The genetic contribution to carpal tunnel syndrome in women: a twin study. (49/549)

OBJECTIVE: To assess the relative genetic and environmental contribution to carpal tunnel syndrome (CTS) using a classic twin study of monozygotic (MZ) and dizygotic (DZ) twins. METHODS: The study group comprised unselected female twin pairs, between 20 and 80 years of age, from the St Thomas' UK Adult Twin Registry. Individuals completed a questionnaire that included details on potential risk factors for CTS. The diagnosis of CTS was made using a standardized hand pain diagram and validated criteria. The genetic contribution to CTS was assessed using variance component and regression methods, the heritability was adjusted for environmental confounders. The role of individual risk factors was assessed by a nested case-control study. RESULTS: An overall prevalence of 14.2% for CTS was found in a population of 4,488 females, comprising 867 MZ and 970 DZ twin pairs, and 814 singletons. The concordance for CTS was significantly higher in MZ compared with DZ twins (case-wise concordance values of 0.35 and 0.24 respectively, with a significantly increased MZ:DZ ratio of 1.48; P = 0.03). Modeling produced a heritability estimate of 0.46 (95% CI 0.34-0.58) that was essentially unchanged after adjustment for environmental risk factors including age, body mass index, physical activities, and hormonal/reproductive factors. No major influence of any individual risk factor was seen in the case-control analysis of 520 cases and 3,154 controls, apart from a modest association with menopausal status with an increased risk of 1.53 and 1.43 in the peri and postmenopausal groups. There was no overall effect of age or body mass index. CONCLUSION: This is the first study to explore the genetic component of CTS. Our data show that up to half of the liability to CTS in women is genetically determined, and this appears to be the single strongest risk factor, with only minor contributions from known environmental factors. Further studies should focus on genetic mechanisms that may lead to tests for susceptibility and detection of those at risk of developing CTS.  (+info)

Discriminatory sonographic criteria for the diagnosis of carpal tunnel syndrome. (50/549)

OBJECTIVE: Sonographic examination of the median nerve has been suggested as a useful alternative to electrophysiologic study in the diagnosis of carpal tunnel syndrome. To determine its usefulness and the best diagnostic criterion, sonograms of patients with the disease were compared with sonograms of healthy subjects in a case-control study. METHODS: Patients with carpal tunnel syndrome and asymptomatic controls who were matched for age and sex were enrolled and underwent sonography of the wrists. Eight separate sonographic criteria were analyzed in each wrist. Data from the patient group and the control group were compared to establish optimal diagnostic criteria for carpal tunnel syndrome, using receiver operating characteristic analytic techniques. RESULTS: Thirty-five patients with carpal tunnel syndrome and 35 asymptomatic controls were examined. Increased cross-sectional area of the median nerve was found to be the most predictive measure of carpal tunnel syndrome, proximal to the tunnel inlet, at the tunnel inlet, and at the tunnel outlet, with significant differences between patients and controls. Using a receiver operating characteristic curve, a cut-off value >0.098 cm(2) at the tunnel inlet provided a diagnostic sensitivity of 89% and a specificity of 83%. CONCLUSION: Sonographic measurement of the median nerve cross-sectional area is both sensitive and specific for the diagnosis of carpal tunnel syndrome.  (+info)

A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome. (51/549)

Carpal tunnel syndrome (CTS) comprises a complex of symptoms in the hand, including pain and paresthesia and weakness of hand muscles thought to result from compression of the median nerve. Many clinicians either refer patients for electrodiagnostic studies to aid diagnosis or conduct electrodiagnostic studies, which may be useful as an aid to decisions on treatment. The aim of this systematic review is to evaluate the evidence base for the use of electrodiagnostic tests in the diagnosis and management of carpal tunnel syndrome. A systematic search was undertaken for studies that included patients with clinical diagnosis of CT5 who were undergoing electrodiagnostic tests and surgery together with reported outcomes of surgery. A published systematic review found that electrodiagnosis was not a useful diagnostic test in patients with clinical signs of CTS. Seven primary studies of prognosis reporting electrodiagnosis and surgery outcomes were found, however, one of them was subsequently retracted. The remaining six were retrospective case senes of poor quality. Four of these studies reported outcomes of surgery in patients with clinically identified CTS, comparing both positive or negative electrodiagnostic results. No study found any statistical difference in surgical outcome between those who were electrodiagnostic test positive and those who were negative. Despite the limited quality of the evidence, in cases of clear-cut clinical CTS, electrodiagnosis is not warranted either as a diagnostic test, where clinical symptoms are well defined, or as a predictive indicator of surgical outcome. It may still be useful in cases where the clinical diagnosis is not clear.  (+info)

