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Peter C. Amadio - One of the best experts on this subject based on the ideXlab platform.
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median nerve deformation in differential finger motions ultrasonographic comparison of Carpal Tunnel Syndrome patients and healthy controls
Journal of Orthopaedic Research, 2012Co-Authors: Margriet H M Van Doesburg, Jacqueline Henderson, Yuichi Yoshii, Aebele Mink B Van Der Molen, Stephen S Cha, Peter C. AmadioAbstract:We investigated the median nerve deformation in the Carpal Tunnel in patients with Carpal Tunnel Syndrome and controls during thumb, index finger, middle finger, and a four finger motion, using ultrasound. Both wrists of 29 asymptomatic volunteers and 29 patients with idiopathic Carpal Tunnel Syndrome were evaluated by ultrasound. Cross-sectional images during motion from full extension to flexion were recorded. Median nerve cross-sectional area, perimeter, aspect ratio of the minimal enclosing rectangle, and circularity in extension and flexion positions were calculated. Additionally, a deformation index was calculated. We also calculated the intra-rater reliability. In both controls and patients, the median nerve cross-sectional area became significantly smaller from extension to flexion in all finger motions (p 0.84). With this study we have shown that it is possible to assess the deformation of the median nerve in Carpal Tunnel Syndrome with ultrasonography and that there is more deformation of the median nerve in Carpal Tunnel Syndrome patients during active finger motion. These parameters might be useful in the evaluation of kinematics within the Carpal Tunnel, and in furthering our understanding of the biomechanics of Carpal Tunnel Syndrome in the future.
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diagnosis of Carpal Tunnel Syndrome
Journal of The American Academy of Orthopaedic Surgeons, 2009Co-Authors: Michael W. Keith, Victoria Masear, Peter C. Amadio, Michael T. Andary, Richard W. Barth, Kevin C. Chung, Kent Maupin, William C. Watters, Michael J Goldberg, Robert H. HaralsonAbstract:AbstractThis clinical practice guideline was created to improve patient care by outlining the appropriate information-gathering and decisionmaking processes involved in managing the diagnosis of Carpal Tunnel Syndrome. The methods used to develop this clinical practice guideline were designed to com
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long term trends in Carpal Tunnel Syndrome
Neurology, 2009Co-Authors: R Gelfman, Peter C. Amadio, L J Melton, Barbara P Yawn, P C Wollan, J C StevensAbstract:Objective: To assess temporal trends in Carpal Tunnel Syndrome (CTS) incidence, surgical treatment, and work-related lost time. Methods: Incident CTS and first-time Carpal Tunnel release among Olmsted County, Minnesota, residents were identified using the medical records linkage system of the Rochester Epidemiology Project; 80% of a sample were confirmed by medical record review. Work-related CTS was identified from the Minnesota Department of Labor and Industry. Results: Altogether, 10,069 Olmsted County residents were initially diagnosed with CTS in 1981–2005. Overall incidence (adjusted to the 2000 US population) was 491 and 258 per 100,000 person-years for women vs men ( p p Conclusions: The incidence of medically diagnosed Carpal Tunnel Syndrome (CTS) accelerated in the 1980s. The cause of the increase is unclear, but it corresponds to an epidemic of CTS cases resulting in lost work days that began in the mid-1980s and lasted through the mid-1990s. The elderly present with more severe disease and are more likely to have Carpal Tunnel surgery, which may have significant health policy implications given the aging population.
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Treatment of Carpal Tunnel Syndrome.
The Journal of the American Academy of Orthopaedic Surgeons, 2009Co-Authors: Michael W. Keith, Victoria Masear, Peter C. Amadio, Michael T. Andary, Richard W. Barth, Brent Graham, Kevin C. Chung, Kent Maupin, William C. Watters, Robert H. HaralsonAbstract:In September 2008, the Board of Directors of the American Academy of Orthopaedic Surgeons approved a clinical practice guideline on the treatment of Carpal Tunnel Syndrome. This guideline was subsequently endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The guideline makes nine specific recommendations: A course of nonsurgical treatment is an option in patients diagnosed with Carpal Tunnel Syndrome. Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects. Another nonsurgical treatment or surgery is suggested when the current treatment fails to resolve symptoms within 2 to 7 weeks. Sufficient evidence is not available to provide specific treatment recommendations for Carpal Tunnel Syndrome associated with such conditions as diabetes mellitus and coexistent cervical radiculopathy. Local steroid injection or splinting is suggested before considering surgery. Oral steroids or ultrasound are options. Carpal Tunnel release is recommended as treatment. Heat therapy is not among the options to be used. Surgical treatment of Carpal Tunnel Syndrome by complete division of the flexor retinaculum is recommended. Routine use of skin nerve preservation and epineurotomy is not suggested when Carpal Tunnel release is performed. Prescribing preoperative antibiotics for Carpal Tunnel surgery is an option. It is suggested that the wrist not be immobilized postoperatively after routine Carpal Tunnel surgery. It is suggested that instruments such as the Boston Carpal Tunnel Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire be used to assess patient responses to Carpal Tunnel Syndrome treatment for research.
