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Neurology230 papers

Carpal tunnel syndrome

Last edited: 4/16/2026

Overview

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy characterized by compression of the median nerve at the wrist, leading to symptoms such as pain, numbness, tingling, and weakness in the hand and fingers 121.

Diagnosis

  • Clinical History and Physical Examination: Key symptoms include nocturnal symptoms, weakness, and sensory deficits in the median nerve distribution 121.
  • Provocative Maneuvers: Phalen's test and Tinel's sign are commonly used but have variable diagnostic accuracy 8.
  • Electrodiagnostic Studies: Nerve conduction studies (NCS) are considered the gold standard for confirming CTS, assessing median nerve conduction velocity and distal latency 122.
  • Imaging: Ultrasound can be useful for identifying anatomical variations and space-occupying lesions contributing to CTS 536.
  • Management

  • First-Line Treatments:
  • - Non-Surgical: Wrist splinting, particularly nighttime use, and corticosteroid injections can provide symptomatic relief 12. - Physical Therapy: Neuromobilization exercises and manual therapy may improve symptoms and function 710.
  • Adjunctive Treatments:
  • - Ultrasound-Guided Procedures: Nerve hydrodissection shows promise as a non-surgical intervention 3. - Alternative Therapies: Limited evidence supports the use of vitamin D supplementation in certain cases 14.
  • Surgical Interventions:
  • - Endoscopic vs Open Release: Both methods are effective, with endoscopic techniques potentially offering quicker recovery 155362. - Indications for Surgery: Consider surgery for persistent symptoms despite conservative management, significant motor deficits, or refractory pain 1.

    Special Populations

  • Pregnancy: CTS symptoms often improve postpartum, but conservative management is typically recommended during pregnancy 21.
  • Pediatrics: CTS in children is rare but can occur, often associated with anatomical variations or repetitive trauma 6676.
  • Elderly: Older adults may have slower recovery post-surgery and may benefit from tailored rehabilitation programs 1.
  • Comorbidities: Obesity is associated with slower sensory conduction velocity, potentially increasing CTS risk 77.
  • Key Recommendations

  • Use Electrodiagnostic Studies for Confirmation: Nerve conduction studies are essential for diagnosing CTS (Evidence: Strong 122).
  • Initiate Conservative Management First: Wrist splinting and corticosteroid injections are recommended initial treatments (Evidence: Moderate 12).
  • Consider Surgery for Persistent Symptoms: Surgical release is advised for patients with persistent symptoms despite conservative therapy (Evidence: Moderate 1).
  • Monitor and Manage Comorbid Factors: Address comorbidities like obesity that may influence CTS progression and recovery (Evidence: Moderate 77).
  • Utilize Ultrasound for Anatomical Assessment: Ultrasound can help identify anatomical causes contributing to CTS (Evidence: Moderate 536).
  • References

