Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study.

Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.

Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach.

INTRODUCTION: In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject. METHODS: This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. RESULTS: This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64-2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45-1.94; P-value < 0.001). CONCLUSION: The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant.

Low-Income, Poor Physical Health, Poor Mental Health, and Other Social Risk Factors Are Associated With Decreased Access to Care in Patients With Carpal Tunnel Syndrome.

BACKGROUND: Carpal Tunnel Syndrome (CTS) is associated with a significant personal and societal burden. Evaluating access to care can identify barriers, limitations, and disparities in the delivery of healthcare services in this population. The purpose of this study was to evaluate access to overall healthcare and healthcare utilization among patients with CTS. METHODS: This is a retrospective cohort study conducted with the All of Us database. Patients diagnosed with CTS that completed the access to care survey were included and matched to a control group. The primary outcomes were access to care across 4 domains: (1) delayed care, (2) could not afford care, (3) skipped medications, and (4) over 1 year since seeing provider. Secondary analysis was then performed to identify patient-specific factors associated with reduced access to care. RESULTS: In total, 7649 patients with CTS were included and control matched to 7649 patients without CTS. In the CTS group, 33.7% (n = 2577) had delayed care, 30.4% (n = 2323) could not afford care, 15.4% (n = 1180) skipped medications, and 1.6% (n = 123) had not seen a provider in more than 1 year. Within the CTS cohort, low-income, worse physical health, and worse mental health were associated with poor access to care. CONCLUSION: Patients experience notable challenges with delayed care, affordability of care, and medication adherence regardless of having a diagnosis of CTS. Targeted interventions on modifiable risk factors such as low income, poor mental health, and poor physical health are important opportunities to improve access to care in this population.

Association between the digit ratio (2D:4D), handgrip strength, wrist ratio, and body fat distribution in women with different carpal tunnel syndrome severity.

BACKGROUND: To evaluate the relationship of the second to fourth digit ratio (2D:4D), a biomarker of prenatal sex hormone exposure, with wrist ratio (WR), wrist-palm ratio (WPR), body mass index (BMI), waist-hip ratio (WHR), and handgrip strength (HGS) in different carpal tunnel syndrome (CTS) severity. METHOD: This study involved 90 female participants (aged 18 to 83) with CTS. According to CTS severity, the participants were divided into four groups: normal, mild, moderate, and severe. All parameters of hand anthropometry and body fat distribution were measured, and the mean 2D:4D, WR, WPR, HGS, BMI, and WHR values were compared based on CTS severity. Data were collected with a visual analog scale (VAS) for pain and a Likert (LS) scale for numbness severity. RESULTS: The mean age, 2D:4D, WD, WW, WR, WPR, BMI, and HGS values showed a significant differences between CTS severity groups. We found that lower 2D:4D and higher WPR and BMI were associated with increased risk of CTS (AUC = 0.728) after removing the effect of age. Bilateral hands were affected in 38.9 % (70/180) of participants. Regression analysis showed that lower HGS can be used as independent variable for predicting the females having bilateral affected hands. The LS score was considerably higher in the severe and moderate groups. Also, the VAS score was significantly higher in the severe group. CONCLUSION: The findings of the study demonstrated an association between 2D:4D, WPR, and BMI among women, emphasizing the effect of intrauterine sex hormone exposure on late life CTS severity.

Is arthritis an associated risk factor for trigger finger occurrence after carpal tunnel release? A nationwide, population-based study in Korea.

PURPOSE: We hypothesized that increased friction between the flexor tendon and surrounding structures due to hand arthritis is an important risk factor for trigger finger (TF) after carpal tunnel release (CTR). Therefore, we compared TF development according to the presence or absence of arthritis in carpal tunnel syndrome (CTS) patients treated with CTR. METHODS: This retrospective study was based on data collected from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in the Republic of Korea between January 1, 2002, and December 31, 2015. Patients diagnosed with TF between one month and one year after the CTR date or with a history of surgery were included in the study. During subsequent follow-up, the patients were divided into subgroups of those (1) with TF and (2) without TF. Sex, age, arthritis, and TF-related comorbidities were compared between the subgroups. RESULTS: The subgroup with TF had a higher proportion of women (9.43% vs 90.57%), the highest age range between 50 and 59 years, more cases of arthritis (32.55% vs 16.79%), and a higher proportion of patients with hypothyroidism (10.85% vs 4.60%) than the group without TF. The association between arthritis and TF after CTR was examined using a multivariate logistic regression model, showing arthritis to be a significant risk factor for TF after CTR (odds ratio, 1.35; P = 0.049). CONCLUSIONS: We identified arthritis as an important risk factor for the development of TF after CTR.

Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System.

BACKGROUND: Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. METHODS: We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. RESULTS: A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. CONCLUSIONS: The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.

Hyperglycaemia is a causal risk factor for upper limb pathologies.

BACKGROUND: Diabetes (regardless of type) and obesity are associated with a range of musculoskeletal disorders. The causal mechanisms driving these associations are unknown for many upper limb pathologies. We used genetic techniques to test the causal link between glycemia, obesity and musculoskeletal conditions. METHODS: In the UK Biobank's unrelated European cohort (N = 379 708) we performed mendelian randomisation (MR) analyses to test for a causal effect of long-term high glycaemia and adiposity on four musculoskeletal pathologies: frozen shoulder, Dupuytren's disease, carpal tunnel syndrome and trigger finger. We also performed single-gene MR using rare variants in the GCK gene. RESULTS: Using MR, we found evidence that long-term high glycaemia has a causal role in the aetiology of upper limb conditions. A 10-mmol/mol increase in genetically predicted haemoglobin A1C (HbA1c) was associated with frozen shoulder: odds ratio (OR) = 1.50 [95% confidence interval (CI), 1.20-1.88], Dupuytren's disease: OR = 1.17 (95% CI, 1.01-1.35), trigger finger: OR = 1.30 (95% CI, 1.09-1.55) and carpal tunnel syndrome: OR = 1.20 (95% CI, 1.09-1.33). Carriers of GCK mutations have increased odds of frozen shoulder: OR = 7.16 (95% CI, 2.93-17.51) and carpal tunnel syndrome: OR = 2.86 (95% CI, 1.50-5.44) but not Dupuytren's disease or trigger finger. We found evidence that an increase in genetically predicted body mass index (BMI) of 5 kg/m2 was associated with carpal tunnel syndrome: OR = 1.13 (95% CI, 1.10-1.16) and associated negatively with Dupuytren's disease: OR = 0.94 (95% CI, 0.90-0.98), but no evidence of association with frozen shoulder or trigger finger. Trigger finger (OR 1.96 (95% CI, 1.42-2.69) P = 3.6e-05) and carpal tunnel syndrome [OR 1.63 (95% CI, 1.36-1.95) P = 8.5e-08] are associated with genetically predicted unfavourable adiposity increase of one standard deviation of body fat. CONCLUSIONS: Our study consistently demonstrates a causal role of long-term high glycaemia in the aetiology of upper limb musculoskeletal conditions. Clinicians treating diabetes patients should be aware of these complications in clinic, specifically those managing the care of GCK mutation carriers. Upper limb musculoskeletal conditions should be considered diabetes complications.

Physical and psychosocial work-related exposures and the incidence of carpal tunnel syndrome: A systematic review of prospective studies.

This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence.

Revision Carpal Tunnel Release Following Endoscopic Compared With Open Decompression.

Importance: Carpal tunnel release (CTR) technique may influence the likelihood of revision surgery. Prior studies of revision CTR following endoscopic CTR (ECTR) compared with open CTR (OCTR) have been limited by sample size and duration of follow-up. Objective: To estimate the incidence of revision CTR following ECTR compared with OCTR in a national cohort. Design, Setting, and Participants: This retrospective cohort study used data from the US Veterans Health Administration. Participants included all adults (age ≥18 years) undergoing at least 1 outpatient CTR from October 1, 1999, to May 20, 2021. Data were analyzed from May 21, 2021, to November 27, 2023. Exposure: Index CTR technique. Main Outcomes and Measures: The primary outcome was time to revision CTR, defined as repeat ipsilateral CTR during the study period. Secondary outcomes were indications for revision, findings during revision, and additional procedures performed during revision. Results: Among 134 851 wrists from 103 455 patients (92 510 [89.4%] male; median [IQR] age, 62 [53-70] years) undergoing at least 1 CTR, 1809 wrists underwent at least 1 revision at a median (IQR) of 2.5 (1.0-3.8) years. In competing-risks analysis, the cumulative incidence of revision was 1.06% (95% CI, 0.99%-1.12%) at 5 years and 1.59% (95% CI, 1.51%-1.67%) at 10 years. ECTR was associated with increased hazard of revision CTR compared with OCTR (adjusted hazard ratio [aHR], 1.56; 95% CI, 1.34-1.81; P < .001). The risk difference for revision CTR associated with ECTR compared with OCTR was 0.57% (95% CI, 0.31%-0.84%) at 5 years (number needed to harm, 176) and 0.72% (95% CI, 0.36%-1.07%) at 10 years (number needed to harm, 139). Regardless of index CTR technique, the most common indication for revision was symptom recurrence (1062 wrists [58.7%]). A reconstituted transverse carpal ligament (TCL) was more common after ECTR compared with OCTR, whereas scarring of the overlying tissues and of the median nerve itself were more common following OCTR. Incomplete transverse-carpal-ligament release was observed in 251 of the wrists undergoing revision CTR (13.94%) and was more common among revisions following ECTR (odds ratio, 1.62; 95% CI, 1.11-2.37; P = .01). Conclusions and Relevance: In this cohort study of revision CTR in the Veterans Health Administration, ECTR was associated with increased risk of revision compared with OCTR, but the absolute risk was low regardless of technique. Intraoperative findings at revision varied significantly according to index CTR technique.

Incidence of infection in carpal tunnel surgery with and without the use of local antibiotics.

Objectives: To compare the infection rate in patients who underwent carpal tunnel surgery with and without instilling local antibiotics into the surgical wound. METHODS: The retrospective cohort study was conducted at the Department of Surgery, Unit of Neurosurgery, Government Naseer Ullah Babar Memorial Hospital, Peshawar, Pakistan, and comprised data from July 2019 to July 2021 related to non-diabetic patients without any comorbidity who had undergone fresh carpal tunnel surgery. The cases had been operated by two surgeons having a different approach to preventing infection in carpal tunnel surgery cases. The surgeon in group A did not use any local antibiotics after completing the surgery, while the surgeon in group B instilled local gentamicin in the open wound for 3 minutes after completing the nerve release. All patients were put on oral antibiotics for a period of 5 days after the procedure in both the cohorts, and were assessed fortnightly for any infection and removal of stitches. Demographics of the patients, use of antibiotics and the occurrence of infection were recorded on a proforma. Data was analysed using SPSS 20. RESULTS: Of the 177 patients operated during the period, 13(7.3%) were discarded owing to missing data. Of the 164(92.7%) patients analysed, 138(84.14%) were females and 26(15.85%) were males. The overall mean age was 32.46±8.97 years. The total surgeries conducted were 176; 96(54.54%) in group A and 80(45.45%) in group B. Infections were found in 3(1.7%) patients; all in group A (p=0.160). CONCLUSIONS: Although not statistically significant, instillation of local antibiotics may play a role in preventing surgical site infections in carpal tunnel surgery cases.

Hand and wrist complaints in dialysis nurses in Germany: a survey of prevalence, severity, and occupational associations.

BACKGROUND AND OBJECTIVE: Occupations involving repetitive movements of the wrists, activities that require a lot of force, and hand-arm swinging are particularly likely to contribute to the development of hand and wrist complaints. The daily setup and dismantling of dialysis machines as part of the dialysis treatment process can strain the wrists and fingers of nurses. However, evidence regarding the relationship between the work activities of dialysis nurses and the incidence of hand and wrist complaints is limited. This study aimed to investigate the prevalence and severity of hand and wrist complaints among dialysis nurses in Germany and to relate these to their work activities. METHODS: An online survey was created and sent to 836 dialysis centres in Germany. The Nordic Musculoskeletal Questionnaire was used in an online survey to assess the prevalence of musculoskeletal complaints in the hands and wrists. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess symptom severity. Dialysis nurses rated the effort required to set up dialysis machines using the BORG-CR10 scale. The analysis was descriptive. RESULTS: A total of 122 dialysis nurses (18 male, 104 female; mean age 45 ± 12 years) participated in the survey, and 59% of them reported developing hands or wrist complaints in the last 12 months. According to BCTQ, the average severity of these complaints is 2.0 ± 0.8 (N = 72). The severity of symptoms increased significantly with the number of setups performed by a dialysis nurse per day (rs = 0.35, P = 0.003, N = 72). The nurses rated the effort required to set up the dialysis machines as 2.8 ± 1.8 on the BORG-CR10 scale (N = 101). DISCUSSION: The results of the online survey showed that dialysis nurses were more likely than the general population to experience hand and wrist complaints. The repetitive activities of the hands and wrists while setting up a dialysis machine are thought to be the cause. CONCLUSIONS: Preventive measures are needed to reduce hand and wrist strain in dialysis nurses.

The impact of electronic gaming on upper-limb neuropathies among esports athletes.

BACKGROUND: The authors aimed to explore carpal tunnel syndrome (CTS) among electronic sports (esports) athletes, to compare hand symptoms and their severity between esports athletes and the control group and within the esports athletes, and to study the relationship between esports athletes' variables. MATERIAL AND METHODS: A cross-sectional survey study via telephone with systematic randomized approach was used for esport athletes sampling. Control group were non-esports athletes who do not use computer for prolonged duration. The survey consisted of sports athletes' characteristics, hand symptoms and functions, and the Boston Carpal Tunnel Questionnaire (BCTQ). The unpaired student's t-test, Mann-Whitney U test, and χ2 test were utilised for statistical comparison, with p < 0.05. Pearson's and Spearman's correlation coefficient tests were used for relationship analyses. RESULTS: Eligible participants were 198 out of 229. Compared to control group, esport athletes reported more CTS (p = 0.01), and radiated pain and numbness in their hands (p = 0.05). Males complained of hand symptoms (p < 0.01) and its radiation (p < 0.01) more than females among esports athletes. Higher BCTQ Symptom Severity Scale (BCTQ-SSS) scores were reported for esports athletes who had been playing esports for prolonged periods compared to those who had playing recently (p = 0.003), with a moderate positive correlation (+0.59, p = 0.004). A significant moderate positive correlation was reported for BCTQ Functional Severity Symptoms (BCTQ-FSS) scores in terms of hours of playing (+0.44, p = 0.04). Esports athletes who used armrests and a PC with a controller for gaming reported less hand symptoms and had milder BCTQ scores than those who used a PC with a keyboard/mouse. Generally, esports athletes spend 5-10 h/day on gaming. CONCLUSIONS: Esports athletes might be at risk of developing upper-extremity nerve compression and CTS. Prolonged playing, hours of playing, type of esports device, and using armrests are possible risk factors. Med Pr Work Health Saf. 2023;74(4):279-87.

High frequency of carpal tunnel syndrome and associated factors: A cross-sectional study in Peruvian workers from agro-export industry.

Carpal tunnel syndrome (CTS) is a peripheral mononeuropathy caused by compression of the median nerve at the wrist and has been reported in workers who perform repetitive movements that involve actions of sustained grasping of vibrating objects. We carried out a cross-sectional analytical study in March 2018 to identify the factors associated with the CTS among workers of agro-export companies in Ica-Peru. CTS confirmation in our study was based on having at least 1 positive screening test (Tinel or Phalen) and a presumptive result of CTS by the Kamath and Stothard Questionnaire. We carried out 4 Poisson regression models to evaluate the factors associated with CTS based on epidemiological and statistical criteria. We enrolled 112 agro-export workers in production (42.0%), packing (35.7%), and administration (22.3%) working areas. The CTS frequency in Peruvian agro-export workers in production, packing, and administrative working area were 78.7%, 45.0%, and 28.0%, respectively. The bivariate analysis found a relationship between the CTS with age, female sex, sports practice, job seniority in the working area (year), and repetitive wrist movements (hours per day). In the multivariate analysis, only job seniority in the working area (year) and repetitive wrist movements maintained their association with CTS. Occupational factors are significantly associated with a high frequency of CTS, such as job seniority in the working area (year) and repetitive wrist movements in agro-export workers. Surveillance programs should be held to prevent, reduce, and monitor workers' health status.

