM) is a promising method to monitor patients with ATTRv, due to similarities between corneal nerves and PNS, as the cornea is innervated by Aδ and C fibers. METHODS: We compared CCM measures from ATTRv patients to a group of healthy individuals, matched by age and gender. We then investigated the correlations between small fiber tests (SFT): CCM, LDI-Flare and CDT, COMPASS-31 and disability scales (RODS and ONLS) in patients. RESULTS: Of 20 patients (6 with V30M), mean age 50.3±15.3Y, 7 female (35%), six (30%) had polyneuropathy and 10 (50%) carpal tunnel syndrome. CDT was abnormal in 9 and LDI-flare in 6 patients. CCM was abnormal in 19 tested patients and significantly reduced when compared to controls (CNFL: 6.31±0.31 vs. 15.21±1.02mm/mm2, p<0.001). Mean COMPASS-31-scores were 22.27±22.84; RODS and ONLS were 38.15±12.33 and 2.05±2.3, with no significant differences between sub-group scores. Disease duration was significantly correlated with ONLS (0.43, p=0.05) and RODS (0.46, p=0.03). There were no significant correlations between measures of disability and SFT. CONCLUSIONS: In a diverse cohort of ATTRv patients, CCM was the most frequent abnormal measurement. CCM can be a useful test to triage patients in the early disease stages and with few or equivocal symptoms.
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Neuropatías Amiloides Familiares , Córnea , Microscopía Confocal , Humanos , Femenino , Masculino , Neuropatías Amiloides Familiares/diagnóstico , Neuropatías Amiloides Familiares/complicaciones , Persona de Mediana Edad , Adulto , Anciano , Córnea/patología , Estudios de Casos y Controles , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/etiología , Fibras Nerviosas/patologíaRESUMEN
Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients agedâ ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; Pâ <â .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; Pâ <â .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; Pâ <â .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.
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Síndrome del Túnel Carpiano , Insuficiencia Renal Crónica , Humanos , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Estudios Retrospectivos , Diálisis Renal/efectos adversos , Factores de Riesgo , Corticoesteroides/uso terapéutico , Insuficiencia Renal Crónica/complicacionesAsunto(s)
Síndrome del Túnel Carpiano , Sarcoma , Humanos , Sarcoma/complicaciones , Sarcoma/cirugía , Sarcoma/patología , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Masculino , Femenino , Neoplasias de los Tejidos Blandos/complicaciones , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Persona de Mediana EdadRESUMEN
Juxta-articular myxoma (JAM) is a rare soft tissue tumour predominantly composed of mucinous tissue and usually found around large joints. We report a 73-year-old woman with a 5-year history of a soft tissue mass in the thenar eminence of the right wrist who presented to our department. An initial diagnosis of a ganglion cyst was made using magnetic resonance imaging (MRI) and the jellied content of the mass by aspiration. Two years after presentation, surgical treatment with tumour resection and carpal tunnel release via the radial approach was performed because the symptoms of carpal tunnel syndrome worsened, and the tumour invaded the carpal tunnel. Histopathological examination revealed a JAM. At the 1-year follow-up, the symptoms of carpal tunnel syndrome had resolved, and no recurrence was confirmed by MRI. Level of Evidence: Level V (Therapeutic).
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Síndrome del Túnel Carpiano , Mixoma , Neoplasias de los Tejidos Blandos , Femenino , Humanos , Anciano , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/etiología , Muñeca/cirugía , Mano , Neoplasias de los Tejidos Blandos/cirugía , Mixoma/diagnóstico , Mixoma/diagnóstico por imagenRESUMEN
In up to 2% of the population, benign tumours called lipomas can develop. When they are more than 5 cm, they are considered giant lipomas. Giant lipomas of the distal forearm and hand may cause compression to the underlying tissues, nerves and muscles, even though they are typically asymptomatic. An older woman with soft tissue swelling in her right wrist and forearm, and numbness and pain in her right hand presented to the general surgery outpatient clinic. Her numb fingers indicated that the median nerve was compressed, and an MRI scan of her wrist and forearm revealed median nerve compression due to a giant lipoma with a dimension of about 9.2×3.4×4 cm. A surgical excision was done with an intraoperative nerve stimulator, and the specimen sent for histopathology confirmed the diagnosis of lipoma. Pain, numbness and motor power improved within 1 week postoperatively, and the patient was discharged.
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Síndrome del Túnel Carpiano , Lipoma , Femenino , Humanos , Anciano , Muñeca/diagnóstico por imagen , Muñeca/patología , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Antebrazo/patología , Hipoestesia/etiología , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Dolor/complicacionesRESUMEN
BACKGROUND: Endoscopy-related musculoskeletal injuries (ERIs) are commonly reported but their exact prevalence and clinical impact remain obscure. We conducted a systematic review and meta-analysis of the current literature aiming to answer these questions. METHODS: The MEDLINE, EMBASE, and SCOPUS databases were searched for studies evaluating ERIs in gastroenterologists and surgeons. The co-primary outcome was the prevalence of ERIs (i.e. carpal tunnel syndrome, de Quervain's tenosynovitis, and hand numbness). The second co-primary outcome was the prevalence of endoscopy-related pain syndromes. RESULTS: 12 studies, including 4563 respondents, were included. The majority of respondents were men (n = 3321; 72.8%) and most were right-handed (86.2%). The career prevalence of carpal tunnel syndrome (pooled from 10 studies) was 5.3% (95%CI 1.5%-8.9%; I 2 = 97.1%), while the prevalence of de Quervain's tenosynovitis (five studies) was 8.5% (95%CI 0.1%-17.0%). The pooled prevalences of thumb pain, neck pain, and back pain were 25.4%, 23.1%, and 19.7%, respectively, but the prevalence varied according to the type of questionnaire used. Only 341/864 respondents (39.5%) had received prior training in ergonomics, while 623/889 respondents (70.1%) expressed a desire for further training in ergonomics. Overall, there is a moderate risk of bias in the present literature. CONCLUSION: ERIs, including carpal tunnel syndrome, de Quervain's tenosynovitis, and endoscopy-related pain, are very common. These injuries can be severe, requiring surgery, and lead to loss of productivity. Most gastroenterologists report an unmet need for training in the proper ergonomics of endoscopy.
