SUBJECT: Carpal Tunnel Syndrome (Aug seminar)
Database: MEDLINE <1996 to June Week 2 2002>
Search Strategy:
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1 Carpal Tunnel Syndrome/ (1263)
2 *Carpal Tunnel Syndrome/ (994)
3 limit 2 to (human and english language) (874)
4 exp sports/ (14684)
5 exp exertion/ (18094)
6 4 or 5 (29591)
7 3 and 6 (7)
8 1 and 6 (10)
9 limit 8 to english language (9)
10 carpal tunnel syndrome.ti. and 3 (538)
11 limit 10 to review articles (45)
12 from 11 keep 1,3-4,6-9,11,13,19,22,26,28,31,38-45 (22)
13 9 or 12 (30)
14 from 13 keep 1-30 (30)
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<1>
Unique Identifier
8669747
Medline Identifier
96266198
Authors
Isakov AP. Broome JR. Dutka AJ.
Institution
Naval Medical Research Institute, Bethesda Maryland, USA.
Title
Acute carpal tunnel syndrome in a diver: evidence of peripheral nervous system involvement in decompression illness.
Source
Annals of Emergency Medicine. 28(1):90-3, 1996 Jul.
Abstract
Conclusive evidence for involvement of the peripheral nervous system in decompression illness is lacking. We report a case of decompression illness associated with shoulder pain and the clinical features of median nerve injury at the wrist. Initial recompression and hyperbaric oxygen treatment produced prompt relief of all symptoms and signs, but carpal tunnel syndrome subsequently recurred. Nerve conduction studies confirmed median nerve conduction delay at the wrist. Repeat measurements after treatment with hyperbaric oxygen showed electrophysiologic improvement that was consistent with improvement in symptoms. We believe this is the first objectively substantiated case of injury to the peripheral nervous system caused by decompression illness.
<2>
Unique Identifier
11128896
Medline Identifier
21012966
Authors
Dickerman RD. Douglas JA. East JW.
Institution
Surgical Neurology Branch, National Institutes of Health, Bethesda, MD 20892, USA.
Title
Bilateral median neuropathy and growth hormone use: a case report.
Source
Archives of Physical Medicine & Rehabilitation. 81(12):1594-5, 2000 Dec.
Abstract
A male elite bodybuilder suffered bilateral median nerve neuropathy during a self-administered course of growth hormone (GH). Nerve conduction velocities revealed bilateral median neuropathy consistent with carpal tunnel syndrome (CTS). This is the first case of GH-induced CTS occurring in an athlete. Contrary to earlier studies, this report demonstrates that GH-induced CTS is not an age-related phenomenon and alerts physicians to include GH abuse as a possible etiology of median neuropathy in athletes.
<3>
Unique Identifier
11932886
Medline Identifier
21929353
Authors
Bruno KM. Farhoomand L. Libman BS. Pappas CN. Landry FJ.
Institution
The University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
Title
Cryptococcal arthritis, tendinitis, tenosynovitis, and carpal tunnel syndrome: report of a case and review of the literature. [Review] [33 refs]
Source
Arthritis & Rheumatism|Arthritis & Rheumatism-Arthritis Care & Research. 47(1):104-8, 2002 Feb.
<4>
Unique Identifier
11458486
Medline Identifier
21352123
Authors
Kanaan N. Sawaya RA.
Institution
Department of Family Medicine, American University Medical Center, POB 113-6044/B-31, Beirut, Lebanon.
Title
Carpal tunnel syndrome: modern diagnostic and management techniques. [see comments.]. [Review] [26 refs]
Comments
Comment in: Br J Gen Pract. 2001 Jul;51(468):582 ; 11462326
Source
British Journal of General Practice. 51(465):311-4, 2001 Apr.
Abstract
Carpal tunnel syndrome is a common disorder characterised by the classical symptoms of numbness and paraesthesiae along the distribution of the median nerve. Thenar muscle weakness is a late manifestation of advanced disease. Tinel's and Phalen's signs are helpful in suggesting the diagnosis. The symptoms and signs arise from entrapment of the median nerve. Electrophysiological tests are helpful in confirming the diagnosis and magnetic resonance imaging may be used in the diagnosis of atypical cases. Ergonomic manoeuvers and steroid injections may alleviate symptoms in mild cases. Surgery is reserved for severe cases and those who do not respond to conservative therapy. Open carpal tunnel release is the classical surgery with usually excellent results. Endoscopic carpal tunnel release surgery was introduced to decrease the morbidity of open surgery. This latter technique also has its complications and is still being refined. [References: 26]
<5>
Unique Identifier
10450483
Medline Identifier
99378977
Authors
Masmejean EH. Chavane H. Chantegret A. Issermann JJ. Alnot JY.