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a histological and immunohistochemical study of the subsynovial connective tissue in idiopathic Carpal Tunnel Syndrome
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Anke M Ettema, Peter C. Amadio, Chunfeng Zhao, Lester E WoldAbstract:Background: The most common histological finding in Carpal Tunnel Syndrome is noninflammatory synovial fibrosis. The accumulated effect of minor injuries is believed to be an important etiologic factor in some cases of Carpal Tunnel Syndrome. We sought evidence of such injuries in the synovial tissue of patients with Carpal Tunnel Syndrome and in cadaver controls. Methods: We compared synovial specimens from thirty patients who had idiopathic Carpal Tunnel Syndrome with specimens from a control group of ten fresh-frozen cadavers of individuals who had not had an antemortem diagnosis of Carpal Tunnel Syndrome and who met the same exclusion criteria. Analysis included histological and immunohistochemical examination for the distribution of collagen types I, II, III, and VI and transforming growth factor-β (TGF-β) RI, RII, and RIII. Results: Histological examination showed a marked increase in fibroblast density, collagen fiber size, and vascular proliferation in the specimens from the patients compared with the control specimens (p < 0.001). Collagen types I and II were not found in the synovium of either the patients or the controls, but collagen type VI was a major component of both. Collagen type-III fibers were more abundant in the patients than in the controls (p < 0.001). Expression of TGF-β RI was found in the endothelial cells and fibroblasts in the patient and control specimens, with a marked increase in expression in the fibroblasts of the patients compared with that in the control tissue (p < 0.001). Conclusions: These findings are similar to those after injury to skin, tendon, and ligament and suggest that patients with idiopathic Carpal Tunnel Syndrome may have sustained an injury to the subsynovial connective tissue. Clinical Relevance: The changes demonstrated in the subsynovial connective tissue not only could lead to an increase in the volume of the contents in the Carpal Tunnel but also may alter its material properties, such as compliance and permeability to fluid flows, and vascularity. These changes may, in turn, predispose the subsynovial connective tissue to additional injury and contribute to the elevation in Carpal Tunnel pressure seen in patients with Carpal Tunnel Syndrome.
Michael G Dunn - One of the best experts on this subject based on the ideXlab platform.
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the prevalence of Carpal Tunnel Syndrome in patients with basal joint arthritis of the thumb
Journal of Hand Surgery (European Volume), 1992Co-Authors: Thomas M Florack, Richard J Miller, Vincent D Pellegrini, Richard I Burton, Michael G DunnAbstract:Basal joint arthritis of the thumb and Carpal Tunnel Syndrome are common conditions with an acknowledged coexistence. This article attempts to quantify the prevalence of Carpal Tunnel Syndrome in patients with basal joint arthritis and to examine some of the etiologic factors that affect the coexistence of the two disorders. Of 246 patients who had surgery about the basal joint, 95 patients (39%) were identified by chart review as having Carpal Tunnel Syndrome. Eleven of 122 remaining patients contacted had symptomatic Carpal Tunnel Syndrome confirmed by nerve-conduction studies, bringing the total to 106 (43%). The prevalence was higher in worker's compensation patients and those with diabetes mellitus. The prevalence was lower in men than in women, and patients with inflammatory joint disease were at less risk than those with osteoarthritis. Given this high association, great care should be taken to diagnose or exclude coexistent Carpal Tunnel Syndrome in patients scheduled for basal joint surgery so that, if present, it can be treated at the same time, diminishing the risk of postoperative morbidity and delayed symptoms.
Nagi Saad - One of the best experts on this subject based on the ideXlab platform.
