scholarly journals Digital Ulcers as Presentation of Carpal Tunnel Syndrome

2020 ◽  
Vol 77 (4) ◽  
pp. 353-356
Author(s):  
T. F. Gomes ◽  
K Kieselova ◽  
F. Santiago ◽  
A. Daniel ◽  
M. Henrique
Keyword(s):  
Systemic Sclerosis ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Assessment ◽  
Gold Standard ◽  
Digital Ulcers ◽  
Tunnel Syndrome ◽  
Sensory Changes ◽  
Hand Radiography

Ulcerating and mutilating variant of carpal tunnel syndrome occurs in longstanding cases of untreated disease. Pa- tients present with painless ulcers of the second and third fingers, accompanied with other cutaneous and sensory changes. These patients are often misdiagnosed as having a Raynaud disease or systemic sclerosis. Clinical assessment is the gold standard for the diagnosis of carpal tunnel syndrome, but hand radiography and electromyography help supporting the diagnosis. The authors present two cases of this ulcerating variant of carpal tunnel syndrome.

scholarly journals Intra-Carpal Injection of Ozone versus Methylprednisolone in Carpal Tunnel Syndrome of Systemic Sclerosis Patients: A Randomized Single-Blind Clinical Trial

2021 ◽  
pp. E453-E458
Keyword(s):  
Systemic Sclerosis ◽  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Favourable Outcome ◽  
University Hospital ◽  
Electrophysiologic Study ◽  
Tunnel Syndrome

BACKGROUND: Carpal tunnel syndrome (CTS) is the most entrapment syndrome in general and is the most frequent peripheral nervous system involvement in systemic sclerosis (SSc). Local injection of steroid hydrodissection or ozone-oxygen showed favourable outcome in CTS in general. OBJECTIVES: To compare the clinical efficacy of ozone versus methylprednisolone intracarpal injection upon pain, functional status, and nerve conduction in patients with CTS due to SSc. STUDY DESIGN: A randomized single-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Fifty CTS patients with > 3 months duration of SSc were equally randomized into either group O (injection of ozone/oxygen 25 mu-g/mL in 20 mL) or group M (methylprednisolone acetate 40mg, and 40 mg lidocaine in 20 mL). Visual analog scale (VAS) was measured pre-injection, then re-evaluated post-injection at 4 time points (1 week, 1 month, 3 months , and 6 months); Cochin Hand Function Scale (CHFS); and a median nerve electrophysiologic study was done before injection, then by the end of 3 months and 6 months. RESULTS: VAS was significantly lower in group M after 1 week (P = 0.01). Group O showed significantly lower VAS after 3 and 6 month (P < 0.001). Additionally, there was a significant decrease in the VAS during the whole study period within each group, in comparison to its baseline value. CHFS was significantly lower in the ozone group after 6 months (P < 0.001). The sixth month’s sensory conduction was significantly higher in group O (P = 0.002). The motor distal latency was significantly lower in the ozone group after 3 and 6 months (P < 0.001). LIMITATIONS: Follow-up period could be furtherly extended. CONCLUSION: Both intracarpal ozone or methylprednisolone afford favorable effects upon CTS in patients with SSc. However, ozone alleviates pain much more, enhances the hand functional status, and improves median nerve conduction in study with over six months duration. KEY WORDS: Carpal Tunnel Syndrome, systemic sclerosis, methylprednisolone, ozone

scholarly journals A study to further develop and refine carpal tunnel syndrome (CTS) nerve conduction grading tool

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Salim Hirani
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Sensory Response ◽  
Grading System ◽  
Grading Systems ◽  
Sensory Motor ◽  
Tunnel Syndrome ◽  
Sensory Changes ◽  
Sensory Responses

Abstract Background 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. Method 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. Result 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. Conclusion 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.

Progressive systemic sclerosis coexistent with carpal tunnel syndrome.

