Surgical management of carpal tunnel syndrome

doi:10.21203/rs.3.rs-3748092/v1

Download PDF

Research Article

Surgical management of carpal tunnel syndrome

https://doi.org/10.21203/rs.3.rs-3748092/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background and Aim:

To determine the prevalence and risk factors of carpal tunnel syndrome among patients who visited Damascus Hospital between the years 1/1/2015 and 1/1/2023 and their relationship with age, gender, and clinical symptoms.

Methods and material:

Information was collected according to the research form to adjust the inclusion and exclusion criteria, and the clinical history information was recorded in detail, which included: age, sex, habits, Tinel's sign, Phalen's maneuver, whether diabetes was present, and other symptoms and signs. The study included 80 male and female patients.

Results:

Most of the patients are in the age group of 25–45 years (57.5%), and the percentage of infected females constituted about two-thirds of the patients (62.5%), and a third of the patients were smokers (30%), and a quarter of the patients had diabetes, and the percentage of pregnant women was (11.3). A statistically significant relationship between gender and signs and symptoms (positive Tinel's sign, positive Phalen's maneuver, presence of numbness, presence of tingling, loss of sensation, presence of pain, presence of weakness and muscle atrophy, presence of complex regional pain, presence of tenderness of scars) (statistical significance less than 0.05), There is a statistically significant relationship between all symptoms and signs except complex regional pain syndrome and scar tenderness, and there is a statistically significant relationship between both diabetes and (positivity of Tinel's sign, positivity of Phalen's maneuver, presence of numbness, presence of tingling, loss of sensation, presence of pain), absence of a relationship. There is a statistically significant relationship between smoking and the occurrence of signs and symptoms, and there is a statistically significant relationship between pregnancy and (positivity of Tinel's sign, positivity of Phalen's maneuver, presence of numbness, presence of tingling).

conclusion:

A health care professional can diagnose patients with mild symptoms of carpal tunnel syndrome without the need for additional testing, and patients with unusual or severe symptoms should undergo electrodiagnostic tests.

Neurosurgery

Carpal tunnel syndrome

risk factors

Damascus Hospital

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are widely recognized and there are several treatments, including surgical and non-surgical treatment. Despite these advantages, it is There is insufficient evidence about the best ways to evaluate carpal tunnel syndrome and make appropriate treatment decisions.

Entrapment neuropathy is the most common neuropathy. Generally encountered in clinical practice, in this Nerve damage: The nerve is damaged at the sites through which it passes. Although entrapment neuropathy is narrow and limited (1), and it only affects a small part of the nerve. They can have physical, psychological and economic consequences. The exact cause of these neuropathy is unknown to A large extent and it is assumed that it has a multi-factor origin, in such cases in cases, entrapment syndromes are defined as being of unknown cause (2–4).

The diagnosis and treatment of carpal tunnel syndrome have been approached in different ways due to its high incidence, its tendency to produce painful symptoms even in mild cases, the availability of sensitive electrophysiological measures (5), in addition to the development of patient-centered measures and new neuroimaging techniques, and the availability of There are many surgical and non-surgical treatments (laser, medication, ultrasound, and complementary treatments). Most often, non-surgical treatment is supported over surgical treatment for fear of serious complications such as regional pain syndrome, the appearance of scars, and spinal pain. Early diagnosis and treatment remain important to prevent The disease progresses and treatment may be done with exercise

Study design:

A retrospective, cross-sectional, descriptive study to determine the prevalence and risk factors of carpal tunnel syndrome among patients who visited Damascus Hospital between the years 1/1/2015 and 1/1/2023, and its relationship with age, gender, clinical symptoms, and several variables, which will be mentioned in the results section.

Patients:

The study included 80 patients who were admitted to Damascus Hospital with a diagnosis of carpal tunnel syndrome.

Methods:

A group of patients who were admitted to Damascus Hospital were studied according to the following inclusion criteria.

All adult and pediatric patients.

Accept patients with symptoms and signs suggesting a diagnosis of carpal tunnel syndrome and high clinical suspicion of the disease.

While the exclusion criteria were as follows:

Damaged patient records and records in which there is insufficient information to serve our study.

Patients with neuropathic diseases, cervical radiculopathy, and osteoporosis.