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High prevalence of Carpal Tunnel Syndrome in individuals with rare nerve growth factor-beta mutation
'Oxford University Press (OUP)', 2020Co-Authors: Ridderström Mikael, Svantesson Mats, Thorell Oumie, Magounakis Theofilos, Minde Jan, Olausson Håkan, Nagi SaadAbstract:In Sweden, a large family with a point mutation in the nerve growth factor-beta gene has previously been identified. The carriers of this mutation have reduced small-fiber density and selective deficits in deep pain and temperature modalities. The clinical findings in this population are described as hereditary sensory and autonomic neuropathy type V. The purpose of the current study was to investigate the prevalence of Carpal Tunnel Syndrome in hereditary sensory and autonomic neuropathy type V based on clinical examinations and electrophysiological measurements. Further, the cross-sectional area of the median nerve at the Carpal Tunnel inlet was measured with ultrasonography. Out of 52 known individuals heterozygous for the nerve growth factor-beta mutation in Sweden, 23 participated in the current study (12 males, 11 females; mean age, 55 years; range, 25 to 86 years). All participants answered a health questionnaire and underwent clinical examination followed by median nerve conduction study in a case-control design, and measurement of the nerve cross-sectional area with ultrasonography. The diagnosis of Carpal Tunnel Syndrome was made based on consensus criteria using patient history and nerve conduction study. The prevalence of Carpal Tunnel Syndrome in the hereditary sensory and autonomic neuropathy group was 35% (95% CI 19-55%) or 52% (95% CI 37-74%) depending on whether those individuals who had classic symptoms of Carpal Tunnel Syndrome but negative nerve conduction studies were included or not. Those who had a high likelihood of Carpal Tunnel Syndrome based on classic/probable patient history with positive nerve conduction study had a significantly larger median nerve cross-sectional area than those who had an unlikely patient history with negative nerve conduction study. The prevalence of Carpal Tunnel Syndrome was 10 to 25 times higher in individuals heterozygous for the nerve growth factor-beta mutation than the general Swedish population. Further studies are needed to better understand the underlying pathophysiological mechanisms
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High prevalence of Carpal Tunnel Syndrome in individuals with rare nerve growth factor-beta mutation
'Oxford University Press (OUP)', 2020Co-Authors: Ridderström Mikael, Svantesson Mats, Thorell Oumie, Magounakis Theofilos, Minde Jan, Olausson Håkan, Nagi SaadAbstract:In Sweden, a large family with a point mutation in the nerve growth factor-beta gene has previously been identified. The carriers of this mutation have reduced small-fiber density and selective deficits in deep pain and temperature modalities. The clinical findings in this population are described as hereditary sensory and autonomic neuropathy type V. The purpose of the current study was to investigate the prevalence of Carpal Tunnel Syndrome in hereditary sensory and autonomic neuropathy type V based on clinical examinations and electrophysiological measurements. Further, the cross-sectional area of the median nerve at the Carpal Tunnel inlet was measured with ultrasonography. Out of 52 known individuals heterozygous for the nerve growth factor-beta mutation in Sweden, 23 participated in the current study (12 males, 11 females; mean age, 55 years; range, 25 to 86 years). All participants answered a health questionnaire and underwent clinical examination followed by median nerve conduction study in a case-control design, and measurement of the nerve cross-sectional area with ultrasonography. The diagnosis of Carpal Tunnel Syndrome was made based on consensus criteria using patient history and nerve conduction study. The prevalence of Carpal Tunnel Syndrome in the hereditary sensory and autonomic neuropathy group was 35% (95% CI 19-55%) or 52% (95% CI 37-74%) depending on whether those individuals who had classic symptoms of Carpal Tunnel Syndrome but negative nerve conduction studies were included or not. Those who had a high likelihood of Carpal Tunnel Syndrome based on classic/probable patient history with positive nerve conduction study had a significantly larger median nerve cross-sectional area than those who had an unlikely patient history with negative nerve conduction study. The prevalence of Carpal Tunnel Syndrome was 10 to 25 times higher in individuals heterozygous for the nerve growth factor-beta mutation than the general Swedish population. Further studies are needed to better understand the underlying pathophysiological mechanisms.Funding agencies:This work was supported by Region Norrbotten (FOU), ALF Grants Region Ostergotland (LIO-900631), and Svenska Lakaresallskapet (The Swedish Society of Medicine, SLS-935894). The funding bodies had no role in the design or the execution of this study.
Hyun Sik Gong - One of the best experts on this subject based on the ideXlab platform.
