PURPOSE: Behcet's disease (BD) is a chronic inflammatory disease characterized by orogenital ulcers, skin and ocular lesions, in addition to articular, vascular, and neurologic symptoms. Carpal tunnel syndrome (CTS), can also occur in BD patients secondary to inflammation in the connective tissues, vessels, and tendons, as well as nerve involvement in BD itself. However, reports of patients who have CTS in BD are rare. The aim of this study was to evaluate the clinical characteristics of CTS in BD patients. MATERIALS AND METHODS: Retrospective analysis of the medical records of 1750 BD patients, and 14 (0.8%) BD patients who were diagnosed with CTS was performed at the BD Specialty Clinic of Severance Hospital. Patient demographics, disease activity/severity for both diseases, and the clinical characteristics of CTS in BD were recorded and analyzed. RESULTS: All 14 BD patients with CTS were women. Twelve patients (85.7%) were diagnosed with active BD. The CTS was mild in 8 patients (57.2%), moderate in 3 patients (21.4%), and severe in 3 patients (21.4%). Ten patients (71.4%) had BD prior to the diagnosis of CTS, and these 10 patients all had active BD. CONCLUSION: CTS can occur as a result of the inflammation associated with BD and can also be the presenting symptom of nerve involvement in BD. CTS can also develop as the initial symptom of BD. Therefore, a higher degree of suspicion should be maintained for CTS in patients with BD and vice versa; however, the exact relationship is uncertain.
Adult ; Age Distribution ; Aged ; Behcet Syndrome/complications/diagnosis/*epidemiology ; Carpal Tunnel Syndrome/diagnosis/*epidemiology ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Retrospective Studies ; Sex Distribution

Melorheostosis is a rare, progressive bone disease accompanied by hyperostosis and soft tissue fibrosis. While affected adults present with contracture and pain, children present with limb length discrepancy and deformity. We report the case of a 20-year-old woman with melorheostosis since childhood who presented with right hand deformity and numbness. Radiographs showed not only a combination of dense sclerosis and opacities, but also the classic 'flowing candle wax' appearance. Radiography can be used to identify melorheostosis, thus preventing unnecessary bone biopsies. Carpal tunnel release revealed the presence of a thickened flexor retinaculum and a degenerated median nerve distal to the retinaculum, but did not show hyperostosis. This case highlights the role of nerve decompression in melorheostosis and the importance of early identification of the disease to prevent unnecessary bone biopsies.
Carpal Tunnel Syndrome ; complications ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Female ; Fibrosis ; pathology ; Hand ; pathology ; Hand Deformities ; diagnostic imaging ; surgery ; Humans ; Hypesthesia ; Median Nerve ; surgery ; Melorheostosis ; complications ; diagnostic imaging ; surgery ; Radiography ; Sclerosis ; diagnostic imaging ; Young Adult

No abstract available.
Alcohol Drinking/adverse effects ; Carpal Tunnel Syndrome/diagnosis/*etiology ; Gout/*complications/diagnosis/drug therapy ; Gout Suppressants/therapeutic use ; Humans ; Male ; Risk Factors ; Tomography, X-Ray Computed

INTRODUCTIONCarpal tunnel syndrome (CTS) is a common pregnancy complication. However, it is often overlooked by medical practitioners and patients alike. This study aimed to describe CTS in relation to pregnancy and assess how significant the disease was among pregnant women.

METHODSIn a prospective cross-sectional study, 333 respondents were randomly selected from among pregnant women attending the primary care maternal health clinic in a university hospital. CTS was diagnosed clinically based on patient history and physical examination. The severity of CTS was assessed using the Boston Carpal Tunnel Questionnaire. Symptomatic respondents were asked whether they had mentioned their problems to doctors and received appropriate treatment.

RESULTS82 (24.6%) pregnant women presented with symptoms of CTS, a majority of whom were ethnic Malays (Malay 87.8%; non-Malay 12.2%). The risk for developing CTS during the third trimester of pregnancy was found to be two-fold among Malay women compared to patients of other ethnicities (odds ratio 2.262; 95% confidence interval 1.10-4.46; p = 0.024). The commonest complaint was daytime numbness (76.8%). The severity of CTS among patients was predominantly mild (80.5%), and the symptoms were severe enough to affect hand function in approximately one-third (34.1%) of the group. However, only 25.6% of symptomatic patients mentioned their problems to their doctors, and of these, 9.5% received treatment.

