• Edema
• Exercise
• Median nerve
• Myofascial release therapy

• Humans
• Carpal Tunnel Syndrome/therapy
• Carpal Tunnel Syndrome/physiopathology
• Carpal Tunnel Syndrome/complications
• Middle Aged
• Male
• Female
• Median Nerve/physiopathology
• Neural Conduction/physiology
• Edema/therapy
• Edema/etiology
• Edema/physiopathology
• Manual Lymphatic Drainage/methods
• Adult
• Hand Strength
• Treatment Outcome
• Pain Measurement
• Physical Therapy Modalities

• Anxiety
• decision making
• hand
• surgery

• Humans
• Male
• Female
• Anxiety/epidemiology
• Anxiety/etiology
• Patient Reported Outcome Measures
• Middle Aged
• Retrospective Studies
• Postoperative Complications/epidemiology
• Postoperative Complications/psychology
• Carpal Tunnel Syndrome/surgery
• Carpal Tunnel Syndrome/psychology
• Trigger Finger Disorder/surgery
• Trigger Finger Disorder/psychology
• Radius Fractures/surgery
• Radius Fractures/psychology
• Elective Surgical Procedures/psychology
• Adult
• Aged

• P50 MH122351 NIMH NIH HHS

• chronic nerve compression
• fluorescein angiography
• laser doppler flowmetry
• nerve blood flow
• neuropathy

• Carpal tunnel syndrome (CTS)
• Endoscopic carpal tunnel release (ECTR)
• Functional recovery
• Hand surgery
• Open carpal tunnel release (OCTR)

• Carpal tunnel syndrome
• diagnosis
• pain
• paresthesia
• provocative test

• carpel tunnel syndrome (cts)
• compression-induced neuropathy (cin)
• median nerve
• nerve conduction study (ncs)
• tinel’s and phalen’s sign

• Automated diagnosis
• Carpal tunnel syndrome
• Computer-aided diagnosis
• Deep learning
• Median nerve
• Ultrasound image

• Humans
• Carpal Tunnel Syndrome/diagnostic imaging
• Deep Learning
• Neural Conduction/physiology
• Median Nerve/diagnostic imaging
• Ultrasonography

• carpal tunnel syndrome
• distal motor latency
• electrodiagnosis
• electromyography
• electroneurography
• sensitivity
• sensory conduction velocity

• Carpal tunnel syndrome
• Electrodiagnostic testing
• Magnetic resonance imaging
• Median neuropathy
• Neurologic examination
• Surgical management
• Ultrasound

• Carpal Tunnel Syndrome/therapy
• Carpal Tunnel Syndrome/diagnosis
• Humans
• Decompression, Surgical/methods

• Adam optimizer
• carpal tunnel syndrome (CTS)
• cross-sectional area (CSA)
• deep learning (DL)
• machine learning (ML)
• statistical analysis

• carpal tunnel release
• carpal tunnel syndrome
• minimally invasive
• ultrasound
• vcarpal tunnel

• 5% dextrose in water
• carpal tunnel syndrome
• clinical efficacy
• local injection therapy
• network meta-analysis
• platelet-rich plasma

• Department of Education of Zhejiang Province

• carpal tunnel syndrome
• extracorporeal shockwave therapy
• median neuropathy

• carpal arch compliance
• carpal tunnel release
• finite element analysis
• median nerve compression
• transverse carpal ligament

• Computer-aided diagnosis
• Image segmentation
• Median nerve
• U2-Net model
• Ultrasound

• Humans
• Image Processing, Computer-Assisted/methods
• Retrospective Studies
• Median Nerve/diagnostic imaging
• Ultrasonography

• carpal tunnel syndrome
• diagnosis
• nerve
• nerve compression
• outcomes
• radiology
• research and health outcomes
• surgery

• Humans
• Aged
• Median Nerve/diagnostic imaging
• Median Nerve/surgery
• Carpal Tunnel Syndrome/diagnostic imaging
• Carpal Tunnel Syndrome/surgery
• Wrist/surgery
• Ultrasonography/methods
• Forearm

• Carpal tunnel syndrome
• Dynamic B mode ultrasound
• Median nerve longitudinal mobility
• Radioulnar wrist compression
• Wrist flexion and extension

• Carpal Tunnel Syndrome
• Diacutaneous Fibrolysis
• physical therapy modalities
• ultrasonography

• Adult
• Aged
• Carpal Tunnel Syndrome/therapy
• Humans
• Hypesthesia
• Median Nerve/diagnostic imaging
• Ultrasonography
• Wrist

• Carpal Tunnel Syndrome
• Cold Exposure
• Cold Injury
• Ergonomics
• Lifting
• Occupational Exposure
• Occupational Health
• Paresthesia
• Sweden
• Vibration

Background: Recently, there was a series of clinical studies focusing on local injection of platelet-rich plasma (PRP) for treatment of patients with carpal tunnel syndrome (CTS). However, the safety and efficacy of PRP in these CTS patients remains controversial. Therefore, we performed a systematic review to compare PRP with other conservative treatments in treatment of CTS patients.

