DIABETES - The interaction between carpal tunnel syndrome and diabetes is complicated. It is generally believed that CTS is commoner in diabetic individuals, whether or not there are other diabetic nerve complications. Diabetic patients are prone to a complex of hand problems including Duputren's contracture, trigger digits and stiff fingers - sometimes termed 'diabetic hand' (See the page - The Triad ). It also appears to be the case that diabetic patients get slightly different symptoms from CTS compared to non-diabetic patients. Several studies have found that diabetic patients tend to present with more severe neurophysiological abnormalities, eg (Jenkins 2012) , so multivariate statistics are required to determine whether diabetes itself has an effect on the outcome of surgery. The existing data is contradictory and as usual many studies are small with inadequate power to do the necessary statistics. The topic has been the subject of a recent review in the Journal of Hand surgery (Brown 2011) . To illustrate the difficulty, consider the following ten papers about 8 study populations:
All of the listed physical exam findings, except for loss of small digit adduction (Wartenberg sign), has been found to be predictive for diagnosing carpal tunnel syndrome.
Szabo et al in a Level 3 study used a regression model to analyze the most predictive factors for correctly diagnosing carpal tunnel syndrome (CTS). Their analysis found that with an abnormal hand diagram, abnormal sensibility by Semmes-Weinstein testing in wrist-neutral position, a positive Durkan's test, and night pain, the probability that carpal tunnel syndrome will be correctly diagnosed is . They found the tests with the highest sensitivity were Durkan's compression test (89%), Semmes-Weinstein testing after Phalen's maneuver (83%), and hand diagram scores (76%). Night pain was a sensitive symptom predictor (96%). The most specific tests were the hand diagram (76%) and Tinel's sign (71%). The authors concluded that the addition of electrodiagnostic tests did not increase the diagnostic power of the combination of these 4 clinical tests, and proceeding with surgical release is appropriate even if the EMG is normal.
Wartenberg sign is persistent abduction and extension of the small digit when a patient is asked to adduct the digits and is seen in cubital tunnel syndrome, but not carpal tunnel syndrome.
Illustration V demonstrate the Durkan's Compression test for carpal tunnel syndrome.
Watch Linda tell her painful Carpal Tunnel Journey – how Carpal Tunnel Surgery Failed and then how she finally found “The Solution to Carpal Tunnel Syndrome.” Elijah works on a computer all day as a Freight Forwarding Specialist in New Jersey. He also loves to play Video Games when he gets home with his family and friends. Both activities contribute to Carpal Tunnel. Avid Gamers have a high incidence of Carpal Tunnel Syndrome and tend to be passionate and intense about their gaming. Watch Elijah tell his Carpal Tunnel Journey and how he finally found natural relief and was able to avoid the potential complications, long rehab and downtime of Carpal Tunnel Surgery using a natural Carpal Tunnel stretching treatment at night. Marcee is a hairstylist and owns a salon in a Suburb of Kansas City, Kansas. “The surgeon told me to schedule surgery and change my career. I have spent my life building my successful business and career around my salon and did not want to change.” I found the Carpal Solution Therapy and started feeling better quickly. Within 3 days I was 80% better. I am not changing my career. I found the Carpal Solution! Rita is a Court Reporter in New York City who over 31 years developed a bad case of Carpal Tunnel Syndrome. She works on a Stenotype machine to do short hand for recording the deposition of witnesses for important court cases. Rita had a moment of truth where she had to reduce her work on the stenotype to only 2 days a week due to hand pain, wrist pain and pain that radiated up her forearm. Debbie in Dallas runs a professional cleaning service and is very active with her hands at home doing landscaping and woodworking. “Rest is just not practical for active people.” She said. “The Carpal Solution is ideal for busy people, like me. It gave me my life back!” Anthony is a Network Engineer who spends 10 to 16 hours per day on the Computer. Anthony tells how he lost productivity at work and in remodeling his home. His hands were always cold and he was losing feeling in his finger tips. Bret Golson is guitarist and a Pastor in Northport, Alabama. He tells how Carpal Tunnel Symptoms were slowing him down and causing him to lose sleep. He was determined to avoid surgery and found the Carpal Solution. It started working the first night he used the doctor developed therapy. Learn the facts about Carpal Tunnel. Read articles written by Doctors on hand pain and Carpal Tunnel Syndrome. CTS Symptoms Read detailed articles on a variety of carpal tunnel symptoms.