Search Our Scientific Publications & Authors

Agri 2021 Apr;33(2):96-102

Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey.

Objectives: Carpal tunnel syndrome (CTS) is the most seen entrapment neuropathy. CTS is a complex syndrome arisen with entrapment of median nerve at wrist. Pain worst at night, paresthesia, hypoesthesia, paralysis, and muscle atrophy can be seen through nerve entrapment level. Read More

Front Pharmacol 2020 5;11:621150. Epub 2021 Mar 5.

Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.

Peripheral nerve entrapment syndromes commonly result in pain, discomfort, and ensuing sensory and motor impairment. Many conservative measures have been proposed as treatment, local injection being one of those measures. Now with high-resolution ultrasound, anatomical details can be visualized allowing diagnosis and more accurate injection treatment. Read More

BMJ Case Rep 2021 Jan 18;14(1). Epub 2021 Jan 18.

Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

A 65-year-old man presented with generalised erythematous pustular rash following an insect bite. He was initially treated with antibiotics for presumed cellulitis. He subsequently developed bilateral carpal tunnel syndrome. Read More

J Hand Surg Am 2021 Feb 31;46(2):92-98. Epub 2020 Oct 31.

Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI. Electronic address:

Purpose: Our study aimed to evaluate the relationship between electrodiagnostic study (EDS) severity and utilization of treatments for carpal tunnel syndrome (CTS) as well as the duration of time between EDS and carpal tunnel release (CTR).

Methods: We conducted a retrospective medical chart review at a single tertiary hand center to evaluate CTS-related care that patients received after EDS. We recorded patient age, sex, race/ethnicity, insurance type, CTS-related surgical and nonsurgical healthcare utilization after EDS testing, and number of days between EDS and CTR. Read More

Sci Rep 2020 09 24;10(1):15607. Epub 2020 Sep 24.

Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunghwndo-ro, Dong-gu, Ulsan, 44033, Republic of Korea.

There are conflicting hypotheses regarding the initial pathogenesis of carpal tunnel syndrome (CTS). One hypothesis characterizes it as inflammation of the median nerve caused by compression, while another hypothesis characterizes CTS as non-inflammatory fibrosis of the subsynovial connective tissue (SSCT). This study aimed to investigate the differences in the ultrasonography parameters before and after a steroid injection, which is effective for CTS, to elucidate the initial pathogenesis of CTS and the mechanisms of action of the injected steroid. Read More

Hand (N Y) 2020 Aug 6:1558944720944263. Epub 2020 Aug 6.

Hospital Universitario Ramón y Cajal, Madrid, Spain.

In a previous paper, we have demonstrated that: (1) local injection of corticosteroids for carpal tunnel syndrome (CTS) is as effective as decompressive surgery, at 1-year follow-up; and (2) surgery has an additional benefit in the 2-year follow-up. In this study, we assess the long-term outcomes of both therapies in an observational extension of the patients originally enrolled in our randomized clinical trial. Patients were included in an open, randomized clinical trial, comparing injections versus surgery in CTS. Read More

Clin Rheumatol 2021 Mar 21;40(3):1069-1076. Epub 2020 Jul 21.

Department of Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India.

Objectives: (1) Development and validation of a composite ultrasound score (cUSS) for the diagnosis of carpal tunnel syndrome (CTS). (2) To predict treatment response after local corticosteroid injection.

Methods: Wrists of CTS patients and controls were evaluated with high-resolution ultrasound and cross-sectional area of median nerve at carpal tunnel inlet (CSAp) and outlet (CSAd) and bowing of flexor retinaculum (FRB), flexor tenosynovitis, and intraneural vascularity and echogenicity changes were noted. Read More

Arch Phys Med Rehabil 2020 11 16;101(11):1857-1864. Epub 2020 Jul 16.

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming University, Taipei, Taiwan. Electronic address:

Objectives: To evaluate whether the therapeutic effect of ultrasound-guided injections with 10 mg or 40 mg triamcinolone acetonide (TA) was dose-dependent in patients with idiopathic mild to moderate carpal tunnel syndrome (CTS).

Design: Prospective, double-blind, randomized controlled study with 12 weeks of follow-up.

