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This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objective: Occupations involving repetitive movements of the wrists, activities that require a lot of force, and hand-arm swinging are particularly likely to contribute to the development of hand and wrist complaints. The daily setup and dismantling of dialysis machines as part of the dialysis treatment process can strain the wrists and fingers of nurses. However, evidence regarding the relationship between the work activities of dialysis nurses and the incidence of hand and wrist complaints is limited. This study aimed to investigate the prevalence and severity of hand and wrist complaints among dialysis nurses in Germany and to relate these to their work activities., Methods: An online survey was created and sent to 836 dialysis centres in Germany. The Nordic Musculoskeletal Questionnaire was used in an online survey to assess the prevalence of musculoskeletal complaints in the hands and wrists. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess symptom severity. Dialysis nurses rated the effort required to set up dialysis machines using the BORG-CR10 scale. The analysis was descriptive., Results: A total of 122 dialysis nurses (18 male, 104 female; mean age 45 ± 12 years) participated in the survey, and 59% of them reported developing hands or wrist complaints in the last 12 months. According to BCTQ, the average severity of these complaints is 2.0 ± 0.8 (N = 72). The severity of symptoms increased significantly with the number of setups performed by a dialysis nurse per day (rs = 0.35, P = 0.003, N = 72). The nurses rated the effort required to set up the dialysis machines as 2.8 ± 1.8 on the BORG-CR10 scale (N = 101)., Discussion: The results of the online survey showed that dialysis nurses were more likely than the general population to experience hand and wrist complaints. The repetitive activities of the hands and wrists while setting up a dialysis machine are thought to be the cause., Conclusions: Preventive measures are needed to reduce hand and wrist strain in dialysis nurses., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Purpose: To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. Methods: A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. Only observational studies that examined specifically the prevalence rates of CTS among dentists were included. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Results: In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through meta-regression analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire. Conclusions: Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Kostares E et al.)

Objective: Decompression of the median nerve by complete endoscopic release of the transverse carpal ligament (TCL) and the distal antebrachial fascia. Minimization of surgical trauma results in decreased postoperative morbidity and earlier return to work and daily activities., Indications: Symptomatic carpal tunnel syndrome., Contraindications: Revision surgery after open or endoscopic procedure, rheumatic diseases., Surgical Technique: Small transverse incision at the ulnar border of the palmaris longus tendon, and proximal to the distal wrist flexion crease. Exposure and incision of the antebrachial fascia, dilatation of the carpal tunnel and dissection of synovial tissue from the undersurface of the TCL. With the wrist in extension, the endoscopic blade assembly with integrated camera is inserted into the canal. Exposure of TCL and short incision in the middle portion. Gradually, dissection of the distal portion of the TCL then completion by retraction of the blade distally to proximally., Postoperative Management: Slightly compressive dressing, selfcare on day 1 after procedure., Results: More than 25 years of experience, more than 8000 treated patients, and 3 documented cases with intraoperative lesions of the median nerve requiring revision. High acceptance and patient satisfaction in AQS1 patient-reported surveillance., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: the validity of the upper limb neurodynamic tests and especially the upper limb neurodynamic test 1 for diagnosing carpal tunnel syndrome has been the subject of several previous studies. However, the upper limb neurodynamic test 2A, which is also a test designated to assess the mechanosensitivity of the median nerve, has not been sufficiently studied, particularly for the diagnosis of carpal tunnel syndrome., Methods: we used the upper limb neurodynamic test 2A as the index test and nerve conduction studies as the reference standard. We considered the upper limb neurodynamic test 2A positive according to Nee et al. criteria. Sensitivity, specificity, positive likelihood, and negative likelihood were calculated. In addition, a receiver operating characteristics analysis was carried out., Results: ninety-four women (188 hands) suspected of carpal tunnel syndrome with a mean age of 48.87 years and SD of 12.09 participated in the study. The sensitivity of the upper limb neurodynamic test 2A was estimated at 73.4%, the specificity at 47%, the positive likelihood ratio was 1.38, the negative likelihood ratio was 0.57, and the Kappa agreement was 20.3%, and the area under the curve 60.1%., Conclusion: the upper limb neurodynamic test 2A does not seem to have value in the diagnosis of carpal tunnel syndrome when compared to nerve conduction studies. It could be alternatively used to detect an increased mechanosensitivity of the median nerve when the upper limb neurodynamic test 1 cannot be performed in case of a range of motion limitation of the shoulder abduction., Competing Interests: The authors declare no competing interests., (Copyright: Hassan Beddaa et al.)

Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS.

Background: In the arboriculture sector, some activities are still manually performed by forestry workers, which result consequently exposed to a high risk of developing muscle skeletal disorders. The Italian Compensation Authority reported an increase of work-related tendinopathies and carpal tunnel syndrome in loggers, but screening protocols are not available yet., Objectives: The objectives were: a) to evaluate the prevalence of tendinopathies and carpal tunnel syndrome in a sample of loggers and b) identify a sound screening approach., Methods: 41 loggers and 41 paired control workers were recruited for a total of 164 hands. The protocol included 1) demographic data; 2) medical history; 3) identification of CTS symptoms through a questionnaire and a hand-chart; 4) upper limbs clinical examination; 5) Raynaud's diseases questionnaire; 6) wrists ultrasound; 7) NCS of the distal median nerve., Results: The prevalence of tendinopathies was statistically significant only in the non-dominant hand (75, 5% in the exposed group and 53, 6% in the non-exposed group). The prevalence of CTS was 32, 2% in the exposed group and 15, 5% in the non-exposed group. The questionnaire had a sensitivity of 56, 7% and a specificity of 75%. The hand-chart had a sensitivity of 30% and a specificity of 92%. The clinical examination had sensitivity of 30% and specificity of 80%. The ultrasound had a sensitivity of 70% and a specificity of 56%., Conclusions: Loggers are a population at risk of occupational hand and wrist disorders. The hand-chart could be considered, together with the questionnaire, as the best secondary prevention tool to diagnose CTS.

Background: Carpal tunnel syndrome (CTS) is one of the most common nerve entrapments in the upper limb. In Saudi Arabia, few studies have investigated CTS in the general population. This study aimed to determine the association between personal factors and CTS., Methods: A case-control study involved adults aged 18 and above. Cases were recruited from electrophysiology lab records as consecutive case series, while controls were individuals who were free of CTS symptoms according to the Boston Carpal Tunnel Questionnaire (BCTQ). The electronic medical records of participants were reviewed to obtain age, height, weight, medical conditions, and mobile numbers. Cases and controls were contacted via phone to complete a questionnaire that was designed based on previous literature. We used multivariate binary logistic regression to identify the personal factors significantly associated with CTS., Results: A total of 95 cases and 190 controls were included. Most of the participants were female (84.2%) and Saudi (93%). Most of cases were above 45 years of age (73.7%), while 84.7% were 45 year - old or younger among the control group. Stratified logistic regression showed that performance of household chores was significantly associated with CTS. While physical exercise associated with decreased odds of CTS., Conclusions: This study adds to the body of evidence on personal factors associated with CTS. However, the degree of differences in the age structure of the cases compared with the controls suggest that there is a considerable potential for residual confounding affecting the results., Trial Registration Number: Not applicable., (© 2021. The Author(s).)

Background: Carpal tunnel syndrome patients demonstrate diminished motion of the median nerve and fibrotic changes in the subsynovial connective tissue within the carpal tunnel. Currently, there are few prognostic factors to help predict the outcome of commonly performed treatments including surgical carpal tunnel release and corticosteroid injections. This study aimed to non-invasively assess the changes in the dynamic response of the subsynovial tissue relative to tendon motion after the intervention and to correlate this with disease severity., Methods: A total of 145 patients with carpal tunnel syndrome were recruited into this study. Clinical and demographic data, electrophysiological severity and dynamic ultrasound images were collected before and after treatment, either by injection or surgery. The relative motion of the subsynovial tissue with the underlying middle finger flexor digitorum superficialis tendon was measured using a speckle tracking algorithm and was expressed as a shear index (SI). Baseline and follow-up data, the association between change in SI and severity, and the role of treatment modality were analyzed and statistically compared., Findings: Overall, there was a significant increase (more relative motion) after treatment in the mean shear index from 79.9% (±15.4% SD) to 82.9% (±14.8% SD) (p = 0.03). Secondary analyses showed that this change was mostly present in those with mild disease severity undergoing surgery (p = 0.01)., Interpretation: This study shows that the relative subsynovial tissue movement increases in patients after intervention. The present study lays a foundation for future studies to non-invasively assess the role of carpal tunnel dynamics in response to treatment., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Previous studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen's test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS)., Methods: Patients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated., Results: In total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant., Discussion: A positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS., (© 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: Dental professionals are prone to carpal tunnel syndrome (CTS) and other nerve-related disorders as they perform repetitive wrist work with static physical position for long hours., Objectives: To evaluate the relationship of thumb radial abduction angle with handgrip strength, hand dexterity, and CTS susceptibility among Saudi senior dental students and interns. The study also intends to compare thumb radial abduction angle based on the gender., Methods: A convenient sample of 100 Saudi dental students and interns participated in the study. Their handgrip strength, dexterity, and thumb radial abduction angle were measured by the use of Jamar dynamometer, nine-hole peg test, and goniometer, respectively. Questionnaires were distributed among the participants to assess CTS susceptibility and its association with thumb radial abduction angle. Regression analysis, Pearson's correlation, and independent t-test were performed to analyze the data., Results: A significant correlation between thumb radial abduction angle and handgrip strength was observed. An association of handgrip strength with CTS susceptibility was also found. No significant relationships were drawn considering hand dexterity. Handgrip strength and dexterity were found to be higher in males when compared to females, however, females were observed to be more susceptible to CTS., Conclusion: The study concludes a significant association between thumb radial abduction angle and handgrip strength that is further related with CTS. The results of the study can be used as a foundation for several academicians' research in this domain., Competing Interests: None

Objectives: To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS., Material and Methods: Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded., Results: A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands., Conclusions: The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Carpal tunnel syndrome (CTS) is a clinical disease that caused by the compression of median nerve within carpal tunnel. Traditional examining for CTS is electrodiagnostic (EDx), but the evaluation of EDx is more expensive and time-consuming. In the present day, ultrasound (US) image is used to clinical examining to make up the lack of nerve electrical inspection. The diagnostic criteria of US image for CTS are also defined in many researches. In this study, we propose a new tracking model with deep similarity learning for median nerve from CTS US images. Six wrist motions are defined in the clinical rehabilitation, and the proposed method can achieve accuracy more than 90 % for median nerve tracking. In the experiment, we discover some wrist motions, such as hook to full fist, the statistical information of median nerve tracking is more significant (P < 0.001). It means that some wrist motions are more easily to diagnose the problem of median nerve, and can be used as a basis for quick examining for CTS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Carpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak. The treatment is associated with costs and may cause discomfort and limit daily and work activities. No placebo-controlled trials have been performed., Methods: This is a randomized controlled trial designed to assess the efficacy of a rigid wrist splint compared with soft wrist bandage (placebo) in patients with primary idiopathic CTS. The trial will be conducted at an orthopedic department. Patients, 25 to 65 years old, who seek primary health-care with symptoms of CTS will be screened, and potentially eligible patients will be referred to the study center. Patients who fulfill the trial's eligibility criteria will be invited to participate. A total of 112 patients who provide informed consent will be randomly assigned to treatment with either a rigid wrist splint or a soft bandage to be used initially for 6 weeks at night and, if possible, during the day. The splints and bandages will be fitted with a temperature-monitoring device to measure the total time during which they have actually been worn. The trial participants will complete a questionnaire that includes the 6-item CTS symptoms scale (CTS-6); the 11-item disabilities of the arm, shoulder, and hand (QuickDASH) scale; and the EuroQol 5-dimension (EQ-5D) health status and quality-of-life measure at baseline and at 6, 12, 24, and 52 weeks after treatment start. The participants will undergo physical examination and nerve conduction testing at baseline and at 52 weeks. The trial's primary outcomes are the change in the CTS-6 score from baseline to 12 weeks and the rate of carpal tunnel release surgery at 52 weeks., Discussion: This is the first placebo-controlled randomized trial with electronic monitoring of actual splint use and will provide evidence regarding the efficacy of wrist splinting in patients with CTS., Trial Registration: ISRCTN Registry, ISRCTN81836603 . Registered on May 5, 2018.

Inhibited movement patterns of carpal tunnel structures have been found in carpal tunnel syndrome (CTS) patients. Motion analysis on ultrasound images allows us to non-invasively study the (relative) movement of carpal tunnel structures and recently a speckle tracking method using singular value decomposition (SVD) has been proposed to optimize this tracking. This study aims to assess the reliability of longitudinal speckle tracking with SVD in both healthy volunteers and patients with CTS. Images from sixteen healthy volunteers and twenty-two CTS patients were used. Ultrasound clips of the third superficial flexor tendon and surrounding subsynovial connective tissue (SSCT) were acquired during finger flexion-extension. A custom made tracking algorithm was used for the analysis. Intra-class correlation coefficients (ICCs) were calculated using a single measure, two-way random model with absolute agreement and Bland-Altman plots were added for graphical representation. ICC values varied between 0.73 and 0.95 in the control group and 0.66-0.98 in the CTS patients, with the majority of the results classified as good to excellent. Tendon tracking showed higher reliability values compared to the SSCT, but values between the control and CTS groups were comparable. Speckle tracking with SVD can reliably be used to analyze longitudinal movement of anatomical structures with different sizes and compositions within the context of the carpal tunnel in both a healthy as well as a pathological state. Based on these results, this technique also holds relevant potential for areas where ultrasound based dynamic imaging requires quantification of motion., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Guided plasticity, induced by cutaneous forearm anaesthesia, improves hand sensibility in patients with nerve injury and vibration-induced neuropathy. This study investigated whether patients with carpal tunnel syndrome (CTS) would benefit from cutaneous forearm anaesthesia., Methods: Seventy patients with clinical and electroneurography-verified CTS were randomised to sensory training combined with either an anaesthetic cream (EMLA ® ) (n = 34) or a placebo cream (n = 36) on the volar part of the forearm. The treatment was repeated at increasing intervals over 8 weeks. The primary outcome was the Boston carpal tunnel questionnaire (BCTQ) symptom severity scale after 8 weeks. Secondary outcomes included activity limitations, sensory function, and nerve conduction. This study compared the longitudinal changes between the two groups, and with correction for multiple comparisons it also compared the longitudinal change within the groups., Results: There were no significant differences in primary or secondary outcomes between the groups. However, the BCTQ symptom severity scale improved significantly within the EMLA ® group over the 8-week period (p = 0.001). Apart from this, no significant improvements in activity limitations, sensory function, or nerve conduction were seen in the two groups compared to baseline. Altogether, 47% of patients in the EMLA ® group and 61% in the placebo group had been operated on with carpal tunnel release by 12 months., Conclusion: An 8-week treatment protocol with cutaneous forearm anaesthesia to guide brain plasticity gave no significant subjective or objective improvements in hand function compared to placebo.

Introduction: The direct causes of idiopathic carpal tunnel syndrome (CTS) are still unknown. It is suggested that pathology of the tendons and other connective tissue structures within the carpal tunnel may play a role in its aetiology. Variants in genes encoding connective tissue proteins, such as type V collagen, have previously been associated with CTS. Since variants within other collagen genes, such as type I, XI and XII collagen, have previously been associated with modulating the risk of musculoskeletal soft tissue injuries, the aim of this study was to determine whether variants within COL1A1, COL11A1, COL11A2 and COL12A1 were associated with CTS., Methods: Self-reported Coloured South African participants, with a history of carpal tunnel release surgery (CTS, n=103) and matched control (CON, n=150) participants without any reported history of CTS symptoms were genotyped for COL1A1 rs1800012 (G/T), COL11A1 rs3753841 (T/C), COL11A1 rs1676486 (C/T), COL11A2 rs1799907 (T/A) and COL12A1 rs970547 (A/G)., Results: The TT genotype of COL11A1 rs3753841 was significantly over-represented in the CTS group (21.4%) compared to CON group (7.9%, p=0.004). Furthermore, a trend for the T minor allele to be over-represented in the CTS group (p=0.055) with a significant association when only female participants (p=0.036) were investigated was observed. Constructed inferred pseudo-haplotypes including a previously investigated COL5A1 variant, rs71746744 (-/AGGG), suggest gene-gene interactions between COL5A1 and COL11A1 modulate the risk of CTS., Discussion: These findings provide further information of the role of the genetic risk factors and the possible role of variations in collagen fibril composition in the aetiology of CTS. Genetic factors could potential be included in models developed to identify indivisuals at risk of CTS. Strategies that target modifiable risk factors to mitigate the effect of non-modifiable risk factors, such as the genetic risk, could be also developed to reduce incidence and morbidity of CTS., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Purpose: High-resolution ultrasound is increasingly used in the diagnosis of carpal tunnel syndrome; yet little is known about gender differences in clinical presentation and ultrasound findings., Materials and Methods: In this high-resolution ultrasound-based retrospective study in 170 cases, we assessed gender influence in CTS in terms of the severity of neural alterations by wrist-to-forearm ratio (WFR), epineural thickening, loss of fascicular anatomy, as well as classical signs and symptoms. The control group consisted of 42 wrists., Results: Women present with a greater WFR at first admission are affected more often bilaterally, and report less subjective pain intensity, while men report fewer nightly pain episodes at higher WFR. Loss of fascicular anatomy is three times more frequent in women. An increase in epineural thickness, loss of fascicular anatomy, and involvement of more than 1.5 fingers correlate significantly with WFR regardless of sex., Conclusion: Women differ significantly from men in terms of clinical presentation and ultrasound findings upon first diagnosis of CTS, which should be included in further diagnostic considerations.

Introduction: CTS, the most common nerve entrapment syndrome of the upper limb, is being diagnosed by clinical criteria, in most cases supported by the electrodiagnosis method, which appears limits regarding its sensitivity and specificity and suggests an intervening and expensive technique. The purpose of this study was to contribute to establishing U/S examination as a method with at least of the same accuracy with electrodiagnosis., Material and Method: A sample of 60 healthy individuals and 30 patients suffering from CTS was scanned. The diagnosis was conducted by both clinical and electrodiagnostic criteria, or by clinical criteria supported by postsurgical outcome., Method: In order to improve the accuracy of measurements, the anteroposterior to transverse diameter of the median nerve inside the canal and in its entrance was scanned and compared, by sonography. The examination conducted three times for each dimension, and the mean value per individual was calculated., Results: The mean ratios for the 60 healthy wrists was found to range within the interval 0.49-0.88 (presenting a mean value of 0.66), and the corresponding for the 30 suffering from CTS wrists was within the interval 1.12-1.59 (with a mean value of 1.39)., Conclusion: The statistical analysis of the examination results clearly demonstrates that the interval of ratios over the value 1.07 can be considered completely safe to diagnose that someone is suffering from CTS. In correspondence, a U/S measurement of ratios in the area up to 0.79 is completely safe to opine that this wrist refers to a healthy individual. The intermediate range of ratios 0.79-1.0 suggests a grey zone, which, by the rational of this study, does not include discrete CTS or healthy cases. This "gap" may describe subclinical or mild cases of CTS which were not been taken under consideration and for which there is no rational to interfere surgically. In the everyday's practice clinical point of view, the grey zone cases are considered healthy.

Recent research has identified DNA sequence variants within genes encoding structural components of the collagen fibril, the basic structural unit of tendons, to modify the risk of carpal tunnel syndrome (CTS). Since the expression of these previously associated genes are regulated by cytokine and growth factor signalling pathways, the aim of this study was to determine whether variants within these cell signalling pathway genes, namely interleukin 1β (IL-1β), IL-6, interleukin 6 receptor (IL-6R) and vascular endothelial growth factor A(VEGFA), are also associated with CTS. One hundred and three self-reported Coloured participants, with a history of carpal tunnel release surgery (CTS) and 149 matched control participants (CON) without any reported history of CTS symptoms were genotyped for the functional IL-1β rs16944 (-511C/T), IL-6 rs1800795 (-174G/C), IL-6R rs2228145 (C/A) and VEGFA rs699947 (-2578C/A) variants. Only the IL-6R variant was significantly associated with CTS (p=0.005, OR=0.41, 95% CI 0.22-0.75). When the previously reported associated COL5A1 and BGN variants were included in the analysis, gene-gene interactions were also shown to significantly modulate the risk of CTS. In conclusion, the AA genotype of IL-6R rs2228145 was independently associated with reduced risk of CTS in a South African Coloured population. The IL-6R variant interacted with the previously reported COL5A1 and BGN variants to modulate CTS risk. This highlights that interleukin and growth factor gene variants should also be considered, in addition to the extracellular matrix proteins, for future research in determining the aetiology of CTS., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Patients suffering from carpal tunnel syndrome (CTS) actively search for medical information on the Internet. The World Wide Web represents the main source of patient information. The aim of this study was to systematically assess the quality of patient information about CTS in the Internet. A qualitative and quantitative assessment of websites was performed with the modified Ensuring Quality Information for Patients (EQIP) tool that contains 36 standardized items. Five hundred websites with information on CTS treatment options were identified through Google, Bing, Yahoo, Ask.com and AOL. Duplicates and irrelevant websites were excluded. One hundred and ten websites were included. Only five websites addressed more than 20 items; quality scores were not significantly different between the various providing groups. A median of 15 EQIP items was found, with the top website addressing 26 out of 36 items. Major complications such as median nerve injury were reported in 27% of the websites and their treatment in only 3%. This analysis revealed several critical shortcomings in the quality of the information provided to patients suffering from CTS. There is a collective need to provide interactive, informative and educational websites for standard procedures in hand surgery. These websites should be compatible with international quality standards for hand surgery procedures., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: We assessed the yield of high-resolution ultrasonography (HRUS) in patients with clinically definite carpal tunnel syndrome (CTS) and normal nerve conduction studies (NCS)., Methods: This blinded, prospective, cross-sectional study involved 35 patients (60 hands) with clinically definite CTS and normal NCS, and 20 controls (40 hands). Cross-sectional area (CSAs) of the median nerve at the level of the pisiform bone and flexor retinaculum thickness (FRT) were measured., Results: CSA was abnormal in 48.6% of patients (confidence interval 32.0-65.2%, P = 0.95). FRT was increased in only 34.3% (18.3-49.7%), but was independently abnormal in 2 patients. CSA abnormalities correlated with positive provocative tests and sensory loss. The HRUS changes were mild., Conclusions: HRUS confirms clinically diagnosed CTS in about half of the patients with normal NCS., (© 2014 Wiley Periodicals, Inc.)

The causes of idiopathic carpal tunnel syndrome (CTS) remain unknown and the involvement of the tendons within the carpal tunnel structure in the aetiology of CTS cannot be excluded. Variants within the COL5A1 gene, an important regulator of fibril assembly in tendons, have previously been associated with modulating the risk of CTS. Furthermore, proteoglycans are also important structural components of tendons and variants within the aggrecan gene are associated with musculoskeletal soft tissue injuries. The aim of this study was to determine whether ACAN and BGN variants are associated with CTS. Self-reported Coloured participants (n=99), with a history of CTS release surgery (CTS), and 136 control participants, with no history of CTS symptoms (CON), were genotyped for ACAN rs1516797(G/T) and BGN rs1126499(C/T) variants. The BGN CC genotype was significantly over-represented (p=0.0498; OR=0.545, 95% CI=0.30-0.99) in the CON group (71.8%) versus the CTS (58.1%) group. When the previously reported associated COL5A1 genotypes were included in the analysis, COL5A1 and BGN gene-gene interactions were also shown to significantly modulate the risk of CTS in females. In conclusion this is the first study to report that variants within the BGN gene, independently and by interacting with COL5A1 variants, are associated with CTS. Further studies are required to replicate these findings., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: To provide a quantitative analysis of ultrasonographic measurements and possible pathophysiology of carpal tunnel syndrome by comparing cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index and the difference in ultrasonographic findings between affected and nonaffected hands and between sexes., Design: Blinded comparison study., Setting: Secondary referral and training hospital of institutional practice., Participants: Patients (N=51; 42 women, 9 men) with suspected carpal tunnel syndrome who underwent sonography within 1 week after the electrodiagnostic study., Interventions: Not applicable., Main Outcome Measures: Electrodiagnostic and ultrasonographic studies were conducted on both upper extremities. Cross-sectional areas of the median nerve and carpal tunnel were measured at 2 separate levels; proximal and distal cross-sectional areas of the carpal tunnel were each measured at the scaphoid-pisiform and trapezium-hamate levels, respectively., Results: Comparison between normative (n=24) and abnormal hands (n=78) revealed the following: the mean proximal cross-sectional areas of the median nerve, carpal tunnel, and nerve/tunnel index of electrodiagnostically normative hands were 10.941mm(2), 192.43mm(2), and 5.635%, respectively, whereas those of abnormal hands were 13.74mm(2), 208.87mm(2), and 6.693%, respectively, showing statistically significant differences for all (P<.05). Distal measurements of the cross-sectional area of the median nerve, carpal tunnel, and nerve/tunnel index were 10.088mm(2), 150.4mm(2), and 6.762%, respectively, in normative hands, and 11.178mm(2), 149.6mm(2), and 7.493%, respectively, in abnormal hands, showing no statistically significant differences (P>.05). In women, proximal cross-sectional areas of the median nerve and nerve/tunnel index of abnormal hands showed statistically significant differences, but no ultrasonographic measurement with a statistically significant difference was observed in men., Conclusions: Compared with nonaffected hands, the proximal cross-sectional areas of the median nerve and carpal tunnel were greater, but the distal ultrasonographic measurements were not in affected hands. Ultrasonographic findings of carpal tunnel syndrome were different according to sex., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy with multifactorial etiologies. We intended in this case–control study to identify, out of a comprehensive set of risk factors, the relatively important ones and develop a quantitative risk assessment model for this disorder. It was also legitimate to define the hazard of those factors in a dose-related manner and the acceptable safe limit especially for work-related stresses. Results: Age and female predominance were comparable between the 60 patients (89 hands with electrophysiologically confirmed CTS) and 50 controls (100 hands). Occupation of the studied sample varied between housewives only, employed housewives, and manual workers with a distribution that differed significantly between patients and controls. Significantly higher body mass index (BMI) and mean wrist depth were found in patients than controls. Wrist ratio (clinically or sonographically) was significantly squarer in patients than controls. Overall workload and number of hours spent daily performing work with repeated hand movements or awkward hand position were significantly higher among patients than controls. ROC curves were constructed for wrist measurements and occupational stresses. Cut-off points of wrist ratio and internal carpal tunnel ratio (by ultrasound) to discriminate subjects with CTS were > 0.68 and ≤ 1.854, respectively. The best cut-off value for number of hours spent daily performing work with repeated hand movements was 3 h/ day. As for working with awkward hand position or cold exposure, cut-off value was 0.6 h/day for both. Two logistic regression models were conducted to investigate nonoccupational and occupational predictors of CTS. The independent predictors concluded from the first model were BMI, positive family history of CTS, wrist ratio, and decrease grip strength. As for the occupational model, predictors were tasks requiring awkward hand position and cold exposure. Conclusion: Occupational risk assessment by clinical, anthropometric, and ultrasonographic measurement should be used in professions requiring repetitive or awkward hand movements, so that in overweight persons with square wrists appropriate workplace setup measures or assistive technology at work or home could be taken to prevent or decrease the impact of work hazards or help choose individuals with low risk for appropriate jobs. [ABSTRACT FROM AUTHOR]

The objective of this study is to test the applicability of Mechanomyographic (MMG) sensors for the diagnosis of Carpal Tunnel Syndrome (CTS) as well as for the follow-up of the post-surgical evolution. After reviewing the literature, three types of MMG sensors (force sensor, accelerometer and infrared) had been selected to compare with the Electromyographic (EMG) signal widely used in clinical evaluation. Three tests (two static and one dynamic) were then defined to evaluate thenar atrophy and thumb opposition strength as well as grip strength. This paper makes a description of the tests that had been carried out, starting from the procedure implemented for the application of the sensors and ending at the method used for sensor readout. Preliminary results obtained from a sample of twelve volunteers, which includes one with CTS surgery performed less than six months ago, are promising namely those from the measurement of thumb opposition strength. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is one of the most diagnosed disabling conditions of the upper extremities. Corticosteroid local injection is one of the traditional treatments. Platelet-Rich Plasma (PRP) local injection has emerged as a new treatment, promoting nerve regeneration. Objectives: Comparison of the effectiveness of a single PRP local injection to a single corticosteroid local injection for treating idiopathic CTS using nerve conduction studies and Visual Analog Scale. Patients and method: 40 patients with mild idiopathic CTS were diagnosed clinically and selected according to Padua's Neurophysiologic Severity Scale (PNSS) started the study. They were divided into 2 equal groups; the first group of patients received a single local corticosteroid injection, and the second group received a single local PRP injection. Nerve conduction studies (NCS) in the form of median nerve sensory conduction velocity and the Visual Analogue Scale (VAS) were compared in both groups before and three months after injection. Results: Our study included 40 patients randomly grouped into two equal main categories. Group I (corticosteroid group) included 20 patients with a mean age of 41.50±11.26 years, while Group II (PRP group) included 20 patients with a mean age of 39.10±11.24 years. VAS and median nerve sensory conduction velocity were significantly reduced in group II compared to group I. Conclusions: PRP single local injection in the wrist proved to be better than corticosteroids single local injection for managing mild idiopathic CTS. [ABSTRACT FROM AUTHOR]

Introduction: Current diagnostic criteria for Carpel Tunnel Syndrome (CTS) include a patient's medical history, physical exam results, and electrophysiological findings. The purpose of the study is to evaluate the diagnostic ability of nerve conduction study, ultrasonography and magnetic resonance imaging for the diagnosis of carpal tunnel syndrome with the use of clinical findings as the gold standard. Methodology: The study was conducted among 30 patients clinically diagnosed having CTS based on the criteria given by American Academy of Neurology and American Academy of Physical Medicine and Rehabilitation. All patients included in the study were underwent USG of affected wrist joint, CT scan as well MRI of the same. Results: Out of total 30 participants, 14 (46.7%) were found moderate severity followed by 11 (36.7%) were found mild severity. Only 5 (16.7%) were found severe carpel tunnel syndrome. Amongst all three investigation methods, nerve conduction study having the lowest sensitivity (83.33%). The sensitivity of the ultrasonography and MRI was 90% each. Conclusion: It is clear from this study that the sensitivity of the parameters utilized in NCS (maximum observed 83.33%) is lower than that of the median nerve cross-sectional area detected on USG (90%) and MRI (90%). The most sensitive, practical, and cost-effective metric of all those seen in the research turned out to be the median nerve cross sectional area evaluated at the wrist crease by USG. [ABSTRACT FROM AUTHOR]

Recently, large language models, such as ChatGPT, have emerged as promising tools to facilitate scientific research and health care management. The present study aimed to explore the extent of knowledge possessed by ChatGPT concerning carpal tunnel syndrome (CTS), a compressive neuropathy that may lead to impaired hand function and that is frequently encountered in the field of hand surgery. Six questions pertaining to diagnosis and management of CTS were posed to ChatGPT. The responses were subsequently analyzed and evaluated based on their accuracy, coherence, and comprehensiveness. In addition, ChatGPT was requested to provide five high-level evidence references in support of its answers. A simulated doctor-patient consultation was also conducted to assess whether ChatGPT could offer safe medical advice. ChatGPT supplied clinically relevant information regarding CTS, although at a relatively superficial level. In the context of doctor-patient interaction, ChatGPT suggested a diagnostic pathway that deviated from the widely accepted clinical consensus on CTS diagnosis. Nevertheless, it incorporated differential diagnoses and valuable management options for CTS. Although ChatGPT demonstrated the ability to retain and recall information from previous patient conversations, it infrequently produced pertinent references, many of which were either nonexistent or incorrect. ChatGPT displayed the capability to deliver validated medical information on CTS to nonmedical individuals. However, the generation of nonexistent and inaccurate references by ChatGPT presents a challenge to academic integrity. To increase their utility in medicine and academia, large language models must go through specialized reputable data set training and validation from experts. It is essential to note that at present, large language models cannot replace the expertise of health care professionals and may act as a supportive tool. [ABSTRACT FROM AUTHOR]

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Purpose: To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. Methods: A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. Only observational studies that examined specifically the prevalence rates of CTS among dentists were included. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Results: In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through meta-regression analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire. Conclusions: Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated.

Purpose: To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. Methods: A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. Only observational studies that examined specifically the prevalence rates of CTS among dentists were included. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Results: In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through meta-regression analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire. Conclusions: Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated.

Purpose: To estimate the prevalence of carpal tunnel syndrome (CTS) among dental surgeons and the effect of possible moderators on it. Methods: A systematic literature search (Medline and Embase databases) was conducted independently by two reviewers. Only observational studies that examined specifically the prevalence rates of CTS among dentists were included. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Results: In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through the moderator analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire (previously diagnosed). Conclusions: Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated.

Purpose: To estimate the prevalence of carpal tunnel syndrome (CTS) among dentists and the effect of possible moderators on it. Methods: A systematic literature search (Medline and Embase databases) was conducted independently by two reviewers. Quality assessment was performed. The pooled prevalence with 95% confidence intervals (CI) was estimated. Outlier and influential analysis were conducted. Moderator analysis was performed in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Results: In total, ten eligible studies (3,547 participants) were finally included in this meta-analysis. The overall prevalence of CTS among dental surgeons was estimated as 9.87% (95%CI 6.84%-14.03%) with significant heterogeneity between studies. No study was identified as influential. Potential sources of heterogeneity were not identified through the moderator analysis. In the subgroup analysis the prevalence was 12.47% (95%CI 6.38%-22.95%) for the group identified as having CTS through medical history and at least clinical examination or electrodiagnostic testing and 8.56% (95%CI 5.53%-13.01%) among those who identified solely through questionnaire (previously diagnosed). Conclusions: Our findings are important to provide the pooled prevalence of CTS among dentists. Our results were based on highly heterogeneous studies. Two of them were estimated as high quality (low risk of bias) and the remaining ones as moderate quality (moderate risk of bias). Our study reports a considerable prevalence, consequently, significance of awareness among dental surgeons regarding the etiology of this issue is more than necessary. More studies need to be conducted that could guide researchers in order this issue to be fully investigated.

