Comparative histopathologic evaluation of diabetic, hypothyroid and idiopathic carpal tunnel syndrome

Taşer, Figen; Deger, Ayse Nur; Deger, Hakki

doi:10.5137/1019-5149.jtn.17618-16.1

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…DM may also produce vascular changes and tendinopathy leading to CTS. 265 In fact, Taser et al 273 have found an increased number of fibroblasts, increased collagen fiber diameter and lengths, as well as, neovascularization in the SSCT of patients with DM undergoing CTR surgery compared to those with idiopathic CTS or patients with hypothyroidism.…”

Section: IImentioning

confidence: 99%

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Erickson¹,

Lawrence²,

Jansen³

et al. 2019

Journal of Orthopaedic & Sports Physical Therapy

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When examining a patient with suspected carpal tunnel syndrome (CTS), clinicians should use Semmes-Weinstein monofilament testing (SWMT), using the 2.83 or 3.22 monofilament as the threshold for normal light touch sensation and static 2-point discrimination on the middle finger to aid in determining the extent of nerve damage. In those with suspected moderate to severe CTS, clinicians should assess any radial finger using the 3.22 filament as the threshold for normal. Semmes-Weinstein monofilament testing should be repeated by the same provider. BIn those with suspected CTS, clinicians should use the Katz hand diagram, Phalen test, Tinel sign, and carpal compression test to determine the likelihood of CTS and interpret examination results in the context of all clinical exam findings.Clinicians should assess and document patient age (older than 45 years), whether shaking their hands relieves their symptoms, sensory loss in the thumb, the wrist ratio index (greater than 0.67), and scores from the Boston Carpal Tunnel Questionnairesymptom severity scale (CTQ-SSS) (greater than 1.9). The presence of more than 3 of these clinical findings has shown acceptable diagnostic accuracy. D There is conflicting evidence on the diagnostic accuracy and clinical utility of the upper-limb neurodynamic tests, scratch-collapse test, and tests of vibration sense in the diagnosis of CTS, and therefore no recommendation can be made. EXAMINATION -OUTCOME MEASURES: ACTIVITY LIMITATIONS/SELF-REPORTED MEASURES BClinicians should use the CTQ-SSS to assess symptoms and the Boston Carpal Tunnel Questionnaire functional scale (CTQ-FS) or the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to assess function when examining patients with CTS. Clinicians should use the CTQ-SSS to assess change in those undergoing nonsurgical management. EXAMINATION -ACTIVITY LIMITATIONS/ PHYSICAL PERFORMANCE MEASURES C Clinicians may use the Purdue Pegboard (PPB) or the Dellon-modified Moberg pick-up test (DMPUT) to quantify dexterity at the onset of treatment and compare scores with established norms. Clinicians should not use the PPB test, Jebsen-Taylor Hand Function Test, or the Nine-Hole Peg Test to assess clinical change following carpal tunnel release (CTR) surgery. Clinicians may use the DMPUT to assess change following CTR surgery. EXAMINATION -ACTIVITY LIMITATIONS/ PHYSICAL IMPAIRMENT MEASURES Strength MeasuresA Clinicians should not use lateral pinch strength as an outcome measure for patients with nonsurgically or surgically managed CTS. B Clinicians should not use grip strength when assessing short-term (less than 3 months) change in individuals following CTR surgery.C Clinicians may assess grip strength and 3-point or tip pinch strength in individuals presenting with signs and symptoms of CTS and compare scores with established norms. D There is conflicting evidence on the use of tip and 3-point pinch strength and abductor pollicis brevis muscle strength testing in individuals following CTR surgery. Sensory and Provocative MeasuresC C...

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Section: IImentioning

confidence: 99%

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Erickson¹,

Lawrence²,

Jansen³

et al. 2019

Journal of Orthopaedic & Sports Physical Therapy

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show abstract

“…54 Contrary to the findings of Taser et al, decreasing the pressure does not result in improvement of symptoms of median nerve entrapment in patients with diabetes with neuropathy. 52 Zimmerman et al reported that patients with diabetes without neuropathy demonstrated ideal results of surgical release treatment. 55 According to our theory, decreased elasticity and disorder of the interfascicular gliding in patients with diabetes with neuropathy are important factors in the development of CTS; in this population, symptoms fail to improve despite surgical release and lessening of tunnel pressure.…”

Section: Diabetic Neuropathy and Results Of Carpal Tunnel Syndrome Trmentioning

confidence: 99%

“…Taser et al studied fibrosis with thicker and irregular fibers of subsynovial connective tissue and also vascular changes significantly increased in diabetic patients with CTS. 52 The study conducted by Deger et al studied on the role of neoangiogenesis and VEGF in the development of CTS in diabetic patients. They found that increased ischemia-reperfusion damage, neoangiogenesis, and VEGF expression that led to significant neovascularization within the subsynovial connective tissue which has an important impact on CTS occurrence in diabetic patients.…”

