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Background: Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model. Methods: Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL. Results: SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R2 = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R2 = 0.996). Conclusion: The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction of tunnel pressure and diagnosis of carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor published in the journal Neurological Sciences. It discusses a unique case study of a teenager with congenital myasthenic syndrome and demyelinating sensorimotor neuropathy. The patient had a specific genetic mutation and experienced significant improvement in symptoms with salbutamol monotherapy. The letter emphasizes the importance of identifying the genetic basis of each syndrome for genetic counseling and appropriate therapy. The study highlights the variability of clinical manifestations in congenital myasthenic syndromes and the potential efficacy of salbutamol as a treatment option. Further research is needed to understand the effects of salbutamol on demyelinating neuropathy and its overall therapeutic efficacy in AChR deficiency-related congenital myasthenic syndromes. [Extracted from the article]

Background: Present study was envisaged to analyze neurophysiological variables in clinically diagnosed Carpal Tunnel Syndrome (CTS) patients and categorize injury into demyelinating, axonal or mixed insult on its basis. The study further evaluated co morbid conditions (diabetes, hypothyroidism and rheumatoid arthritis) in CTS patients and its impact on variation of neurophysiological variables. Methods: This was prospective cross-sectional study in which 480 hands i.e. (240 patients) of clinically diagnosed Carpal Tunnel Syndrome (CTS) patients were studied. Nerve Conduction Study (NCS) was conducted on median sensory & median motor nerve. Various Neurophysiological variables i.e. Sensory Nerve Action Potential (SNAP), Compound muscle action potential (CMAP), Distal Latency (sensory), distal latency (motor), Nerve Conduction Velocity (sensory), Nerve Conduction Velocity (motor) were recorded. CTS patients with comorbid conditions of diabetes, hypothyroidism, rheumatoid arthritis were studied for variation of neurophysiological variables, along with CTS patients without above stated co-morbid conditions. Results: Out of 240 patients with CTS, 75.4% were females and 24.6% were males. The mean duration of CTS symptoms exhibited was 7.55 ± 5.32 months. Median Sensory & Median Motor neurophysiological variables were affected in 73% hands while Median Sensory neurophysiological variable was affected in 26.3 % hands. CTS patients with predisposing diabetes disease were 25%, with rheumatoid arthritis were 9% and with hypothyroidism were 16%. Conclusion: Nerve conduction studies are reliable and versatile method for diagnosis of CTS when used with clinical history. The study emphasis the importance of variation of neurophysiological variables in predisposing diseases i.e. diabetes, hypothyroidism, rheumatoid arthritis and categorization of insult to median nerve i.e. sensory, motor, axonal, demyelinating or mixed. [ABSTRACT FROM AUTHOR]

Hydroxyapatite crystal deposition disease (HADD) is a common disorder resulting from the deposition of calcium hydroxyapatite crystals in various soft tissues, typically in periarticular distribution, including tendons, tendon sheaths, joint capsules, ligaments, bursae, periarticular soft tissues, and occasionally within the joints. The more commonly known subtypes of HADD are calcific tendinopathy and calcific periarthritis. Carpal tunnel syndrome (CTS) can be rarely caused by calcific deposits within the carpal tunnel in the setting of HADD-related calcific periarthritis. Imaging, particularly ultrasound and radiographs, is crucial in distinguishing this entity from the conventional form of CTS that tends to be idiopathic. We describe a rare presentation of CTS secondary to calcific periarthritis in a 45-year-old patient, with imaging demonstrating mass-like calcification within the carpal tunnel, with typical features of those seen with HADD. The patient was treated with ultrasound-guided barbotage, with significant clinical improvement. The case highlights a lesser-known cause of CTS as well as a presentation of HADD, and the role of ultrasound-guided barbotage, a minimally invasive procedure, as a viable first-line management option as an alternative to surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study is to develop and validate a radiomics model based on ultrasound image features for predicting carpal tunnel syndrome (CTS) severity. Methods: This retrospective study included 237 CTS hands (106 for mild symptom, 68 for moderate symptom and 63 for severe symptom). There were no statistically significant differences among the three groups in terms of age, gender, race, etc. The data set was randomly divided into a training set and a test set in a ratio of 7:3. Firstly, a senior musculoskeletal ultrasound expert measures the cross-sectional area of median nerve (MN) at the scaphoid-pisiform level. Subsequently, a recursive feature elimination (RFE) method was used to identify the most discriminative radiomic features of each MN at the entrance of the carpal tunnel. Eventually, a random forest model was employed to classify the selected features for prediction. To evaluate the performance of the model, the confusion matrix, receiver operating characteristic (ROC) curves, and F1 values were calculated and plotted correspondingly. Results: The prediction capability of the radiomics model was significantly better than that of ultrasound measurements when 10 robust features were selected. The training set performed perfect classification with 100% accuracy for all participants, while the testing set performed accurate classification of severity for 76.39% of participants with F1 values of 80.00, 63.40, and 84.80 for predicting mild, moderate, and severe CTS, respectively. Comparably, the F1 values for mild, moderate, and severe CTS predicted based on the MN cross-sectional area were 76.46, 57.78, and 64.00, respectively.. Conclusion: This radiomics model based on ultrasound images has certain value in distinguishing the severity of CTS, and was slightly superior to using only MN cross-sectional area for judgment. Although its diagnostic efficacy was still inferior to that of neuroelectrophysiology. However, this method was non-invasive and did not require additional costs, and could provide additional information for clinical physicians to develop diagnosis and treatment plans. [ABSTRACT FROM AUTHOR]

Total supported abduction, or TSA, is a position for ultrasound evaluations and guided interventions of the upper extremity. It provides optimal access to the medial arm through the volar wrist and palmar hand for diagnostic evaluations of the median and ulnar nerves as well as procedures including injections for carpal tunnel syndrome, ulnar neuropathy at the elbow, and stenosing tenosynovitis. It enables ease of both ipsilateral and bilateral evaluations/interventions without the need for significant positional changes by the patient or physician. Incorporation of TSA may enhance clinical efficiency by reducing the amount of time, materials, and space required to provide such services. [ABSTRACT FROM AUTHOR]

Introduction/Aims Methods Results Discussion T2 magnetic resonance imaging (MRI) mapping has been applied to carpal tunnel syndrome (CTS) for quantitative assessment of the median nerve. However, quantitative changes in the median nerve before and after surgery using T2 MRI mapping remain unclear. We aimed to investigate whether pathological changes could be identified by pre‐ and postoperative T2 MRI mapping of the median nerve in CTS patients after open carpal tunnel release.This was a prospective study that measured median nerve T2 and cross‐sectional area (CSA) values at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels pre‐ and postoperatively. Associations between T2, CSA, and nerve conduction latency were also evaluated.A total of 36 patients with CTS (mean age, 64.5 ± 11.7 years) who underwent surgery were studied. The mean preoperative T2 values significantly decreased from 56.3 to 46.9 ms at the proximal carpal tunnel levels (p = .001), and from 52.4 to 48.7 ms at the hamate levels postoperatively (p = .04). Although there was a moderate association between preoperative T2 values at the distal carpal tunnel levels and distal motor latency values (r = −.46), other T2 values at all four carpal tunnel levels were not significantly associated with CSA or nerve conduction latency pre‐ or postoperatively.T2 MRI mapping of the carpal tunnel suggested a decrease in nerve edema after surgery. T2 MRI mapping provides quantitative information on the median nerve before and after surgery. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS), an entrapment neuropathy caused by pressure of the median nerve, is a progressive condition that can lead to a decreased quality of life. Studies suggest an association between CTS and arthritis; however, previous studies examining osteoarthritis (OA) and CTS are limited in number, scope and study design. This study estimated the incidence and risk of CTS among patients with OA, both overall and by specific joints, in a large population-based cohort in the United States. Methods: Patients from the Optum claims database aged ≥ 45 years and diagnosed with OA between January 1, 2018, and December 31, 2022, were eligible for the OA cohort. The non-OA cohort included those without a diagnosis of OA at the index date and no history of OA for 12 months pre-index. Baseline characteristics were balanced using propensity score matching. The risk of CTS in the OA and non-OA cohort were evaluated using incidence rates and adjusted hazard ratios that were estimated using Cox regression. Results: After applying the inclusion/exclusion criteria, 3,610,240 of the 6,023,384 adults with a diagnosis of OA remained in the OA cohort. After propensity-score matching, each cohort included 1,033,439 individuals. The incidence rates for CTS per 1000 person-years were 7.35 (95% confidence interval [CI] 7.21–7.49) in the OA cohort and 1.44 (95% CI 1.38–1.50) in the non-OA cohort. The risk of developing CTS in patients with OA was ~ 4 times that of patients without (hazard ratio = 3.80; 95% CI 3.54–4.07). This increased risk was found across all OA joint types, with OA of the hand/wrist having the highest risk for CTS. Additionally, multiple OA joints presented a higher risk compared with a single affected joint. Conclusions: OA increases the risk of CTS, but this is not limited to patients with hand/wrist OA, suggesting a systemic impact of OA on CTS. While the risk appears highest for patients with hand/wrist OA, patients with more distant affected joints like knee or hip also have an increased risk of CTS. [ABSTRACT FROM AUTHOR]