Setting: Rehabilitation outpatient clinic of a single medical center. Read More

World Neurosurg 2020 07 27;139:548. Epub 2020 Apr 27.

Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA. Electronic address:

Carpal tunnel syndrome represents compression of the median nerve in the carpal tunnel, which is defined by the carpal bones on the lateral, medial, and dorsal aspects and the transverse carpal ligament on the anterior aspect. Symptoms of carpal tunnel syndrome include paresthesia, anesthesia, paresis, and pain located in the median nerve distribution. In severe cases, there may be atrophy of median nerve-innervated thenar muscles. Read More

J Hand Surg Am 2020 Aug 25;45(8):690-697.e7. Epub 2020 Apr 25.

Purpose: To evaluate, from the surgeon's perspective, the importance, feasibility, and appropriateness of sharing decisions during an episode of care of carpal tunnel syndrome (CTS) or distal radius fracture in patients aged greater than 65 years.

Methods: A consortium of 9 fellowship-trained hand/upper-limb surgeons used the RAND Corporation/University of California Los Angeles Delphi Appropriateness method to evaluate the importance, feasibility, and appropriateness of sharing 27 decisions for CTS and 28 decisions for distal radius fractures in patients aged greater than 65 years. Panelists rated each measure on a scale of 1 (definitely not important/feasible/appropriate) to 9 (definitely important/feasible/appropriate) in 2 voting rounds with an intervening face-to-face discussion. Read More

Ann Plast Surg 2020 08;85(2):127-134

From the Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.

Purpose: The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. Read More

J Pharmacopuncture 2020 Mar;23(1):37-41

Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea.

Objectives: Round Acupuncture having blunt end has developed from acupotomy. This case report is to find out that Round Acupuncture is effective in treating patients with recurrent carpal tunnel syndrome (CTS), which has not improved by steroid injection or acupotomy.

Methods: Round Acupuncture was inserted into the distal fibers of transverse carpal ligament and released toward the proximal fibers. Read More

Muscle Nerve 2020 07 23;62(1):89-94. Epub 2020 Apr 23.

Department of Medical Biometrics and Informatics, Jawaharlal Institute of Postgraduate Medical Education, Pondicherry, India.

Introduction: Evidence for the efficacy of distal corticosteroid injection compared with proximal injection in carpal tunnel syndrome (CTS) is inadequate.

Methods: We conducted a randomized, double-blind noninferiority trial of 131 wrists with CTS. Forty milligrams of methylprednisolone was injected medial to the palmaris longus tendon 2 cm proximal to the wrist crease, or at the volar aspect, 2 to 3 cm distal to the wrist crease. Read More

Pharmaceuticals (Basel) 2020 Mar 18;13(3). Epub 2020 Mar 18.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey.

This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Read More

Ann Dermatol Venereol 2020 Apr 11;147(4):316-317. Epub 2020 Mar 11.

Service de dermatologie et allergologie, faculté de médecine, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.

Obstet Gynecol Surv 2020 Feb;75(2):121-126

Associate Professor, Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.

Importance: Carpal tunnel syndrome and meralgia paresthetica are 2 common neuropathies complicating pregnancy. Each of these causes significant discomfort but can be diagnosed and treated safely during pregnancy.

Objective: This article outlines the existing literature diagnosis, treatment, and prognosis of carpal tunnel syndrome and meralgia paresthetica, specifically looking at the implications during pregnancy. Read More

Pain Ther 2020 Jun 25;9(1):129-142. Epub 2020 Feb 25.

Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.

Introduction: This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. Read More

Case Reports Plast Surg Hand Surg 2020 20;7(1):13-15. Epub 2020 Jan 20.

Department of Plastic, Reconstructive and Hand Surgery, Isala Hospital, Zwolle, The Netherlands.

We present a case in which a depot triamcinolone acetonide (Kenacort) was unintentionally injected intra-arterially into the ulnar artery, resulting in microembolic capillary occlusion in the digits supplied by the artery. Ischemic changes and subungual petechial hemorrhages were seen in the ulnar three digits. Angiography confirmed microembolic occlusion. Read More

Eur Radiol 2020 Mar 11;30(3):1498-1506. Epub 2019 Nov 11.

