Carpal Tunnel Syndrome

Purpose To test the null hypothesis that depression does not correlate with patient satisfaction after open release of electrodiagnostically confirmed carpal tunnel syndrome when controlling for other demographic, disease-related, and psychosocial factors. Methods Eighty-two survey respondents who had recovered (minimum 2 years after surgery) from a limited incision open carpal tunnel release completed measures of satisfaction, perceived disability, depression, pain catastrophizing, and pain anxiety. Univariate and multivariate analyses sought predictors of satisfaction and perceived disability from among demographic, disease related, and psychological factors. Results The average satisfaction score was 8 points (range, 0-10) and the average Disabilities of the Arm, Shoulder, and Hand score was 13 points (range, 0-76). Predictors of greater dissatisfaction included greater depression and the categorical electrophysiologic test rating. Predictors of perceived disability included depression, pain catastrophizing, and static numbness. Depression was the dominant predictor of both satisfaction and perceived disability. Conclusions Dissatisfaction and perceived disability after limited open carpal tunnel release for electrodiagnostically confirmed idiopathic carpal tunnel syndrome is predicted primarily by depression and ineffective coping skills and to a lesser degree by clinical or electrophysiologic evidence of advanced nerve damage.

In this pilot study, hypertonic dextrose solution was used to induce fibrosis of the subsynovial connective tissue (SSCT) and create an animal model of potential use in the study of carpal tunnel syndrome (CTS). The SSCT of the carpal tunnel in 15 New Zealand white rabbits were injected with 0.05 ml of 10% dextrose solution in 1 paw and 0.05 ml of

To determine prevalence and incidence of carpal tunnel syndrome (CTS) in a modern meat packing plant. The secondary objective was to explore the relation between ethnicity and CTS. Six hundred and sixty five workers were interviewed and examined to find the prevalence of CTS. Subsequently, 421 workers without CTS were followed up and examined at a median interval of 253 days; of those, 333 remained without CTS and were again examined at a median interval of 148 days. The prevalence and incidence of CTS was 21% and 11/100 person-years, respectively. The incidence for Asian mixed, white, and other ethnicities was 12.0, 12.2, and 7.2 cases/100 person-years, respectively. The observed incidence for men and women was 9.7 and 18.4 cases/100 person-years, respectively. This difference was not quite significant (p = 0.068) with an estimated relative risk (women v men) of 1.9 (95% confidence interval (95% CI) 0.9 to 3.8). The interaction between sex and use of tools was significant (p = 0.04), however, although the relative risk for CTS in women who used tools was 4.2 the numbers were small and not significant. The relative risk for men who used tools was 0.64 and not significant. The percentage of incident cases with comorbid disease was only 6.3% (3/47). The prevalence and incidence of CTS in this workforce were higher than in the general population. However, the prevalence of CTS in this modern, mechanised plant was not significantly different from that reported in older plants. No relation was found between ethnicity, age, body mass index, and CTS for either prevalence or incidence. Comorbid disease among the cases of CTS is significantly less than that found in other industry.

The aim of this study was to identify cutoff values for body, hand, and wrist measurements in order to correctly identify individuals with increased risk of carpal tunnel syndrome (CTS). Patients and methods This study included 30 patients with clinically diagnosed and electrophysiologically confirmed idiopathic CTS and 30 age-matched and sex-matched healthy volunteers as the control group. Both groups performed sensory and motor conduction studies of the median nerve. Body, hand, and wrist anthropometric measurements were taken including weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, palm length/width, and hand length. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), confidence intervals, cutoff values, sensitivity, and specificity were calculated separately for each measured parameter. Results There were statistically significant differences among the studied participants regarding all measured anthropometric parameters (P<0.001). As a result, all studied patients had squarer wrists and shorter hands than healthy participants. The AUC values for all studied measurements showed high accuracy (AUC<95) except for hip circumference, waist-to-hip ratio, palm length, third digit length, and digit index which showed moderate accuracy. In the studied patients there were positive significant correlations between BMI, wrist depth, wrist ratio, and shape index with an electrophysiological severity grading of CTS of the studied patients; on the other hand, there were negative significant correlations between palm length, hand length, and hand ratio with electrophysiological severity grading of CTS. Conclusion The cutoff values for body, wrist, and hand anthropometric measurements are useful tools to assess the risk factors for CTS.

