Utilization of nerve conduction studies in the investigation and management of carpal tunnel syndrome varies according to their perceived usefulness and availability. The use of steroid injections and splinting also varies according to service availability and their perceived effectiveness. We present a three year follow up of 230 patients managed in an environment where nerve conduction testing was not readily available. The majority received splinting and a steroid injection in an effort to manage their symptoms conservatively in the first instance. Our results show that a clear majority of patients who were treated with initial splinting and steroid injections saw a recurrence of their symptoms (71.9% and 79.7% respectively) requiring eventual surgical decompression. These results would seem to suggest that conservative management of carpal tunnel does not produce the desired curative results and that there may be an argument for proceeding directly to surgery. We also showed that 55% of patients referred for Nerve Conduction Studies seem to progress to surgical decompression. This would seem to suggest that Nerve Conduction Studies could form a robust part of the standard investigation of carpal tunnel in order to identify those who would benefit from surgery

Background. To investigate the new theory of hydroneurolysis and hydrodissection in the treatment of carpal tunnel syndrome (CTS). Independently of the fluid hydrodissolution works due to mechanical forces and it may have some positive effects in patients with ischemic damage caused by scar tissue pressure at the nerve's surface. Methods. A prospective blind clinical study of 31 patients suffering from carpal tunnel syndrome, established by nerve conduction studies and clinical tests. 14 patients (out of 29), who refused to undergo an open operation as a treatment to their disease at this point of time, were treated with a simple ultrasound-guided injection at the proximal carpal tunnel. In order to exclude the biochemical influence of the fluid in the treating disease we choosed to infiltrate 3 cc. of normal saline 0,9%. In the follow-up period our group was asked to answer to a new Q-DASH score and visual analogue scale (VAS) 100/100 in 2, 4 and 8 weeks. Results. At the end of the second month we found only 2 out of 14 patients of the infiltration's group with clinical improvement. As far as the control group (17 patients), there was just one patient with recovery of the symptoms at the end of the second month who avoided operation. The rest 16 patients experienced insistence or worsening of CTS while they were waiting to be operated (mean time till operation in our department's waiting list: 2 months) and underwent a surgical decompression of the median nerve. Comparing the two groups in Q-DASH score, VAS 100/100 and ultrasound cross sectional area measurements we found no statistical difference between the two groups at the endpoint of our follow-up period. Conclusion. As far as nerve entrapment syndromes we proved that normal saline hydrodissolution appears to be non effective as a conservative treatment. The mechanical way of action seems to have only very short term effects. Level of Evidence. II

Carpal tunnel syndrome (CTS) is the most common condition affecting the hand, with a prevalence of 2–3% in most populations, and a lifetime incidence over 10%. There is consensus that CTS results from increased pressure in the carpal tunnel, which eventually affects nerve function, but, aside from direct trauma and space occupying lesions, there is no consensus on what causes the pressure to rise. In the absence of an identifiable biological mechanism, the most common treatment involves surgical opening of the carpal tunnel. Recent data suggests that CTS patients demonstrate, in the carpal tunnel synovium and subsynovial connective tissue (SSCT), evidence of cellular senescence, with a senescence associated secretory phenotype (SASP). This finding suggests the potential for a biological treatment for CTS with senolytic drugs. This presentation will review the evidence for CTS as a disease of cellular senescence, and our preliminary data on the effects of senolytics, including in a relevant animal model of CTS and SSCT fibrosis

Background & Objectives. Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The aim of this study is to demonstrate that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance. Methods. Patients with clinical and electrophysiological signs of idiopathic carpal tunnel syndrome meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The measurements were taken from the palmar aspect of distal phalanx of the index and little finger of the affected hand. Normal healthy patients with no signs and symptoms of carpal tunnel syndrome were recruited as controls and skin capacitance was measured in a similar fashion as the CTS group. Results. The CTS group consisted of 25 patients (18 female & 7 male) and 35 hands with an average age of 59.2 years (33-83 years). The mean symptom severity score was 2.80 (1.27-4.18; SD 0.82) and functional status score was 2.53 (1-4.26; SD 1.08). The mean ratio of skin hydration between the index and little finger was 0.85 (0.6-1.25; SD 0.155). Using the paired t-test to determine paired differences between index and little finger measurements, the mean difference was 12.6 (p<0.001). The control group consisted of 15 people (9 female and 6 male) and 30 hands. The average age was 47.3 years. The mean ratio of skin hydration between the index and little finger was 0.97 (0.77-1.42 SD 0.105). Using the paired t-test to determine paired differences between index and little finger measurements, the mean difference was 1.31 (p=0.317). The difference in skin hydration between the index and little finger was directly compared between the controls and CTS group, this difference was statistically significant, p=0.002. Conclusion. A simple method to determine dysautonomia, using Corneometer CM825, by the clinician has been demonstrated. Measurement of skin capacitance will reduce the dependence on electrophysiological studies, thus reducing the time for arriving at a diagnosis, improved patient satisfaction and cost-effectiveness

