Risk factors, associations, and high-risk patient profiles for nocturnal pain in carpal tunnel syndrome: implications for patient care.

INTRODUCTION: Carpal tunnel syndrome results from chronic compression of the median nerve, causing pain and paresthesia, especially at night. The impact of these symptoms on patients includes disrupted sleep patterns and a desire to alleviate discomfort through hand movements. Our study aims to investigate risk factors, associations, and high-risk patient profiles associated with these nocturnal manifestations in carpal tunnel syndrome. METHODOLOGY: Utilizing a retrospective case-control design, our study comprises 681 patients with carpal tunnel syndrome, including 581 with nocturnal symptoms and 90 without. Data were obtained through personalized phone calls and health records, covering health profiles, medical comorbidities, perioperative variables, and selected outcomes. RESULTS: Analyzing 591 patients with night symptoms revealed significant differences compared to the non-night symptoms group. The night symptoms group exhibited a lower mean age (51.3 vs. 56.6 years, p = 0.001), higher prevalence of diabetes (30.1% vs. 45.6%, p = 0.003), and paresthesia (98.5% vs. 81.1%, p < 0.001). In addition, the night symptoms group reported a higher incidence of disabling pain (89.2% vs. 70.0%, p < 0.001), weak hand grip (80.5% vs. 62.2%, p < 0.001), and night splints use (37.7% vs. 24.4%, p < 0.001). Preoperatively, the night symptoms group exhibited slightly higher intraoperative anxiety (40.9% vs. 30.0%, p = 0.12) and a slightly longer recovery time (1.7 vs. 1.4 months, p = 0.22), with no significant difference in pain relief scores (8.1 vs. 7.7, p = 0.16). CONCLUSION: Patients with night symptoms show increased likelihood of comorbidities (diabetes, and renal, conditions), along with a propensity for disabling symptoms and paresthesia. Although they experience slightly longer recovery times, they demonstrate improved pain relief scores. LEVEL OF EVIDENCE III: Case-Control Study.

Prevalence of growing pains in a general paediatric OPD: A descriptive, observational and cross-sectional study.

Context: Growing pain (GP) is a common presentation in primary care settings. Aims: To find out the prevalence of GP and to observe its characteristics and associations. Settings and Design: General paediatric outpatient department (OPD). Methods and Material: Children coming to the general paediatric OPD of a tertiary centre in India between April 2019 and March 2020 for 'chronic leg pains' were screened with Peterson's criteria. Patients with systemic illness were excluded. All received vitamin D and calcium supplementation. Patients with haemoglobin less than 11 gm% received additional 3 mg/kg iron supplementation. Then, patients were asked for follow-up. Statistical Analysis Used: Chi-square test. Results: A total of 333 children were diagnosed as GP out of the total OPD attendance of 26750. The prevalence was 1.24% and 72.7% among the children with chronic leg pain. Highest prevalence was in winter (1.74%). The mean age of the patients was 7.88 years. The mean duration of symptoms was 10.92 months. After 3 months, 267 patients could be followed up. Seventy-two out of 107 (67.3%) children, who received iron became symptom-free. Only 43 (28.8%) patients became symptom-free out of 160, who received only calcium and vitamin D3 and did not receive iron. The difference was highly significant statistically (P < 0.0001). Conclusions: The prevalence of GP in the OPD was 1.24% and 72.7% among the children with chronic leg pain. Iron supplementation along with vitamin D3 and calcium was associated with faster resolution of the symptoms.

Investigation of Vitamin D Levels and the Effects of Being an Agricultural Worker on Etiology and Night Pain in Children and Adolescents With Chronic Low Back Pain.

OBJECTIVE: Chronic low back pain in children is a condition that should be investigated. In this study, we examined the effects of agricultural work on imaging results, risk factors, night pain, and vitamin D levels in children and adolescents with chronic low back pain. MATERIAL AND METHODS: The study included 133 patients who presented to the Physical Medicine and Rehabilitation and Neurosurgery outpatient clinics with low back pain that had lasted more than three months. The patients were evaluated based on the duration of their low back pain, the presence of night pain, a family history of low back pain, their employment status, local or radicular pain, and their body mass index (BMI). A physical examination was carried out to look into the etiologies of low back pain. Appropriate imaging, such as x-ray radiography, magnetic resonance imaging (MRI), and computed tomography (CT), was performed for the patients. Blood samples were collected from patients to assess inflammatory pathologies and vitamin D levels. RESULTS: The 133 patients in the study ranged in age from seven to 16 years, with a mean age of 14.3 + 1.9 years. Further, 60.2% (n = 80) of the cases were male, while 39.8% (n = 53) were female. Imaging revealed findings in 59.4% of the patients. In 97.7% of the participants, D hypovitaminosis was detected. There was no significant relationship between the patients' imaging findings and vitamin D deficiency, family history, BMI, and employment status (p = 0.441, 0.147, 0.082, 0.605). The relationship between family history, employment status, and night pain was statistically significant (p < 0.001). There was no statistically significant relationship between night pain and vitamin D deficiency (p = 0.667). CONCLUSION: Mechanical strain due to agricultural work and family history was found to be associated with night pain in patients with chronic low back pain in our study. The most important finding of this study is that night pain, which is considered a red flag, can occur in both inflammatory pathologies and situations causing mechanical low back pain, and risk factors should be thoroughly investigated. Studies with patients who have sufficient vitamin D will help to clarify the relationship between chronic low back pain and vitamin D.

