• Safety and Health at Work
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• v.5 no.1
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• pp.27-31
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• 2014

Background: Carpal tunnel syndrome (CTS) is a common work-related peripheral neuropathy. In addition to grip force and repetitive hand exertions, wrist posture (hyperextension and hyperflexion) may be a risk factor for CTS among workers. However, findings of studies evaluating the relationship between wrist posture and CTS are inconsistent. The purpose of this paper was to conduct a meta-analysis of existing studies to evaluate the evidence of the relationship between wrist posture at work and risk of CTS. Methods: PubMed and Google Scholar were searched to identify relevant studies published between 1980 and 2012. The following search terms were used: "work related", "carpal tunnel syndrome", "wrist posture", and "epidemiology". The studies defined wrist posture as the deviation of the wrist in extension or flexion from a neutral wrist posture. Relative risk (RR) of individual studies for postural risk was pooled to evaluate the overall risk of wrist posture on CTS. Results: Nine studies met the inclusion criteria. All were cross-sectional or case-control designs and relied on self-report or observer's estimates for wrist posture assessment. The pooled RR of work-related CTS increased with increasing hours of exposure to wrist deviation or extension/flexion [RR = 2.01; 95% confidence interval (CI): 1.646-2.43; p < 0.01: Shore-adjusted 95% CI: 1.32-2.97]. Conclusion: We found evidence that prolonged exposure to non-neutral wrist postures is associated with a twofold increased risk for CTS compared with low hours of exposure to non-neutral wrist postures. Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

• The Korean Journal of Pain
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• v.37 no.1
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• pp.34-40
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• 2024

Background: This study aimed to evaluate the efficacy of pulsed radiofrequency applied using transcutaneous electrodes in carpal tunnel syndrome (CTS). Methods: After randomization, the patients received two cycles of noninvasive pulsed radiofrequency (NiPRF), once weekly, or splinting (the control group) for three months. Clinical evaluations were recorded at baseline and weeks 4 and 8. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the functional status and symptom severity. Results: Sixty-two patients were followed up for three months. There was no difference between the groups in the BCTQ scores before and after treatment. The NiPRF group found a significant difference between the BCTQ measurements at all time intervals (paired sample t-test; P < 0.001). In the splint group, there was a significant difference only between the basal-1st month and basal-3rd month (paired samples t-test; P < 0.001). The main effect of the time variable was statistically significant (ANOVA; P < 0.001), but the group variable was not. There was no correlation between the BCTQ results measured at any time and the electroneuromyelogragphy findings in either group. Conclusions: NiPRF effectively improves symptoms and functionality in patients with CTS for up to 3 months. Thus, NiPRF can be considered an easy, safe, and useful alternative treatment modality for CTS.

• Journal of Medicine and Life Science
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• v.15 no.2
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• pp.101-104
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• 2018

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by focal compression of the median nerve in the carpal tunnel. However, many patients with CTS, who are diagnosed clinically and confirmed with electrophysiological studies, complain of the sensory symptoms extends to the ulnar nerve territory. The aim of this study was to evaluate whether a dysfunction in sensory fibers of the ulnar nerve was present or not in hands with CTS patients who had extramedian spread of sensory symptoms over the hand. We retrospectively analyzed the recording of the subjects who were diagnosed with CTS within a one-year-period of time. After exclusions, 136 hands recordings of 87 patient were included. We compared the results of median and ulnar nerve sensory conduction studies between normal hands and hands with CTS. We did not detect statistically significant difference on all parameters of ulnar nerve sensory conduction studies between the normal hands and the hands with CTS. The parameters of the obtained in median nerve sensory conduction studies were statistically different between the healthy control and CTS patients. The hands with CTS showed similar rate of ulnar sensory conduction abnormalities compared with the normal hands. In conclusion, our study showed that none of the parameters in ulnar sensory nerve conduction studies differ between two groups. Accordingly, our study revealed that ulnar nerve involvement does not contribute in CTS patients underlying the spread of paresthesia extends to the ulnar nerve territory.