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Carpal Tunnel Syndrome and radiographically evident basal joint arthritis of the thumb in elderly koreans
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Chang Ho Shin, Namjong Paik, Jaeyoung Lim, Tae Kyun Kim, Ki Woong Kim, Jung Jae Lee, Joon Hyuk Park, Goo Hyun Baek, Hyun Sik GongAbstract:BACKGROUND Previous studies have suggested a high prevalence of Carpal Tunnel Syndrome in patients seeking treatment for basal joint arthritis of the thumb. The purpose of this study was to compare the prevalence of Carpal Tunnel Syndrome between individuals with and those without radiographic evidence of basal joint arthritis of the thumb in the general elderly Korean population, and to determine if there is a correlation between the severity of Carpal Tunnel Syndrome shown by electrophysiological studies and the severity of basal joint arthritis as seen on radiographs. METHODS We evaluated hand radiographs and nerve conduction studies of 192 men and 176 women (more than sixty-five years of age) who participated in the Korean Longitudinal Study on Health and Aging. The basal joint of the thumb was assigned a grade for osteoarthritis of 0 to 4 on radiographs with use of the Kellgren and Lawrence criteria. The diagnosis of Carpal Tunnel Syndrome was based on the combination of a positive response to survey questions and a positive nerve conduction study. Motor distal latency and motor conduction velocity were measured to assess the electrophysiological severity of Carpal Tunnel Syndrome. RESULTS The prevalence of Carpal Tunnel Syndrome was 16.7% in the group with basal joint arthritis and 10.9% in the group without basal joint arthritis, a difference that was not significant (p = 0.249). Neither motor distal latency nor motor conduction velocity was significantly correlated with the severity of the basal joint arthritis in the entire group of 368 study subjects (p = 0.154 and p = 0.662, respectively) or in those with Carpal Tunnel Syndrome (p = 0.603 and p = 0.998, respectively). CONCLUSIONS This study of Koreans who were more than sixty-five years of age showed that the prevalence of Carpal Tunnel Syndrome is similar in patients with and those without radiographic findings of basal joint arthritis of the thumb. We found no correlation between the electrophysiological severity of Carpal Tunnel Syndrome and the severity of basal joint arthritis.
Lester E Wold - One of the best experts on this subject based on the ideXlab platform.
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a histological and immunohistochemical study of the subsynovial connective tissue in idiopathic Carpal Tunnel Syndrome
Journal of Bone and Joint Surgery American Volume, 2004Co-Authors: Anke M Ettema, Peter C. Amadio, Chunfeng Zhao, Lester E WoldAbstract:Background: The most common histological finding in Carpal Tunnel Syndrome is noninflammatory synovial fibrosis. The accumulated effect of minor injuries is believed to be an important etiologic factor in some cases of Carpal Tunnel Syndrome. We sought evidence of such injuries in the synovial tissue of patients with Carpal Tunnel Syndrome and in cadaver controls. Methods: We compared synovial specimens from thirty patients who had idiopathic Carpal Tunnel Syndrome with specimens from a control group of ten fresh-frozen cadavers of individuals who had not had an antemortem diagnosis of Carpal Tunnel Syndrome and who met the same exclusion criteria. Analysis included histological and immunohistochemical examination for the distribution of collagen types I, II, III, and VI and transforming growth factor-β (TGF-β) RI, RII, and RIII. Results: Histological examination showed a marked increase in fibroblast density, collagen fiber size, and vascular proliferation in the specimens from the patients compared with the control specimens (p < 0.001). Collagen types I and II were not found in the synovium of either the patients or the controls, but collagen type VI was a major component of both. Collagen type-III fibers were more abundant in the patients than in the controls (p < 0.001). Expression of TGF-β RI was found in the endothelial cells and fibroblasts in the patient and control specimens, with a marked increase in expression in the fibroblasts of the patients compared with that in the control tissue (p < 0.001). Conclusions: These findings are similar to those after injury to skin, tendon, and ligament and suggest that patients with idiopathic Carpal Tunnel Syndrome may have sustained an injury to the subsynovial connective tissue. Clinical Relevance: The changes demonstrated in the subsynovial connective tissue not only could lead to an increase in the volume of the contents in the Carpal Tunnel but also may alter its material properties, such as compliance and permeability to fluid flows, and vascularity. These changes may, in turn, predispose the subsynovial connective tissue to additional injury and contribute to the elevation in Carpal Tunnel pressure seen in patients with Carpal Tunnel Syndrome.