Presence of Night Pain, Neuropathic Pain, or Depressive Disorder Does Not Adversely Affect Outcomes After Total Knee Arthroplasty: A Prospective Cohort Study.

BACKGROUND: A considerable proportion of patients warranting total knee arthroplasty (TKA) have night pain, neuropathic pain, and/or depressive disorder, which may not be resolved by TKA. This prospective, longitudinal cohort study aimed to document the prevalence of night pain, neuropathic pain, and depressive disorder in patients with advanced knee osteoarthritis undergoing TKA and to determine whether the specific coexisting pain and/or disorder at the time of TKA adversely affected postoperative outcomes. METHODS: In this study, 148 patients undergoing TKA were longitudinally evaluated. The presence of night pain, neuropathic pain (determined using Douleur Neuropathique 4 [DN4]) and depressive disorder (determined using the Patient Health Questionnaire-9 [PHQ-9]) was determined before and 6 weeks, 3 months and 1 year after TKA. In addition, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol-5 Dimension (EQ-5D) scores were assessed before and 1 year after TKA. Potential associations of night pain, neuropathic pain, and/or depressive disorder with pre- and postoperative WOMAC and EQ-5D scores were examined in subgroup analyses. RESULTS: Preoperatively, 72% (n = 106) of patients reported night pain, and the prevalences of neuropathic pain and depressive disorder were 15% and 17%, respectively. Preoperatively, compared with patients without night pain, those with night pain had significantly poorer preoperative WOMAC scores, but no significant difference was seen between groups 1 year after TKA. Preoperatively, the WOMAC, EQ-5D, and EQ-5D health scores of patients with neuropathic pain were not significantly different from those of patients without neuropathic pain, and there was no difference in clinical outcome scores 1 year after TKA between these groups. Preoperatively, the patients with depressive disorder showed significantly poorer preoperative WOMAC, EQ-5D, and EQ-5D health scores than those without depressive disorder, but no significant differences in scores were observed 1 year after TKA between these groups. CONCLUSION: This study revealed a considerable prevalence of night pain, neuropathic pain, and depressive disorder in patients undergoing TKA and that patients with these specific conditions reported poorer functional and quality of life scores preoperatively. However, such adverse effects disappeared after TKA. Our study findings suggest that TKA can provide satisfactory outcomes for patients with these specific conditions.

[Rotator cuff injuries with nighttime pain and sleep quality before and after treatment]. / Lesiones del manguito rotador con dolor nocturno y calidad de sueño antes y después del tratamiento.

INTRODUCTION: Growing evidence suggests that shoulder injuries involving the rotator cuff cause severe pain and deterioration of quality of life and sleep. OBJECTIVE: To present the results of a systematic review on the association of rotator cuff injuries with nighttime pain and sleep quality before and after treatment. MATERIAL AND METHODS: We searched PubMed limited to humans, with no language, age and time period limit with the following terms: [rotator cuff tear and (nocturnal pain OR sleep)]. We used the PRISMA criteria for systematic reviews. Information was extracted on the frequency of nighttime pain and sleep quality in patients with rotator cuff injuries. RESULTS: Of 123 records found, 10 studies were included for meeting criteria, including 1,516 patients. Nighttime pain affected 91-93% of patients; its average intensity was 5.5 points of the EVA. 100% of the studies reported alterations in sleep quality associated with rotator cuff injury. After repair, a decrease in pain to inferior scores of 2 and improvement in sleep quality were reported. CONCLUSION: Rotator cuff injuries produce nighttime pain and sleep quality disturbances that improve with treatment. Alterations in sleep quality are due not only to pain but to alterations in shoulder functionality.

