Background
Pain and autonomic dysfunction are prominent symptoms in some patients with carpal tunnel syndrome (CTS). Infrared thermography (IRT) has been used to evaluate CTS by measuring the cutaneous temperature and sympathetic vasomotor function.
Methods
This study enrolled the 66 hands of 33 subjects, some of which had clinical CTS and the others were healthy. The enrolled patients completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Historical-Objective scale, and underwent nerve conduction studies (NCSs) and IRT. Skin temperature was measured at the fingertips and the thenar and hypothenar regions in each hand. We analyzed (1) the correlations between self-reported severity, physician-assessed severity, and test results, and (2) the sensitivity and specificity of IRT in diagnosing CTS.
Results
No significant correlation was observed between the results of the BCTQ, NCS, and IRT. IRT had a low sensitivity and high specificity in diagnosing CTS.
Conclusions
IRT cannot replace NCS in diagnosing CTS, nor did it provide an advantage in combination with NCS. However, lower temperatures at the median nerve in some hands with moderate-to-severe CTS suggested the involvement of sympathetic nerve fiber function. Follow-up studies with a larger-scale and complementary design are required to elucidate the relationships.

Citations

• Infrared medical thermography, medical applications, and its basic principles: A review
  Ali Faisal Abdulkareem, Auns Qusai Hashim, N. Aldahan, A.J. Ramadhan
  BIO Web of Conferences.2024; 97: 00140.     CrossRef

Background
The median-to-ulnar comparison test (MUCT), and increasingly, ultrasonography (US) are considered as complementary to and more sensitive than median nerve conduction study (NCS) in diagnosing carpal tunnel syndrome (CTS).
Methods
In consecutive patients with hand paresthesia compatible with CTS but with normal median NCS, we additionally performed the MUCT and analyzed whether it yielded better diagnostic sensitivity.
Results
In total, 163 hands of clinically diagnosed CTS patients were examined with routine NCS. The MUCT and US were performed in 81 hands and 31 hands, respectively. While median NCS was diagnostic in 85 (52.1%) hands, MUCT failed to demonstrate superior sensitivity over median NCS in the other hands and US revealed related abnormalities better than both routine NCS (p=0.006) and MUCT (p=0.002).
Conclusions
The MUCT offered no additional diagnostic benefit. On the other hand, sonographic examination had higher sensitivity for the diagnosis of CTS when applying several diagnostic criteria. Thus, US could be the screening test for diagnosing CTS prior to NCS with higher sensitivity than MUCT. However, further studies are needed to define the appropriate diagnostic criteria for US.

Background: Electrophysiological study has been known as a useful method to evaluate the therapeutic effect of operation in idiopathic carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the clinical and electrophysiological changes after carpal tunnel release (CTR) compared to the preoperative results. Methods: We analyzed the changes of nerve conduction study (NCS) before and after minimal open carpal tunnel release in 18 patients (25 hands) with CTS. Follow-up study was performed over 6 months after operation. Results: Clinical improvement was seen in all cases after CTR. In contrast, electrophysiological improvement was various depending on the parameters; the mean median sensory latency and nerve conduction velocity (NCV) improved significantly (p = 0.001). The mean median motor latency also improved, but NCV and compound muscle action potential (CMAP) amplitude did not change. The extent of improvement was evident in moderate CTS, but not in severe CTS. Conclusions: In this preliminary study, all subjects who underwent CTR achieved a clinical relief along with a significant improvement of electrophysiological parameters such as median sensory latency, sensory NCV and median distal motor latency. After CTR, a number of cases with mild to moderate CTS showed a prominent improvement of clinical and electrophysiological parameters, while fewer improvements were seen in severe CTS, although it did not reach the statistical significance.

Citations

• Analysis of Electrodiagnostic Recovery after Carpal Tunnel Release: A Retrospective Study
  Hyungsun Peo, Jun Gyu Lee, Yoonhee Kim, Don-Kyu Kim, Hyun Iee Shin, Du Hwan Kim
  Journal of Electrodiagnosis and Neuromuscular Dise.2022; 24(3): 70.     CrossRef

Background: Local steroid injection is used to treat carpal tunnel syndrome (CTS). The aim of this study was to evaluate the clinical and electrophysiological effects of local steroid injection in patients with CTS over a 3-months period.
Methods: Twenty-one satients (35 hands) with clinical and electrophysiological evidence of CTS were treated by injection of triamcinolone 40 mg to the carpal tunnel. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), rates of paresthesia, night awakening, and electrophysiological studies were used as outcomes. Clinical and electrophysiological assessments were performed before, 1 and 3 months after treatment.
Results: Prior to treatment, 86% of patients complained of night awakening. At 1 and 3 months after injection, only 17% and 29% of the patients, respectively, had night awakening (p<0.001). All patients complained of paresthesia before the treatment. This symptom disappeared in 60% and 31% of the patients after 1 and 3 months, respectively (p<0.001). Compared to baseline, both BCTQ and VAS show significant improvement during the 3 months of the study (p<0.005). Although significant improvements in clinical parameters were shown, electrophysiological parameters were not significantly improved at 1 and 3 months.
Conclusions: Local corticosteroid injection for the treatment of CTS provides significant improvement in symptoms for 3 months. On the other hand, no significant improvement was observed in electrophysiological parameters.