Introduction/Aims Methods Results Discussion Using a set of process‐of‐care quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome (CTS), the research team previously documented large variations in electrodiagnostic testing practices and adherence to quality measures. This study sought to enhance the applicability and validity of the quality measures by integrating acceptable variations in testing practices.We recruited 13 expert electrodiagnostic medicine specialists from five specialty societies. The experts iteratively refined five quality measures, and then rated the validity of the refined quality measures (1–9 scale). During this process, the experts reviewed data on adherence to existing quality measures and variations in electrodiagnostic testing practices, and considered recently published quality measures from the American Association of Neuromuscular and Electrodiagnostic Medicine.Three quality measures (electrodiagnostic testing before surgery for CTS, temperature assessment during electrodiagnostic testing, and electrodiagnostic criteria for severe median neuropathy) underwent few refinements and were rated valid (medians 8–9). Two measures (essential components of electrodiagnosis, criteria for interpreting electrodiagnostic tests as median neuropathy) were judged valid (medians 8) after revisions. For these measures, experts' ratings on the recommended components of sensory or mixed nerve conduction studies varied: agreement among the experts about the use of sensory peak latency was greater than for onset latency or sensory velocity.This study produced quality measures that provide minimum standards for electrodiagnostic testing for suspected CTS that are more comprehensive and nuanced than prior versions. Future work can assess the feasibility, reliability, and validity of these refined measures in diverse physician practices. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders are one of the most common work-related illnesses. At the European level, they affect the health of millions of workers, and, at the same time, the employers themselves pay high costs for their compensation. According to the data from the automotive industry, the costs of introducing ergonomic controls at the initial stage of production design are significantly lower than the costs of compensating musculoskeletal disorders. Along with the implementation of ergonomic controls at an early stage, the risks of developing work-related musculoskeletal disorders are reduced or eliminated. The need for a scientific research approach in the implementation of ergonomic controls is imposed as one of the most significant ways to deal with musculoskeletal disorders and to improve safety, wellbeing, and effectiveness of employees. This paper analyzes the ergonomic risks among employees in the automotive car seats production as well as the control mechanisms that can reduce or eliminate the occurrence of work-related musculoskeletal disorders (MSDs). [ABSTRACT FROM AUTHOR]

Background: Carpal Tunnel Syndrome (CTS) provocative tests, such as Phalen, reverse Phalen, Tinel and compression, are solely used to help diagnosis. However, there are limited data about the application of these clinical tests for severities determination. Methods: A total of 64 patients with confirmed CTS were included. Three groups of mild, moderate, and severe were then defined based on the electrodiagnostic (EDx) test. The time to turning positive for Phalen, reverse Phalen, and compression tests were recorded. Initially, the percentage of positive results were compared among three groups of disease severity. Then, test positivation time was categorized into two groups of below and above 30 s, and comparison was made among groups with regard to this threshold. Finally, correlational analysis between mean positivation time and EDx quantitative parameters was conducted. Results: We found no difference between the three groups of disease severity, and there was no correlation between the time duration for three tests to become positive and EDx severity parameters. Conclusions: CTS clinical provocative tests are not of use in evaluation of disease severity. [ABSTRACT FROM AUTHOR]

(1) Background: Neurodynamic tests are recommended for the diagnosis of entrapment neuropathies such as carpal tunnel syndrome (CTS). However, their association with clinical variables in severe patients or patients with associated comorbidities is poorly documented. This study aims to analyze the association between the mechanosensitivity of the median nerve and symptoms, function and psycho-social variables in moderate and severe carpal tunnel syndrome patients with comorbidities; (2) Methods: Correlational study. In total, 42 pre-surgical patients (24 females; 59.1 ± 12.7 years) included in the Spanish Public Healthcare System with an electrodiagnostic of CTS were selected. Sociodemographic variables and clinical features (symptoms, function, sensitivity and quality of life evaluated with the 36-item Short Form Survey (SF-36) and the Medical Outcomes Study Sleep Scale (MOS-sleep) were recorded. Upper Limb Neurodynamic Test 1 was used to evaluate neural mechanosensitivity; (3) Results: The 81% had a severe CTS and 78.6% had some comorbidity. The average time from the first medical visit to the surgeon's visit was 365.5 days. Median nerve mechanosensitivity correlated weakly with the SF-36 subscale, General Health, (Spearman's rho = 0.367) and MOS sleep scale, Awaken Short of Breath or with headache dimension (Spearman's rho = −0.353) and moderately with SF-36 subscale, Social Functioning (Spearman's rho = 0.553); (4) Conclusions: No associations were observed for median nerve mechanosensitivity, except for quality of life and sleep. Both social determinants and clinical variables should be considered when examining and treating these patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Erosive hand osteoarthritis (EHOA) is an aggressive form of hand osteoarthritis (OA) and a severely disabling condition. Patients affected by OA frequently lament symptoms suggestive of neuropathic pain (NP). The aim of our study was to ascertain the presence and severity of NP in patients with EHOA and correlate its presence with EHOA clinical characteristics. Methods: In this retrospective study, we included all consecutive EHOA patients with NP symptoms who underwent upper limb electroneurography (ENoG) and nerve ultrasound. The presence of NP was screened using the ID pain neuropathic pain-screening questionnaire (ID-Pain). In addition, the following NP questionnaires were also used: Douleur Neuropathique en 4 Questions (DN4), PainDETECT, and Neuropathic Pain Symptom Inventory (NPSI). Moreover, patients completed the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Dreiser's algofunctional finger index questionnaires assessing EHOA disease activity. The following clinical and laboratory data were collected: age, sex, BMI, disease duration, intensity of pain (VAS 0–10), painful and swollen joints, and inflammatory indices, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Of the 34 patients studied, 24 (70.6%) presented NP to the ID-Pain questionnaire. According to DN4, 14 (41.2%) patients had NP, while using the PainDETECT questionnaire, 67.6% had NP. Patients with NP were statistically younger and had a higher VAS pain score compared to subjects without NP. The ENoG and median nerve ultrasound were normal in 81% of patients, while four patients had carpal tunnel syndrome. The ID-Pain questionnaire correlated with the number of painful joints (r = 0.48, p = 0.03) and with the AUSCAN questionnaire (r = 0.37, p = 0.05). The DN4 questionnaire correlated with PainDETECT (r = 0.58, p < 0.01). The PainDETECT questionnaire correlated with VAS pain (r = 0.49, p = 0.02), the DN4 questionnaire (r = 0.58, p < 0.01), and AUSCAN (r = 0.51, p = 0.02). The NPSI questionnaire correlated negatively with BMI (r = −0.53, p = 0.01) and positively with the PainDETECT questionnaire (r = 0.49, p = 0.02). Conclusions: Our study revealed that 32% to 70% of EHOA patients exhibited symptoms consistent with NP, with observed variability depending on the questionnaire utilized. Despite patients frequently exhibiting symptoms compatible with NP, only 19% of patients presented alterations on ENoG and ultrasound examinations confirming CTS. This suggests a probable nociplastic component for pain in patients with EHOA, which warrants tailored treatment. In the present study, NP correlated with clinical and functional indices of EHOA. [ABSTRACT FROM AUTHOR]

Background/Objectives: The anxiolytic effect of transcutaneous electrical nerve stimulation (TENS) is associated with the activation of endogenous inhibitory mechanisms in the central nervous system. Both low-frequency, high-amplitude TENS (LF-TENS) and high-frequency, low-amplitude TENS (HF-TENS) are capable of activating opioid, GABA, serotonin, muscarinic, and cannabinoid receptors. However, there has been no comparative analysis of the effectiveness of HF-TENS and LF-TENS in the treatment of GAD. The purpose of our research was to study the effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of patients with GAD compared with sham TENS. Methods: The effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of GAD was studied using Generalized Anxiety Disorder 7-item scale (GAD-7) and the Hamilton Anxiety Rating Scale (HAM-A). 40 patients underwent sham TENS, 40 patients passed HF-TENS (50 Hz—50 μs—sensory response) and 41 patients completed LF –TENS (1 Hz—200 μs—motor response) for 30 days daily. After completion of treatment, half of the patients received weekly maintenance therapy for 6 months. Electroencephalography was performed before and after treatment. Results: Our study showed that a significant reduction in the clinical symptoms of GAD as assessed by GAD-7 and HAM-A was observed after HF-TENS and LF-TENS by an average of 42.4%, and after sham stimulation only by 13.5% for at least 2 months after the end of treatment. However, LF-TENS turned out to be superior in effectiveness to HF-TENS by 51% and only on electroencephalography leads to an increase in PSD for the alpha rhythm in the occipital regions by 24% and a decrease in PSD for the beta I rhythm in the temporal and frontal regions by 28%. The prolonged effect of HF-TENS and LF-TENS was maintained without negative dynamics when TENS treatment was continued weekly throughout the entire six-month observation period. Conclusions: A prolonged anxiolytic effect of direct TENS of the right median nerve has been proven with greater regression of clinical and neurophysiological manifestations of GAD after LF-TENS compared to HF-TENS. Minimal side effects, low cost, safety, and simplicity of TENS procedures are appropriate as a home treatment modality. [ABSTRACT FROM AUTHOR]

Mesenteric angina has a high mortality rate. Occlusion of the superior mesenteric artery is the most common cause. Increasingly, it is managed endovascularly instead of by open revascularization. Despite the lower risk of complications in minimally invasive procedures, it is important to be mindful of long-term sequelae of minor complications. Patient education regarding risks and complications is paramount for better clinical outcomes. The risks of transbrachial angiography procedures are low. Postprocedural vigilance for interventionists and written educational advice to patients are paramount in all minimally invasive endovascular procedures, especially because most of these patients with a complication require urgent operative correction. [ABSTRACT FROM AUTHOR]

Dialysis-related amyloidosis (DRA) is a severe complication in end-stage kidney disease (ESKD) patients undergoing long-term dialysis treatment, characterized by the deposition of β2-microglobulin-related amyloids (Aβ2M amyloid). To inhibit DRA progression, hexadecyl-immobilized cellulose bead (HICB) columns are employed to adsorb circulating β2-microglobulin (β2M). However, it is possible that the HICB also adsorbs other molecules involved in amyloidogenesis. We enrolled 14 ESKD patients using HICB columns for DRA treatment; proteins were extracted from HICBs following treatment and identified using liquid chromatography–linked mass spectrometry. We measured the removal rate of these proteins and examined the effect of those molecules on Aβ2M amyloid fibril formation in vitro. We identified 200 proteins adsorbed by HICBs. Of these, 21 were also detected in the amyloid deposits in the carpal tunnels of patients with DRA. After passing through the HICB column and hemodialyzer, the serum levels of proteins such as β2M, lysozyme, angiogenin, complement factor D and matrix Gla protein were reduced. These proteins acted in the Aβ2M amyloid fibril formation. HICBs adsorbed diverse proteins in ESKD patients with DRA, including those detected in amyloid lesions. Direct hemoperfusion utilizing HICBs may play a role in acting Aβ2M amyloidogenesis by reducing the amyloid-related proteins. [ABSTRACT FROM AUTHOR]

Introduction: Carpal Tunnel Syndrome (CTS) presents with symptoms like numbness, tingling, and weakness along the median nerve pathway. Risk factors include prolonged wrist positions, repetitive muscle contractions, and exposure to vibrations. Aim: To determine the prevalence of CTS among healthcare practitioners at vaccine facilities in Saudi Arabia. Materials and Methods: A cross-sectional study on a total of 150 healthcare practitioners (aged 25-30 years) working in vaccination centres in Riyadh, Saudi Arabia were recruited. The study was conducted from November 2021 to March 2022. The authors collected demographic data, Body Mass Index (BMI) and work shift information, and administered two validated questionnaires, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and the Duruoz Hand Index (DHI). CTS symptoms were diagnosed using Phalen's and Arm Raising Test (ART). Results: Of the 150 practitioners (aged 25-45 years), predominantly in the 25-30 age group, n=65 (44.0%) tested positive on the Phalen's test, and n=65 (43.5%) on the ART. Females had higher BCTSQ scores, while DHI scores were similar across genders. Spearman's correlation analysis showed positive correlations between BCTSQ and DHI, and a moderate negative correlation between ART and DHI. Logistic regression analysed factors affecting the likelihood of CTS diagnosed by ART and Phalen's Test. Higher BCTSQ and DHI scores increased the likelihood of CTS (ART: BCTSQ OR=0.843, DHI OR=1.064; Phalen's Test: BCTSQ OR=0.830, DHI OR=1.069). Conclusion: During the Coronavirus Disease-2019 (COVID-19) pandemic, the prevalence of CTS among healthcare practitioners at vaccine centres in Riyadh, Saudi Arabia reached up to 43-44%. The present study highlights that day shift workers face a higher risk of CTS compared to night shift workers, likely due to heavier daytime workloads. This underscores the need for ergonomic interventions and workload management, especially during high-demand periods like the vaccination campaign, to safeguard healthcare workers' health and productivity. [ABSTRACT FROM AUTHOR]

One of the most common causes of carpal tunnel syndrome (CTS) in childhood is mucopolysaccharidosis (MPS). While ultrasonography (US) can aid in the diagnosis of CTS in adult patients, there is limited experience of this in the pediatric group. We aimed to investigate the results of wrist ultrasonography, which may be a candidate alternative to electrophysiological examination. The participants were evaluated for symptoms, physical examination findings, electrophysiological tests and grayscale US. CTS was diagnosed in accordance with the American Academy of Orthopedic Surgeons Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. Included in the study were 27 MPS patients aged 4.5–32 years and 30 healthy control subjects aged 4.3–26 years. Of the 54 wrists in the MPS group, 30 were diagnosed with CTS. The median cross-sectional area (CSA) at the proximal carpal tunnel, the CSA at the forearm, and the wrist-forearm ratio (WFR) were higher in the wrists of the MPS with CTS group than in those without CTS and the healthy control subjects. The WFR cutoff of ≥1.35, 56.6% (95% CI: 437.4–74.5) sensitivity, and 89.8% (95% CI: 81.0–95.5) specificity were consistent with a diagnosis of CTS (receiver operating characteristics analysis, area under the curve = 0.775, 95% CI: 0.673–0.877). Although the US provides results with unsatisfactory specificity and sensitivity, it is a candidate for further investigation for the diagnosis of CTS because it is an innovative, noninvasive, and more accessible method. WFR value may produce more meaningful results than wrist or forearm nerve area measurements. [ABSTRACT FROM AUTHOR]

Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by a deficiency of glycosaminoglycan (GAG) catalytic enzymes, resulting in an accumulation of unprocessed or partly degraded GAGs in different tissues, including bones and joints. Notably, skeletal and joint abnormalities may be the first complaint that prompts patients to seek medical attention, especially in the milder forms of the disease. To our knowledge, there are no prior imaging reports that have documented capsuloligamentous thickening in patients with MPS on MRI. In this study, we present four cases of patients with clinically and genetically confirmed diagnosis of type II MPS, encompassing seven MRI examination of different joints, including cervical spine, hip, wrist, knee, and shoulder. All of the patients were male, aged between 14 and 35 years, and exhibited varying degrees of joint stiffness in the clinical examination and carpal tunnel syndrome in cases of the wrist joint was affected. None of the patients had a history of surgical procedures on the affected joint, other metabolic or deposit diseases, or sports activity practice. The MRI revealed significant capsuloligamentous and retinaculum thickening, up to eight times greater than the normal capsular thickness reported in the literature. [ABSTRACT FROM AUTHOR]

This study investigated the reliability of measuring the median nerve cross-sectional area (CSA) at the carpal tunnel inlet using a handheld ultrasound device (HUD) compared to a standard ultrasound system, focusing on intra- and inter-operator reproducibility among novice and expert operators. Employing a prospective cross-sectional design, 37 asymptomatic adults were assessed using both devices, with measurements taken by an expert with over five years of experience and a novice with less than six months. The CSA was determined using manual tracing and ellipse methods, with reproducibility evaluated through intraclass correlation coefficients (ICCs) and agreement assessed via Bland–Altman plots. Results showed a high degree of agreement between the devices, with excellent intra-operator reproducibility (ICC > 0.80) for the expert, and moderate reproducibility for the novice (ICCs ranging from 0.539 to 0.841). Inter-operator reliability was generally moderate, indicating acceptable consistency across different experience levels. The study concludes that HUDs are comparable to standard ultrasound systems for assessing median nerve CSA in asymptomatic subjects, with both devices providing reliable measurements. This supports the use of HUDs in diverse clinical environments, particularly where access to traditional ultrasound is limited. Further research with a larger sample and symptomatic patients is recommended to validate these findings. [ABSTRACT FROM AUTHOR]

This study introduces a novel wearable Inertial Measurement Unit (IMU)-based system for an objective and comprehensive assessment of Work-Related Musculoskeletal Disorders (WMSDs), thus enhancing workplace safety. The system integrates wearable technology with a user-friendly interface, providing magnetometer-free orientation estimation, joint angle measurements, and WMSDs risk evaluation. Tested in a cable manufacturing facility, the system was evaluated with ten female employees. The evaluation involved work cycle identification, inter-subject comparisons, and benchmarking against standard WMSD risk assessments like RULA, REBA, Strain Index, and Rodgers Muscle Fatigue Analysis. The evaluation demonstrated uniform joint patterns across participants ( I C C = 0.72 ± 0.23 ) and revealed a higher occurrence of postures warranting further investigation, which is not easily detected by traditional methods such as RULA. The experimental results showed that the proposed system's risk assessments closely aligned with the established methods and enabled detailed and targeted risk assessments, pinpointing specific bodily areas for immediate ergonomic interventions. This approach not only enhances the detection of ergonomic risks but also supports the development of personalized intervention strategies, addressing common workplace issues such as tendinitis, low back pain, and carpal tunnel syndrome. The outcomes highlight the system's sensitivity and specificity in identifying ergonomic hazards. Future efforts should focus on broader validation and exploring the relative influence of various WMSDs risk factors to refine risk assessment and intervention strategies for improved applicability in occupational health. [ABSTRACT FROM AUTHOR]

Purpose: Regarding surgical indications for carpal tunnel syndrome (CTS), the hypothesis that the recovery processes of subjective symptoms differ among pain, sensory, and motor symptoms and correlate with recovery in objective nerve conduction studies was examined in the present study. Methods: The global symptom score (GSS) is a method used to assess clinical outcomes and covers subjective symptoms, including pain (pain and nocturnal awakening), sensory (numbness and paresthesia), and motor (weakness/clumsiness) symptoms. The relationships between long-term changes in GSS and recovery in nerve conduction studies were investigated. Results: Forty patients (40 hands) were included (mean age 65 years; 80% female; 68% with moderate CTS: sensory nerve conduction velocity < 45 m/s and motor nerve distal latency > 4.5 ms). Pain and nocturnal awakening rapidly subsided within 1 month after surgery and did not recur in the long term (median 5.6 years). Paresthesia significantly decreased 3 months after surgery and in the long term thereafter. Weakness/clumsiness significantly decreased at 1 year. Sensory nerve distal latency, conduction velocity, and amplitude significantly improved 3 months and 1 year after surgery, and correlated with nocturnal awakening in the short term (3 months) in moderate CTS cases. The patient satisfaction rate was 91%. Conclusion: Rapid recovery was observed in pain and nocturnal awakening, of which nocturnal awakening correlated with the recovery of sensory nerve conduction velocity. Patients with pain symptoms due to moderate CTS may benefit from surgical release. [ABSTRACT FROM AUTHOR]

Various injectants are available for the treatment of carpal tunnel syndrome. This systematic review and network meta-analysis was conducted to investigate the effectiveness of different injection therapies in alleviating the symptoms of carpal tunnel syndrome. Various databases were searched for relevant studies from inception until May 10, 2023. Eligible studies were identified using the patient (P), intervention (I), comparison (C), and outcomes (O) model, which involved (P) participants with carpal tunnel syndrome, (I) an intervention based on injection therapy, (C) the use of placebo or another injectant as a control treatment, and (O) the measurement of clinical and electrodiagnostic outcomes of interest. A total of 18 studies were included in the analysis. The network meta-analysis revealed that platelet-rich plasma is effective in the treatment of carpal tunnel syndrome in terms of symptom and pain relief and functional improvement in both the short and long term, whereas steroids are effective only in the short term. Additionally, injections of dextrose solution may offer long-term pain relief as well as short- and long-term symptom alleviation and functional improvement. The study findings suggest that platelet-rich plasma should be used as the first-line treatment for carpal tunnel syndrome, with dextrose and steroids serving as alternative treatment options. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses a scoping review conducted by Zitek et al. on the palmaris profundus muscle variant and its role in carpal tunnel syndrome. The authors of this letter express their appreciation for the thoroughness of the review and highlight the potential misclassification of the flexor carpi radialis brevis (FCRB) variation as the palmaris profundus type 1 variation in surgical reports. They provide detailed anatomical descriptions of both variations and emphasize the importance of correctly identifying these muscles during surgical procedures. The authors suggest that the underrepresentation of palmaris profundus type 1 variations in surgical case reports may be due to the standard scope of the surgical procedure. They also note the potential confusion caused by similarities in nomenclature. The letter concludes by acknowledging the value of Zitek et al.'s work and aims to raise awareness of the potential underrepresentation of palmaris profundus type 1 variations in surgical reports. [Extracted from the article]

Carpal tunnel syndrome (CTS) occurs more often among individuals with diabetes. The aim of this retrospective observational registry study was to examine whether individuals with diabetes and CTS are treated surgically to the same extent as individuals with CTS but without diabetes. Data on CTS diagnosis and surgery were collected from the Skåne Healthcare Register (SHR). A total of 35,105 individuals (age ≥ 18 years) diagnosed with CTS from 2004–2019 were included. Data were matched to the Swedish National Diabetes Register (NDR. Cox regression models were used to calculate the risk of the use of surgical treatment. Of the 35,105 included individuals with a CTS diagnosis, 17,662 (50%) were treated surgically, and 4,966 (14%) had diabetes. A higher number of individuals with diabetes were treated surgically (2,935/4,966, 59%) than individuals without diabetes (14,727/30,139, 49%). In the Cox regression model, diabetes remained a significant risk factor for surgical treatment (PR 1.14 (95% CI 1.11–1.17)). Individuals with type 1 diabetes were more frequently treated surgically (490/757, 65%) than individuals with type 2 diabetes (2,445/4,209, 58%). There was no difference between the sexes and their treatment. The duration of diabetes was also a risk factor for surgical treatment in diabetes type 2, but high HbA1c levels were not. Individuals with diabetes are more likely to be treated surgically for CTS than individuals without diabetes. Individuals with type 1 diabetes are more likely to be treated surgically for CTS than individuals with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT). Materials and Methods: This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28– 57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed. Results: CSAu and CSAu–CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively). Conclusion: The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS. [ABSTRACT FROM AUTHOR]

Background: Adolescents who identify as sexual minorities often face social stigmatisation, which can lead to increased adversity and a higher risk of suicidal behaviours. However, there are also protective factors that may promote resilience to these risk behaviours. This study aims to identify factors that predict resilience in sexual minority adolescents with high suicidal vulnerability. Methods: The study sample comprised 78 self-reported LGBTIQ+ adolescents aged between 13 and 18 years old (M = 16.11, SD = 1.56) who had previously attempted suicide. They completed several psychosocial instruments to measure risk and protective variables related to suicidal vulnerability. Results: Entrapment was found to be the most predictive risk variable for suicide attempts. However, protective variables promoting resilience were also found, such as adequate parental communication, life satisfaction, and cognitive reframing. Discussion: The findings related to prevention of suicide attempts are discussed and we highlight the urgent need to enhance certain internal and contextual protective factors to promote resilience in the face of suicidal vulnerability in certain clinical subpopulations exposed to highly adverse situations. [ABSTRACT FROM AUTHOR]

Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. ATTR-CM now is an increasingly recognized cause of heart failure (HF) and mortality worldwide with effective pharmacological treatments. Advances in non-invasive diagnosis, coupled with the development of effective treatments, have transformed the diagnosis of ATTR-CM, which is now possible without recourse to endomyocardial biopsy in ≈70 % of cases. Many patients are now diagnosed at an earlier stage. Echocardiography and cardiac magnetic resonance have enabled identification of patients with possible ATTR-CM and more accurate prognostic stratification. Although radionuclide scintigraphy with 'bone' tracers has an established diagnostic value, the diagnostic performance of the bone tracers validated for non-invasive confirmation of ATTR-CM may not be equal. Characterising the wider clinical phenotype of patients with ATTR-CM has enabled identification of features with potential for earlier diagnosis such as carpal tunnel syndrome. Therapies able to slow or halt ATTR-CM progression and increase survival are now available and there is also evidence that patients may benefit from specific conventional HF medications. Cutting-edge research in the field of antibody-mediated removal of ATTR deposits compellingly suggest that ATTR-CM is a truly reversible disorder, bringing hope for patients even with advanced disease. A wide horizon of possibilities is unfolding and awaits discovery. [ABSTRACT FROM AUTHOR]

Objectives Recently, there has been a renewed interest in traditional medicine for carpal tunnel syndrome (CTS). Curcumin has been reported as an agent with antioxidant, anti-inflammatory, analgesic, and neuroprotective attributes. This study is one of the first investigations to assess the effect of curcumin gel on CTS. Methods This study is a prospective, 8-week, randomized, placebo-controlled, parallel-group clinical trial. A total of 70 patients with CTS were analyzed. The intervention group (n  = 35) received a topical curcumin gel and a night wrist splint and the control group (n  = 35) received a placebo gel and a night wrist splint for 8 weeks. The primary outcome was the assessment of the symptom severity scale (SSS) and functional status scale (FSS) of the participants using the Boston Carpal Tunnel Questionnaire (BCTQ) after 8 weeks. In addition, all participants were evaluated by electrodiagnostic (EDX) test at baseline and after 8 weeks. Results The mean scores of SSS demonstrated a significant decrease in the curcumin group compared to the placebo group; P-value = 0.021. The mean change score of SSS after the intervention was 12.45 ± 8.18 in curcumin and 3.28 ± 7.06 in the placebo group; P-value  =   0.0001 and the mean change score of FSS were 6.24 ± 4.91 and 2.31 ± 4.95 in curcumin and placebo groups, respectively; P-value  =   0.002. However, the EDX study showed no significant changes in both groups. Conclusions It seems that curcumin gel could be effective in the improvement of the symptom severity and daily activity of patients with CTS. [ABSTRACT FROM AUTHOR]

Background and purpose: This study aimed to assess the diagnostic criteria, ancillary investigations and treatment response using real‐life data in multifocal motor neuropathy (MMN) patients. Methods: Clinical and laboratory data were collected from 110 patients enrolled in the Italian MMN database through a structured questionnaire. Twenty‐six patients were excluded due to the unavailability of nerve conduction studies or the presence of clinical signs and symptoms and electrodiagnostic abnormalities inconsistent with the MMN diagnosis. Analyses were conducted on 73 patients with a confirmed MMN diagnosis and 11 patients who did not meet the diagnostic criteria. Results: The European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria were variably applied. AUTHOR:When applying the American Association of Electrodiagnostic Medicine criteria, an additional 17% of patients fulfilled the criteria for probable/definite diagnosis whilst a further 9.5% missed the diagnosis. In 17% of the patients only compound muscle action potential amplitude, but not area, was measured and subsequently recorded in the database by the treating physician. Additional investigations, including anti‐GM1 immunoglobulin M antibodies, cerebrospinal fluid analysis, nerve ultrasound and magnetic resonance imaging, supported the diagnosis in 46%–83% of the patients. Anti‐GM1 immunoglobulin M antibodies and nerve ultrasound demonstrated the highest sensitivity. Additional tests were frequently performed outside the EFNS/PNS guideline recommendations. Conclusions: This study provides insights into the real‐world diagnostic and management strategies for MMN, highlighting the challenges in applying diagnostic criteria. [ABSTRACT FROM AUTHOR]

Background and purpose: Charcot−Marie−Tooth disease type 1A (CMT1A) is the most prevalent hereditary neuropathy worldwide and classically has slow nerve conduction velocity (NCV), in most cases below 38 m/s. Two unrelated patients with motor NCVs in the upper limbs above 38 m/s are reported. Method: Case report. Results: Two genetically confirmed CMT1A patients are presented, from two unrelated families (one of British origin and the other of Brazilian origin). Both individuals had upper limb motor NCVs above 38 m/s, with values ranging from 41.9 to 45 m/s in the median nerve and from 42 to 42.3 m/s in the ulnar nerve. They presented with a very mild phenotype, with CMT Neuropathy Score version 2 (CMTNSv2) of 6 and 5, respectively. In contrast, affected family members within both kinships exhibited a classical phenotype with more severe disease manifestation (CMTNSv2 ranging from 12 to 20) and motor NCVs below 30 m/s. Conclusion: These cases, although very rare, highlight the importance of testing PMP22 duplication in patients with intermediate conduction velocities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse. OBSERVATIONS: We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient’s family reported subjective improvement in lower extremity mobility and plantar flexion. LESSONS: In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome. [ABSTRACT FROM AUTHOR]

Background: The most common entrapment neuropathy of the upper limb is Carpal tunnel syndrome (CTS). Endoscopic carpal tunnel release (ECTR) is superior to open CTR. Fewer techniques exist using instruments to guide endoscope from outside carpal tunnel and published reports regarding that are quite rare. This study is to evaluate safety and effectiveness of single portal supra-retinacular ECTR in treatment of idiopathic CTS. Methods: This study included consecutive patients with idiopathic CTS underwent single portal supra-retinacular ECTR from December 2019 to June 2020 with postoperative follow-up period of 6 months. The Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) results at 1-, 3-, and 6-months postoperative compared to pre-operative scores as main clinical evaluation. In addition to scar tenderness scale, recurrence of symptoms and post-operative complications. Results: 45 patients aged from 29 to 63 years were included (a total of 51 procedures). There was a significant improvement in Functional Status Score (FSS) and Symptom Severity Score (SSS) post-operative compared to pre-operative scores (P=0.0001). And also, a significant progressive reduction in mean FSS/SSS recorded 1, 3 and 6-months postoperative than pre-operative. Pillar pain recorded in 7 hands and disappeared in 3 patients during follow up. No wound infection. Recurrent symptoms were not detected at end of follow-up. Conclusion: This technique is safe and effective alternative to Infra-Retinacular ECTR in treatment of idiopathic CTS. Also, it is simple, less expensive technique enabling complete division of transverse carpal ligament and avoiding higher risk for transient median nerve dysfunction. [ABSTRACT FROM AUTHOR]

Background: To specify peripheral nerve affection in autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) by correlating high-resolution nerve ultrasound and nerve conduction studies. Methods: We assessed a cohort of 11 ARSACS patients with standardized nerve conduction studies and high-resolution ultrasound of peripheral nerves and compared nerve ultrasound findings to a healthy control group matched for age, sex, size and weight. Results: Mean age of patients was 39.0 (± 14.1) years and disease duration at assessment 30.6 (± 12.5) years. All patients presented with a spasticity, ataxia and peripheral neuropathy. Neuropathy appeared to be primarily demyelinating in 9/11 cases and was not classifiable in 2/11 cases due to not evocable potentials. Nerve ultrasound revealed a normal ultrasound pattern sum score (UPSS) in each ARSACS patient and no significant nerve enlargement compared to the control group. Conclusions: Peripheral neuropathy in ARSACS showed primarily demyelinating rather than axonal characteristics and presented without nerve enlargement. As demyelinating neuropathies do commonly present enlarged nerves we recommend further genetic testing of the SACS gene in patients who present with this combination of demyelinating neuropathy without nerve enlargement. ARSACS cases that initially presented only with neuropathy without spasticity or ataxia and therefore were misdiagnosed as Charcot-Marie-Tooth disease are supporting this suggestion. [ABSTRACT FROM AUTHOR]

This article, published in the journal Diabetes, Obesity & Metabolism, discusses a study that examines the connection between carpal tunnel syndrome (CTS) and the development of diabetes. The study used data from Danish nationwide registries to compare patients who had surgery for CTS with a control group from the general population. The findings indicate that individuals with CTS have a higher risk of developing diabetes compared to the control group. The study emphasizes the importance of early detection and intervention for better outcomes. However, other factors like obesity and glycated hemoglobin levels may also influence this relationship. Further research is needed to fully understand the connection between CTS and diabetes. [Extracted from the article]

Background: Though mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL), it has no curative treatment. The aim of current topical and systemic treatment is centered around relieving symptoms and optimizing disease-free time. The use of surgical management to achieve the same goals of symptomatic reduction is not well described in the current literature. Methods: We present a case of refractory MF that failed chemotherapy, radiotherapy, and UV light therapy. Despite medical management, the tumor burden progressed to significant compression neuropathy of the ulnar and median nerves. Results: To reduce tumor burden and attempt to provide symptomatic relief, a surgical plan was developed to include radical resection of the tumor of the left upper extremity (LUE) with release of the cubital tunnel, carpal tunnel, Guyon canal, and coverage with split-thickness skin graft. The patient reported decreased symptomatology interfering with her daily activities and, overall, a better quality of life postoperatively. Conclusion: Surgical intervention, in addition to established medical standards of care, for symptomatic relief of compression neuropathy from tumor mass effect for refractory CTCL should be considered to achieve quality of life goals for patients. [ABSTRACT FROM AUTHOR]

Objective To analyze the effect and prognosis of COMP gene mutation on the treatment of carpal tunnel syndrome with ultrasound-guided dental crochet knife. Methods A total of 35 carpal tunnel syndrome patients with Cartilage oligomeric matrix protein gene mutation (COMP) who were treated in the outpatient department from June 2022 to June 2023 were selected as the control group. Another 40 patients with carpal tunnel syndrome without mutation of COMP gene who received treatment during the same period were selected as the observation group. All patients were treated with ultrasound-guided lower tooth crochet knife. The Transverse carpal ligament thickness, paresthesia score, muscle loss score and transverse carpal ligament thickness were compared between the two groups. Pisiform cross section median nerve cross section area, pisiform cross section median nerve cross section area, CSA), Anterior and posterior diameter of median nerve in cross section of uncinate bone (D), clinical efficacy and incidence of adverse events. Results After treatment, compared with observation group, paresthesia score, hand function satisfaction score, TTCL, CSA and D in control group were all increased, while muscle loss score was decreased, with statistical difference (P < 0.05). In addition, the total clinical efficiency increased significantly and the incidence of adverse effects decreased significantly in the observation group. The prognosis of carpal tunnel syndrome patients with COMP gene mutation was evaluated according to the satisfaction degree of hand function, which showed that compared with the good prognosis group, the hand function score of the poor prognosis group increased significantly, with statistical difference (P < 0.05). Before treatment, there was no significant difference in clinical manifestations between the two groups (P > 0.05). Conclusions The application of ultrasound-guided crochet in carpal tunnel syndrome patients with COMP gene mutation plays an important role in the development of carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Objectives: Carpal tunnel syndrome (CTS) stands as the most prevalent upper extremity entrapment neuropathy, with a multifaceted etiology encompassing various risk factors. This study aimed to investigate whether anthropometric measurements of the hand, grip strength, and pinch strength could serve as predictive indicators for CTS through machine learning techniques. Methods: Enrollment encompassed patients exhibiting CTS symptoms (n = 56) and asymptomatic healthy controls (n = 56), with confirmation via electrophysiological assessments. Anthropometric measurements of the hand were obtained using a digital caliper, grip strength was gauged via a digital handgrip dynamometer, and pinch strengths were assessed using a pinchmeter. A comprehensive analysis was conducted employing four most common and effective machine learning algorithms, integrating thorough parameter tuning and cross-validation procedures. Additionally, the outcomes of variable importance were presented. Results: Among the diverse algorithms, Random Forests (accuracy of 89.474%, F1-score of 0.905, and kappa value of 0.789) and XGBoost (accuracy of 86.842%, F1-score of 0.878, and kappa value of 0.736) emerged as the top-performing choices based on distinct classification metrics. In addition, using variable importance calculations specific to these models, the most important variables were found to be wrist circumference, hand width, hand grip strength, tip pinch, key pinch, and middle finger length. Conclusion: The findings of this study demonstrated that wrist circumference, hand width, hand grip strength, tip pinch, key pinch, and middle finger length can be utilized as reliable indicators of CTS. Also, the model developed herein, along with the identified crucial variables, could serve as an informative guide for healthcare professionals, enhancing precision and efficacy in CTS prediction. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject. Methods: This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. Results: This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64–2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45–1.94; P-value < 0.001). Conclusion: The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant. [ABSTRACT FROM AUTHOR]

Background: Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective: We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods: In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results: We identified five major themes: (1) the 'Significant Impact of CTS' of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) 'Waiting and Paying for Care'– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of 'Occupation and CTS Onset' whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the 'Information Scarcity' of good information about CTS and the high relational and appraising work associated with using online resources; (5) 'Negotiating Telehealth Perspectives' where telehealth was valued if it meant earlier access for all despite the challenges it held for many. Conclusion: Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the inter-rater reliability of the median nerve, evaluated at different levels by ultrasound (US) in asymptomatic subjects. Materials and Methods: A cross-sectional study. This study included 61 healthy controls. The mediolateral and anteroposterior diameters and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet were measured. The CSA of the median nerves at the carpal tunnel outlet and forearm level was measured. Flattening ratio, wrist-forearm ratio and wrist-forearm difference were calculated. Results: In the inter-rater comparison of the measurements, there was a statistically significant difference only in the carpal tunnel outlet cross sectional area (p<0.048). There was no statistically significant difference between the observers in terms of other measurements (p>0.05). For the median nerve measurement, agreement was also moderate to good inter-rater reliability [intraclass correlation coefficient (ICC) =0.54- 0.81] except for the forearm cross sectional area, swelling ratio of the medial nerve. For the median nerve forearm cross sectional area, agreement was excellent inter-rater reliability (ICC =0.91). However, for swelling ratio, agreement was poor interrater reliability (ICC =0.27). Conclusion: In this study, US showed to be a reliable tool for measuring median nerve dimensions in asymptomatic subjects. [ABSTRACT FROM AUTHOR]

Background: The lay public is increasingly using ChatGPT (a large language model) as a source of medical information. Traditional search engines such as Google provide several distinct responses to each search query and indicate the source for each response, but ChatGPT provides responses in paragraph form in prose without providing the sources used, which makes it difficult or impossible to ascertain whether those sources are reliable. One practical method to infer the sources used by ChatGPT is text network analysis. By understanding how ChatGPT uses source information in relation to traditional search engines, physicians and physician organizations can better counsel patients on the use of this new tool. Questions/purposes: (1) In terms of key content words, how similar are ChatGPT and Google Search responses for queries related to topics in orthopaedic surgery? (2) Does the source distribution (academic, governmental, commercial, or form of a scientific manuscript) differ for Google Search responses based on the topic's level of medical consensus, and how is this reflected in the text similarity between ChatGPT and Google Search responses? (3) Do these results vary between different versions of ChatGPT? Methods: We evaluated three search queries relating to orthopaedic conditions: "What is the cause of carpal tunnel syndrome?," "What is the cause of tennis elbow?," and "Platelet-rich plasma for thumb arthritis?" These were selected because of their relatively high, medium, and low consensus in the medical evidence, respectively. Each question was posed to ChatGPT version 3.5 and version 4.0 20 times for a total of 120 responses. Text network analysis using term frequency–inverse document frequency (TF-IDF) was used to compare text similarity between responses from ChatGPT and Google Search. In the field of information retrieval, TF-IDF is a weighted statistical measure of the importance of a key word to a document in a collection of documents. Higher TF-IDF scores indicate greater similarity between two sources. TF-IDF scores are most often used to compare and rank the text similarity of documents. Using this type of text network analysis, text similarity between ChatGPT and Google Search can be determined by calculating and summing the TF-IDF for all keywords in a ChatGPT response and comparing it with each Google search result to assess their text similarity to each other. In this way, text similarity can be used to infer relative content similarity. To answer our first question, we characterized the text similarity between ChatGPT and Google Search responses by finding the TF-IDF scores of the ChatGPT response and each of the 20 Google Search results for each question. Using these scores, we could compare the similarity of each ChatGPT response to the Google Search results. To provide a reference point for interpreting TF-IDF values, we generated randomized text samples with the same term distribution as the Google Search results. By comparing ChatGPT TF-IDF to the random text sample, we could assess whether TF-IDF values were statistically significant from TF-IDF values obtained by random chance, and it allowed us to test whether text similarity was an appropriate quantitative statistical measure of relative content similarity. To answer our second question, we classified the Google Search results to better understand sourcing. Google Search provides 20 or more distinct sources of information, but ChatGPT gives only a single prose paragraph in response to each query. So, to answer this question, we used TF-IDF to ascertain whether the ChatGPT response was principally driven by one of four source categories: academic, government, commercial, or material that took the form of a scientific manuscript but was not peer-reviewed or indexed on a government site (such as PubMed). We then compared the TF-IDF similarity between ChatGPT responses and the source category. To answer our third research question, we repeated both analyses and compared the results when using ChatGPT 3.5 versus ChatGPT 4.0. Results: The ChatGPT response was dominated by the top Google Search result. For example, for carpal tunnel syndrome, the top result was an academic website with a mean TF-IDF of 7.2. A similar result was observed for the other search topics. To provide a reference point for interpreting TF-IDF values, a randomly generated sample of text compared with Google Search would have a mean TF-IDF of 2.7 ± 1.9, controlling for text length and keyword distribution. The observed TF-IDF distribution was higher for ChatGPT responses than for random text samples, supporting the claim that keyword text similarity is a measure of relative content similarity. When comparing source distribution, the ChatGPT response was most similar to the most common source category from Google Search. For the subject where there was strong consensus (carpal tunnel syndrome), the ChatGPT response was most similar to high-quality academic sources rather than lower-quality commercial sources (TF-IDF 8.6 versus 2.2). For topics with low consensus, the ChatGPT response paralleled lower-quality commercial websites compared with higher-quality academic websites (TF-IDF 14.6 versus 0.2). ChatGPT 4.0 had higher text similarity to Google Search results than ChatGPT 3.5 (mean increase in TF-IDF similarity of 0.80 to 0.91; p < 0.001). The ChatGPT 4.0 response was still dominated by the top Google Search result and reflected the most common search category for all search topics. Conclusion: ChatGPT responses are similar to individual Google Search results for queries related to orthopaedic surgery, but the distribution of source information can vary substantially based on the relative level of consensus on a topic. For example, for carpal tunnel syndrome, where there is widely accepted medical consensus, ChatGPT responses had higher similarity to academic sources and therefore used those sources more. When fewer academic or government sources are available, especially in our search related to platelet-rich plasma, ChatGPT appears to have relied more heavily on a small number of nonacademic sources. These findings persisted even as ChatGPT was updated from version 3.5 to version 4.0. Clinical Relevance: Physicians should be aware that ChatGPT and Google likely use the same sources for a specific question. The main difference is that ChatGPT can draw upon multiple sources to create one aggregate response, while Google maintains its distinctness by providing multiple results. For topics with a low consensus and therefore a low number of quality sources, there is a much higher chance that ChatGPT will use less-reliable sources, in which case physicians should take the time to educate patients on the topic or provide resources that give more reliable information. Physician organizations should make it clear when the evidence is limited so that ChatGPT can reflect the lack of quality information or evidence. [ABSTRACT FROM AUTHOR]

Background: The thyroid hormone is so essential that it is involved in the functioning of all the body systems, especially in the development of the brain in fetal life. The World Health Organization has estimated that around 2 billion individuals are suffering from thyroid disorders. Hence, it is essential to identify and diagnose hypothyroid patients so that the treatment strategy can be started at the earliest. Aims and Objectives: The present study aimed to find out the peripheral nerve conduction velocity, range, and degree of movement of joints in newly diagnosed hypothyroid women and compare them with those of normal euthyroid women. Materials and Methods: The present study was a case--control study conducted from July 2015 to March 2016. A total of 50 cases of newly diagnosed hypothyroid women and 50 age-matched euthyroid women were part of the study after obtaining written and informed consent. Thyroid estimation was performed in the Clinical Biochemistry Department by the ELISA method, and nerve conduction studies were performed in the Neurology Department. Results: The age and height of the participants were not statistically significant. Weight and body mass index were significantly higher in the cases when compared to the control group. Sensory and motor conduction velocities of the right median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the right ulnar nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left median nerve are significantly less in these cases when compared to control group participants. Sensory and motor conduction velocities of the left ulnar nerve are significantly less in these cases when compared to control group participants. The goniometric parameters (right and left sides) of the cases and control group participants were not significantly different. Conclusion: Hypothyroid women have a delay in peripheral nerve conduction velocities, including sensory and motor components, and the degree and range of movements of limb joints were not affected. A nerve conduction study may be utilized as a routine screening test for hypothyroid individuals so that hormone replacement therapy can be instituted at the earliest. [ABSTRACT FROM AUTHOR]

