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Carpal tunnel syndrome 2(CTS2)

MedGen UID:
1725962
Concept ID:
C5436916
Disease or Syndrome
Synonyms: CARPAL TUNNEL SYNDROME 2; CTS2
 
Gene (location): COMP (19p13.11)
 
Monarch Initiative: MONDO:0030883
OMIM®: 619161

Definition

Carpal tunnel syndrome-2 (CTS2) is characterized by the relatively early onset of symptoms of median nerve compression in the wrist. Patients experience pain and numbness in the thumb, index, and middle fingers, correlating with the median nerve distribution in the hand. In addition to thickening of the tendons and ligaments of the wrist, thickening of other tendons has been observed (Li et al., 2020). For a general phenotypic description and discussion of genetic heterogeneity of carpal tunnel syndrome, see CTS1 (115430). [from OMIM]

Clinical features

From HPO
Hand pain
MedGen UID:
536933
Concept ID:
C0239833
Sign or Symptom
An unpleasant sensation characterized by physical discomfort localized to the hand.
Hand paresthesia
MedGen UID:
536934
Concept ID:
C0239836
Sign or Symptom
Tingling (often referred to as a pins and needles feeling) and numbness in the hand.
Positive Phalen test
MedGen UID:
660310
Concept ID:
C0576714
Finding
The Phalen maneuver is performed by having the patient hold both wrists in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30-60 seconds. This can increase the pressure in the carpal tunnel. The test is positive (abnormal) if the patient experiences characteristic symptoms of carpal tunnel syndrome (pain and paresthesias along the distribution of the median nerve, i.e., thumb, index finger, and middle finger).
Constrictive median neuropathy
MedGen UID:
868610
Concept ID:
C4023009
Anatomical Abnormality
Injury to the median nerve caused by its entrapment at the wrist as it traverses through the carpal tunnel. Clinically, constrictive median neuropathy is characterized by pain, paresthesia, and weakness in the median nerve distribution of the hand.
Positive carpal Tinel sign
MedGen UID:
1779488
Concept ID:
C5539755
Laboratory or Test Result
The Tinel test is performed by lightly tapping (percussing) over the median nerve. It is positive (abnormal) if the patient experiences pain and paresthesias (tingling, numbness) along the distribution of the median nerve.
Thenar muscle atrophy
MedGen UID:
355274
Concept ID:
C1864715
Finding
Wasting of thenar muscles, which are located on palm of the hand at the base of the thumb.

Professional guidelines

PubMed

Hermiz SJ, Kalliainen LK
Plast Reconstr Surg 2017 Jul;140(1):120e-129e. doi: 10.1097/PRS.0000000000003477. PMID: 28654613

Recent clinical studies

Etiology

Hamzeh H, Madi M, Alghwiri AA, Hawamdeh Z
J Hand Ther 2021 Oct-Dec;34(4):521-530. Epub 2020 Jul 30 doi: 10.1016/j.jht.2020.07.005. PMID: 32893098
Keskin Y, Kilic G, Taspinar O, Posul SO, Halac G, Eren F, Erol E, Urkmez B, Aydin T
J Pak Med Assoc 2020 Feb;70(2):202-207. doi: 10.5455/JPMA.1846. PMID: 32063607
Calandruccio JH, Thompson NB
Orthop Clin North Am 2018 Apr;49(2):223-229. Epub 2018 Feb 1 doi: 10.1016/j.ocl.2017.11.009. PMID: 29499823
Giddins G
J Hand Surg Eur Vol 2014 Feb;39(2):131. doi: 10.1177/1753193413518139. PMID: 24448791
Aroori S, Spence RA
Ulster Med J 2008 Jan;77(1):6-17. PMID: 18269111Free PMC Article

Diagnosis

Dengler J, Stephens JD, Bamberger HB, Moore AM
JBJS Rev 2020 Feb;8(2):e0087. doi: 10.2106/JBJS.RVW.19.00087. PMID: 32224629
Petrover D, Richette P
Joint Bone Spine 2018 Oct;85(5):545-552. Epub 2017 Nov 16 doi: 10.1016/j.jbspin.2017.11.003. PMID: 29154980
Chammas M
Chir Main 2014 Apr;33(2):75-94. Epub 2014 Feb 15 doi: 10.1016/j.main.2013.11.010. PMID: 24646612
Peetrons PA, Derbali W
Semin Musculoskelet Radiol 2013 Feb;17(1):28-33. Epub 2013 Mar 13 doi: 10.1055/s-0033-1333911. PMID: 23487331
Aroori S, Spence RA
Ulster Med J 2008 Jan;77(1):6-17. PMID: 18269111Free PMC Article

