Acute carpal tunnel syndrome

Although the carpal tunnel is open at both ends, it has the physiologic properties of a closed compartment bounded by synovium proximally and distally. When the intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. Acute carpal tunnel syndrome is recognized frequently as occurring secondary to wrist trauma and infrequently due to a variety of infectious, rheumatologic, and hematologic disorders. This condition warrants prompt recognition and the treatment is early carpal tunnel release.     

Surgical treatment results in patients with severe forms of the carpal tunnel syndrome

A retrospective and prospective study was undertaken to determine efficacy of carpal tunnel decompression in patients with advanced carpal tunnel syndrome (CTS). The criteria for inclusion in this study were clinical and nerve conduction studies (NCS). Between 1985-1991, 1511 NCSs performed were positive for CTS.     

Reoperation for carpal tunnel syndrome

Although primary carpal tunnel release is usually successful, reoperation is needed in up to 3% of patients. Common indications of reoperation are previous incomplete surgery and postoperative fibrosis. Although most patients improve after reoperation, persistent systems are likely and failure is more frequent than after primary carpal tunnel surgery. Risk factors for failure following reoperation include the presence of an active Worker's Compensation claim, pain in the ulnar nerve distribution, and the absence of abnormality on preoperative EMG.     

Re: Management of idiopathic carpal tunnel syndrome

A male fetus of gestation day 187 was aborted from a Holstein-Friesian cow in an epizootic of the Aino virus (AINOV) in September 1995. Neutralizing antibody titers against AINOV were 1:128, 1:16 and 1:64 in the dam serum, fetal ascites and cerebrospinal fluid, respectively. A 10% brain suspension of the aborted fetus was prepared immediately after autopsy, rinsed three times and sonicated before centrifugation. The supernatant was then inoculated into HmLu-1 cell cultures. A cytopathic effect was noted on post-inoculation day 7. The isolated virus was identified as the AINOV based on the physicochemical properties and cross neutralization test. This is the first report on the isolation of AINOV from an aborted bovine fetus.     

Persistent or recurrent carpal tunnel syndrome following prior endoscopic carpal tunnel release

Immunohistochemistry was applied in the investigation of the possible existence of serotonin in human skin. It was found that epidermal melanocytes express a serotonin-like immunoreactivity. The immunoreactivity was associated with both the cytoplasm and the cellular membrane, though the latter was only found in certain cells. The serotonin anti-serum labeled the same cells as NKI-beteb, which is known as a reliable marker of melanocytes. Blocking experiments showed that both serotonin and NKI-beteb have different epitopes in the melanocytes. In in vitro studies, serotonin-like immunoreactivity appeared in approximately 90% of cultured human melanocytes, and was found both in the cytoplasm and also in the nuclei. Thus, we believe the melanocytes to be the origin of serotonin (or a serotonin-like molecule) in the skin.     

Predicting acute denervation in carpal tunnel syndrome

OBJECTIVE: Defects of the cochlear modiolus have been found to be associated with most cases of large vestibular aqueduct. The clinical significance of these modiolar defects has not been studied previously. The purpose of this article is to correlate clinical (functional) parameters, such as hearing outcomes, with the severity of the radiographic findings in these dysplastic inner ears. STUDY DESIGN: The study design was a retrospective chart review, supplemented with telephone interviews and clinic visits. SETTING: The study was conducted at an academic, tertiary care center. PATIENTS: Thirty consecutive patients with large vestibular aqueducts participated. RESULTS: Scores of modiolar deficiencies yielded inconsistent correlations with hearing loss. Vestibular aqueduct morphology and thickness correlated very strongly with the severity of hearing loss. CONCLUSIONS: These observations support the hypothesis that large vestibular aqueduct-related hearing loss may be caused by transmission of subarachnoid pressure forces into the inner ear. However, the thickness and morphology of the vestibular aqueduct may simply be markers for more subtle cochlear dysplasia manifest by modiolar deficiency.     

