Prevalence of Carpal Tunnel syndrome among dental health care providers -systematic review protocol

Review question / Objective: What is the prevalence of Carpal Tunnel syndrome among dental health care providers? Condition being studied: Carpal tunnel syndrome is median nerve peripheral neuropathy which causes paresthesia, pain, and numbness in territory of median nerve (thumb, index, middle, and lateral half of the ring finger). Information sources: Pubmed, SCOPUS, EMBASE, CINAHL, Web of Sciences, Dentistry and Oral Science Source from inception to January 1st 2022.

Analysis of Mechanoreceptors and Free Nerve Endings of the Transverse Carpal Ligament

Background: The treatment of carpal tunnel syndrome (CTS) by sectioning the transverse carpal ligament (TCL) is not exempt from complications. Some nerve branches may be damaged by the incision. The aim of this study is to identify and map the TCL nerve endings, serving as a guide for sectioning this structure in a zone with less nerve ending density. Methods: Ten TCLs were obtained from fresh frozen cadavers. The TCLs were measured, divided into 3 equal bands (radial, central, and ulnar), and submitted to cryostat sectioning. The sections were subjected to immunofluorescence with the protein gene product (PGP) 9.5 and confocal microscopy analysis. Results: All the specimens contained type I and type IV mechanoreceptors. Neural elements occupied 0.695 ± 0.056% of the ligament area. The density of the neural elements was greater in the radial, followed by the ulnar and central bands, with 0.730 ± 0.083%, 0.686 ± 0.009%, and 0.669 ± 0.031%, respectively. Conclusion: The present findings suggest that the region with the least potential for neural element injury during TCL release is the central third near the transition with the ulnar third. When performed distally to proximally with a slight inclination from the radial to the ulnar, this release compromises the lowest nerve element density. Topographically, the proximal limit of the release is the distal wrist crease, while the distal limit is the intersection of Kaplan cardinal line and the axis of the third webspace.

A genome-wide meta-analysis identifies 53 sequence variants associating with carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and has a largely unknown underlying biology. In a genome-wide association study of CTS (Ncases = 48,843, Ncontrols = 1,190,837), we found 53 sequence variants at 50 loci that associate with the syndrome. The most significant association is with a missense variant (p.Glu366Lys) in SERPINA1 that protects against CTS (P = 2.9 × 10−24, OR = 0.76). Through various functional analyses, we conclude that at least 22 genes mediate CTS risk and highlight the role of 19 CTS variants in the biology of the extracellular matrix. We show that the genetic component to the risk is higher in recurrent/persistent cases than nonrecurrent/nonresistant cases. Anthropometric traits including height and BMI are genetically correlated with CTS, in addition to early hormonal-replacement therapy, osteoarthritis, and restlessness. Our findings suggest that the components of the extracellular matrix play a key role in the pathogenesis of CTS.

Us and Mri Neurography Assessment of Diagnostic Criteria in Patients With Carpal Tunnel Syndrome Using Electrophysiological Tests as Gold Standard: A Prospective Study

BackgroundPeripheral neuropathy evaluation depends mainly on physical examination, patient history, electrophysiological studies, with evoked potential abnormalities. High-resolution US has the advantage of being fast, non-invasive modality with nerve dynamic assessment allowing examination of long part of nerve. MR imaging serve better in examination of deeper nerves with higher contrast resolution. It shows great benefit in patient with atypical presentation, Equivocal diagnosis and suspicious of secondary cause and post-surgical relapse.MethodsThis study was conducted prospectively on 32 patients, presented with carpal tunnel syndrome diagnosed by electrophysiological tests. Superficial US of the wrist joint was done to all participants followed by MRI within 1 weeks of the US.We aimed to assess the measurements & criteria of both US & MRN in diagnosis of CTS, depending mainly on the three-measurement assessed by Buchberger et al., then to find the agreement between US & MR Neurography (MRN)ResultsUs proved to have higher rate of CTS prediction, the three main parameters CSA measurement, distal nerve flattening and flexor retinaculum bowing indices showed positive occurrence of 93.7%,59.4% &59.4% respectively. While we found that decreased nerve echotexture was positive in 90.6% of patients.Regarding MRI it showed less diagnostic ability when using CSA measurement as it was positive in 81.2% of patients, also distal tunnel nerve increased flattening and bowed flexor retinaculum positive results were slightly decreased to 56.2% for each. In contrast to high T2 signal of median nerve which was positive in 90.6% of patients.In agreement study, we found statically significant difference supporting US as the primary diagnostic modality of CTS depending mainly on the three measurement CSA, Flattening and bowing indices. Yet, for cases of secondary CTS and detection of underlying entrapping cause as well as innervated muscle early abnormality detection and better tissue characterization, MRI was better diagnostic modality with statistically significant difference. ConclusionsOur results proved that ultrasound examination can be used as first imaging modality after physician evaluation with comparable results to electrophysiological studies in evaluating CTS and try to find the cause. MRN examination came as second step in patients with suspected muscle denervation changes that could not be elicited by US or equivocal cases for detection of secondary cause in clinically suspected patient.

Role of homoeopathic medicine in the treatment of a case of carpal tunnel syndrome with dysthymia: A case report

This case report focuses on 50-year-old woman who was diagnosed with dysthymia and carpal tunnel syndrome (CTS). After reviewing her detailed history, she was prescribed homoeopathic medicine Natrum Carb considering the grief after death of her middle daughter, suppression of emotions since her childhood and her characteristic mental state of desiring to be alone and weeping when alone; her characteristic physical generals and dispositional qualities were also considered. After taking homoeopathic medicine, significant improvement occurred in her subjective symptoms such as paraesthesia as well as in the objective CTS-related signs such as the Tinel sign and Phalen test. Her anger, weeping spells, sleep disturbances and sadness were ameliorated as well. Homoeopathic medicine was found to be effective in relieving CTS and dysthymia in this case. Further research is needed to prove the efficacy of this treatment method in this disease.