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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Musculoskeletal complications of diabetes include carpal tunnel syndrome, Dupuytren contracture, adhesive capsulitis, and sclerodactyly. Carpal tunnel syndrome is compression of the median nerve along its course through the carpal tunnel in the wrist. Dupuytren contracture is progressive contracture of the palmar fascial bands, resulting in finger flexion deformities. Adhesive capsulitis is commonly known as frozen shoulder, associated with shoulder pain and stiffness. Sclerodactyly is a localized thickening and tightness of the skin on the fingers or toes.
Clinical Evaluation
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The ulnar nerve is the first and most commonly affected nerve in the upper extremity with or without skin lesions. Median nerve compression may present as carpal tunnel syndrome in the wrist. These enlarged nerves may be palpable, palpable and visible, or palpable and fluctuant. The nerve may be soft, not rollable, firm or hard. The most common clinical presentation is with numbness or weakness; wasting, deformity and pain/tingling can also be presenting symptoms in a small minority of cases. Sometimes, they present like acute cellulitis with a nerve abscess and caseous granuloma between the nerve fibres (Figure 2.11). The abscess may be fluctuant, non-fluctuant, subcutaneous, deep, painless, painful, collar stud, moderate in size with or without an impending sinus. A longitudinal epineurotomy along the entire enlarge nerve decompresses the extra perineural pressure over the fibrosseous tunnel. Caseous material is drained, and nerve fascicles are not disturbed. This relieves pain and prevents further deterioration of the nerve function.
Screening and Diagnostic Tests
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
The National Institute for Occupational Safety and Health has developed a case definition of carpal tunnel syndrome – an affliction of the wrist – that incorporates three criteria: symptoms of nerve involvement, a history of occupational risk factors, and the presence of physical exam findings [154]. The sensitivity of this definition as a diagnostic test for carpal tunnel syndrome is 0.67, and its specificity is 0.58.
Prevalence and risk factors for self-reported symptoms of carpal tunnel syndrome among hospital office workers: a cross-sectional study
Published in International Journal of Occupational Safety and Ergonomics, 2023
Carpal tunnel syndrome (CTS) occurs as a result of compression of the median nerve in the carpal tunnel at the wrist joint level and is the most common peripheral nerve entrapment disease. CTS is not a simple condition but a serious cause of disability, and is defined as the upper extremity musculoskeletal disease associated with the highest cost among working-age patients in relation to taking sick leave, decreased productivity and personal financial losses [1]. The US Bureau of Labor Statistics reported that all musculoskeletal problems were responsible for an estimated 32.2 cases and an average 12 days off work per 10,000 workers in 2015, in all industries in the USA, while CTS accounted for the highest number of workdays lost (on average, 28 days off work per case) [2]. Early detection of CTS can also be a critical factor affecting the return to work. Workers with a correct and early diagnosis of CTS were found to be much more likely to return to work than workers diagnosed weeks or months later [3].
Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Carpal bone mobilization is a therapeutic technique where the carpal bones are manipulated through multidirectional glide or distraction at the radiocarpal and midcarpal joint. When used in conjunction with wrist splinting, these techniques have shown improvement in carpal tunnel syndrome symptom severity (Huisstede et al. 2010). Previous studies suggest that physical methods which apply forces at or near the carpal bones may serve to decompress the median nerve by increasing the CAA (Marquardt et al. 2015) or total CSA (Bueno-Gracia, Pérez-Bellmunt, et al., 2018; Bueno-Gracia, Ruiz-de-Escudero-Zapico, et al. 2018). The results of this study support these previous findings which show how carpal bone motion can increase the carpal tunnel space near the median nerve. Additionally, the results of this study suggest that carpal bone mobilization techniques which induce inward rotation of the hamate and trapezium may act to increase the CAA, thus relieving the pressure at the median nerve and alleviating the associated carpal tunnel syndrome symptoms.
Modified dome osteotomy and anterior locking plate fixation for distal radius variant of Madelung deformity: a retrospective study
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Andrea Leti Acciaro, Lorenzo Garagnani, Mario Lando, Debora Lana, Silvana Sartini, Roberto Adani
All children with ‘distal radius’ Madelung deformity, treated with a standardized surgical procedure, including the modified reverse dome osteotomy of the distal radius and volar fixation with a small locking plate, at a single center between 2010 and 2018 were included. Exclusion criteria specified treatment with K-wires or external fixation (due to different post-operative immobilization and rehabilitation programs) or wide volar locking plates (due to the augmented invasivity of the hardware system and subsequent need for plate removal). Of the 24 children (28 wrists) with Madelung deformity treated at the single center during the study period, 13 patients (15 wrists) presented with the ‘distal radius’ variant, were treated with the modified technique and enrolled into the current study. Most patients were female (n = 12/13) and mean patient age at the time of surgery was 15.6 years (ranging from 11 to 19 years). Three patients were affected by Leri-Weill dyschondrosteosis; 2 were sisters who also presented with associated carpal tunnel syndrome and who underwent delayed carpal tunnel release. In 2 patients, bilateral surgery was necessary. All wrists were symptomatic, with constant pain or pain and functional impairment during daily activities.