Methods. A health status questionnaire was mailed to 2,465 persons of working age (25-65 years) who were randomly selected from the general population of a representative region of Sweden. The questionnaire required the subjects to provide information about the presence and severity of pain, numbness and tingling in each body region, employment history, and work activities, including average time spent using a keyboard during a usual working day. Those reporting recurrent hand numbness or tingling in the median nerve distribution were asked to undergo a physical examination and nerve conduction testing. The prevalence of CTS, defined as symptoms plus abnormal results on nerve conduction tests, was compared between groups of subjects that differed in their intensity of keyboard use, adjusting for age, sex, body mass index, and smoking status.

To improve accuracy in the diagnosis of carpal tunnel syndrome (CTS) by comparing cross-sectional area (CSA) measurements of the median nerve obtained at the level of the carpal tunnel (CSAc) with those obtained more proximally (CSAp), at the level of the pronator quadratus muscle.

Neurological disease presents a particular range of problems in pregnancy. The majority of these disorders are preexisting and may require a modification of therapy to ensure that a therapeutic effect is maintained while fetal and neonatal morbidity is avoided. The drug management of epilepsy presents particular challenges in pregnancy. Some neurological conditions occur more frequently in pregnant women, for example compression mononeuropathies, benign intracranial hypertension and cerebral venous and sinus thrombosis, whereas others, such as eclampsia, are unique to pregnancy. The investigation, diagnosis and appropriate management of neurological symptoms and signs in pregnancy require a knowledge of neuroanatomy, physiology of pregnancy and the appropriate application of neuroimaging and neurophysiological testing.

The frequency of positive results of four conventional provocative tests (Phalen sign, Tinel sign, wrist extension and pressure provocation test) was evaluated in 179 patients with clinical and electrophysiological findings consistent with idiopathic carpal tunnel syndrome (CTS), 147 control subjects and 39 patients with polyneuropathy. The diagnostic accuracy was evaluated for each test alone and in combination and the sensitivity correlated with the clinical and electrophysiological severity of CTS. For comparison of the CTS group with the control group, none of the tests reached sufficient diagnostic accuracy. The same was found for comparison of the CTS group with the polyneuropathy group, the Tinel sign being the least accurate. The combination of signs was not found to be more useful than single signs. The sensitivity of all signs was much less in severe clinical stages of CTS, especially for tests that increase the intra-carpal canal pressure. Traditional provocative tests, such as those tested here, have limited or no value for distinguishing patients with and without CTS, one reason being that their sensitivity depends largely on the clinical and electrophysiological severity of CTS. This correlation may also explain the contradictory results in the literature.

