SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Carpal tunnel syndrome is a result of median nerve compression within the carpal canal. Factors associated with the appearance of carpal tunnel syndrome can be related to the bony architecture of the carpal canal, to its contents and to systemic disease. The purpose of this work is to see if changes in the elasticity of the transverse carpal ligament may cause carpal tunnel syndrome.
Carpal tunnel syndrome is the most common of all the so-called entrapment syndromes. It therefore features as a most important medical condition for which the underlying cause is unknown. In the USA, this condition is commonly regarded as work related, and as a condition, it results in a cost of medical expenditure alone of 13, 263 US dollars per employee so affected. The incidence in the United States of America is 99 out of 100,000 people. Four hundred and fifty thousand carpal tunnel releases are carried out annually in the USA, at a total cost of 2 BIL US dollars.(1) The condition gives rise to opinions that vary as to whether it is work related. In my practice now as a full-time medicolegal consultant, so many opinions are written that blandly put forward the statement that 'Carpal Tunnel Syndrome is work related' or 'Carpal Tunnel Syndrome is related to repetitive movement or hard physical labour'. These opinions, in my view, are not supported by current knowledge of carpal tunnel syndrome and it is for that reason that this study has been instituted.
Carpal tunnel syndrome is caused by the pressure of the medianus nerve in the carpal canal. This syndrome is characterized by the following symptoms: numbness of the thumb and fingers, hand pain, particularly at night, and handicap of the hand efficiency. The examination of the perception, provocation tests, electromyography, carpal radiography, ultrasonography and magnetic resonance imaging are very helpful in the diagnosis of carpal tunnel syndrome. Pathological changes in flexor's theca are the most frequent causes of the syndrome. It may also occur in patients with lupus erythematosus, tuberculosis, endocrinopathy, rheumatic diseases and during pregnancy. Carpal tunnel syndrome is one of the most common occupational neuropathy. It is associated with the recurrence of carpal movements and observed in seamstresses, butchers, persons testing bar codes in supermarkets and meat packers.
Carpal tunnel syndrome is associated with increased intracarpal canal pressure. The effect of tendon loading on intracarpal canal pressures is documented in biomechanical studies. Palmaris longus loading in wrist extension induces the greatest absolute increase in intracarpal canal pressure. Despite this fact, the palmaris longus is not yet a proven independent risk factor for the development of carpal tunnel syndrome. The purpose of this prospective clinical study was to assess and quantify the association between the presence of a palmaris longus tendon and carpal tunnel syndrome. Thirty-six carpal tunnel subjects with bilateral disease were compared with 36 controls. Each subject was clinically examined for the presence of the palmaris longus tendon. The prevalence of palmaris longus agenesis was significantly lower in the carpal tunnel group. The palmaris longus tendon is a strong independent risk factor for carpal tunnel syndrome.
Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. Compression of the median nerve in the carpal tunnel, disrupts the blood-nerve barrier causing edema, inflammation and fibrosis of its surrounding connective tissues. In the next stage of the syndrome there is a disruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include intrinsic factors (which cause pressure within the tunnel), extrinsic factors (which cause pressure from outside the tunnel) and overuse/exertional factors. Patients usually report numbness and pain of the palmar aspect of their 1st, 2nd, 3rd and radial half of their 4th finger, night pain and gradual worsening of their symptoms. At a later stage, weakness and atrophy of the thenar muscles appears. The physical examination may show a decrease in sensibility, positive provocative tests and a decrease in thenar strength. The typical finding in the nerve conduction tests is a prolonged latency period. The conservative treatment for carpal tunnel syndrome includes ergonomic modifications, anti inflammatory medications and splintage and less frequently, special exercise and therapeutic ultrasound. The indications for operative treatment are failure of conservative treatment or severe carpal tunnel syndrome. The purpose of the operation is to relieve the pressure in the carpal tunnel by dissecting the transverse ligament. The operation can be done in an open approach, endoscopic approach or limited invasive approach.
Carpal tunnel syndrome is a neuropathy resulting from compression of the median nerve as it passes through a narrow tunnel in the wrist on its way to the hand. The lack of precise objective and clinical tests, along with symptoms that are synonymous with other syndromes in the upper extremity, cause carpal tunnel syndrome to appear to be a rare entity in athletics. However, it should not be ruled out as a possible etiology of upper extremity paralysis in the athlete. More typically, carpal tunnel syndrome is the most common peripheral entrapment neuropathy encountered in industry. Treatment may include rest and/or splinting of the involved wrist, ice application, galvanic stimulation, or iontophoresis to reduce inflammation, and then transition to heat modalities and therapeutic exercises for developing flexibility, strength, and endurance. In addition, an ergonomic assessment should be conducted, resulting in modifications to accommodate the carpal tunnel syndrome patient.
