Maintaining intraoperative haemostasis is crucial when conducting wide-awake hand surgeries, this is particularly to improve visibility which will improve patient\'s outcome. There are various methods that could achieve the aforementioned, some of which is wide awake local anaesthesia without tourniquet (WALANT) or Tourniquet alongside sedation. Each method has its own benefits and drawbacks. This study primarily focuses on Carpal Tunnel Syndrome and Trigger Finger release. A comprehensive literature review was conducted through PUBMED, Scopus, google scholar, and web of science. A total of 45 articles were included in the study. We aimed to assess whether the literature supports the use of a tourniquet alongside sedation, or only local anesthesia and epinephrine in wide awake hand surgeries. Moreover, we aimed to highlight the benefits and drawbacks of using a tourniquet, and determine the patient population most likely to benefit from tourniquet application.

Popular artificial intelligence systems, like ChatGPT, may be used by anyone to generate humanlike answers to questions. This study assessed whether ChatGPT version 3.5 (ChatGPTv3.5) or the first five results from a Google search provide more accurate, complete, and concise answers to the most common questions patients have about carpal tunnel syndrome. Three orthopedic hand surgeons blindly graded the answers using Likert scales to assess accuracy, completeness, and conciseness. ChatGPTv3.5 and the first five Google results provide answers to carpal tunnel syndrome questions that are similar in accuracy and completeness, but ChatGPTv3.5 answers are more concise. ChatGPTv3.5, being freely accessible to the public, is therefore a good resource for patients seeking concise, Google-equivalent answers to specific medical questions regarding carpal tunnel syndrome. ChatGPTv3.5, given its lack of updated sourcing and risk of presenting false information, should not replace frequently updated academic websites as the primary online medical resource for patients.

Introduction The COVID-19 pandemic prompted individuals to make a number of lifestyle alterations. Few studies have examined the development of any hand and/or arm dysfunctions that may have resulted. The purpose of this study was to identify hand and/or arm overuse injuries that may have occurred as a result of the stay-at-home orders during the COVID-19 pandemic. Methods A Google Trends analysis of the terms \"hand pain,\" \"carpal tunnel syndrome,\" \"cubital tunnel syndrome,\" \"trigger finger,\" \"de Quervain tenosynovitis,\" \"elbow pain,\" \"tennis elbow,\" \"golfer\'s elbow,\" \"thumb base arthritis,\" and \"extensor carpi ulnaris tenosynovitis\" in the United States, United Kingdom, Canada, and India was performed from June 2019 to January 2023. The noted timeframe was divided into quarters of 47 weeks, with the first quarter (June 2, 2019, through April 19, 2020) serving as a pre-pandemic baseline. The analysis compared initial results noted in the first quarter to individual results from the second, third, and fourth quarters. Results The most notable findings were the upward trends of the terms \"hand pain,\" \"carpal tunnel,\" and \"trigger finger.\" Specifically, India showed a significant increase in the terms \"hand pain\" and \"carpal tunnel syndrome\" in the second, third, and fourth quarters. The United States additionally showed a significant upward trend in the terms \"carpal tunnel syndrome\" and \"trigger finger\" in the second, third, and fourth quarters. The United Kingdom also reported a significant upward trend in the term \"trigger finger\" in the second, third, and fourth quarters. Conclusion Numerous factors likely contributed to the increased interest in these terms, such as the increase in telework and associated mobile device usage due to lockdown during the COVID-19 pandemic. Movements associated with performing these tasks may have led to an increased prevalence of hand pain, thus prompting increased queries of these terms through an online search engine.

BACKGROUND: Appropriate cut-off values and diagnostic accuracy (DA) [sensitivity, specificity, predictive values, positive (PPV) and negative (NPV)] of electrodiagnostic findings for carpal tunnel syndrome (CTS) based on age, gender, and diabetes mellitus (DM) were not reported.
METHODS: In a retrospective study, we described the latency difference values and DA of comparative latency studies COLS [median to ulnar through palmar difference (palmdiff) and ring difference study (ringdiff), median to radial through thumb difference study (thumbdiff), and combined sensory index (CSI)] among non-CTS and CTS groups based on age, DM, and gender.
RESULTS: We included 632 patients (228 without CTS and 404 with CTS). For PPV > 90% and NPV > 50%, the best cut-offs among patients without DM, were 0.5ms, 0.8-1 ms, 1.4 ms, and 2 ms for palmdiff, thumbdiff, CSI (age < 60 years), and CSI (age > 60 years), respectively. The best cut-offs among patients with DM were 0.5 ms, 1.2 ms, 0.8 ms, 1.0-1.2 ms, 1.8 ms, 1-1.2 ms, 3.0 ms, and 3.5 ms for palmdiff (age < 50 years), palmdiff (age > 50 years), thumbdiff (age < 40 years), thumbdiff (age 40-59 years), thumbdiff (age > 60 years), CSI (age < 50 years), CSI (age 50-59 years), and CSI (age > 60 years), respectively.
CONCLUSIONS: The cut-off values of COLS to confirm CTS and their DA were different according to age and DM.