Citations

• A Narrative Review of Carpal Tunnel Syndrome in Traditional Chinese Medicine: Using China National Knowledge Infrastructure Database
  Hyun-A Jeon, Won-Bin Shin, Su-Yeon Lim, Young-Joo Moon, Ji-Yun Lee, Seung-Hyeok Ku, Sung-Hyun Kim, Hyun-Woo Moon
  Journal of Korean Medicine Rehabilitation.2020; 30(4): 119.     CrossRef
• Miniscalpel Needle Therapy with Integrative Korean Medical Treatment for Carpal Tunnel or Tarsal Tunnel Syndrome: Case Series of Three Patients
  Jae Ik Kim, Hye Su Kim, Gi Nam Park, Ju Hyon Jeon, Jung Ho Kim, Young Il Kim
  The Acupuncture.2017; 34(3): 139.     CrossRef

and others underwent flash goggle VEPs. Results : Brain imaging were abnormal in 29 and were normal in 2. Of the 29 abnormal scans, lesions in posterior visual pathway were detected in 21 scans(predictive value=68%). The predictive value ws not significantly different between flash goggle VEP(75%) and pattern reversal VEP(68%). The predictive value was higher in patient with visual field defect(100%) than those without visual field defect(25%). The pathologic nature of lesion also showed close relations to the predictive value. VEPs is usually paradoxically lateralized(78%), but in all patients. Conclusion : VEPs abnormalities suggesting retrochiasmal lesion were usually corresponded with brain MRI findings. Diagnostic reliability could be increased when considering the visual field defect and nature of lesion. Therefore, the authors suggest that VEPs studies could be useful in evaluating the patients with the retrochismal lesion.

Purpose
: Carpal tunnel syndrome(CTS) is a disorder of median nerve at wrist. it is usually diagnosed through clinical manifestation and nerve conduction study(NCS). However, sometimes, NCS does not provide a reliable evidence to reach the diagnosis. Thus, authors performed this study to determine whether NCS was correlated with specific parameters measured on magnetic resonance imaging (MRI) which might become a potential complemental diagnostic tool. Methods : We performed MRI in 34 wrists of 18 patients with clinical manifestations of CTS and pathologic nerve conduction values and analyzed them at levels of the distal radioulnar joint, pisiform and hook of hamate. Results : Increase in the cross-sectional area of the median nerve a the pisiform level and flattening, increased signal intensity, and contrast enhancement of the median nerve at levels of the pisiform and hook of hamate were statistically significant, Change in cross sectional areas between the distal radioulnar joint and hamate and the signal intensities at levels of pisiform and hamate were well correlated with the median nerve conduction velocity. Conclusions : Characteristic MRI findings in CTS reported previously were well demonstrated and some of MRI parameters are well correlated with nerve conduction study. MRI, despite cost, may help in evaluating CTS.

Background
and Objective : Carpal tunnel syndrome(CTS) is the most common mononeuropathy encountered in clinical practice. No single procedure or group of procedures has demonstrated adequate sensitivity. F-wave study in CTS is very rarely reported. To determine the diagnostic usefulness of new parameters of F-wave and comparative study of F-wave parameters of median and ulnar nerves in patients with CTS. Methods : F-wave responses of median and ulnar nerves were analyzed from 27 patients with clinically diagnosed CTS and 22 age and gender-matched normal control. Conventional F-wave parameters were studied. Also, the usefulness of new parameters such as mean and maximal ulnar-median F-wave latency differences, ulnar-median F-wave persistence and chronodispersion differences, median/ulnar F-wave amplitude ratio, and F-wave conduction velocity(FCV) using mean and maximal latency were assessed. Results : Compared with controls, median F-wave minimal, maximal and mean latencies, mean F-wave amplitude/M-wave amplitude, minimal, mean and maximal ulnar-median F-wave latency differences, and FCVs using minimal, maximal and mean latency difference, and FCVs using minimal, maximal and mean latency showed high sensitivity and specificity. Mean ulnar-median F-wave latency difference and FCVs using maximal and mean latency were new parameters. Conclusion : New F-wave parameter including mean ulnar-median F-wave latency difference and FCVs using maximal and mean latency may be a useful to assess the CTS. Also, median F-wave minimal, maximal and mean latencies, and FCV using minimal latency may be included in routine diagnostic tests in CTS

Background
s : Carpal tunnel syndrome(CTS) is a common condition that is usually diagnosed by electrophysiologic studies. However, CTS provide limited information to determine the causes of CTS and to choose the treatment method. We evaluated diagnostic sensitivity of MR imaging and treatment decisions by MR imaging in electrodiagnosed CTS. Methods : 14 patients (26 wrists) with electrodiagnosed CTS were studied using MR imaging. In 26 wrists for which axial T1 & T2 weighted images were obtained at 1.5T with a decided wrist coil. Previously described MR imaging of CTS such as increased median nerve signal, flattening of median nerve, reticular bowing, tenosynovitis and space occupying lesions were retrospectively evaluated. Degree of improvement was evaluated by global symptom score(GSS). The GSS rated symptoms from 0 (no symptoms) to 10 (severe0 in each of five categories; pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awaking. Subjects' GSS was recorded at baseline, 2 weeks, 1 month,6 months after treatment. We decided to medical treatment that showed mainly inflammatory sign such as increased median nerve signal, tenosinvitis and to surgical treatment such as space occupying lesion, high canal pressure sign. Results : MR imaging showed that increased median nerve signal were in 29 wrists(77%), flattening of median nerve were in 6 wrists (23%), reticular bowing were in 3 wrists (12%), tenosyovitis were in 8 wrists (32%), decreased canal size in 2 wrists (7.6%), space occupying lesion were in 1 wrists (4%). A good outcome was revealed in 21 wrists by medical treatment that showed mainly increased median nerve signal, tenosynovitis. The mean GSS were 27.7 at baseline 11.2 at 2 weeks, 11.0 at 6 month in medical treatment group. Another 5 wrists had surgical treatment shown by ganglion and high canal pressure sign such as median nerve flattening, reticular bowing, decreased canal size : 3 wrists had good prognosis, but 2 wrists (one patient) had no significant improvement due to small carpal tunnel size. Conclusions : Our results are in agreement with most previously described MR imaging signs of CTS. MR imaging plays an important role in several cases and especially in the assessment of failure of surgical treatment. Knowledge of MR findings may permit more rational choice of treatment.

Background
and Objectives: A nerve conduction study (NCS) has been known as a useful method to evaluate thetherapeutic effect of operation in carpal tunnel syndrome (CTS). To evaluate the temporal relationship between symptomaticand electrophysiological improvement, we compared the preoperative symptoms and electrophysiological resultswith postoperative those.Methods: We analyzed the NCS changes before and after minimal release of carpal tunnel in 26 patients (34 hands)with CTS. The time of postoperative symptomatic changes, postoperative electrophysiological changes and temporalrelationship between symptomatic and electrophysiological changes were evaluated.Results: The mean age was 49

Background
Carpal tunnel syndrome (CTS) is a common condition characterized by entrapment neuropathy of themedian nerves. Clinical manifestations are the most important findings for diagnosis and assessment of therapeuticeffects. But, objective indicators, such as electrophysiological findings, are also valuable supplementary tools. Thisstudy investigated the relationship between clinical grading and sensory nerve conduction velocity (SNCV) of medianproper palmar digital nerve (MPPDN) in CTS patients.Method: This study was done on 90 upper limbs of 53 patients with CTS (men: 6, women: 47, age: 26~69 years,mean age; 52 years). Each SNCV of MPPDN was recorded with bar electrode using antidromic method. Each SNCVwas compared with clinical grading of CTS. The clinical grades of CTS were designated as follows; group 1 is mildsymptoms, 2 is moderate symptoms, and 3 is severe and longstanding symptoms.Result: In thumb, the SNCV of MPPDN was not different significantly between 3 groups (p=0.817). In the index finger,the SNCV was the fastest in the group 1, but faster in group 3 than in group 2 (p=0.001). In the middle and ring fingers,SNCV was decreased in higher clinical grading groups (middle finger: p=0.015, ring finger: p=0.044).Conclusion: SNCV of MPPDN of middle and ring finger correlated with the clinical grading of CTS. SNCV of indexfinger was the fastest in group 1. But SNCV of thumb did not correlate with the clinical grading of CTS.