Methods: We systematically searched from electronic databases (Cochrane, PubMed, Web of Science, and EMBASE) up to 10 December 2021. The data of clinical results were extracted and analyzed by RevMan Manager 5.4.

Results: Finally, eight randomized controlled studies, involving 220 CTS patients undergoing local injection of PRP were enrolled in this systematic review. All enrolled trials were considered to be of high quality. In the short-term efficacy, the PRP group was significantly lower in symptom severity scale (SSS) compared with the control group (MD = −2.00; 95% CI, −3.15 to −0.85; p = 0.0007; I² = 0%). In the mid-term efficacy, the PRP group was significantly effective than the control group in the visual analogue scale (MD = −0.63; 95% CI, −1.22 to −0.04; p = 0.04; I² = 61%), SSS (MD = −3.56; 95% CI, −4.93 to −2.18; p < 0.00001; I² = 0%), functional status scale (MD = −2.29; 95% CI, −3.03 to −1.56; p < 0.00001; I² = 45%), sensory peak latency (MD = −0.39; 95% CI, −0.58 to −0.19; p = 0.0001; I² = 0%) and cross-sectional area of median nerve (MD = -0.20; 95% CI, −0.31 to −0.10; p = 0.0002; I² = 0%). In the mid-long-term efficacy, the PRP group was only significantly lower in SSS compared with the control group (MD = −2.71; 95% CI, −4.33 to −1.10; p = 0.001; I² = 38%).

Conclusion: Local PRP injection is more effective than other conservative treatments in terms of mid-term efficacy in relieving pain, improving wrist function and symptoms, reducing MN swelling, and partially improving electrophysiological indicators. However, the long-term adverse side and consensus on standardization of PRP in CTS patients still need further large-scale trials.

• carpal tunnel syndrome
• local injection
• platelet-rich plasma
• steroid
• systematic review

Evaluating patient comfort during full awake local anesthesia in carpal tunnel release surgery, without tourniquet use, by using epinephrine to obtain a completely dry surgical field.

We included into the study 41 patients who underwent carpal tunnel syndrome surgery under full awake combined anesthesia, using a 9-point questionnaire. Pain and anxiety in all patients were evaluated through a Wang-Baker 0–5 scale. The injection solution consisted of 0.1cc of epinephrine and 10cc of 1% lidocaine (1:100.000); 5cc were used for local cutaneous anesthesia, and 5cc were used for distal median nerve block. All patients underwent a classic, open carpal tunnel release.

Anxiety scores during anesthesia and the post-operative period did not show a statistically significant difference (p > 0.01), with keeping their levels at low perception scores (average score of 1.68 ± 0.38 CI 95%, with a modal value of 2, compared to an average of 0.78 ± 0.29 CI 95% with a modal value of 0). Similar results were obtained for pain scores during anesthesia (1.73 ± 0.48 CI 95% with a most frequent modal score of 1). Our results also showed that the effects of combined anesthesia in carpal tunnel release surgery persisted well into the 6-hour post-operative moment, pain scores remaining low, statistically significant similar to recorded values during the anesthesia moment (p > 0.01), at an average of 2.29 ± 0.5 CI 95% with a modal value of 1. No serious complications were recorded.

Combined distal median nerve block and local anesthesia with epinephrine:lidocaine provides a comfortable option for patients, with minimal risks of complications.

• Anesthesia
• Carpal tunnel
• Epinephrine
• Lidocaine

Introduction

Perineural corticosteroid injection is an extensively used and accepted treatment for carpal tunnel syndrome (CTS). However, to this date, there is no guideline as to which corticosteroid has to be used as the standard treatment for CTS. Triamcinolone acetonide is a commonly used particulate steroid that can cause permanent nerve injury if it is accidentally injected into the nerve. Conversely, dexamethasone sodium phosphate is a nonparticulate steroid that would not cause permanent nerve damage following accidental injection.