OBJECTIVE Thyroid dysfunction may cause musculoskeletal symptoms. We have evaluated the prevalence of adhesive capsulitis, Dupuytren's contracture, trigger finger, limited joint mobility and carpal tunnel syndrome in a series of patients with various thyroid diseases and differing levels of function. DESIGN AND PATIENTS Patients with euthyroid (diffuse and /or nodular) goitre, Hashimoto's thyroiditis, Graves' disease, toxic nodular goitre, toxic diffuse goitre and patients with goitre who had partial thyroidectomy were included in the study (n = 137). Neurological and musculoskeletal examinations were performed after a standardized symptom questionnaire. The prevalence of musculoskeletal problems was analysed with respect to thyroid function and thyroid autoantibody status. MEASUREMENTS Serum concentrations of free T3, free T4, TSH and thyroglobulin and thyroperoxidase antibodies were determined. Serum levels of creatine kinase, lactate dehydrogenase, calcium and phosphate along with erythrocyte sedimentation rate were measured to exclude other causes of musculoskeletal complaints. RESULTS When the study group (n = 137) was divided according to thyroid status, 30•6% (n = 42) were thyrotoxic, 16•8% (n = 23) had subclinical thyrotoxicosis, 28•5% (n = 39) were euthyroid, 7•3% (n = 10) had subclinical hypothyroidism and 16•8% (n = 23) were hypothyroid. Overall, adhesive capsulitis was found in 10•9% (n = 15), Dupuytren's contracture in 8•8% (n = 12), limited joint mobility in 4•4% (n = 6), trigger finger in 2•9% (n = 4) and carpal tunnel syndrome in 9•5% (n = 13) of the patients. The prevalence of adhesive capsulitis was highest in patients with subclinical thyrotoxicosis (17•4%); Dupuytren's contracture, limited joint mobility and carpal tunnel syndrome were commonest in hypothyroid patients (21•7%, 8•7% and 30•4%, respectively). Trigger finger occurred in 10% of patients with subclinical hypothyroidism. When these prevalences were analysed with respect to thyroid status, carpal tunnel syndrome was significantly more prevalent in the hypothyroid group (P = 0•004). When thyroperoxidase antibody-positive and-negative patients were compared, adhesive capsulitis negatively (P = 0•03, r = − − − −0•18) and trigger finger positively correlated with (P = 0•03, r = 0•21) thyroperoxidase antibody existence. CONCLUSIONS These results demonstrate that musculoskeletal disorders often accompany thyroid dysfunction. In addition to the well-known observation that these disorders are common in patients with hypothyroidism, they are also observed in patients with thyrotoxicosis. Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.

A 63-center prospective study of endoscopic carpal tunnel release using the Agee Carpal Tunnel Release System was conducted in 1049 procedures in 988 patients. Prior experience with endoscopic release varied significantly among surgeon participants. Surgeons evaluated the newly redesigned system for blade visibility, blade height, and mechanical function. Data on patient complications were collected at the time of surgery and 3-4 weeks postoperative. The results indicated minimal complications and no confirmed injuries to vessels or nerves; the symptoms from one possible digital nerve injury eventually resolved completely. Surgeons were able to observe the point of entry of the blade into the transverse carpal ligament in 97.5% of procedures. Introduction of the blade assembly into the carpal tunnel was rated easy or adequate in 90.6% of procedures, and blade height was rated adequate in 97.4% of procedures.

Despite the high prevalence of carpal tunnel syndrome and cubital tunnel syndrome, the quality of clinical practice guidelines is poor and non-invasive treatment modalities are often poorly documented. The aim of this cadaveric biomechanical study was to measure longitudinal excursion and strain in the median and ulnar nerve at the wrist and proximal to the elbow during different types of nerve gliding exercises. The results confirmed the clinical assumption that 'sliding techniques' result in a substantially larger excursion of the nerve than 'tensioning techniques' (e.g., median nerve at the wrist: 12.6 versus 6.1 mm, ulnar nerve at the elbow: 8.3 versus 3.8 mm), and that this larger excursion is associated with a much smaller change in strain (e.g., median nerve at the wrist: 0.8% (sliding) versus 6.8% (tensioning)). The findings demonstrate that different types of nerve gliding exercises have largely different mechanical effects on the peripheral nervous system. Hence different types of techniques should not be regarded as part of a homogenous group of exercises as they may influence neuropathological processes differently. The findings of this study and a discussion of possible beneficial effects of nerve gliding exercises on neuropathological processes may assist the clinician in selecting more appropriate nerve gliding exercises in the conservative and post-operative management of common neuropathies. r