Background
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by compression of themedian nerve beneath the transverse carpal ligament. CTS can be correctly diagnosed by the patients' description of symptomsand electrophysiological tests that measure nerve conduction through the wrist. Many previous studies reported variousrisk factors of CTS, such as obesity, diabetes mellitus, thyroid disease and trauma. Obesity is associated with both hyperlipidemiaand CTS. This study focused on the relationship between severity of CTS and serum lipid level. Methods: Onehundred fourteen patients with CTS and 74 controls were divided into four groups according to the severity; normal, mild,moderate and severe. And then serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) andhigh-density lipoprotein (HDL-C) were measured in each group. Results: There was a positive correlation between TG andCTS severity (p<0.001). But TC, LDL-C and HDL-C were not correlated with CTS severity. Conclusions: These results suggestthat high serum TG may act as an aggravating factor of CTS.

Background
The aim of this study is to identify the correlation between ultrasonographic findings of median nerve andclinical scale and electrophysiologic data in carpal tunnel syndrome. Methods: Forty three patients (79 hands) with electrophysiologicallyconfirmed carpal tunnel syndrome were evaluated. Clinical symptoms were examined by Historical-Objective(Hi-Ob) scale. Electrophysiologic data and Padua scale were used for severity of electrophysiology. In ultrasonographic study,cross sectional area and flattening ratio of median nerve were measured at distal wrist crease level (DWC), 1cm proximalto distal wrist crease level, and 1cm distal to distal wrist crease level. The correlation between Hi-Ob scale, electrophysiologicdata and ultrasonography was measured with Spearman rank test. Results: The mean Hi-Ob scale was 2.4. Mean Padua scalewas 4.0. In ultrasnonographic study, cross sectional area and flattening ratio were 0.112 cm2

Background
Carpal tunnel syndrome (CTS) and tarsal tunnel syndrome (TTS) are thought to share a similar pathophysiology,compression of the median and plantar nerve by the carpal tunnel and flexor retinaculum. A few reports introduced the relationshipbetween idiopathic CTS and TTS without definite evidence of coexistence. The current study was designed to analyze theelectrophysiologic characteristics of combined idiopathic CTS and TTS by comparing with each idiopathic CTS or TTS.Methods: We retrospectively collected patients with combined idiopathic CTS and TTS (CTS-TTS group) from June 2001 toFebruary 2009. Patients with each idiopathic CTS or TTS were collected as controls. Electrophysiologic data of median and plantarnerves were compared between CTS-TTS group and controls. Results: CTS-TTS group was composed of 31 patients. Control groupof each CTS or TTS were 50 CTS and 49 TTS patients. In comparison of median nerve conduction study between CTS-TTS groupand CTS control group, decreased compound muscle action potential amplitude (p<0.001), decreased median sensory nerve actionpotential amplitude (p<0.001) and sensory nerve conduction velocity at finger stimulation (p=0.013) were prominent in CTS-TTSgroup. Decreased medial plantar sensory nerve action potential amplitude (p=0.034) was indicated when CTS-TTS groups and TTScontrol group were compared. Conclusions: If the electrophysiology study of patients with CTS or TTS was suggestive of severe degreeof nerve injury, concerns about the possibility of combined CTS and TTS would be helpful.

Background
Carpal tunnel syndrome (CTS) and tarsal tunnel syndrome (TTS) are thought to share a similar pathophysiology,compression of the median and plantar nerve by the carpal tunnel and flexor retinaculum. A few reports introduced the relationshipbetween idiopathic CTS and TTS without definite evidence of coexistence. The current study was designed to analyze theelectrophysiologic characteristics of combined idiopathic CTS and TTS by comparing with each idiopathic CTS or TTS.Methods: We retrospectively collected patients with combined idiopathic CTS and TTS (CTS-TTS group) from June 2001 toFebruary 2009. Patients with each idiopathic CTS or TTS were collected as controls. Electrophysiologic data of median and plantarnerves were compared between CTS-TTS group and controls. Results: CTS-TTS group was composed of 31 patients. Control groupof each CTS or TTS were 50 CTS and 49 TTS patients. In comparison of median nerve conduction study between CTS-TTS groupand CTS control group, decreased compound muscle action potential amplitude (p<0.001), decreased median sensory nerve actionpotential amplitude (p<0.001) and sensory nerve conduction velocity at finger stimulation (p=0.013) were prominent in CTS-TTSgroup. Decreased medial plantar sensory nerve action potential amplitude (p=0.034) was indicated when CTS-TTS groups and TTScontrol group were compared. Conclusions: If the electrophysiology study of patients with CTS or TTS was suggestive of severe degreeof nerve injury, concerns about the possibility of combined CTS and TTS would be helpful.

Thenar motor neuropathy (TMN) is a compressive mononeuropathy of recurrent motor branch of median nerve. It is infrequentand may have different pathogenesis. It may be a unique entity of disease or considered a variant of carpal tunnelsyndrome involving the motor branch only. We report a case of TMN induced by vigorous massage that applied strong digitalpressure in the region of the base of palm and thenar muscles.