    1 Shapiro LM, Kamal RN. American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome. The Journal of the American Academy of Orthopaedic Surgeons 2025. link 2 Chen Y, Han B, Zhang X, Guo C, Han Q, Zhang Z et al.. Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis. Archives of physical medicine and rehabilitation 2025. link 3 Lee K, Park JM, Yoon SY, Kim MS, Kim YW, Shin JI et al.. Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis. Yonsei medical journal 2025. link 4 Aagaard TH, Biering K, Vestergaard JM, Willert MV, Kyndi M. Work Participation in Patients With Carpal Tunnel Syndrome Referred to Departments of Occupational Medicine-A Danish Register-Based Cohort Study. American journal of industrial medicine 2025. link 5 Leinfelder S, Nacey NC. Thrombosed persistent median artery in a medical sonographer. Medical ultrasonography 2025. link 6 Hines EM, Roberts CJ, Frahm-Jensen G. Acute carpal tunnel syndrome from thrombosed persistent median artery in a patient with congenitally absent radial artery. Vascular 2024. link 7 Paraskevopoulos E, Karanasios S, Gioftsos G, Tatsios P, Koumantakis G, Papandreou M. The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis. Physiotherapy theory and practice 2023. link 8 Dabbagh A, MacDermid JC, Yong J, Packham TL, Grewal R, Boutsikari EC. Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. Physical therapy 2023. link 9 Liu J, Gu F, Liu Q, Chen W, Ying Q, Xu Y et al.. Comparative study of trimming and resection of diseased finger superficial flexor tendons in gouty carpal tunnel syndrome. BMC musculoskeletal disorders 2023. link 10 Jiménez-Del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E et al.. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. International orthopaedics 2022. link 11 Sheridan J, Waslewski G, Sheridan D. Surgical Excision of a Thrombosed Persistent Median Artery in a Professional Hockey Player. The Journal of hand surgery 2022. link 12 Sadek M, Pergamo M, Almeida JI, Jacobowitz GR, Kabnick LS. An algorithm combining VVSYmQ® and VCSS scores may help to predict disease severity in C2 patients. Phlebology 2021. link 13 Joseph AE, Leiby BM, Beckman JP. Clinical Results of Ultrasound-Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2020. link 14 Saçmaci H, Tanik N, Balbaloğlu Ö, Aktürk T, Inan LE. Electrophysiological evaluation of carpal tunnel syndrome female patients after vitamin D replacement. Arquivos de neuro-psiquiatria 2020. link 15 Tulipan JE, Kim N, Ilyas AM, Matzon JL. Endoscopic Carpal Tunnel Release with and without Sedation. Plastic and reconstructive surgery 2018. link 16 Wong YS, Ong CT, Hsieh YY, Hung TW, Guo HR. Carpal tunnel syndrome after an electrical injury: a case report and review of literature. Journal of occupational health 2018. link 17 Werner BC, Teran VA, Deal DN. Patient-Related Risk Factors for Infection Following Open Carpal Tunnel Release: An Analysis of Over 450,000 Medicare Patients. The Journal of hand surgery 2018. link 18 Aouatef M, Asma B, Hajer H, Charfeddine A, Lamia B, Taoufik K. Work-related carpal tunnel syndrome treatment: a cross-sectional study among 106 patients. Reumatismo 2017. link 19 Chiang CL, Liao CY, Kuo HW. Postures of upper extremity correlated with carpal tunnel syndrome (CTS). International journal of occupational medicine and environmental health 2017. link 20 . Carpal Tunnel Syndrome: Physical Therapy or Surgery?. The Journal of orthopaedic and sports physical therapy 2017. link 21 Franklin GM, Friedman AS. Work-Related Carpal Tunnel Syndrome: Diagnosis and Treatment Guideline. Physical medicine and rehabilitation clinics of North America 2015. link 22 Thiese MS, Gerr F, Hegmann KT, Harris-Adamson C, Dale AM, Evanoff B et al.. Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Archives of physical medicine and rehabilitation 2014. link 23 Pearce L. Operation in hand. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2013. link 24 Oyola S, Jones K, Rao G. PURLs: Suspect carpal tunnel? Try this. The Journal of family practice 2013. link 25 Chen CH, Wu T, Sun JS, Lin WH, Chen CY. Unusual causes of carpal tunnel syndrome: space occupying lesions. The Journal of hand surgery, European volume 2012. link 26 Russo GS, Olson RL, Varthi A, Patel N, Leger R, Rodner CM. Physical examination and radiographic interpretation of carpal anatomy in orthopedic residents and emergency medicine physicians. American journal of orthopedics (Belle Mead, N.J.) 2012. link 27 Morizaki Y, Zhao C, van Doesburg MH, Zhao K, An KN, Amadio PC. The gliding characteristics of the flexor pollicis longus tendon in the carpal tunnel: potential implications for manual pipette users. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2012. link 28 Hartmann P, Mohokum M, Schlattmann P. The association of Raynaud's syndrome with carpal tunnel syndrome: a meta-analysis. Rheumatology international 2012. link 29 Nuckols T, Harber P, Sandin K, Benner D, Weng H, Shaw R et al.. Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings. Journal of occupational rehabilitation 2011. link 30 Cobb TK. Endoscopic cubital tunnel release. The Journal of hand surgery 2010. link 31 Kang HJ, Jung SH, Yoon HK, Hahn SB, Kim SJ. Carpal tunnel syndrome caused by space occupying lesions. Yonsei medical journal 2009. link 32 Newey M, Clarke M. Getting patients back to work after carpal tunnel surgery. Journal of perioperative practice 2008. link 33 Cherniack M, Brammer AJ, Lundstrom R, Morse TF, Neely G, Nilsson T et al.. Syndromes from segmental vibration and nerve entrapment: observations on case definitions for carpal tunnel syndrome. International archives of occupational and environmental health 2008. link 34 Bland JD. Use of screening blood tests in patients with carpal tunnel syndrome. Journal of neurology, neurosurgery, and psychiatry 2007. link 35 Wu WC. Endoscope damaged during endoscopic carpal tunnel release--the solution method. Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand 2007. link 36 Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo JC, Erausquin C. What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?. Clinical and experimental rheumatology 2007. link 37 Bugajska J, Jedryka-Góral A, Sudoł-Szopińska I, Tomczykiewicz K. Carpal tunnel syndrome in occupational medicine practice. International journal of occupational safety and ergonomics : JOSE 2007. link 38 Breuer B, Sperber K, Wallenstein S, Kiprovski K, Calapa A, Snow B et al.. Clinically significant placebo analgesic response in a pilot trial of botulinum B in patients with hand pain and carpal tunnel syndrome. Pain medicine (Malden, Mass.) 2006. link 39 Derebery J. Work-related carpal tunnel syndrome: the facts and the myths. Clinics in occupational and environmental medicine 2006. link 40 Katz RT. NC-stat as a screening tool for carpal tunnel syndrome in industrial workers. Journal of occupational and environmental medicine 2006. link 41 Aslam N, Spiteri V, McNab I. Ulnar tunnel syndrome due to anatomical variant of the ulnar artery. Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand 2005. link 42 Jayasekera N, Akhtar N, Compson JP. Physical examination of the carpal bones by orthopaedic and accident and emergency surgeons. Journal of hand surgery (Edinburgh, Scotland) 2005. link 43 Mandal A, Colville J, Jones M, Erdmann MW. An unusual case of haemorrhagic median neuropathy. Annals of the Royal College of Surgeons of England 2004. link 44 Papanastasiou S, Sood M. Aberrant position of the ulnar nerve within the carpal canal. Microsurgery 2004. link 45 Dalal S, Bostock SH. Carpal tunnel syndrome presenting as a non-healing ulcer. Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand 2004. link 46 Zakaria D. Rates of carpal tunnel syndrome, epicondylitis, and rotator cuff claims in Ontario workers during 1997. Chronic diseases in Canada 2004. link 47 Zieren J, Agnes A, Müller JM. Isolated dislocation of the hamate bone. Case report and review of the literature. Archives of orthopaedic and trauma surgery 2000. link 48 Lascar T, Laulan J. Cubital tunnel syndrome: a retrospective review of 53 anterior subcutaneous transpositions. Journal of hand surgery (Edinburgh, Scotland) 2000. link 49 De Smet L, Fabry G. Carpal tunnel syndrome: familial occurrence presenting in childhood. Journal of pediatric orthopedics. Part B 1999. link 50 Mirza MA, King ET, Reinhart MK. Carpal tunnel syndrome associated with macrodactyly. Journal of hand surgery (Edinburgh, Scotland) 1998. link80012-0) 51 Dheansa BS, Belcher HJ. Median nerve contusion during endoscopic carpal tunnel release. Journal of hand surgery (Edinburgh, Scotland) 1998. link80237-4) 52 Pal B, Morris J, Keenan J, Mangion P. Management of idiopathic carpal tunnel syndrome (ICTS): a survey of rheumatologists' practice and proposed guidelines. British journal of rheumatology 1997. link 53 Chow JC. Endoscopic carpal tunnel release. Clinics in sports medicine 1996. link 54 Einhorn N, Leddy JP. Pitfalls of endoscopic carpal tunnel release. The Orthopedic clinics of North America 1996. link 55 Fischer TJ, Hastings H. Endoscopic carpal tunnel release. Chow technique. Hand clinics 1996. link 56 Ruch DS, Poehling GG. Endoscopic carpal tunnel release. The Agee technique. Hand clinics 1996. link 57 Kuschner SH. Cubital tunnel syndrome. Treatment by medial epicondylectomy. Hand clinics 1996. link 58 Lee WP, Plancher KD, Strickland JW. Carpal tunnel release with a small palmar incision. Hand clinics 1996. link 59 Amadio PC. The first carpal tunnel release?. Journal of hand surgery (Edinburgh, Scotland) 1995. link80013-0) 60 Sellers DS. Endoscopic carpal tunnel release. Clinics in plastic surgery 1995. link 61 Murray DP, Saccone PG, Rayan GM. Complications after subfascial carpal tunnel release. Southern medical journal 1994. link 62 McDonough JW, Gruenloh TJ. A comparison of endoscopic and open carpal tunnel release. Wisconsin medical journal 1993. link 63 Wilson KM. Distal forearm regional block anesthesia for carpal tunnel release. The Journal of hand surgery 1993. link90087-J) 64 Nakamichi K, Tachibana S. Ultrasonography in the diagnosis of carpal tunnel syndrome caused by an occult ganglion. Journal of hand surgery (Edinburgh, Scotland) 1993. link90099-2) 65 Sharara KH, Farrar M. Isolated dislocation of the pisiform bone. Journal of hand surgery (Edinburgh, Scotland) 1993. link90108-r) 66 Eglseder WA. Carpal tunnel syndrome associated with histoplasmosis: a case