• Journal of Korean Neurosurgical Society
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• v.39 no.6
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• pp.423-426
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• 2006

Objective : There is still debate about the diagnostic efficacy of digital infrared thermographic imaging[DITI], nevertheless, it has been used for the diagnosis of carpal tunnel syndrome[CTS]. We performed comparative study between patient and control groups to investigate the diagnostic value of DITI in CTS. Methods : We studied 27 patients with electrodiagnostically-proven CTS and 18 symptom-free volunteers as a control. We measured thermal difference on DITI in the corresponding regions of the hands and forearms. We statistically analyzed the thermal data using a t-test. Results : The average thermal difference in the diagnosed patient group ranged from $0.0303^{\circ}C$ to $0.2856^{\circ}C$, while that in control group ranged from $0.0611^{\circ}C$ to $0.2878^{\circ}C$. In the CTS patient group, thermal difference between each 2nd finger was higher than that of other regions. However, there was no statistical significance between patient and control groups. Conclusion : We found that the diagnostic value of DITI in CTS was not sufficient. There should be a reconsideration of the usefulness of DITI in CTS.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.472-475
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• 2012

Objective : The aim of this study is to establish the value of hand elevation test as a reproducible provocative test for the diagnosis of carpal tunnel syndrome (CTS). Methods : We had a prospective study of 45 hands of 38 patients diagnosed with CTS between April 2005 and February 2009. The diagnosis of CTS was based on the American Academy of Neurology clinical diagnostic criteria. Experimental and control group patients underwent Tinel's test, Phalen's test, carpal compression test and hand elevation test as provocative tests for CTS. Results : We used chi-square analysis to compare Tinel's test and Phalen's test, carpal compression test with hand elevation test. The sensitivity and specificity of the hand elevation test is 86.7% and 88.9% each. Tinel's test had 82.2% sensitivity and 88.9% specificity. Phalen's test had 84.4% sensitivity and 86.7% specificity. Carpal compression test had 84.4% sensitivity 82.2% specificity. Comparisons of sensitivity and specificity between hand elevation test and Tinel's test, Phalen's test, and carpal compression test had no statistically significant differences. To compare the diagnostic accuracies of four tests, the area under the non-parametric receiver operating character curve was applied. Conclusion : The hand elevation test has higher sensitivity and specificity than Tinel's test, Phalen's test, and carpal compression test. Chi-square statistical analysis confirms the hand elevation test is not ineffective campared with Tinel's test, Phalen's test, and carpal compression test.

• Annals of Clinical Neurophysiology
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• v.23 no.2
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• pp.99-107
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• 2021

Background: Pain and autonomic dysfunction are prominent symptoms in some patients with carpal tunnel syndrome (CTS). Infrared thermography (IRT) has been used to evaluate CTS by measuring the cutaneous temperature and sympathetic vasomotor function. Methods: This study enrolled the 66 hands of 33 subjects, some of which had clinical CTS and the others were healthy. The enrolled patients completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Historical-Objective scale, and underwent nerve conduction studies (NCSs) and IRT. Skin temperature was measured at the fingertips and the thenar and hypothenar regions in each hand. We analyzed (1) the correlations between self-reported severity, physician-assessed severity, and test results, and (2) the sensitivity and specificity of IRT in diagnosing CTS. Results: No significant correlation was observed between the results of the BCTQ, NCS, and IRT. IRT had a low sensitivity and high specificity in diagnosing CTS. Conclusions: IRT cannot replace NCS in diagnosing CTS, nor did it provide an advantage in combination with NCS. However, lower temperatures at the median nerve in some hands with moderate-to-severe CTS suggested the involvement of sympathetic nerve fiber function. Follow-up studies with a larger-scale and complementary design are required to elucidate the relationships.

• Annals of Clinical Neurophysiology
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• v.12 no.2
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• pp.47-54
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• 2010

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by compression of the median nerve beneath the transverse carpal ligament. CTS can be correctly diagnosed by the patients' description of symptoms and electrophysiological tests that measure nerve conduction through the wrist. Many previous studies reported various risk factors of CTS, such as obesity, diabetes mellitus, thyroid disease and trauma. Obesity is associated with both hyperlipidemia and CTS. This study focused on the relationship between severity of CTS and serum lipid level. Methods: One hundred fourteen patients with CTS and 74 controls were divided into four groups according to the severity; normal, mild, moderate and severe. And then serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) were measured in each group. Results: There was a positive correlation between TG and CTS severity (p<0.001). But TC, LDL-C and HDL-C were not correlated with CTS severity. Conclusions: These results suggest that high serum TG may act as an aggravating factor of CTS.

