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      Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis) ☆☆ Translated title: Síndrome do túnel do carpo – Parte I (anatomia, fisiologia, etiologia e diagnóstico)

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          Abstract

          Carpal tunnel syndrome (CTS) is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Electroneuromyographic examination may be recommended before the operation or in cases of occupational illnesses.

          Resumo

          A síndrome do túnel do carpo (STC) é definida pela compressão do nervo mediano no punho. É a mais frequente das síndromes compressivas e a causa mais frequente é a idiopática. Ainda que as regressões espontâneas sejam possíveis, o agravamento dos sintomas é a regra. O diagnóstico é, acima de tudo, clínico pelos sintomas e testes provocativos. Um exame eletroneuromiográfico pode ser recomendado no pré-operatório ou em caso de doença laboral.

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          Prevalence of carpal tunnel syndrome in a general population.

          Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. To estimate the prevalence of CTS in a general population. General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). A region in southern Sweden with a population of 170000. A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.
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            The double crush in nerve entrapment syndromes.

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              Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Quality Assurance Committee.

              The sensitivity and specificity of nerve conduction studies (NCS's) and electromyography (EMG) for the diagnosis of carpal tunnel syndrome (CTS) were evaluated by a critical review of the literature. With a search of the medical literature in English through May 1991, 165 articles were identified and reviewed on the basis of six criteria of scientific methodology. The findings of 11 articles that met all six criteria and the results of 48 additional studies that met four or five criteria are presented. We concluded that median sensory and motor NCS's are valid and reproducible clinical laboratory studies that confirm a clinical diagnosis of CTS with a high degree of sensitivity and specificity. Clinical practice recommendations are made based on a comparison of the sensitivities of the several different median nerve conduction study (NCS) techniques.
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                Author and article information

                Contributors
                Journal
                Rev Bras Ortop
                Rev Bras Ortop
                Revista Brasileira de Ortopedia
                Elsevier
                2255-4971
                20 August 2014
                Sep-Oct 2014
                20 August 2014
                : 49
                : 5
                : 429-436
                Affiliations
                [a ]Hand and Upper-Limb Surgery Service, Peripheral Nerve Surgery, Hospital Lapeyronie, University Hospital Center, Montpellier, France
                [b ]Hand Surgery Service, Italian Hospital, Buenos Aires, Argentina
                [c ]Hand Surgery Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brazil
                Author notes
                [* ] Corresponding author. jeffmao@ 123456terra.com.br
                Article
                S2255-4971(14)00128-1
                10.1016/j.rboe.2014.08.001
                4487499
                26229841
                b47dc1aa-74fe-479d-889f-28756c7d7dc6
                © 2014 Sociedade Brasileira de Ortopedia e Traumatologia. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 10 July 2013
                : 28 August 2013
                Categories
                Review Article

                carpal tunnel syndrome/physiopathology,carpal tunnel syndrome/etiology,carpal tunnel syndrome/diagnosis,median nerve,síndrome do túnel do carpo/fisiopatologia,síndrome do túnel do carpo/etiologia,síndrome do túnel do carpo/diagnóstico,nervo mediano

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