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Síndrome del Túnel Carpiano , Humanos , Prevalencia , Síndrome del Túnel Carpiano/epidemiología , Síndrome del Túnel Carpiano/etiología , Enfermedad de De Quervain/epidemiología , Endoscopía/efectos adversos , Traumatismos Ocupacionales/epidemiología , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Gastroenterólogos/estadística & datos numéricosRESUMEN
In recent years, there is increasing literature in cardiac and hand surgery journals demonstrating a stronger association between seemingly idiopathic carpal tunnel and amyloidosis. Despite this, it can be difficult for hand surgeons to identify who need biopsies, and this is further complicated by the cost of a biopsy and the low likelihood that a patient has cardiac amyloidosis. In patients with cardiac amyloidosis and carpal tunnel syndrome (CTS), CTS is typically diagnosed 5-10 years prior. Early diagnosis of cardiac amyloidosis is crucial, as current medications work to slow disease progression, but do not treat existing amyloid deposits. Hand surgeons can play an essential role in early diagnosis. The patient case discussed describes a man who had a carpal tunnel biopsy because of his bilateral CTS, recurrent trigger fingers, and his age. After confirmation of amyloidosis, he was referred for cardiac amyloidosis evaluation. Testing confirmed this diagnosis, and he was started on tafamidis, which studies show provide patients an opportunity for increased survival and quality of life. The responsibility falls on cardiologists and hand surgeons to continue refining the indications for carpal tunnel biopsy and spreading awareness of carpal tunnel biopsy and amyloid testing, as much work is still needed.
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Amiloidosis , Síndrome del Túnel Carpiano , Masculino , Humanos , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/diagnóstico , Calidad de Vida , Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Amiloidosis/cirugía , Mano/cirugía , Mano/patología , Biopsia/efectos adversosRESUMEN
INTRODUCTION: A supracondylar process is a bony spur on the distal anteromedial surface of the humerus, and it is considered an anatomical variant with a prevalence of 0.4-2.7% according to anatomical studies. In almost all cases, it is associated with a fibrous, sometimes ossified ligament, which extends from the supracondylar process to the medial epicondyle. This ligament is known in the literature as the ligament of Struthers, named after the Scottish anatomist who first described it in detail in 1854. In rare cases, the supracondylar process can be a clinically relevant finding as a cause of nerve compression syndrome. The median and ulnar nerve can be trapped by the ring-shaped structure formed by the ligament of Struthers and the supracondylar process. CASE REPORT: A 59-year-old patient with symptoms of a cubital tunnel syndrome and additional ipsilateral sensory deficits in his thumb was referred to our clinic. Electroneurography showed no signs of an additional carpal tunnel syndrome. Preoperative x-ray and CT scans of the upper arm revealed a supracondylar process, which led us to suspect an associated entrapment of the median nerve. An MRI scan of the upper arm showed a ligament of Struthers and signs of a related median nerve compression as we initially assumed. We performed a surgical decompression of the median nerve in the distal upper arm and of the ulnar nerve in the cubital tunnel. Intraoperatively, there was evidence of compression of the median nerve due to the supracondylar process and the ligament of Struthers. The latter was cleaved and then resected along with the supracondylar process. Three months after surgery, the patient had no motor or sensory deficits. SUMMARY: The ring-shaped structure formed by the supracondylar process and ligament of Struthers represents a rare cause of compression syndrome of the median and ulnar nerve. Its incidence remains unknown so far. This anatomical variant should be considered a differential diagnosis in case of possibly related nerve entrapment symptoms after ruling out other, more frequent nerve compression causes. Moreover, the supracondylar process should be completely resected including the periosteum during surgery to minimise the risk of recurrence.
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Síndrome del Túnel Carpiano , Síndromes de Compresión Nerviosa , Humanos , Persona de Mediana Edad , Nervio Mediano/cirugía , Ligamentos/cirugía , Húmero/diagnóstico por imagen , Húmero/cirugía , Húmero/inervación , Brazo , Nervio Cubital/cirugía , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/cirugíaRESUMEN
We present a case of a 29-year-old woman with diffuse, unilateral wrist pain and carpal tunnel syndrome secondary to an interosseous ganglion of the lunate and aim to highlight uncommon aetiologies when assessing patients with atypical carpal tunnel symptoms.
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Síndrome del Túnel Carpiano , Ganglión , Hueso Semilunar , Humanos , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Femenino , Adulto , Ganglión/complicaciones , Ganglión/cirugía , Ganglión/diagnóstico por imagen , Hueso Semilunar/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence.