BACKGROUND Osteochondroma,a benign bone tumour,is commonly seen in the metaphyseal region of long bones.It is not so common in short bones and occurs rarely in carpals.The literature involving an osteochondroma of pis...BACKGROUND Osteochondroma,a benign bone tumour,is commonly seen in the metaphyseal region of long bones.It is not so common in short bones and occurs rarely in carpals.The literature involving an osteochondroma of pisiform is scarce.CASE SUMMARY We present a 12-year-old male Asian child with a gradually progressive,bony,hard swelling on the volar aspect of the right wrist,which,on investigation,was suggestive of a solitary osteochondroma of the pisiform and its management.CONCLUSION The current report describes a child with a wrist swelling which on evaluation was found to be an osteochondroma of the pisiform,which is seldom described in the literature,and managed by excision biopsy.Though osteochondromas of the carpal bones are rare they should be included in the differential of any wrist swelling with the symptom complex varying from pressure effects to surrounding soft tissues and nerves,attritional tendon ruptures,carpal instabilities and arthritis.展开更多
Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90%...Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anat-omy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.展开更多
AIM To evaluate the impact of pioglitazone pharmacotherapy in median nerve electrophysiology in the carpal tunnel among type 2 diabetes patients.METHODS The study was executed in patients with type 2 diabetes, treated...AIM To evaluate the impact of pioglitazone pharmacotherapy in median nerve electrophysiology in the carpal tunnel among type 2 diabetes patients.METHODS The study was executed in patients with type 2 diabetes, treated with oral drugs, categorized under pioglitazone or non-pioglitazone group(14 in each group), and who received electrophysiological evaluation by nerve conduction velocity at baseline and 3 mo.RESULTS At 3 mo, pioglitazone-category had inferior amplitude in sensory median nerve [8.5 interquartile range(IQR) = 6.5 to 11.5) vs non-pioglitazone 14.5(IQR 10.5 to 18.75)](P = 0.002). Non-pioglitazone category displayed amelioration in amplitude in the sensory median nerve [baseline 13(IQR = 9 to 16.25) vs 3 mo 8.5(IQR = 6.5 to 11.5)](P = 0.01) and amplitude in motor median nerve [baseline 9(IQR = 4.75 to 11) vs 3 mo 6.75(IQR = 4.75 to 10.25)](P = 0.049); and deterioration of terminal latency of in motor ulnar nerve [baseline 2.07(IQR = 1.92 to 2.25) vs 3 mo 2.16(IQR = 1.97 to 2.325)](P = 0.043). There was amelioration of terminal latency in sensory ulnar nerve [baseline 2.45(IQR = 2.315 to 2.88) vs 3 mo 2.37(IQR = 2.275 to 2.445) for pioglitazone group(P = 0.038).CONCLUSION Treatment with pioglitazone accentuates probability of compressive neuropathy. In spite of comparable glycemic control over 3 mo, patients treated with pioglitazone showed superior electrophysiological parameters for the ulnar nerve. Pioglitazone has favourable outcome in nerve electrophysiology which was repealed when the nerve was subjected to compressive neuropathy.展开更多
Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard qu...Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.展开更多
Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate ...Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 m L of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.展开更多
AIM To investigate the causes of the recurrent carpal tunnel syndrome(CTS)and implemented surgical interventions.METHODS Four hundred and eighty-seven patients,who were diagnosed with CTS and underwent surgical interv...AIM To investigate the causes of the recurrent carpal tunnel syndrome(CTS)and implemented surgical interventions.METHODS Four hundred and eighty-seven patients,who were diagnosed with CTS and underwent surgical intervention between October 2016 and September 2007,were evaluated in this retrospective study.The age,gender,physical evaluation findings,electrophysiological examination reports and implemented surgical treatment methods were analyzed.RESULTS Thirty-nine of the cases were operated due to recurrent CTS.Further examination of the patients with recurrent CTS revealed that ten cases had diabetic polyneuropathy,three cases had hypothyroidism,two cases had rheumatoid arthritis and one case had systemic amyloidosis.Postoperative electromyography confirmed the neuropathy was due to systemic diseases.The remaining 23 patients with recurrent CTS did not have any systemic disease and all of them had applied previously to another health center.CONCLUSION We concluded that the recurrence rates in CTS might be decreased with exploration and incision of the entire transverse ligament.Damage to the motor and sensory branches of the median nerve could be avoided with an incision on the ulnar side.展开更多
Carpal tunnel syndrome(CTS) is well recognized as the most common type of peripheral neuropathy. A rare cause of CTS is tophaceous gout. Tophi deposits can accumulate in various structures including the flexor tendons...Carpal tunnel syndrome(CTS) is well recognized as the most common type of peripheral neuropathy. A rare cause of CTS is tophaceous gout. Tophi deposits can accumulate in various structures including the flexor tendons, tendon sheaths, the carpal tunnel floor, transverse carpal ligament, and even the median nerve, causing various symptoms such as pain, numbness, and weakness. Tophi forming in the carpal canal can compress the median nerve, leading to CTS. Here, we describe a 25-year-old male with a family history of tophaceous gout who presented with typical CTS symptoms. Although he had chronic numbness in his right hand, he failed to present with any obvious pal-pable masses on his forearm or hand. However, his family history, laboratory, clinical, and magnetic re-sonance imaging findings were consistent with tophi deposits. CTS symptoms were eased through surgical removal of tophi and decompression of the median nerve. No recurrences of gout and CTS symptoms were reported at a one-year follow-up. This case shows that CTS symptoms could be the initial manifestation of tophaceous gout. In patients with a family history of gout and with CTS symptoms, imaging examinations are critical for early diagnosis and selecting appropriate treatment. Surgical removal of "covert" tophi and decompression of the median nerve is an effective option for eliminating symptoms.展开更多
