Computer Professionals and Carpal Tunnel Syndrome (CTS) The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. Recovery after carpal tunnel syndrome operation: the influence of the opposite hand, if operated on in the same session Effects of perineural steroid injections on median nerve conduction during the carpal tunnel release. An Aggressive Return‐to‐Work Program in Surgical Treatment of Carpal Tunnel Syndrome: A Comparison of Costs A Longitudinal Study of Industrial and Clerical Workers: Incidence of Carpal Tunnel Syndrome and Assessment of Risk Factors Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Sonographic Wrist Measurements and Detection of Anatomical Features in Carpal Tunnel Syndrome The potential value of ultrasonography in the evaluation of carpal tunnel syndrome Sensitivity and specificity of carpal tunnel syndrome signs. Conservative treatment of carpal tunnel syndrome: an outcome study of adjunct exercises. Prevalence of carpal tunnel syndrome in a general population. Double-blind randomized controlled trial of low-level laser therapy in carpal tunnel syndrome. Sickness Absence from Work among Persons with New Physician-Diagnosed Carpal Tunnel Syndrome: A Population-Based Matched-Cohort Study Sonography versus nerve conduction studies in patients referred with a clinical diagnosis of carpal tunnel syndrome. Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome Splinting for carpal tunnel syndrome: in search of the optimal angle. Effect of ultrasound thermotherapy in mild to moderate carpal tunnel syndrome. Single-Portal Endoscopic Carpal Tunnel Release Compared with Open Release: A Prospective, Randomized Trial Prospective, Randomized Evaluation of Endoscopic Versus Open Carpal Tunnel Release in Bilateral Carpal Tunnel Syndrome: An Interim Analysis Carpal tunnel syndrome: diagnostic usefulness of sonography.
Carpal Tunnel Syndrome ( CTS ) is an important problem among computer professionals . Hence the prevalence of CTS among computer professionals and risk factors were studied . 648 subjects were selected from 4,276 computer professionals from 21 companies with a simple r and om sampling method . CTS was diagnosed based on clinical features . The prevalence of CTS was found to be 13.1 % ( 95 % CI 10.5–15.7 % ) . Subjects with over 8 years of computer work , over 12 hrs of work per day and system administrators were at a higher risk for CTS ( OR 3.3 , 4.9 and 2.5 respectively ) . Flexed or extended h and position had higher risk for CTS . Higher risk for CTS was found with higher exposure to computer work . Ergonomic considerations are important in facilitating proper positioning of h and while working with a computer . Further studies on CTS risk factors among computer professionals are essential for planning prevention BACKGROUND There is no clear-cut consensus on the best diagnostic criteria for carpal tunnel syndrome . The objective of this study was to compare the probability of carpal tunnel syndrome being present following electrodiagnostic testing with the probability of it being present after the diagnosis was established on the basis of a clinical evaluation alone . METHODS The study sample included patients with any peripheral nerve diagnosis who had been referred to the electrodiagnostic laboratory of an academic health-care center . The probability of carpal tunnel syndrome before electrodiagnostic testing ( pretest probability ) was estimated with use of the CTS-6 , a vali date d clinical diagnostic aid that is used to estimate the probability of carpal tunnel syndrome on the basis of the presence or absence of six clinical findings recorded as part of the history or noted on physical examination . All patients then underwent a st and ard electrodiagnostic assessment of the median nerve by a neurologist blinded to the result of the CTS-6 evaluation . Sensory nerve conduction velocity was used to classify the result of the electrodiagnostic testing as either positive or negative for carpal tunnel syndrome with use of two different criteria ( one stringent and one lax ) derived from the literature . The main outcome measure was the difference between the pretest and posttest probabilities of carpal tunnel syndrome . RESULTS One hundred and forty-three patients were studied . The pretest probability of carpal tunnel syndrome ranged between 0.10 and 0.99 ( mean [ and st and ard deviation ] , 0.81 + /- 0.22 ) . Seventy-three percent of the patients had a pretest probability of at least 0.80 . The average change in probability for these patients was -0.02 when the stringent electrodiagnostic criterion was used and -0.06 when the lax criterion was used . With either electrodiagnostic criterion , the majority of the large changes in probability were for patients for whom the pretest probability was < or = 0.50 . The probability of carpal tunnel syndrome was lowered after the electrodiagnostic testing in most of these cases . CONCLUSIONS For the majority of patients who are considered to have carpal tunnel syndrome on the basis of their history and physical examination alone , electrodiagnostic tests do not change the probability of diagnosing this condition to an extent that is clinical ly relevant Abstract In a clinical , retrospectively r and omised study , we compared the results of the operation for a carpal tunnel syndrome when one side only or both sides were simultaneously assessed in one session . Of the 125 patients examined , 47.2 % had both h and s operated on in one session , 52.8 % had only one h and operated on in one session or both h and s in two sessions . We found the bilateral simultaneous operation to be associated with better results concerning earlier return to work , earlier relief of symptoms and better patient satisfaction than the operation on one side only . These are explained by the necessity of using both h and s for daily activities and thus a guaranteed functional follow-up treatment after the bilateral operation . In conclusion , we propose operating on both h and s simultaneously whenever possible , even if the opposite h and presents with only a slight CTS , which would otherwise not be considered for operation yet BACKGROUND / AIM The treatment outcome of the median nerve compressive neuropathy in the carpal zone due to carpal tunnel syndrome ( CTS ) is represented by recovering the nerves sensibility , conductivity , condition and strength . Perineural application of betamethasone during the surgical decompression might result in faster recovery of compressed median nerve 's conduction speed . METHODS In this study 40 patients with CTS were r and omly divided in the two groups . In the first group ( n = 20 ) we performed the surgical decompression of the median nerve by the open release of the carpal tunnel , and in the second group ( n = 20 ) we applicated a perineural injection of 1 ml of betamethason immediately after the surgical decompression . We performed the electrodiagnostic ( ED ) examinations 7 , 30 and 90 days after the surgery , and measured the conduction speed of the median nerve in the carpal tunnel zone and the sensitivity conduction speed of the median nerve . RESULTS Significant differences in examined ED respective variable values in different time intervals were obtained . At the final measurements , 90 days after the surgical procedure , both groups evidence d a full recovery of the conduction speed in the carpal tunnel with statistically significant better results in the second group of the patients ( t = -2.116 ; p = 0.043 ) . CONCLUSION Intraoperative application of the corticosteroid injection during the surgical decompression results in faster regaining of conduction speed of the median nerve Carpal tunnel syndrome is a common malady associated with modern manufacturing . An aggressive return-to-work program was begun in 1980 . A prospect i ve study was begun in 1982 , and data matured through 1988 comparing the costs of a control group of patients treated by the more traditional method ( in the author 's geographic area ) and the author 's aggressive return-to-work policy .  Sixty-seven patients with 94 carpal tunnel surgeries were studied . The results reveal that the aggressively treated group had 1 of 44 patients fail to return to work following surgery , and 3 of 23 failed to return to work from the control group . One patient of each group developed a recurrence . The tangible costs that could be computed were found to be 58 percent less in the aggressively treated group than in the control group . At the same time , the patients can maintain their st and ard of living This study followed workers over an extended period of time to identify factors which may influence the onset of  Carpal Tunnel Syndrome ( CTS ) . The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS . This prospect i ve study followed 432 industrial and clerical workers over 5.4 years . Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening . On the basis of logistic regression , significant predictors for CTS include baseline median-ulnar peak latency difference , a history of wrist/h and /finger tendonitis , a history of numbness , tingling , burning , and /or pain in the h and , and work above the action level of the peak force and h and activity level threshold limit value . This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS OBJECTIVES To determine whether nocturnal splinting of workers identified through active surveillance with symptoms consistent with carpal tunnel syndrome ( CTS ) would improve symptoms and median nerve function as well as impact medical care . DESIGN R and omized controlled trial . SETTING A Midwestern auto assembly plant . PARTICIPANTS Active workers with symptoms suggestive of CTS based on a h and diagram . INTERVENTION The treatment group received customized wrist splints , which were worn at night for 6 weeks ; the control group received ergonomic education alone . MAIN OUTCOME MEASURES Change in wrist , h and , and /or finger discomfort , carpal tunnel symptom severity index , median sensory nerve function , and the percentage of subjects who had carpal tunnel release surgery . RESULTS The splinted group , unlike the controls , had a significant reduction in wrist , h and , and /or finger discomfort and a similar trend in the Levine carpal tunnel symptom severity index , which was maintained at 12 months . A secondary analysis showed that more median nerve impairment at baseline was associated with less clinical improvement among controls but not among the splinted group . CONCLUSIONS Workers identified with CTS symptoms in an active symptom surveillance tended to benefit from a 6-week nocturnal splinting trial , and the benefits were still evident at the 1-year follow-up . The splinted group improved in terms of h and discomfort regardless of the degree of median nerve impairment , whereas the controls showed improvement only among subjects with normal median nerve function . Results suggest that a short course of nocturnal splinting may