Carpal tunnel syndrome: clinical features, diagnosis, and management

Padua, Luca; Coraci, Daniele; Erra, Carmen; Pazzaglia, Costanza; Paolasso, Ilaria; Loreti, Claudia; Caliandro, Pietro; Hobson‐Webb, Lisa D.

doi:10.1016/s1474-4422(16)30231-9

Cited by 552 publications

(594 citation statements)

References 103 publications

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“…Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, affecting 2.7% to 3.8% of the general population . Carpal tunnel syndrome results from compression of the median nerve within the carpal tunnel region, resulting in intraneural edema, demyelination, and, in severe cases, axonal loss and fibrosis . Depending on the extent of median nerve dysfunction, clinical symptoms and signs may include thenar atrophy, numbness, paresthesia, pain, and weakness in the median nerve distribution .…”

mentioning

confidence: 99%

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Chappell¹,

Beckman²,

Baird

et al. 2019

J of Ultrasound Medicine

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Objective To document changes in the median nerve cross‐sectional area (CSA) in the proximal carpal tunnel region after ultrasound (US)‐guided carpal tunnel release (CTR). Methods Prospective data were collected on 23 consecutive patients (37 wrists) treated with US‐guided CTR by the primary author using the same office‐based microinvasive technique. Ultrasound was used to measure the largest CSA of the median nerve in the proximal carpal tunnel region both preoperatively and postoperatively. The primary outcome measure was the change in the preoperative versus 6‐ to 10‐week postoperative median nerve CSA. Results The mean CSA of the median nerve decreased from 16.08 to 12.75 mm2 at 6 to 10 weeks after US‐guided CTR (P < .001). During the same period, the mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom score decreased from 3.23 to 1.67 (P < .001), and mean BCTQ functional score decreased from 2.49 to 1.47 (P < .001), both exceeding minimal clinically important differences. Although the primary end point was the median nerve CSA at 6 to 10 weeks, statistically significant reductions in the median nerve CSA, as well as BCTQ scores, were also observed as early as 2 to 4 weeks after US‐guided CTR (median nerve CSA, 12.40 mm2; BCTQ symptom score, 2.00; BCTQ functional score, 1.75; all P ≤ .03). Conclusions To our knowledge, this investigation was the largest to date examining changes in the proximal median nerve CSA after US‐guided CTR. Statistically significant reductions in the proximal median nerve CSA were observed within 6 to 10 weeks after ultrasound‐guided CTR. These reductions were similar to those previously reported for open and endoscopic CTR and validate the ability of US‐guided CTR to relieve median nerve compression.

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confidence: 99%

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Chappell¹,

Beckman²,

Baird

et al. 2019

J of Ultrasound Medicine

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“…The diagnosis is suspected by the symptoms and provocative manoeuvres (Phalen test (Figure 1A) and the Tinel and the carpal compression signs) [ Up to 20% of CTS cases improve with conservative treatments [44,45]. Night-time wrist splints help 60% of patients but many eventually need an operation [46,47].…”

Section: Carpal Tunnel Syndrome (Cts)mentioning

confidence: 99%

Peripheral Nerve Entrapment and their Surgical Treatment

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

MaríaOrtiz‐Criado³

et al. 2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Nerves pass from one body area to another through channels made of connective tissue and/or bone. In these narrow passages, they can get trapped due to anatomic abnormalities, ganglion cysts, muscle or connective tissue hypertrophy, tumours, trauma or iatrogenic mishaps. Nearly all nerves can be affected. The clinical presentation is pain, paraesthesia, sensory and motor power loss. The specific clinical features will depend on the affected nerve and on the chronicity, severity, speed and mechanism of compression.Its incidence is higher under some occupations and is some systemic conditions: diabetes mellitus, hypothyroidism, acromegaly, alcoholism, oedema and inflammatory diseases. The diagnosis is suspected with the clinical presentation and provocative clinical test, being confirmed with electrodiagnostic and/or ultrasonographic studies. Magnetic Resonance Studies (MRI) rule out ganglion cysts or tumours. Conservative medical treatment is often sufficient. In refractory ones, surgical decompression should be performed before nerve damage and muscle atrophy are irreversible. The 'double crash' syndrome happens when a peripheral nerve is compressed at more than one point along its trajectory. In cases with marked muscle atrophy, a 'supercharge end-to-side' nerve transfer can be added to the decompression. After decompression in those few cases with refractory pain, a nerve neurostimulator can be applied.

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“…It has been estimated to occur in 3-4% of the general population with a predominance among the female gender [2]. The cause of CTS is the compression of the median nerve under the transverse carpal ligament (TCL) [3]. CTS is characterized by signs and symptoms such as numbness, a tingling sensation, weakness of the hand, and pain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

Guo

Xiong²,

Zhao³

et al. 2017

Eur Neurol

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Background: To compare the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS). Methods: Between May 2014 and June 2016, 52 patients (56 wrists) with CTS were included in this study. Among these patients, 28 wrists were treated with ultrasound-guided corticosteroid injection plus needle release of the TCL (group A) and 28 wrists were treated with a single ultrasound-guided corticosteroids injection (group B). The following parameters were assessed and compared including postoperative results of procedure based on relief of symptoms, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of median nerve), and ultrasound parameters (anteroposterior diameter and cross-sectional area of the median nerve at the levels of pisiform and hamate bone, and the thicknesses of TCL on the cross-section at the level of hamate bone). Results: The overall excellent and good rate regarding the postoperative results of procedure based on the relief of symptoms at 1 month postoperatively was 82.1% in group A and 46.4% in group B (p = 0.004). There was significant difference in the above electrophysiological and ultrasound parameters between the preoperative and postoperative values in both groups (all p < 0.05). Furthermore, a significant difference was also observed in the postoperative values of the above-mentioned electrophysiological and ultrasound parameters in the 2 groups (all p < 0.05). Conclusions: Both approaches had treatment benefit in CTS. Ultrasound-guided corticosteroid injection in combination with needle release of the TCL is superior to the single ultrasound-guided corticosteroids injection.

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Carpal tunnel syndrome: clinical features, diagnosis, and management

Cited by 552 publications

References 103 publications

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

Peripheral Nerve Entrapment and their Surgical Treatment

Comparison of the Clinical Effectiveness of Ultrasound-Guided Corticosteroid Injection with and without Needle Release of the Transverse Carpal Ligament in Carpal Tunnel Syndrome

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