Carpal tunnel syndrome and its associated factors among computer user bankers in South Gondar Zone, Northwest Ethiopia, 2021: a cross sectional study.

INTRODUCTION: The use of information devices like computers is skyrocketed in recent years, leading injuries. Carpal Tunnel Syndrome is a leading cause of upper extremity MSDs specially to banking workers. Hence, this paper was intended to highlight its magnitude associated factors in the study area. METHODS AND MATERIALS: Institutional based cross-sectional study was conducted from September 13, 2021 to October 09, 2021. A total of 422 private and government owned computer user bankers were participated. Simple random sampling technique was used to select the study participants. Data were collected using Durkan's compression test, flexion and compression test, Phalen's test, and Tinel's test. Multivariable logistic regression model was used to investigate the relationship between predictors and Carpal Tunnel Syndrome. P-value less than 0.05 was considered to declare as a significant and Adjusted Odds Ration for strength association between risk factors and Carpal Tunnel Syndrome. RESULT: Among 422 participants, the annual prevalence of CTS was 11.7%. Being smoker [AOR: 4.2; 95% CI: 1.76-10.26], having > 5-year work experience [AOR: 7.98; 95% CI: 3.7-17.33], movement repetition [AOR: 3.9; 95% CI: 1.66-9.4] and lack of ergonomics training [AOR: 5.2; 95% CI: 2.8-9.5] were independently associated risk factors to Carpal Tunnel Syndrome. CONCLUSION: Carpal Tunnel Syndrome was high (11.7%) among bankers in this study area. Carpal Tunnel Syndrome was predicted by smoking, length of employment, movement repetition, and not received ergonomics training. Therefore, fore the banking industry, it would be better to maintain strict follow-up and provision of ergonomics training.

SARS-COV-2 INFECTION AND INVOLVEMENT OF PERIPHERAL NERVOUS SYSTEM: A CASE SERIES OF CARPAL TUNNEL SYNDROME AGGRAVATION OR NEW ONSET WITH COVID-19 DISEASE AND A REVIEW OF LITERATURE.

COVID-19 may be asymptomatic or have a typical presentation with fever, cough, anosmia, lymphocytopenia. In some cases, it occurs with a "chimeric" presentation, with more subtle and ambiguous symptoms which may be initially misdiagnosed and are referred to in long covid condition. A possible central and peripheral nervous system involvement has been recognized. We present our experience and review the literature about association between carpal tunnel syndrome (CTS) and hand's arthritis presenting a case series of patients who firmly state that their condition of CTS arised or got worse during a typical presentation of COVID-19. The outbreak of COVID-19 has resulted in significant global healthcare implications. While the respiratory manifestations of COVID-19 have been widely studied, there is emerging evidence suggesting potential associations between COVID-19 and various other health conditions. This review of the literature aims to investigate the potential relationship between COVID-19 and the development or exacerbation of CTS. By synthesizing the available literature on this topic, we aim to provide a comprehensive overview of the current knowledge and enhance our understanding of the potential implications of COVID-19 on CTS. Case series: In this article we report 13 cases of typical presentations of COVID-19 with fever, myalgia, and respiratory system involvement, with a simultaneous aggravation of the median nerve pre-existing neuralgia and some cases that developed a median nerve neuralgia during COVID-19, which came to the attention of the hand surgeon. Some cases had stable symptomatic CTS and were on waiting list for surgical carpal tunnel release, some cases were previously asymptomatic and developed a median nerve neuralgia during COVID-19. All patients referred to a rapid worsening of acral paraesthesia and neuralgic pain of the same quality of CTS and in the median nerve topography. Some patients developed typical COVID-19 symptoms and died; the others were surgically treated. CTS could be an atypical presentations of COVID-19 or a condition of long-covid disease and clinical and epidemiological significance needs to be fully studied. We presented cases of worsening of the median nerve neuralgia which presented among other symptoms of COVID infection. We conclude a causal relation may exist and needs to be further investigated.