reduce wrist , h and , and /or finger discomfort among active workers with symptoms consistent with CTS Introduction . This study compares anatomical findings at wrist level in patients with known carpal tunnel syndrome ( CTS ) and controls by ultrasonography ( US ) . Material and Methods . Wrist-US investigations of 28 consecutive patients with 38 diagnosed , idiopathic CTS were compared to 49 healthy volunteers without history of CTS . Internal wrists dimensions , the presence of flexor muscle bellies in the carpal tunnel , and cross-sectional area of the median nerve were analyzed . The findings were correlated to gender , age , and BMI . Results . US demonstrated a square internal carpal tunnel configuration in CTS patients compared to controls ( P < 0.001 ) . Patients with CTS showed a trend towards the presence of flexor muscles bellies in the carpal tunnel ( odds ratio 1.77 , 95 % CI 0.337–8.33 ) . CTS was present in women with  higher BMI  ( P = 0.015 ) . Conclusion . US allowed detection of specific anatomical features at wrist level in CTS patients . This observation may enable — following confirmation in larger prospect i ve studies —risk evaluation for CTS development The authors compared ultrasonography with electrophysiology for the diagnosis of  carpal tunnel syndrome ( CTS ) on 110 clinical ly affected wrists . An increased cross sectional area in the proximal carpal tunnel larger than 0.11 cm2 in combination with compression signs on longitudinal scans proved to be highly predictive for CTS ( sensitivity , 89.1 % ; specificity , 98.0 % ) . Ultrasound was comparable to electrophysiology in the diagnosis of CTS , and in 35 % of cases changes in morphology suggested a specific therapeutic strategy The sensitivity and specificity of six carpal tunnel syndrome ( CTS ) signs were determined by evaluating 143 subjects ( 228 h and s ) with symptoms of CTS . Immediately after performing the six physical examination tests , st and ard nerve conduction studies were performed on all 228 h and s to determine the presence or absence of CTS . CTS was present in 142 h and s and absent in 86 h and s. The signs were not very sensitive ( 23 - 69 % ) , but were fairly specific ( 66 - 87 % ) for CTS . A square-shaped wrist and abductor pollicis brevis weakness were the most sensitive signs ( 69 and 66 % , respectively ) , and are recommended as part of the examination of CTS . Median nerve hypesthesia and the Phalen sign both have fair sensitivity ( 51 % ) but good specificity ( 85 and 76 % , respectively ) . The median nerve compression sign and the Hoffmann-Tinel sign both have poor sensitivity ( 28 and 23 % , respectively ) , and thus are less helpful in evaluating subjects with suspected CTS We conducted a prospect i ve study to evaluate the effect of a new non-surgical protocol for treating carpal tunnel syndrome ( CTS ) . It incorporates the Carpal Tunnel Decompression Exercise Program ( Exercise Program ) into conventional non-surgical treatment .  Twenty-eight patients ( 33 h and s ) met the inclusion criteria and were followed for 18 months . The outcome measurement tools used were the Symptom Severity Scale ( SSS ) and the Functional Status Scale ( FSS ) . The outcome tools were administered at admission and repeated at 1 , 2 , and 18 months after admission to the treatment program . Using the adjunct treatment , 80 % of the h and s in the mild category and 71 % in the moderate category were successfully treated without surgery . All patients in the severe category required surgery . The average success rate of our adjunct non-surgical treatment protocol was 67 % , a substantial improvement over the 18 % to 34 % success rate reported nationally for conventional treatment methods . Furthermore , improvement in the outcome of carpal tunnel syndrome by the adjunct non-surgical treatment can result in significant savings in human suffering , medical cost , lost work time , and socioeconomic distress CONTEXT Carpal tunnel syndrome ( CTS ) is a cause of pain , numbness , and tingling in the h and s and is an important cause of work disability . Although high prevalence rates of CTS in certain occupations have been reported , little is known about its prevalence in the general population . OBJECTIVE To estimate the prevalence of CTS in a general population . DESIGN General health mail survey sent in February 1997 , inquiring about symptoms of pain , numbness , and tingling in any part of the body , followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the h and s , as well as of a sample of those not reporting these symptoms ( controls ) . SETTING A region in southern Sweden with a population of 170000 . PARTICIPANTS A sex- and age-stratified sample of 3000 subjects ( age range , 25 - 74 years ) was r and omly selected from the general population register and sent the survey , with a response rate of 83 % ( n = 2466 ; 46 % men ) . Of the symptomatic responders , 81 % underwent clinical examination . MAIN OUTCOME MEASURES Population prevalence rates , calculated as the number of symptomatic responders diagnosed on examination as having clinical ly certain CTS and /or electrophysiological median neuropathy divided by the total number of responders . RESULTS Of the 2466 responders , 354 reported pain , numbness , and /or tingling in the median nerve distribution in the h and s ( prevalence , 14.4 % ; 95 % confidence interval [ CI ] , 13.0%-15.8 % ) . On clinical examination , 94 symptomatic subjects were diagnosed as having clinical ly certain CTS ( prevalence , 3.8 % ; 95 % CI , 3.1%-4.6 % ) . Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects ( prevalence , 4.9 % ; 95 % CI , 4.1%-5.8 % ) . Sixty-six symptomatic subjects had clinical ly and electrophysiologically confirmed CTS ( prevalence , 2.7 % ; 95 % CI , 2.1%-3.4 % ) . Of 125 control subjects clinical ly examined , electrophysiological median neuropathy was found in 23 ( 18.4 % ; 95 % CI , 12.0%-26.3 % ) . CONCLUSION Symptoms of pain , numbness , and tingling in the h and s are common in the general population . Based on our data , 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and  electrophysiologic testing Several studies have suggested that low-level laser therapy ( LLLT ) is effective in patients with carpal tunnel syndrome ( CTS ) . In a double-blind r and omized controlled trial of LLLT , 15 CTS patients , 34 to 67 years of age , were r and omly assigned to either the control group ( n = 8) or treatment group ( n = 7 ) . Both groups were treated three times per week for 5 weeks . Those in the treatment group received 860 nm galium/aluminum/arsenide laser at a dosage of 6 J/cm2 over the carpal tunnel , whereas those in the control group were treated with sham laser . The primary outcome measure was the Levine Carpal Tunnel Syndrome Question naire , and the secondary outcome measures were electrophysiological data and the Purdue pegboard test .  All patients completed the study without adverse effects .  There was a significant symptomatic improvement in both the control ( P = 0.034 ) and treatment ( P = 0.043 ) groups . However , there was no significant difference in any of the outcome measures between the two groups . Thus , LLLT is no more effective in the reduction of symptoms of CTS than is sham treatment Background Carpal tunnel syndrome is common among employed persons . Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational population s. We aim ed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population . Methods In Skåne region in Sweden we identified all subjects , aged 17–57 years , with new physician-made diagnosis of carpal tunnel syndrome during 5 years ( 2004–2008 ) . For each subject we r and omly sample d , from the general population , 4 matched reference subjects without carpal tunnel syndrome ; the two cohorts comprised 5456 and 21,667 subjects , respectively ( 73 % women ; mean age 43 years ) . We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis . Of those with carpal tunnel syndrome 2111 women ( 53 % ) and 710 men ( 48 % ) underwent surgery within 24 months of diagnosis . We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery . Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort . A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12 % of the women ( n = 492 ) and 11 % of the men ( n = 170 ) and with surgery in 53 % ( n = 1121 ) and 58 % ( n = 408 ) of the surgically treated , respectively ; median duration in conjunction with surgery was 35 days ( IQR 27–45 ) for women and 41 days ( IQR 28–50 ) for men . Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis . Gender differences were small PURPOSE To compare the diagnostic value of high-resolution ultrasound ( US ) with nerve conduction studies ( NCS ) in patients with clinical ly defined carpal tunnel syndrome ( CTS ) . METHODS A prospect i ve study was conducted on 66 consecutive patients investigated for sensory h and symptoms . The gold st and ard was the clinical diagnosis of CTS . RESULTS NCS showed greater diagnostic sensitivity ( 82 % ) than US ( 62 % ) in supporting a diagnosis of CTS . With increasing neurophysiologic severity of median neuropathy , there was increasing convergence of the two test methods . Abnormal US as the only diagnostic supportive evidence of CTS was rare . However , the positive predictive value of US for CTS was 100 % . CONCLUSION NCS show better sensitivity than US in supporting a diagnosis of CTS . However , because of its high positive predictive value , one may consider using US as a screening test , eliminating the need for NCS in the majority of clinical suspicion of CTS and reserving NCS for cases in which US is negative OBJECTIVE To investigate whether real or sham low-level laser therapy ( LLLT ) plus microamperes transcutaneous electric nerve stimulation ( TENS ) applied to acupuncture points significantly reduces pain in carpal tunnel syndrome ( CTS ) . DESIGN R and omized , double-blind , placebo-control , crossover trial . Patients and staff administered outcome measures blinded . SETTING Outpatient , university-affiliated Department of Veterans Affairs medical center . PARTICIPANTS Eleven mild to moderate CTS cases ( nerve conduction study , clinical examination ) who failed st and ard medical or surgical treatment for 3 to 30 months . INTERVENTION Patients received real and sham treatment series ( each for 3 - 4wk ) , in a r and omized order . Real treatments used red-beam laser ( continuous wave , 15mW , 632.8 nm ) on shallow acupuncture points on the affected h and , infrared laser ( pulsed , 9.4W , 904 nm ) on deeper points on upper extremity and cervical paraspinal areas , and microamps TENS on the affected wrist . Devices were painless , noninvasive , and produced no sensation whether they were real or sham . The h and was treated behind a hanging black curtain without the patient knowing if devices were on ( real ) or off ( sham ) . MAIN OUTCOME MEASURES McGill Pain Question naire ( MPQ ) score , sensory and motor latencies , and Phalen and Tinel signs . RESULTS Significant decreases in MPQ score , median nerve sensory latency , and Phalen and Tinel signs after the real treatment series but not after the sham treatment series . Patients could perform their previous work ( computer typist , h and yman ) and were stable for 1 to 3 years . CONCLUSIONS This new , conservative treatment was effective in treating CTS pain ; larger studies are recommended Orthodromic SNAPs were recorded over the median nerve using needle electrodes at the wrist and elbow after stimulation of the thumb and middle fingers . CMAPs were recorded with concentric needle electrodes placed in the endplate zone of the APB after stimulation at the wrist and elbow . NCVs were determined for 28 male and 20 female normal subjects aged 16 to 62 years . There was no significant difference in NCV between male and female subjects . There was a decrease in NCV with increasing age . No CTS patients were studied . 186 . Occupational Disease Surveillance . Carpal tunnel syndrome . MMWR Morb Mortal Wkly Rep 1989;38:485 - 489 . Background Reference Source : Baker , 1990 . 187 . * Osborn JB , Newell KJ , Rudney JD , Stoltenberg JL . Carpal tunnel syndrome among Minnesota dental hygienists . J Dent Hyg 1990;64(2):79 - 85 . Criteria Met ( 2/6 : 1,2 ) Source : Medline Search . 188 . Padua L , Lo Monaco M , Valente EM , Tonali PA . A useful electrophysiologic parameter for diagnosis of carpal tunnel syndrome . Muscle Nerve 1996;19:48 - 53 . Criteria Met ( 6/6 : 1,2,3,4,5,6 ) . Source : Medline Search . Abstract : In 43 patients ( 50 h and s ) with clinical manifestations of mild-moderate CTS and 36 healthy volunteers ( 40 h and s ) , orthodromic sensory nerve conduction velocity ( SNCV ) was measured with surface electrodes in the median nerve between the third digit and palm and between the palm and wrist . These figures were used to calculate the ratio of distal to proximal conduction ( distoproximal ratio ) . All 90 h and s were also subjected to other nerve conduction studies used for diagnosis of CTS . All control h and s presented distoproximal ratios less than 1.0 reflecting higher conduction rates in the proximal segment . In contrast , 49 of 50 CTS h and s ( 98 % ) presented reversed ratios ( > 1.0 ) indicating compromised proximal conduction . The sensitivity of this test was significantly greater than that of other methods evaluated , including comparative studies and segmental study of the palm-wrist portion of the median nerve . Segmental study of median SNCV with calculation of the distoproximal ratio is a sensitive technique for diagnosis of CTS in patients with normal findings in st and ard nerve conduction studies . Note : The author indicated by correspondence that the mean ± SD for the Control DML in Table 1 should read 3.2 ± 0.4 and not 3.2 ± 0.8 as published . 189 . Padua L , LoMonaco M , Gregori B , Valente EM , Padua R , Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome h and s. Acta Neurol Sc and 1997;96:211 - 217 . Criteria Med ( 6/6 : 1,2,3,4,5,6 ) Source : Medline Search . Abstract : Prospect i ve study of 500 h and s ( 379 patients ) with clinical diagnosis of CTS symptoms . Normal values from the same laboratory previously published ( Padua , 1996 ) . In the 500 CTS patients , DML was prolonged ( 55 % ) , median orthodromic sensory latency was prolonged ( D2 , 74 % ; D3 , 67 % ) . Of the remaining 117 patients with normal DML and median orthodromic sensory studies over 14 cm , the median sensory palmwrist NCV over 8 cm was abnormal in 21 % and the distoproximo ratio of the median palm and digit segments was abnormal in 87 % . 190 . Palliyath SK , Holden L. Refractory studies in early detection of carpal tunnel syndrome . Electromyogr Clin Neurophysiol 1990;30:307 - 309 . Criteria Met ( 5/6 : 1,3,4,5,6 ) Source : Medline Search . Abstract : Using paired stimuli and varying the inter-stimulus interval , the absolute refractory period ( ARP ) and relative refractory period ( RRP ) , were determined in 10 patients with mild electrophysiologic changes suggestive of CTS . They found that the sensory RRP was sensitive in diagnosing early CTS . 191 . * Pavesi G , Olivieri MF , Misk A , Mancia D. Clinical electrophysiological correlations in the carpal tunnel syndrome . Ital J Neurol Sci 1986;7:93 - 96 . Criteria Met ( 3/6 : 2,3,5 ) Source : Medline Search . 192 . Pease WS , Cannell CD , Johnson EW . Median to radial latency difference test in mild carpal tunnel syndrome . Muscle Nerve 1989;12:905 - 909 . Criteria Met ( 4/6 : 1,3,5,6 ) Source : Medline Search . Abstract : The following techniques were studied : ( a ) antidromic DSL median radial differences to the thumb , ( b ) antidromic DSL after stimulation at the wrist and recording from the third digit , ( c ) median mid-palmar DSL compared as a ratio of the wrist to middle finger DSL , ( d ) median ulnar DSL latency difference between the ulnar Practice Parameter : Carpal Tunnel Syndrome Muscle & Nerve Supplement X 2002 S971 SNAP recorded from the little finger after stimulation at the wrist and the median DSL after stimulation at the wrist and recording from the middle finger , and ( e ) median motor DML after recording from the APB after stimulation at the wrist .  Three hundred thirty-three symptomatic h and s in 262 patients were initially evaluated with subgroups of patients with CTS evaluated with different tests . The median radial DSL difference and median ulnar DSL difference were most likely to be abnormal followed by median DSL then the palmto-wrist DSL latency ratio and lastly the DML . 