CONCLUSIONCTS is prevalent in the third trimester of pregnancy, especially among Malay women, in whom the risk of developing the syndrome is two-fold. Yet, this troublesome complication of pregnancy appears to be under-recognised, with most patients not being treated appropriately.

Adolescent ; Adult ; Carpal Tunnel Syndrome ; diagnosis ; epidemiology ; etiology ; pathology ; Cross-Sectional Studies ; Female ; Humans ; Middle Aged ; Pregnancy ; Pregnancy Complications ; diagnosis ; epidemiology ; pathology ; Pregnancy Trimesters ; Risk Factors ; Severity of Illness Index ; Young Adult

OBJECTIVETo investigate the effects of open reduction by palm side for the distal radius fracture and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after operation.

METHODSFrom March 2000 to March 2007, 32 patients (8 males and 24 females, ranging in age from 46 to 66 years) with distal radius fracture were treated with open reduction by palm side and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection; while 30 patients (7 males and 23 females,ranging in age from 45 to 65 years) only with open reduction by palm side and T shape plate internal fixation. The incidences of delayed carpal tunnel syndrome between the two groups were compared.

RESULTSAmong 32 patients treated with open reduction by palm side and T shape plate internal fixation with anterior transverse carpal ligament resection, 3 patients had delayed carpal tunnel syndrome; while in 30 patients treated with open reduction by palm side and T shape plate internal fixation, 10 patients had delayed carpal tunnel syndrome. There was significant statistically difference (P < 0.05%).

CONCLUSIONSimultaneous anterior transverse carpal ligament resection can effectively prevent the delayed carpal tunnel syndrome occurrence for the distal radius fracture with open reduction by palm side.

Aged ; Carpal Bones ; Carpal Tunnel Syndrome ; prevention & control ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; Humans ; Ligaments, Articular ; surgery ; Male ; Middle Aged ; Radius Fractures ; complications ; surgery

This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS.
Adult ; Aged ; Amyloidosis/complications ; Arteriovenous Fistula/complications ; Blood Urea Nitrogen ; Carpal Tunnel Syndrome/*complications/*diagnosis ; Creatinine/blood ; Electrophysiological Phenomena ; Female ; Humans ; Kidney Failure, Chronic/*complications/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis/adverse effects ; Polyneuropathies/*complications/*diagnosis ; Renal Dialysis/adverse effects ; beta 2-Microglobulin/blood

OBJECTIVETo study the clinicopathologic features of lipomatosis of nerve (NLS).

METHODSThe clinical, radiologic and pathologic features were analyzed in 15 cases of NLS.

RESULTSThere were a total of 10 males and 5 females. The age of patients ranged from 4 to 42 years (mean age = 22.4 years). Eleven cases were located in the upper limbs and 4 cases in the lower limbs. The median nerve was the most common involved nerve. The patients typically presented before 30 years of age (often at birth or in early childhood) with a soft and slowly enlarging mass in the limb, with or without accompanying motor and sensory deficits. Some cases also had macrodactyly and carpal tunnel syndrome. MRI showed the presence of fatty tissue between nerve fascicles, resembling coaxial cable in axial plane and assuming a spaghetti-like appearance in coronal plane. On gross examination, the affected nerve was markedly increased in length and diameter. It consisted of a diffusely enlarged greyish-yellow lobulated fusiform beaded mass within the epineural sheath. Histologically, the epineurium was infiltrated by fibrofatty tissue which separated, surrounded and compressed the usually normal-appearing nerve fascicles, resulting in perineural septation of nerve fascicles and microfascicle formation. The infiltration sometimes resulted in concentric arrangement of perineural cells and pseudo-onion bulb-like hypertrophic changes. The perineurial cells might proliferate, with thickening of collagen fibers, degeneration and atrophic changes of nerve bundles. Immunohistochemical study showed that the nerve fibers expressed S-100 protein, neurofilament and CD56 (weak). The endothelial cells and dendritic fibers were highlighted by CD34. The intravascular smooth muscle cells were positive for muscle-specific actin.

