Search Results (28)

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, often impairing daily function and quality of life. This study aimed to translate, cross-culturally adapt, and assess the validity of the Boston Carpal Tunnel Questionnaire (BCTQ) in a Romanian cohort. Methods: We conducted a cross-sectional study to translate, culturally adapt, and validate the Romanian version of the BCTQ. A total of 190 participants were recruited, representing 380 wrists, including 130 patients with suspected or confirmed CTS and 60 healthy controls. The adaptation process followed international standards, with forward and backward translation, expert committee review, and pilot testing. Participants completed the Romanian BCTQ and performed standardized nerve conduction studies. The internal consistency and validity, including convergent and discriminant validity, exploratory factor analysis, and test–retest assessments, were performed. Results: The Romanian BCTQ exhibited exceptional internal consistency (Cronbach’s α = 0.96), significant inter-item correlations, and robust factor loadings confirming a one-factor structure. Convergent validity was evidenced by strong correlations with electrodiagnostic measurements. The test–retest reliability was high, with intraclass correlation coefficients above 0,99. Conclusions: The Romanian adaptation of the BCTQ is a valid, reliable, and culturally appropriate patient-reported instrument to assess symptom severity and functional status in CTS, improving clinical decision-making and cross-cultural research. Full article

Background/Objectives: Ultrasound-guided carpal tunnel release (UGCTR) has emerged as a minimally invasive alternative to open surgery for the treatment of carpal tunnel syndrome (CTS). This study aimed to evaluate the clinical outcomes, complication rates, and recovery profiles associated with UGCTR in a large multicenter cohort. Methods: A retrospective observational study was conducted across Italian hand surgery centers, including 735 patients who underwent UGCTR between January 2012 and April 2025. Data were collected on demographics, comorbidities, ultrasound measurements, and surgical outcomes. Primary endpoints included pain (measured using the Visual Analog Scale [VAS]), symptom severity and function (assessed via the Boston Carpal Tunnel Questionnaire [BCTQ]), complication rates, time to return to daily activities (RDA), and return to work (RTW). Follow-up assessments were performed at 1, 4, and 12 weeks postoperatively. Results: A significant improvement in pain was observed, with mean VAS scores decreasing from 6.37 preoperatively to 0.58 at 12 weeks. The mean cross-sectional area (CSA) of the median nerve decreased from 12.81 mm² to 8.83 mm² at 4 weeks. Both the BCTQ Symptom Severity Scale (BCTQ-SS) and Functional Status Scale (BCTQ-FS) scores showed significant improvement by week 1. The mean RDA was 5.7 days, and RTW was 14.5 days. Complication rates were low and decreasing over time, from 8.7% at 1 week to 3.4% at 12 weeks. Conclusions: UGCTR is a safe and effective technique for the treatment of CTS, offering rapid functional recovery and a favorable complication profile. Its feasibility in outpatient settings and potential for cost-effectiveness support its role as a viable alternative to open surgery and as a model of image-guided, minimally invasive intervention. Full article

Objectives: This study aimed to evaluate the relationship between the median nerve cross-sectional area (CSA, mm²) and clinical findings, blood test results, and electrodiagnostic (EDX) measurements in patients with carpal tunnel syndrome (CTS). Methods: This cross-sectional study included 62 patients (111 hands). The median nerve CSA was assessed using ultrasound (US). The clinical assessment included symptom duration, symptom severity, the Boston Carpal Tunnel Questionnaire (BCTQ), and physical examination. Patient-level analyses used the CSA of the most symptomatic hand for clinical and laboratory variables (n = 62 patients). Hand-level EDX analyses accounted for within-patient clustering by reporting right and left hands separately. Associations were summarized with Spearman’s ρ and 95% confidence intervals (CIs); multiplicity was addressed using Benjamini–Hochberg false discovery rate (FDR). EDX units: latency ms, amplitude mV/µV, and velocity m/s. Results: CSA was not associated with global symptom burden (Visual Analog Scale; BCTQ). No laboratory marker remained significant after FDR across the full panel. By contrast, CSA correlated with EDX impairment at the hand level with low-to-moderate effect sizes; for example, distal motor latency was positively associated with CSA on the right (ρ = 0.557, 95% CI 0.334–0.733) and left (ρ = 0.318, 95% CI 0.022–0.578). CSA also correlated positively with CTS EDX severity (right: ρ = 0.449, 95% CI 0.223–0.646; left: ρ = 0.354, 95% CI 0.071–0.609). Conclusions: Ultrasonographic CSA was associated with electrophysiologic impairment and was not associated with overall symptom burden; laboratory signals did not survive FDR control. Accordingly, CSA may serve as a complementary morphologic adjunct to clinical assessment and EDX, with limited utility as a stand-alone severity metric. Full article