Background

We searched -in transverse ultrasound view- the value of the difference (Delta) between -proximal to the tunnel- CSA (a) and -in the tunnel's inlet- CSA (b) for separating normal from abnormal median nerves.

The Cochrane Collaboration has produced five new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner These reviews are relevant to a wide range of musculoskeletal specialists, and include reviews in Morton’s neuroma, scoliosis, vertebral fractures, carpal tunnel syndrome, and lower limb arthroplasty

Introduction and Objective. Carpal tunnel syndrome (CTS) is a very common compressive neuropathy involving the median nerve. The typical symptoms are paraesthesia, dysesthesia and loss of strength; in severe case, this compression deteriorates the sensorimotor control of the hand and interferes with the adjustment of the forces at the level of the fingers, thus affecting the components that are the basis of dexterity and control of fine movements. For these reasons, the CTS has repercussions on various activities of daily life, including writing skills. Word processing via PC and mobile device (touch-typing) require a fine control of the hand-wrist movement and of the opposition of the thumb, while in handwriting, gripping and gripping movements are carried out in a protracted manner. In modern society, present skills play a role of fundamental importance from an educational, professional and social point of view. The aim of the study is to describe the effects of carpal tunnel release (CTR) on handwriting and digital writing performance. Materials and Methods. We recruited patients suffering from carpal tunnel syndrome (CTS) who were candidates for CTR surgery and collected clinical and demographic data, including age, occupation, duration of symptoms and electromyography outcomes. The first trial session was carried out before surgery and the subsequent ones at 1, 2, 3, 4, 8 and 12 weeks after the CTR. These trials involved copying a 500-character paragraph by handwriting, personal computer (PC) and mobile device, for which a dedicate Google Colab web page was computed. We used as parameters the speed, expressed in words per minute (wpm), and the accuracy of copying, which was measured in number of errors (en). Moreover in each session the patient filled in the QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire. We used the one-way anova to evaluate the change in the three performances and in the QuickDASH score in follow-up sessions. We used the two-way anova to detect a possible interactions between speed improvement and groups of variables, namely gender, writing frequency, schooling, diabetes, dysthyroidism and metabolic syndrome. Results. We recruited 20 patients of whom 7 dropped out for personal reasons and 13 had completed all trial sessions. The PC writing performance had an average speed and accuracy of 15.1 ± 6.8 wpm and 13.1 ± 8.2 en, respectively, while post-operatively it returned values of 17.6 ± 5.0 wpm and 9.9 ± 5.6 en. Regarding touch-typing, a pre-operative average of 16.9 ± 5.8 wpm and 14.3 ± 14.4 en was recorded, while post-operatively an average of 21.7 ± 6.5 wpm and 11.5 ± 14.7 en was reported. Handwriting performance initially had a mean of 20.5 ± 7.1 wpm and 0.1 ± 0.6 en and after three months returned a mean of 22.4 ± 4.0 wpm and 0 ± 0 n. The QuickDASH score had a pre-operative mean of 39.1 ± 9.1 and post-operative mean of 17 ± 6 points. The only statistically significant improvements were those related to touch-typing (P = 0.022) and QuickDASH score (P < 0.001). There was no significant interaction between gender, comorbidity, writing frequency, level of schooling and recovery of writing ability. Conclusions. The data collected showed, in agreement with previous studies, that CTS has a significant impact on the patient's writing ability, who benefits from the surgical treatment, especially in terms of touch-typing and general manual dexterity. In addition, the recovery of writing ability did not show significant correlation with other variables