Purpose: Endoscopic carpal tunnel release using Menon's technique has been shown to reduce recovery time, although previous studies have shown that there is still a considerable risk of nerve complications. The purpose of this study was to evaluate data from 227 hands of 191 patients who underwent releases with Menon's technique. Type of Study: Prospective study. Methods: Endoscopic releases were performed as an outpatient intervention by one surgeon. Follow-up evaluations included were analysis of satisfaction, quantitative measurements of grip strength, return to work time, and complications. After the surgery on the first 50 hands in 41 consecutive cases, the technique was modified. Prospectively, changes in the technique are due to difficulties maintaining the knife within the center of the cannula's slot and a relatively high complication rate. In the modified technique, a 2.7-mm 25°endoscope and a triangular diamond-tipped knife were used to allow for more room for the instruments and a more safe procedure. Results: During the first month after the surgery, 91% of the patients had better subjective satisfaction scores and by 12 weeks, 81% obtained 75% to 100% or greater grip strength. Within 3 weeks, 70% of the patients had returned to work. Twelve of 50 hands operated on using the original technique had nerve disturbance diagnosed at follow-up. Three of these 12 patients developed reflex sympathetic dystrophy. One patient had partial median nerve injury that was repaired at the time of the index operation. There was no serious complication observed in 177 hands of 150 cases operated on using the modified Menon's technique, except one postoperative hypoesthesia along the long and ring fingers that improved with time.

To compare the efficacy of acupuncture with night splinting for carpal tunnel syndrome (CTS). Sixty one mild-to-moderate degree CTS patients, aged 27-67 were randomly assigned to acupuncture (Acu) and night splinting (NS) groups. The Acu group received 10 sessions of electro-acupuncture twice a week. The NS group received prefabricated volar neutral wrist splint during the night for 5 weeks. Outcomes were assessed at baseline and the end of treatment protocol by Boston Carpal Tunnel Scale comprising symptom severity scale (SSS) and functional status scale (FSS). Pain was measured by 100 mm visual analog scale (VAS). VAS decreased more in Acu than in the NS group (p = 0.028) whereas improvements in SSS and FSS were not significant between both groups. Electro-acupuncture was as effective as night splinting in respect of overall symptoms and functions in mild-to-moderate degree CTS. However, pain was reduced more by electro-acupuncture than night splinting.

Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997: 96: 211-217. 0 Munksgaard 1997 Objectives -To evaluate the following points about carpal tunnel syndrome (CTS): 1) characterization of a wide population; 2) sensitivity of electrodiagnostic tests, and particularly the contribution of disto-proximal ratio test; 3) validity of a neurophysiological classification developed by us.

Objective: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft tissue mobilization (GISTM) and soft tissue mobilization administered with the clinician hands.

Delayed reduction of avulsed FDP tendons may be complicated by difficulty in passing the tendon through the A4 or, less often, the A2 pulley. The various techniques of doing this were comprehensively reviewed recently by Kamath and Bhardwaj (2007). We present a simple solution to this problem. A 6Fr urinary catheter is passed in a retrograde direction down the empty tendon sheath to the free end of the tendon. If necessary, the catheter can be inflated to dilate pulleys, as described by Jarvis et al. (2002), and this has proven helpful in 25% of cases. A further catheter is then placed adjacent to the first and both are secured to the tip of the tendon with individual or combined core type sutures (Figs 1a and b). The tendon is then pulled distally through the pulleys by gentle traction on both catheters (Fig 2). We have used this technique successfully in eight cases.

