Recent Advances in the Understanding and Management of Carpal Tunnel Syndrome: a Comprehensive Review

Urits, Ivan; Gress, Kyle; Charipova, Karina; Orhurhu, Vwaire; Kaye, Alan D.; Viswanath, Omar

doi:10.1007/s11916-019-0811-z

Cited by 29 publications

(28 citation statements)

References 32 publications

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“…In total, 1081 participants developed CTS (3.6%; 1081/30 323) during a median follow-up of 21.4 (IQR 5.9) years, corresponding to an incidence of 1.84 cases per 1000 person-years, which is in line with previous studies. 10 Median follow-up was 21.6 (IQR 5.5) years for participants without DM and 18.1 (IQR 11.1) years for participants with DM.…”

Section: Carpal Tunnel Syndromementioning

confidence: 97%

Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

Rydberg

Zimmerman

Gottsäter³

et al. 2020

BMJ Open Diab Res Care

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IntroductionCompression neuropathies (CN) in the upper extremity, the most common being carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE), are frequent among patients with diabetes mellitus (DM). Earlier studies have shown contradicting results regarding DM as a risk factor for CN. Thus, the aim of the present population-based, longitudinal study was to explore potential associations between DM, CTS, and UNE during long-term follow-up.Research design and methodsA total of 30 466 participants aged 46–73 years, included in the population-based Malmö Diet and Cancer Study during 1991–1996, were followed up in Swedish national registries regarding incident CTS and UNE until 2016. Associations between prevalent DM at baseline and incident CTS or UNE were calculated using Cox proportional hazard models, adjusted for baseline confounders, such as sex, age at study entry, smoking, hypertension, use of antihypertensive treatment, alcohol consumption, and body mass index (BMI). HbA1c and fasting plasma glucose levels had been measured at baseline in a subgroup of 5508 participants and were related to incident CTS and UNE in age and sex-adjusted binary logistic regression models.ResultsA total of 1081 participants developed CTS and 223 participants developed UNE during a median follow-up of 21 years. Participants with incident CTS or UNE had higher prevalence of DM and higher BMI at baseline. Using multivariate Cox regression models, prevalent DM at baseline was independently associated with both incident CTS (HR 2.10; 95% CI 1.65 to 2.70, p<0.0001) and incident UNE (HR 2.20; 95% CI 1.30 to 3.74, p=0.003). Higher levels of HbA1c and plasma glucose were associated with an increased risk for CTS, but not for UNE.ConclusionThis study establishes DM as a major risk factor in the development of both CTS and UNE. Furthermore, a higher BMI is associated with both CTS and UNE. Finally, hyperglycemia seems to affect the median and ulnar nerves differently.

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Section: Carpal Tunnel Syndromementioning

confidence: 97%

Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

Rydberg

Zimmerman

Gottsäter³

et al. 2020

BMJ Open Diab Res Care

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“…Surgical release provides the most effective long-term outcome, but fails in 8% to 25% of patients. 8 Splinting is less effective than surgical release or injections of steroids around the nerve, which are also not always effective. 9 The establishment of tissue fibrosis is the main cause of longterm discomfort and functional decline.…”

Section: Introductionmentioning

confidence: 99%

“…Treatments for median mononeuropathy range from rest, splinting, nonsteroidal anti‐inflammatory, and corticosteroid drug (all conservative treatments) to surgical release interventions. Surgical release provides the most effective long‐term outcome, but fails in 8% to 25% of patients 8 . Splinting is less effective than surgical release or injections of steroids around the nerve, which are also not always effective 9 …”

Section: Introductionmentioning

confidence: 99%

Blocking CTGF/CCN2 reverses neural fibrosis and sensorimotor declines in a rat model of overuse‐induced median mononeuropathy