UNASSIGNED: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with paresthesias and pain in the hand and wrist. CTS is also associated with insomnia and excessive daytime sleepiness (EDS) resulting from the nocturnal exacerbation of symptoms. The Boston Carpal Tunnel Questionnaire (BCTQ) was developed for the assessment of therapeutic outcomes. It consists of two subscales: the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). The aim of this study was to perform an adaptation and validation of the Polish language version of BCTQ (pBCTQ). A second aim was to investigate the influence of treatment of CTS on insomnia and EDS.
UNASSIGNED: The validation of the pBCTQ followed the widely accepted recommendations. In our consecutive sampling survey 130 patients with CTS filled out the pBCTQ, EQ-5D-5L quality of life questionnaire, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS). 26 of them filled out pBCTQ once again, two weeks later, and 35 filled out the pBCTQ and other items after therapy.
UNASSIGNED: The pBCTQ showed good internal consistency: 0.91 for SSS and 0.93 for FSS (Cronbach\'s α). The test-retest reliability showed an intraclass coefficient of 0.69 for SSS and 0.55 for FSS. Both subscales correlated also with nerve conduction studies (NCS) as well as with the EQ-5D-5L, AIS, and ESS. After therapy, both subscales and AIS significantly decreased. Improvement was also seen in the NCS and EQ-5D-5L, but not in the ESS.
UNASSIGNED: The pBCTQ is a reliable, valid, and responsive tool for measuring the outcome of CTS. Therapy for CTS leads to the improvement of concurrent insomnia but may not change daytime sleepiness.

OBJECTIVE: Pain often accompanies carpal tunnel syndrome and affects patients\' health-related quality of life. The aim was to develop and validate a predictive model for the pain intensity of carpal tunnel syndrome using demographic, clinical, electrophysiological, and ultrasound findings.
METHODS: We conducted a secondary analysis of data from a large sample of patients (May 2017 to December 2022) with carpal tunnel syndrome. A total of 520 (53.0 %) mild, 276 (28.1 %) moderate, and 186 (18.9 %) severe syndromes were included in the complete data set of 982 hands (61.1 % female). The mean age was 57.8 (10.7) years and the median duration [interquartile range] of the symptoms was 4 [2,10] months. A regression model was developed and validated to predict pain intensity on a numerical rating scale using a tree-based machine learning algorithm.
RESULTS: The validation of the regression model showed good performance with a root mean squared error, R-squared, and mean absolute error of 1.35, 0.42, and 1.05, respectively. Overall, the top significant predictors of pain intensity were compound motor nerve action potential latency, nocturnal pain, and thenar weakness. These were followed by the cross-sectional area of the median nerve, sensory nerve action potential, bowing of the flexor retinaculum, disease duration, and body mass index. We did not find strong associations between the median nerve transcarpal latency, age, sex, and diabetes with the pain intensity of carpal tunnel syndrome.
CONCLUSIONS: Our model showed good performance in predicting the subjective pain intensity of carpal tunnel syndrome, even in the context of non-linear relations.

Hydroxyapatite crystal deposition disease (HADD) is a common disorder resulting from the deposition of calcium hydroxyapatite crystals in various soft tissues, typically in periarticular distribution, including tendons, tendon sheaths, joint capsules, ligaments, bursae, periarticular soft tissues, and occasionally within the joints. The more commonly known subtypes of HADD are calcific tendinopathy and calcific periarthritis. Carpal tunnel syndrome (CTS) can be rarely caused by calcific deposits within the carpal tunnel in the setting of HADD-related calcific periarthritis. Imaging, particularly ultrasound and radiographs, is crucial in distinguishing this entity from the conventional form of CTS that tends to be idiopathic. We describe a rare presentation of CTS secondary to calcific periarthritis in a 45-year-old patient, with imaging demonstrating mass-like calcification within the carpal tunnel, with typical features of those seen with HADD. The patient was treated with ultrasound-guided barbotage, with significant clinical improvement. The case highlights a lesser-known cause of CTS as well as a presentation of HADD, and the role of ultrasound-guided barbotage, a minimally invasive procedure, as a viable first-line management option as an alternative to surgery.