Objective:To probe into quick and effective therapies for carpal tunnel syndrome.Methods:Totally 98 cases of carpal tunnel syndrome were randomly divided into a treatment group and a control group.The treatment group ...Objective:To probe into quick and effective therapies for carpal tunnel syndrome.Methods:Totally 98 cases of carpal tunnel syndrome were randomly divided into a treatment group and a control group.The treatment group received warm-needling plus Tuina relaxing,while the control group was treated by hormone block therapy and drug medication.Results:The cure rate was 81.7%in the treatment group and 47.4%in the control group,with a significant difference between the two groups(P<0.01) .Conclusion:Acupuncture plus Tuina manipulation is a simple therapy for carpal tunnel syndrome,but with remarkable therapeutic effects.展开更多
Carpal tunnel syndrome is the most common compressive neuropathy,presenting with sensorimotor dysfunction.In carpal tunnel syndrome patients,irregular afferent signals on functional magnetic resonance imaging are asso...Carpal tunnel syndrome is the most common compressive neuropathy,presenting with sensorimotor dysfunction.In carpal tunnel syndrome patients,irregular afferent signals on functional magnetic resonance imaging are associated with changes in neural plasticity during peripheral nerve injury.However,it is difficult to obtain multi-point neuroimaging data of the brain in the clinic.In the present study,a rat model of median nerve compression was established by median nerve ligation,i.e.,carpal tunnel syndrome model.Sensory cortex remodeling was determined by functional magnetic resonance imaging between normal rats and carpal tunnel syndrome models at 2 weeks and 2 months after operation.Stimulation of bilateral paws by electricity for 30 seconds,alternating with 30 seconds of rest period（repeatedly 3 times）,resulted in activation of the contralateral sensorimotor cortex in normal rats.When carpal tunnel syndrome rats received this stimulation,the contralateral cerebral hemisphere was markedly activated at 2 weeks after operation,including the primary motor cortex,cerebellum,and thalamus.Moreover,this activation was not visible at 2 months after operation.These findings suggest that significant remodeling of the cerebral cortex appears at 2 weeks and 2 months after median nerve compression.展开更多
Neuropathy is a common complication of diabetes mellitus(DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies(EN), which are focal forms, are so frequen...Neuropathy is a common complication of diabetes mellitus(DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies(EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmarkof peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM,particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism,the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage,making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.展开更多
Carpal tunnel syndrome(CTS)is a multifactorial compression neuropathy.It is reported to be very common and rising globally.CTS’s treatment varies from conservative measures to surgical treatments.Surgery has shown to...Carpal tunnel syndrome(CTS)is a multifactorial compression neuropathy.It is reported to be very common and rising globally.CTS’s treatment varies from conservative measures to surgical treatments.Surgery has shown to be an effective method for more severe cases.However few unclear aspects and room for further research and improvements still remains.We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS.The simple algorithm of leaving the choice of the surgical method to surgeons’preference and experience(together with consideration of patients’related factors)seem to be the best available option,which is supported by the most recent metanalysis and systematic reviews.We suggest that surgeons(unless in presence of precise indications towards endoscopic release)should tend to perform a minimally invasive open approach release,favoring the advantage of a better neurovascular structures visualization(and a consequent higher chance to perform a complete release with long term relief of symptoms)instead of favoring an early reduction(in the first postoperative days)of immobilization and pain.Research towards a universally accepted standardization should be aimed for by the researchers,who have failed to date to sufficiently limit bias and limitations.展开更多
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient,accounting for over 85%of all sport-related carpal bone fractures,and is particularly common in sports involving high imp...BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient,accounting for over 85%of all sport-related carpal bone fractures,and is particularly common in sports involving high impact injuries to the wrist.The management of such injuries comprises both conservative and surgical techniques,as guided by fracture location and type.Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport,as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures,to collate information on return rates to sport(RRS)and mean return times(RTS)to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE,EMBASE,CINAHAL,Cochrane,Google Scholar,Physiotherapy Evidence Database,SPORTDiscus,Web of Science and Scopus was performed in August 2018 using the keywords"scaphoid","fracture","acute","carpal","athletes","sports","non-operative","conservative","operative"and"return to sport".All studies that recorded RRS and RTS following scaphoid fractures were included.RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included:Two randomised controlled trials,six retrospective cohort studies and three case series.Seven studies reported on conservative management(n=77),and eight studies reported on surgical management(n=83).For conservative management,RRS was 90%(69/77),and the mean RTS was9.6 wk.Three studies allowed to return to sport in cast[RRS 89%(25/28);RTS 1.9 wk],and four studies required completion of cast treatment prior to returning to sport[RRS 90%(44/49);RTS 13.9 wk].Four studies recorded fracture union data:Union rate 85%(47/55);mean time to union 14.0 wk.For surgical management,RRS was 98%(81/83),and RTS was 7.3 wk.Three studies reported on Percutaneous Screw Fixation[RRS 97%(32/33);RTS 6.5 wk],and five studies reported on Open Reduction Internal Fixation[RRS 98%(49/50);RTS 7.9 wk].Six studies recorded fracture union data:Union rate 97%(69/71);mean time to union9.8 wk.On meta-analysis,RRS(RR=1.09;95%confidence interval(CI):1.00-1.18;P<0.045),RTS(MD 2.3 wk;95%CI:0.79-3.87;P<0.002),union rates(RR=1.14;95%CI:1.01-1.28;P<0.030)and mean times to union(MD 4.2 wk;95%CI:3.94-4.36;P<0.001)were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management.Both treatments,however,remain acceptable options,and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans.Immediate return to sport in a cast should be avoided due to the significant risk of non-union.展开更多
Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of ...Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of the sciatic nerve due to individual differences. The use of a silicone tube with a uniform internal diameter may not provide a reliable and consistent model. We have established a chronic sciatic nerve compression model that can induce demyelination of the sciatic nerve and lead to atrophy of skeletal muscle. In 3-week-old pups and adult rats, the sciatic nerve of the right hind limb was exposed, and a piece of surgical latex glove was gently placed under the nerve. N-butyl-cyanoacrylate was then placed over the nerve, and after it had set, another piece of glove latex was placed on top of the target area and allowed to adhere to the first piece to form a sandwich-like complex. Thus, a chronic sciatic nerve compression model was produced. Control pups with latex or N-butyl-cyanoacrylate were also prepared. Functional changes to nerves were assessed using the hot plate test and electromyography. Immunofluorescence and electron microscopy analyses of the nerves were performed to quantify the degree of neuropathological change. Masson staining was conducted to assess the degree of fibrosis in the gastrocnemius and intrinsic paw muscles. The pup group rats subjected to nerve compression displayed thermal hypoesthesia and a gradual decrease in nerve conduction velocity at 2 weeks after surgery. Neuropathological studies demonstrated that the model caused nerve demyelination and axonal irregularities and triggered collagen deposition in the epineurium and perineurium of the affected nerve at 8 weeks after surgery. The degree of fibrosis in the gastrocnemius and intrinsic paw muscles was significantly increased at 20 weeks after surgery. In conclusion, our novel model can reproduce the functional and histological changes of chronic nerve compression injury that occurs in humans and it will be a useful new tool for investigating the mechanisms underlying chronic nerve compression.展开更多
This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict ...This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict the positive and negative results of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome. The hand specialist, preceding NCS administered the questionnaire;it was then scored at a later date. Results showed a sensitivity of 86% and specificity of 84% referring to the ability to predict a positive NCS when using a predetermined cut-off score. When analysed with Receiver Operating Characteristics, a threshold score could be determined in order to obtain 100% sensitivity/specificity. This questionnaire can be used as a useful adjunct to assessment of those presenting with suspected Carpal Tunnel Syndrome. Using the questionnaire to identify those patients scoring outside a predetermined threshold range would reduce the need for NCS by nearly 50%, with significant cost and clinical practice implications.展开更多
Objective To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome. Methods A prospective, randomized study was performed on 70 ...Objective To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome. Methods A prospective, randomized study was performed on 70 hands in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004. Either open (36 hands in 30 patients) or endoscopic (34 hands in 32 patients) carpal tunnel release was performed randomly. Symptom improvement, complications, and the time of operation, in-hospital stay, and return to work between the two groups were assessed with average 2 years of follow-up. The electromyography was tested pre- and 3 months post-operation. Results There were no significant differences between the two surgical groups with regard to postoperative improvements of symptom, electromyography tests, and the incidence of complications. But it was statistically less in the rate of scar tenderness, the time of operation, in-hospital stay, and return to work in the endoscopic group compared with the open group (P<0.05). Conclusions The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome. And it has the advantages of slight scar tenderness, less operation time, less in-hospital stay, early functional recovery, safety, and high satisfaction rate compared with open methods.展开更多
Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome r...Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.展开更多
Two hundred and sixty-two patients with carpal tunnel syndrome (CTS) were analyzed retrospectively. Results showed that middle-and older-age women were more apt to have CTS than men, and that the dominant hand was mor...Two hundred and sixty-two patients with carpal tunnel syndrome (CTS) were analyzed retrospectively. Results showed that middle-and older-age women were more apt to have CTS than men, and that the dominant hand was more frequently affected. Hormonal changes , repetitive and forceful movements, awkward positions of hand and wrist, and other factors may be associated with CTS. Typical clinical manifestations include pain and paresthesia in the median nerve territory, worsening at night or in the early morning , and being relieved by shaking the hand. Although the patients may localize the discomfort beyond the territory, sensory changes are variable and not entirely reliable. Conduction abnormalities often appeared selectively in the median nerve distal to the wrist in CTS. If the patient who is clinically suggestive of CTS shows normal conduction with conventional methods, palmar stimulation and inching technique is recommended. The diagnosis of CTS requires confirmation of illness history, symptoms and signs with objective electrodiagnostic tests.展开更多