Carpal tunnel syndrome (CTS) patients are known to show gender-related differences in severity. The main aim of this cross-sectional study was to determine whether these differences between women and men may be related to age, education or body mass index (BMI) in two populations, one with idiopathic CTS not treated surgically and the other with idiopathic CTS treated by surgical decompression. A secondary aim was to check differences in surgical results between the genders in the surgical population. The non-surgical population consisted of 172 subjects (126 women and 46 men, mean age 55.1 years) whose data were obtained at electrophysiological examination. The surgical population consisted of 219 patients (177 women and 42 men, mean age 55.1 years) whose data were obtained before surgery. Age, education, BMI, duration of symptoms, electrophysiological and clinical severity of CTS (with ordinal scales), and the self-administered Boston Questionnaire (BQ) of symptoms and functional status of hands were considered. There were no differences in age or clinical and electrophysiological severity between women and men in either group, except for distal motor latency of the median nerve that was more delayed and duration of symptoms that was shorter in men than women in non-surgical sample. Men had a higher BMI than women. Women had higher BQ scores in the surgical and non-surgical samples. These differences remained when the results were analysed matching the men with an identical number of women of the same age, education and BMI. In the surgical population, the results of surgical decompression did not modify the gender-related differences in severity. As in many other syndromes and diseases, for a given clinical severity, women with CTS were more sensitive than men in reporting their symptoms. Risk factors of CTS, such as age, education and BMI, were not responsible for these differences. The results of surgical decompression were similar in men and women. Ó 2005 EFNS European Journal of Neurology 2005, 12: 976-983

Work-related overload syndromes are chiefly associated with the upper limbs, where carpal tunnel syndrome (CTS) plays a leading role. This article analyses methods of diagnosing CTS, with special emphasis on those that can be used by physicians in early diagnosis of CTS in workers doing monotonous work. It also discusses occupational (e.g., assembly work, typing, playing instruments, packaging and work associated with the use of a hammer or pruning scissors) and extra-occupational factors (e.g., post-traumatic deformation of bone elements of the carpal tunnel, degenerative and inflammatory changes in tendon sheaths, connective tissue hypertrophy or formation of crystal deposits) leading to CTS; diagnostic methods (subjective symptoms, physical examination and manual provocative tests, vibration perception threshold, electrophysiological examination and imaging methods); and therapeutic and preventive management tools accessible in occupational medicine practice.

The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sensibility in patients with Carpal Tunnel Syndrome (CTS). No study has investigated the relationship between the SWMT and sensory nerve conduction studies (SNCS) in patients with CTS. To assess the relationship between the SWMT and SNCS findings in patients with CTS. This cross-sectional clinical measurement study included 35 patients with CTS (55 hands) with a mean age of 45 ± 12 years. The outcome measures were the SWMT and SNCS measures of distal latency (DLs), amplitude (AMPs), and nerve conduction velocity (NCV). The median innervated fingers were tested using SWMT and electrodiagnostic tests. The primary outcome was the correlations between the SWMTs and NCS measures. All of the patients/hands had abnormal NCS findings. When looking at the three digits of interest (thumb, index and middle), the thumb SWMTs had the highest number of abnormal findings (58.2%), with the middle digit havi...

Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central pain mechanisms. As previous studies included patients with shoulder/arm symptoms or neck pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the pain during thermal pain testing significantly higher than healthy participants. This was especially apparent for heat pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and arm pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated pain ratings may however be an early indication of central pain mechanisms.

Carpal tunnel syndrome (CTS) is a constellation of symptoms associated with compression of the median nerve at the wrist. The pathophysiology of CTS is not fully understood but mechanical aspects of injury within the carpal tunnel are most likely. The issues of ischemia, mechanical trauma, ectopic impulse generation, demyelination, tendonitis, elevated carpal tunnel pressure, mechanical factors, small and large fiber involvement and the variability of symptoms are presented.

This study aimed at identifying the anatomic structures which may be responsible for entrapment neuropathies of the median nerve. Thirty upper extremities of 15 formalin fixed adult cadavers were dissected from the axilla to the distal forearm under Zeiss Opmi 9--FC microscope. We encountered seven different anatomic structures that may compress the median nerve. These structures are the brachialis muscle, Struther&#39;s ligament, the bicipital aponeurosis, pronator teres, flexor digitorum superficialis, the accessory head of plexor pollicis longus (Gantzer&#39;s muscle) and vascular structures. The supracondylar process, which we did not encounter in our dissection, has been reported as another cause. Based on our dissection findings and on literature, the median nerve can be compressed by seven different structures from the axilla to the distal forearm. Knowledge of the course of the median nerve and its relations with the adjacent anatomic structures facilitates determination of ...