Information was collected according to the research form to set the inclusion and exclusion criteria, and detailed clinical history information was recorded, which included: age, sex, habits, Tinel's sign, Phalen's maneuver, whether diabetes was present, and other symptoms and signs.

Data Analysis:

The data from the forms were filled into an Excel file, simple statistics were conducted, the results were summarized and explained in tables and charts, the Spss-28 statistics program was used, and a predictive value of less than 0.05 (p.value < 0.05) was considered a statistically significant value.!

Descriptive statistics were reviewed based on percentages and graphs, in addition to measures of central tendency (arithmetic mean and standard deviation). To test the statistical relationships between basic characteristics, we used the following statistical methods:

Chi-square test to compare categorical variables with a normal distribution.

Ethical considerations:

Ethical approval was obtained from the Institutional Review Board (IRB) Faculty of Medicine, Syrian Private University, and the Damascus Hospital Institutional Review Board (IRB). Verbal consent was obtained from each patient when contacting them for data collection purposes.

The number of patients was 80, and it was found that the majority of patients were in the age group of 25–45 years (57.5%), followed by the age group older than 45 years, with a percentage of (33.8%), followed by the age group of 0–25 years, with a percentage of (8.8%). The cases were distributed according to gender into (37.5% males), (62.5% females), and the percentage of patients who smoked was (30%). As for medical history, the percentage of patients with diabetes was (25%), and the percentage of pregnant women was (11.3%).

It showed a positive rate of Tinel's sign (62.5%), a positive Phalen maneuver (71.3%), a percentage of numbness (93.8%), a percentage of tingling (85%), a percentage of sensory loss (12.5%), and a percentage of pain (23.8%). The percentage of presence of muscle weakness (11.3%), the percentage of presence of muscular atrophy (5%), the percentage of presence of complex pain syndrome, and tenderness of scars (1.3% for each).

The effect of gender on the occurrence of symptoms and signs was studied, and it was found that there was a statistically significant relationship between the presence of Tinel's sign and gender, where (statistical significance: 0.013), and it was found that there was a statistically significant relationship between gender and the positivity of the Phalen maneuver, where (statistical significance: 0.001), and it was found that there was a statistically significant relationship between gender. And the presence of numbness in patients, where (statistical significance: 0.000), and it was shown that there is a statistically significant relationship between gender and the presence of tingling in patients, where (statistical significance: 0.000), and it was found that there is a statistically significant relationship between gender and the presence of pain (statistical significance: 0.04), and it was found that there is a relationship Statistically significant between gender and the presence of muscular weakness, where (statistical significance: 0.000), and showing that there is no statistically significant relationship between gender and the presence of muscle weakness, where (statistical significance: 0.569), and showing that there is a statistically significant relationship between gender and both the presence of complex regional pain syndrome and the presence of tenderness. With scars (statistical significance: 0.002),

The effect of age on the occurrence of symptoms and signs was studied, and it was found that there was a statistically significant value between age and positivity of Tinel's sign, where (statistical significance: 0.000). It was shown that there is a statistically significant relationship between age and the positivity of the Phalen maneuver, where (statistical significance: 0.000), and it was shown that there is a statistically significant relationship between age and the presence of numbness in patients, where (statistical significance: 0.000), and it was found that there is a statistically significant relationship between age and the presence of tingling in patients, where ( Statistical significance: 0.000), and it shows that there is a statistically significant relationship between age and the presence of pain (statistical significance: 0.046), and it shows that there is a statistically significant relationship between age and the presence of muscle weakness (statistical significance: 0.000), and it shows that there is a statistically significant relationship between age and the presence of muscle weakness. Where (statistical significance: 0.000), it was found that there is no statistically significant relationship between age and the presence of complex regional pain syndrome and the presence of painful scars, where (statistical significance: 0.).

