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Introduction: Carpal tunnel syndrome is an entrapment neuropathy that affects 3% of adults in the United States. The current techniques used for diagnosis have limited specificity/sensitivity, and the techniques used for treatment have limited efficacy.Case Report: A 34-year-old female presented to the emergency department with two months of worsening painful paresthesias in her right thenar eminence. Ultrasound was performed showing a median nerve area of 20.4 square millimeters within the carpal tunnel. Median nerve block was performed within the carpal tunnel causing complete resolution of her pain.Conclusion: Emergency physicians skilled in point-of-care ultrasound and needle-guided procedures can diagnose and treat carpel tunnel syndrome.

BackgroundObjectiveMethodsResultsConclusionThe effectiveness of Kinesio Taping (KT) for mild-to-moderate Carpal Tunnel Syndrome (CTS) remains controversial.To evaluate both the short-term and long-term efficacy of KT in the management of CTS.Electronic searches were conducted in PubMed, EMBASE, The Cochrane Library, Web of Science and Scopus databases up to October 2024. Randomized controlled trials comparing KT with control (sham, no intervention, or basic treatment) or other conservative treatment were included. The revised Cochrane Risk of Bias tool (ROB-2) was used to assess the risk of bias across studies. Meta-analysis was performed to pool data from studies, calculating Mean Differences (MD) and 95% confidence intervals (CI) for continuous outcomes.Fourteen studies with 637 participants were included. Kinesio Taping (KT) significantly improved long-term pain relief compared to control (MD = -1.14, 95% CI: −1.69 to −0.59, p < .001). Additionally, KT led to significant improvements in symptoms and functional status. KT showed similar therapeutic outcomes to orthoses, and combining KT with orthoses provided greater short-term pain relief than orthoses alone (MD = -0.94, 95% CI: −1.76 to −0.11, p = .03).Low to moderate quality evidence indicates that KT may effectively improve long-term pain relief and functional outcomes in patients with CTS. Additionally, low quality evidence suggests that the combination of KT and orthoses may provide greater short-term pain relief.PROSPERO registration number: CRD42024555320 [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy. The reference standard for the diagnosis of CTS remains an area of controversy. The diagnosis can be established clinically, but options for confirmatory testing include electrodiagnostic studies, ultrasound and diagnostic aids such as the CTS-6 score. This review article summarises the current evidence for each confirmatory testing modality, contrasts their advantages and disadvantages and discusses future directions for investigation. Level of Evidence: Level V (Diagnostic) [ABSTRACT FROM AUTHOR]