Carpal tunnel syndrome is the most frequent among entrapment neuropathies. It is mainly due to entrapment of the median nerve at wrist level. The authors analyze conservative treatment options, which can be useful in the early stages of the disease. Afterward, they compare various surgical techniques. The goal of surgery is to reduce the pressure on the nerve by cutting the transverse carpal ligament. Surgery can be accomplished with open carpal tunnel release or endoscopic carpal tunnel release. Open techniques can, in rare cases, cause scar problems. On the other hand, endoscopic surgery techniques can cause iatrogenic problems.

This study aims to investigate the involvement of the peripheral nervous system, with particular attention to entrapment syndromes, in JHS/EDS-HT patients by performing an extensive clinical, neurophysiological and ultrasonographic (US) examination. The study shows an inconsistency between symptoms and neurophysiological and ultrasound evidences of focal or diffuse nerve involvement. The high prevalence of ulnar nerve subluxation/luxation at elbow in Ehlers-Danlos syndromes/hypermobility type patients could be explained by the presence of Osborne ligament laxity.

Objectives: To assess the inter-tester reliability of clinical examination items for carpal tunnel syndrome (CTS), to assess the validity of individual clinical test items and selfreport measures for the diagnosis of CTS and to assess the accuracy of an optimum test item cluster for the diagnosis of CTS.

Over the last two decades, ultrasound has developed into a useful technology for the evaluation of diseases of nerve and muscle. Since it is currently not used at by the majority of clinicians involved in diagnosis or care of patients with neuromuscular disorders, this review briefly describes the technical aspects of ultrasound and its physical principles. It relates normal muscle anatomy and movement to ultrasound images in the axial and sagittal planes and follows with a discussion of ultrasound findings in chronic muscle disease. These include evident atrophy and the loss of the hypoechoic architecture of normal muscle tissue. It highlights evolving uses of the technique to measure other pathologic changes in disease including altered muscle dynamics. With high-resolution instruments nerve imaging has now become standard, and the relationships of median nerve anatomy and observations of static and dynamic images from ultrasound are reviewed. Changes seen in carpal tunnel syndrome include significant increases in the cross-sectional area of the nerve just proximal to the site of compression, loss of hyperechoic intensities within nerve, and reduced mobility. Preliminary use of the technique for the study of other nerves is reviewed as well. Ultrasound is an ideal tool for the clinical and research investigation of normal and diseased nerve and muscle complementary to existing diagnostic techniques. As the technology continues to evolve, it will likely assume a more significant role in these areas as those most able to exploit its potential, clinical neurophysiologists and neuromuscular clinicians, incorporate its use at the bedside.

There is a scarcity of validated hand performance tests with proven reliability for quantifying functional deficits in patients with carpal tunnel syndrome (CTS). The Dellonmodified Moberg pick-up test (DMMPUT), composed of commonly used daily objects, is potentially well suited for that purpose. This study was designed to evaluate the test-retest reliability and discriminative validity of the DMMPUT in CTS patients. We compared 162 CTS patients with 116 age-matched controls. CTS severity was determined based on electrophysiological parameters and Levine's Self-Assessment Questionnaire. The mean time to complete each subset of the DMMPUT by the CTS patients was compared with that by the healthy subjects. Test-retest reliability was examined in 46 CTS patients. Discriminative validity was demonstrated through a significant difference in test completion time between the CTS subjects and their age-matched controls. With few exceptions, the test scores declined with increasing severity of electrophysiological abnormalities and subjective symptom severity. Test-retest reliability of the DMMPUT was high with an intra-class correlation coefficient of 0.91. The DMMPUT has discriminative validity and high test-retest reliability in patients with CTS. It can be a useful standardized outcome measure to gauge disease severity.