Background: Carpal tunnel syndrome (CTS) may present with atypical proximal symptoms other than hand symptoms.Among proximal symptoms, shoulder symptoms are most distant to the site of compression and leads to a battery of investigations to exclude other pathologies. The recovery patterns of proximal symptoms have not been studied following carpal tunnel decompression. Methods: A prospective cohort study was conducted to compare the recovery patterns between subgroup-A; CTS patients (n=55) with shoulder symptoms, with subgroup-B; patients (n=55) without shoulder symptoms. A pre-tested questionnaire was administered prior and after the surgery and information was gathered on day-7, day-14 and day-21. Results: Of 110 patients, 81.8% were females. The mean age(+SD) of the total population was 49.2(+10.6), that of subgroup-A was 48.7(+10.3), and subgroup-B was 49.7(+11) years. They were predominantly right-handed (82.7%), 73% had their dominant hand affected while 74.5% were affected bilaterally at presentation. All had hand symptoms: numbness in 94.5%, pain in 85.4%, tingling of hand in 66.3% and all-three symptoms in 57.2%. In subgroup-A, pain was the predominant shoulder symptom which appeared before hand symptoms in 34.5%, after in 47.3% and simultaneously in 18.2%. It was aching-type in 91%. The pain radiated proximally (neck and scapula) in 61.8% and to the arm in 81.8%. The recovery rates (RR) of hand symptoms following decompression on day-7 were 41.8% in subgroup-A and 40.0% in subgroup-B. RR of hand symptoms in subgroup-A and subgroup-B on day-14 were 72.7% and 70.9%, while on day-21 were 83.6%and 85.5% respectively. RR of shoulder symptoms in subgroup-A were 38.2% on day-7, 65.4% on day-14, and 78.2% on day-21. Conclusions: Near identical RR of hand and shoulder symptoms were seen between the two subgroups after decompression, which indicates CTS with shoulder symptoms is not a different entity.

Abstract Background Carpal tunnel syndrome (CTS) is one of the most common nerve entrapments in the upper limb. In Saudi Arabia, few studies have investigated CTS in the general population. This study aimed to determine the association between personal factors and CTS. Methods A case-control study involved adults aged 18 and above. Cases were recruited from electrophysiology lab records as consecutive case series, while controls were individuals who were free of CTS symptoms according to the Boston Carpal Tunnel Questionnaire (BCTQ). The electronic medical records of participants were reviewed to obtain age, height, weight, medical conditions, and mobile numbers. Cases and controls were contacted via phone to complete a questionnaire that was designed based on previous literature. We used multivariate binary logistic regression to identify the personal factors significantly associated with CTS. Results A total of 95 cases and 190 controls were included. Most of the participants were female (84.2%) and Saudi (93%). Most of cases were above 45 years of age (73.7%), while 84.7% were 45 year – old or younger among the control group. Stratified logistic regression showed that performance of household chores was significantly associated with CTS. While physical exercise associated with decreased odds of CTS. Conclusions This study adds to the body of evidence on personal factors associated with CTS. However, the degree of differences in the age structure of the cases compared with the controls suggest that there is a considerable potential for residual confounding affecting the results. Trial registration number Not applicable.

The flexor retinaculum is a structure located in the wrist, which spreads between the bones forming the carpal tunnel. Its task is to maintain the relative stabilization and protection of incorporated structures. It is also an attachment for the thenar muscles, causing biomechanical interactions in the wrist. Pathologies occurring in the carpal tunnel structures often cause pressure increase, leading to compression of the median nerve, causing carpal tunnel syndrome (CTS). This work aims to review literature knowledge and compile research outcomes in the PubMED and Google scholar databases. The results indicate the variability in size and aspects of flexor retinaculum due to gender, and the relationship between gender and the incidence of CTS. The data also show the flexor retinaculum's molecular variability and environmental factors' potential impact on these changes. This article demonstrates how anatomical conditions and physical features influence CTS development. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A job exposure matrix (JEM) is a tool to estimate workers’ exposure to occupational physical risk factors. We evaluated the performance of two general population JEM (CONSTANCES and O*NET) to detect known exposure–disease relationships in an American prospective cohort study. We compared exposure estimates from three data sources and explored whether combining exposures from these two JEM, or combining exposure from each JEM with individual-level measures, improved prediction of carpal tunnel syndrome (CTS). METHODS: Using Cox proportional hazard models, we evaluated relationships between physical work exposure and incident CTS of 2393 workers using JEM-assigned and individual-level measure exposure information. We compared exposure estimates using Spearman’s rank correlation and Cohen’s kappa. We compared combined exposure models to single source exposure models by using binomial logistic regression and examined differences based on model fit and performance. RESULTS: The O*NET JEM [hazard ratio (HR) range 1.3–2.01] demonstrated generally similar exposure–disease associations as individual-level measures (HR range 1.00–1.42); we found fewer associations with the CONSTANCES JEM (HR range 1.08–2.05). Comparisons between the three sources showed stronger correlations and agreement at the job versus worker level. Combined models improved goodness-of-fit and had lower Akaike information criterion (AIC) values compared to single-source models. CONCLUSIONS: JEM can be applied cross nationally and there is potential to combine complementary exposure methods to improve estimation of workplace physical exposures in the prediction of CTS. More investigations are needed to explore exposure-disease associations in other samples and combinations of exposure data from different methods.