Background: Health state utility values provide the quality component of quality-adjusted life years and are essential for health economic analyses, such as the National Institute for Health and Care Excellence Technology Appraisal. The aims of this systematic review were to: catalogue utility values for health states experienced by patients with hand conditions; provide pooled utility estimates for common hand conditions; and determine how utilities have been estimated. Methods: A PRISMA-compliant systematic review and meta-analysis was conducted (registered in PROSPERO, the international prospective register of systematic reviews (CRD42021226098)). Five databases were searched from inception until April 2023 (Embase, MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL)). All studies that reported primary utility values for hand health states in adult patients were eligible for inclusion. Pooled utility estimates were determined across conditions and intervention status using random-effects meta-analysis. Results: A total of 10 254 articles were identified; 57 studies met the full inclusion criteria and reported 363 distinct health state utility values. Health state utility values were estimated using a range of methods; the most common measure was the EQ-5D. Pooled utility estimates for carpal tunnel syndrome and hand osteoarthritis before surgical intervention were 0.69 (95% c.i. 0.66 to 0.73) and 0.63 (95% c.i. 0.60 to 0.67) respectively. Conclusion: Pooled utility estimates for patients with untreated carpal tunnel syndrome and hand osteoarthritis are 11% and 18% lower than age-matched population norms respectively. Hand conditions have a significant detrimental impact on health-related quality of life and this study provides catalogued utility values for use in future economic analyses to support the delivery of value-based hand surgery. This meta-analysis aimed to determine health state utility values for electively managed conditions affecting the hand. Pooled health state utility value estimates for carpal tunnel syndrome and hand osteoarthritis before surgical intervention were 0.69 (95% c.i. 0.66 to 0.73) and 0.63 (95% c.i. 0.60 to 0.67) respectively. These health state utility value estimates suggest patients with untreated carpal tunnel syndrome and hand osteoarthritis have substantial impairments in quality of life and are comparable to health states experienced by patients with coronary artery disease and chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Background and Objectives Surgical techniques for carpal tunnel release (CTR) have gradually become less invasive. No substantial evidence supports replacing the open carpal tunnel release (OCTR) with novel minimally invasive approaches. Thread carpal tunnel release (TCTR) is a new minimally invasive CTR method associated with promising results. This study aimed to compare the aesthetic and functional outcomes of OCTR with TCTR. Materials and Methods This study was a randomized clinical trial conducted in a hospital in Tehran, Iran, in 2022. Patients were randomized to OCTR and TCTR groups through simple randomization. Data such as demographics, nerve conduction study, electromyography, pain, and sensory evaluation by monofilament test were recorded in patients at baseline and after 3 months. Aesthetic evaluation was conducted by assessing the scar length and patients' satisfaction 3 months after the surgery. Results Twenty patients (10 in each group) entered the final analysis. Nerve conduction study, electromyography, and sensory evaluation were similar between groups 3 months after the operation. The TCTR group had lower postsurgical pain (p < 0.001) and lower scar length (p < 0.001) compared to the OCTR group. Overall satisfaction was not statistically different between TCTR and OCTR. Conclusion The TCTR method is safe in patients with CTS, and its efficacy is similar to OCTR. It can be a good alternative for OCTR, with a better aesthetic outcome. [ABSTRACT FROM AUTHOR]

Juxta-articular myxoma (JAM) is a rare soft tissue tumour predominantly composed of mucinous tissue and usually found around large joints. We report a 73-year-old woman with a 5-year history of a soft tissue mass in the thenar eminence of the right wrist who presented to our department. An initial diagnosis of a ganglion cyst was made using magnetic resonance imaging (MRI) and the jellied content of the mass by aspiration. Two years after presentation, surgical treatment with tumour resection and carpal tunnel release via the radial approach was performed because the symptoms of carpal tunnel syndrome worsened, and the tumour invaded the carpal tunnel. Histopathological examination revealed a JAM. At the 1-year follow-up, the symptoms of carpal tunnel syndrome had resolved, and no recurrence was confirmed by MRI. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy. Methods: Sixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient's satisfaction with the surgery. Results: In the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7). Conclusions: ECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction. [ABSTRACT FROM AUTHOR]

More than six million people worldwide, particularly in vulnerable communities in Latin America, are infected with Trypanosoma cruzi , the causative agent of Chagas disease. Only a small portion have access to diagnosis and treatment. Both drugs used to treat this chronic, neglected infection, benznidazole and nifurtimox, were developed more than 50 years ago, and adverse drug reactions during treatment pose a major barrier, causing 20% of patients to discontinue therapy. Fexinidazole proved efficacious in an earlier, interrupted clinical trial, but the doses evaluated were not well tolerated. The present study evaluated fexinidazole at lower doses and for shorter treatment durations. In this randomised, double-blind, phase 2 trial, we included adult patients (18–60 years old) with confirmed T cruzi infection by serology and PCR and without signs of organ involvement. We evaluated three regimens of fexinidazole—600 mg once daily for 10 days (6·0 g total dose), 1200 mg daily for 3 days (3·6 g), and 600 mg daily for 3 days followed by 1200 mg daily for 4 days (6·6 g)—and compared them with a historical placebo control group (n=47). The primary endpoint was sustained negative results by PCR at end of treatment and on each visit up to four months of follow-up. This study is registered with ClinicalTrials.gov , NCT03587766 , and EudraCT, 2016-004905-15. Between Oct 16, 2017, and Aug 7, 2018, we enrolled 45 patients (n=15 for each group), of whom 43 completed the study. Eight (19%) of 43 fexinidazole-treated patients reached the primary endpoint, compared with six (13%) of 46 in the historical control group. Mean parasite load decreased sharply following treatment but rebounded beginning 10 weeks after treatment. Five participants had seven grade 3 adverse events: carpal tunnel, sciatica, device infection, pneumonia, staphylococcal infection, and joint and device dislocation. Two participants discontinued treatment due to adverse events unrelated to fexinidazole. The fexinidazole regimens in this study had an acceptable safety profile but did not prove effective against T cruzi infection. Development of fexinidazole monotherapy for treating T cruzi infection has been stopped. The Drugs for Neglected Diseases initiative. [ABSTRACT FROM AUTHOR]

The relationship between menopausal status and clinical outcomes of female patients with carpal tunnel release (CTR) has been not clearly investigated. This study aimed to evaluate the clinical outcomes of CTR among women with different menopausal statuses. Two hundred-eighteen consecutive female patients with carpal tunnel syndrome (CTS) who underwent surgery at our hospital between May 2016 and May 2020 were included in this study. Based on whether subjects had undergone menopause before surgery, they were divided into three groups: the premenopausal group, the early postmenopausal group (less than 10 years since menopause) and the late postmenopausal group (more than 10 years since menopause). The clinical outcome was assessed before surgery and at six-month postoperative visits using the Boston Carpal Tunnel Questionnaire (BCTQ). There were 86 patients in the premenopausal group, 70 patients in the early postmenopausal group and 62 patients in the late postmenopausal group. All the groups showed significant improvements in their Symptom Severity Scale (SSS) and Functional Status Scale (FSS) compared with preoperative scores. Although, there was a significant difference between the groups based and post-surgical SSS and FSS (p < 0.05). Patients in the postmenopausal group had less improvement in SSS and FSS in comparison with those in the other groups (p < 0.05). Our results showed that all the groups had significant improvement in their SSS and FSS. However, the clinical outcomes were poorer in late postmenopausal patients than in premenopausal or early postmenopausal patients. These findings can be used in pre-operative counseling and interpretation of outcomes in women with CTR. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of carpal tunnel syndrome symptoms and assessed the median nerve cross-sectional area measurement by ultrasound in pregnant women in the second and third trimester with hypertensive disorders. Methods: This study presented four groups that were included in the cross-sectional study: one group of healthy pregnant women (control group) and three groups of pregnant women with hypertensive disorders (gestational hypertension, chronic hypertension, and preeclampsia). Results: Carpal tunnel syndrome symptoms such as hand numbness and hand pain were significantly higher in the hypertensive group than in the control group (p=.013, p= .002, respectively). We found that the right and left median nerves’ cross-sectional area was significantly higher in the hypertensive group than in the control group (p<.001). Also, participants had a positive low correlation and statistically significant difference between body mass index, gestational weight gain, and median nerve cross-sectional area (r= .347, p<.001; r=.414, p<.001). We showed excellent reliability for intraclass correlation coefficients of right and left median nerve cross-sectional area measurements (Intra observer Intraclass correlation coefficients= 0.926 and 0.955, respectively). Conclusion: Obstetricians should be aware of the increased prevalence of carpal tunnel syndrome in pregnant women with hypertensive disorders and increased carpal tunnel syndrome symptoms in the second and third trimesters. Because of its convenience and low cost, ultrasonography may be preferred for diagnosing carpal tunnel syndrome symptoms in pregnant women. In addition, pregnant women should be referred for early diagnosis and treatment of carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]