1988 ◽  
Vol 50 (4) ◽  
pp. 645-649
Author(s):  
Yukari HIROTANI ◽  
Jiro ARATA ◽  
Yasuhiko FUJITA ◽  
Tatsuhiko YAMAGUCHI
Keyword(s):  
Systemic Sclerosis ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Progressive Systemic Sclerosis ◽  
Tunnel Syndrome

A Clinical Questionnaire for the Diagnosis of Carpal Tunnel Syndrome

2003 ◽  
Vol 28 (5) ◽  
pp. 455-459 ◽  
Author(s):  
V. KAMATH ◽  
J. STOTHARD
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Gold Standard ◽  
Symptom Relief ◽  
Nerve Conduction Studies ◽  
Initial Assessment ◽  
Hand Surgeon ◽  
Tunnel Syndrome ◽  
Electrophysiological Examination

This prospective study compared the sensitivities of a scored questionnaire and electrophysiological examination in the diagnosis of carpal tunnel syndrome. Patients were assessed by a hand surgeon using a scored questionnaire, and then underwent an electrophysiological assessment by an experienced neurophysiologist (blinded to the questionnaire results). Patients diagnosed as having carpal tunnel syndrome by either the questionnaire, the electrophysiological examination or both underwent decompression. Symptom relief was taken as the “gold standard” for true carpal tunnel syndrome. The results showed a sensitivity of 85% for the scored questionnaire and 92% for nerve conduction studies with a positive predictive value of 90% for the scored questionnaire and 92% for nerve conduction studies. The authors recommend that a scored questionnaire can replace nerve conduction studies in the initial assessment of whether patients presenting with dysaesthesiae in the fingers should undergo surgery. This will give major time, personnel and cost benefits.

scholarly journals Digital ulcers as the first manifestation of carpal tunnel syndrome

2009 ◽  
Vol 31 (5) ◽  
pp. 685-686 ◽  
Author(s):  
Katja Perdan-Pirkmajer ◽  
Sonja Praprotnik ◽  
Matija Tomšič
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Digital Ulcers ◽  
Tunnel Syndrome

scholarly journals The Diagnosis of Carpal Tunnel Syndrome

1997 ◽  
Vol 22 (1) ◽  
pp. 34-37 ◽  
Author(s):  
L.-G. GUNNARSSON ◽  
A. AMILON ◽  
P. HELLSTRAND ◽  
P. LEISSNER ◽  
L. PHILIPSON
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Gold Standard ◽  
Nerve Conduction Velocity ◽  
Sensory Nerve ◽  
Study Group ◽  
Atypical Symptoms ◽  
History Of ◽  
Tunnel Syndrome ◽  
History Of Pain

The study group consisted of 100 persons referred with suspected carpal tunnel syndrome. Clinical and neurophysiological examinations were performed blinded from each other. The gold standard for the carpal tunnel syndrome (CTS) diagnosis was based on the results of these examinations but relief of CTS symptoms after surgery was also required. The sensitivity and specificity for the combined results of the clinical examinations were 94% and 80% respectively, and for the neurophysiological examinations, 85% and 87%. Of the neurophysiological methods used, the quotient of sensory nerve conduction velocity between palm to wrist and wrist to elbow was best and the cut-off for this test was studied by means of an ROC-curve. According to our results clinical examination by an experienced doctor seems to be sufficient if there are typical symptoms of carpal tunnel syndrome, but if there is a history of pain, atypical symptoms or earlier fractures in the arm, wrist or hand, it is important to add a neurophysiological examination.

scholarly journals Ulcer-mutilating variety of Carpal Tunnel Syndrome

2021 ◽  
pp. 37-39
Author(s):  
Carmen M. Baied ◽  
Stella M. Fernández García ◽  
Fabio Karlen ◽  
Ernesto Gutfraind
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Skin Lesions ◽  
Entrapment Neuropathy ◽  
Digital Ulcers ◽  
Tunnel Syndrome

Carpal tunnel syndrome is the most common entrapment neuropathy, affecting 1 to 3% of the population. Even the fact that is very frequent, digital ulcers and skin lesions are unusually related to this neuropathy. We present the case of a patient with digital ulcers secondary to carpal tunnel síndrome.

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