Background: Triphasic bone scintigraphy (TPBS) is often used to diagnose complex regional pain syndrome (CRPS). The primary aim of this study is to determine if the diagnosis of CRPS in patients with a positive TPBS (TPBS +ve) is accurate. A secondary aim is to determine if there was delay in treatment of patients who underwent TPBS compared to those who did not have a TPBS. Methods: Of 225 consecutive patients presenting to the first author's practice with a diagnosis of CRPS, 65 had TPBS performed before referral with 62 having TPBS +ve. The remaining 160 were clinically diagnosed and a TPBS was not done (TPBS-ND). Patients were classified into five categories – wrong diagnosis, dystonic-psychogenic hand, causalgia, flare reaction and irritative carpal tunnel syndrome (ICTS). Patients with flare reaction and ICTS were considered as having true CRPS and the rest were considered as misdiagnosis. The patients' demographics, duration of symptoms, pre- and postoperative pain, functional score and patient satisfaction were compared. Results: Of the 62 TPBS +ve, there were 38 (61%) misdiagnosis. The proportion of misdiagnoses was fewer in the TPBS-ND group (45%; p = 0.036). Thirty-two of the 62 TPBS group (52%) and 92/160 (56%) of the TPBS-ND group had surgical treatment. At a mean follow-up of 19 months, pain dropped 6.5 ± 2.5 points in the TPBS +ve group. Disabilities of the arm, shoulder and hand (DASH) score fell by 56 ± 27. The mean single assessment numeric evaluation (SANE) score was 8.6 ± 2.3. These results did not differ substantially from those of the TPBS-ND group. Conclusions: A significant number of patients in this study who had TPBS +ve were misdiagnosed in this study. Outcomes after treatment of CRPS were consistently good despite the results of the TPBS. Patients with TPBS +ve had a significant delay to diagnosis. We conclude that TPBS is not useful in the management of CRPS. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) can be treated surgically. Although the minimally invasive open surgical method is widely used, it is not possible to directly visualise the entire length of the carpal tunnel, especially the proximal end, which is on the side away from the skin incision. In this study, we performed a mini-open carpal tunnel release with endoscopic assistance to release the entire length of the carpal tunnel under direct vision and investigated the treatment outcomes. Methods: The surgical method included an incision of ≤2 cm in the palm, cutting of the transverse carpal ligament under direct vision and cutting of the forearm fascia under endoscopic vision. A uniquely designed sheath was used for the endoscopic resection. We investigated the sex, age, medical history, symptoms, examination findings, anaesthesia method, operation time, thenar motor branch variation, postoperative complications, presence or absence of pillar pain and final examination findings of the target patients. Results: A total of 100 hands (85 patients) were included. Anatomical variations of the thenar motor branches were observed in 19 hands. At the final follow-up, hand numbness improved in all patients, while mild numbness was observed in 25 hands. The abductor pollicis brevis muscle improved in all patients with paresis, but 8 of the 27 hands remained completely paralysed. Pillar pain was observed in 36 hands at 8 weeks postoperative, but the condition improved in all patients. The clinical outcomes of this study were good with no cases of major complications or reoperation. Conclusions: The minimally invasive open surgical method described here can be reliably used to release the forearm fascia proximal to the carpal tunnel. The thenar motor branch can also be confirmed under direct visualisation, making it a relatively safe and useful approach. Level of Evidence: Level Ⅳ (Therapeutic) [ABSTRACT FROM AUTHOR]

Paraproteinemic neuropathies represent an important subset of peripheral neuropathies. Once identified, further evaluation into the paraproteinemic subtype, clinical exam pattern, and electrodiagnostic phenotype helps clarify if the paraproteinemia is coincidental or causal of the neuropathy, as not all paraproteinemias cause neuropathy. Of all paraproteinemias, immunoglobulin M (IgM)-associated peripheral neuropathy, or IgM neuropathy, is of particular importance as half of IgM neuropathies also harbor anti-myelin-associated glycoprotein antibodies, which produce a characteristic demyelinating pattern on nerve conduction testing. Immunoglobulin G and immunoglobulin A paraproteinemias are less strongly associated with peripheral neuropathy, except in the setting of multiple myeloma or osteosclerotic myeloma (POEMS syndrome), which have characteristic systemic features. In multiple myeloma, chemotherapy is more likely to result in neuropathy than the myeloma itself. Finally, the presence of systemic features (e.g., cardiomyopathy, nephropathy, recurrent carpal tunnel syndrome, and autonomic insufficiency) should raise concern for hereditary or acquired light (AL) chain amyloidosis. AL amyloidosis can occur in the setting of any light or heavy chain paraproteinemia. Central to the proper evaluation of paraproteinemic neuropathy is electrodiagnostic testing, which helps delineate axonal versus demyelinating paraproteinemic neuropathy, the latter often misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy. [ABSTRACT FROM AUTHOR]

This article provides an overview of the most common mononeuropathies. It includes a description of the neuroanatomy and function of each nerve which allows clinical localization of the lesion. It also describes the clinical presentation, findings in electrodiagnostic studies, updates in imaging including neuromuscular ultrasound and magnetic resonance neurography, and recommended treatment. While mononeuropathies may be part of polyneuropathy, this scenario is beyond the scope of this article. The most common mononeuropathy is carpal tunnel syndrome. Its prevalence in the United States is estimated at 50 per 1,000. The second most common entrapment neuropathy is ulnar neuropathy at the elbow. The incidence was calculated as 20.9% in a 2005 study. The most common compressive neuropathy of the lower extremity is peroneal neuropathy. Other common mononeuropathies included in this article are radial neuropathy, tibial neuropathy, and femoral neuropathy. [ABSTRACT FROM AUTHOR]