report and literature review. Military medicine 1992. link 67 Nathan PA, Keniston RC, Myers LD, Meadows KD. Obesity as a risk factor for slowing of sensory conduction of the median nerve in industry. A cross-sectional and longitudinal study involving 429 workers. Journal of occupational medicine. : official publication of the Industrial Medical Association 1992. link 68 Foucher G, Malizos C, Sammut D, Braun FM, Michon J. Primary palmaris longus transfer as an opponensplasty in carpal tunnel release. A series of 73 cases. Journal of hand surgery (Edinburgh, Scotland) 1991. link90128-b) 69 al-Qattan MM, Husband JB. Median nerve compression by the supracondylar process: a case report. Journal of hand surgery (Edinburgh, Scotland) 1991. link90142-b) 70 Edwards KS. Square wrists and carpal tunnel syndrome. Ohio medicine : journal of the Ohio State Medical Association 1990. link 71 Cobb J. Volar wrist ganglia cured by carpal tunnel decompression. Journal of hand surgery (Edinburgh, Scotland) 1990. link 72 Katz JN, Stirrat CR, Larson MG, Fossel AH, Eaton HM, Liang MH. A self-administered hand symptom diagram for the diagnosis and epidemiologic study of carpal tunnel syndrome. The Journal of rheumatology 1990. link 73 Molitor PJ. A diagnostic test for carpal tunnel syndrome using ultrasound. Journal of hand surgery (Edinburgh, Scotland) 1988. link 74 Jessurun W, Hillen B, Huffstadt AJ. Carpal tunnel release; postoperative care. Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V... 1988. link 75 Amadio PC. Bifid median nerve with a double compartment within the transverse carpal canal. The Journal of hand surgery 1987. link80005-9) 76 Gibson CT, Manske PR. Carpal tunnel syndrome in the adolescent. The Journal of hand surgery 1987. link80289-7) 77 Schlafly B, Lister G. Median nerve compression secondary to bifid reversed palmaris longus. The Journal of hand surgery 1987. link80007-2) 78 Wulle C. Treatment of recurrence of the carpal tunnel syndrome. Annales de chirurgie de la main : organe officiel des societes de chirurgie de la main 1987. link80059-5) 79 Fodor J, Malott JC, Merhar GL. Carpal tunnel syndrome: the role of radiography. Radiologic technology 1987. link 80 Vanwijck R, Bouillenne C. HL-A and carpal tunnel syndrome. Clinical rheumatology 1986. link 81 Rayan GM. Persistent median artery and compression neuropathy. Orthopaedic review 1986. link 82 Ametewee K, Harris A, Samuel M. Acute carpal tunnel syndrome produced by anomalous flexor digitorum superficialis indicis muscle. Journal of hand surgery (Edinburgh, Scotland) 1985. link80025-5) 83 Böstman OM, Bakalim GE. Carpal tunnel syndrome in a melorheostotic limb. Journal of hand surgery (Edinburgh, Scotland) 1985. link80031-0) 84 Dieck GS, Kelsey JL. An epidemiologic study of the carpal tunnel syndrome in an adult female population. Preventive medicine 1985. link90021-0) 85 Minami M, Yamazaki J, Ishii S. Isolated dislocation of the pisiform: a case report and review of the literature. The Journal of hand surgery 1984. link80200-2) 86 Rossi E, Sighinolfi E, Bortolotti P, De Santis G, Schoenhuber R, Grandi M et al.. Nocturnal prolactin secretion in carpal tunnel syndrome. Italian journal of neurological sciences 1984. link 87 Howie CR, Buxton R. Acute carpal tunnel syndrome due to spontaneous haemorrhage. Journal of hand surgery (Edinburgh, Scotland) 1984. link 88 Frontera WR. Cyclist's palsy: clinical and electrodiagnostic findings. British journal of sports medicine 1983. link 89 Gessini L, Jandolo B, Pietrangeli A, Senese A. Compression of the palmar cutaneous nerve by ganglions of the wrist. Journal of neurosurgical sciences 1983. link 90 Carroll RE, Hurst LC. The relationship of thoracic outlet syndrome and carpal tunnel syndrome. Clinical orthopaedics and related research 1982. link 91 Hutton P, Kernohan J, Birch R. An anomalous flexor digitorum superficialis indicis muscle presenting as carpal tunnel syndrome. The Hand 1981. link80037-x) 92 Lavey EB, Pearl RM. Patent median artery as a cause of carpal tunnel syndrome. Annals of plastic surgery 1981. link 93 Shenoy KT, Saha PK, Ravindran M. Carpal tunnel syndrome: an unusual presentation of brachial hypertrophy. Journal of neurology, neurosurgery, and psychiatry 1980. link 94 Pritsch M, Engel J, Horowitz A. Cystic change in the wrist, causing carpal tunnel syndrome. Plastic and reconstructive surgery 1980. link 95 Nather A, Chacha PB, Lim P. Acute carpal tunnel syndrome secondary to thrombosis of a persistent median artery (with high division of the median nerve). A case report. Annals of the Academy of Medicine, Singapore 1980. link 96 Chopra JS, Khanna SK, Murthy JM. Congenital arteriovenous fistula producing carpal tunnel syndrome. Journal of neurology, neurosurgery, and psychiatry 1979. link 97 Werschkul JD. Anomalous course of the recurrent motor branch of the median nerve in a patient with carpal tunnel syndrome. Journal of neurosurgery 1977. link 98 Das SK, Brown HG. In search of complications in carpal tunnel decompression. The Hand 1976. link90009-7) 99 Jones D. The Fisk splint--description and assembly. Injury 1975. link90187-4) 100 Posch JL, Prpic I. Surgical treatment of the carpal tunnel syndrome. Handchirurgie 1975. link