The effect of diabetes, pregnancy, and smoking on the occurrence of symptoms and signs of carpal tunnel syndrome was studied, and it was found that there is no statistically significant relationship between the symptoms and signs and smoking, as (most statistical significances: greater than 0.05), and it was shown that there is a statistically significant relationship between diabetes and the occurrence of both ( Positive Tinel and Phalen sign, presence of numbness, tingling, loss of sensation, and presence of pain (statistical significance: smaller than 0.05), and the absence of a statistically significant relationship between diabetes and each of (the presence of muscle weakness, muscular atrophy, the presence of complex regional pain syndrome, and the presence of scar tenderness). ), where (statistical significance: greater than 0.05), and when studying the relationship between pregnancy and the occurrence of symptoms and signs of carpal tunnel syndrome, it was revealed that there is a statistically significant relationship between both pregnancy and the occurrence of (positive Tinel and Phalen sign, and the presence of numbness and tingling), where (statistical significance: greater of 0.05), and it was shown that there is no statistically significant relationship between the occurrence of (loss of sensation, presence of pain, presence of muscle weakness, presence of muscular atrophy, presence of regional pain syndrome, and presence of scar tenderness), where (statistical significance: greater than 0.05),

We mentioned previously in the research results that the number of patients reached 80, with the necessity of taking information about the clinical history and writing all the information about the patients’ clinical examination, as it was found that most of the patients are from the age group (25–45 years) (57.5% of the patients) and then the age group is older. From 45 years (33.8% of patients), meaning that the youth stage is a distinctive feature of the study patients, and this is consistent with international studies, perhaps due to the increase in work and the increase in the incidence of pregnancy among women in this period, and the cases were distributed according to gender to (62.5% of patients) Females, and (37.5% of patients) are males, meaning that the ratio of females to males is almost double, and this is consistent with international studies that confirm the prevalence of this disease in females is greater compared to males, and the reason for this is often due to the presence of greater risk factors among Females, such as (pregnancy, delicate manual work such as sewing, etc.), and it was found that the percentage of smokers is (30% of patients). Although the percentage of smokers is small in the research, it is still one of the most important risk factors causing carpal tunnel syndrome in general. Contrary to international studies that mention an increase in the incidence of this syndrome in smokers due to the effect of smoking in causing blood ischemia, it was found that the percentage of diabetes among the sample members was (25% of patients), and the percentage of pregnant women was (11.3%), and we found that the percentage of positive Tinel’s signs (62.5%), the percentage of positive Phalen’s sign (71.3%), the percentage of numbness (93.8%), the percentage of tingling (85%), the percentage of loss of sensation (12.5%), the percentage of pain (23.8%), and the percentage of weakness Muscular (11.3%), the percentage of muscular atrophy (5%), the percentage of complex pain syndrome, and tenderness of scars (1.3% for each), and this explains to us the importance of the clinical examination in its ability to diagnose carpal tunnel syndrome. The association between gender and the occurrence of carpal tunnel syndrome was also studied. Symptoms and signs: The percentage of positive Tinel's sign in males/females is (22.5%/40%).

The percentage of positivity of Phalen's sign in males/females is (25%/46.3%), the percentage of numbness in males/females is (35%/58.8%), the percentage of tingling in males/females is (32.5%/52.5%), and the percentage of Loss of sensation in males/females (5%/7.5%), the percentage of pain in males/females, (10%/13.8%), the percentage of muscle weakness in males/females, (5%/6.3%), and the percentage of atrophy Muscular pain in males/females, (2.5%/2.5%), the percentage of complex regional pain in males/females, (1.3%/0%), and the percentage of scarring tenderness in males/females, (0%/1.3%).

