Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release

Fowler, John R.; Munsch, Maria A.; Huang, Yajuan; Hagberg, William C; Imbriglia, Joseph E.

doi:10.1177/1753193415576248

Cited by 36 publications

(29 citation statements)

References 35 publications

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“…This is the strongest recommendation in the guideline 13 ; 90% of hand surgeons reported using electrodiagnostic testing 22 , although the utility of routine testing remains debatable 23 . Patients with less severe electrodiagnostic abnormalities note faster symptom improvement 24 , which can be useful in preoperative counseling. Subjective symptoms and electrodiagnostic studies typically correspond with severity in bilateral disease; discrepancies should raise concern for alternative diagnoses 25 .…”

Section: Electrodiagnosticsmentioning

confidence: 99%

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

2016

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Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. Treatment options include wrist-neutral bracing, corticosteroid injections, operative release of the transverse carpal ligament, and symptom-relief options. Endoscopic carpal tunnel release may give patients a faster recovery compared with traditional open release, but there are no ultimate differences in outcome among the various surgical options.

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Section: Electrodiagnosticsmentioning

confidence: 99%

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

2016

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“…[3][4][5] Various diagnostic tools are also required to assess the degree of involvement, need for therapy or surgery, and to document the response to conservative and surgical management. 6 A weak abductor pollicis brevis (APB) in CTS has been reported in up to 94% of patients. 7,8 However, relatively few studies support the motor and muscle strength examination as being better, or at least as good as the sensory examination in defining and quantifying CTS.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 However, relatively few studies support the motor and muscle strength examination as being better, or at least as good as the sensory examination in defining and quantifying CTS. [6][7][8][9] Some studies defined patients with CTS and a predominantly motor presentation as a separate subgroup of CTS; others believe that motor symptoms appear later than sensory symptoms. Not all cases of CTS actually present with thenar muscle weakness, but it remains unclear whether these are indeed separate groups and whether there is a common natural history.…”

Section: Introductionmentioning

confidence: 99%

Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

et al. 2017

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The relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.

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“…1,2 It occurs more often in women, in a ratio of 5:1. 3,4 The common age at onset is 40 to 50, although a person of any age may be affected. When symptoms are bilateral, they generally occur first and are more severe in the dominant limb.…”

Section: Introductionmentioning

confidence: 99%

“…The transverse carpal ligament also stabilizes the transverse carpal arch. 4 The three stages of ischemic injury in the compression neuropathy include: (1) increased intrafunicular pressure; (2) capillary damage with leakage and edema and (3) obstruction of arterial flow. There are dramatic changes in fluid pressure in the carpal tunnel with wrist position; extension increases the pressure 9 fold and wrist flexion increases it 8 fold.…”

Section: Introductionmentioning

confidence: 99%

Functional outcome of surgery done for carpal tunnel syndrome

Thomas¹

2016

Int J Res Orthop

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Background: Carpal tunnel syndrome is a common, chronic and disabling condition afflicting many people. The common age at onset is 40 to 50, although a person of any age may be affected. The diagnosis of carpal tunnel syndrome is often based on clinical findings alone. Electro-diagnostic studies of carpal tunnel syndrome were first established in 1956 by demonstrating focal slowing of median nerve conduction at wrist. This study is meant to evaluate the functional outcome of carpal tunnel release surgery done in Al Azhar Medical College from 2012-2014.Methods: 50 cases (5 cases being bilateral) of carpal tunnel syndrome were operated between 2012 to 2014. All cases were done under local anesthesia. Patients were retrospectively evaluated and interviewed for 2 months follow up after the surgery.Results: Out of the 50 patients who had undergone surgery, 44 patients (88%) had symptomatic relief in the first 10 days. Remaining patients had symptomatic relief in 2 months time.Conclusions: Surgery is always the preferred treatment for carpal tunnel syndrome. In my study, 6 patients (12%) had long standing carpal tunnel syndrome, hence it took 2 months for symptomatic relief. Remaining patients had symptomatic relief in the first 10 days.

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Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release

Abstract: IV.

Cited by 36 publications

References 35 publications

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome

Motor Examination in the Diagnosis of Carpal Tunnel Syndrome

Functional outcome of surgery done for carpal tunnel syndrome

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