Carpal tunnel syndrome
Carpal tunnel syndrome occurs when the median nerve, becomes pressed or squeezed at the wrist.
The most common compressive neuropathy affects the median nerve in the carpal tunnel; it is typically chronic and progressive.
Etiology
Osteoid Osteoma, because of its nonspecific presentation in the wrist, it remains a diagnostic challenge. Basran et al. report an unusual case of Osteoid Osteoma at distal radius having symptoms resembling that of carpal tunnel syndrome. The diagnosis was confirmed preoperatively with X-rays; bone scintigraphy, CT, and MRI, later histological examination confirmed the diagnoses. Surgical excision lead to a dramatic improvement in the condition of the patient 1)
Scores
Visual analog scale to assess the intensity of pain and paresthesia symptoms.
Boston Carpal Tunnel Questionnaire (BCTQ)
Michigan Hand Outcome Questionnaire (MHQ)
Quick form of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire,
Duruoz Hand Index (DHI).
The BCTQ, pain and paresthesia results were assumed as gold standards. Correlations between the MHQ, QuickDASH, and the DHI were analyzed. A correlation analysis between the variables was tested using Spearman's rho test or Pearson's test for variables.
The QuickDASH was well correlated with pain, paresthesia and the BCTQ (p<0.001). The questionnaires complied with each other.
In addition to its complicated scoring, the MHQ contained detailed subparameters with similar questions and takes a long time to complete. Further studies may confirm the effective usage of the DHI. The easier QuickDASH questionnaire appears to be more practical for carpal tunnel release patients 2).
Clinical features
Pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.
Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly.
Zoicas et al. hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. They prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly 3).
Clinical tests
wrist flexion, wrist extension, Tinel's, tethered median nerve (TMN), pinch, vibration and Semmes-Weinstein monofilament (SWMF) tests. Substantial inter-rater agreement was observed between two therapists for five of the clinical tests (k > 0.71) with SWMF and TMN having lower agreement. The most accurate test was Phalen's wrist flexion test. Good accuracy was demonstrated by pinch and vibration tests. Tinel's test was characterized by lower sensitivity, but false positives were rare. Wrist extension and TMN tests had poor sensitivity. SWMF testing was very sensitive, but a high number of false positives occurred when 'normal' was classified as 2.83. Reliability and accuracy of these tests supports their use as components of a clinical diagnosis of CTS 4).