Background: Dentists are at an increased risk of developing musculoskeletal disorders, particularly carpal tunnel syndrome (CTS), due to repetitive hand movements, awkward postures, and sustained grip forces. This study aimed to investigate the prevalence and risk factors of self-reported wrist and hand symptoms and clinically relevant CTS indicators among dentists in Jordan. Methods: A cross-sectional study was conducted among 201 licensed dentists in Jordan. Participants completed demographic questionnaires and the Valid Arabic version Boston Carpal Tunnel Questionnaire (BCTQ) to assess their symptom severity and hand function. Data was analyzed using STATA version 17, applying descriptive statistics, chi-squared tests, t-tests, ANOVA, and multivariable linear regression to evaluate association between sociodemographic factors and BCTQ scores. Results: Of the 201 participants, 64.2% were female and 35.8% were male. Female dentists were significantly younger (median age 31 vs. 39 years, p < 0.001), reported higher symptom severity (median score 18.0 vs. 16.0, p = 0.019), and experienced greater functional limitations (median score 15 vs. 9, p < 0.001) than male dentists. The overall mean symptom severity score was 19.12 (SD = 7.82), and the functional impairment score was 14.20 (SD = 6.37), indicating mild pain and functional limitation. Multivariable regression revealed that male sex was associated with significantly lower symptom scores (β = 0.7, p = 0.001) and better function (β = 0.722, p = 0.002). Geographic location, higher education level (PhD), and full-time employment were associated with higher symptom scores in the study. Conclusions: Wrist and hand symptoms are prevalent among dentists in Jordan, with significant sex differences in symptom severity and functional impairment. Geographic location, academic degree, and working hours were significant predictors of CTS-related symptoms. These findings underscore the need for ergonomic interventions and targeted preventive strategies, especially for high-risk groups, such as female and full-time practitioners. Full article

Aim: This study aimed to assess the effect of educational programs on symptom severity for women at high risk of carpal tunnel syndrome (CTS). Methods: A quasi-experimental design was applied. A purposive sample of 250 women at high risk of CTS was selected from the Faculty of Nursing, Assiut University, Egypt. Data collection instruments included a structured interview questionnaire and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: Most participants were middle-aged (41–50 years), married, and had higher education. At baseline, 61.2% of participants reported mild symptoms, 24.8% moderate, and 11.6% were asymptomatic. Following the educational program, symptom severity was significantly improved (p = 0.007). The proportion of asymptomatic participants increased from 11.6% to 20.4%, while those with moderate symptoms decreased from 24.8% to 6.4%. Functional status also improved significantly, with the percentage of participants reporting no difficulty increasing from 17.6% to 30% (p = 0.008). We found a significant reduction in symptom severity scores (p = 0.05) and functional impairment (p = 0.008). Conclusions: The educational program effectively reduced CTS symptoms and improved hand function, demonstrating its potential as a preventive and therapeutic intervention for women at high risk of CTS. However, this study’s quasi-experimental design without a control group and a short follow-up period limits conclusions regarding long-term effectiveness and causal inference. Full article

Introduction: Carpal Tunnel Syndrome (CTS) is a prevalent neuropathy requiring accurate, non-invasive diagnostics to minimize patient burden. This study evaluates the New Energy Vision (NEV) camera, an RGB-based multispectral imaging tool, to detect CTS through skin texture and color analysis, developing a machine learning algorithm to distinguish CTS-affected hands from controls. Methods: A two-part observational study included 103 participants (50 controls, 53 CTS patients) in Part 1, using NEV camera images to train a Support Vector Machine (SVM) classifier. Part 2 compared median nerve-damaged (MED) and ulnar nerve-normal (ULN) palm areas in 32 CTS patients. Validations included nerve conduction tests (NCT), Semmes–Weinstein monofilament testing (SWMT), and Boston Carpal Tunnel Questionnaire (BCTQ). Results: The SVM classifier achieved 93.33% accuracy (confusion matrix: [[14, 1], [1, 14]]), with 81.79% cross-validation accuracy. Part 2 identified significant differences (p < 0.05) in color proportions (e.g., red_proportion) and Haralick texture features between MED and ULN areas, corroborated by BCTQ and SWMT. Conclusions: The NEV camera, leveraging multispectral imaging, offers a promising non-invasive CTS diagnostic tool using detection of nerve-related skin changes. Further validation is needed for clinical adoption. Full article