Therapy

Currie KB, Tadisina KK, Mackinnon SE
JAMA 2022 Jun 28;327(24):2434-2445. doi: 10.1001/jama.2022.8481. PMID: 35762992
Ezzati K, Laakso EL, Saberi A, Yousefzadeh Chabok S, Nasiri E, Bakhshayesh Eghbali B
Eur J Phys Rehabil Med 2020 Dec;56(6):733-740. Epub 2019 Nov 18 doi: 10.23736/S1973-9087.19.05835-0. PMID: 31742366
Peters S, Page MJ, Coppieters MW, Ross M, Johnston V
Cochrane Database Syst Rev 2016 Feb 17;2(2):CD004158. doi: 10.1002/14651858.CD004158.pub3. PMID: 26884379Free PMC Article
Fernández-de-Las Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, Martínez-Perez A, Fahandezh-Saddi Díaz H, Martínez-Martín J, Pareja JA, Cuadrado-Pérez ML
J Pain 2015 Nov;16(11):1087-94. Epub 2015 Aug 15 doi: 10.1016/j.jpain.2015.07.012. PMID: 26281946
Page MJ, O'Connor D, Pitt V, Massy-Westropp N
Cochrane Database Syst Rev 2012 Jun 13;2012(6):CD009899. doi: 10.1002/14651858.CD009899. PMID: 22696387Free PMC Article

Prognosis

Calandruccio JH, Thompson NB
Orthop Clin North Am 2018 Apr;49(2):223-229. Epub 2018 Feb 1 doi: 10.1016/j.ocl.2017.11.009. PMID: 29499823
Petrover D, Richette P
Joint Bone Spine 2018 Oct;85(5):545-552. Epub 2017 Nov 16 doi: 10.1016/j.jbspin.2017.11.003. PMID: 29154980
Maeda Y, Kim H, Kettner N, Kim J, Cina S, Malatesta C, Gerber J, McManus C, Ong-Sutherland R, Mezzacappa P, Libby A, Mawla I, Morse LR, Kaptchuk TJ, Audette J, Napadow V
Brain 2017 Apr 1;140(4):914-927. doi: 10.1093/brain/awx015. PMID: 28334999Free PMC Article
Fernández-de-Las Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, Martínez-Perez A, Fahandezh-Saddi Díaz H, Martínez-Martín J, Pareja JA, Cuadrado-Pérez ML
J Pain 2015 Nov;16(11):1087-94. Epub 2015 Aug 15 doi: 10.1016/j.jpain.2015.07.012. PMID: 26281946
Kulick RG
Orthop Clin North Am 1996 Apr;27(2):345-54. PMID: 8614583

Clinical prediction guides

Abdolrazaghi HA, Khansari M, Mirshahi M, Ahmadi Pishkuhi M
Hand (N Y) 2023 Mar;18(2):222-229. Epub 2021 Apr 15 doi: 10.1177/15589447211006857. PMID: 33855879Free PMC Article
Gesslbauer C, Mickel M, Schuhfried O, Huber D, Keilani M, Crevenna R
Wien Klin Wochenschr 2021 Jun;133(11-12):568-577. Epub 2020 Dec 22 doi: 10.1007/s00508-020-01785-9. PMID: 33351153Free PMC Article
Hamzeh H, Madi M, Alghwiri AA, Hawamdeh Z
J Hand Ther 2021 Oct-Dec;34(4):521-530. Epub 2020 Jul 30 doi: 10.1016/j.jht.2020.07.005. PMID: 32893098
Viera AJ
Am Fam Physician 2003 Jul 15;68(2):265-72. PMID: 12892346
Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN
J Bone Joint Surg Am 1993 Nov;75(11):1585-92. doi: 10.2106/00004623-199311000-00002. PMID: 8245050

Recent systematic reviews

Karjalainen TV, Lusa V, Page MJ, O'Connor D, Massy-Westropp N, Peters SE
Cochrane Database Syst Rev 2023 Feb 27;2(2):CD010003. doi: 10.1002/14651858.CD010003.pub2. PMID: 36848651Free PMC Article
Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V
Blood Transfus 2023 Mar;21(2):119-136. Epub 2022 Oct 17 doi: 10.2450/2022.0087-22. PMID: 36346880Free PMC Article
Jiménez-Del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E, Pérez-Bellmunt A
Int Orthop 2022 Feb;46(2):301-312. Epub 2021 Dec 3 doi: 10.1007/s00264-021-05272-2. PMID: 34862562Free PMC Article
Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W
J Orthop Sports Phys Ther 2017 Sep;47(9):593-615. Epub 2017 Jul 13 doi: 10.2519/jospt.2017.7117. PMID: 28704626
Ballestero-Pérez R, Plaza-Manzano G, Urraca-Gesto A, Romo-Romo F, Atín-Arratibel MLÁ, Pecos-Martín D, Gallego-Izquierdo T, Romero-Franco N
J Manipulative Physiol Ther 2017 Jan;40(1):50-59. Epub 2016 Nov 11 doi: 10.1016/j.jmpt.2016.10.004. PMID: 27842937

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