193 . Pease WS , Cunningham ML , Walsh WE , Johnson EW . Determining neurapraxia in carpal tunnel syndrome . Am J Phys Med Rehabil 1988;67:117 - 119 . Criteria Met ( 5/6 : 1,3,4,5,6 ) Source : Medline Search . Abstract : With needle stimulation at the wrist and midpalm , CMAPs were recorded over the APB in 25 CTS patients and 23 healthy asymptomatic persons . They found a significant difference in the amplitude of the CMAP in the CTS group when compared to the control group . They propose that this is evidence for conduction block ( neurapraxia ) in CTS . 194 . Pease WS , Lee HH , Johnson EW . Forearm median nerve conduction velocity in carpal tunnel syndrome . Electromyogr Clin Neurophysiol 1990;30:299 - 302 . Criteria Met ( 4/6 : 1,3,4,5 ) Source : Medline Search . Abstract : The NCV of the median nerve in the forearm was determined by 2 methods : ( a ) stimulation in the forearm and recording the nerve action potential at the wrist , and ( b ) stimulation at the wrist and elbow with recording over the APB , in 21 CTS patients and 16 control subjects . They found that the forearm NCV was slowed in the CTS group using either technique . The authors have proposed that this suggest that there is proximal nerve dysfunction as a result of median nerve compression in the carpal tunnel . 195 . * Peterson GW , Will AD . Newer electrodiagnostic techniques in peripheral nerve injuries . Orthop Clin North Am 1988;19:13 - 25 . Criteria Met ( 0/6 ) Source : Narkis , 1990 . 196 . * Phalen GS . The carpal tunnel syndrome : clinical evaluation of 598 h and s. Clin Orthop 1972;83:29 - 40 . Background Reference . Source : Katz 1990 ( J Rheumatology ) . 197 . * Phalen GS . The carpal tunnel syndrome : seventeen years ’ experience in diagnosis and treatment of 654 h and s. J Bone Joint Surg 1966;48:211 - 228 . Criteria Met ( 1/6 : 2 ) Source : Meyers , 1989 . 198 . Phalen GS , Gardner WJ , LaLonde AA . Neuropathy of the median nerve due to compression beneath the transverse carpal ligament . J Bone Joint Surg 1950;32-A:109 - 112 . Background Reference . Source : Braun , 1989 . 199 . Plaja J. Comparative value of different electrodiagnostic methods in carpal tunnel syndrome . Scan J Rehabil Med 1971;3:101 - 108 . Criteria Met ( 4/6 : 1,3,5,6 ) Source : Joynt , 1989 . Abstract : The following techniques were studied : ( a ) CMAP potentials were recorded after stimulation at the wrist and recording with coaxial needle electrodes , ( b ) orthodromic SNAPs with stimulation over the index finger and recording with surface electrodes at the wrist , ( c ) needle EMG using a coaxial needle  , ( d ) strength/ duration curves and chronaxy .  Fifty-six cases of CTS and 20 normal subjects were evaluated .  Sensory latencies were more likely to be abnormal than the other techniques measured . 200 . Preston DC , Logigian EL . Lumbrical and interossei recording in carpal tunnel syndrome [ see comments ] . Muscle Nerve 1992 ; 15 : 1253 - 1257 . Criteria Met ( 5/6 : 1,3,4,5,6 ) Source : Medline Search . Abstract : Median motor studies are commonly “ normal ” in mild carpal tunnel syndrome ( CTS ) . This reflects either the sparing of motor compared to sensory fibers , or the inability of conventional studies to detect an abnormality . A novel approach to demonstrate early motor fiber involvement in CTS is the placement of the same active electrode lateral to the third metacarpal , allowing recording from the second lumbrical or the deeper interossei , when stimulating the median or ulnar nerves at the wrist , respectively . We compared the difference between these latencies in 51 normal control h and s to 107 consecutive patient h and s referred with symptoms and signs suggestive of CTS , who were subsequently proven to have electrophysiologic CTS by st and ard nerve conduction criteria . A prolonged lumbrical-interossei latency difference ( > 0.4 ms ) was found to be a sensitive indicator of CTS in all patient groups . It was also helpful in patients with coexistent polyneuropathy , where localization of median nerve pathology at the wrist was otherwise difficult . 201 . * Preston DC , Ross MH , Kothari MJ , Plotkin GM , Venkatesh S , Logigian EL . The median-ulnar latency difference studies are comparable in mild carpal tunnel syndrome . Muscle Nerve 1994 ; 17 : 1469 - 1471 . Criteria Met ( 2/6 : 1,3 ) . Source : Medline Search . Abstract : Compares sensitivity 159 patients of orthodromic palm-wrist mixed palmar median-ulnar peak latency difference with normal < 0.4 ms , antidromic wrist-D4 sensory median-ulnar onset latency difference with normal < 0.5 ms , and the second lumbrical/interossei motor with normal < 0.5 ms . See discussion of benefits of techniques and diagrams of electrode placements and line drawings of electrode and stimulator placement . 