Characteristics of diabetic and non-diabetic carpal tunnel syndrome in terms of clinical, electrophysiological, and Sonographic features: a cross-sectional study.

BACKGROUND: Although diabetes is considered a major risk factor for carpal tunnel syndrome (CTS), the characteristics of diabetic CTS have not been fully understood. OBJECTIVE: This study is aimed at evaluation of the clinical, electrophysiological, and ultrasonographic findings of non-diabetic and diabetic CTS. METHODS: This retrospective, cross-sectional study included patients diagnosed with CTS. Patient age, sex, involved side, body mass index, clinical and electrophysiological findings, and median nerve cross-sectional area (CSA) were identified. Diabetes was identified through patient or guardian interviews, medical records, and medication history. Linear and binary logistic regression models were established to confirm the associations between the electrophysiological findings, median nerve CSA, and clinical outcomes. Covariates, such as age, sex, body mass index, diabetes, symptom duration, and thenar muscle weakness were adjusted. RESULTS: Out of the 920 hands, 126 and 794 belonged to the diabetic and non-diabetic CTS groups, respectively. The patients were significantly older in the diabetic CTS group (P < 0.001). The rate of thenar weakness in the diabetic CTS group was also significantly higher than that in the non-diabetic CTS group (P = 0.009). The diabetic CTS group had a more severe electrodiagnostic grade (P = 0.001). The prolonged onset latency of the compound motor nerve action potential (CMAP) and median nerve CSA were well associated with the degree of clinical symptoms. Increased median nerve CSA was significantly associated with prolonged CMAP onset latency (ß = 0.64; P = 0.012), prolonged transcarpal latency (ß = 0.95; P = 0.044), and decreased CMAP amplitude (ß = -0.17; P = 0.002) in the non-diabetic CTS group. CONCLUSION: Diabetic CTS had more profound electrophysiological abnormalities. Distal motor latency and median nerve CSA were not only associated with each other, but also with clinical symptoms. Further studies are needed to investigate the pathophysiological mechanisms underlying diabetic CTS.

The prevalence of double- and multiple crush syndromes in patients surgically treated for peripheral nerve compression in the upper limb.

OBJECTIVE: The double crush syndrome describes a condition characterized by multifocal entrapment of a nerve. In the upper limb, the high prevalence of carpal tunnel syndrome makes it a common diagnosis of assumption in the setting of median neuropathy. More proximal compressions may tend to be overlooked, under-diagnosed and under-treated in the population. This study aims to map the prevalence of peripheral upper limb nerve compressions among patients undergoing peripheral nerve decompression. METHODS: A prospective case series was conducted on 183 patients undergoing peripheral nerve decompression in a private hand surgery clinic. Level(s) of nerve compression in the median, ulnar and radial nerves were determined by history and physical examination. The prevalence of each nerve compression syndrome or combination of syndromes was analyzed. RESULTS: A total of 320 upper limbs in 183 patients were analyzed. A double crush of the median nerve at the levels of the lacertus fibrosus and carpal tunnel was identified in 78% of upper limbs with median neuropathy, whereas isolated lacertus syndrome and carpal tunnel syndrome were present in only 5% and 17% of affected limbs respectively. Cubital tunnel syndrome affected 12.5% of upper limbs, and 80% of these had concomitant lacertus and carpal tunnel syndromes, compared to only 7.5% with isolated cubital tunnel syndrome. CONCLUSION: A high prevalence should prompt clinicians towards more routine assessment for double crush syndrome to avoid misdiagnosis, inadequate treatment, recurrence, and revision surgeries.

Musculoskeletal manifestations associated with transthyretin-mediated (ATTR) amyloidosis: a systematic review.