Carpal tunnel syndrome (CTS) is the most common compression neuropathy with a significant influense on the quality of life of a large number of patients and serious social and economic consequenses for the society. The adequate therapeutical approach according to the stage of this disease is of great importance for the improvement of patient’s condition, recovering the function of the injured extremity and returning to usual daily and professional activity. Physical therapy can act upon either symptomatical and etiopatogenical level The aim of this study is to evaluate the effectiveness of a complex of physical factors and their influence upon the subjective complaints, clinical symptoms and functional status of patients with CTS based on scientifical evidence. The necessity of earlier and complex physiothrerapeutical treatment, including electrotherapy and kinesitherapy is grounded. A thorough study of short and long term effects of physiothrerapeutical treatment is done. A complex physiothrerapeutical programme is developed and it’s effectiveness in the treatment of average forms of CTS is proven

Objective To develop a psychometrically appropriate brief symptoms measure of carpal tunnel syndrome (CTS). Methods Preoperative CTS 11-item symptom severity and 8-item functional status scales from 693 patients (71% women) with CTS were subjected to exploratory factor analysis and item response theory (IRT) analysis yielding a revised CTS symptoms scale. A validation sample of 213 patients (68% women) with CTS completed the 11-item disabilities of the arm, shoulder and hand (QuickDASH), and the revised symptoms scale and 116 patients also completed the original CTS symptom severity scale (median interval 11 days). Results Of the 11 CTS symptom severity scale items, 2 items that on factor analysis associated with the functional status items were removed. After IRT recalibrations of the remaining symptom severity scale items, 2 non-fitting items were removed and 2 items were merged creating the 6-item CTS symptoms scale. Factor analysis showed one dominant factor explaining 58% of the variance. Reliability was high (Cronbach alpha = 0.86; IRT person separation reliability = 0.88). No item displayed significant differential item functioning. The 6-item CTS symptoms scale showed strong correlation with the QuickDASH (r = 0.70) and agreement with the original symptom severity scale (ICC = 0.80). Conclusion The 6-item CTS symptoms scale has good reliability and validity and can be used to measure symptom severity and treatment outcome in CTS.

Different ways of expressing the severity of carpal tunnel syndrome (CTS) are found in the existing literature and in clinical records. This paper documents the distribution of patients on a scale based upon the nerve conduction study findings, which are largely independent of the exact normal values used in any given laboratory and demonstrate a highly significant linear relationship between the neurophysiological grading and a numerical score derived from the clinical history. Patients with more characteristic stories of CTS generally have higher neurophysiological grades. The scale is as follows: normal (grade 0); very mild (grade 1), CTS demonstrable only with most sensitive tests; mild (grade 2), sensory nerve conduction velocity slow on finger/wrist measurement, normal terminal motor latency; moderate (grade 3), sensory potential preserved with motor slowing, distal motor latency to abductor pollicis brevis (APB) < 6.5 ms; severe (grade 4), sensory potentials absent but motor response preserved, distal motor latency to APB < 6.5 ms; very severe (grade 5), terminal latency to APB > 6.5 ms; extremely severe (grade 6), sensory and motor potentials effectively unrecordable (surface motor potential from APB < 0.2 mV amplitude).