202 . Preswick G. The effect of stimulus intensity in motor latency in carpal tunnel syndrome . J Neurol Neurosurg Psychiatry 1963;26:398 - 401 . Criteria Met ( 4/6 : 1,3,5,6 ) Source : Loong , 1971 . Abstract : With stimulation at the wrist and coaxial needle electrode recording from the APB , DMLs were recorded at super-maximal stimulation and threshold stimulation in 29 CTS h and s Background : Decompressive surgery and steroid injection are widely used forms of treatment for carpal tunnel syndrome ( CTS ) but there is no consensus on their effectiveness in comparison to each other . The authors evaluated the efficacy of surgery vs steroid injection in relieving symptoms in patients with CTS . Methods : The authors conducted a r and omized , single blind , controlled trial . Fifty patients with electrophysiologically confirmed idiopathic CTS were r and omized and assigned to  open carpal tunnel release  ( 25 patients ) or to a  single injection of steroid ( 25 patients ) . Patients were followed up at 6 and 20 weeks . The primary outcome was symptom relief in terms of the Global Symptom Score ( GSS ) , which rates symptoms on a scale of 0 ( no symptoms ) to 50 ( most severe ) . Nerve conduction studies and grip strength measurements were used as secondary outcome assessment s. Results : At 20 weeks after r and omization , patients who underwent surgery had greater symptomatic improvement than those who were injected . The mean improvement in GSS after 20 weeks was 24.2 ( SD 11.0 ) in the surgery group vs 8.7 ( SD 13.0 ) in the injection group ( p < 0.001 ) ; surgical decompression also result ed in greater improvement in median nerve distal motor latencies and sensory nerve conduction velocity . Mean grip strength in the surgical group was reduced by 1.7 kg ( SD 5.1 ) compared with a gain of 2.4 kg ( SD 5.5 ) in the injection group . Conclusion : Compared with steroid injection , open carpal tunnel release result ed in better symptomatic and neurophysiologic outcome but not grip strength in patients with idiopathic carpal tunnel syndrome over a 20-week period Carpal tunnel syndrome ( CTS ) is the most common of the compression neuropathies . Several studies have demonstrated the efficacy of wrist splinting in relieving the symptoms of CTS ; however , the chosen angle of immobilization has varied . Wick catheter measurements of carpal tunnel pressures suggest that the neural position has less pressure and , therefore , greater potential to provide relief from symptoms . This study is a prospect ively gathered , blind trial comparing the symptom relief experienced by wearers of splints immobilized at 20 degrees extension and at neutral . The results indicate that the neutral angle provided superior symptom relief , and that the relief did not often improve between 2 weeks and 2 months of wear . Relief of symptoms was not related to the length of time that the patient had experienced of CTS symptoms . The results also indicate that the results of the electromyography/nerve conduction study ( EMG/NCS ) do not provide information about the subjects ' likely response to splinting OBJECTIVE To investigate the efficacy of low intensity ultrasound thermotherapy , a conservative option of treatment of mild to moderate carpal tunnel syndrome ( CTS ) . DESIGN Prospect i ve experimental , placebo- controlled , before-after treatment trial . SETTING King Chulalongkorn Memorial Hospital , Outpatient Clinic and Electrodiagnostic Laboratory , Department of Rehabilitation Medicine . PATIENTS Eighteen women , 30 h and s who had clinical and electrophysiologic evidence of mild to moderate CTS . INTERVENTIONS Patients of CTS were divided into two groups ; A and B of 15 h and s by r and om sampling . Group A was given placebo and continuous ultrasound therapy with the intensity of 0.5 W/cm2 applied to the palmar carpal tunnel for 10 minutes . Group B was given Diclofenac 75 mg/day in divided doses and sham ultrasound . The ultrasound was applied 5 days a week for 4 weeks . OUTCOME MEASURES Each patient was clinical ly and electrophysiologically evaluated before and after treatment . RESULTS There were statistically significant improvements ( p < 0.05 ) , in the clinical parameters of both groups after treatment . In the electrophysiologic study , the median SNAP amplitude was increased significantly after the treatment in ultrasound group ( group A ) . When both groups were compared , group A had significant difference in increasing of median SNAP amplitude after treatment . CONCLUSION The therapeutic efficacy of low intensity ultrasound thermotherapy was satisfied for mild to moderate CTS . However , the electrophysiological changes after ultrasound treatment need further investigation Background : Carpal tunnel syndrome is a common condition causing h and pain and numbness .  Endoscopic carpal tunnel release has been demonstrated to reduce recovery time , although previous studies have raised concerns about an increased rate of complications . The purpose of this prospect i ve , r and omized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release . Methods : A prospect i ve , r and omized , multicenter center study was performed on 192 h and s in 147 patients . The open method was performed in ninety-five h and s in seventy-two patients , and the  endoscopic method  was performed in ninety-seven h and s in seventy-five patients . All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to , or had refused , nonoperative management . Follow-up evaluations with use of vali date d outcome instruments and quantitative measurements of grip strength , pinch strength , and h and dexterity were performed at two , four , eight , twelve , twenty-six , and fifty-two weeks after the surgery . Complications were identified . The cost of the procedures and the time until return to work were recorded and compared between the groups . Results : During the first three months after surgery , the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores , better Carpal Tunnel Syndrome Functional Status Scores , and better subjective satisfaction scores . During the first three months after surgery , they also had significantly ( p < 0.05 ) greater grip strength , pinch strength , and h and dexterity . The open technique result ed in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work ( median , thirty-eight days compared with eighteen days after the endoscopic release ) . No technical problems with respect to nerve , tendon , or artery injuries were noted in either group . There was no significant difference in the rate of complications or the cost of surgery between the two groups . Conclusion : Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used . Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome Background Most r and omized trials have shown similar results with endoscopic carpal tunnel release ( ECTR ) and open carpal tunnel release ( OCTR ) ; however , there are studies suggesting less postoperative pain , faster improvement in grip and pinch strength , and earlier return to work with the endoscopic technique . The goal of this study was to prospect ively examine subjective and functional outcomes , satisfaction , and complications after both ECTR and OCTR in the opposite h and s of the same patient , serving as their own control . Methods This was a prospect i ve , r and omized study in which patients underwent surgery for bilateral carpal tunnel syndrome . The first carpal tunnel release was performed on the most symptomatic h and —determined by the patient . Operative approach was r and omly assigned and , approximately 1 month later , the alternative technique was performed on the contralateral side . Demographic data were obtained , and functional outcomes were recorded preoperatively and postoperatively , including pain score , 2-point discrimination , Semmes-Weinstein monofilament testing , thenar strength , and overall grip strength . The carpal tunnel syndrome-functional status score and carpal tunnel syndrome-symptom severity score were recorded before surgery and at 2 , 4 , 8 , 12 , and 24 weeks postoperatively . Overall satisfaction with each technique was recorded at the conclusion of the study . Results Currently , 25 subjects have completed final visit testing . There were no differences in pain score , 2-point discrimination , Semmes-Weinstein monofilament testing , thenar strength , or overall grip strength at any of the postoperative time points . Carpal tunnel syndrome-symptom severity score and carpal tunnel syndrome-functional status score were not significantly different between groups at any of the evaluations . Overall satisfaction , where patients recorded a number from 0 to 100 , was significantly greater in the ECTR group ( 95.95 vs 91.60 , P = 0.04 ) . There were no complications with either technique . Discussion This interim analysis , using the same patient as an internal control , suggests that both OCTR and ECTR are well tolerated with no differences in functional outcomes , symptom severity and functional status question naires , or complications . Although there were no differences between groups using our study metrics , patients still preferred the ECTR , demonstrated by significantly higher overall satisfaction scores at the conclusion of the study PURPOSE To prospect ively evaluate accuracy of sonography for diagnosis of carpal tunnel syndrome ( CTS ) in patients clinical ly suspected of having the disease in one or both h and s. MATERIAL S AND METHODS A prospect i ve cohort of 133 patients suspected of having CTS were referred to a teaching hospital between October 2001 and June 2002 for electrodiagnostic study . One hundred twenty patients ( 98 women , 22 men ; mean age , 49 years ; range , 19 - 83 years ) underwent sonography  within 1 week after electrodiagnostic study . Radiologist was blinded to electrodiagnostic study results . Seventy-five patients had bilateral symptoms ; 23 patients , right-h and symptoms ; and 22 patients , left-h and symptoms ( total , 195 symptomatic h and s ) . Cross-sectional area of median nerve was measured at three levels : immediately proximal to carpal tunnel inlet , at carpal tunnel inlet , and at carpal tunnel outlet . Flexor retinaculum was used as a l and mark to margins of carpal tunnel . Optimal threshold levels ( determined with classification and regression tree analysis ) for areas proximal to and at tunnel inlet and at tunnel outlet were used to discriminate between patients with and patients without disease . Sensitivity , specificity , and false-positive and false-negative rates were derived on the basis of final diagnosis , which was determined with clinical history and electrodiagnostic study results as reference st and ard . RESULTS For right h and s , sonography had sensitivity of 94 % ( 66 of 70 ) ; specificity , 65 % ( 17 of 26 ) ; false-positive rate , 12 % ( nine of 75 ) ; and false-negative rate , 19 % ( four of 21 ) ( cutoff , 0.09 cm(2 ) proximal to tunnel inlet and 0.12 cm(2 ) at tunnel outlet ) . For left h and s , sensitivity was 83 % ( 53 of 64 ) ; specificity , 73 % ( 24 of 33 ) ; false-positive rate , 15 % ( nine of 62 ) ; and false-negative rate , 31 % ( 11 of 35 ) ( cutoff , 0.10 cm(2 ) proximal to tunnel inlet ) . CONCLUSION Sonography is comparable to electrodiagnostic study in diagnosis of CTS and should be considered as initial test of choice for patients suspected of having CTS
Conclusion There is insufficient epidemiological evidence that computer work causes CTS
Background This review examines evidence for an association between  computer work and carpal tunnel syndrome ( CTS ) .