The article "Comments on 'high-intensity versus low-level laser in musculoskeletal disorders'" published in Lasers in Medical Science discusses a study comparing high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) for musculoskeletal disorders. The study raises methodological and statistical concerns that may impact its validity and interpretation, emphasizing the need for further examination. The article suggests improvements in transparency, reproducibility, and data analysis to strengthen the study's contribution to evidence-based practice. Additionally, discrepancies in reporting and the need for updated searches are highlighted, urging future reviews to address these limitations for a clearer comparison of laser therapies' efficacy in treating musculoskeletal disorders. [Extracted from the article]

Imaging plays an important role in evaluating peripheral nerves. In the preoperative setting, imaging helps overcome pitfalls of electrodiagnostic testing and provides key anatomical information to guide surgical management. In the postoperative setting, imaging also offers key information for treating physicians, although it comes with several challenges due to postsurgical changes and alteration of normal anatomy. This article reviews our approach to peripheral nerve imaging, including how we use imaging in the pre- and postoperative setting for several common indications. [ABSTRACT FROM AUTHOR]

Background: Trials demonstrated an increased risk of distal median nerve dysfunction (DMND) and carpal tunnel syndrome (CTS) associated with teriflunomide in people with multiple (pwMS). Objective: To estimate the real-world prevalence of clinical CTS and electrodiagnostic DMND in teriflunomide-treated pwMS. Methods: Cross-sectional study on selected teriflunomide (WHOATC code: L04AK02)-treated, risk factor-free pwMS at the Isfahan MS clinic in 2022. CTS was diagnosed through history and physical examination, and DMND was diagnosed by nerve conduction studies (NCS). Outcome consisted of an ordinal scale of DMND as follows: no DMND, all values within normal limits; mild, sensory conduction velocity < 40 m/s with motor onset latency < 4.5ms; moderate, motor onset latency between 4.5–6.5ms; severe, motor onset latency > 6.5ms with amplitude > 0.2mV; and very severe, motor amplitude < 0.2mV. Results: 52 participants were included (median [range] duration of teriflunomide treatment: 3 [18] years); 5.8% were diagnosed with CTS, yet, 51.9% showed at least some evidence of DMND; of the 104 hands, 25% showed mild, 11.5% moderate, 2.9% severe, and none showed very severe DMND. Right hand side (aβ [SE]: 0.67 [0.26]; p = 0.01), duration of MS (aβ [SE]: -0.14 [0.05]; p = 0.01) and age (aβ [SE]: 0.06 [0.03]; p = 0.05) were associated with a worse grade of DMND, while the association of DMND grade with sex, EDSS score, duration of teriflunomide treatment, and prior DMT, were not confirmed (all p values > 0.05). Conclusion: A considerable proportion of teriflunomide-treated pwMS had DMND in at least one hand. The etiology, along its optimal management strategy, remains to be explored. [ABSTRACT FROM AUTHOR]

Background: Lacertus syndrome, a condition characterized by median nerve compression at the elbow due to anatomical variations, is often misdiagnosed. This case report describes a 53-year-old female patient who presented with severe lateral elbow and shoulder pain, previously diagnosed with cervicalgia and tennis elbow. Methods: Upon admission, she reported significant pain (NRS—Numerical Rating Scale 8/10) and occasional radiating paresthesia in the first three digits of her left hand. Clinical examination revealed weakness in the wrist and finger flexion, which was exacerbated by a positive Cutaneous Scratch Test (CST), while Magnetic Resonance Imaging (MRI) of the cervical spine showed no definitive abnormalities. Electroneurography (ENG) indicated reduced amplitude in the left anterior interosseous nerve. Ultrasound excluded carpal tunnel syndrome but identified nerve flattening beneath the pronator teres muscle. A surgical decompression of the median nerve was performed, resulting in immediate improvement in muscle strength and significant pain reduction (NRS 1/10) postoperatively. Follow-up evaluations confirmed substantial recovery in nerve function and morphology. Conclusions: This case illustrates the atypical presentation of Lacertus syndrome, emphasizing the need for comprehensive diagnostic approaches that include clinical, imaging, and neurophysiological assessments. Awareness of this syndrome is crucial for differential diagnosis in patients exhibiting uncharacteristic symptoms, such as shoulder or elbow pain, to ensure timely and effective treatment. [ABSTRACT FROM AUTHOR]