Section: Diabetic Neuropathy and Results Of Carpal Tunnel Syndrome Tr...mentioning

confidence: 99%

Interfascicular Gliding Dysfunction Relation with Focal Neuropathy in Diabetic Patients with Carpal Tunnel Syndrome

Afshar

Tabrizi

2022

Journal of Hand and Microsurgery

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Carpal tunnel syndrome (CTS), a common neuropathy of the upper limb, is highly prevalent in diabetic patients. Recent findings indicate that changes in median nerve elasticity and its gliding characteristics may contribute to the development of CTS. Normally, each nerve should be able to adapt to the positional changes by passive movement relative to the surrounding tissues. This ability is provided by a gliding apparatus around the nerve trunk in the surrounding soft tissue. The fascicles of nerve trunks can also glide against each other (interfascicular gliding). Sonoelastography indicates that nerve elasticity is decreased in patients with CTS compared to healthy patients. Moreover, decreased nerve elasticity in diabetes mellitus type II is associated with increased neuropathy, especially in peripheral nerves. Biomechanical factors, oxidative stress, and microvascular defects are also observed in diabetic neuropathy and account for different complications. A reduction in the elasticity of peripheral nerves may be related to decreased interfascicular gliding because of the biomechanical changes that occur in neuropathy. Surgical treatments, including nerve release and reduction of carpal tunnel pressure, improve peripheral gliding but do not resolve disease symptoms completely. According to the evidence, interfascicular gliding dysfunction is the most important factor in the pathogenesis of CTS in diabetic patients. Available evidence suggests that biomechanical variations affect interfascicular gliding more than peripheral gliding in diabetic patients. Decreased nerve elasticity is strongly correlated with decreased interfascicular gliding. It is further hypothesized that the concurrent use of antioxidants and pharmacological treatment (neuroprotection) such as alpha lipoic acid with carpal tunnel release in diabetic patients may alleviate the interfascicular gliding dysfunction and improve median neve elasticity. Decreased nerve elasticity and interfascicular gliding dysfunction play significant roles in the pathogenesis of CTS in diabetic patients.

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“…Eine höhere Prävalenz besteht ebenfalls bei einer Hypothyreose. Hierbei kommt es zu einer diffusen Auftreibung der Unterhaut (Myxödem), die histopathologisch auch im synovialen Gewebe nachgewiesen werden kann [2]. Einen Zusammenhang zwischen Syndrom und Handstellung an der Tastatur konnte bislang nicht nachgewiesen werden [3].…”

Section: Discussionunclassified

Treatment of Peripheral Nerve Compression Syndromes of the Upper Extremities: a Systematic Review

et al. 2021

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Background Nerve compression syndromes are referred to as chronic irritation or pressure palsies of peripheral nerves in areas of preformed anatomical constriction. Carpal tunnel syndrome is the most common nerve compression syndrome, followed by cubital tunnel syndrome. In addition, less frequent nerve compression syndromes of the upper extremities that affect the median, ulnar or radial nerves have been described. This review provides an overview of current treatment options for nerve compression syndromes of the upper extremities. Study Design Systematic overview. Methods Based on established national (AWMF) and international guidelines as well as the Cochrane Library, we performed a systematic literature search on PubMed (NLM), focusing on randomised controlled trials. Results Over the research period (2012 – 2020), there were 43 randomised trials that investigated surgical carpal tunnel release methods, 68 that compared different conservative therapies and 12 that compared surgical versus conservative treatments. Furthermore, eight studies analysed surgical techniques and four analysed conservative techniques for cubital tunnel syndrome. No randomised trials were conducted on the less common peripheral nerve compression syndromes, but case reports and observational studies were conducted. Conclusion For carpal and cubital tunnel syndromes, there are evidence-based diagnostic methods as well as therapeutic recommendations based on randomised and controlled trials. When diagnosis is made after clinical examination and supported by radiological and electrophysiological evaluation, surgical treatment is considered superior to conservative treatment. In particular, excellent long-term results can be achieved by surgery for carpal and cubital tunnel syndromes. More controlled studies are needed to establish evidence-based therapeutic recommendations for the less common nerve compression syndromes, which are somewhat controversially and inconsistently defined.

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Comparative histopathologic evaluation of diabetic, hypothyroid and idiopathic carpal tunnel syndrome

Cited by 8 publications

References 24 publications

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Interfascicular Gliding Dysfunction Relation with Focal Neuropathy in Diabetic Patients with Carpal Tunnel Syndrome

Treatment of Peripheral Nerve Compression Syndromes of the Upper Extremities: a Systematic Review

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