INTRODUCCIÓN: Evidencia creciente sugiere que las lesiones del hombro que involucran al manguito rotador causan dolor severo y deterioro de la calidad de vida y del sueño. OBJETIVO: Presentar los resultados de una revisión sistemática sobre la asociación de lesiones del manguito rotador con dolor nocturno y calidad de sueño antes y después del tratamiento. MATERIAL Y MÉTODOS: Se realizó una búsqueda en PubMed limitada a humanos, sin límite de idioma, edad y período de tiempo con los siguientes términos: [rotator cuff tear and (nocturnal pain OR sleep)]. Se utilizaron los criterios PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) para revisiones sistemáticas. Se extrajo información sobre la frecuencia de dolor nocturno y calidad del sueño en pacientes con lesiones del manguito rotador. RESULTADOS: De 123 registros encontrados, 10 estudios fueron incluidos por cumplir criterios, incluyendo 1,516 pacientes. El dolor nocturno afectó de 91-93% de los pacientes; su intensidad media fue de 5.5 puntos de la escala visual análoga (EVA). Cien por ciento de los estudios reportaron alteraciones en la calidad de sueño asociado a lesión del manguito rotador. Tras la reparación, en todos los estudios se reportó disminución de dolor a puntuaciones inferiores a 2 y mejoría de la calidad del sueño. CONCLUSIÓN: Las lesiones del manguito rotador producen dolor nocturno y alteraciones de la calidad del sueño que mejoran con el tratamiento. Las alteraciones de la calidad del sueño se deben no sólo a dolor, sino a alteraciones en la funcionalidad del hombro.

Synchronization of Blood Flow Velocity in the Anterior Humeral Circumflex Artery and Reduction in Night Pain After Arthroscopic Rotator Cuff Repair: A Case Report.

Rotator cuff tears are commonly associated with pain at rest and at night particularly if lying on the affected shoulder. This case describes a 54-year-old man who reported concerns of severe night pain in his left shoulder and had to undergo arthroscopic rotator cuff repair. The severity of night pain and blood flow velocity in the anterior humeral circumflex artery (AHCA) were measured over time. The patient reported his night pain as 10/10 on the numerical rating scale in the first week after surgery. In the fourth week, he rated his night pain as 6/10, and in the fifth week, his pain was <2/10. We measured blood flow velocity in the AHCA using a 3-11MHz color Doppler and power Doppler ultrasound (SONIMAGE HS2, Konica Minolta, Tokyo, Japan), and we calculated peak systolic velocity. The course of peak systolic velocity in the AHCA ranged from 27.7 to 62.4 cm/s until four weeks after surgery when his night pain was severe; AHCA flow velocity ranged from 16.7 to 19.3 cm/s five weeks after surgery when his night pain had reduced. The initially high blood flow velocity in the AHCA decreased almost simultaneously with the improvement in night pain. Our case highlights that blood flow velocity in the AHCA synchronized with the severity of night pain, which may contribute to the understanding of sleep disturbances in patients after arthroscopic rotator cuff repair.

Nocturnal pain in patients with rotator cuff related shoulder pain: A prospective study.

INTRODUCTION: Nocturnal pain is a common complaint in rotator cuff related shoulder pain (RCRSP), and there is no study in literature that has evaluated the relationship between nocturnal pain severity and other evaluation parameters in RCRSP. The objective of the study was to investigate the relationship between the severity of nighttime pain and demographic and clinical data including physical examination findings, magnetic resonance imaging (MRI) findings, disability, kinesiophobia, and quality of life scores in patients diagnosed with RCRSP. MATERIALS AND METHODS: We assessed 61 patients (52.4% female) using the Visual Analog Scale (VAS) for nighttime and daytime, Shoulder Pain and Disability Questionnaire (SPADI), Tampa Scale of Kinesiophobia (TSK), and Short Form-36 (SF-36). Demographic and clinical data were recorded and rotator cuff specific examinations were performed and documented. RCRSP lesions were evaluated in terms of tendonitis and rupture by MRI. RESULTS: The nighttime VAS score was positively correlated with SPADI disability and total scores, and daytime VAS score, and negatively correlated with SF-36 physical function subscale. The nighttime VAS score was associated with presence of calcific tendonitis in supraspinatus, infraspinatus tendinosis, and subscapularis tendinosis. On multivariate analysis with a linear regression model, presence of subscapularis tendinosis was an independent predictor of nighttime VAS score. In shoulder clinical tests, the nighttime VAS score correlated with only Neer test positivity. CONCLUSIONS: Our results suggest that there is a relationship between nocturnal pain severity and disability. Presence of subscapularis tendinosis appears to be a predictor of nocturnal pain severity. Additionally, patients with positive Neer test may experience more nocturnal pain.

