BACKGROUND: 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.
METHODS: 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).
CONCLUSIONS: 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.
METHODS: Case-Control Study.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by painful ulcerated lesions. Postoperative PG, which typically begins with erythema and severe pain within two weeks after surgery, progresses into ulcerated lesions. It is often misdiagnosed as it resembles necrotizing skin infections, resulting in delayed treatment. Cases of postoperative PG located in the upper extremity are uncommon. In this case report, we discuss a male patient who developed postoperative PG after carpal tunnel surgery.

Background Carpal tunnel syndrome (CTS), a common and often underdiagnosed condition, imposes a significant burden on individuals, particularly in middle-aged populations. This study aims to assess the awareness and prevalence of CTS among middle-aged residents in Riyadh, highlighting the crucial need for targeted educational initiatives to address knowledge gaps. Methodology A cross-sectional study design was employed to capture a snapshot of CTS awareness and prevalence among the middle-aged population in Riyadh, Saudi Arabia. Participants aged 40-60 residing in Riyadh were included. A self-reported questionnaire gathered data on demographics, CTS diagnosis, and awareness levels regarding symptoms, risk factors, treatment, and the impact of CTS. Statistical analysis included descriptive statistics and Chi-squared tests. Results We collected 415 valid responses to the questionnaire. The demographic profile revealed a balanced gender distribution, with 48.4% (n=201) males and 51.6% (n=214) females, and a majority (66.5%; n=276) within the 40-50 age range. A substantial 87.2% (n=362) reported no prior CTS diagnosis. Neuroimaging studies were infrequently conducted at 15.9% (n=66). Participants exhibited significant knowledge gaps, notably in the awareness of CTS diagnosis 66.3% (n=275) uncertainty, symptoms 55.4% (n=230) lack of knowledge, and risk factors 54.7% (n=227) lack of awareness. The results indicated uncertainty regarding the relationship between CTS and diabetes 63.9% (n=265) and knowledge gaps on anesthesia methods for CTS operations 64.1% (n=294). The association between age and CTS diagnosis was significant (p-value 0.004), while awareness did not significantly vary with gender or age. Conclusion This study unveils a substantial lack of awareness about CTS among the middle-aged population in Riyadh, emphasizing the need for targeted educational interventions. The prevalence of CTS remains underreported, with a notable gap in understanding symptoms, risk factors, and available treatments; the findings underscore the vital importance of targeted educational programs designed to raise public awareness, bridge information gaps, and empower individuals to make informed decisions about their hand health.

Diagnosing of tuberculous arthritis can be challenging due to its insidious onset and non-specific clinical presentation. A high index of suspicion is required for early diagnosis. A 54-year-old butcher was admitted to an orthopedic clinic with complaints of pain, paresthesia and an enlarging mass in the left wrist, which limited finger flexion. Initially the patient was diagnosed with carpal tunnel syndrome (CTS); the patient had no history of tuberculosis (TB), but had direct contact with animals. On clinical examination, a small mass was found in the distal volar region of the forearm and no lymphadenopathy was observed. Despite the diagnosis the patient refused to receive TB treatment. After a period of 4 months, the patient once again exhibited symptoms of CTS. This case highlights the importance of considering TB as a potential etiology for persistent symptoms of carpal tunnel surgery. Early diagnosis and prompt initiation of TB treatment can result in favorable outcomes and can prevent future recurrence.

We aimed to study psychological health, as approximated by the use of psychotropic drugs, in a population diagnosed and surgically treated for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, also considering the demographic and socioeconomic factors of the individuals. Linking data from five large national registers, use of psychotropics (at least one dispensation during the first year after the surgery or the baseline date) was examined in around 5.8 million people 25-80 years old residing in Sweden 2010. Among these individuals, 9728 (0.17%), 890 (0.02%) and 149 (0.00%) were identified as diagnosed and surgically treated for CTS, UNE, or both, respectively. As much as 28%, 34% and 36% in each group, respectively, used psychotropic drugs, compared with 19% in the general population. Regression analyses showed a general higher risk for use of psychotropics related to these nerve compression disorders, to higher age, being a woman, and having low income or low occupational qualification level. Individuals born outside of Sweden had a lower risk. We conclude that surgically treated individuals with a nerve compression disorder have an increased risk of impaired psychological health. Caregivers should be aware of the risk and provide necessary attention.

UNASSIGNED: Endoscopic carpal tunnel release has been shown to have a shorter recovery period than open surgery. This study was aimed at assessing the efficacy and possible clinical complications of a novel supraretinacular endoscopic carpal tunnel release technique.
UNASSIGNED: A total of 50 cases involving 46 patients were evaluated in this prospective study, in which all surgeries were performed by a single surgeon between 2016 and 2018. The patients were evaluated preoperatively; at 3, 7, and 14 days after surgery; and at 1, 3, and 6 months after surgery. The effectiveness of the surgery was evaluated using pinch and grip strengths, modified table test, visual analog scale pain score, the Disabilities of the Arm, Shoulder and Hand, the Boston Carpal Tunnel Questionnaire symptom severity scale, and the Boston Carpal Tunnel Questionnaire functional status scale. The Friedman test and Wilcoxon signed-rank test were used for a statistical analysis.
UNASSIGNED: At 6 months after the surgery, all measured parameters showed improvements. The pinch strength score improved from 2.29 kg before the surgery to 2.96 kg 6 months after the surgery (P = .003), the grip strength score improved from 12.10 kg to 13.98 kg (P = .028), the modified table test score increased from 6.55 kg to 8.76 kg (P < .001), the visual analog scale score decreased from 6.31 to 0.52 (P < .001), the Disabilities of the Arm, Shoulder and Hand score reduced from 41.66 to 14.10 (P < .001), and the Boston Carpal Tunnel Questionnaire symptom severity scale and the Boston Carpal Tunnel Questionnaire functional status scale scores reduced from 2.68 to 1.51 (P < .001) and from 2.56 to 1.44 (P < .001), respectively. There were no serious injuries or complications reported in this series.
UNASSIGNED: This new supraretinacular endoscopic carpal tunnel release technique was shown to be efficacious in this series.
UNASSIGNED: Therapeutic IV.