61 patients with clinically diagnosed and electromyographically confirmed carpal tunnel syndrome were enrolled in a prospective study to evaluate the effectiveness of a nerve supplement on pillar pain after carpal tun...61 patients with clinically diagnosed and electromyographically confirmed carpal tunnel syndrome were enrolled in a prospective study to evaluate the effectiveness of a nerve supplement on pillar pain after carpal tunnel surgery. All of the patients underwent endoscopic carpal tunnel release. 15 of the patients also took the nerve support supplement NeuroGen? as part of their perioperative treatment. The supplement group demonstrated a significantly lower amount of pillar pain (VAS) at initial follow up compared to the control group (1.13 and 4.05 respectively). 46% (7/15) of the supplement group were completely free of pillar pain compared to only 9% (4/46) of the control group at the first follow up. 53% (8/15) of the NeuroGen? group did not require any pain medications compared to 35% (16/46) of the control group. The Nerve supplement NeuroGen? significantly reduces pain after carpal tunnel surgery.展开更多
The aim of this paper is to point out the growing clinical importance of Carpal tunnel syndrome in patients on hemodialysis especially in aspect of the diagnosis, treatment and possible cause of the syndrome. Sixty pa...The aim of this paper is to point out the growing clinical importance of Carpal tunnel syndrome in patients on hemodialysis especially in aspect of the diagnosis, treatment and possible cause of the syndrome. Sixty patients with clinical diagnosis of Carpal Tunnel Syndrome was defined as the presence of two subjective symptoms (numbness, tingling in the median nerve distribution). The diagnosis was confirmed by electromyography. The patients with rheumatoid arthritis, thalasemia and thyroid dysfunction and the patients having pain due to arthritis or tenosynovitis were excluded. Fifty patients with clinical diagnosis of idiopathic CTS and seven hemodialysis patients having CTS were analyzed. Of 50 patients (47 female, 3 male) with clinical diagnosis of idiopathic CTS, 11 patients (22%) were involved bilaterally, 25 patients (50%) were affected only on the right and 14 patients (28%) were symptomatic only on the left. Of 7 hemodialysis patients (2 female, 5 male) with CTS, 1 patient (14%) was involved bilaterally (having two-sided A-V fistula), 4 patients (57%) were affected only on the right and 2 patients (28%) were symptomatic only on the left. There was significant correlation between the arteriovenous fistula and subsequent development of CTS. The all patients had fistulas in the affected side (5 of them were patent and 2 were occluded). In the relation between the duration of hemodialysis and development of CTS, 4 patients were over 10 years of hemodialysis, 2 patients were between 5 to 9 years and only 1 patient was below 4 years of duration. Amyloid deposit was demonstrated in 4 of 7 operated hands in the hemodialysis group. When we compared the presence of amyloid deposits in these groups, the difference between these two groups were found as statistically significant (p < 0.009). Although hemodialysis has no significant effect on development of fibrosis, the incidence of fibrosis was found as statistically significant in idiopathic carpal tunnel syndrome (p < 0.048). It is likely that there are numerous factors that may act either independently or in concert to potentiate the risk for developing CTS in patients on long-term hemodialysis.展开更多
Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invas...Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invasive neuroimaging technique can be applied to directly quantify the neuronal activities of individual brain regions that show the persistent symptoms owing to its better spatial resolution and increased signal-to-noise ratio.Therefore,this prospective observational study was conducted in 27 eligible female carpal tunnel syndrome,aged 57.7±6.51 years.Psychometric tests,nerve conduction studies and pCASL neuroimaging assessment were performed.The results showed that the relevant activated brain regions in the cortical,subcrotical,and cerebral regions were correlated with numbness,pain,functionality,median nerve status and motor amplitude of median nerve(K=21–2849,r=–0.77–0.76,P<0.05).There was a tendency of pain processing which shifted from the nociceptive circuitry to the emotional and cognitive one during the process of chronic pain caused by carpal tunnel syndrome.It suggests the necessity of addressing the ignored cognitive or emotional state when managing patients with carpal tunnel syndrome.Approval for this study was obtained from the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West,China(HKU/HA HKW IRB,approval No.UW17-129)on April 11,2017.This study was registered in Clinical Trial Registry of The University of Hong Kong,China(registration number:HKUCTR-2220)on April 24,2017.展开更多
文摘BACKGROUND Osteochondroma,a benign bone tumour,is commonly seen in the metaphyseal region of long bones.It is not so common in short bones and occurs rarely in carpals.The literature involving an osteochondroma of pisiform is scarce.CASE SUMMARY We present a 12-year-old male Asian child with a gradually progressive,bony,hard swelling on the volar aspect of the right wrist,which,on investigation,was suggestive of a solitary osteochondroma of the pisiform and its management.CONCLUSION The current report describes a child with a wrist swelling which on evaluation was found to be an osteochondroma of the pisiform,which is seldom described in the literature,and managed by excision biopsy.Though osteochondromas of the carpal bones are rare they should be included in the differential of any wrist swelling with the symptom complex varying from pressure effects to surrounding soft tissues and nerves,attritional tendon ruptures,carpal instabilities and arthritis.