Lesiones del manguito rotador con dolor nocturno y calidad de sueño antes y después del tratamiento / Rotator cuff injuries with nighttime pain and sleep quality before and after treatment

Resumen: Introducción: Evidencia creciente sugiere que las lesiones del hombro que involucran al manguito rotador causan dolor severo y deterioro de la calidad de vida y del sueño. Objetivo: Presentar los resultados de una revisión sistemática sobre la asociación de lesiones del manguito rotador con dolor nocturno y calidad de sueño antes y después del tratamiento. Material y métodos: Se realizó una búsqueda en PubMed limitada a humanos, sin límite de idioma, edad y período de tiempo con los siguientes términos: [rotator cuff tear and (nocturnal pain OR sleep)]. Se utilizaron los criterios PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) para revisiones sistemáticas. Se extrajo información sobre la frecuencia de dolor nocturno y calidad del sueño en pacientes con lesiones del manguito rotador. Resultados: De 123 registros encontrados, 10 estudios fueron incluidos por cumplir criterios, incluyendo 1,516 pacientes. El dolor nocturno afectó de 91-93% de los pacientes; su intensidad media fue de 5.5 puntos de la escala visual análoga (EVA). Cien por ciento de los estudios reportaron alteraciones en la calidad de sueño asociado a lesión del manguito rotador. Tras la reparación, en todos los estudios se reportó disminución de dolor a puntuaciones inferiores a 2 y mejoría de la calidad del sueño. Conclusión: Las lesiones del manguito rotador producen dolor nocturno y alteraciones de la calidad del sueño que mejoran con el tratamiento. Las alteraciones de la calidad del sueño se deben no sólo a dolor, sino a alteraciones en la funcionalidad del hombro.

Abstract: Introduction: Growing evidence suggests that shoulder injuries involving the rotator cuff cause severe pain and deterioration of quality of life and sleep. Objective: To present the results of a systematic review on the association of rotator cuff injuries with nighttime pain and sleep quality before and after treatment. Material and methods: We searched PubMed limited to humans, with no language, age and time period limit with the following terms: [rotator cuff tear and (nocturnal pain OR sleep)]. We used the PRISMA criteria for systematic reviews. Information was extracted on the frequency of nighttime pain and sleep quality in patients with rotator cuff injuries. Results: Of 123 records found, 10 studies were included for meeting criteria, including 1,516 patients. Nighttime pain affected 91-93% of patients; its average intensity was 5.5 points of the EVA. 100% of the studies reported alterations in sleep quality associated with rotator cuff injury. After repair, a decrease in pain to inferior scores of 2 and improvement in sleep quality were reported. Conclusion: Rotator cuff injuries produce nighttime pain and sleep quality disturbances that improve with treatment. Alterations in sleep quality are due not only to pain but to alterations in shoulder functionality.

The connection between the night pain of patients with rotator cuff tears and circadian clock / 医学研究生学报

Patients with rotator cuff tears often have repeated irregular neck and shoulder pain, and all of them are aggravated at night. The patient is very painful and cannot suffer from lateral position. Most of them cannot or do not do the exercises such as stretching the elbow and bending the arm, which seriously affect sleep. Numerous studies have shown that in addition to inflammation, the two-way interaction to the circadian clock, the circadian clock also regulated many aspects of the immune system. And the mechanism of night pain caused by rotator cuff injury was related to factors such as inflammation of the acromion sac. This suggests that the night pain of rotator cuff tears may have a circadian rhythm. This article mainly reviews the mechanism of night pain caused by rotator cuff tears.

Evaluation of Factors Associated with Night Pain in Women Undergoing Carpal Tunnel Release.

BACKGROUND: Night pain has important diagnostic and prognostic values in patients with carpal tunnel syndrome (CTS). We aimed to determine whether night pain is associated with certain patient characteristics in female patients undergoing carpal tunnel release. METHODS: We recruited 75 women with the mean age of 54 years who were scheduled for carpal tunnel release. Diagnosis of CTS was made based on both the clinical symptoms and the results of electrophysiologic studies. Patient characteristics investigated as factors potentially associated with night pain were: age, body mass index (BMI), symptom duration, comorbidities such as diabetes mellitus (DM) and thyroid disease, electrophysiologic severity of CTS, and sleep position. We conducted a logistic regression analysis to examine the relationships between the presence of night pain and the different patients' demographic and clinical variables. RESULTS: Absence of night pain was associated with increased age (odds ratio (OR), 0.918, 95% confidence interval (CI), 0.851 to 0.99) and presence of DM (OR, 0.196; 95% CI, 0.046 to 0.835). The other variables assessed were not found to be associated with presence or absence of night pain. CONCLUSIONS: This study found that in women undergoing carpal tunnel release, older patients or those having DM are slightly less likely to have night pain. As night pain is an important prognostic factor for CTS, further studies are warranted to determine whether the absence of night pain could affect outcome assessment of CTS in the elderly or patients with DM.