carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder that is diagnosed using clinical signs and symptoms and confirmed via nerve conduction studies (NCSs). While NCS is a semi-invasive procedure, magnetic resonance imaging (MRI) is a non-invasive diagnostic tool that detects macroscopic nerve abnormalities and evaluates a patient's surgical or medication treatment options. This study assessed magnetic resonance neurography (MRN)’s diagnostic and grading value by comparing it to electrodiagnostic studies in patients with CTS and healthy individuals. This was a cross-sectional study on 27 wrists with CTS and 27 healthy wrists. After history taking and physical examination, we employed an NCS to confirm and determine the severity of CTS, then MRN and diffusion tensor imaging (DTI) were used to calculate apparent diffusion coefficient (ADC), fractional anisotropy (FA), and cross-sectional area (CSA). 18 patients with CTS (27 median nerves) and 15 healthy controls (27 median nerves) were evaluated. The mean FA in the CTS group was significantly lower (0.38 ± 0.05 vs. 0.45 ± 0.06, P < 0.001). The mean CSA and ADC were higher in patients with CTS but not statistically significant. FA’s diagnostic cut-off was 0.42, with a sensitivity of 70.4% and a specificity of 63%. MRN with DTI can be an effective and non-invasive diagnostic technique for the detection of CTS. The FA measure demonstrated adequate sensitivity and specificity for differentiating patients with CTS from healthy individuals.

Carpal tunnel syndrome (CTS) is a common neuropathy caused by pressure on the median nerve in the wrist, affecting 1% to 5% of the population. Treatment options include pharmacologic management, rest, splints, local steroid injections, and physical therapy. Conservative treatments, such as ultrasound therapy and nerve-gliding exercises, can also be effective.

This study aimed to compare the effects of ultrasound therapy and nerve-gliding exercises on reducing symptoms, improving hand function, and electrodiagnostic tests in patients with CTS.

This randomized clinical trial was conducted on patients with CTS at the specialized physical medicine and rehabilitation clinic at Birjand University of Medical Sciences. The study included 48 patients with CTS, divided into two groups. The ultrasound group received therapy at a frequency of 1 MHz and a current intensity of 1 watt/cm², with each session lasting 5 minutes. The nerve-gliding group underwent 10 sessions of treatment, three times a week. Pain intensity was evaluated using VAS criteria, symptom intensity using the BOSTON Questionnaire, and median nerve latency with EMG-NCS.

The study included 48 patients with CTS, divided into two groups. Both groups showed improved severity of symptoms and function scores at the end of the study (P < 0.001). The ultrasound group significantly reduced the sensory and motor median nerve latency scores (P < 0.001 and P = 0.001, respectively), and the pain score diminished significantly in both groups (P < 0.001).

Ultrasound and neural-gliding techniques are effective in reducing patients' symptoms and pain intensity in the short term. Additionally, ultrasound can improve electrodiagnostic indicators.

Carpal tunnel syndrome (CTS) is a common disease resulting from the median nerve entrapment at the wrist. Although CTS (prevalence=5%–10% in the general population) is the most common neuropathy, its molecular mechanisms need elucidation. We used bioinformatics to detect genes with differential expressions in CTS and introduce the molecular regulatory noncoding RNAs and signaling pathways involved.

The raw files of the RNA sequencing of CTS patients and controls were obtained from GEO (accession: GSE108023), and the samples were analyzed. Differentially expressed genes were isolated using DESeq2 R. Functional analyses were conducted on the signaling pathways, biological processes, molecular functions, and cellular components of the differentially expressed genes. Additionally, interactions between the most differentially expressed genes and miRNAs and lncRNAs were investigated bioinformatically.

Upregulation and downregulation were observed in 790 and 922 genes, respectively. The signaling pathway analysis identified the metabolism pathways of arachidonic acid, linoleic acid, and tyrosine as the most significant pathways in CTS. Moreover, PLA2G2D and PLA2G2A with upregulated expressions and PLA2G2F, PLA2G4F, PLA2G4D, PLA2G3, and PLA2G4E with downregulated expressions were genes from the phospholipase family playing significant roles in the pathways. Further analyses demonstrated that hsa-miR-3150b-3p targeted PLA2G2A and PLA2G4F, and RP11-573D15.8-018 lncRNA had regulatory interactions with the aforementioned genes.

Molecular studies on CTS will clarify the involved signaling pathways and provide critical data for biomedical research, drug development, and clinical applications.

Surgical site hematoma is one of the factors that influence the results of the carpal tunnel release (CTR) and patients’satisfaction; therefore, this study was designed to evaluate the effects of using Penrose drain to reduce the operation site hematoma and improve the results of surgery.