文摘Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anat-omy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.
基金Supported by Vivekananda Institute of Medical Sciences,Ramakrishna Mission Seva Pratishthan,Kolkata who provided a research grant
文摘AIM To evaluate the impact of pioglitazone pharmacotherapy in median nerve electrophysiology in the carpal tunnel among type 2 diabetes patients.METHODS The study was executed in patients with type 2 diabetes, treated with oral drugs, categorized under pioglitazone or non-pioglitazone group(14 in each group), and who received electrophysiological evaluation by nerve conduction velocity at baseline and 3 mo.RESULTS At 3 mo, pioglitazone-category had inferior amplitude in sensory median nerve [8.5 interquartile range(IQR) = 6.5 to 11.5) vs non-pioglitazone 14.5(IQR 10.5 to 18.75)](P = 0.002). Non-pioglitazone category displayed amelioration in amplitude in the sensory median nerve [baseline 13(IQR = 9 to 16.25) vs 3 mo 8.5(IQR = 6.5 to 11.5)](P = 0.01) and amplitude in motor median nerve [baseline 9(IQR = 4.75 to 11) vs 3 mo 6.75(IQR = 4.75 to 10.25)](P = 0.049); and deterioration of terminal latency of in motor ulnar nerve [baseline 2.07(IQR = 1.92 to 2.25) vs 3 mo 2.16(IQR = 1.97 to 2.325)](P = 0.043). There was amelioration of terminal latency in sensory ulnar nerve [baseline 2.45(IQR = 2.315 to 2.88) vs 3 mo 2.37(IQR = 2.275 to 2.445) for pioglitazone group(P = 0.038).CONCLUSION Treatment with pioglitazone accentuates probability of compressive neuropathy. In spite of comparable glycemic control over 3 mo, patients treated with pioglitazone showed superior electrophysiological parameters for the ulnar nerve. Pioglitazone has favourable outcome in nerve electrophysiology which was repealed when the nerve was subjected to compressive neuropathy.
文摘Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.
文摘Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 m L of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.
文摘AIM To investigate the causes of the recurrent carpal tunnel syndrome(CTS)and implemented surgical interventions.METHODS Four hundred and eighty-seven patients,who were diagnosed with CTS and underwent surgical intervention between October 2016 and September 2007,were evaluated in this retrospective study.The age,gender,physical evaluation findings,electrophysiological examination reports and implemented surgical treatment methods were analyzed.RESULTS Thirty-nine of the cases were operated due to recurrent CTS.Further examination of the patients with recurrent CTS revealed that ten cases had diabetic polyneuropathy,three cases had hypothyroidism,two cases had rheumatoid arthritis and one case had systemic amyloidosis.Postoperative electromyography confirmed the neuropathy was due to systemic diseases.The remaining 23 patients with recurrent CTS did not have any systemic disease and all of them had applied previously to another health center.CONCLUSION We concluded that the recurrence rates in CTS might be decreased with exploration and incision of the entire transverse ligament.Damage to the motor and sensory branches of the median nerve could be avoided with an incision on the ulnar side.