BACKGROUND: Hereditary and wild-type transthyretin-mediated (ATTRv and ATTRwt) amyloidoses result from the misfolding of transthyretin and aggregation of amyloid plaques in multiple organ systems. Diagnosis of ATTR amyloidosis is often delayed due to its heterogenous and non-specific presentation. This review investigates the association of musculoskeletal (MSK) manifestations with ATTR amyloidosis and the delay from the onset of these manifestations to the diagnosis of ATTR amyloidosis. METHODS: This systematic review utilized Medline and EMBASE databases. Search criteria were outlined using a pre-specified patient, intervention, comparator, outcome, time, study (PICOTS) criteria and included: amyloidosis, ATTR, and MSK manifestations. Publication quality was assessed utilizing Joanna Briggs Institute (JBI) critical appraisal checklists. The search initially identified 7,139 publications, 164 of which were included. PICOTS criteria led to the inclusion of epidemiology, clinical burden and practice, pathophysiology, and temporality of MSK manifestations associated with ATTR amyloidosis. 163 publications reported on ATTR amyloidosis and MSK manifestations, and 13 publications reported on the delay in ATTR amyloidosis diagnosis following the onset of MSK manifestations. RESULTS: The MSK manifestation most frequently associated with ATTR amyloidosis was carpal tunnel syndrome (CTS); spinal stenosis (SS) and osteoarthritis (OA), among others, were also identified. The exact prevalence of different MSK manifestations in patients with ATTR amyloidosis remains unclear, as a broad range of prevalence estimates were reported. Moreover, the reported prevalence of MSK manifestations showed no clear trend or distinction in association between ATTRv and ATTRwt amyloidosis. MSK manifestations precede the diagnosis of ATTR amyloidosis by years, and there was substantial variation in the reported delay to ATTR amyloidosis diagnosis. Reports do suggest a longer diagnostic delay in patients with ATTRv amyloidosis, with 2 to 12 years delay in ATTRv versus 1.3 to 1.9 years delay in ATTRwt amyloidosis. CONCLUSION: These findings suggest that orthopedic surgeons may play a role in the early diagnosis of and treatment referrals for ATTR amyloidosis. Detection of MSK manifestations may enable earlier diagnosis and administration of effective treatments before disease progression occurs.

El síndrome del túnel carpiano y su abordaje terapéutico / Carpal Tunnel Syndrome and its Therapeutic Approach

Introducción: El síndrome del túnel carpiano es una de las causas más frecuentes de dolor crónico, su mayor incidencia está entre la quinta y sexta década de la vida; en Colombia tiene una alta incidencia, llegando al 14 por ciento especialmente en cierto grupo de trabajadores. El abordaje terapéutico incluye tratamiento médico y quirúrgico; en la actualidad ha sido ampliamente discutida la elección entre método endoscópico y cirugía abierta como primera línea de tratamiento. Objetivo: Desarrollar una revisión acerca de los aspectos clínicos y las diferentes opciones de abordaje terapéutico del síndrome del túnel carpiano a través de una exploración de la literatura científica existente. Métodos: Se realizó una búsqueda en las bases de datos SciELO, PubMed, ScienceDirect y Lilacs con las palabras clave indexadas en el DeCS. Conclusión: El síndrome de túnel carpiano es una entidad común con un impacto clínico importante en la vida del paciente, su sintomatología y sus complicaciones afectan las actividades diarias de quien lo padece; el abordaje terapéutico de esta enfermedad se establece comúnmente de forma escalonada, el abordaje quirúrgico es un tema ampliamente discutido; sin embargo, no hay evidencia contundente que establezca una de las opciones quirúrgicas como la definitiva(AU)

Introduction: Carpal tunnel syndrome is one of the most frequent causes of chronic pain, with its highest incidence between the fifth and sixth decades of life; in Colombia, it has a high incidence, reaching 14 percent especially in a certain group of workers. The therapeutic approach includes medical and surgical treatment; currently, the choice between the endoscopic method or open surgery as the first line of treatment has been widely discussed. Objective: To develop a review of the clinical aspects and the different options of therapeutic approach for carpal tunnel syndrome, through an exploration of the existing scientific literature. Methods: A search was carried out in the SciELO, PubMed, ScienceDirect and Lilacs databases, using the keywords indexed in the DeCS. Conclusion: Carpal tunnel syndrome is a common entity with an important clinical impact on the patient's life; its symptomatology and complications affect the daily activities of those who suffer from it. The therapeutic approach to this disease is commonly established in a stepwise manner; the surgical approach is a widely discussed topic. However, there is no conclusive evidence that establishes one of the surgical options as the definitive one/AU)