Topic
Carpal tunnel syndrome
About: Carpal tunnel syndrome is a research topic. Over the lifetime, 9730 publications have been published within this topic receiving 203593 citations. The topic is also known as: Carpal tunnel Syndrome & Carpal tunnel syndrome (disorder).
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TL;DR: This report provides the best available prevalence estimates for the US for osteoarthritis, polymyalgia rheumatica, gout, fibromyalgia, and carpal tunnel syndrome as well as the symptoms of neck and back pain.
Abstract: Objective
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.
4,813 citations
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TL;DR: About 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing, which indicates symptoms of pain, numbness, and tingling in the hands are common in the general population.
Abstract: Context Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling
in the hands and is an important cause of work disability. Although high prevalence
rates of CTS in certain occupations have been reported, little is known about
its prevalence in the general population. Objective To estimate the prevalence of CTS in a general population. Design General health mail survey sent in February 1997, inquiring about symptoms
of pain, numbness, and tingling in any part of the body, followed 2 months
later by clinical examination and nerve conduction testing of responders reporting
symptoms in the median nerve distribution in the hands, as well as of a sample
of those not reporting these symptoms (controls). Setting A region in southern Sweden with a population of 170,000. Participants A sex- and age-stratified sample of 3000 subjects (age range, 25-74
years) was randomly selected from the general population register and sent
the survey, with a response rate of 83% (n=2466; 46% men). Of the symptomatic
responders, 81% underwent clinical examination. Main Outcome Measures Population prevalence rates, calculated as the number of symptomatic
responders diagnosed on examination as having clinically certain CTS and/or
electrophysiological median neuropathy divided by the total number of responders.
Results Of the 2466 responders, 354 reported pain, numbness, and/or tingling
in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence
interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects
were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI,
3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal
tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%).
Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed
CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically
examined, electrophysiological median neuropathy was found in 23 (18.4%; 95%
CI, 12.0%-26.3%). Conclusion Symptoms of pain, numbness, and tingling in the hands are common in
the general population. Based on our data, 1 in 5 symptomatic subjects would
be expected to have CTS based on clinical examination and electrophysiologic
testing.
1,698 citations
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TL;DR: It is concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve.
Abstract: We developed a self-administered questionnaire for the assessment of severity of symptoms and functional status in patients who have carpal tunnel syndrome. The reproducibility, internal consistency, validity, and responsiveness to clinical change of scales for the measurement of severity of symptoms and functional status were evaluated in a clinical study. The scales were highly reproducible (Pearson correlation coefficient, r = 0.91 and 0.93 for severity of symptoms and functional status, respectively) and internally consistent (Cronbach alpha, 0.89 and 0.91 for severity of symptoms and functional status, respectively). Both scales had positive, but modest or weak, correlations with two-point discrimination and Semmes-Weinstein monofilament testing (Spearman coefficient, r = 0.12 to 0.42). In thirty-eight patients who were operated on in 1990 and were evaluated a median of fourteen months postoperatively, the mean symptom-severity score improved from 3.4 points preoperatively to 1.9 points at the latest follow-up examination, while the mean functional-status score improved from 3 to 2 points (5 points is the worst score and 1 point is the best score for each scale). Similar improvement was noted in twenty-six patients who were evaluated before and three months after the operation. We concluded that the scales for the measurement of severity of symptoms and functional status are reproducible, internally consistent, and responsive to clinical change, and that they measure dimensions of outcomes not captured by traditional measurements of impairment of the median nerve. These scales should enhance standardization of measurement of outcomes in studies of treatment for carpal tunnel syndrome.
1,683 citations
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TL;DR: The purpose of the operation is to relieve the pressure in the carpal tunnel by dissecting the transverse ligament, which can be done in an open approach, endoscopic approach or limited invasive approach.
Abstract: 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.
1,134 citations
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TL;DR: Treatment of carpal-tunnel syndrome with steroid injections into the carpal tunnel will almost always relieve the patient's pain and numbness in the hand, and in many cases will also cure the paralysis of the thenar muscles, which may be present.
Abstract: At the Cleveland Clinic the diagnosis of carpal-tunnel syndrome has been made in 654 hands of 439 patients during the last seventeen years. The typical patient with this syndrome is a middle-aged housewife with numbness and tingling in the thumb and index, long, and ring fingers, which is worse at night and worse after excessive activity of the hands. The sensory disturbances, both objective and subjective, must be directly related to the sensory distribution of the median nerve distal to the wrist; but pain may be referred proximal to the wrist as high as the shoulder. There is usually a positive Tinel sign over the median nerve at the wrist, and the wrist-flexion test I described is also usually positive. About half of the patients also have some degree of thenar atrophy.
If steroid injections into the carpal tunnel give only transient relief, treatment should be by complete section of the transverse carpal ligament. This procedure will almost always relieve the patient's pain and numbness in the hand, and in many cases will also cure the paralysis of the thenar muscles, which may be present.
1,102 citations