A New Neurological Sign Shows Severity of Carpal Tunnel Syndrome
Affiliation(s)
Department of Neurology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. Department of Neurosurgery, Okmeydan? Training and Research Hospital, Istanbul, Turkey . Department of Neurology, Okmeydan? Training and Research Hospital, Istanbul, Turkey .
Department of Neurology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. Department of Neurosurgery, Okmeydan? Training and Research Hospital, Istanbul, Turkey . Department of Neurology, Okmeydan? Training and Research Hospital, Istanbul, Turkey .
ABSTRACT
The objective of this study was prospective comparative determination of both clinical and neurophysiological characteristics of a new pathological reflex in CTS. The authors investigated 300 patients with severe carpal tunnel syndrome undergoing surgery. The 134 patients who showed the sign were allocated as the reflex group. The remaining 166 cases with no sign were named the control group. Two blinded neurology specialists evaluated all patients prior to and after the surgery. Their clinical data, the reflex sign and the electrophysiological results were recorded. The ligament thicknesses during surgery and postoperative changes were also recorded. The reflex group showed exaggerated symptoms with worse electrophysiological results. The reflex group also had thicker median carpal ligament in operative measurements. The difference was significant. The reflex does not disappear easily after surgery and persists up to three months. In the author’s opinion, this sign may present a new pathological reflex indicating severe long-lasting nerve compression with the requirement of surgical decompression of the median nerve in CTS subjects.
The objective of this study was prospective comparative determination of both clinical and neurophysiological characteristics of a new pathological reflex in CTS. The authors investigated 300 patients with severe carpal tunnel syndrome undergoing surgery. The 134 patients who showed the sign were allocated as the reflex group. The remaining 166 cases with no sign were named the control group. Two blinded neurology specialists evaluated all patients prior to and after the surgery. Their clinical data, the reflex sign and the electrophysiological results were recorded. The ligament thicknesses during surgery and postoperative changes were also recorded. The reflex group showed exaggerated symptoms with worse electrophysiological results. The reflex group also had thicker median carpal ligament in operative measurements. The difference was significant. The reflex does not disappear easily after surgery and persists up to three months. In the author’s opinion, this sign may present a new pathological reflex indicating severe long-lasting nerve compression with the requirement of surgical decompression of the median nerve in CTS subjects.
Cite this paper
S. Çelik, S. Erol Çelik and C. Bolcu Emir, "A New Neurological Sign Shows Severity of Carpal Tunnel Syndrome," Open Journal of Modern Neurosurgery, Vol. 4 No. 1, 2014, pp. 38-42. doi: 10.4236/ojmn.2014.41009.
S. Çelik, S. Erol Çelik and C. Bolcu Emir, "A New Neurological Sign Shows Severity of Carpal Tunnel Syndrome," Open Journal of Modern Neurosurgery, Vol. 4 No. 1, 2014, pp. 38-42. doi: 10.4236/ojmn.2014.41009.
References
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[1] J. G. Jarvik, B. A. Comstock, P. J. Heagerty, et al., “Magnetic Resonance Imaging Compared with Electrodiagnostic Studies in Patients with Suspected Carpal Tunnel Syndrome. Predicting Symptoms, Function and Surgical Benefit at 1 Year,” Journal of Neurosurgery, Vol. 108, No. 3, 2008, pp. 541-550. [2] C. A. Pacek, M. Chakan, R. J. Goitz, et al., “Morphological Analysis of the Transverse Carpal Ligament,” Hand, Vol. 5, No. 2, 2010, pp. 135-140. [3] R. C. Tanzer, “The Carpal Tunnel Syndrome. A Clinical and Anatomical Study,” The Journal of Bone & Joint Surgery, Vol. 41, No. 4, 1959, pp. 626-634. [4] I. Atroshi, C. Gummesson, R. Johnsson, et al., “Prevalence of Carpal Tunnel Syndrome in a General Population,” JAMA, Vol. 282, No. 2, 1999, pp. 153-158. [5] M. Mondelli, F. Giannini and M. Giacchi, “Carpal Tunnel Syndrome Incidence in a General Population,” Neurology, Vol. 58, No. 2, 2002, pp. 289-294. [6] P. C. Armadio, “The First Carpal Tunnel Release,” Journal of Hand Surgery, Vol. 20, No. 1, 1995, pp. 40-41. [7] G. S. Phalen, “Spontaneous Compression of the Median Nerve at the Wrist,” The Journal of the American Medical Association, Vol. 145, No. 15, 1951, pp. 1128-1133. [8] G. S. Phalen, “The Carpal-Tunnel Syndrome. Clinical Evaluation of 598 Hands,” Clinical Orthopaedics, Vol. 83, No. 1, 1972, pp. 29-40. [9] A. W. Siegmeth and J. A. Hopkinson-Woolley, “Standard Open Decompression in Carpal Tunnel Syndrome Compared with a Modified Open Technique Preserving the Superficial Skin Nerves. A Prospective Randomized Study,” Journal of Hand Surgery, Vol. 31A, No. 9, 2006, pp. 1483-1489. [10] J. D. Steward and A. Eisen, “Tinel’s Sign and the Carpal Tunnel Syndrome,” British Medical Journal, Vol. 2, No. 6145, 1978, pp. 1125-1126. [11] J. A. Durkan and H. River, “A New Diagnostic Test for Carpal Tunnel Syndrome,” The Journal of Bone & Joint Surgery, Vol. 73, No. 4, 1991, pp. 535-538. [12] T. J. Madhav, P. To and P. J. Stern, “The Palmar Fat Pad Is a Reliable Intraoperative Landmark during Carpal Tunnel Release,” Journal of Hand Surgery, Vol. 34A, No. 7, 2009, pp. 1204-1209. [13] P. Girlanda, A. Quartarone, F. Battaglia, et al., “Changes in Spinal Cord Excitability in Patients Affected by Ulnar Neuropathy,” Neurology, Vol. 55, No. 7, 2000, pp. 975-978. [14] R. Dubner and A. Basbaum, “Spinal Cord Plasticity Following Tissue or Nerve Injury,” In: P. Wall and W. Melzack, Eds., Textbook of Pain, Edinburg Churchill Living-stone, 1994, pp. 243-257. [15] B. Javan and E. P. Zehr, “Short-Term Plasticity of Spinal Reflex Excitability Induced by rhythmic Arm Movement,” Journal of Neurophysiology, Vol. 99, No. 4, 2008, pp. 2000-2005. [16] S. Jaberzadeh and S. Scutter, “Flexor Carpi Radialismotoneuron Pool in Subjects with Chronic Carpal Tunnel Syndrome Is More Excitable than Matched Control Subjects,” Manual Therapy, Vol. 11, No. 1, 2006, pp. 22-27. [17] R. Gupta and O. Steward, “Chronic Nerve Compression Induces Concurrent Apoptosis and Proliferation of Schwann Cells,” Journal of Comparative Neurology, Vol. 461, No. 2, 2003, pp. 174-186. [18] A. Truini, L. Padua, A. Biasiotta, et al., “Differential Involvement of A-Delta and A-Beta Fibres in Neuropathic Pain Related to Carpal Tunnel Syndrome,” Pain, Vol. 145, No. 1-2, 2009, pp. 105-109. http://dx.doi.org/10.1016/j.pain.2009.05.023 [19] P. Montagna and R. Liguori, “The Motor Tinnel Sign; a Useful Sign in Entrapment Neuropathy,” Muscle Nerve, Vol. 23, No. 6, 2000, pp. 976-978.