    Original source

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      American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome.Shapiro LM, Kamal RN The Journal of the American Academy of Orthopaedic Surgeons (2025)
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      Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis.Chen Y, Han B, Zhang X, Guo C, Han Q, Zhang Z et al. Archives of physical medicine and rehabilitation (2025)
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      Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis.Lee K, Park JM, Yoon SY, Kim MS, Kim YW, Shin JI et al. Yonsei medical journal (2025)
    4. [4]
      Work Participation in Patients With Carpal Tunnel Syndrome Referred to Departments of Occupational Medicine-A Danish Register-Based Cohort Study.Aagaard TH, Biering K, Vestergaard JM, Willert MV, Kyndi M American journal of industrial medicine (2025)
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      Thrombosed persistent median artery in a medical sonographer.Leinfelder S, Nacey NC Medical ultrasonography (2025)
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      The effectiveness of neuromobilization exercises in carpal tunnel syndrome: Systematic review and meta-analysis.Paraskevopoulos E, Karanasios S, Gioftsos G, Tatsios P, Koumantakis G, Papandreou M Physiotherapy theory and practice (2023)
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      Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.Dabbagh A, MacDermid JC, Yong J, Packham TL, Grewal R, Boutsikari EC Physical therapy (2023)
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      Comparative study of trimming and resection of diseased finger superficial flexor tendons in gouty carpal tunnel syndrome.Liu J, Gu F, Liu Q, Chen W, Ying Q, Xu Y et al. BMC musculoskeletal disorders (2023)
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      The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis.Jiménez-Del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E et al. International orthopaedics (2022)
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      Electrophysiological evaluation of carpal tunnel syndrome female patients after vitamin D replacement.Saçmaci H, Tanik N, Balbaloğlu Ö, Aktürk T, Inan LE Arquivos de neuro-psiquiatria (2020)
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      Physical examination and radiographic interpretation of carpal anatomy in orthopedic residents and emergency medicine physicians.Russo GS, Olson RL, Varthi A, Patel N, Leger R, Rodner CM American journal of orthopedics (Belle Mead, N.J.) (2012)
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