The postoperative course of median nerve decompression in the carpal tunnel syndrome may sometimes be complicated by postoperative pain, paresthesias, and other unpleasant symptoms, or be characterized by a slow recovery of nerve function due to prolonged preoperative injury causing extensive nerve damage. The aim of this study is to explore any possible effects of alpha lipoic acid (ALA) in the postoperative period after surgical decompression of the median nerve at the wrist. Patients were enrolled with proven carpal tunnel syndrome and randomly assigned into one of two groups: Group A: surgical decompression of the median nerve followed by ALA for 40 days. Group P: surgical decompression followed by placebo. The primary endpoint of the study was nerve conduction velocity at 3 months post surgery, Other endpoints were static 2 point discrimination, the Boston score for hand function, pillar pain and use of pain killers beyond the second postoperative day. ALA did not show to significantly improve nerve conduction velocity or Boston score. However, a statistically significant reduction in the postoperative incidence of pillar pain was noted in Group A. In addition, static 2 point discrimination showed to be significantly improved by ALA. Administration of ALA following decompression of the median nerve for carpal tunnel release is effective on nerve recovery, although this is not detectable through nerve conduction studies but in terms of accelerated and improved static two-point discrimination. The use of ALA as a supplementation for nerve recovery after surgical decompression may be extended to all types of compression syndromes or conditions where a nerve is freed from a mechanical insult. Furthermore, ALA limits post-decompression pain, including late pericicatricial pain at the base of the palm, the so called pillar pain, which seems to be associated with a reversible damage to the superfical sensitive small nerve fibers. In conclusion postoperative administration of ALA for 40 days post-median nerve decompression was positively associated with nerve recovery, induced a lower incidence of postoperative pillar pain and was associated with a more rapid improvement of static two-point discrimination. This treatment is well tolerated and associated with high levels of satisfaction and compliance, supporting its value as a standard postoperative supplementation after carpal tunnel decompression

Objectives. There are various pin-in-plaster methods for treating fractures of the distal radius. The purpose of this study is to introduce a modified technique of ‘pin in plaster’. Methods. Fifty-four patients with fractures of the distal radius were followed for one year post-operatively. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than seven days after injury. Range of movement and functional results were evaluated at three and six months and one and two years post-operatively. Radiographic parameters including radial inclination, tilt, and height, were measured pre- and post-operatively. Results. The average radial tilt was 10.6° of volar flexion and radial height was 10.2 mm at the sixth month post-operatively. Three cases of pin tract infection were recorded, all of which were treated successfully with oral antibiotics. There were no cases of pin loosening. A total of 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. There were no cases of median nerve compression or carpal tunnel syndrome, and no cases of tendon injury. Conclusion. Our modified technique is effective to restore anatomic congruity and maintain reduction in fractures of the distal radius. Cite this article: Bone Joint Res 2015;4:176–180

In recent years, there has been an increase in using self- admistrated questionnaires to accurately assess intervention outcomes in hand surgery to determine the quality of healthcare. This study aims to evaluate whether the Manchester Modified Disabilities of the Arm, Shoulder and Hand (M2DASH) questionnaire is a valid, reliable, responsive, and unbiased outcome measure for Carpal Tunnel syndrome compared to the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, Boston questionnaire (BQ), and Nerve Conduction Studies (NCS). Method. 48 patients with CTS confirmed by NCS completed the M2DASH, original DASH, and the BQ, at least twice at different time intervals. The scores obtained from M2DASH were compared and correlated with the DASH, BQ, and NCS to assess validity, reliability, responsiveness, and bias of the questionnaires. Results. Validity analysis for M2DASH showed strong positive correlations with the Original DASH and BQ. No significant correlation was obtained from correlating with NCS. Reliability testing confirmed that the M2DASH is internally consistent and reproducible outcome. Significant results for responsiveness were noted in BQ symptom severity scale only. There was no age, gender, hand dominance, or side affected bias in all three questionnaires. Conclusions. The M2DASH is a valid, reliable, and unbiased outcome measure for CTS. In terms of responsiveness this study demonstrated that M2DASH & DASH is weak in detecting the clinical change for CTS, except for the BQ. Further assessment of responsiveness specifically for CTS is required in order to implement this questionnaire in clinical practice to accurately obtain results reflecting the patients progression

Objectives

The aim of this study was to investigate the effect of hyperglycaemia on oxidative stress markers and inflammatory and matrix gene expression within tendons of normal and diabetic rats and to give insights into the processes involved in tendinopathy.