Objectives: The cultural and linguistic adaptation of the Boston Carpal Tunnel Questionnaire (BCTQ) to Polish and the assessment of its psychometric properties among patients undergoing extracorporeal shock wave therapy (ESWT). Methods: This was a cross-sectional study with repeated measures during retest examinations. Subjects from an outpatient rehabilitation center in Poland (n = 103) with mild to moderate carpal tunnel syndrome (CTS) were evaluated three times. Test 1 and test 3 (after a series of four treatments using EWST) included the following: completing the BCTQ, QuickDASH, and SF-36 questionnaires, the VAS pain scale, performing the Tinel–Hoffmann and Phalen tests, and an assessment of grip strength. Test 2 (test–retest BCTQ) was performed two to seven days after test 1. Results: The Polish version of the BCTQ demonstrated a high internal consistency, with a Cronbach’s alpha of 0.861 for the Symptom Severity Scale (SSS) and 0.924 for the Functional Status Scale (FSS). It also showed excellent test–retest reliability, with Intraclass Correlation Coefficients (ICCs) of 0.941 for the SSS and 0.925 for the FSS. The Standard Error of Measurement (SEM) was 0.16 for the SSS and 0.21 for the FSS, while the Minimal Detectable Change (MDC) was 0.43 and 0.59, respectively. It has a high construct validity as 80% of the a priori adopted hypotheses were confirmed. The mean decrease after ESWT on the SSS was 1.04 points, and on the FSS was 0.77 points. The ES value for the SSS scale was 1.62 and for FSS 0.99, and the SRM was 1.35 for the SSS, and 1.01 for the FSS, which proves a higher sensitivity to changes in the BCTQ-PL. Conclusions: The BCTQ-PL is a valid and reliable tool for assessing CTS-related symptoms and functional status in Polish-speaking patients. Full article

Background and Objectives: The aim of this study was to compare the short- and long-term effectiveness of ultrasound-guided percutaneous release (CTR-US) and mini-open surgery in the treatment of carpal tunnel syndrome (CTS). Materials and Methods: A retrospective analysis was conducted on 172 patients who underwent surgical treatment for CTS between 2015 and 2020. The patients were divided into two groups: those who underwent CTR-US (Group A, n = 66) and those treated with mini-open surgery (Group B, n = 106). All patients were evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores before surgery and at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Electrophysiological and ultrasound findings were also compared. Statistical analyses were performed using t-tests, Mann–Whitney U tests, and Chi-square tests, with significance set at p < 0.05. Results: A total of 172 patients who met the study criteria were included. Among the participants, 112 were women and 60 were men. The mean age was calculated as 61 years for female patients and 54 years for male patients. No significant differences were found between the groups in terms of age, gender, laterality, and disease duration. Both groups demonstrated significant improvements in BCTQ and QDASH scores at all postoperative time points compared to preoperative scores (p < 0.001). The CTR-US group showed advantages in shorter treatment duration (p < 0.001), lower cost (p < 0.05), and faster recovery time. Electrophysiological evaluations revealed faster improvements in distal motor latency (DML) and sensory conduction velocity (SCV) in the CTR-US group (p < 0.05). Ultrasound assessments indicated that both methods achieved effective release of the transverse carpal ligament. No significant differences were observed between the groups in long-term questionnaire scores. Conclusion: CTR-US offers advantages such as shorter treatment duration, lower cost, and faster recovery due to its minimally invasive nature. Consistent with the literature, CTR-US provided faster recovery and improved patient comfort. However, mini-open surgery remains a reliable alternative with long-term symptom control and low complication rates. Our study found that both methods are effective, but CTR-US stands out for its esthetic and functional advantages. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and various surgical techniques are used for its treatment. Extended open carpal tunnel release (EOCTR) has been proposed for improved nerve decompression. This study compares the clinical and functional outcomes of open carpal tunnel release (OCTR) and EOCTR in severe CTS, hypothesizing superior functional outcomes and lower pain levels with EOCTR. Methods: This retrospective study included 53 patients (45 females, 8 males) with severe CTS confirmed by electromyography. Patients underwent either OCTR (n = 28) or EOCTR (n = 25) between January 2020 and February 2023. The EOCTR techinque involved additional neurolysis of the recurrent motor branch and palmar cutaneous branch of the median nerve. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the Visual Analog Scale (VAS) for pain, and hand strength measurements. Complications and recovery parameters were also analyzed. Results: EOCTR resulted in significantly lower postoperative VAS scores (3.31 vs. 3.78, p < 0.001), DASH scores (16.54 vs. 20.68, p < 0.001), and BCTQ symptom scores (1.87 vs. 2.01, p < 0.001). No significant differences were found in grip strength (p = 0.52) or pinch strength (tip-to-tip: p = 0.54, lateral: p = 0.061, 3-point: p = 0.17). No major complications occurred, and pillar pain was similar in both groups (p = 0.82), resolving with conservative treatment. Conclusions: EOCTR with additional palmar cutaneous branch of the median nerve neurolysis may provide better short-term functional outcomes and lower pain levels compared to OCTR in severe CTS. Further prospective studies are needed to validate the long-term benefits and safety of this surgical approach. Full article