Barbe

Hilliard

Amin

et al. 2020

Journal Orthopaedic Research

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Encapsulation of median nerves is a hallmark of overuse-induced median mononeuropathy and contributes to functional declines. We tested if an antibody against CTGF/CCN2 (termed FG-3019 or Pamrevlumab) reduces established neural fibrosis and sensorimotor declines in a clinically relevant rodent model of overuse in which median mononeuropathy develops. Young adult female rats performed a high repetition high force (HRHF) lever-pulling task for 18 weeks. Rats were then euthanised at 18 weeks (HRHF untreated), or rested and systemically treated for 6 weeks with either an anti-CCN2 monoclonal antibody (HRHF-Rest/FG-3019) or IgG (HRHF-Rest/IgG), with results compared with nontask control rats. Neuropathology was evident in HRHF-untreated and HRHF-Rest/IgG rats as increased perineural collagen deposition and degraded myelin basic protein (dMBP) in median nerves, and increased substance P in lower cervical dorsal root ganglia (DRG), compared with controls. Both groups showed functional declines, specifically, decreased sensory conduction velocity in median nerves, noxious cold temperature hypersensitivity, and grip strength declines, compared with controls. There were also increases of ATF3-immunopositive nuclei in ventral horn neurons in HRHFuntreated rats, compared with controls (which showed none). FG-3019-treated rats showed no increase above control levels of perineural collagen or dMBP in median nerves, Substance P in lower cervical DRGs, or ATF3-immunopositive nuclei in ventral horns, and similar median nerve conduction velocities and thermal sensitivity, compared with controls. We hypothesize that neural fibrotic processes underpin the sensorimotor declines by compressing or impeding median nerves during movement, and that inhibiting fibrosis using an anti-CCN2 treatment reverses these effects.

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“…En una gran revisión sistemática que incluyó más de cien estudios, las intervenciones quirúrgicas se compararon con el tratamiento conservador y las inyecciones de corticosteroides (7). Si bien los corticosteroides generalmente proporcionan un alivio más inmediato que los procedimientos quirúrgicos o las intervenciones conservadoras, el beneficio de las inyecciones disminuye con el tiempo; El alivio quirúrgico proporciona los resultados más efectivos a mediano y largo plazo.…”

Section: Tratamiento Quirúrgicounclassified

“…El túnel carpiano contiene cuatro tendones FDP y cuatro tendones FDS, así como el tendón FPL y el nervio mediano. El daño de cualquiera de estos componentes durante la cirugía puede conducir a déficits motores o sensoriales (7). La lesión del nervio mediano, la estructura más superficial y más dañada en el túnel carpiano, puede ocurrir cuando se realiza la incisión en el ligamento transverso del carpo.…”

Section: Tratamiento Quirúrgicounclassified

Tratamiento del síndrome del túnel del carpo

Contreras¹,

Salazar²,

Alvarado³

et al. 2020

jah

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Esta revisión narrativa analiza la literatura para determinar los conceptos actuales sobre el tratamiento de síndrome del túnel carpiano que permitan actualizar los conocimientos al personal sanitario. Se utilizó repositorios digitales como Pubmed, Elsevier y SCIELO para la búsqueda avanzada de la bibliografía sobre el tema, usando las palabras clave específicas “túnel carpiano”, “tratamiento”, “parestesias” y “electromiografía”. Se analizaron artículos con menos de cinco años de publicación que resultaron de la búsqueda avanzada de la información. Conclusión: Esta revisión aclara algunos aspectos sobre el tratamiento de esta enfermedad. Las opciones de tratamiento conservador incluyen inmovilizar la muñeca en una posición neutral y fisioterapia. Los corticosteroides orales pueden ser efectivos a corto plazo (dos a cuatro semanas), pero las inyecciones locales pueden mejorar los síntomas durante un período más prolongado. Si los síntomas son refractarios a las medidas conservadoras o si los estudios de conducción nerviosa muestran un atrapamiento severo, puede ser necesaria la liberación abierta o endoscópico del túnel carpiano.

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Recent Advances in the Understanding and Management of Carpal Tunnel Syndrome: a Comprehensive Review

Cited by 29 publications

References 32 publications

Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

Blocking CTGF/CCN2 reverses neural fibrosis and sensorimotor declines in a rat model of overuse‐induced median mononeuropathy

Tratamiento del síndrome del túnel del carpo

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