Institution
Hopital Bichat Hand Surgery Service, Paris, France.
Title
The wrist of the formula 1 driver.
Source
British Journal of Sports Medicine. 33(4):270-3, 1999 Aug.
Abstract
OBJECTIVES: During formula 1 driving, repetitive cumulative trauma may provoke nerve disorders such as nerve compression syndrome as well as osteoligament injuries. A study based on interrogatory and clinical examination of 22 drivers was carried out during the 1998 formula 1 World Championship in order to better define the type and frequency of these lesions. METHODS: The questions investigated nervous symptoms, such as paraesthesia and diminishment of sensitivity, and osteoligamentous symptoms, such as pain, specifying the localisation (ulnar side, dorsal aspect of the wrist, snuff box) and the effect of the wrist position on the intensity of the pain. Clinical examination was carried out bilaterally and symmetrically. RESULTS: Fourteen of the 22 drivers reported symptoms. One suffered cramp in his hands at the end of each race and one described a typical forearm effort compartment syndrome. Six drivers had effort "osteoligamentous" symptoms: three scapholunate pain; one medial hypercompression of the wrist; two sequellae of a distal radius fracture. Seven reported nerve disorders: two effort carpal tunnel syndromes; one typical carpal tunnel syndrome; one effort cubital tunnel syndrome; three paraesthesia in all fingers at the end of a race, without any objective signs. CONCLUSIONS: This appears to be the first report of upper extremity disorders in competition drivers. The use of a wrist pad to reduce the effects of vibration may help to prevent trauma to the wrist in formula 1 drivers.
<6>
Unique Identifier
11578281
Medline Identifier
21462443
Authors
Gerritsen AA. Uitdehaag BM. van Geldere D. Scholten RJ. de Vet HC. Bouter LM.
Institution
Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
Title
Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. [Review] [48 refs]
Source
British Journal of Surgery. 88(10):1285-95, 2001 Oct.
Abstract
BACKGROUND: Carpal tunnel syndrome (CTS) is a common disorder for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment. The object of this systematic review is to compare the efficacy of the various surgical techniques in relieving the symptoms of CTS and promoting return to work and/or activities of daily living. METHODS: Computer-aided searches of Medline, EMBASE and the Cochrane Controlled Trials Register were conducted, together with reference checking. A rating system, based on the number of studies and their methodological quality and findings, was used to determine the strength of the available evidence for the efficacy of the treatment. RESULTS: Fourteen studies were included in the review. None of the alternatives to standard open carpal tunnel release (OCTR) seems to offer better relief of symptoms. There is conflicting evidence about whether endoscopic carpal tunnel release results in earlier return to work and/or activities of daily living. CONCLUSION: Standard OCTR is still the preferred method of treatment for CTS. It is just as effective as the alternatives, but is technically less demanding, so incurs a lower risk of complications and of added costs. [References: 48]
<7>
Unique Identifier
8925362
Medline Identifier
96402634
Authors
Jackson DL. Hynninen BC. Caborn DN. McLean J.
Institution
Department of Sports Medicine, University of Kentucky, Lexington, USA.
Title
Electrodiagnostic study of carpal tunnel syndrome in wheelchair basketball players. [Review] [21 refs]
Source
Clinical Journal of Sport Medicine. 6(1):27-31, 1996 Jan.
Abstract
OBJECTIVE-DESIGN-SUBJECTS: Compression neuropathies are common injuries about the wrist in wheelchair athletes. Thirty-three world-class wheelchair basketball players were studied electrodiagnostically to determine the prevalence and severity of median neuropathy at the wrist in these athletes. RESULTS: Thirty percent of these athletes had symptoms consistent with carpal tunnel syndrome (CTS), and 70% of these had electrodiagnostic confirmation of this injury. Overall, 52% of the 33 athletes had electrodiagnostic findings of median neuropathy at the wrist with nine athletes (27%) exhibiting bilateral abnormalities. Four athletes (12%) had abnormal electrodiagnostic findings involving the ulnar nerve at the wrist. CONCLUSIONS: This prevalence of CTS in wheelchair basketball players appears to be similar to that found in the general paraplegic population. Early recognition and treatment of CTS in these athletes are recommended to avoid chronic problems. [References: 21]
<8>
Unique Identifier
9646750
Medline Identifier
98310718
Authors
Szabo RM.
Institution
School of Medicine, University of California at Davis, Sacramento 95817, USA.
Title
Carpal tunnel syndrome as a repetitive motion disorder. [Review] [59 refs]
Source
Clinical Orthopaedics & Related Research. (351):78-89, 1998 Jun.