Background: Neurologic symptoms seen in patients receiving immune checkpoint inhibitors (ICI) may not be entirely caused by immunotoxicity. We aim to highlight these confounding conditions through clinical cases to encourage early recognition and management. Methods: We describe a series of seven cases from our institution that were treated with ICI and presented with Neurologic symptoms and were diagnosed with superimposed conditions beyond immunotoxicity. Results: A total of 7 cases are described that include acute motor axonal neuropathy with vitamin B12 deficiency, lumbosacral radiculopathy with Wernicke's, Herpes simplex virus (HSV) encephalitis reactivation, central nervous system vasculitis with renal vasculitis, myositis with fasciitis, myositis with fixed clinical deficit at resolution, and synovitis with accompanying carpal tunnel syndrome. Primary cancer site included lung adenocarcinoma (2/7), melanoma (4/7), and oropharyngeal squamous cell carcinoma (1/7). All patients had received treatment with more than one ICI. Median number of cycles prior to neurotoxicity was 3 cycles. Discussion: Neurologic symptoms seen in patients receiving ICI may include other causes beyond immunotoxicity. [ABSTRACT FROM AUTHOR]

The article discusses the presentation and outcomes of transsphenoidal surgery in patients with acromegaly at a newly established center of excellence. It highlights the characteristics of acromegaly, the importance of early diagnosis, and the factors influencing surgical remission. The study, conducted between July 2018 and February 2024, emphasizes the role of a specialized pituitary center in providing comprehensive care and achieving favorable treatment outcomes for patients with acromegaly. [Extracted from the article]

Purpose: Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis. Materials and Methods: PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA). Results: Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks, respectively. In terms of both BCTQ symptoms and BCTQ function, the 5 cc injection was the most effective, with SUCRA values of 99.5 for both categories. However, the effectiveness of the electrodiagnostic assessment and ultrasound variables was dependent on the type and dose of medication. Conclusion: Administration of 5% DW showed better results in terms of initial symptom relief and long-term functional recovery compared to other agents, while platelet-rich plasma showed greater long-term symptom improvement; an injection dose of 5 cc showed the greatest benefit. However, additional research is required to establish precise protocols based on disease severity. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) and cervical spondylosis (CS) are both common diseases, yet differentiation between the two is sometimes necessary. However, there are few evidence-based reviews on the differentiation of these conditions. This review examined the literature on the diagnosis of CTS and CS, focusing on how to distinguish between them. The analysis is divided into four categories: clinical symptoms, physical examination, diagnostic imaging, and electrodiagnosis. A total of 281 studies are reviewed, revealing a major issue: the inclusion criteria for defining each disease varies widely across studies. Understanding this limitation, the conclusion drawn is that no single clinical symptom, test, or imaging evaluation can be deemed uniquely reliable for diagnosing CTS or CS. Therefore, it is essential to apply the most up-to-date knowledge, conduct thorough examinations, and perform necessary tests for each patient to achieve a confident and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is characterized as a compressive neuropathy of the median nerve and has several treatments, including photobiomodulation, which can be performed with low-intensity laser therapy (LLLT) and light-emitting diodes (LEDs). Purpose: To carry out a literature review on the effectiveness of low-intensity laser therapy (LLLT) in CTS. Methods: This study is characterized by being a systematic review with metaanalysis. The databases included were PubMed, Embase, Cochrane, the Physiotherapy Evidence Database (PEDro), Scopus and LILACS. Also, gray literature: Google Scholar, OpenGrey and CAPES Theses and Dissertations Catalog. The search was carried out in all databases on October 11, 2023 and updated on June 06, 2024. The risk of bias was assessed using the Cochrane tool, RoB 2, by two blinded reviewers and conflicts were resolved by consensus. The outcomes of interest were pain intensity (Visual analogue scale), strength (handgrip and pinch) and hand functionality (Boston questionnaire, Levine questionnaire, Purdue Pergboard Test). Statistical analysis was carried out using RevMan 5.4.1. Continuous results were expressed as standard mean differences (95% CI), with p-value of < 0.05 considered statistically significant. The value of the I2 statistical test was calculated to test for heterogeneity between studies. A random effects model was adopted. Results: 13 randomized controlled trials were selected from 1.613 records. In the general bias analysis, two studies (15,4%) were considered to have some relevant problems that could interfere with the quality of the study, and three (23,1%) were identified as having a high risk of bias, eight studies (61,5%) were classified as having a low risk of bias. In the meta-analysis, it was possible to observe that there were no advantages of the laser for pain (p = 0.08), nor for handgrip strength (p = 0.11), but it did produce improvements in functionality. Conclusion: It is concluded that LLLT is an effective therapeutic modality in the treatment of CTS, improving functionality; however, despite the studies pointing to advantages for the modality in reducing pain and improving grip strength, the meta-analysis did not show this result. Even so, there is a need for more clinical trials are needed to standardize dosimetry, mainly because the primary studies showed clinical advantages of PBM. Registration: Open Science Framework (OSF)—https://doi.org/10.17605/OSF.IO/HQCRP. [ABSTRACT FROM AUTHOR]

