BACKGROUND: The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease.
METHODS: A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand.
METHODS: Left-sided infected wrist arthritis complicating ACTS.
METHODS: The child received emergency surgery and anti-infective treatment combined with regular rehabilitation.
RESULTS: During the treatment period, the child\'s wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited.
CONCLUSIONS: In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.

UNASSIGNED: Electroacupuncture (EA) is commonly employed for carpal tunnel syndrome (CTS), whereas laser acupuncture (LA) seems to offer a safer and more convenient alternative. Nevertheless, transitioning from EA to LA requires evidence. This study aims to compare their clinical efficacy and safety.
UNASSIGNED: A randomized single-blind controlled trial was conducted on 76 CTS patients, with 38 patients assigned to receive EA (EA group) and 38 assigned to receive LA (LA group). Acupoints selected for both groups included PC4, PC6, PC7, PC8, LI4, LI10, LI11, HT3, HT7, and LU10. The intervention consisted of 20 sessions over 4 weeks. Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores, patients\' satisfaction, and adverse events (AEs) were recorded.
UNASSIGNED: The LA group demonstrated significantly greater reductions in SSS and FSS scores than the EA group, with mean differences (MDs) and 95% confidence interval (95% CI) of -4.29 (-5.40 to -3.18) and -0.73 (-1.24 to -0.24), respectively, after 4 weeks of treatment. Complete symptom, functional recovery, and both were also significantly better in the LA group (relative risks [RR] [95% CI]: 14.00 [1.94 to 101.22], 1.58 [1.24 to 2.02], and 14.00 [1.94 to 101.22], respectively). Overall treatment effectiveness and satisfaction levels were notably higher in the LA group. Six patients experienced AEs in the EA group, whereas no AEs were reported in the LA group.
UNASSIGNED: In this study, the findings indicate that LA may offer a safer and more effective alternative to EA. Further studies with longer follow-up periods and assessment of electrodiagnostic changes after intervention are needed.

OBJECTIVE: The primary goal was to determine the performance of the cross-section area swelling rate (CSASR) for diagnostic and therapeutic purposes based on the reference standard of electrodiagnosis examination (EDX) in this diagnostic test study.
METHODS: First, patients with symptoms like unilateral carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS), and radial nerve compression (RNC) underwent EDX and ultrasound examination. Second, patients with positive ultrasound were calculated for the CSASR of diseased nerve. Based on previously established CSASR criteria, each patient was categorized as having or not having peripheral nerve entrapment, and for those meeting diagnostic criteria, non-surgical or surgical treatment was recommended. Then, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate (ACC) of ultrasound diagnosis and therapeutic decision-making were calculated based on the reference standard of EDX that had been historically used in the practice.
RESULTS: The total sensitivity, specificity, PPV, NPV, and ACC of ultrasound diagnosis are respectively 93.4, 85.2, 94.7, 82.1, and 91.3%. Which of therapeutic decision-making by ultrasound are, respectively, 83.3, 52.2, 78.4, 60.0, and 73.2%.
CONCLUSIONS: The sensitivity and Youden\'s index of CSASR diagnostic threshold for CuTS is higher than other ultrasound methods. The CSASR diagnostic threshold for CuTS has a potential diagnostic role, but the current date is still not enough to support the potential diagnostic role for CTS or RNS. There is insufficient evidence to suggest that CSASR for CuTS can be used in isolation for diagnosis. Additional research is needed to confirm the diagnostic role of CSASR. The current results suggest that this ultrasound examination method is not suitable for therapeutic decision-making.

OBJECTIVE: Preclinical studies have shown that sodium-glucose cotransporter 2 inhibitors (SGLT2is) have a neuroprotective effect. This study compared the risks of carpal tunnel syndrome and carpal tunnel release surgery between new users of SGLT2is and new users of glucagon-like peptide-1 receptor agonists (GLP-1RAs).
METHODS: A retrospective new-user active comparator cohort study with a target trial design was conducted by using the TriNetX platform. Patients with type 2 diabetes mellitus prescribed SGLT2is or GLP-1RAs were identified. Covariates were balanced using propensity score matching to form 2 homogenous treatment groups. Outcomes were the risk of carpal tunnel syndrome and the risk of carpal tunnel release surgery. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using the TriNetX platform.
RESULTS: The crude cohort included 86,188 and 100,244 patients in the SGLT2is group and GLP-1RAs group, respectively. After matching, each group included 65,464 patients. The SGLT2is group had an average age of 59.6 years, and 46 % were women. The GLP-1RAs group had an average age of 59.5 years, and 45.9 % were women. The incidences of carpal tunnel syndrome (HR: 0.928; 95 % CI: 0.869 to 0.991) and carpal tunnel release surgery (HR: 0.840; 95 % CI: 0.726 to 0.971) were significantly lower in the SGLT2is group than in the GLP-1RAs group.
CONCLUSIONS: In patients with type 2 diabetes mellitus, SGLT2is seem to decrease the risk of carpal tunnel syndrome and the need for carpal tunnel release surgery. Prospective studies are required to confirm our results.

