Displaying publications 1 - 20 of 23 in total

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  1. Sikkandar MF, Sapuan J, Singh R, Abdullah S
    Med J Malaysia, 2012 Jun;67(3):333-4.
    PMID: 23082430
    A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.
    Matched MeSH terms: Carpal Tunnel Syndrome/etiology*; Carpal Tunnel Syndrome/radiography; Carpal Tunnel Syndrome/surgery
  2. Lim PG, Tan S, Ahmad TS
    J Hand Surg Eur Vol, 2008 Oct;33(5):645-7.
    PMID: 18662961 DOI: 10.1177/1753193408093326
    Anthropometric wrist measurement ratios were examined for an association with idiopathic carpal tunnel syndrome (CTS). Wrist measurements were recorded in 67 patients with CTS and in a matched control group of 67 healthy volunteers. The Wrist Ratio (WR) (wrist anterior to posterior dimension/wrist medial-lateral dimension) and the Wrist Palm Ratio (wrist anterior to posterior dimension/palm length) were calculated for each case. We found that a WR of > or =0.70 and a Wrist Palm Ratio of >0.342 were significantly associated with idiopathic CTS.
    Matched MeSH terms: Carpal Tunnel Syndrome/diagnosis; Carpal Tunnel Syndrome/etiology; Carpal Tunnel Syndrome/pathology*
  3. Sapuan J, Yam KF, Noorman MF, De Cruz PK, Abdul Razab WN, Rozali ZI, et al.
    Singapore Med J, 2012 Oct;53(10):671-5.
    PMID: 23112019
    Carpal 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.
    Matched MeSH terms: Carpal Tunnel Syndrome/diagnosis; Carpal Tunnel Syndrome/etiology*; Carpal Tunnel Syndrome/epidemiology; Carpal Tunnel Syndrome/pathology
  4. Omar MI
    JUMMEC, 2005;8:50-55.
    A retrospective study of 102 hands with carpal tunnel syndrome which were treated conservatively initially. Patients who were successfully treated with this method were then compared with those who had failed with this method and had to be treated with surgical decompression. This study found that it took a mean period of about 5.1 months of conservative treatment before deciding on surgery. Generally, the study shows a predominant involvement of the right hand and the female sex as full-time homemakers. Those who finally needed surgery had a longer duration of symptoms prior to consultation. Surgery brought a faster relief from both pain and numbness. It is recommended that conservative treatment be abandoned after a trial period of at least three to five months in order to encourage a speedier recovery.
    Matched MeSH terms: Carpal Tunnel Syndrome
  5. Sakthiswary R, Singh R
    Rev Bras Reumatol Engl Ed, 2016 09 30;57(2):122-128.
    PMID: 28343616 DOI: 10.1016/j.rbre.2016.09.001
    Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.
    Matched MeSH terms: Carpal Tunnel Syndrome/etiology; Carpal Tunnel Syndrome/pathology*
  6. Goh CH, Lau BL, Teong SY, Law WC, Tan CS, Vasu R, et al.
    Med J Malaysia, 2019 12;74(6):499-503.
    PMID: 31929475
    INTRODUCTION: Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy of the hand, up to 90% of all nerve compression syndromes. The disease is often treated with conservative measures or surgery. The senior author initially intended to treat his own neurosurgical patients concurrently diagnosed with carpal tunnel syndrome in 2014, subsequently, he began to pick up more referrals from the primary healthcare group over the years. This has led to the setup of a peripheral and spine clinic to act as a hub of referrals.

    OBJECTIVE: Department of Neurosurgery Sarawak aimed to evaluate the surgical outcome of carpal tunnel release done over five years.

    METHODS: The carpal tunnel surgeries were done under local anaesthesia (LA) given by neurosurgeons (Bupivacaine 0.5% or Lignocaine 2%). Monitored anaesthesia care (MAC) was later introduced by our hospital neuroanaesthetist in the beginning of 2018 (Target-controlled infusion propofol and boluses of fentanyl). We looked into our first 17 cases and compared these to the two anaesthesia techniques (LA versus MAC + LA) in terms of patient's pain score based on visual analogue scale (VAS).

    RESULTS: Result showed MAC provided excellent pain control during and immediately after the surgery. None experienced anaesthesia complications. There was no difference in pain control at post-operation one month. Both techniques had equal good clinical outcome during patients' clinic follow up.

    CONCLUSION: Neurosurgeons provide alternative route for CTS patients to receive surgical treatment. Being a designated pain free hospital, anaesthetist collaboration in carpal tunnel surgery is an added value and improves patients overall experience and satisfaction.

