Wrist surgery is a common method for treating carpal tunnel syndrome (CTS) although few studies have examined patient outcomes or predictive correlates of such procedures. The objectives of this study were to characterize Utah workers who received surgery for CTS in terms of relevant presurgical and outcome variables and to identify presurgical correlates of patient outcomes. Participants were 75 Utah workers' compensation patients who underwent surgery for CTS from 1999-2002 and were at least 6 months postsurgery at time of follow-up. A retrospective cohort design was utilized consisting of a review of presurgical medical records and a postsurgical telephone survey. Presurgical variables included: gender, age, history of depression, and litigation status. Correlational analyses revealed that age and lawyer involvement were consistent significant predictors of poorer outcomes. The importance of conceptualizing CTS surgery patient outcomes from a biopsychosocial perspective is discussed.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Orientador: Luiz Antonio de Lima Resende / Banca: Renato Mazzonetto / Banca: Paulo André Teixeira Kimaid / Resumo: Este trabalho estudou pacientes com síndrome do túnel do carpo, submetidos a estudos de condução nervosa em diferentes equipamentos: Nihon-Kohden e Nicolet Viking Select (Grupo I), Neuromax 1000 e Nicolet compass meridien (Grupo II). Para os estudos de condução nervosa sensitiva, não foram observadas diferenças estatisticamente significativas entre os equipamentos. Para os estudos de condução nervosa motora, foram observadas latências motoras mais prolongadas nos aparelhos Nicolet que nos equipamentos Nihon-Kohden e Neuromax. As diferenças entre os equipamentos foram mais pronunciadas para os casos menos graves. / Abstract: This work analysed motor and sensory conduction studies in patients with carpal tunnel syndrome. Different equipments were employed: Nihon- Kohden and Nicolet Viking Select (Group I), Neuromax 1000 and Nicolet compass meridien (Group II). For sensory conduction studies no significant statistic differences were found; for motor conduction studies enlargements of the distal motor latencies were observed for Nicolet equipments in relation to the Nihon-Kohden and Neuromax. The differences were more marked for the slight cases. / Mestre

Performance-related musculoskeletal disorders in musicians are common due to the biomechanics required in their craft. Unfortunately, injuries can cause many to abandon music, so determining the best approach to treatment and prevention is key. This case study’s importance is to evaluate the optimal approach to carpal tunnel syndrome in a drummer. The patient is a 55-year-old male full-time drummer with a history of diabetes mellitus and osteoarthritis, who presented to clinic with chronic bilateral hand numbness and tingling that had been present for years. The location of the symptoms were mainly in the palmar aspect of the 1st digit, 2nd digit, 3rd digit, and the radial side of the 4th digit. The symptoms had progressively been worsening, and his discomfort was initially rated at a 10/10 bilaterally. He had tried over-the-counter and prescription anti-inflammatory medications as well as braces without improvement. His physical exam was positive for Tinel’s sign. The diagnosis of carpal tunnel syndrome was eventually made. The patient was treated with bilateral ultrasound-guided carpal tunnel injections with lidocaine and methylprednisolone. The other component of treatment was relative rest, which allowed us to tailor treatment to his drumming. After treatment, his discomfort was rated at 0/10 bilaterally, and he was drumming without issue. It was found that relative rest and carpal tunnel injections are effective in treating carpal tunnel syndrome in drummers. His treatment was tailored to his specific instrument type, which was a key component to the success. Upon review, there is limited to no specific information on treating drummers as a specific group in the literature, but rather more information on treating musicians as a whole. Different instrumentalists have different postures and repetitive movements, so future studies would do well to examine the individual biomechanics of the different instrumentalists to better tailor treatment and prevention.

The purpose of this thesis was to understand the implications of ultrasound in the assessment of flexor tendon shear to establish its role in carpal tunnel syndrome. An in vitro and in vivo approach was used to examine ultrasound “shear” between the tendon and adjacent tenosynovium. Ultrasound shear is defined by the relative displacement between the tendon and tenosynovium, and has been considered a surrogate measure of tendon shear. However, the mechanical implications of relative displacement are not well understood. In Chapters 2 and 3, an in vitro approach was used to compare ultrasound to direct measurements of tendon displacement and tendon shear. Chapter 2 demonstrated the validity of colour Doppler ultrasonography in the evaluation of tendon displacement. Chapter 3 assessed the relationship between ultrasound shear and mechanical tendon shear using frictional work. We dispelled the notion that ultrasound shear represents tendon shear by showing it only captures the viscoelastic stretch of the tenosynovium in tendon shear; missing surface friction from neighbouring anatomical structures in the carpal tunnel. However, measuring viscoelastic resistance in tendon motion is important for the development of pathological fibrosis and thickening of the tenosynovium, a characteristic finding in carpal tunnel syndrome. In Chapter 4 we further established the clinical utility of ultrasound in vivo by showing ultrasound shear discriminated carpal tunnel syndrome symptomatic individuals from the healthy population. Ultrasound measures progressed with symptoms suggesting an etiological progression of fibrosis and thickening with carpal tunnel syndrome. This thesis concluded that ultrasound only partially represents tendon shear with the viscoelastic component, but underscored the clinical implications. Ultrasound provides a non-invasive assessment of viscoelastic resistance that will be highly valuable for our understanding of the role of wrist and hand motion in the etiology of injury with potential applications in the diagnosis of carpal tunnel syndrome. / Thesis / Master of Science in Kinesiology

Thesis (M.Sc.)--Memorial University of Newfoundland, 2005. / Restricted until May 2006. Bibliography: leaves 67-74.