Abstract
The incidence of repetitive motion disorders is increasing and in 1990 comprised 48% of all reported workplace illnesses (up from 18% in 1980). Carpal tunnel syndrome is the most prevalent disease classified as a repetitive motion disorder, thus making its prevention and management an occupational health and safety priority. The clinical picture of carpal tunnel syndrome, pain and paresthesias on the palmar radial aspect of the hand, often worse at night, and/or exacerbated by repetitive, forceful use of the hand, is recognized readily. Carpal tunnel syndrome is a condition of middle aged people and most middle aged people work. It follows that more often than not carpal tunnel syndrome occurs in a work-place setting, and the extent to which the work contributes to the condition is of great interest regarding prevention and treatment. Some studies find little evidence supporting the concept of carpal tunnel syndrome as caused by work, whereas others propose that more than half of cases of carpal tunnel syndrome in workers may be attributed to workplace factors. It is explored whether the incidence, prevalence, and significance of carpal tunnel syndrome as a repetitive motion disorder is known. [References: 59]
<9>
Unique Identifier
9456012
Medline Identifier
98115547
Authors
Cantatore FP. Dell'Accio F. Lapadula G.
Institution
Dipartimento di Medicina Interna e del Lavoro, Sezione di Reumatologia, Universita di Bari, Italy.
Title
Carpal tunnel syndrome: a review. [Review] [151 refs]
Source
Clinical Rheumatology. 16(6):596-603, 1997 Nov.
<10>
Unique Identifier
11034724
Medline Identifier
21061755
Authors
Marshall S. Tardif G. Ashworth N.
Institution
Medicine, University of Ottawa, 505 Smyth Road, Ottawa, Ontario, Canada, K1H 8M2.
Title
Local corticosteroid injection for carpal tunnel syndrome. [Review] [28 refs]
Source
Cochrane Database System Review. (4):CD001554, 2000.
Abstract
BACKGROUND: Carpal tunnel syndrome (CTS) is a clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the level of the carpal tunnel in the wrist. Treatment of CTS can be surgical or non-surgical. Local corticosteroid injection for CTS has been previously studied but most studies have been either retrospective or uncontrolled. The effectiveness and duration of benefit of local corticosteroid injection for CTS remain unknown. OBJECTIVES: To evaluate the effectiveness of local steroid injection for carpal tunnel syndrome versus placebo injection or other non-surgical interventions in improving clinical outcome and to determine the length of symptom relief post injection. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group register, MEDLINE, EMBASE and CINAHL. SELECTION CRITERIA: Studies using either a randomized or quasi-randomized methodology were eligible for inclusion. The studies included participants with the diagnosis of carpal tunnel syndrome and the treatment intervention was local corticosteroid injection. The primary outcome measure was clinical improvement after injection. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the study. Studies were rated for their overall quality independently by the reviewers. Studies were compared for heterogeneity using the chi square statistic. Relative risks and 95% confidence intervals were calculated for each trial and summary relative risks and 95% confidence intervals (CI) were also calculated. MAIN RESULTS: We identified four randomized controlled trials studying local corticosteroid injection for the treatment of CTS. Two trials were excluded. One did not include clinical assessment as an outcome and the other did not provide patient outcomes, but only statistical values. Each of the remaining two trials had demonstrated clinical improvement of CTS at one month following local corticosteroid injection compared to placebo injection. The pooled relative risk (RR) favouring treatment was 3.62 (95% CI 1.94 to 6.73). REVIEWER'S CONCLUSIONS: Local corticosteroid injection for CTS provides greater clinical improvement in symptoms one month after injection compared to placebo. Symptom relief beyond one month compared to placebo has not been demonstrated. The effectiveness of local corticosteroid injection has not been compared to other non-surgical or surgical interventions for CTS in randomized controlled trials. [References: 28]
<11>
Unique Identifier
11305571
Medline Identifier
21200163
Authors
Sarria L. Cabada T. Cozcolluela R. Martinez-Berganza T. Garcia S.
Institution
Department of Radiology, Hospital Reina Sofia, Tudela, Spain.
Title
Carpal tunnel syndrome: usefulness of sonography. [Review] [21 refs]
Source
European Radiology. 10(12):1920-5, 2000.