The relationship between age and the occurrence of symptoms and signs was also studied, and it was found that the percentage of positivity of Tinel’s sign in the age groups 0–25 years / 25–45 years / older than 45 years / (8.8% / 53.8% / 62.5%), and the percentage of positivity of Phalen’s sign in Age groups 0–25 years / 25–45 years / older than 45 years / (8.8% / 57.5% / 5%), and the percentage of numbness in the age groups 0–25 years / 25–45 years / older than 45 years / ( 7.5% / 55% / 31.3%), and the percentage of tingling sensations in the age groups 0–25 years / 25–45 years / older than 45 years / (7.5% / 50% / 27.5%), and the percentage of sensory loss in the age groups 0–25 years / 25–45 years / older than 45 years / (0% / 8.8% / 3.8%), and the percentage of pain in the age groups 0–25 years / 25–45 years / older than 45 years / (1.3% / 10% / 12.5%), and the percentage of presence of muscular weakness in the age groups 0–25 years / 25–45 years / older than 45 years / (0% / 0% / 11.3%), and the percentage of presence of muscular weakness in the age groups 0–25 One year / 25–45 years / older than 45 years / (0% / 0% / 5%), and the percentage of complex regional pain syndrome in the age groups 0–25 years / 25–45 years / older than 45 years / (0%) / 0% / 1.3%), and the percentage of painful scars in the age groups 0–25 years / 25–45 years / older than 45 years / (0% / 0% / 1.3%). The association between diabetes, pregnancy, smoking, and the occurrence of symptoms was also studied. And carpal tunnel signs. It was found that the incidence of a positive Tinel’s sign in diabetics/smokers/and pregnant women is (25%/15%/11.3%), and the incidence of a positive Phalen’s sign in diabetics/smokers/and pregnant women is (25%/17.5%). / 11.3%), and the incidence of numbness in diabetics / smokers / and pregnant women, (23.8% / 27.5% / 11.3), and the incidence of tingling in diabetics / smokers / and pregnant women, (22.5% / 25% / 8.8%), and the incidence of Loss of sensation in diabetics / smokers / pregnant women, (6.3% / 5% / 2.5%), the incidence of pain in diabetics / smokers / pregnant women, (2.5% / 10% / 2.5%), and the incidence of muscle weakness in diabetics / and smokers / and pregnant women, (0% / 5% / 0%), and the incidence of muscular atrophy in diabetics / and smokers / and pregnant women, (0% / 2.5% / 0%), and the incidence of complex regional pain syndrome in diabetics / and smokers / and pregnant women, (0% / 1.3% / 0%), and the incidence of painful scars in diabetics / and smokers / and pregnant women, (0% / 0% / 0%), In comparison with a prospective global study conducted in Italy between 1991 and 1998 on 120,000 people, entitled (Carpal tunnel syndrome incidence in a general population), in which they were found over a period of 8 years, 3142 cases were identified (79.7% women and 20.3% men; Median age 55 years; range 13 to 97 years). The average annual crude incidence rate was 329 cases per 100,000 person-years, and the standardized incidence rate was 276. The sex-specific incidence rate was 139 for men and 506 for women. The average annual incidence rate for men increased moderately but significantly over the study period, while the rate remained constant for women. Age-related infection rates for women gradually increase with age, reaching a peak between 50 and 59 years of age, and then decreasing after that. In men, there was a bimodal distribution, with peaks between 50 and 59 years and between 70 and 79 years. Rural and industrialized areas had higher, age- and sex-specific rates than urban areas.

Ethics approval and consent to participate:

The Research Ethics Committee at the Syrian Private University and the ethical committees of the respective hospitals approved the study protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards. Similar.

Consent for publication:

Not applicable.

Availability of data and materials:

All data related to this paper’s conclusion are available and stored by the authors. All data are available from the corresponding author on a reasonable request.

Conflict of interest:

The authors declare that they have no conflict of interest

Funding:

This research received no specific grant from SPU or any other funding agency in the public, commercial or non-profit sectors.

Authors’ contributions:

F.N. and A.B conceptualized the study. F.N. and A.B wrote the study protocol, performed the statistical analysis, participated in data collection, and did the literature search and participated in the literature search, interpret the results, wrote the main manuscript J.A. revised the draft. All authors read and approved the final draft.

Acknowledgments:

We are thankful to the management of the Syrian Private University and Damascus Hospital for their support in the field of medical training and research. We would also like to thank Dr. Jihad Abdin for his help and supervision in the paper.

England JD. Entrapment neuropathies. Curr Opin Neurol 1999; 12: 597–602.
Atroshi I, Gummesson C, Johnsson R, Sprinchorn A. Symptoms, disability, and quality of life in patients with carpal tunnel syndrome. J Hand Surg Am 1999; 24: 398–404.
Wilson d’Almeida K, Godard C, Leclerc A, Lahon G. Sickness absence for upper limb disorders in a French company. Occup Med (Lond) 2008; 58: 506–08.
Foley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State. Am J Ind Med 2007; 50: 155–72.
Olney RK. Carpal tunnel syndrome: complex issues with a “simple” condition. Neurology 2001; 56: 1431–32.
Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter for carpal tunnel syndrome (summary statement). Neurology 1993; 43: 2406–09.

The authors declare potential competing interests as follows: There are no additives

Download PDF

Version 1

posted

You are reading this latest preprint version

Surgical management of carpal tunnel syndrome

Status:

Version 1

Abstract

Introduction

Methods and material

Study design:

Patients:

Methods:

Data Analysis:

Ethical considerations:

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1