Methods

Mild to moderate cases of CTS, confirmed by nerve conduction studies (NCS), with symptoms greater than three months were recruited. The participants received one session of ultrasound-guided perineural injection by the in-plane axial ulnar-sided approach with 4 mL of either dexamethasone (dexamethasone sodium phosphate 8 mg (2 mL) + 2 mL 0.5% bupivacaine) or triamcinolone (triamcinolone acetonide 40 mg/mL (1 mL) + 2 mL 0.5% bupivacaine + 1 mL normal saline) solution. The parameters assessed were Phalen’s test time (in seconds), visual analog scale (VAS), and Boston carpal tunnel questionnaire (BCTQ) scores at baseline and two and four months, and NCS changes in sensory nerve conduction velocity (SNCV) and distal motor latency (DML) of the median nerve at baseline and four months. Statistical analysis was conducted using the software SPSS version 26.0 (IBM Corporation, Armonk, NY, USA). Independent samples t-test was used for comparison between groups and the paired t-test for improvement within each group. P values < 0.05 were considered statistically significant.

Results

The mean age was 42.64 ± 10.99 in the dexamethasone and 45.22 ± 10.602 in the triamcinolone group cases (P = 0.324).There were 58 females (84.06%) and 11 males (15.94%). Each of Phalen’s test time, VAS, and BCTQ scores significantly improved within both dexamethasone and triamcinolone groups at the second and fourth months after injection (P < 0.05). The NCS parameters (SNCV and DML) also significantly improved in both groups at the fourth month after the injection (P < 0.05). However, there were no significant differences in the improvement of Phalen’s test time between the two groups (P = 0.745), VAS score (P = 0.319), BCTQ score (P = 0.137), SNCV (P = 0.511), or DML (P = 0.753). Postprocedural pain lasted significantly longer in the triamcinolone group (P < 0.05). No major complications were noted in either of the two groups.

Conclusion

Dexamethasone is as effective as triamcinolone in improving the symptoms of CTS and can be used as a safer and more effective alternative in the treatment of mild to moderate CTS cases.

• Humans
• Carpal Tunnel Syndrome/surgery
• Carpal Tunnel Syndrome/complications
• Cicatrix/complications
• Median Nerve/surgery
• Pain/etiology
• Retrospective Studies
• Surgical Wound/complications
• Treatment Outcome

There is an emerging trend to employ dynamic sonography in the diagnosis of entrapment neuropathy, which exhibits aberrant spatiotemporal characteristics of the entrapped nerve when adjacent tissues move. However, the manual tracking of the entrapped nerve in consecutive images demands tons of human labors and impedes its popularity clinically. Here we evaluated the performance of automated median nerve segmentation in dynamic sonography using a variety of deep learning models pretrained with ImageNet, including DeepLabV3+, U-Net, FPN, and Mask-R-CNN. Dynamic ultrasound images of the median nerve at across wrist level were acquired from 52 subjects diagnosed as carpal tunnel syndrome when they moved their fingers. The videos of 16 subjects exhibiting diverse appearance and that of the remaining 36 subjects were used for model test and training, respectively. The centroid, circularity, perimeter, and cross section area of the median nerve in individual frame were automatically determined from the inferred nerve. The model performance was evaluated by the score of intersection over union (IoU) between the annotated and model-predicted data. We found that both DeepLabV3+ and Mask R-CNN predicted median nerve the best with averaged IOU scores close to 0.83, which indicates the feasibility of automated median nerve segmentation in dynamic sonography using deep learning.

• carpal tunnel syndrome
• deep learning
• nerve segmentation
• ultrasound

• Activities of daily living
• Blood pressure
• Body mass index
• Breastfeeding
• Gravidity
• Hand grip strength
• Physical function
• Pregnancy

• Adolescent
• Adult
• Blood Pressure/physiology
• Cross-Sectional Studies
• Female
• Hand Strength/physiology
• Humans
• Nigeria
• Pregnancy/physiology
• Pregnancy Trimesters/physiology
• Young Adult

• Carpal tunnel syndrome
• kinesio taping
• laser therapy
• low power laser

• Adult
• Aged
• Aged, 80 and over
• Carpal Tunnel Syndrome/diagnostic imaging
• Female
• Forearm/diagnostic imaging
• Forearm/innervation
• Humans
• Male
• Median Nerve/diagnostic imaging
• Middle Aged
• Neurologic Examination
• Retrospective Studies
• Ultrasonography
• Wrist/diagnostic imaging
• Wrist/innervation
• Young Adult