Various injectants are available for the treatment of carpal tunnel syndrome. This systematic review and network meta-analysis was conducted to investigate the effectiveness of different injection therapies in alleviating the symptoms of carpal tunnel syndrome. Various databases were searched for relevant studies from inception until May 10, 2023. Eligible studies were identified using the patient (P), intervention (I), comparison (C), and outcomes (O) model, which involved (P) participants with carpal tunnel syndrome, (I) an intervention based on injection therapy, (C) the use of placebo or another injectant as a control treatment, and (O) the measurement of clinical and electrodiagnostic outcomes of interest. A total of 18 studies were included in the analysis. The network meta-analysis revealed that platelet-rich plasma is effective in the treatment of carpal tunnel syndrome in terms of symptom and pain relief and functional improvement in both the short and long term, whereas steroids are effective only in the short term. Additionally, injections of dextrose solution may offer long-term pain relief as well as short- and long-term symptom alleviation and functional improvement. The study findings suggest that platelet-rich plasma should be used as the first-line treatment for carpal tunnel syndrome, with dextrose and steroids serving as alternative treatment options.

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UNASSIGNED: To assess and compare the clinical and functional outcomes of corticosteroid injections in patients with carpal tunnel syndrome, focusing on two different approaches: ultrasound-guided and landmark-guided.
UNASSIGNED: A systematic search was conducted in PubMed, Scopus and Embase databases for relevant studies published prior to 30th April 2023. Studies that were either randomized controlled trials or had a cohort design were included. The review assessed symptom severity, functional status, electrodiagnostic parameters, complications, need for surgical intervention, visual analogue score, and grip strength. Pooled effect sizes were reported as relative risk (RR) or weighted mean difference (WMD).
UNASSIGNED: A total of 8 articles were included. Compared to those that received steroid injection using landmark approach, those with ultrasound guided approach had lower symptom severity scale (SSS) score on Boston Carpal Tunnel Questionnaire (BCTQ) [WMD -0.50, 95% CI: -0.94, -0.07; I2=78.0%, N=7], lower risk of \"any complications\" [RR 0.58, 95% CI: 0.36, 0.93; I2= 22.9%, N=3] and lower risk of need for surgical intervention [RR 0.55, 95% CI: 0.34, 0.89; I2= 3.0%, N=2]. All other parameters were similar in the two groups i.e., functional status scale (FSS) score, visual analogue score (VAS) and grip strength. The electrophysiological findings were similar in the two groups.
UNASSIGNED: Findings suggest that ultrasound guided approach may be better than landmark guided approach especially in terms of alleviation of symptoms, reducing the risk of complications and need for surgical intervention. However, larger trials with long term follow up may provide conclusive evidence.

UNASSIGNED: Carpal tunnel syndrome (CTS) is the most prevalent upper limb compressive neuropathy. A considerable number of clinical trials and meta-analyses have provided evidence supporting the effectiveness of acupuncture in treating CTS. Nevertheless, the ideal choice of acupoints remains ambiguous.
UNASSIGNED: A data mining analysis was conducted with the objective of determining the most effective acupoint combinations and selection for CTS.
UNASSIGNED: A search was conducted across seven Chinese and English electronic bibliographic databases spanning from their inception to March 2023. Selected were clinical trials that evaluated the efficacy of acupuncture therapy for CTS, with or without randomised controlled methods. Data extraction mainly included acupoint prescriptions. Information such as first author, study design and study setting were also extracted. The principal outcomes comprised the clinical manifestations linked to CTS. Statistical descriptions were generated using Excel 2019. The analysis of association rules was conducted using SPSS Modeler 18.0. Using SPSS Statistics 26.0, exploratory factor analysis and cluster analysis were conducted.
UNASSIGNED: 142 trials (including 86 RCTs and 56 non RCTs) were identified, and 193 groups of effective prescriptions involving 68 acupoints were extracted. The most frequently used acupoints were Da-ling (PC7), Nei-guan (PC6), He-gu (LI4), Wai-guan (TE5), and Yang-xi (LI5). The most frequently used meridians were the pericardial meridian and the large intestine meridian. The majority of special acupoints used were Five-shu points and Yuan-source points, with acupoints on the upper limbs being the most frequently used. The core acupoint groups were analyzed and 11 groups of association rules, 8 factors, and 5 effective cluster groups were obtained.
UNASSIGNED: The evidence-based acupoint selection and combinations of acupuncture therapy for carpal tunnel syndrome were provided by the findings of this study.

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