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, often assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The BCTQ evaluates symptom severity (SSS) and functional status (FSS) but has limitations in stratifying CTS severity, particularly in severe cases. Objective: This study aimed to evaluate the utility of the BCTQ in a homogeneous cohort of female workers engaged in repetitive manual tasks, exploring its correlation with objective clinical measures and its performance in detecting CTS severity. Methods: A cross-sectional study was conducted on 24 right-hand-dominant female workers with repetitive occupational tasks. CTS diagnosis was confirmed via clinical and electrodiagnostic criteria. Subjects completed the BCTQ, and correlations between BCTQ scores and objective measures such as median nerve cross-sectional area and nerve conduction studies were analyzed. Statistical analyses included comparisons across CTS severity groups and subgroup evaluations based on age and tenure. Results: The BCTQ demonstrated moderate correlations with objective measures, with a strong correlation between SSS and FSS scores (r = 0.86, p < 0.001). However, the sensitivity of the SSS and FSS was limited, particularly for severe CTS cases. Paradoxically lower scores in severe cases may reflect questionnaire limitations or adaptive responses. Targeted questions addressing pain and sensory symptoms showed better sensitivity (>80%) and may guide clinicians in identifying slight CTS cases. Conclusions: While the BCTQ remains a valuable tool for assessing CTS, its limitations necessitate complementary use of objective diagnostic tools, particularly for severe cases. Future refinements, such as tailored scoring systems and integration with clinical measures, could enhance its diagnostic utility and ensure comprehensive assessment of CTS severity. Full article

This study investigates the long-term efficacy of carpal tunnel release surgery (CTR) on patient outcomes. We aimed to assess symptom severity, functional limitations, and quality of life in a large cohort (n = 186) at least five years post-surgery via a retrospective cross-sectional design that evaluated participants using the validated Boston Carpal Tunnel Questionnaire (BCTQ) over a phone interview. The BCTQ measures symptom severity, functional limitations, and quality of life specific to carpal tunnel syndrome. Seventy-three percent (73.1%) of patients reported complete resolution of symptoms and functional limitations (BCTQ = 1) with an average follow-up of 11 years. No statistically significant decline in BCTQ scores was observed over time. Univariate analysis revealed a significant association between poorer outcomes and older age at surgery and current unemployment. Carpal tunnel release surgery demonstrates long-term effectiveness in relieving symptoms and improving function in most patients. These findings contribute to the understanding of CTR’s impact on patient well-being beyond short-term outcomes. Full article

Background: Carpal tunnel syndrome (CTS) presents a high burden on the healthcare system. However, no alternative treatments are provided during the waiting period. In addition, the incidence of severe patients with comorbidities is underestimated. The aim of this study was to determine whether nerve mechanical interface treatment improves the symptoms, function, and quality of life in pre-surgical CTS patients. Methods: A randomized controlled trial and intention-to-treat analysis were carried out. Forty-two patients with an electrodiagnosis of carpal tunnel syndrome, included on the surgery waiting list of a public healthcare system, were analyzed. The intervention group (n = 20) received a 45 min session/per week of instrument-assisted manual therapy (diacutaneous fibrolysis) for 3 weeks. The Boston Carpal Tunnel Questionnaire (BCTQ) was the primary outcome. The symptoms, mechanical threshold, grip strength, mechanosensitivity of the median nerve, quality of life, and patient satisfaction were included as secondary outcomes. The control group (n = 22) remained on the waiting list. Results: The intervention seems to be beneficial for the BCTQ score (function and symptoms scale), pain, and mechanosensitivity after treatment, at the 3 and 6 months follow-up (p < 0.05). Kinesiophobia was improved at 6 months (p = 0.043; η² = 0.10) and the mechanical threshold at the 3-month follow-up (p = 0.048; η² = 0.10). No differences were identified for grip strength. At 6 months, the intervention group patients were satisfied (100%), as opposed to the controls, who felt that they had experienced a worsening of their condition (50.1%). Conclusions: Nerve mechanical interface treatment improved the symptoms, function, and quality of life in pre-surgical CTS patients. One hundred percent of the treated patients, characterized as moderate and severe CTS with associated comorbidities, were satisfied. Full article