Idiopathic carpal tunnel syndrome is the most common entrapment neuropathy in hand surgery, and it is characterized by Noninflammatory fibrosis of subsynovial connective tissues. The prevalence and incidence differ between male and female individuals, and the mechanism underlying this difference remains largely unclear. In the present study, we collected subsynovial connective tissues from six male and six female patients diagnosed with idiopathic carpal tunnel syndrome during surgery. We performed a comprehensive gene expression analysis using RNA sequencing to compare the gene expression profiles between male and female patients with idiopathic carpal tunnel syndrome. We identified 26 genes with significantly different expressions between male and female patients, in which POSTN, COL1A1, and COL3A1, which are involved in extracellular matrix organization, and IGF1, an important fibrotic factor, were significantly upregulated in male patients. Immunohistochemistry confirmed the expression of proteins encoded by these genes in tissues, and male patients tended to show increased POSTN expression. Our results indicate that fibrosis of subsynovial connective tissues is induced by different mechanisms in male and female patients, and genes involved in extracellular matrix organization, especially POSTN, might be important factors in male patients. This study provides insight into the pathogenesis of idiopathic carpal syndrome and might contribute to the development of new treatment strategies.

UNASSIGNED: Ultrasonography (US) is a useful diagnostic modality for diagnosis of carpal tunnel syndrome (CTS). Diabetes mellitus is increasingly prevalent and is a risk factor for CTS. Given the increasing use of US in the diagnosis of CTS, our goal was to evaluate the influence of diabetes on CTS severity and the cross-sectional area (CSA) of the median nerve in patients with CTS.
UNASSIGNED: Patients with clinically diagnosed CTS were seen in the outpatient setting from October 2014 to February 2021. Median nerve CSA and patient reported severity measures were obtained: Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6. For patients with diabetes, additional parameters were collected including most recent A1c, insulin pharmacotherapy, and polypharmacy.
UNASSIGNED: Ninety-nine patients (122 nerves) without diabetes and 55 patients (82 nerves) with diabetes were recruited for the study. Patients in the diabetes group were more obese and older and had a significantly increased median nerve CSA compared with patients without diabetes. Obesity was associated with higher median nerve CSA in all patients but not in patients with diabetes. There was no difference in disease severity in patients with and without diabetes as reported by BCTSQ or CTS-6 scores. In patients with diabetes, there was significantly decreased median nerve CSA with A1c of 6.5 or higher and a trend to decreased CSA with polypharmacy. There was no influence of insulin therapy on median nerve CSA.
UNASSIGNED: Diabetes is associated with higher median nerve CSA in patients with CTS of similar disease severity. The increased median nerve CSA in patients with diabetes may be reflective of diabetes-related microvascular changes. Interestingly, the trend to decreased median nerve CSA in patients with suboptimal diabetic control (A1c ≥ 6.5) may suggest eventual degenerative changes to the median nerve. In summary, clinicians should be cautious with interpreting a larger median nerve CSA as more severe CTS in patients with diabetes.
UNASSIGNED: Level 3 Diagnostic.

UNASSIGNED: Ultrasound is an effective diagnostic tool for carpal tunnel syndrome (CTS). However, it is unclear how ultrasound correlates with axonal loss and/or demyelination on electrodiagnostic studies (EDS). The objective of this study is to determine whether ultrasound cross-sectional area (CSA) of the median nerve varies between patients with axonal loss or demyelination.
UNASSIGNED: A retrospective review was completed of patients who presented to an orthopaedic hand clinic with numbness/paresthesias over a 6-year period. Demographics, CTS symptoms scale 6 (CTS-6) scores, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, EDS results, and ultrasound results were collected. Median neuropathies were graded as normal, demyelination, or axonal loss using EDS reports. The data were analyzed with chi-square and t-tests.
UNASSIGNED: In all, 383 hands were included (92 axonal loss, 182 demyelination only, and 108 neither). The average patient age was 52.2 and the average body mass index (BMI) was 31.7. The group consisted of 70.7% females, and 23.2% had diabetes. Patients with either axonal loss or demyelination had larger CSA and higher CTS-6 and BCTQ scores than patients with negative EDS. Patients with axonal loss also had larger CSA and higher CTS-6 and BCTQ scores than patients with demyelination only. The rates of positive ultrasound results between axonal loss and demyelination groups did not differ until the ultrasound cutoff was increased from 10 to 12 mm2.
UNASSIGNED: Rates of positive ultrasound results (CSA ≥ 10 mm2) do not differ between wrists with axonal loss or demyelination alone. Therefore, the character of carpal tunnel neuropathy does not affect ultrasound\'s diagnostic ability. Additionally, CSA increases as wrists develop axonal loss, and an increased ultrasound cutoff of 12 mm2 is correlated with this pathology.