• Carpal tunnel syndrome
• Patient-reported outcome measures
• Polytomous Rasch analysis
• Self-report
• Surveys and questionnaires

• Carpal Tunnel Syndrome
• Humans
• Pain
• Psychometrics
• Quality of Life/psychology
• Surveys and Questionnaires

The aim of this article was to investigate the knowledge, management, and clinical practice of Italian physiotherapists concerning patients with carpal tunnel syndrome (CTS). A national cross-sectional survey consisted of 24 questions was administered from December 2019 until February 2020. A Chi-squared independence test was run to study any difference between subgroups of the sample and responses to the questionnaire. Five hundred and eight respondents completed the survey. Most respondents (n = 225/508; 44.3%) are under 29 years old, female (n = 256/508; 50.4%) and have been working as physiotherapists for less than 5 years (n = 213/508; 41.9%). Most of respondents correctly knows about the cause (n = 455/508, 89.6%), main signs and symptoms of CTS (n = 415/508, 81.70%) and administer education, manual therapy, myofascial techniques and therapeutic exercises (n = 457/508, 89.88%). Three hundred and sixty-four (71.68%) respondents were aware of the influence of psychosocial factors on the patient’s outcomes. The survey showed greater adherence to evidences by physiotherapists holding a master’s degree. The results are mostly comparable with other surveys structured all over the world on the same topic. Italian physiotherapists management of the CTS was not always in line with current evidence. Interventions such as education, manual therapy, therapeutic exercise, nerve and tendon glide techniques are widely used, while the orthotic is only offered by half of the sample.

• Italian survey
• care management
• carpal tunnel syndrome
• physiotherapy
• rehabilitation

• Adult
• Carpal Tunnel Syndrome/epidemiology
• Carpal Tunnel Syndrome/therapy
• Cross-Sectional Studies
• Exercise Therapy
• Female
• Humans
• Musculoskeletal Manipulations
• Surveys and Questionnaires

This study aims to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in carpal tunnel syndrome (CTS) compared to the wrist splint treatment.

Between April 2016 and March 2017, a total of 189 patients (22 males, 167 females, mean age 48.8±9.5 years, range, 24 to 70 years) with mild-to-moderate CTS were included in this double-blind, prospective, randomized, placebo-controlled study. The patients were divided into four treatment groups using stratified randomization: splint group (Group 1, n=47), splint+ESWT (Group 2, n=47), ESWT (Group 3, n=45), and splint+placebo ESWT (Group 4, n=50). All patients were evaluated at baseline, and one and three months. Pain using the Visual Analog Scale (VAS), finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and electrophysiological examination were assessed.

A total of 168 patients completed the study. There was no significant difference among the four groups in terms of age, sex, comorbid diseases, symptom duration, VAS-pain, BCTQ, and LANSS scores (p>0.05). Pain and functionality significantly improved in all groups (p<0.05). In the group with ESWT and using wrist splint combined, a greater improvement of the hand function and electrophysiological measures was observed.

Our study results show that ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS.

• Carpal tunnel syndrome
• high-energy shock waves
• neuropathic pain

Nerve entrapments such as carpal tunnel syndrome are the most common mononeuropathies. The lesional mechanism includes a scarring reaction that causes a vascular compromise. The most effective treatment is surgery, which consists of removing the scarred area, thus reverting the vascular impairment. In the present study, a more conservative therapeutic approach has been undertaken to release the nerve by means of galvanic current (GC) applied with a needle: percutaneous needle electrolysis (PNE). For this purpose, a mouse model of sciatic nerve entrapment has been created using albumin coagulated by glutaraldehyde (albumin 35% and glutaraldehyde 2% volume applied, 10 μl). After two weeks, a fibrous reaction was obtained which entrapped the nerve to the extent of causing atrophy of the leg musculature (14.7%, P < 0.05 compared to the control leg). Ultrasound imaging confirmed that the model's image was compatible with that of nerve entrapment in patients. To quantify the degree of entrapment, nerve conduction recordings were made. The amplitude (peak-to-peak) of the compound muscle action potential (CMAPs) decreased by 32.2% (P < 0.05), and the proximal latency increases by 17.7% (P < 0.05, in both cases). In order to release the sciatic nerve, PNE was applied (1.5 mA for 3 seconds and 3 repetitions; 1.5/3/3) by means of a solid needle in the immediacy of perineural fibrosis before and 5 minutes after the application of GC, and the proximal latency shows a decrease of 16% (P < 0.05). The recovery of CMAPs amplitude was about 48.7% (P < 0.05). Three weeks later, the CMAPs amplitude was almost completely recovered (94.64%). Therefore, with the application of GC by means of a solid needle, the sciatic nerve was definitively released from its fibrous entrapment.