Background: This study aimed to estimate the influence of continuous and cluster nursing on carpal tunnel syndrome (CTS) release surgery. Methods: Ninety-six patients with CTS were treated in our hospital from November 2019 to December 2021. These patients were randomly divided into two groups of 48 patients. Both groups underwent open carpal tunnel release surgery. The control group received routine nursing care, while the study group received a combination of continuous and cluster nursing interventions. The Boston carpal tunnel question, the Visual Analogue Scale (VAS), the Numerical Rating Scale (NRS), the Pittsburgh Sleep Quality Index (PSQI), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and the Barthel index were used to compare hand function recovery, hand pain, sleep quality, and quality of life between the two groups before and 3 months after surgery. Results: Both groups experienced improvements in hand function and pain 3 months after surgery. However, the study group demonstrated lower scores in symptom and dysfunction, as well as lower VAS and NRS scores compared to the control group (P < 0.05). Additionally, both groups showed an increase in the Barthel and PSQI scores 3 months after surgery. Notably, the study group exhibited higher Barthel scores and lower PSQI scores than the control group (P < 0.05). Conclusion: The use of continuous and cluster nursing in patients undergoing CTS release surgery proves to be advantageous in alleviating hand pain, facilitating hand function recovery, and effectively enhancing sleep quality and overall quality of life for patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Discussion Extrapolated reference values (E‐Ref) procedure is a new method for determining the cutoff value without collecting the control data. We tried to apply this method to determine the cutoff value for the distal motor latency of the median nerve (median DML). During this process, we found two pitfalls of the E‐Ref method. First, the E‐Ref procedure did not correctly work when the DML values measured with 0.1 ms accuracy frequently took on tie values. Second, the result was influenced by the proportion of abnormal values. This study investigated these issues.Data of the median DML were extracted from our laboratory database. To solve the problem of tie values, we tried a wider post‐smoothing window in the original E‐Ref method. We also devised a modified method conducting pre‐smoothing. To see the effect of the proportion of abnormal data, we simulated many datasets having different proportion of abnormal data.In total, 1016 DML values were identified. False deflections due to tie values were often identified as the E‐Ref point using the original methods even using a wider window, resulting in unrealistically low values. Modified method was free from this drawback. For all methods, the E‐Ref value increased as the proportion of abnormal values increased.The problem of tie values, a pitfall of the E‐Ref method, might be solved by pre‐smoothing the data. The E‐Ref value is influenced by the proportion of the normal data, and datasets containing less than 20% abnormal data may achieve appropriate results. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, often assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The BCTQ evaluates symptom severity (SSS) and functional status (FSS) but has limitations in stratifying CTS severity, particularly in severe cases. Objective: This study aimed to evaluate the utility of the BCTQ in a homogeneous cohort of female workers engaged in repetitive manual tasks, exploring its correlation with objective clinical measures and its performance in detecting CTS severity. Methods: A cross-sectional study was conducted on 24 right-hand-dominant female workers with repetitive occupational tasks. CTS diagnosis was confirmed via clinical and electrodiagnostic criteria. Subjects completed the BCTQ, and correlations between BCTQ scores and objective measures such as median nerve cross-sectional area and nerve conduction studies were analyzed. Statistical analyses included comparisons across CTS severity groups and subgroup evaluations based on age and tenure. Results: The BCTQ demonstrated moderate correlations with objective measures, with a strong correlation between SSS and FSS scores (r = 0.86, p < 0.001). However, the sensitivity of the SSS and FSS was limited, particularly for severe CTS cases. Paradoxically lower scores in severe cases may reflect questionnaire limitations or adaptive responses. Targeted questions addressing pain and sensory symptoms showed better sensitivity (>80%) and may guide clinicians in identifying slight CTS cases. Conclusions: While the BCTQ remains a valuable tool for assessing CTS, its limitations necessitate complementary use of objective diagnostic tools, particularly for severe cases. Future refinements, such as tailored scoring systems and integration with clinical measures, could enhance its diagnostic utility and ensure comprehensive assessment of CTS severity. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the diagnostic and evaluative significance of combining median nerve (MN) morphological measurements with diffusion tensor imaging (DTI) and T2 mapping metrics for carpal tunnel syndrome (CTS). Morphological and multiparametric magnetic resonance neurography (MRN), along with clinical evaluation, were conducted on 33 CTS patients and 32 healthy controls. The MRN metrics included fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity (RD), T2 value, cross-sectional area (CSA) and MN flattening ratio (MNFR) at both the pisiform bone and hamate bone levels. Differences in MRN metrics between the above two levels (Delta FA, Delta ADC, Delta AD, Delta RD and Delta T2) were calculated. T-tests, multivariable regression, and receiver operating characteristic (ROC) curve analyses were used to compare and classify patients with CTS and controls. The correlations between MRN metrics and clinical characteristics were analyzed. Comparisons were also made between MRN metrics in patients with and without significant symptom improvement after treatment. FA, AD, T2 value, and CSA at the pisiform bone level were identified as independent predictors of CTS. The combination of these metrics improved diagnostic performance (AUC 0.922, sensitivity 84.85% and specificity 90.62%). Delta ADC, Delta AD, and Delta T2 correlated with function Boston scores. The T2 value at hamate bone level, along with Delta AD and FA, correlated with visual analogue score (VAS). CSA and Delta T2 had higher AUCs for classifying patients with and without significant symptom improvement after treatment. These findings suggest that combining MN morphological and multiparametric MRN metrics can enhance the diagnostic performance of CTS and has the potential to provide an objective and quantitative basis for further study of the degree of entrapment and prognosis. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal ultrasonography of the hand and wrist is becoming the trend in assessing and diagnosing most hand and wrist injuries, soft-tissue mass, and occult fractures. Its advantages include ultra-high frequency probes, noninvasiveness, cost-effectiveness, lack of ionising radiation, and portability. The patients are comfortable doing this procedure in the outpatient department, and visualising the ultrasound images increases their confidence. Conclusions: Ultrasound has a practical and dynamic real-time diagnostic capability compared to other modalities, playing an important role in hand and wrist pathologies. Apart from the diagnostic utility, it has also been beneficial in musculoskeletal intervention procedures, such as trigger finger, carpal tunnel syndrome, and various tenosynovitis. The learning curve and limited deeper penetrations are relative limitations to ultrasound usage. More dedicated training centres and modules for future generations and CT/MRI for deeper structures are always an alternative. This article reviews the role of ultrasound in hand and wrist pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce. Objective: To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS. Methods: A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent. Results: Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (β = 0.003; 95% CI: 0.002–0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R2 Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations. Conclusion: Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension. [ABSTRACT FROM AUTHOR]