• Annals of Clinical Neurophysiology
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• v.16 no.1
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• pp.21-26
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• 2014

Background: Electrophysiological study has been known as a useful method to evaluate the therapeutic effect of operation in idiopathic carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the clinical and electrophysiological changes after carpal tunnel release (CTR) compared to the preoperative results. Methods: We analyzed the changes of nerve conduction study (NCS) before and after minimal open carpal tunnel release in 18 patients (25 hands) with CTS. Follow-up study was performed over 6 months after operation. Results: Clinical improvement was seen in all cases after CTR. In contrast, electrophysiological improvement was various depending on the parameters; the mean median sensory latency and nerve conduction velocity (NCV) improved significantly (p = 0.001). The mean median motor latency also improved, but NCV and compound muscle action potential (CMAP) amplitude did not change. The extent of improvement was evident in moderate CTS, but not in severe CTS. Conclusions: In this preliminary study, all subjects who underwent CTR achieved a clinical relief along with a significant improvement of electrophysiological parameters such as median sensory latency, sensory NCV and median distal motor latency. After CTR, a number of cases with mild to moderate CTS showed a prominent improvement of clinical and electrophysiological parameters, while fewer improvements were seen in severe CTS, although it did not reach the statistical significance.

• The Korean Journal of Pain
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• v.33 no.1
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• pp.54-59
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• 2020

Background: The median nerve cross-sectional area (MNCSA) is a useful morphological parameter for the evaluation of carpal tunnel syndrome (CTS). However, there have been limited studies investigating the anatomical basis of median nerve flattening. Thus, to evaluate the connection between median nerve flattening and CTS, we carried out a measurement of the median nerve thickness (MNT). Methods: Both MNCSA and MNT measurement tools were collected from 20 patients with CTS, and from 20 control individuals who underwent carpal tunnel magnetic resonance imaging (CTMRI). We measured the MNCSA and MNT at the level of the hook of hamate on CTMRI. The MNCSA was measured on the transverse angled sections through the whole area. The MNT was measured based on the most compressed MNT. Results: The mean MNCSA was 9.01 ± 1.94 ㎟ in the control group and 6.58 ± 1.75 ㎟ in the CTS group. The mean MNT was 2.18 ± 0.39 mm in the control group and 1.43 ± 0.28 mm in the CTS group. Receiver operating characteristics curve analysis demonstrated that the optimal cut-off value for the MNCSA was 7.72 ㎟, with 75.0% sensitivity, 75.0% specificity, and an area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.69-0.95). The best cut off-threshold of the MNT was 1.76 mm, with 85% sensitivity, 85% specificity, and an AUC of 0.94 (95% CI, 0.87-1.00). Conclusions: Even though both MNCSA and MNT were significantly associated with CTS, MNT was identified as a more suitable measurement parameter.

• Journal of Pharmacopuncture
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• v.24 no.2
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• pp.76-83
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• 2021

While carpal tunnel syndrome (CTS) is the most common entrapment neuropathy affecting the wrist, resulting in substantial physical, psychological, and economic effects, there is no gold standard therapy for CTS. In this case series study, we aimed to report CTS patients treated with Carthami Semen Pharmacopuncture (CSP) and electroacupuncture (EA) showing improvements in their symptoms, and the combinatorial effects of CSP and EA. We collected medical records of CTS outpatients who received CSP and EA at Chuku Acupuncture & Moxibustion Korean Medicine Clinic from August 2017 to September 2018. The outcome measures were the visual analog scale (VAS) for pain, paresthesia, the Korean version of the Boston carpal tunnel questionnaire (K-BCTQ) score, and changes in nocturnal pain, Tinel sign, and Phalen's test. We included patient satisfaction at the completion of all treatments. 17 patients were included for this case series study. After treatment, VAS for pain decreased significantly from 50.41 ± 16.19 to 9.59 ± 9.46, VAS for paresthesia also decreased significantly from 63.50 ± 11.49 to 14.75 ± 12.97, and K-BCTQ symptom severity scale decreased from 2.48 ± 0.68 to 1.89 ± 0.70 (all p < 0.001). Nocturnal pain, Tinel signs, and Phalen's test showed improvements after all the treatments. All the patients reported favorable overall satisfaction with the treatments, and 69.23% wanted future pharmacopuncture treatments if CTS recurred. No complications were detected. The combination of CSP and EA could be an effective and safe option in treating CTS.