• CTS-6
• Kamath
• Lo
• Wainner
• carpal tunnel syndrome
• latent class analysis
• ultrasonography

• Carpal tunnel syndrome
• health utilities
• patient preferences
• quality of life

• Carpal tunnel syndrome
• dietary integrator
• median nerve
• non-invasive treatment
• physical therapy
• sensory nerve conduction velocity

• BCTQ
• DASH
• Hi-Ob
• amniotic membrane
• carpal tunnel syndrome
• treatment

A rare case of carpal tunnel syndrome caused by a thrombosed persistent median artery is presented here.

The diagnosis was delayed due to the overlapping cervical radiculopathy. Acute severe pain and nocturnal paresthesia were chief complaints. Ultrasonography, magnetic resonance imaging, and computed tomography angiography revealed that the median nerve was compressed by the occluded median artery. Instead of surgery, conservative therapy was tried. It worked well for six months.

The importance of using modalities for decision making of diagnosis and treatment is emphasized in this report.

• Carpal tunnel syndrome
• Computed tomography angiography
• Persistent median artery
• Thrombosis

• Carpal tunnel syndrome
• inflammatory cytokines
• interleukin 1
• interleukin 6
• interleukin10
• tumor necrotizing factor

• Carpal tunnel syndrome
• Catastrophization
• Educational status
• Hand strength

• Adult
• Aged
• Carpal Tunnel Syndrome/epidemiology
• Carpal Tunnel Syndrome/physiopathology
• Carpal Tunnel Syndrome/psychology
• Catastrophization
• Cross-Sectional Studies
• Educational Status
• Female
• Hand Strength
• Humans
• Life Style
• Middle Aged
• Pain Measurement
• Pinch Strength
• Quality of Life
• Surveys and Questionnaires
• Treatment Outcome

• carpal tunnel syndrome
• measurement of the median nerve
• median nerve cross-sectional area
• nerve conduction studies
• role of ultrasound in diagnosis
• severity of carpal tunnel syndrome
• test for severe carpal tunnel syndrome

The severity of carpal tunnel syndrome (CTS) may be categorised in a number of ways utilising one of a range of presently available grading tools. The grading systems proposed by Bland and Padua are the most commonly used, however, both have limitations, which are discussed in detail in this paper.

The aim of this research is to establish, using the best available evidence, a clinically appropriate revision of the current CTS nerve conduction grading tool, and to compare with existing grading tools used in UK Neurophysiology clinics. The revised scale is designed from a clinical physiologist perspective and based on the numerical values of nerve conduction findings.

The proposed revised grading system is based on more nuanced, descriptive categories, ranging from Normal to Early, Mild Sensory, Mild Sensory Motor, Moderate Sensory, Moderate Sensory Motor, Severe Sensory Motor, Extremely Severe Sensory Motor, and Complete absence.

A total of 1123 patients (2246 hands) were included in this study, with the aim of evaluating the revised grading system. Data was collected based on the extensive and detailed grading systems previously described by Bland and Padua. All data was recorded numerically to ensure methodological reliability.

Of the 2246 patients’ hands tested, the nerve conduction was graded as normal in 968 hands; nerve conduction showed early changes in 271 hands; mild sensory changes in 215 hands, mild changes in both motor and sensory response in 51 hands; moderate sensory changes in 134 hands; moderate sensory and motor changes in 356 hands; severe changes in motor and sensory responses in 204 hands; extremely severe sensory and motor changes in 33 hands and complete absence of response in 14 hands.

The revised grading tool could offer a more numerical grading to the Clinical Physiologist and could help the surgeon to ascertain the level of severity in order to decide on either a conservative or surgical approach to treatment if they decide to use the proposed grading which could support them to defend their decision in cases of litigation.

• CTS Gradings
• Grading tools for carpal tunnel syndrome
• Neurophysiological CTS grading

• anxiety
• carpal tunnel syndrome
• depression
• neurophysiology
• pain