Demographics of Patients Undergoing Carpal Tunnel Release in an Urban Tertiary Hospital in Malaysia

@#Introduction: Carpal tunnel syndrome (CTS) is the most commonly encountered neuropathy. The entrapment of the median nerve at the wrist can be corrected with a carpal tunnel release (CTR) procedure. The objective of this retrospective study was to determine the demographic, medical, and surgical characteristics of the patients with CTS who presented for CTR surgery in a tertiary hospital in Malaysia. Materials and Methods:Malaysians patients with CTS who had undergone a CTR during the period from 1st June 2017 to 31st December 2017 were enrolled into the study. Each patient had a minimum follow-up of three months. The demographic data of age, gender, race and occupation, and the comorbid illnesses and associated risk factors were recorded. The prevalence and occurrence of CTS in the dominant or non-dominant hand and the effectiveness of surgical intervention were also noted. Data was collected, analysed and stored in Microsoft Excel and SPSS 25. Results: There was a total of 76 cases of CTR surgeries done in 62 patients in the study. Eighty percent of the patients were female, and most of the patients belonged to the age group of 41-60 years. Malays constituted 74.2% of the patients, and 34% were housewives. Hypertension, dyslipidaemia and diabetes mellitus were the three major comorbidities. Cervical spondylosis was seen in one-fourth of the patients. Bilateral hand involvement was present in 54.8% of patients. 59.7% of CTR surgery was done on the dominant hand alone, 17.7 % CTR on the non-dominant hand alone and 22.6% CTR on both hands. Numbness and pain (50%) were the predominant presenting symptoms. The most positive signs were the Durkan test (77.6%), followed by the Tinel sign at the carpal tunnel and the Phalen’s test. At follow-up, three months or more, after the surgery, 75% of the patients showed a satisfactory improvement. Conclusion:Patients, who had undergone CTR, had a higher prevalence of pre-morbid conditions, and a quarter of them presented with associated cervical spondylosis. The most common presentation was a combination of numbness and pain. Many obtained satisfactory improvement post-surgery and thus open surgery could be considered a reliable treatment for CTS.

Clinical manifestations and imaging analysis of cervicogenic headache / 中国骨伤

OBJECTIVE@#To investigate the clinical characteristics and mechanism of cervicogenic headache.@*METHODS@#Fifty-seven patients with cervicogenic headache who were treated from May 2013 to December 2017 and had complete imaging data were selected, including 18 males and 39 females with an average age of(43.26±10.39) years old ranging from 20 to 63 years old. The duration of the disease was 4 months to 35 years with a mean of (11.74±9.47) years. The pain situation, iconography and Tinel sign were analyzed.@*RESULTS@#The patients with cervicogenic headache often had bilateral pain. The regions mainly concentrated in the temporal region, with occipital, head or orbit pains. The VAS scores decreased with the duration of the disease. There were many cases of disc herniation(91.30%), vertebral instability(73.91%), atlantoaxial displacement(56.52%), curvature change of cervicogenic vertebra(54.35%). The number of positive Tinel sign points was between 3 and 24 (13.58±5.8) per patient. The number and extent of Tinel sign were significantly different between the affected side and healthy side(<0.05). C₂,₃ facet joints(92.98%), post mastoid(89.47%), occipital concavity(89.47%), C₃,₄ facet joints(84.21%), third occipital nerve(80.70%) were the positive Tinel sign points in patients with cervicogenic headache.@*CONCLUSIONS@#The iconography changes of cervicogenic headache and Tinel sign may contribute to the clinical diagnosis and mechanism of the disease.

Early Surgical Treatment of Pronator Teres Syndrome

We report a rare case of pronator teres syndrome in a young female patient. She reported that her right hand grip had weakened and development of tingling sensation in the first-third fingers two months previous. Thenar muscle atrophy was prominent, and hypoesthesia was also examined on median nerve territory. The pronation test and Tinel sign on the proximal forearm were positive. Severe pinch grip power weakness and production of a weak "OK" sign were also noted. Routine electromyography and nerve conduction velocity showed incomplete median neuropathy above the elbow level with severe axonal loss. Surgical treatment was performed because spontaneous recovery was not seen one month later.

Benign schwannoma of the radial nerve mimicking cervical radicular pain.

Radicular pain on the arm often referred to cervical disc problems. If cervical MRI is normal, then it is necessary to rule out peripheral nerve tumor. A 54-year old man presented with radicular pain in his left arm, investigated for cervical disc problems, with normal cervical MRI. Examination shows a positive Tinel’s sign on the proximal part of his left arm. Focal MRI revealed a lobulated tumor in the radial nerve 1.5 cm in diameter. The patient was operated and the tumor was completely removed. Histopathology confirmed the diagnosis of schwannoma.

Clinical Characteristics of Carpal Tunnel Syndrome in Patients With Diabetes

BACKGROUND: The clinical symptoms and signs of carpal tunnel syndrome (CTS) were investigated in patients with diabetes. METHODS: The nondominant hands of 105 consecutive patients with diabetes or CTS were divided into three groups: diabetic CTS, diabetic non-CTS, and nondiabetic CTS. The symptoms of CTS (pain, paresthesias, numbness, awakening, weakness, and clumsiness) were scored using the Global Symptom Score. The following signs of CTS were evaluated: Tinel's sign, Phalen's sign, thenar atrophy, and weakness of the abductor pollicis brevis (APB). The severity of the diabetic neuropathy was evaluated using the Michigan Diabetic Neuropathy Score. The score on the neuropathy scale, number of nerves involved, and the score for each CTS symptom and sign were compared among the groups. RESULTS: The duration of diabetes was longer (p=0.000) and diabetic polyneuropathy was more severe (p=0.014) in the diabetic CTS group than in the diabetic non-CTS group. The mean scores for pain and paresthesias were lower in the diabetic CTS group than in the nondiabetic CTS group (p=0.047 and p=0.049, respectively), whereas the mean scores for numbness and weakness did not differ significantly between these two groups (p=0.528 and p=0.638, respectively). In addition, APB weakness was more frequent whereas Phalen's sign was less frequent in the diabetic CTS group than in the nondiabetic CTS group (p=0.002 and p=0.02, respectively). CONCLUSIONS: Patients with diabetic CTS complained less of pain and paresthesias, but their intrinsic hand function did not differ significantly from that of patients with nondiabetic CTS.