Patients with a diagnosis of carpal tunnel syndrome (CTS) were randomly divided into intervention and control groups and then were evaluated by pain with the visual analog scale (VAS) and pinch power. The Penrose drain was placed for the intervention group and removed after two days. Three months after surgery, all patients were re-evaluated by VAS and pinch power.

Out of 46 patients, Penrose drains were placed for 21 patients. According to the results, the VAS and pinch power evaluations were better in patients with Penrose drain (P = 0.001) but in patients without Penrose drain, only the VAS evaluation resultswere improved, but a decrease in pinch power was detected.

CTR surgery with or without the Penrose drain decreases pain in patients after three months of operation. CTR with Penrose drain improves pinch power and also decreases the pain, but in patients without Penrose drain, pinch power was reducedafter this period.

This study aims to assess the efficacy of local heat therapy (Kaiy) in alleviating symptoms of mild to moderate idiopathic carpal tunnel syndrome (CTS). A single-blind clinical trial was conducted involving patients with mild and moderate idiopathic carpal tunnel syndrome. A total of 120 patients were randomly assigned to either the intervention or control group. Both groups utilized a medical wristband during nighttime. The intervention group received pen moxa as a local heat therapy tool (Kaiy) applied to the wrist region. The Boston questionnaire was employed for assessment. Heat therapy using Kaiy (pen moxa) significantly improved symptom severity (P≤0.0001), functional status (P≤0.0001), and pain scores (P≤0.0001) in patients with mild to moderate CTS compared to those in the control group without heat therapy. This study demonstrates the positive impact of heat therapy (Kaiy) as a non-surgical approach for reducing pain, symptom severity, and functional impairment in CTS patients. Integrating complementary and alternative medicine with conventional treatment modalities could enhance symptom management with minimal side effects.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. There are several factors that influence the severity of CTS. The purpose of this study was to explore the severity of CTS in hypothyroid patients.

This cross-sectional study was conducted in the university clinic. Seventy-six participants with a clinically and electrophysiological confirmed diagnosis of CTS were included in the study. The demographic data and severity of CTS were analyzed based on the presence (n=38) or the absence (n=38) of primary hypothyroid disease. Thirty-eight hypothyroid patients who were being treated were included in this study. For the assessment of the severity of CTS, the Boston questionnaire (BCTQ) and electrodiagnostic tests were used. For data analysis, an independent sample t-test and chi-squared test were carried out. A P<0.05 was considered significant.

The mean age of hypothyroid and non-hypothyroid CTS patients was 46.21±7.22 and 44.24±8.02 years, respectively. Body mass index (BMI) was >30 kg/m2 in both groups. There was no significant difference in demographic data among the two groups. The mean score of symptom severity in hypothyroid and non-hypothyroid-CTS patients were 30.37±10.84 and 35.89±7.19, and also functional status was 21.71±9.04 and 25.92±6.62, respectively. There was a significant difference between the two groups, in terms of symptom severity scale (P=0.017, 95% CI, 31.14%, 35.48%) and functional status scale (P=0.023, 95% CI, 21.95%, 25.67%). In terms of electrophysiological findings, there was no statistically significant difference between these two groups. 

The results of this study indicated that, contrary to expectation, the severity of CTS is higher in non-hypothyroid patients than in hypothyroid patients.

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy with squeezing of the median nerve and the patient is unable to function properly. There are different physiotherapy interventions for the management of these patients and recently, shock wave therapy and low-power laser (LPL) have been widely used, but there is no strong evidence comparing the effect of shock wave therapy and LLLT. Therefore, this trial was designed to compare the effect of extracorporeal shock wave therapy (ESWT), LPL, and routine interventions on clinical outcomes and electrophysiological parameters in patients with moderate CTS.

Fifty-four patients were randomly assigned to the control (routine interventions), ESWT, and LPL therapy groups. All participants received transcutaneous electrical nerve stimulation (TENS) therapeutic ultrasound, hot pack, mobilization, and stretching for ten sessions over two weeks. Additionally, the ESWT group received radial ESWT in four sessions, and the LPL therapy group received laser in ten sessions. The primary outcomes were pain (assessed by the visual analog scale), function (assessed using the Boston questionnaire (BQ)), hand grip, and finger pinch strength. Secondary outcomes were electrophysiological parameters (distal motor and sensory latency and nerve conduction velocity (NCV) of the median nerve. 

Time group interactions were significant for pain, the symptom severity subscale of BQ, finger pinch, and hand grip strength (p<0.001). Significant improvements were seen in clinical and sensory latency and motor NCV of the median nerve (p<0.05). The ESWT group experienced significant improvements with a large effect size in pain, function, and finger pinch strength compared to the control group (p<0.01). Additionally, the LPL therapy group showed significant changes in the function and finger pinch and hand grip strength compared to the control group. There were no significant differences between the LPL therapy and ESWT groups except for pain in favor of the ESWT group. No significant differences were found among the three groups in electrophysiological parameters (p>0.05).