    Matched MeSH terms: Carpal Tunnel Syndrome/diagnosis; Carpal Tunnel Syndrome/surgery*
  7. Abdullah S, Mat Nor NF, Mohamed Haflah NH
    Singapore Med J, 2014 Apr;55(4):e54-6.
    PMID: 24763843
    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.
    Matched MeSH terms: Carpal Tunnel Syndrome/complications; Carpal Tunnel Syndrome/surgery
  8. Nor Azura Azmi, Nor Azlin Mohd. Nordin, Nor Azila Noh
    MyJurnal
    The study evaluated the function of median sensory nerve fibers, as well as determining the relationship between its function with the duration of Carpal Tunnel Syndrome (CTS) and body mass index (BMI) among CTS patients in Physiotherapy Unit, Universiti Kebangsaan Malaysia Hospital (HUKM). Thirty subjects (6 males and 24 females) with mean age 53.30 +/- 9.20 years and duration of the CTS 51.17 +/- 50.22 months participated in this study. The sensitivity of median sensory nerve was evaluated using Current Perception Threshold (CPT) Test with stimulation frequencies of 5 Hz, 250 Hz and 2000 Hz; which demonstrated the function of C, A-delta and A-beta nerve fiber respectively. Majority of the CTS patients had normal function in the 3 types of median sensory nerve fiber. Forty percents of the subjects had abnormality in the Aa function, 7% had abnormality of the A-beta function and 27% demonstrated abnormality in the C fiber function. Spearman Correlation Test showed no significant relationship between the function of median sensory nerve and the duration of CTS and body mass index (BMI) (p > 0.05). In conclusion, although majority of the patients demonstrated normal median sensory nerve function, abnormality of the A-beta, A-delta and C fibers sensitivity in some patients requires attention to prevent worsening of the nerve function thus avoiding related complications. Physiotherapists in HUKM may intensify the use of nerve stimulating modalities such as Transcutaneous Electrical Nerve Stimulation (TENS) to normalize the nerve functions of these patients.
    Keywords: Carpal Tunnel Syndrome; Current perception threshold; Median sensory nerve sensitivity; Body mass index
    Study site: Physiotherapy Unit, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
    Matched MeSH terms: Carpal Tunnel Syndrome
  9. Raffael, I., Rajesh, S.
    MyJurnal
    We describe a case of median nerve compression by gouty tophi. This is a rare condition and presented with loss of function with paraesthesia of both hands in addition to multiple tophis. Surgery was chosen for immediate relief, where a debulking of left flexor digitorum superficialis with decompression of carpal tunnel was done and resulted in improvement of symptoms but became complicated due to inadequate physiotherapy.
    Matched MeSH terms: Carpal Tunnel Syndrome
  10. Sethu, V.S.
    MyJurnal
    Work-related musculoskeletal disorders of the upper limb (WRMSDs-UL) account for one of the largest types of occupational disorders worldwide. This broad term includes several disorders, such as carpal tunnel syndrome, tendonitis, tension neck syndrome and lateral epicondylitis (tennis elbow) which are generally caused by poor postures, repetitive strain and psychosocial factors. Various workplace interventions have been investigated and employed to prevent the different WRMSDs-UL, but a common consensus to address the problem has yet to be achieved. This paper reviews and discusses the efficacies of some interventions which have been tested for the most prevalent type of WRMSDs-UL, carpal tunnel syndrome (CTS). The focus will be on computer users who developed CTS out of the prolonged and repetitive use of keyboards and pointing devices. The interventions studied include engineering design, management strategies, personal development, medical treatment and multi-dimensional approaches. Outcome of the study reveals that the most effective approach would be one that is multi-dimensional in nature, with the inclusion of at least two or more intervention strategies at the same time.
    Matched MeSH terms: Carpal Tunnel Syndrome
  11. Siddiq MAB, Hossain Parash MT
    Cureus, 2019 Sep 30;11(9):e5809.
    PMID: 31728251 DOI: 10.7759/cureus.5809
    Several anatomical variations concerning the median nerve have surfaced in the medical literature. Among them, bifid median nerve or median nerve bifurcation with or without persistent median artery has been widely reported. Sporadic case reports describe median nerve trifurcation (trifid median nerve) as well. In the present report, we describe carpal tunnel syndrome manifestations in association with trifid median nerve unveiled incidentally under high-frequency musculoskeletal ultrasonogram in a lactating mother-a first in the medical literature.
    Matched MeSH terms: Carpal Tunnel Syndrome
  12. Passiatore M, Perna A, De-Vitis R, Taccardo G
    Malays Orthop J, 2020 Mar;14(1):1-6.
    PMID: 32296475 DOI: 10.5704/MOJ.2003.001
    Introduction: Carpal tunnel syndrome is one of the most common peripheral neuropathies. Only a few studies evaluate the efficacy of "nutraceuticals" on peripheral nerves and neuropathic pain. The aim of the present investigation is to evaluate the role of Alfa-Lipoic Acid-R (ALA-R) on clinical and functional outcomes in patients affected by mild to moderate carpal tunnel syndrome.