Carpal tunnel syndrome was studied by use of supplemental palpatory diagnosis in 20 abnormal wrists. Restriction in motion at the carpal tunnel was quantified with a rating system. All wrists with carpal tunnel syndrome revealed at least moderate restriction to motion, as compared with only mild or no restriction in 20 wrists in normal, symptom-free subjects. Several participants (16 abnormal wrists) underwent osteopathic manipulative treatment, including a new "opponens roll" maneuver, and self-stretching, or a similar treatment accomplished by use of a self-treatment accomplished by use of a self-treatment appliance. In those treated, palpatory restriction decreased into the normal range, often before symptoms decreased. Improvement in nerve conduction studies usually followed within 1 to 3 months. Palpatory diagnosis is a useful adjunctive method of assessing patient status in carpal tunnel syndrome and helpful in prognosticating outcome. The modified manipulative technique described for the treatment of mild to moderate carpal tunnel syndrome may be effective in more severe cases.
Carpal tunnel syndrome is common in adults and is usually sporadic and idiopathic. When carpal tunnel syndrome is inherited, it is often the manifestation of a systemic disease. We report carpal tunnel syndrome in an otherwise healthy woman aged 35 years. Family history reveals that her daughter, her sister and a sister's daughter, an aunt, a first cousin, her father and the paternal grandmother are also affected. The age of onset of the disease in this family was between 9 and 52 years of age. The family in this paper demonstrates an interesting pattern of inheritance with earlier onset of symptoms in subsequent generations, suggestive of anticipation.
Carpal tunnel area was investigated as a risk factor for carpal tunnel syndrome (CTS). It was hypothesized that if canal area is a risk factor for the syndrome, individuals who develop the syndrome should have smaller carpal canal areas than those who remain free of the syndrome. Sixty-one subjects, approximately equally divided by sex, age group, and diagnosis, were examined. A measurement of cross-sectional areas of the carpal canal by computerized axial tomography indicated that individuals diagnosed as carpal tunnel patients had significantly larger carpal canal areas than controls. The results indicate that a small carpal canal area does not appear to be a risk factor for carpal tunnel syndrome.
Carpal tunnel syndrome is the most frequently diagnosed, best understood and most easily treated entrapment neuropathy. During the first half of the 20th century, however, most patients with carpal tunnel syndrome were diagnosed as having compression of either the brachial plexus or thenar nerve motor branch of the median nerve. As late as 1950, only twelve patients with operative release of the transverse carpal ligament for idiopathic carpal tunnel syndrome had been reported. The delay in accurate anatomical localization of this compressive neuropathy can be attributed both to the confusion caused by the diverse manifestations of median nerve compression in the carpal tunnel, and to some interesting developments that altered early investigations in this area.
Carpal tunnel syndrome affects approximately 3 percent of adults in the United States. Pain and paresthesias in the distribution of the median nerve are the classic symptoms. While Tinel's sign and a positive Phalen's maneuver are classic clinical signs of the syndrome, hypalgesia and weak thumb abduction are more predictive of abnormal nerve conduction studies. Conservative treatment options include splinting the wrist in a neutral position and ultrasound therapy. Orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injections may improve symptoms for a longer period. A recent systematic review demonstrated that nonsteroidal anti-inflammatory drugs, pyridoxine, and diuretics are no more effective than placebo in relieving the symptoms of carpal tunnel syndrome. If symptoms are refractory to conservative measures or if nerve conduction studies show severe entrapment, open or endoscopic carpal tunnel release may be necessary. Carpal tunnel syndrome should be treated conservatively in pregnant women because spontaneous postpartum resolution is common.
Carpal tunnel syndrome, the most prevalent compressive neuropathy, is exceedingly common. The incidence of this condition has been estimated to be as low as 0.1% to as high as 10%. Direct medical costs related to carpal tunnel syndrome exceed $1 billion per year, with over 200,000 surgical procedures performed annually. Additionally, untold millions of dollars are spent on as-of-yet unproven ergonomic aides in attempts to prevent the condition. a survey of nearly 30,000 workers affected by carpal tunnel syndrome were reported to have lost a median of 25 work days that further adds to the cost of this condition. After spending time in any busy hand surgeon's office, one would think that an epidemic of "carpal tunnel" has erupted.
