Selected BMJ topics: 11 November 2014

Clinical review
Renal cell carcinoma   –     Eric Jonasch, Jianjun Gao, and W Kimryn Rathmell

Carpal tunnel syndrome   – Scott D Middleton and Raymond E Anakwe

Measuring symptomatic relief in men with lower urinary tract symptoms

Marco H Blanker, Kenny R van Deventer, and Dick Bijl

Safety of modern treatment for cervical pre-cancer

Björn Strander and Jan Adolfsson

Dheerendra SK, Journal of Bone Joint Surgery: Measurement of Skin Capacitance

A novel method of diagnosing autonomic dysfunction in carpal tunnel syndrome by SK DheerendraWS KhanP Smitham and NJ Goddard

This article by SK Dheerendra of the Dept of Trauma and Orthopaedics  and colleagues from other Trusts was published in J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XXXVI 17


Background & Objectives Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The aim of this study is to demonstrate that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance.

Methods Patients with clinical and electrophysiological signs of idiopathic carpal tunnel syndrome meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The measurements were taken from the palmar aspect of distal phalanx of the index and little finger of the affected hand. Normal healthy patients with no signs and symptoms of carpal tunnel syndrome were recruited as controls and skin capacitance was measured in a similar fashion as the CTS group.

Results The CTS group consisted of 25 patients (18 female & 7 male) and 35 hands with an average age of 59.2 years (33-83 years). The mean symptom severity score was 2.80 (1.27-4.18; SD 0.82) and functional status score was 2.53 (1-4.26; SD 1.08). The mean ratio of skin hydration between the index and little finger was 0.85 (0.6-1.25; SD 0.155). Using the paired t-test to determine paired differences between index and little finger measurements, the mean difference was 12.6 (p<0.001).

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