    Material and Methods: The present investigation is a prospective randomised controlled open label study, performed at our Hand Surgery Department (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome) from October 2018 to March 2019. The enrolled patients were divided in two groups: Group A (ALA-R 600mg once day for 60 days) and Group B (control Group, no drug administration).

    Results: 134 patients (74 F, 60 M) met the inclusion and exclusion criteria. In Group A, there was a statistically significant pain reduction compared to the control Group. Using the Boston Carpal Tunnel Questionnaire, there were no significant improvements in the other symptoms and function.

    Conclusion: ALA-R full dose administration for two months leads to positive short term results in terms of symptoms and function improvement, even if the surgical carpal tunnel release remains the treatment of choice.

    Matched MeSH terms: Carpal Tunnel Syndrome
  13. Teh KK, Ng ES, Choon DS
    J Hand Surg Eur Vol, 2009 Aug;34(4):506-10.
    PMID: 19675032 DOI: 10.1177/1753193409100962
    This cadaveric study evaluates the margin of safety and technical efficacy of mini open carpal tunnel release performed using Knifelight (Stryker Instruments) through a transverse 1 cm wrist incision. A single investigator released 32 wrists in 17 cadavers. The wrists were then explored to assess the completeness of release and damage to vital structures including the superficial palmar arch, palmar cutaneous branch and recurrent branch of the median nerve. All the releases were complete and no injury to the median nerve and other structures were observed. The mean distance of the recurrent motor branch to the ligamentous divisions was 5.7 +/- 2.4 mm, superficial palmar arch was 8.7 +/- 3.1 mm and palmar cutaneous branch to the ligamentous division was 7.2 +/- 2.4 mm. The mean length of the transverse carpal ligament was 29.3 +/- 3.7 mm. Guyon's canal was preserved in all cases.
    Matched MeSH terms: Carpal Tunnel Syndrome/surgery*
  14. Sim SE, Gunasagaran J, Goh KJ, Ahmad TS
    J Hand Ther, 2018 02 13;32(4):411-416.
    PMID: 29426574 DOI: 10.1016/j.jht.2018.01.004
    STUDY DESIGN: Prospective randomized study.

    INTRODUCTION: Carpal tunnel syndrome (CTS) has been described as the most common compression neuropathy. Many modalities exist for conservative treatment. Efficacy of each modality has been described in the literature. However, the effectiveness of combination of these modalities is not well established. The purpose of this study is to assess the short-term clinical outcome of conservative treatment for CTS comparing orthosis alone with combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy.

    METHODS: Forty-one patients who presented to Upper Limb Reconstructive and Microsurgery Clinic, University Malaya Medical Centre with CTS and positive electrodiagnostic study were recruited. Fifteen patients had bilateral CTS. Fifty-six wrists were equally randomized to orthosis alone and a combined therapy of orthosis, nerve/tendon gliding exercise, and ultrasound therapy. All patients were required to complete the Boston Carpal Tunnel Questionnaire during the first visit and 2 months after treatment.

    RESULTS: Both the orthosis and combined therapy groups showed a significant improvement in symptoms and function after treatment. The mean difference of symptoms in the orthosis group was 0.53; 95% confidence interval [CI]: 0.23-0.83 (P = .001) and in the combined therapy group was 0.48; 95% CI: 0.24-0.72 (P 

    Matched MeSH terms: Carpal Tunnel Syndrome/therapy*
  15. Rozali ZI, Noorman FM, De Cruz PK, Feng YK, Razab HW, Sapuan J, et al.
    Asia Pac Fam Med, 2012 Jan 30;11(1):1.
    PMID: 22283968 DOI: 10.1186/1447-056X-11-1
    INTRODUCTION: Carpal Tunnel Syndrome is known to be a common complication during pregnancy especially during the third trimester.

    AIM: This article focuses on its impact to the third trimester pregnant mothers with CTS.

    METHODS: Third trimester pregnant mothers with no other known risk factors for CTS, were interviewed and examined for a clinical diagnosis of CTS. The severity of CTS was assessed by means of symptoms severity and functionality using the Boston Carpal Tunnel Questionnaire.