Silent period abnormalities in carpal tunnel syndrome

Zygosaccharomyces bailii inactivation was evaluated in oscillatory high hydrostatic pressure (HHP) treatments at sublethal pressures (207, 241, or 276 MPa) and compared with continuous HHP treatments in laboratory model systems with a water activity (aw) of 0.98 and pH 3.5. The yeast was inoculated into laboratory model systems and subjected to HHP in sterile bags. Two HHP treatments were conducted: continuous (holding times of 5, 10, 15, 20, 30, 60, or 90 min) and oscillatory (two, three, or four cycles with holding times of 5 min and two cycles with holding times of 10 min). Oscillatory pressure treatments increased the effectiveness of HHP processing. For equal holding times, Z. bailii counts decreased as the number of cycles increased. Holding times of 20 min in HHP oscillatory treatments at 276 MPa assured inactivation (< 10 CFU/ml) of Z. bailii initial inoculum. Oscillatory pressurization could be useful to decrease Z. bailii inactivation time.     

The electrophysiological diagnosis of carpal tunnel syndrome

Electrophysiological investigations were carried out both in patients with carpal tunnel syndrome (CTS) and in healthy individuals. The evoked potentials were examined during stimulation of sensitive branches of n. medianus and of other nerves. The most sensitive and important for diagnosis appeared to be the electrophysiological test of alteration of responsive reaction to the stimulation of the sensitive branch of n. medianus for 4 finger and the considerable difference of evoked reactions on stimulation of skin palm branch and branch of the 1-st finger of n. medianus. The diagnostic importance of these indices corresponds well to anatomical and pathophysiological characteristics of CTS.     

Less common causes of carpal tunnel syndrome

A new DRB3*02 allele (DRB3*0207) was detected in a female Luxembourg Caucasian blood donor by sequence-based typing. The new allele differs from DRB3*0202 by two substitutions in codon 57 resulting in an amino acid change from a charged aspartic acid to a neutral valine. This is the first example of a DRB3 allele pair differing only at codon 57.     

Screening for carpal tunnel syndrome in the workplace

Diaphragmatic crus lipoma is a very rare entity. In this case report, smooth, rounded masses of diaphragmatic lipoma, incidentally observed in a 37-year-old female on routine abdominal computed tomographic scanning is presented.     

Symptomatic carpal tunnel syndrome after orthotopic liver transplantation: a retrospective analysis

BACKGROUND: Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve and has been reported after renal transplantation; there are no reports of CTS after liver transplantation. METHODS: The incidence of and the risk factors for CTS were assessed in 1350 liver allograft recipients. RESULTS: Seventeen women and two men with CTS were identified. Women developed symptoms at a median time of 6.8 months, and all but one received transplants because of primary biliary cirrhosis (PBC). All 17 patients were taking cyclosporine. The only risk factor for CTS was the pretransplant diagnosis of PBC (6.7% of 240 PBC patients surviving 6 months or more compared with 0.4% of 717 patients who received grafts for other indications). CONCLUSIONS: CTS may occur in patients early after liver transplantation; because in many cases the symptoms were attributed to cyclosporine neurotoxicity, the diagnosis should be considered, especially in patients who received grafts because of PBC.     

The nerve lesion in the carpal tunnel syndrome

The relative roles of pressure deformation and ischaemia in the production of compression nerve lesions remain a controversial issue. This paper concerns the genesis of the structural changes which follow compression of the median nerve in the carpal tunnel. The initial lesion is an intrafunicular anoxia caused by obstruction to the venous return from the funiculi as the result of increased pressure in the tunnel. This leads to intrafunicular oedema and an increase in intrafunicular pressure which imperil and finally destroy nerve fibres by impairing their blood supply and by compression. The final outcome is the fibrous tissue replacement of the contents of the funiculi.     

Clinical management of carpal tunnel syndrome: a 12-year review of outcomes

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational-related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985-1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well-being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well-controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS.     

High-resolution ultrasonography in the study of carpal tunnel syndrome

The cellular activity of hemocytes from the marine mollusc Mytilus galloprovincialis was studied using computer-assisted microscopic image analysis. PDGF-AB and TGF-beta 1 caused changes in cellular shape and induced the immunocytes to migrate in a chemotactic manner. The effect of PDGF-AB was more potent than that of TGF-beta 1, and the responses were dose-correlated for PDGF-AB, while they were dose-dependent up to 5 pg/ml for TGF-beta 1. Moreover, the PDGF-AB response was extracellular Ca(2+)-independent, while TGF-beta 1 was Ca(2+)-dependent.