<p>A model to predict carpal tunnel syndrome (CTS) risk would improve ergonomic assessments and help reduce the incidence of occupational CTS and its associated costs. Research spanning over sixty years has shown that deviated wrist, forearm, and hand posture has on the hydrostatic pressure within the carpal tunnel (also known as carpal tunnel pressure, CTP). Elevated CTP is a mechanism of the development, or aggravation of CTS symptoms. The purpose of this thesis was to develop a model to predict CTS risk, based on CTP, and incorporate the model into an ergonomic tool for use by ergonomists. An extensive literature review identified additional studies that investigated the effects of pronation/supination, finger posture, and fingertip loading on CTP. The effect of wrist, forearm, and hand posture was then incorporated into the model via a series of regression equations developed for each plane of movement. The effect of fingertip loading (independent to the posture effects) was included using a multiplier based on the hand posture and load magnitude. To provide a user-friendly tool for ergonomists, a graphical-user-interface was developed to predict CTS risk based on the developed model. Input variables were wrist, hand, and forearm posture, and fingertip loading. CTP program estimated CTP, and compared the predicted pressure to a known threshold beyond which median nerve function has been shown to degrade. The tool was then evaluated by comparing the output of the tool (CTS risk) to the incidence of CTS in a large automotive manufacturing environment. There was no significant difference between the two groups (workers completing jobs with an incidence of CTS and workers completing jobs with no incidence of CTS). The tool marks an important first step v towards providing ergonomists with a much-needed tool to predict CTS risk based on posture, frequency, and fingertip force.</p> / Master of Science (MSc)

No description available.

Research suggests that, in individuals with carpal tunnel syndrome (CTS), low plasma pyridoxal 5'-phosphate (PLP) concentrations are related to an increased incidence and severity of symptoms associated with CTS. This study was designed to determine the relationship between plasma and red blood cell PLP concentrations and the severity and incidence of CTS symptoms. Thirty people with CTS were selected for a 9 month exercise study. Subjects were divided into either vitamin users or non-vitamin users based on supplement use data gathered at the beginning of the study. Blood was drawn at 1, 6 and 9 months. CTS symptoms questionnaires and health questionnaires were also administered at these intervals. The symptoms questionnaires were used to gather data on the frequency and nature of hand and wrist symptoms. Health questionnaires focused on vitamin supplement usage including frequency, amount and length of use. Mean plasma PLP, total plasma vitamin B6 and erythrocyte PLP concentrations were significantly higher in the sixteen vitamin users when compared to the fourteen non-vitamin users (p<0.001). While there was variation in plasma PLP and total plasma vitamin B6 over time, within each group, there were no significant changes in any of the status measures over the nine month period. Mean erythrocyte PLP concentration, in particular, was stable over time. In vitamin users, the intensity of pain, numbness and tingling was significantly higher when compared to non-vitamin users. In both groups, plasma PLP was negatively correlated with pain. This correlation reached statistical significance in vitamin users at month one and nine (p<0.01), but not at month six; a statistically significant correlation between these two variables was not found in non-vitamin users at any time point. Pain was also negatively and significantly correlated with plasma total vitamin B6 and erythrocyte PLP in vitamin users. No other symptoms were significantly correlated with the status measures. These results indicate that a higher vitamin B6 status may be related to a decrease in the severity of pain experienced by some individuals with CTS. / Graduation date: 1998

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Technikon Natal, 2002. / Carpal Tunnel Syndrome is defined as a median nerve entrapment beneath the flexor retinaculum in the carpal canal such that it produces symptoms in the hand, wrist and upper extremity. A review of related literature suggests that statistics on the incidence of Carpal Tunnel Syndrome in South Africa are unavailable. In the U. s. A, Carpal Tunnel Syndrome occurs in 1% of the population and is the most frequently diagnosed peripheral neuropathy. Several studies investigating the use of conservative care in managing Carpal Tunnel Syndrome have been performed, but none have compared the effect of wrist joint manipulation and ultrasound in the management of Carpal Tunnel Syndrome, The purpose of this study was to investigate the effectiveness of wrist joint manipulation compared to ultrasound in the management of Carpal Tunnel Syndrome. This randomized controlled clinical trial consisted of a study population offorty patients. The patients were randomly allocated to two groups of twenty each. One group received wrist joint manipulation while the other received ultrasound application to the palmar-radial aspect of the wrist. Both groups received four treatments over a two week period. Subjective measures included the Numerical Rating Scale-I 0 1 Questionnaire and the Carpal Tunnel Pain and Disability Form and objective measures consisted of the grip strength reading and goniometer readings for wrist flexion and extension. Both the subjective and objective measures were taken before the first and third visit and at the fifth follow- up consultation which took place during the following week. Inter-group analysis was done using the Mann- Whitney U test. Friedman's T test was used for intra-group analysis. ct was set at the 0.05 level of significance. The results were illustrated by means of tables and bar- charts. The results indicated that for intragroup analysis, a statistically significant difference existed for both groups, warranting the use of a multiple comparison procedure (Dunn' s procedure) to determine at which stage the treatment made a significant difference. For all the measures except the wrist extension reading in the ultrasound group, most improvement occurred between the first and fifth consultations. For inter-group analysis, no significant difference for any of the measures, except the wrist extension readings, was present between the two groups indicating that both wrist joint manipulation and ultrasound were equally effective in treating Carpal Tunnel Syndrome. The improvement in wrist extension, in the wrist joint manipulation group was significantly better than that in the ultrasound group. Although this study was limited by its single researcher design and could not clarify which treatment protocol was more effective, it supports the existing body of evidence in favour of both wrist joint manipulation and therapeutic ultrasound application in the management of Carpal Tunnel Syndrome / M