Diagnosis of Carpal Tunnel Syndrome

Keith, Michael W.; Masear, Victoria R.; Chung, Kevin C.; Maupin, Kent; Andary, Michael; Amadio, Peter C.; Barth, Richard W.; Watters, William C.; Goldberg, Michael J.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.

doi:10.5435/00124635-200906000-00007

Cited by 160 publications

(123 citation statements)

References 24 publications

(13 reference statements)

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“…According to the American Academy of Neurology practice parameters criteria, CTS is defined [12,13] as follows:…”

Section: Methodsmentioning

confidence: 99%

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Boyacı

Tutoğlu²,

Boyacı³

et al. 2014

J Clin Exp Invest

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ÖZETAmaç: Diabetes mellituslu (DM) hastalarda karpal tünel sendromu (KTS) teşhisinde ultrasonografinin değerini ve diabetik KTS'li hastalarda radial ve ulnar arterlerin akım karakteristiklerini araştırmak amaçlanmıştır. Bulgular: DM-KTS grubunda, CSA-p ve CSA-d değerle-ri DM ve C gruplarına göre anlamlı olarak daha büyüktü (p<0.01). FR-p, DM-KTS grubunda C grubuna göre anlamlı olarak daha büyüktü (p<0.01). ROC eğrisi analizinde, CSA-p ≥ 9.5 mm 2 (AUC 0.84; duyarlılık 78.3% and özgüllük 88%) ve CSA-d ≥ 9.5 mm 2 (AUC 0.78; duyarlılık 73.9% and özgüllük 84%), DM-KTS elin çok güçlü bir prediktörüdür. Doppler incelemesinde her iki radial ve ulnar arter akım volumü, pik sistolik hız, end-diyastolik hız ve rezistif indeks ölçümlerinde gruplar arası farklılık yoktu (p>0.05). Radial arter damar çapı, DM-KTS grubunda C grubuna göre anlamlı olarak daha büyüktü (p<0.05). Sonuçlar: Diabetik KTS'li hastalarda diabetli ve sağlıklı kişilere göre median sinir CSA anlamlı olarak büyüktür. Diabetik hastalarda KTS değerlendirilmesinde, ultrasonografiyle ölçülen CSA diagnostik bir araç olabilir. YöntemlerAnahtar kelimeler: Karpal tünel sendromu, kesit alanı, median sinir, ultrasonografi ABSTRACTObjective: This study aimed to research the value of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS) in patients with diabetes mellitus (DM) and to examine the flow characteristics of the radial and ulnar arteries in diabetic patients with CTS. Methods:A total of 23 diabetic hands diagnosed with CTS from electrophysiological evaluation (DM-CTS), 47 asymptomatic diabetic hands (DM) and 50 healthy hands (C) as the control group were evaluated with high resolution ultrasonography. The median nerve was measured in the crosssectional area (CSA), flattening ratio (FR) and at the level of the carpal tunnel inlet [proximal (p)] and the wrist crease [distal (d)]. The radial and ulnar arteries were evaluated with both hands in a neutral position. Results:In the DM-CTS group, the CSA-p and CSA-d values were statistically signficantly greater compared to the DM and C groups (p<0.01). The FR-p in the DM-CTS group was statistically significantly greater than that of the C groups (p<0.01). In the ROC curve analysis, CSA-p ≥ 9.5 mm 2 (AUC 0.84; sensitivity 78.3% and specificity 88%) and CSA-d ≥ 9.5 mm 2 (AUC 0.78; sensitivity 73.9% and specificity 84%) were very strong predictors of the DM-CTS hand. In the Doppler examination, no difference was determined between the groups in terms of flow volume, peak systolic velocity, enddiastolic velocity and resistive index measurements of both radial and ulnar arteries (p>0.05). The radial artery diameter was determined to be statistically significantly greater in the DM-CTS group than the C group (p<0.05). Conclusion:The median nerve CSA is significantly greater in diabetic CTS patients compared to patients with diabetes only and healthy controls. In the evaluation of CTS in diabetic patients, CSA measured with ultrasonography may be a diagnostic tool. J Clin Exp Invest 2014; 5 (2): 179-185

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“…According to the American Academy of Neurology practice parameters criteria, CTS is defined [12,13] as follows:…”