Although laser therapy increased the efficacy of routine interventions, it seems adding ESWT to the routine treatment may be superior for the management of moderate CTS patients.

Carpal tunnel syndrome (CTS) is the most typical peripheral entrapment neuropathy. To date, various non-invasive methods have been used tomanageCTS. This study investigates the effectiveness of Transfer Energy Capacitive and Resistive (TECAR), a new physical agent modality, on symptoms and neurophysiological parameters in patients with CTS.

In this single-blind randomized clinical trial, 29 patients with mild or moderate CTS were randomly assigned to two groups. Group 1 received TECAR therapy with a frequency of 500 Hz and an intensity of 30 to 50%, 2 sessions/week, in addition to wrist splints and vitamin B supplements for 4 weeks. Group 2 also received a wrist splint and vitamin B for 4 weeks without TECAR therapy. The Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ-SSS and FSS), as well as clinical and neurophysiological findings, were assessed before and 8 weeks after treatment. Within and between-group comparisons were made after the intervention period.

VAS and the Boston Carpal Tunnel Questionnaire (FSS and SSS) showed significant changes. Clinical CTS tests and electrophysiological parameters did not show significant differences before and after the study. From a clinical perspective (pain relief and functional improvement), the TECAR therapy group showed more definite changes.

TECAR can be considered an effective non-invasive treatment for patients with mild to moderate CTS.

Obtaining a blood-free surgical field is critical during carpal tunnel decompression (CTD) to identify anatomic structures and avoid iatrogenic injury. A tourniquet is often used to minimize bleeding and improve visualization. However, it may be associated with discomfort and intolerance when sedation is not employed. WALANT ("Wide awake local anesthesia no tourniquet") technique surgeries have become very popular and enable the patient to be involved in the procedure; in addition, the adrenaline avoids the use of the tourniquet and the discomfort it produces. We hypothesized that there is no difference in postoperative pain after CTD between local anesthetic with a tourniquet (LA-T) and WALANT technique. The objective of this paper is to report the results of CTD, comparing those performed with local anesthesia and those performed with the WALANT. In this prospective study, 60 CTS were operated in two different institutions. Patients in group 1 (30 patients) were operated under LA-T, while patients in group 2 (30patients) were operated on using lidocaine with epinephrine (WALANT). Statistical analysis was performed. Postoperative pain immediately after surgery, at 4 and 24 hours, and 15, and 30 days after surgery; and degree of satisfaction did not show a significant difference between the two groups. Moreover, surgical time was slightly shorter in the LA-T group, but the difference was not significant. In our study, CTD performed with LA-T, and WALANT technique resulted in similar results. In cases of experienced surgeons, LA-T may be enough to perform the procedure, avoiding epinephrine's low but complex complications. In less experienced surgeons who require more surgical time, the use of WALANT may increase the intraoperative comfort of the patient.  Level of evidence: IV

The aim of this study was to perform a bibliometric analysis to assess the number of articles published by Iranian researchers in the field of hand and microsurgery over the last four decades.

An online search was conducted using 685 keywords in the abstract/ title sections of articles, including carpal tunnel syndrome, wrist fractures, nerve injury and repair, skin flap and graft in the hand, congenital disorders in the hand and forearm, tumor in the hand and wrist, and infection in the hand and wrist. From February 1976 to May 2021, EndNote software version 8.1 was used to search articles in PubMed and Scopus databases. Articles in which at least one of the authors was affiliated with Iran were chosen. The name of the original institution, field of study, total number of publications, type of study, collaboration rate of Iranian hand surgeons for each year, and annual sharing of Iranian articles in journals with the highest cite scores in the field of hand and microsurgery were all examined in the present study.

The total number of publications in the field of hand and microsurgery was 632 (an average of 11 papers per year). Most of the Iranian hand and microsurgery papers were from the capital city, Tehran (38.09%). There was an increasing trend in the number of publications over the years, most which were about carpal tunnel syndrome (21.5%), tendon (9.8%), and nerve (9.6%). In total, 59.6% were descriptive articles, whereas the proportion of clinical trials was relatively small (22.3%).

Iranian hand microsurgeons have continued to increase their scientific output in hand microsurgery and related fields over the last 40 years. The quality of Iranian hand microsurgeons’ scientific output, both within and outside their discipline, has greatly improved; however, they still have a long way to go before becoming a hub of science.

Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy. Due to the results of recent studies about the protective effects of L-carnitine on nerves, this study was conducted to evaluate the effects L-carnitine on CTS improvement in terms of patient's function, electrodiagnostic study (EDX), and median nerve sonography.

In this double-blind, randomized, controlled trial, patients with CTS were selected based on the inclusion and exclusion criteria, and then, divided into two groups of placebo and L-carnitine at a dose of 500 mg twice daily for 6 weeks. They were assessed at baseline, and 4 and 6 weeks later using Boston Carpal Tunnel Questionnaire (BCTQ)‎, median nerve conduction study (EDX), and sonography.