CONCLUSIONSNLS is a rare benign soft tissue tumor of peripheral nerve. The MRI findings are characteristic. A definitive diagnosis can be made with histologic examination of tissue biopsy.

Adolescent ; Adult ; Antigens, CD34 ; metabolism ; CD56 Antigen ; metabolism ; Carpal Tunnel Syndrome ; complications ; pathology ; Child ; Child, Preschool ; Diagnosis, Differential ; Extremities ; innervation ; Female ; Hand Deformities, Congenital ; complications ; pathology ; Humans ; Lipoma ; pathology ; Lipomatosis ; complications ; diagnosis ; metabolism ; pathology ; surgery ; Magnetic Resonance Imaging ; Male ; Median Nerve ; metabolism ; pathology ; Nerve Sheath Neoplasms ; pathology ; Neurofibroma ; pathology ; Neurofilament Proteins ; metabolism ; Neuroma ; pathology ; Peripheral Nervous System Diseases ; complications ; diagnosis ; metabolism ; pathology ; surgery ; Peripheral Nervous System Neoplasms ; pathology ; Retrospective Studies ; S100 Proteins ; metabolism ; Vimentin ; metabolism ; Young Adult

Adolescent ; Adult ; Carpal Tunnel Syndrome ; etiology ; surgery ; Female ; Fractures, Bone ; complications ; surgery ; Humans ; Joint Dislocations ; complications ; surgery ; Male ; Middle Aged ; Wrist Injuries ; complications ; surgery

OBJECTIVETo compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome.

METHODSA prospective, randomized study was performed on 70 hands in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004. Either open (36 hands in 30 patients) or endoscopic (34 hands in 32 patients) carpal tunnel release was performed randomly. Symptom improvement, complications, and the time of operation, in-hospital stay, and return to work between the two groups were assessed with average 2 years of follow-up. The electromyography was tested pre- and 3 months post-operation.

RESULTSThere were no significant differences between the two surgical groups with regard to postoperative improvements of symptom, electromyography tests, and the incidence of complications. But it was statistically less in the rate of scar tenderness, the time of operation, in-hospital stay, and return to work in the endoscopic group compared with the open group (P < 0.05).

CONCLUSIONSThe endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome. And it has the advantages of slight scar tenderness, less operation time, less in-hospital stay, early functional recovery, safety, and high- satisfaction rate compared with open methods.

Adult ; Aged ; Carpal Tunnel Syndrome ; surgery ; Endoscopy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; classification ; epidemiology ; Retrospective Studies ; Surgical Procedures, Operative ; adverse effects ; methods

OBJECTIVE: This research aimed to evaluate the relationship of limited joint motion (LJM) and shoulder adhesive capsulitis with diabetic complications and related diseases in type II diabetic patients. METHOD: A cross sectional study in 155 type II diabetic patients was done. The presence of LJM and shoulder adhesive capsulitis was sought. The diseases closely related to diabetes were recorded. The patients were assessed for retinopathy, nephropathy, and neuropathy. RESULTS: The prevalence of LJM and shoulder adhesive capsulitis in type II diabetic patients was 32.3% and 29.7%, respectively. Development of LJM and shoulder adhesive capsulitis was correlated with age and duration of diabetes. Higher blood HbA1c level was noticed in mild and moderate degree of LJM. The prevalence of shoulder adhesive capsulitis was shown association with LJM. The prevalence of LJM was associated with a history of myocardial infarction and chronic diabetic complications. The prevalence of shoulder adhesive capsulitis was associated with retinopathy, carpal tunnel syndrome, and autonomic neuropathy. CONCLUSION: According to the results, around 30% of type II DM patients could have hand LJM and should adhesive capsulitis, which suggested more attention and effort to prevent the LJM and shoulder adhesive capsulitis were needed.
Bursitis ; Carpal Tunnel Syndrome ; Diabetes Complications* ; Hand ; Humans ; Joints* ; Myocardial Infarction ; Prevalence ; Shoulder