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Hand Symptom Diagram

Hand Symptom Diagram

Evaluated symptom patterns on a hand diagram as predictors of surgical outcome in carpal tunnel syndrome (CTS).

Marked on the hand diagram the location of 3 symptoms: pain, numbness/tingling (NT), and "other" symptoms. The diagram was first divided into 6 regions following a standardized procedure. Outcomes 6 months after surgery were expressed as the percentage of change on the Symptom Severity Scale and Function Status Scale of the Carpal Tunnel Syndrome Assessment Questionnaire, and the satisfaction with the results of the surgery.

Patients receiving Workers' Compensation (37% of the cohort) had more wrist pain and NT of the arm, and less pain involving the arm and upper palm. This group also had worse outcomes and were less satisfied with surgery. Drawing expansion was associated with a low score on the SF-36 mental health subscale. However, psychological impairment was not associated with a worse outcome.

Symptom patterns identified preoperatively with a hand symptom diagram help to predict the outcome of carpal tunnel release.

Bessette L et al., Prognostic value of a hand symptom diagram in surgery for carpal tunnel syndrome. J Rheumatol, 1997 Apr, 24:4, 726-34.

Oral Anticoagulants (CTS)

Oral Anticoagulants        

Acute carpal tunnel syndrome is well recognized in patients with haemophilia and conservative management with factor replacement and temporary splinting is recommended.

There have, however, been very few reported cases of acute carpal tunnel syndrome as a complication of oral anticoagulant therapy (e.g. warfarin).

Recommend prompt decompression under local anaesthesia and continuation of the anticoagulant therapy.

Black PR et al., Acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. J Hand Surg [Br], 1997 Feb, 22:1, 50-1.

Polymyalgia Rheumatica

Polymyalgia Rheumatica

Presenting symptoms in polymyalgia rheumatica (PMR) may be atypical.

Casereports of 2 old females who developed a bilateral carpal tunnel syndrome several months before the typical symptoms of PMR appeared. In both patients the diagnosis of PMR was overlooked and a surgical release of the median nerve was performed.

PMR should be considered in elderly people who develop an acute or subacute carpal tunnel syndrome.

Herrera B et al., Carpal tunnel syndrome heralding polymyalgia rheumatica. Scand J Rheumatol, 1997, 26:3, 222-4.

Rheumatic Disorders

Rheumatic Disorders

In 6 patients aged 59-71 years carpal tunnel syndrome, seemingly idiopathic, was followed by connective tissue disorders, in most cases autoimmune in nature.

Patients with idiopathic carpal tunnel syndrome may therefore require long-term follow-up, if inflammatory rheumatic conditions are not to be missed.

Pal B: Carpal tunnel syndrome as a herald of autoimmune rheumatic disorders. J R Soc Med, 1997 Apr, 90:4, 216-7.

Vitamin B6

Vitamin B6

This study evaluated 20 patients, nine of whom were males, between 27 and 63 years of "age" with carpal tunnel syndrome. All of whom had been taking 200 mgs of oral "vitamin B6" daily for three months, for vitamin B6's effect on clinical and electrophysiological parameters.

Electroencephalogram and motor latency did not appear to have any relationship to vitamin B6 status.

Parameters which changed most significantly with vitamin B6 was "pain" scores and sensory latency which were mostly correlated with clinical assessment. Vitamin B6 therapy pain scores were greatly improved than any other parameter assessed.

It is noted that vitamin B6 can change pain thresholds.

Even though vitamin B6 appeared to have a therapeutic benefit without toxicity, it is probably not related to a resolution of vitamin B6 deficiency but due more to vitamin B6's effect on pain threshold.

Pain scores dramatically improved during the course of this study, and predicted accurately functional return. The authors further concluded that vitamin B6 did not have any neurotoxicity in this study, and is therefore safe at a 200 mg dose.

"Brief Communication: Effect of Pharmacologic Doses of Vitamin B6 on Carpal Tunnel Syndrome, Electroencephalographic Results and Pain," Bernstein, Allan L., MD and Dinesen, Jamie S., RN, Journal of the American College of "Nutrition", 1993;12(1):73-76.

Vitamin Supplements (CTS)

Vitamin Supplements

Supplemental use of vitamins to prevent disease constitutes a major commercial enterprise in the United States.

Recently published data have given strong support to several of the claims for major benefits of disease prevention, including that of cancer, cardiovascular disease, carpal tunnel syndrome, and neural tube defects, to name just a few.

The purported benefits for supplemental vitamin usage are discussed for these diseases, along with a call for a re-evaluation of the underlying philosophy of the Recommended Dietary Allowances, or consideration of their abolition, based on newly emerging data.

Reynolds RD: Vitamin supplements: current controversies. J Am Coll Nutr, 1994 Apr, 13:2, 118-26.