Introduction: There exist conflicting electrodiagnostic reports between diagnosing mild carpal tunnel syndrome (CTS) and normal results, depending on the interpretation methods used by electrodiagnosticians. This underscores the necessity for precise clinical guidelines. This study aims to assess how the variation between mild and normal electrophysiological reports impacts (1) subsequent clinical outcomes in patients diagnosed with CTS and (2) physicians’ decision-making. Methods: In a prospective cohort study, we followed 102 patients with suspected CTS who underwent electrodiagnostic studies (EDX). The EDX results for these patients were categorized as either normal or indicative of mild CTS, based on the interpreter’s chosen assessment method, which included median-ulnar palmar mixed comparison or median sensory nerve studies. Patient demographics, EDX reports, the choice between surgical or non-surgical treatment, as well as repeated measurements of post-operative pain and paresthesia, were collected at day 0, two weeks, and 12 weeks post treatment. Results: The study includes an equal number of patients with mild and normal electrodiagnostic reports, totaling 51 individuals in each group, and revealed no significant differences in their demographic and baseline characteristics. Over time, both groups showed a decrease in symptom severity. Nevertheless, the reduction in pain (P = 0.77 at 12 weeks) and paresthesia (P = 0.32 at 12 weeks) showed no significant differences between the two groups. Furthermore, there were no differences observed between the groups concerning the treatment choices made by the surgeon (P = 0.218). Conclusion: When EDX reports indicate either normal or mild CTS, it seems that this interpretation doesn’t substantially influence a surgeon’s decision in selecting the treatment option or the resulting clinical outcome post-treatment. This highlights the importance of clinical assessment rather than relying solely on EDX reports in managing these patients. Level of evidence: Level II (Prospective cohort study). [ABSTRACT FROM AUTHOR]