Department of Physiology, Universidad de Valencia/INCLIVA, 46010, Valencia, Spain.

Background: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence.

Methods: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. Read More

Int Orthop 2020 01 26;44(1):141-146. Epub 2019 Oct 26.

Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, 315000, China.

Purpose: Extracorporeal shock wave therapy (ESWT) has been reported as a new therapy for carpal tunnel syndrome (CTS). However, few studies have compared ESWT with the local corticosteroid injection (LCI).

Methods: In this study, a randomized controlled trial comparing 30 patients with ESWT and 25 patients treated with LCI was conducted. Read More

Altern Ther Health Med 2020 Mar;26(2):10-16

Background: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in humans. Nonsurgical management is still a matter of debate, and conservative treatments include splinting, local steroid injections, ultrasound, and oral steroids. Acupuncture and electroacupuncture therapy for symptomatic CTS may improve symptoms and aid nerve repair as well as improve sensory and motor functions. Read More

Anesth Essays Res 2019 Jul-Sep;13(3):417-422

Department of Anesthesia and Pain Management, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Background: Carpal tunnel syndrome (CTS) is one of the most common focal entrapment neuropathies. Although the exact etiology remains unclear, high-pressure-related intracarpal tunnel compression of the median nerve (MN), progressing ischemia, and mechanical strangulation are common mechanisms. The therapeutic managements for CTS depend on the disease severity, varying from a conservative treatment to surgical interventions. Read More

Arq Neuropsiquiatr 2019 23;77(9):638-645. Epub 2019 Sep 23.

University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurosurgery, Istanbul, Turkey.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. Read More

Eplasty 2019 29;19:e19. Epub 2019 Jul 29.

Division of Plastic Surgery, University of Louisville, Louisville.

Carpal tunnel syndrome is the most common entrapment neuropathy involving the upper extremity. As such, various nonoperative techniques have been developed to aid in management of mild to moderate disease, including local steroid injection. However, definitive guidelines for needle/injection location have not been defined, especially in relation to diminishment of iatrogenic injury to the median nerve. Read More

Clin Rheumatol 2019 Dec 16;38(12):3643-3654. Epub 2019 Aug 16.

Faculty of Medicine, Department of Rheumatology and Rehabilitation, Mansoura University, Elgomhoria St., Mansoura, Egypt.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Read More

Hand (N Y) 2019 Jul 9:1558944719861715. Epub 2019 Jul 9.

4 Department of Pain & Rehab Medicine, BayCare Clinic, Green Bay, WI, USA.

The aim of this report is to describe a new ultrasound guided technique for carpal tunnel injection and median nerve hydrodissection using distal to proximal approach. From 2015 to 2019, 827 consecutive injections by distal-to-proximal approach were included using coding information to check for post-procedural skin hypopigmentation, hematoma, seroma, nerve injury, or vascular injury. There were no occurrences of post-procedural skin-hypopigmentation, hematoma or seroma formation, or neurovascular injury. Read More

Clin Rheumatol 2019 Oct 17;38(10):2933-2940. Epub 2019 Jun 17.

Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt.

Objective: To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM).

Method: Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. Read More

Arch Phys Med Rehabil 2019 09 17;100(9):1592-1598. Epub 2019 Apr 17.

Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA.

Objective: Carpal tunnel syndrome (CTS) is frequently seen as a work-related disorder. Few studies have examined the treatment of CTS by insurance coverage, and none have used a large, population-based dataset. This study examined the extent to which the use of CTS tests and treatments varied for those on workers' compensation insurance (WCI) vs private insurance and Medicaid, controlling for patient and provider characteristics. Read More

J Hand Surg Am 2019 Apr;44(4):304-310

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.

Purpose: Although a local corticosteroid injection for carpal tunnel syndrome (CTS) is frequently performed by palpation using anatomical landmarks, ultrasound (US) allows physicians to visualize and confirm placement of the injectate close to the median nerve, possibly improving the efficacy of the injection. The aim of this study was to compare the effectiveness and complications of US-guided steroid injections with landmark-based injections for CTS.

Methods: A total of 102 patients with CTS were randomized into 2 groups: landmark-based injection and US-guided injection. Read More