There was no statistically significant difference between the intervention and control groups in terms of BCTQ‎ scores, electrodiagnostic findings, and sonographic indexes. Although based on the results of the repeated measures test of the intervention and control groups separately, there was a statistically significant difference in some electrodiagnostic criteria and BCTQ‎ scores. These indexes improved after the intervention.

The effectiveness of L-carnitine on mild to moderate CTS improvement cannot be approve based on the findings of this study and more studies and systematic reviews are required in this regard.

Since diabetic generalized neuropathy affects peripheral nerves, the diagnosis of carpal tunnel syndrome (CTS) with conventional electrodiagnostic techniques (EDX) [onset latency of median sensory nerve action potential (SNAP) or distal latency of median compound muscle action potential (CMAP)] is controversial. The aim of this study is to investigate the diagnostic values of two other techniques including inching method and second lumbrical-interossei test in patients with diabetic polyneuropathy (DPN) as well as signs or symptoms of CTS. Fifteen patients (30 hands) with definite diagnosis of generalized peripheral neuropathy secondary to diabetes who developed signs and symptoms of CTS were participated. For diagnosis of CTS, sensory and motor median distal latencies were considered by nerve conduction study. In the next step, inching method and second lumbrical-interossei test were performed for all hands. Finally, sensitivity and specificity of two tests were calculated. Mean age of participants was 53.87 ± 11.53 years. The sensitivity and specificity of inching method in this study were 95.65% and 85.71%, respectively, and for the second lumbrical-interossei test, they were 73.91% and 71.42%, respectively. Inching method was more sensitive and specific than second lumbrical-interossei test in diagnosis of CTS among patients with diabetic peripheral neuropathy. Moreover, the sensitivity of inching method was greater than specificity.

The median artery is an embryonic structure that typically regresses during gestation. Occasionally, the artery remains and is then termed a persistent median artery (PMA). A PMA can be associated with other anatomic anomalies, and has been known to contribute to carpal tunnel syndrome (CTS). Recent literature has observed an increase in PMA prevalence, speculated to indicate microevolutionary change. We performed a prospective observational study to investigate the current prevalence rate of PMA in patients undergoing carpal tunnel release (CTR).  Institutional review board approval was obtained. From October 2020 to January 2021, patients ≥18 years old undergoing open CTR by 9 orthopaedic hand surgeons were included in analysis. Patients undergoing endoscopic CTR were excluded. Intraoperatively, the carpal tunnel was evaluated for the presence of a PMA, median nerve anomalies, or any other anatomic anomalies. If a patient underwent bilateral CTR during the study, only one side was included in analysis as determined randomly.  Three hundred and sixty open CTRs in 327 patients were performed during the study. Twenty-seven PMAs were identified, for an overall prevalence rate of 8.3%. The average age of patients with a PMA was 63.6 years (SD 13.3 years), consisting of 15 men and 12 women. There were no statistical differences in age, gender, or laterality between patients that did and did not have a PMA. Thirty-three patients underwent bilateral CTR during the study, with 3 being found to have a PMA unilaterally, and zero having a PMA bilaterally. Two bifid median nerves (0.6%) were also identified. This study represents the highest prevalence rate of PMA directly observed in CTR patients reported to date (8.3%). A PMA is not a rare finding, and it should be recognized and protected during CTR. Occasionally, a PMA can be the cause of an acute presentation of CTS. Level of evidence: IV

Carpal tunnel syndrome (CTS) is a common disorder with several known risk factors. However, the role of radiographic characteristics of the distal radius and risk factors of CTS has been overlooked.

To identify radiographic characteristics of the distal radius as the risk factors of CTS.

In a case-control study, 60 patients with CTS who underwent surgical treatment (case group) and 60 people who underwent radiographic evaluation for reasons other than CTS (control group) were included. The case and control participants were matched for age and sex. Radiographic records of the patients were reviewed in the picture archiving and communication system, and the distal radius characteristics, including volar tilt, radius slope, radius height, and ulnar variance, were investigated.

The Mean±SD volar tilt was 10.49±6.42º in the case group and 16.65±5.31º in the control group (P <0.001). The Mean±SD radius inclination angle was 19.58±4.72º in the case group and 17.88±4.88º in the control group (P=0.049). The Mean±SD height of radius was 10.30±3.21 mm in the case group and 12.24±5.33 mm in the control group (P=0.017). The Mean±SD ulnar variance was 1.36±1.43 mm in the case group and 0.75±0.27 mm in the control groups (P=0.002).

Radiological characteristics of the distal radius are significantly different between the CTS and non-CTS patients and could be regarded as the inherent risk factors of CTS development.