文摘Carpal tunnel syndrome(CTS) is well recognized as the most common type of peripheral neuropathy. A rare cause of CTS is tophaceous gout. Tophi deposits can accumulate in various structures including the flexor tendons, tendon sheaths, the carpal tunnel floor, transverse carpal ligament, and even the median nerve, causing various symptoms such as pain, numbness, and weakness. Tophi forming in the carpal canal can compress the median nerve, leading to CTS. Here, we describe a 25-year-old male with a family history of tophaceous gout who presented with typical CTS symptoms. Although he had chronic numbness in his right hand, he failed to present with any obvious pal-pable masses on his forearm or hand. However, his family history, laboratory, clinical, and magnetic re-sonance imaging findings were consistent with tophi deposits. CTS symptoms were eased through surgical removal of tophi and decompression of the median nerve. No recurrences of gout and CTS symptoms were reported at a one-year follow-up. This case shows that CTS symptoms could be the initial manifestation of tophaceous gout. In patients with a family history of gout and with CTS symptoms, imaging examinations are critical for early diagnosis and selecting appropriate treatment. Surgical removal of "covert" tophi and decompression of the median nerve is an effective option for eliminating symptoms.
文摘Objective:To probe into quick and effective therapies for carpal tunnel syndrome.Methods:Totally 98 cases of carpal tunnel syndrome were randomly divided into a treatment group and a control group.The treatment group received warm-needling plus Tuina relaxing,while the control group was treated by hormone block therapy and drug medication.Results:The cure rate was 81.7%in the treatment group and 47.4%in the control group,with a significant difference between the two groups(P<0.01) .Conclusion:Acupuncture plus Tuina manipulation is a simple therapy for carpal tunnel syndrome,but with remarkable therapeutic effects.
基金supported by the National Natural Science Foundation of China,No.81371965,81672144a grant from the Shanghai Pujiang Program of China,No.16PJD035
文摘Carpal tunnel syndrome is the most common compressive neuropathy,presenting with sensorimotor dysfunction.In carpal tunnel syndrome patients,irregular afferent signals on functional magnetic resonance imaging are associated with changes in neural plasticity during peripheral nerve injury.However,it is difficult to obtain multi-point neuroimaging data of the brain in the clinic.In the present study,a rat model of median nerve compression was established by median nerve ligation,i.e.,carpal tunnel syndrome model.Sensory cortex remodeling was determined by functional magnetic resonance imaging between normal rats and carpal tunnel syndrome models at 2 weeks and 2 months after operation.Stimulation of bilateral paws by electricity for 30 seconds,alternating with 30 seconds of rest period（repeatedly 3 times）,resulted in activation of the contralateral sensorimotor cortex in normal rats.When carpal tunnel syndrome rats received this stimulation,the contralateral cerebral hemisphere was markedly activated at 2 weeks after operation,including the primary motor cortex,cerebellum,and thalamus.Moreover,this activation was not visible at 2 months after operation.These findings suggest that significant remodeling of the cerebral cortex appears at 2 weeks and 2 months after median nerve compression.
文摘Neuropathy is a common complication of diabetes mellitus(DM) with a wide clinical spectrum that encompasses generalized to focal and multifocal forms. Entrapment neuropathies(EN), which are focal forms, are so frequent at any stage of the diabetic disease, that they may be considered a neurophysiological hallmarkof peripheral nerve involvement in DM. Indeed, EN may be the earliest neurophysiological abnormalities in DM,particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. This remarkable frequency of EN in diabetes is underlain by a peculiar pathophysiological background. Due to the metabolic alterations consequent to abnormal glucose metabolism,the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage,making them more prone to entrapment in anatomically constrained channels. This review discusses the most common and relevant EN encountered in diabetic patient in their epidemiological, pathophysiological and diagnostic features.
文摘Carpal tunnel syndrome(CTS)is a multifactorial compression neuropathy.It is reported to be very common and rising globally.CTS’s treatment varies from conservative measures to surgical treatments.Surgery has shown to be an effective method for more severe cases.However few unclear aspects and room for further research and improvements still remains.We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS.The simple algorithm of leaving the choice of the surgical method to surgeons’preference and experience(together with consideration of patients’related factors)seem to be the best available option,which is supported by the most recent metanalysis and systematic reviews.We suggest that surgeons(unless in presence of precise indications towards endoscopic release)should tend to perform a minimally invasive open approach release,favoring the advantage of a better neurovascular structures visualization(and a consequent higher chance to perform a complete release with long term relief of symptoms)instead of favoring an early reduction(in the first postoperative days)of immobilization and pain.Research towards a universally accepted standardization should be aimed for by the researchers,who have failed to date to sufficiently limit bias and limitations.