A descriptive study of women injured by hand-arm vibration. (52/549)

The aim of this study was to describe the symptoms and the prognosis of vibration injuries in women. The investigation was based on a study of 374 women who had reported an injury due to hand-arm vibration to the Social Insurance Office or had received financial compensation from the Swedish Labor Market Insurance scheme during 1988-1997. Information on, for example, self-rated health symptoms and vibration exposure was collected by means of a questionnaire. On average, the first symptoms started after 7 yr of exposure and the first visit to a doctor took place after 11 yr. Neurological symptoms developed after a shorter period of exposure compared to vascular symptoms, 6.8 and 9.2 yr, respectively. The prevalence of numbness at the time of reporting the injury was 91% and the prevalence of white fingers was reported by 54%. The occupational group with the highest prevalence of vibration injuries was dental technicians. Two thirds of the women had stopped using vibrating machines in their work. Among the women who suffered from white fingers when they reported the injury, 50% declared impairment or no improvement of the symptoms. One woman in five was retired and the same number of women had retrained due to the occupational injury.  (+info)

The influence of age on outcome after operation for the carpal tunnel syndrome. A prospective study. (53/549)

Decompression of the carpal tunnel is a common surgical procedure. Although the incidence of the carpal tunnel syndrome increases with age, there is no clear information available on the outcome of surgery in relation to age. We studied prospectively 87 consecutive patients who underwent decompression, using a validated self-administered questionnaire, and found that improvement in symptoms and function decreased with increasing age. This was most marked in patients over the age of sixty years.  (+info)

Physical therapy intervention following surgical treatment of carpal tunnel syndrome in an individual with a history of postmastectomy lymphedema. (54/549)

BACKGROUND AND PURPOSE: This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. CASE DESCRIPTION: The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. OUTCOMES: Following surgical release, the patient's numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. DISCUSSION: This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.  (+info)

Carpal tunnel pressure in patients with carpal tunnel syndrome due to long-term hemodialysis. (55/549)

We studied carpal tunnel pressure and outcome of endoscopic carpal tunnel release in 42 patients (53 hands) with carpal tunnel syndrome (CTS) and receiving long-term hemodialysis. We compared these results with those of 41 patients (49 hands) with idiopathic CTS. Pressure was measured peroperatively: first, before dilation of the carpal tunnel; second, after dilation but before release of the transverse carpal ligament; and third, after completion of the release. In patients receiving long-term hemodialysis, the highest pressures were 76.9, 56.0, and 7.8 mmHg respectively. In patients with idiopathic CTS, pressures were 68.8, 44.1, and 4.0 mmHg respectively. The clinical outcome was inferior in patients receiving long-term hemodialysis.  (+info)

Power spectrum analysis of compound muscle action potential in carpal tunnel syndrome patients. (56/549)

The objective of using wave-form analysis to assess compound muscle action potential (CMAP) in entrapment neuropathy had not been fully developed. We applied the power spectrum analysis to patients with carpal tunnel syndrome (CTS) for this purpose. 24 patients with CTS were divided into three stages according to Mackinnon s classification, and 50 normal volunteers were examined. CMAP was obtained from the abductor pollicis brevis with supramaximal stimulation to median nerve. Mean and peak frequencies were measured by power spectrum analysis. The distal latencies of CMAP and the sensory nerve conduction velocities showed some prolongation in CTS patients. Integral values of CMAP were also decreased in CTS patients. Mean and peak frequencies of power spectrum of CMAP in volunteers were 134 Hz and 98 Hz, respectively. These values shifted into lower frequencies in CTS patients, namely 102 Hz and 61 Hz. Regardless of clinical stage, distal latency of CTS patients correlated with mean frequency.  (+info)