BACKGROUND: Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome.
METHODS: With ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; \"worse\" or \"no change\" and good outcome; \"slightly better\", \"much better\" or \"completely cured\".
RESULTS: Seventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability (p < 0.001). Symptom severity diminished (p < 0.001), as did pain-related worry (p < 0.001), anxiety (p = 0.02) and insomnia (p < 0.001). Patient-rated surgical outcome was good in 92% of the cohort, poor in 8%. Baseline sensory phenotype category was not associated with surgical outcome however pain-related worry, anxiety and functional interference were significantly associated with outcome (p ≤ 0.05).
CONCLUSIONS: In patients undergoing carpal tunnel surgery, pain-related worry, anxiety and pain functional interference are candidate prognostic outcome factors and require further elucidation.

Background: Endoscopic carpal tunnel release is a common treatment for moderate to severe carpal tunnel syndrome. Recently there have been various new techniques which offer improved accuracy and decreased recovery time. In this study, orthopedic surgeons and biomedical engineers from the Faculty of Medicine and Faculty of Engineering, Prince of Songkla University, designed a wireless endoscopic carpal tunnel release with a single portal technique and tested the efficacy and safety of the new technique in a cadaveric study. Methods: Ten fresh cadaveric forearms were used in the study. The surgical technique began with a surgical incision 15-20 mm above the wrist crease on the line between the middle finger and ring finger. The palmaris longus aponeurosis was retracted by Senn retractors. A visual enhancer was inserted to improve the internal visual field in order to see the flexor retinaculum clearly. The flexor retinaculum was cut distally to create an entry and the flexor retinaculum was cut by the scalpel. The flexor retinaculum length was observed until the release was completed. The median nerve was observed. Results: Each flexor retinaculum was cut completely. All of the median nerves were carefully observed during the operation and none were injured. This technique showed the effectiveness and safety of minimally invasive carpal tunnel surgery. Conclusions: The study found that the new device using this technique is effective for carpal tunnel syndrome (CTS) surgery in terms of minimally invasive endoscopic carpal tunnel surgery.

Background: Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is a life-threatening progressive disease. Recent studies have shown that the detection of transthyretin (TTR) amyloid in tenosynovial tissue may play an important role in the diagnosis of cardiac amyloidosis. The aim of this study was to determine the prevalence of TTR amyloid deposits in surgical tissue of patients undergoing carpal tunnel surgery and to clarify the clinical significance of concomitant cardiac examination with 99 mTc-labeled pyrophosphate (99 mTc-PYP) scintigraphy in those patients with TTR deposition. Methods and Results: We evaluated 79 consecutive patients undergoing carpal tunnel release surgery and biopsy of tenosynovial tissue. The mean (±SD) age of the patients at surgery was 71.6±12.5 years (range 30-95 years); 32 patients (41%) were male. TTR amyloid deposition in tenosynovial tissue was observed in 27 patients (34%). Sixteen of those 27 patients underwent 99 mTc-PYP scintigraphy. Of those 16 patients, 3 (19%) had Grade 2 uptake on 99 mTc-PYP scintigraphy. None of the 3 patients with a diagnosis of ATTRwt-CA had apparent cardiac symptoms and left ventricular wall thickness >13 mm. Conclusions: Concomitant cardiac examination with 99 mTc-PYP scintigraphy in patients who had TTR amyloid deposition in tenosynovial tissue resulted in the identification of 19% of patients with a diagnosis of ATTRwt-CA. This diagnostic approach seems to be useful for the early diagnosis of the disease.

UNASSIGNED: This study aims to identify the optimal follow-up method for evaluation of the surgical outcome for carpal tunnel syndrome (CTS).
UNASSIGNED: Between January 2006 and December 2010, 61 hands of a total of 46 patients (7 males, 39 females; mean age 56.0±10.4 years; range, 20 to 71 years) with a diagnosis of CTS were retrospectively analyzed. All operations were performed by a single surgeon with a mini-incision distal to the transverse carpal ligament. At a mean follow-up of seven years after surgery, electromyography (EMG) was repeated for all patients. The Boston Carpal Tunnel Questionnaire (BCTQ), Boston Symptom Severity Scale, Boston Functional Status Scale, palmar pinch strength, grip strength, and EMG of the patients were compared before and after surgery.
UNASSIGNED: The mean follow-up was 84±10 (range, 72 to 104) months. There were significant improvements in the Boston Symptom and Functional Scale scores postoperatively, as well as in the grip and pinch strength. After surgery, EMG findings improved in 83.6% of the patients. However, there was no significant correlation between pre- and postoperative Boston Symptom Severity Scale scores, functional status, pinch and grip strengths, and pre- and postoperative EMG results.
UNASSIGNED: Our study results demonstrate that the symptom severity and functional status scores of the BCTQ are favorable, and this tool is reliable and easy-to-apply for the diagnosis and follow-up of CTS surgeries.