    RESULTS: Out of 333 third trimester pregnant mothers, 82 (24.6%) were clinically diagnosed with CTS. Malay race was found to have significant correlation with the diagnosis of CTS (p = 0.024) and are two times more likely to get CTS during pregnancy (OR = 2.26) compare to the non-Malays. Bilateral CTS was two times higher (n = 58, 63.4%) than unilateral cases (n = 30, 36.6%), however no significant correlation between the two was found with severity (p = 0.284) or functional (p = 0.906). The commonest complaint was numbness/tingling during day time (n = 63, 76.8%). Majority of the CTS cases were mild (n = 66, 80.5%) and approximately one third (n = 28, 34.1%) had affected hand functions. All symptoms related to pain was found to have significant correlation with severity (p = 0.00, OR = 12.23) and function (p = 0.005, OR = 5.01), whereas numbness and tingling does not (Severity, p = 0.843, function, p = 0.632).

    CONCLUSION: This study shows that even though CTS in third trimester pregnancy is prevalent, generally it would be mild. However, function can still be affected especially if patients complain of pain.
    Matched MeSH terms: Carpal Tunnel Syndrome
  16. Mohamed Faizal Sikkandar, Shalimar Abdullah, Rajesh Singh, Parminder Singh Gill, Nur Azuatul Akmal Kamaludin, Tan Jin Aun, et al.
    MyJurnal
    Introduction: Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ul- trasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm ie larger, while non-CTS patients had a mean of 0.797 cm inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were sta- tistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.
    Matched MeSH terms: Carpal Tunnel Syndrome
  17. Mahendran, S, Paisal, H., Ng, E.S., Sara, T.
    Malays Orthop J, 2008;2(2):37-39.
    MyJurnal
    Dupuytren contracture is commonly seen in northern European populations but not in Asians. Even more rare is a presentation of flexion deformity of fingers involving two different pathologies with incidental carpal tunnel syndrome in the same patient. We report herein a case of Dupuytren contracture with congenital camptodactyly and unilateral carpal tunnel syndrome.
    Matched MeSH terms: Carpal Tunnel Syndrome
  18. Ravindran, T., Sara, T., Loh, Y.C.
    Malays Orthop J, 2009;3(1):46-52.
    MyJurnal
    To evaluate the functional outcome of patients who underwent endoscopic carpal tunnel release (ECTR). This was a prospective study in 24 patients with idiopathic carpal tunnel syndrome undergoing ECTR. Patient assessment entailing both subjective and objective tests at intervals of two and six weeks, three, six and nine months and finally at one year postoperatively. Our assessment results showed overall improvement in symptoms. As early as two weeks post-operatively, there was a low incidence of pillar pain and scar tenderness, allowing patients to return to work early. There were no serious complications. ECTR can be effectively performed with a low perioperative and late postoperative rate of complications. This minimally invasive method can be an option of surgical treatment for patients with carpal tunnel syndrome, who intend to return to work soon after surgery.
    Matched MeSH terms: Carpal Tunnel Syndrome
  19. Nurfarah Wahidah Mohd Nor Rasid, Nurul Syafiqah Noh, Munirah Mohd Adnan, Azizah Yusoff
    MyJurnal
    Prolonged work with highly repetitious flexion and extension of the wrist and forceful grip task were shown to increase the risk of developing carpal tunnel syndrome (CTS) among dental personnel. The present study was carried out to determine the prevalence, risk factors and coping strategies of probable CTS among clinical dental support staff in Hospital Universiti Sains Malaysia (HUSM). A cross-sectional study was conducted and a set of questionnaire consisting of socio-demographic status, work-related and psychosocial risk factors and coping strategies was distributed. Ninety-five clinical dental support staff completed and returned the questionnaire with a response rate of 80.5%. The prevalence of probable CTS was 38.9%, with the highest prevalence was found among dental surgery assistants (40.5%) followed by dental technologists (29.7%). There was no significant association between work-related or psychosocial risk factors with probable CTS (p>0.05). Most of the respondents with symptoms of CTS chose religion as the coping mechanism; mean 7.11 (SD 1.13). Awareness training should be emphasized among clinical dental support staff on the prevention of CTS.

    Study site: Hospital Universiti Sains Malaysia (HUSM)
    Matched MeSH terms: Carpal Tunnel Syndrome
  20. Lee YJ, Harmony T, Jamal-Azmi IS, Gunasagaran J, Ahmad TS
    Malays Orthop J, 2021 Mar;15(1):113-118.
    PMID: 33880157 DOI: 10.5704/MOJ.2103.017
    Introduction: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes.

    Materials and methods: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain's tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire.

    Results: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain's tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population.

    Conclusion: The incidence of de Quervain's tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.

    Matched MeSH terms: Carpal Tunnel Syndrome
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