Carpal tunnel syndrome is associated with greater body mass index and less physical activity. To determine the effect of aerobic exercise on median nerve conduction and symptoms suggestive of carpal tunnel syndrome, 30 symptomatic volunteers (30 to 64 years old) with abnormal median nerve conduction studies participated in a 10-month program of supervised aerobic exercise. Changes in percentage of body fat, body mass index, peak oxygen consumption, 14-cm median sensory latency, and hand/wrist symptoms were assessed. A decrease in 14-cm sensory median latency correlated with a decrease in percentage of body fat (R = 0.52, P = 0.004) and was predicted by an increase in peak oxygen utilization (partial R = 0.52, P = 0.005) and a decrease in body mass index (partial R = 0.47, P = 0.014). There was also a tendency for a set of symptoms sometimes associated with carpal tunnel syndrome (pain, tightness, and clumsiness) to be relieved by the exercise program. These results suggest that an aerobic exercise program can be beneficial to median nerve function and may be associated with a reduction in hand symptoms.
Carpal tunnel syndrome is a common condition with many aetiologies. We present a case report of a glioblastoma which presented as carpal tunnel syndrome, and highlights that the most proximal site for pathology is not the spinal cord.
Carpal tunnel syndrome (CTS) is a clinical entity characterized by pain, paresthesias, and numbness in the distribution of the median nerve with weakness and atrophy of the thenar muscles in advanced cases. It is universally accepted that CTS is the clinical concomitant of compression of the median nerve as it passes through the carpal canal. It is reported to be the most common of the entrapment neuropathies. Increasing evidence suggests that occupational factors, including forceful use of the hands, repetitive use of the hands, and hand-arm vibration, are etiologic for CTS. When occurring as a result of occupational exposures, the term "work-related carpal tunnel syndrome" is applied. Clinical approaches to the diagnosis and treatment of work-related CTS are described in this paper. Particular attention is paid to the clinical features and pathophysiology of CTS, the epidemiology of work-related CTS, ascertainment of work-relatedness in the clinical setting, treatment including both work and non-work interventions, and control of occupational ergonomic risk factors that may contribute to the illness.
Carpal tunnel release is the most common hand operation performed in this country. In the absence of specific systemic diseases, the etiology and persistence of pain and dysfunction even after surgical decompression is poorly understood. The focus of this investigation was to investigate the biological factors present within the patients serum that may lead to increased sensitivity to pain. Tissue was collected from patients during surgery. The tissue was homogenized and the homogenate analyzed for the presence of IL-1, IL-6, prostaglandin E series (PGE2). The levels were compared with volunteers that had no evidence of carpal tunnel syndrome or pain. The results showed similar levels of IL-1 (range 42-26 ng/ml) in tissue homogenates, and a significant increase in levels of IL-6 and malionaldehyde bis-(diethyl acetal) in CTS patients in comparison to control tissues. This increase may be associated with oxidative changes occurring as a result of ischemia and reperfusion. Tissue homogenates were also evaluated for PGE2. The CTS tissues showed a five fold elevation in PGE2 compared to control tissues. Levels of PGE2 in CTS tissues were statistically different using a two-tailed student T-test. Increased levels of PGE2 can enhance vascular permeability at the site of injury, and can play an important role in activating adenylate cyclase which increases intracellular cyclic adenosine monophosphate (cAMP). This increase in cAMP levels can inhibit functional responses to other inflammatory stimuli. Increases in PGE2 can also cause sensitization of the nerve endings so that a normal stimulus that would not necessarily cause pain will now be experienced as painful. The results of this study demonstrate that arachidonic acid metabolites PGE2 may be responsible for both the pathological changes and clinical symptomatology in carpal tunnel syndrome.
Carpal tunnel syndrome associated with laceration of the median nerve in the distal forearm sometimes occurs. The presenting symptoms related to the initial trauma and the obvious sequelae of the nerve injury itself may focus attention on the neuroma, but the neurological disability may be due in great part to carpal tunnel compression of the nerve distal to the neuroma. Operative decompression usually results in prompt recovery. The possibility of post-traumatic carpal tunnel syndrome must be considered by those evaluating and caring for the primary nerve injury.
Carpal tunnel syndrome, a common and well-described clinical disorder, usually has been considered a chronic disorder with a fixed set of symptoms and typically affecting middle-aged women. Because of the many variations in its initial clinical manifestations, however, its diagnosis at times can be difficult. In this review, we describe nonclassic manifestations of carpal tunnel syndrome and discuss the differential diagnosis, the importance of electrodiagnostic studies, and treatment modalities.