Recent literature has revealed a long discussion about the importance and necessity of nerve conduction studies in carpal tunnel syndrome management. The purpose of this study was to investigate the possibility of automatic detection, based on electrodiagnostic features, for the median nerve mononeuropathy and decision making about carpal tunnel syndrome. The study included 38 volunteers, examined prospectively. The purpose was to investigate the possibility of automatically detecting the median nerve mononeuropathy based on common electrodiagnostic criteria, used in everyday clinical practice, as well as new features selected based on physiology and mathematics. Machine learning techniques were used to combine the examined characteristics for a stable and accurate diagnosis. Automatic electrodiagnosis reached an accuracy of 95% compared to the standard neurophysiological diagnosis of the physicians with nerve conduction studies and 89% compared to the clinical diagnosis. The results show that the automatic detection of carpal tunnel syndrome is possible and can be employed in decision making, excluding human error. It is also shown that the novel features investigated can be used for the detection of the syndrome, complementary to the commonly used ones, increasing the accuracy of the method. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Carpal tunnel syndrome (CTS) causes a considerable amount of sick leave and healthcare costs. The etiology of CTS is multifactorial, involving both personal and occupational risk factors. To date, few prospective cohort studies on occupational risk factors of CTS have examined the general working population. METHODS: The study population consisted of participants from the Northern Finland Birth Cohort of 1966 who attended the 31-year follow-up in 1997 and were working ≥3 days a week in a paid job (N=6326). Information on socio-economic status, weight and height, smoking, exposure to occupational physical factors, and long-term illnesses was collected at baseline in 1997. Data on hospitalizations due to CTS came from the Care Register for Health Care, 1997–2016. RESULTS: Between 1997 and 2016, 3.4% of the participants had been hospitalized (attended secondary care) for CTS. After adjusting for confounders, women [hazard ratio (HR) 3.77, 95% confidence interval (CI) 2.70–5.25], overweight/obese participants (HR 1.69, 95% CI 1.29–2.22), smokers (HR 1.48, 95% CI 1.12–1.96), farmers and manual workers (HR 3.02, 95% CI 1.85–4.92 compared with upper clerical workers), lower clerical workers (HR 1.74, 95% CI=1.08–2.80), workers exposed to hand vibration (HR 2.29, 95% CI 1.48–3.54) and participants with physically demanding jobs (HR 1.71, CI 1.06–2.76) were at increased risk of hospitalization for CTS. Physically demanding work increased the risk of hospitalization for CTS for overweight/obese participants at baseline, but not for participants of normal weight. CONCLUSIONS: Excess body mass and occupational physical factors increase the risk of hospitalization for CTS. Excess body mass potentiates the adverse effects of strenuous work on CTS.

ObjectivesThis paper aimed to quantify exposure-response relationships between the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS).MethodsManufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions.ResultsThe longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11-1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2-2.5) and 1.5 (95% CI 1.0-2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05-1.25), and 1.04 per unit (95% CI 0.93-1.15), respectively.ConclusionThose with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS.

This literature review provides a range of neurological and other organic causes of brachialgia. Features of pain syndrome in different medical conditions are described.

Abstract Background Carpal tunnel syndrome (CTS) is a common cause of pain, weakness, sensory loss, and activity limitations. Currently, the most common initial treatment is use of a rigid splint immobilizing the wrist, usually during night-time, for several weeks. Evidence regarding the efficacy and effect durability of wrist splinting is weak. The treatment is associated with costs and may cause discomfort and limit daily and work activities. No placebo-controlled trials have been performed. Methods This is a randomized controlled trial designed to assess the efficacy of a rigid wrist splint compared with soft wrist bandage (placebo) in patients with primary idiopathic CTS. The trial will be conducted at an orthopedic department. Patients, 25 to 65 years old, who seek primary health-care with symptoms of CTS will be screened, and potentially eligible patients will be referred to the study center. Patients who fulfill the trial’s eligibility criteria will be invited to participate. A total of 112 patients who provide informed consent will be randomly assigned to treatment with either a rigid wrist splint or a soft bandage to be used initially for 6 weeks at night and, if possible, during the day. The splints and bandages will be fitted with a temperature-monitoring device to measure the total time during which they have actually been worn. The trial participants will complete a questionnaire that includes the 6-item CTS symptoms scale (CTS-6); the 11-item disabilities of the arm, shoulder, and hand (QuickDASH) scale; and the EuroQol 5-dimension (EQ-5D) health status and quality-of-life measure at baseline and at 6, 12, 24, and 52 weeks after treatment start. The participants will undergo physical examination and nerve conduction testing at baseline and at 52 weeks. The trial’s primary outcomes are the change in the CTS-6 score from baseline to 12 weeks and the rate of carpal tunnel release surgery at 52 weeks. Discussion This is the first placebo-controlled randomized trial with electronic monitoring of actual splint use and will provide evidence regarding the efficacy of wrist splinting in patients with CTS. Trial registration ISRCTN Registry, ISRCTN81836603. Registered on May 5, 2018.

To perform an updated systematic review with meta-analysis on trials focusing on patient-reported outcome measures (PROMs), nerve conduction studies (NCS) result and cross sectional area (CSA) measurements of those who underwent PRP injection for mild to moderate CTS, versus a control. This study indicates that there may be a potential role for the use of PRP in the non-operative management of mild to moderate CTS results in improvements in pain scores, functional outcomes as well as CSA measurements of the MN at short-term follow-up. However, PRP does not result in improvements in NCS. II; Systematic Review & Meta-Analysis of Prospective Trials; [ABSTRACT FROM AUTHOR]

Abstract Objective Previous studies reported variable sensitivity and specificity of the Phalen test. We investigated whether a timed Phalen’s test (TPT) could predict abnormal nerve conduction studies (NCS) results in carpal tunnel syndrome (CTS). Methods Patients with CTS were consecutively recruited. A neurologist confirmed the clinical diagnosis of CTS and recorded the TPT before NCS were performed. Another neurologist, blinded to the TPT, graded the severity of NCS. The TPT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results In total, 403 patients with 706 hands were recruited and diagnosed with CTS; 465 hands had positive TPT, and 611 hands showed abnormal NCS results. A positive TPT at ≤ 10 s had a specificity of 96.8% and a PPV of 96.6% in predicting abnormal NCS. The sensitivity and NPV of TPT were insignificant. Discussion A positive TPT at ≤ 10 s can be useful in predicting NCS abnormalities in patients with CTS.

OBJECTIVES: The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns. METHODS: A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range. RESULTS: A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4–168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7–41), compared with 39 days for manual work (range 18–101). Median time to return to modified or full duties was 23 days (ranges 12–50 and 17–64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data. CONCLUSIONS: This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-opprotocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation. [ABSTRACT FROM AUTHOR]