文摘BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient,accounting for over 85%of all sport-related carpal bone fractures,and is particularly common in sports involving high impact injuries to the wrist.The management of such injuries comprises both conservative and surgical techniques,as guided by fracture location and type.Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport,as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures,to collate information on return rates to sport(RRS)and mean return times(RTS)to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE,EMBASE,CINAHAL,Cochrane,Google Scholar,Physiotherapy Evidence Database,SPORTDiscus,Web of Science and Scopus was performed in August 2018 using the keywords"scaphoid","fracture","acute","carpal","athletes","sports","non-operative","conservative","operative"and"return to sport".All studies that recorded RRS and RTS following scaphoid fractures were included.RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included:Two randomised controlled trials,six retrospective cohort studies and three case series.Seven studies reported on conservative management(n=77),and eight studies reported on surgical management(n=83).For conservative management,RRS was 90%(69/77),and the mean RTS was9.6 wk.Three studies allowed to return to sport in cast[RRS 89%(25/28);RTS 1.9 wk],and four studies required completion of cast treatment prior to returning to sport[RRS 90%(44/49);RTS 13.9 wk].Four studies recorded fracture union data:Union rate 85%(47/55);mean time to union 14.0 wk.For surgical management,RRS was 98%(81/83),and RTS was 7.3 wk.Three studies reported on Percutaneous Screw Fixation[RRS 97%(32/33);RTS 6.5 wk],and five studies reported on Open Reduction Internal Fixation[RRS 98%(49/50);RTS 7.9 wk].Six studies recorded fracture union data:Union rate 97%(69/71);mean time to union9.8 wk.On meta-analysis,RRS(RR=1.09;95%confidence interval(CI):1.00-1.18;P<0.045),RTS(MD 2.3 wk;95%CI:0.79-3.87;P<0.002),union rates(RR=1.14;95%CI:1.01-1.28;P<0.030)and mean times to union(MD 4.2 wk;95%CI:3.94-4.36;P<0.001)were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management.Both treatments,however,remain acceptable options,and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans.Immediate return to sport in a cast should be avoided due to the significant risk of non-union.
基金supported by the National Natural Science Foundation of China,No.81471270
文摘Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of the sciatic nerve due to individual differences. The use of a silicone tube with a uniform internal diameter may not provide a reliable and consistent model. We have established a chronic sciatic nerve compression model that can induce demyelination of the sciatic nerve and lead to atrophy of skeletal muscle. In 3-week-old pups and adult rats, the sciatic nerve of the right hind limb was exposed, and a piece of surgical latex glove was gently placed under the nerve. N-butyl-cyanoacrylate was then placed over the nerve, and after it had set, another piece of glove latex was placed on top of the target area and allowed to adhere to the first piece to form a sandwich-like complex. Thus, a chronic sciatic nerve compression model was produced. Control pups with latex or N-butyl-cyanoacrylate were also prepared. Functional changes to nerves were assessed using the hot plate test and electromyography. Immunofluorescence and electron microscopy analyses of the nerves were performed to quantify the degree of neuropathological change. Masson staining was conducted to assess the degree of fibrosis in the gastrocnemius and intrinsic paw muscles. The pup group rats subjected to nerve compression displayed thermal hypoesthesia and a gradual decrease in nerve conduction velocity at 2 weeks after surgery. Neuropathological studies demonstrated that the model caused nerve demyelination and axonal irregularities and triggered collagen deposition in the epineurium and perineurium of the affected nerve at 8 weeks after surgery. The degree of fibrosis in the gastrocnemius and intrinsic paw muscles was significantly increased at 20 weeks after surgery. In conclusion, our novel model can reproduce the functional and histological changes of chronic nerve compression injury that occurs in humans and it will be a useful new tool for investigating the mechanisms underlying chronic nerve compression.
文摘This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict the positive and negative results of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome. The hand specialist, preceding NCS administered the questionnaire;it was then scored at a later date. Results showed a sensitivity of 86% and specificity of 84% referring to the ability to predict a positive NCS when using a predetermined cut-off score. When analysed with Receiver Operating Characteristics, a threshold score could be determined in order to obtain 100% sensitivity/specificity. This questionnaire can be used as a useful adjunct to assessment of those presenting with suspected Carpal Tunnel Syndrome. Using the questionnaire to identify those patients scoring outside a predetermined threshold range would reduce the need for NCS by nearly 50%, with significant cost and clinical practice implications.
文摘Objective To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome. Methods A prospective, randomized study was performed on 70 hands in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004. Either open (36 hands in 30 patients) or endoscopic (34 hands in 32 patients) carpal tunnel release was performed randomly. Symptom improvement, complications, and the time of operation, in-hospital stay, and return to work between the two groups were assessed with average 2 years of follow-up. The electromyography was tested pre- and 3 months post-operation. Results There were no significant differences between the two surgical groups with regard to postoperative improvements of symptom, electromyography tests, and the incidence of complications. But it was statistically less in the rate of scar tenderness, the time of operation, in-hospital stay, and return to work in the endoscopic group compared with the open group (P<0.05). Conclusions The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome. And it has the advantages of slight scar tenderness, less operation time, less in-hospital stay, early functional recovery, safety, and high satisfaction rate compared with open methods.
基金supported by a grant from the Shanghai Key Laboratory of Peripheral Nerve and Microsurgery in China,No.14DZ2273300the Natural Science Foundation of Shanghai in China,No.13ZR1404600a grant from the National Key Basic Research Program of China(973 Program),No.2014CB542201
文摘Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe（moderate and severe） carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.