Carpal tunnel syndrome (CTS) is the most common nerve entrapment. Electrodiagnostic (EDX) studies are a valid and reliable means of confirming the diagnosis. This monograph addresses the various EDX techniques used to evaluate the median nerve at the wrist. It also demonstrates the limitations of EDX studies with a focus on the sensitivity and specificity of EDX testing for CTS. The need to use reference values for populations such as diabetics and active workers, where normative values differ from conventional cutoffs used to confirm suspected CTS, is presented. The value of needle electromyography (EMG) is examined. 44: 597-607, 2011 Carpal tunnel syndrome (CTS) is a clinical syn-Abbreviations: AANEM, American Association of Neuromuscular and Electrodiagnostic Medicine; AAOS, American Academy of Orthopedic Surgeons; APB, abductor pollicis brevis; CMAP, compound muscle action potential; CSI, combined summary index; CTS, carpal tunnel syndrome; EDX, electrodiagnostic; EMG, electromyography; inching, median sensory short segment stimulation across the wrist; MGA, Martin-Gruber anastomosis; MMW, median mononeuropathy at the wrist; NAP, nerve action potential; NCS, nerve conduction studies; palmdiff, median-ulnar mixed nerve palm latency difference from palm to wrist; ringdiff, median-ulnar sensory latency difference to the ring finger; SNAP, sensory nerve action potential; thumbdiff, median-radial latency difference to the thumb

The California Department of Health Services evaluated carpal tunnel syndrome (CTS), a median nerve entrapment condition associated with forceful and repetitive wrist motion, among grocery store workers at a large California supermarket where a CTS cluster had been reported. Forceful and repetitive wrist motion was measured, in three exposure levels, through a job classification scheme based upon type of work tasks and average time per week spent performing these tasks. A medical questionnaire and measurements of median sensory nerve conduction were used to measure CTS. CTS prevalence was 23% based upon a sample of 56 participants drawn from a workforce of 69 employees. A relative risk of 8.3 (95% confidence interval 2.6-26.4) for a history of CTS-like symptoms between the high and low exposure level groups held up after adjustment for the potential confounders of age, sex, alcohol consumption, and high-risk medical history. It was concluded that the basic principles of good ergonomic design should be used to prevent or diminish the risk of musculoskeletal injury in the workplace.

M.N. is a 35-year-old otherwise healthy female software engineer with a 2-year history of intermittent right hand numbness that has worsened in the past 2-3 months. She endorses numbness in the hand, worse in the thumb, index, and middle fingers. Typing and driving aggravate her symptoms, and she frequently wakes up at night with numbness in the hand. She also endorses intermittent neck pain that she believes is unrelated and occasional numbness in the forearm. She denies any weakness or history of dropping items.

Introduction: Carpal Tunnel Syndrome (CTS) is one of the common musculoskeletal problems among dental personnel.
Aim & Objectives: The aims of this study were to determine the prevalence of probable CTS and its association with individuals, work characteristics and psychosocial factors among government dentists in Kelantan, Malaysia.
Methods: The design of the study was a cross-sectional study. The study was conducted on 109 government dentists in Kelantan. A self-administered questionnaire consisted of socio-demographic, individuals, work characteristics, psychosocial factors and clinical diagnosis questionnaire was used. Data were entered and analyzed using SPSS version 20.0. Study respondents were categorized into ‘probable CTS’ and ‘non-probable CTS’ based on scoring of the clinical diagnosis questionnaire. The association between associated factors (individual factors, work characteristics and psychosocial job factors) and probable CTS was calculated using multiple logistic regression analysis.
Results: Ninety-nine dentists completed and returned the questionnaire (response rate= 90.8%). Majority of the study respondents were female (81.8%) and Malay (93.9%). Their mean age was 32.5 years old (SD=7.32). The prevalence of probable CTS was 21.2% (95% CI: 13.0-29.4). After controlling all possible confounders by using multiple logistic regression, it was found that chronic disease and decision latitude were significantly associated with probable CTS. Suffering from a chronic disease increases the odds of having probable CTS by 26.5 (95% CI: 2.1, 334.8) times. It was also found that for every 1 unit increased in the decision latitude, the risk of having probable CTS was 0.8 (95% CI; 0.7, 0.1) times lower.
Conclusion: The prevalence of probable CTS among dentists in this study population was relatively high. Having chronic disease and low in decision latitude were significantly associated with the risk of developing probable CTS.