Abstract
The aim of this study was to evaluate sonographic signs described for carpal tunnel syndrome (CTS). Sixty-four wrists from 40 patients with CTS confirmed by electromyography, and 42 wrists from 24 healthy individuals, were examined using sonography. Cross-sectional area, flattening ratio in proximal, middle and distal segments of the carpal median nerve and bowing of the flexor retinaculum were measured. The accuracies of the sonographic diagnostic criteria for CTS were assessed using receiver-operating-characteristic (ROC) analytical techniques. A significant swelling of the median nerve was observed at the proximal (p < 0.001), middle (p < 0.0001) and distal (p< 0.0001) segments and a significant bowing of the flexor retinaculum in CTS patients with respect to healthy subjects. No significant differences were found in the mean value of flattening ratio between the groups. The sensitivity, specificity, positive predictive value, and the negative predictive value were 73.4, 57.1, 72.3 and 58.5%, respectively, in the proximal and middle segments; 75, 57.1, 72.7 and 60% in the distal segment for areas greater than 11 mm2: and 81.3, 64.3, 77.6 and 69.2% for the bowing of the flexor retinaculum greater than 2.5 mm. All sonographic criteria were found in 34 CTS patients (53.1%) and none in 3 patients. Sonography may be useful in the diagnosis of CTS. The most reliable sign was increased bowing of the flexor retinaculum and cross-sectional area of median nerve with specificity close to 60%. [References: 21]
<12>
Unique Identifier
8724577
Medline Identifier
96321224
Authors
Jacobson MD. Plancher KD. Kleinman WB.
Institution
Department of Orthopaedics, Montefiore Medical Center, Bronx, New York, USA.
Title
Vitamin B6 (pyridoxine) therapy for carpal tunnel syndrome. [Review] [38 refs]
Source
Hand Clinics. 12(2):253-7, 1996 May.
Abstract
The literature at this time does not give convincing evidence for use of pyridoxine as the sole treatment when confronted with a patient with idiopathic CTS. It may be of value as an adjunct in conservative therapy through altered perception of pain and increased pain threshold. For patients not responsive to conservative therapy, surgical decompression of the carpal canal is the treatment of choice. [References: 38]
<13>
Unique Identifier
8724583
Medline Identifier
96321230
Authors
Cobb TK. Amadio PC.
Institution
Department of Orthopedic Surgery, Mayo Medical School, Rochester, Minnesota, USA.
Title
Reoperation for carpal tunnel syndrome. [Review] [64 refs]
Source
Hand Clinics. 12(2):313-23, 1996 May.
Abstract
Although primary carpal tunnel release is usually successful, reoperation is needed in up to 3% of patients. Common indications of reoperation are previous incomplete surgery and postoperative fibrosis. Although most patients improve after reoperation, persistent systems are likely and failure is more frequent than after primary carpal tunnel surgery. Risk factors for failure following reoperation include the presence of an active Worker's Compensation claim, pain in the ulnar nerve distribution, and the absence of abnormality on preoperative EMG. [References: 64]
<14>
Unique Identifier
8953285
Medline Identifier
97111483
Authors
von Schroeder HP. Botte MJ.
Institution
Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada.
Title
Carpal tunnel syndrome. [Review] [78 refs]
Source
Hand Clinics. 12(4):643-55, 1996 Nov.
Abstract
CTS is a common upper extremity problem that has an increasing incidence and poorly understood causes. Radiographs and electrodiagnostic tests are helpful, but the diagnosis remains based on clinical symptoms and signs. The several sites of median nerve compression must be considered. Splinting and steroid injections are often effective. Carpal tunnel release is indicated in refractory or acute problems, and both open and endoscopic methods remain popular. Each has specific advantages. [References: 78]
<15>
Unique Identifier
8724576
Medline Identifier
96321223
Authors
Kerwin G. Williams CS. Seiler JG 3rd.
Institution
Department of General Surgery, Emory University, Atlanta Georgia, USA.
Title
The pathophysiology of carpal tunnel syndrome. [Review] [55 refs]
Source
Hand Clinics. 12(2):243-51, 1996 May.
Abstract
Carpal tunnel syndrome (CTS) is the most frequently encountered peripheral compressive neuropathy. Although the clinical diagnosis and treatment of CTS have been well defined, the pathophysiologic basis still is not understood completely. This article summarizes current thought and research pertinent to the pathophysiology of CTS. [References: 55]
<16>
Unique Identifier
9742421
Medline Identifier
98414829
Authors
Szabo RM.
Institution
Department of Orthopaedic Surgery, University of California at Davis, School of Medicine, Sacramento, USA.
Title
Acute carpal tunnel syndrome. [Review] [57 refs]
Source
Hand Clinics. 14(3):419-29, ix, 1998 Aug.
Abstract
Although the carpal tunnel is open at both ends, it has the physiologic properties of a closed compartment bounded by synovium proximally and distally. When the intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. Acute carpal tunnel syndrome is recognized frequently as occurring secondary to wrist trauma and infrequently due to a variety of infectious, rheumatologic, and hematologic disorders. This condition warrants prompt recognition and the treatment is early carpal tunnel release. [References: 57]