文摘Two hundred and sixty-two patients with carpal tunnel syndrome (CTS) were analyzed retrospectively. Results showed that middle-and older-age women were more apt to have CTS than men, and that the dominant hand was more frequently affected. Hormonal changes , repetitive and forceful movements, awkward positions of hand and wrist, and other factors may be associated with CTS. Typical clinical manifestations include pain and paresthesia in the median nerve territory, worsening at night or in the early morning , and being relieved by shaking the hand. Although the patients may localize the discomfort beyond the territory, sensory changes are variable and not entirely reliable. Conduction abnormalities often appeared selectively in the median nerve distal to the wrist in CTS. If the patient who is clinically suggestive of CTS shows normal conduction with conventional methods, palmar stimulation and inching technique is recommended. The diagnosis of CTS requires confirmation of illness history, symptoms and signs with objective electrodiagnostic tests.
文摘61 patients with clinically diagnosed and electromyographically confirmed carpal tunnel syndrome were enrolled in a prospective study to evaluate the effectiveness of a nerve supplement on pillar pain after carpal tunnel surgery. All of the patients underwent endoscopic carpal tunnel release. 15 of the patients also took the nerve support supplement NeuroGen? as part of their perioperative treatment. The supplement group demonstrated a significantly lower amount of pillar pain (VAS) at initial follow up compared to the control group (1.13 and 4.05 respectively). 46% (7/15) of the supplement group were completely free of pillar pain compared to only 9% (4/46) of the control group at the first follow up. 53% (8/15) of the NeuroGen? group did not require any pain medications compared to 35% (16/46) of the control group. The Nerve supplement NeuroGen? significantly reduces pain after carpal tunnel surgery.
文摘The aim of this paper is to point out the growing clinical importance of Carpal tunnel syndrome in patients on hemodialysis especially in aspect of the diagnosis, treatment and possible cause of the syndrome. Sixty patients with clinical diagnosis of Carpal Tunnel Syndrome was defined as the presence of two subjective symptoms (numbness, tingling in the median nerve distribution). The diagnosis was confirmed by electromyography. The patients with rheumatoid arthritis, thalasemia and thyroid dysfunction and the patients having pain due to arthritis or tenosynovitis were excluded. Fifty patients with clinical diagnosis of idiopathic CTS and seven hemodialysis patients having CTS were analyzed. Of 50 patients (47 female, 3 male) with clinical diagnosis of idiopathic CTS, 11 patients (22%) were involved bilaterally, 25 patients (50%) were affected only on the right and 14 patients (28%) were symptomatic only on the left. Of 7 hemodialysis patients (2 female, 5 male) with CTS, 1 patient (14%) was involved bilaterally (having two-sided A-V fistula), 4 patients (57%) were affected only on the right and 2 patients (28%) were symptomatic only on the left. There was significant correlation between the arteriovenous fistula and subsequent development of CTS. The all patients had fistulas in the affected side (5 of them were patent and 2 were occluded). In the relation between the duration of hemodialysis and development of CTS, 4 patients were over 10 years of hemodialysis, 2 patients were between 5 to 9 years and only 1 patient was below 4 years of duration. Amyloid deposit was demonstrated in 4 of 7 operated hands in the hemodialysis group. When we compared the presence of amyloid deposits in these groups, the difference between these two groups were found as statistically significant (p < 0.009). Although hemodialysis has no significant effect on development of fibrosis, the incidence of fibrosis was found as statistically significant in idiopathic carpal tunnel syndrome (p < 0.048). It is likely that there are numerous factors that may act either independently or in concert to potentiate the risk for developing CTS in patients on long-term hemodialysis.
文摘Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invasive neuroimaging technique can be applied to directly quantify the neuronal activities of individual brain regions that show the persistent symptoms owing to its better spatial resolution and increased signal-to-noise ratio.Therefore,this prospective observational study was conducted in 27 eligible female carpal tunnel syndrome,aged 57.7±6.51 years.Psychometric tests,nerve conduction studies and pCASL neuroimaging assessment were performed.The results showed that the relevant activated brain regions in the cortical,subcrotical,and cerebral regions were correlated with numbness,pain,functionality,median nerve status and motor amplitude of median nerve(K=21–2849,r=–0.77–0.76,P<0.05).There was a tendency of pain processing which shifted from the nociceptive circuitry to the emotional and cognitive one during the process of chronic pain caused by carpal tunnel syndrome.It suggests the necessity of addressing the ignored cognitive or emotional state when managing patients with carpal tunnel syndrome.Approval for this study was obtained from the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West,China(HKU/HA HKW IRB,approval No.UW17-129)on April 11,2017.This study was registered in Clinical Trial Registry of The University of Hong Kong,China(registration number:HKUCTR-2220)on April 24,2017.