Section: Methodsmentioning

confidence: 99%

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

Boyacı

Tutoğlu²,

Boyacı³

et al. 2014

J Clin Exp Invest

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“…4 The diagnosis is based on the presence of symptoms, physical findings, positive nerve conduction studies and provocative tests such as Tinel's, and Phalen's signs, taken together. 5,[6][7][8][9][10][11] The clinical diagnosis is most commonly confirmed by electrodiagnostic (EDX) studies as the reliable, differentiating, and the most objective diagnostic test. 5,6,9,12,13 Severity of carpal tunnel syndrome can also be evaluated by EDX, done bilaterally.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of carpal tunnel syndrome among long-term manual wheelchair users with spinal cord injury: A cross-sectional study

Asheghan

Hollisaz

Taheri³

et al. 2015

The Journal of Spinal Cord Medicine

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Context: Use of a handrim wheelchair could force the wrist into extreme excursions and encroachment of the median nerve.Objective: We performed a study of the prevalence of carpal tunnel syndrome in prolonged wheelchair users. Design and setting: A cross-sectional study was conducted for one year in an outpatient clinic of spinal cord injury. Participants: Patients had traumatic injury at the first thoracic level and below, with time since injury of at least 5 years. Outcome measure: The prevalence of carpal tunnel syndrome by history taking, clinical examinations and motor and sensory nerve conduction studies of median nerve performed for both hands. Results: Participants (N = 297) were all male. Mean (SD) age and duration since injury were 48 (8.5) and 23 (6.6) years, respectively. A significant difference in median duration of injury based on the severity of the syndrome (P < 0.001), and a significant trend in time since injury for the severity (P (one tailed) < 0.001) were seen. There was a significant difference in the median age among the groups (P = 0.009), and the median increased with the severity (P (one tailed) = 0.001). Conclusions: Carpal tunnel syndrome is a common side effect of the long time use of wheelchair, and its severity is associated with duration of wheelchair use and age. Alternative methods for wheelchair propulsion should be developed to diminish the likelihood of the syndrome.

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“…In traditional open surgical procedure, transverse carpal ligament is cut in order to release the median nerve. 46 Recent surgical trend involves mini-open and endoscopic approaches to reduce recovery time and pain. However, presently, there is no evidence of any significant long-term advantages of less-invasive procedures than open release surgery.…”

mentioning

confidence: 99%

Dialysis-related amyloidosis: challenges and solutions

Scarpioni¹,

Ricardi²,

Albertazzi³

et al. 2016

IJNRD

107

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Amyloidosis refers to the extracellular tissue deposition of fibrils composed of lowmolecular-weight subunits of a variety of proteins. These deposits may result in a wide range of clinical manifestations depending upon their type, location, and the amount of deposition. Dialysis-related amyloidosis is a serious complication of long-term dialysis therapy and is characterized by the deposition of amyloid fibrils, principally composed of b2 microglobulins (b2M), in the osteoarticular structures and viscera. Most of the b2M is eliminated through glomerular filtration and subsequent reabsorption and catabolism by the proximal tubules. As a consequence, the serum levels of b2M are inversely related to the glomerular filtration rate; therefore, in end-stage renal disease patients, b2M levels increase up to 60-fold. Serum levels of b2M are also elevated in several pathological conditions such as chronic inflammation, liver disease, and above all, in renal dysfunction. Retention of amyloidogenic protein has been attributed to several factors including type of dialysis membrane, prolonged uremic state and/or decreased diuresis, advanced glycation end products, elevated levels of cytokines and dialysate. Dialysis treatment per se has been considered to be an inflammatory stimulus, inducing cytokine production (such as interleukin-1, tumor necrosis factor-α, interleukin-6) and complement activation. The released cytokines are thought to stimulate the synthesis and release of b2M by the macrophages and/or augment the expression of human leukocyte antigens (class I), increasing b2M expression. Residual renal function is probably the best determinant of b2M levels. Therefore, it has to be maintained as long as possible. In this article, we will focus our attention on the etiology of dialysis-related amyloidosis, its prevention, therapy, and future solutions.

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Diagnosis of Carpal Tunnel Syndrome

Abstract: This clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decision-making processes involved in managing the diagnosis of This clinical practice guideline was approved by the

Cited by 160 publications

References 24 publications

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

The prevalence of carpal tunnel syndrome among long-term manual wheelchair users with spinal cord injury: A cross-sectional study

Dialysis-related amyloidosis: challenges and solutions

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