INTRODUCTION: It is currently uncertain whether smoking is a risk factor for carpal tunnel syndrome (CTS). This study aims to elucidate association between smoking and CTS using Mendelian randomization (MR) analysis. METHODS: This study was a secondary analysis of publicly available GWAS data, using four smoking phenotypes (smoking initiation, smoking status, lifetime smoking, and never smoking) as exposures, and two CTS datasets (discovery and validation sets) as outcomes for MR analysis. The discovery set (n=480201) was used to explore the causal relationship between smoking and CTS, while the validation set (n=385304) was used to confirm the results. The effects of smoking on CTS were assessed using inverse variance weighted (IVW), MR-Egger, and weighted median methods. Cochran's Q test was used to detect heterogeneity, and MREgger to test for pleiotropy. Finally, a meta-analysis was performed on the IVW results from both the discovery and validation sets. RESULTS: IVW results showed that in both the discovery and validation sets, smoking initiation, smoking status, and lifetime smoking are risk factors for CTS. The summary results from the meta-analysis are as follows: smoking initiation (OR=1.17; 95% CI: 1.08–1.27, p<0.001), smoking status (OR=1.87; 95% CI: 1.56–2.24, p<0.001), and lifetime smoking (OR=2.46; 95% CI: 2.03–3.00, p<0.001). Conversely, never smoking is a protective factor against CTS, with the summary result of the meta-analysis being: OR=0.55; 95% CI: 0.42–0.71, p<0.001. CONCLUSIONS: Based on genetic evidence, smoking may be a risk factor for CTS. Further clinical trials are needed to confirm this causal relationship. [ABSTRACT FROM AUTHOR]

Objective: To investigate and compare the median nerve-cross sectional area at the wrist region of the dominant and non-dominant hands of high- and low- smartphone users. Method: This descriptive cross-sectional study was based on 128 human subjects conducted at Bahria University Health Sciences Karachi Campus from January to June 2022. The sample size was calculated using the method of sample size for frequency in a population www.openepi.com which is an open-source calculator, version 3-SSPropor using the following equation: Sample size n = [DEFF*Np(1-p)]/[(d²/Z²1-α/2*(N-1)+p*(1-P)]. The subjects were from MBBS, BDS, DPT, and Dental House Officers. They were grouped into two categories: high-smartphone users and lowsmartphone users, based on the smartphone addiction scale (SAS). Ultrasound was carried out on each subject’s wrist regions at the carpal tunnel level. The readings were compared between the dominant and non-dominant hands of each individual. Results: In this descriptive cross-sectional study on 128 subjects, the difference between the median nerve crosssectional areas (MN-CSAs) of the dominant and non-dominant hand of the high-smartphone group was highly significant (p=0.007). The difference between the MN-CSAs of the dominant and non-dominant hand of the low-smartphone group was significant too (p=0.0103). Conclusion: Smartphone overuse resulted in an enlarged median nerve, especially in the dominant hand. [ABSTRACT FROM AUTHOR]

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