Carpal Tunnel Syndrome with Thenar Atrophy: Evaluation of the Pinch and Grip Strength in Patients Undergoing Surgical Treatment

Fernandes, Carlos Henrique; Meirelles, Lia M.; Neto, Jorge Raduan; Nakachima, Luís Renato; Santos, João Baptista Gomes dos; Faloppa, Flávio

doi:10.1007/s11552-012-9471-8

Cited by 28 publications

(15 citation statements)

References 17 publications

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“…Regarding the strength, it was observed in all types analyzed a decrease in the values in the first postoperative month, with a gradual increase up to six months, with a value equal to or greater than the preoperative values. 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Corticoid injection as a predictive factor of results of carpal tunnel release

et al. 2015

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OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment. Level of Evidence II, Prognostic Study.

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Section: Discussionmentioning

confidence: 99%

Corticoid injection as a predictive factor of results of carpal tunnel release

et al. 2015

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“…Patients tend to delay seeing a doctor until the numbness worsens; thus, in most cases, thenar atrophy has occurred by the first hospital visit [5]. Early-stage CTS, prior to thenar atrophy, can be treated conservatively by using a night splint, anti-inflammatory injection, or surgical intervention [1]; however, for advanced-stage CTS with thenar atrophy, carpal tunnel release surgery is the first choice [3,6,7].…”

Section: Introductionmentioning

confidence: 99%

A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study

Fujita

Watanabe

Kuroiwa

et al. 2019

JMIR Mhealth Uhealth

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BackgroundCarpal tunnel syndrome (CTS), the most common neuropathy, is caused by a compression of the median nerve in the carpal tunnel and is related to aging. The initial symptom is numbness and pain of the median nerve distributed in the hand area, while thenar muscle atrophy occurs in advanced stages. This atrophy causes failure of thumb motion and results in clumsiness; even after surgery, thenar atrophy does not recover for an extended period. Medical examination and electrophysiological testing are useful to diagnose CTS; however, visits to the doctor tend to be delayed because patients neglect the symptom of numbness in the hand. To avoid thenar atrophy-related clumsiness, early detection of CTS is important.ObjectiveTo establish a CTS screening system without medical examination, we have developed a tablet-based CTS detection system, focusing on movement of the thumb in CTS patients; we examined the accuracy of this screening system.MethodsA total of 22 female CTS patients, involving 29 hands, and 11 female non-CTS participants were recruited. The diagnosis of CTS was made by hand surgeons based on electrophysiological testing. We developed an iPad-based app that recorded the speed and timing of thumb movements while playing a short game. A support vector machine (SVM) learning algorithm was then used by comparing the thumb movements in each direction among CTS and non-CTS groups with leave-one-out cross-validation; with this, we conducted screening for CTS in real time.ResultsThe maximum speed of thumb movements between CTS and non-CTS groups in each direction did not show any statistically significant difference. The CTS group showed significantly slower average thumb movement speed in the 3 and 6 o’clock directions (P=.03 and P=.005, respectively). The CTS group also took a significantly longer time to reach the points in the 2, 3, 4, 5, 6, 8, 9, and 11 o’clock directions (P<.05). Cross-validation revealed that 27 of 29 CTS hands (93%) were classified as having CTS, while 2 of 29 CTS hands (7%) did not have CTS. CTS and non-CTS were classified with 93% sensitivity and 73% specificity.ConclusionsOur newly developed app could classify disturbance of thumb opposition movement and could be useful as a screening test for CTS patients. Outside of the clinic, this app might be able to detect middle-to-severe-stage CTS and prompt these patients to visit a hand surgery specialist; this may also lead to medical cost-savings.

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“…Impaired two-point discrimination test and thenar muscle atrophy were also noted as signs of severe and prolonged median nerve compression [5, 20]. Measurement of grip strength is another useful method to evaluate hand function in patients with CTS [21]. Pre-operative clinical features of our patient groups in the aspects of the Phalen’s test, Tinel’s signs, visible thenar atrophy, two-point discrimination, and grip strength were similar.…”

Section: Discussionmentioning

confidence: 76%

Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?

Duman

Şahin²,

Sofu

et al. 2017

SICOT-J

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Introduction: The purpose of this study was to comparatively evaluate the clinical outcomes of open carpal tunnel release with or without flexor tenosynovectomy and epineurectomy for the treatment of idiopathic carpal tunnel syndrome. Methods: In this prospective single-blinded study, 61 wrists of 47 patients randomized to open carpal tunnel release without (Group-1) or with (Group-2) flexor tenosynovectomy and microsurgical epineurectomy. Physical examination including Phalen and Tinel’s signs, visible thenar atrophy, two-point discrimination, and grip strength measurement was performed. Visual Analogue Scale (VAS), Quick Disability of Arm Shoulder Hand (DASH) Questionnaire, Symptoms Severity Scale, Functional Status Scale, and electrophysiological study were assessed. Results: The increase in the grip strength and Quick Disability of Arm Shoulder Hand Questionnaire score were significantly better in flexor tenosynovectomy and microsurgical epineurectomy group. The average pre-operative two-point discrimination was 6.3 ± 2 mm in Group-1 and 5.8 ± 1.7 mm in Group-2. Post-operatively at the end of 12 months, the mean two-point discrimination was measured as 5.9 ± 1.6 mm in Group-1 and 5.6 ± 1.3 mm in Group-2. When we compare the two groups according to the changes in VAS, Quick-DASH, symptoms severity scale, and functional status scale, only Quick-DASH score improvement was significantly better in Group-2 (p < 0.05). Improvements in VAS, symptoms severity scale, and functional status scale did not differ significantly. Conclusion: We do not recommend routine flexor tenosynovectomy and microsurgical epineurectomy during open carpal tunnel release in patients with idiopathic carpal tunnel syndrome.

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Carpal Tunnel Syndrome with Thenar Atrophy: Evaluation of the Pinch and Grip Strength in Patients Undergoing Surgical Treatment

Cited by 28 publications

References 17 publications

Corticoid injection as a predictive factor of results of carpal tunnel release

Corticoid injection as a predictive factor of results of carpal tunnel release

A Tablet-Based App for Carpal Tunnel Syndrome Screening: Diagnostic Case-Control Study

Can flexor tenosynovectomy and microsurgical epineurectomy improve clinical outcomes following open carpal tunnel release?

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