Carpal, cubital or tarsal tunnel syndrome after SARS-CoV-2 infection: A causal link?

Roncati, Luca; Gianotti, Greta; Gravina, Davide; Attolini, Giovanna; Zanelli, G.; Rosa, Norman Della; Adani, Roberto

doi:10.1016/j.mehy.2021.110638

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…Other types of peripheral nerve involvement were rare. We identified two cases of post infectious carpal tunnel syndrome, raising concerns about cross reaction between SARS-CoV- 2 antigens and synovial cells [ 24 ]. Parsonage Turner was also found in a few patients, appearing in one case during the first days of hospitalization for COVID-19 [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

et al. 2023

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There is increasing evidence of both central and peripheral nervous system (PNS) involvement in COVID-19. We conducted this systematic literature review to investigate the characteristics, management and outcomes of patients with PNS, including the types and severity of cranial nerves (CN) involvement. We systematically searched on PubMed for studies reporting adult patients diagnosed with COVID-19 and PNS involvement until July 2021. From 1670 records, 225 articles matched the inclusion criteria, with a total of 1320 neurological events, in 1004 patients. There were 805 (61%) CN, 350 (26.5%) PNS, and 165 (12.5%) PNS plus CN events. The most frequently involved CN were the facial, vestibulo-cochlear and olfactory nerve in 27.3%, 25.4% and 16.1%, respectively. Guillain-Barre syndrome spectrum was identified in 84.2% of PNS events. We analysed 328 patients reported in 225 articles with CN, PNS, and PNS plus CN involvement. The patients with CN involvement were younger (mean age 46.2±17.1, p = .003), and were more frequently treated as outpatients (p < .001), mostly with glucocorticoids (p < .001). Patients that had PNS with or without CN involvement were more likely to be hospitalized (p < .001), and to receive intravenous immunoglobulins (p = .002) or plasma exchange (p = .002). Patients with CN, PNS, and PNS plus CN had severe COVID -19 disease in 24.8%, 37.3%, 34.9% respectively. The most common neurological outcome was mild/moderate sequelae in patients with CN, PNS, and PNS plus CN in 54.7%, 67.5% and 67.8% respectively (p = .1) and no significant difference was found between the three categories regarding death, disease severity, time from disease onset to neurological symptoms, lack of improvement and complete recovery. CN involvement was the most frequent PNS finding. All three categories of PNS involvement were rather associated to non-severe COVID-19 but it may be an important cause of hospitalization and post COVID-19 sequelae.

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Section: Resultsmentioning

confidence: 99%

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

et al. 2023

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“…He suffered from post-COVID-19 CIP burdened with left-sided CTS-like positioning-related PNI, the most disabling sign of the disease; the absence of mechanical compression on the medial nerve made pharmacological therapy particularly indicated, as well as the absence of demyelination typical of Guillain-Barré syndrome but not of CIP. 5 Previously, our research group had described two cases of concomitant CTS and cubital tunnel syndrome in the nondominant limbs of middle-aged men affected by serious COVID-19, 45 and one case of cubital tunnel syndrome in the nondominant arm after 7 days from the first homolateral dose of COVID-19 vaccine (Spikevax) in a 28-year-old healthy male 46 ; therefore, the association post-COVID-19 CTS and CIP is not surprising, given the postinfectious neuroinflammatory state and the long-term prone/supine mechanical pressure. Our patient was treated with ultramicronized PEA 400 mg plus ultramicronized luteolin 40 mg (Glìalia), two tablets a day 12 hours apart for 6 months.…”

Section: Discussionmentioning

confidence: 99%

Ultramicronized Palmitoylethanolamide and Luteolin: Drug Candidates in Post-COVID-19 Critical Illness Neuropathy and Positioning-Related Peripheral Nerve Injury of the Upper Extremity

Roncati

Marra²,

Gravina

et al. 2024

Journal of Hand and Microsurgery

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Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium and patients with serious infection can stay in intensive care unit (ICU) for weeks in a clinical scenario of systemic inflammatory response syndrome, likely related to the subsequent development of critical illness polyneuropathy (CIP). It is in fact now accepted that COVID-19 ICU surviving patients can develop CIP; moreover, prone positioning-related stretch may favor the onset of positioning-related peripheral nerve injuries (PNI). Therefore, the urgent need to test drug candidates for the treatment of these debilitating sequelae is emerged even more. For the first time in medical literature, we have successfully treated after informed consent a 71-year-old Italian man suffering from post-COVID-19 CIP burdened with positioning-related PNI of the left upper extremity by means of ultramicronized palmitoylethanolamide 400 mg plus ultramicronized luteolin 40 mg (Glìalia), two tablets a day 12 hours apart for 6 months. In the wake of our pilot study, a larger clinical trial to definitively ascertain the advantages of this neuroprotective, neurotrophic, and anti-inflammatory therapy is advocated.

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“…We have reviewed post-COVID-19 rheumatic diseases at an earlier stage of the pandemic [ 57 ]. Post-COVID-19 peripheral nerve entrapment syndromes like carpal tunnel or tarsal tunnel syndromes have been hypothesized to be either due to localized demyelination, microangiopathy involving the vasa nervosum or an immune phenomenon targeting the adjacent synovial sheath [ 58 ]. An interesting group is the patients who have clinical phenotype and antibodies suggestive of rheumatoid arthritis developing post-COVID-19.…”

Section: Current Definitions and Limitationsmentioning

confidence: 99%

Reactive arthritis before and after the onset of the COVID-19 pandemic

et al. 2022

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Most accepted definitions of reactive arthritis (ReA) consider it a type of spondyloarthritis (SpA) precipitated by a gut or urogenital infection. A wider definition considers any arthritis that occurs after a mucosal surface infection as ReA. There is limited consensus regarding a working definition, status of HLA-B27, or even classification criteria for ReA. This may also contribute to a lack of systemic studies or clinical trials for ReA, thereby reducing further treatment recommendations to expert opinions only. The emergence of post-COVID-19 ReA has brought the focus back on this enigmatic entity. Post-COVID-19 ReA can present at extremes of age, appears to affect both sexes equally and can have different presentations. Some present with small joint arthritis, others with SpA phenotype-either with peripheral or axial involvement, while a few have only tenosynovitis or dactylitis. The emergence of post-vaccination inflammatory arthritis hints at similar pathophysiology involved. There needs to be a global consensus on whether or not to include all such conditions under the umbrella of ReA. Doing so will enable studies on uniform groups on how infections precipitate arthritis and what predicts chronicity. These have implications beyond ReA and might be extrapolated to other inflammatory arthritides. Key Points • Classical reactive arthritis (ReA) has a spondyloarthritis phenotype and is preceded by symptomatic gut or urogenital infection • The demonstration of antigen and nucleic acid sequences of pathogens in synovium has blurred the difference between invasive arthritis and reactive arthritis • Post-COVID-19 ReA has a transient phenotype and can have different presentations. All reported cases are self-limiting • The large amount of literature reporting post-COVID-19 ReA calls for introspection if the existing definitions of ReA need to be updated.

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Carpal, cubital or tarsal tunnel syndrome after SARS-CoV-2 infection: A causal link?

Cited by 10 publications

References 12 publications

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

Ultramicronized Palmitoylethanolamide and Luteolin: Drug Candidates in Post-COVID-19 Critical Illness Neuropathy and Positioning-Related Peripheral Nerve Injury of the Upper Extremity

Reactive arthritis before and after the onset of the COVID-19 pandemic

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