The prevalence of N. medianus compression neuropathies remains high in clinical practice. The objective was to evaluate modalities of conservative treatments for carpal tunnel syndrome (CTS) focusing on the role of acetylcholinesterase inhibitors. This observational study involved 51 adult outpatients diagnosed with CTS. Patients were observed during routine clinical protocols and we compared two groups of 25 and 26 individuals, with the first group receiving basic therapy for CTS and 20 mg of ipidacrine (Neiromidin^®) two or three times a day per os, while the second group received only basic therapy. The condition of all patients was assessed twice, with at least a one-month interval. The parameters evaluated included the Boston Carpal Tunnel Questionnaire (BCTQ); the Disabilities of the Arm, Shoulder, and Hand scale (DASH); and pain intensity on the Numeric Rating Scale (NRS). The mean reduction in DASH score was 12.3 (SD 7.7) in Group 1 and 7.1 (SD 6.3) in Group 2 (p < 0.01). Also, other scores showed statistically significant differences between the two groups: −2.3 vs. −1.0 for NRS, −0.89 vs. −0.44 for SSS, and −0.68 vs. −0.31 for FSS, respectively (p < 0.01). Moreover, these findings correlated positively with the global improvement (CGI-I) between the groups. The addition of ipidacrine to basic therapy led to improved recovery in patients with CTSs of varying severity. Full article

Ultrasound-guided thread carpal tunnel release (TCTR) was proposed as an effective and safe surgical technique with faster recovery and fewer complications. This study was conducted to confirm the long-term outcomes after TCTR and verify its clinical effectiveness in severe carpal tunnel syndrome (CTS) for more insights into TCTR procedure. A total of 168 TCTR procedures were performed in 152 individual patients by two physiatrists during 36-month period. In an assessment of 82 hands, surgical outcomes of 2 years after TCTR could be obtained, and the grade 6 CTS group of 21 hands, classified as extremely severe grade by Bland’s classification, was compared with other severity groups (grade 1–5). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to assess surgical outcomes. No adverse events occurred in all cases including the case of severe CTS and anatomical variants. TCTR showed significant improvement in BCTQ scale within 1–2 weeks, which continued up to 2 years with no recurrence (p < 0.01). Although slower and more progressive than the other severity group, there was also significant improvement relative to the BCTQ scale around 4 weeks after procedure in the grade 6 CTS group (p < 0.05). With the familiarity of ultrasound, ultrasound-guided TCTR is an effective and reliable surgical treatment for CTS in long-term outcomes and in severe CTS. Full article

Background: Dropping objects from hands (DOH) is a common symptom of carpal tunnel syndrome (CTS). We evaluated the clinical, neurophysiological, and psychophysiological features of 120 CTS patients to elucidate the DOH pathophysiology. Forty-nine healthy controls were included. Methods: In the patients, the Boston Carpal Tunnel Questionnaire (BCTQ), the Douleur Neuropathique 4 questions (DN4), and a numeric rating scale for pain (NRS) were evaluated. In patients and controls, we evaluated bilateral median and ulnar motor and sensory nerve conduction studies, cutaneous silent period and cutaneomuscular reflexes (CMR) of the abductor pollicis brevis, cold-detection threshold (CDT) and heat-pain detection threshold (HPT) at the index, little finger, and dorsum of the hand, and vibratory detection threshold at the index and little finger by quantitative sensory testing. Results: CTS with DOH had higher BCTQ, DN4 and NRS, lower median sensory action potential, longer CMR duration, lower CDT and higher HPT at all tested sites than controls and CTS without DOH. Predictive features for DOH were abnormal CDT and HPT at the right index and dorsum (OR: 3.88, p: 0.03) or at the little finger (OR: 3.27, p: 0.04) and a DN4 higher than 4 (OR: 2.16, p < 0.0001). Conclusions: Thermal hypoesthesia in median and extra-median innervated territories and neuropathic pain are predictive of DOH in CTS. Full article