Electroacupuncture for Carpal Tunnel Syndrome: A Review of Randomized Controlled Trials

The pregabalin is approved for the management of persistent pain. The aim of this study is to assess the advantages and disadvantages of the use of pregabalin in eye pain management. The PubMed, Cochrane Library, Embase, and Web of Science databases were searched until January 2022 for randomized controlled trials. Randomized, double-blinded trials comparing pregabalin with placebo in eye pain management were included. The primary outcome was visual analog scale or numerical rating scale at acute (24 hours) and chronic (≥7 days after surgery) timepoints. The secondary outcomes were analgesic medication requirements and pregabalin-related complications (nausea, vomiting, dizziness, and headache). We also compared the effect of pregabalin on dry-eye syndrome. Six relevant articles were identified that studied the use of pregabalin as pain relief for photorefractive keratectomy (n = 2), laser epithelial keratomileusis (n = 1), laser-assisted in situ keratomileusis (n = 1), eyelid surgery (n = 1), and dacryocystorhinostomy (n = 1). Pregabalin was associated with a significant reduction in pain scores (95% confidence interval = -0.41 [-0.76--0.06]) 24 hours after surgical procedures. The data were insufficient to draw conclusions regarding dry eye symptoms. Because of the high heterogeneity of outcomes regarding adverse effects, there is no conclusion regarding the safety of pregabalin in eye pain. Pregabalin reduced acute eye pain but had no significant effect on long-term analgesia after ophthalmological surgery in adults. It had no effect on dry-eye symptoms after ocular surgery. Further studies on the safety of pregabalin in eye pain management are required to draw solid conclusions.

BackgroundLow-level laser therapy (LLLT) has been found to have beneficial effects in treatment of entrapment neuropathy and various musculoskeletal conditions.ObjectivesThe aim of the study was to evaluate the efficacy of...

Carpal tunnel syndrome (CTS) is a neuropathy due to the compression of the median nerve. It is shown that gabapentin in high doses is effective in treatment of CTS patients. In this study we evaluated the efficacy of low doses of gabapentin in treatment of CTS patients. Ninety patients with CTS were randomly assigned to groups A, B and C. Gabapentin was administered to group A with dose of 100 mg/day and to group B with dose of 300 mg/day for 2 months. Group C received no treatment. Before and after treatment, patients were evaluated using Visual analogue scale (VAS) for pain and parasthesia, Boston carpal tunnel questionnaire (BCTQ) including Symptom Severity Scale (SSS) and Functional Status Scale (FSS) to evaluate the efficacy of the treatment. The pinch and grip strength was also measured. There was significant improvement in VAS, grip strength, pinch strength, SSS, FSS and BCTQ score in all three groups (p < 0.05), but the changes in CMAP and SNAP was not significant. Groups A and B in comparison to group C had significantly better improvement in VAS, pinch strength, SSS, FSS and BCTQ total score (p < 0.05). There was significantly more improvement in pinch strength and SSS score in group B compared to group A (p < 0.05). Gabapentin in low doses is a useful drug in treatment of CTS symptoms with no side effects and intolerance. Gabapentin with dose of 300 mg/day is more effective than the dose of 100 mg/day.

The aim of this study was to compare the efficacy of ultrasound (US) and ketoprofen phonophoresis (PH) in the treatment of carpal tunnel syndrome (CTS). This study was a prospective, randomised, controlled, double-blinded clinical trial with follow-up at 8 weeks. Fiftyone patients (76 median nerves) with clinical and electrophysiologic evidence of mild or moderate CTS were included in the study. They were randomly assigned to one of three groups; group 1 received sham US and splinting, group 2 received US and splinting, and group 3 received ketoprofen phonophoresis and splinting. Patients were evaluated by use of electrophysiological variables such as median motor distal latency (mMDL), median sensory distal latency (mSDL), functional status scale (FSS), symptom severity scale (SSS) and visual analog scale (VAS). Electrophysiological variables and scales were evaluated at the beginning, end of therapy (2nd week) and 8th week. All the randomised patients were included in the intention-to-treat (ITT) analysis. The per protocol (PP) analysis included only those patients who complied with the study protocol. After completing 2 weeks of treatment, seven out of 51 randomized patients did not finish the study protocol due to non-compliance to splinting, illness and lost to follow-up. Those patients were excluded from PP analysis. Participants were similar in all clinical, electrophysiological and demographic respects (p>0.05). An improvement was found in all parameters (VAS, FSS, SSS, mMDL and mSDL) for all groups at the end of the treatment and 8th week. It was found that pain score was significantly lower in group 3 compared to other treatment groups at 8th week according to ITT and PP analysis (p= 0.002, p=0.004 and p=0.001, p=0.001). Ketoprofen PH as adjuvant therapy on splinting is effective with respect to reduction of pain. Adding US therapy to the splinting is not superior to the splinting alone in patients with CTS.

This study evaluated the applicability of diffusion tensor imaging (DTI) of therapeutic ultrasound (US) and wrist splints in addition to clinical and electrophysiological assessments of patients with carpal tunnel syndrome (CTS). This prospective study analyzed 41 patients (30 women, 11 men; 56 wrists) with CTS. Therapeutic US and wrist splints were performed for 3 and 4 weeks, respectively. Fractional anisotropy and the apparent diffusion coefficient (ADC) were evaluated in addition to a visual analog scale (VAS), symptom severity scale (SSS), functional status scale (FSS), and electrodiagnostic studies (EDX) before and after treatment. There were significant decreases in the mean ADC, VAS, SSS, FSS, and EDX after treatment. This study suggests that DTI parameters provide helpful information that complements clinical and electrophysiological assessments for evaluating the efficacy of nonsurgical treatment of patients with CTS.

Abstract&#x0D; &#x0D; Background: Carpal tunnel syndrome occurs when median nerve is entrapped or compressed causing paresthesia and sometimes pain in patients’ hands, this can result in functional impairments and disability. Objective: To evaluate the level of functional impairment using symptom severity and functional status scales in participants with this syndrome. Methods: An observational study was conducted on 150 patients with carpal tunnel syndrome by using non-probability purposive sampling and collecting data from various private and government hospitals of Lahore in six months from October 2020 to March 2020. The level of functional impairments was evaluated by using functional status and symptom severity scale. Results: Findings showed that 62% were females and 38% were males. According to Boston carpal tunnel questionnaire score most of the patients had moderate symptoms (39.3%) with the mean of 2.97 and mild functional limitations (42%) with the mean of 2.34. Conclusion: It was concluded that mild and moderate mean values were found by using functional status and symptoms severity scale respectively. There is existence of correlation between symptom and functional severity scales among patients with this syndrome.&#x0D; *Corresponding author: Ramsha Zafar, Sharif Trust Hospital, Lahore, Pakistan; Email: ranahamzanadeem127@gmail.com&#x0D; Citation: Zafar R. 2021. Level of functional impairment in patients with carpal tunnel syndrome using functional status and symptom severity scales. The healer Journal of Physiotherapy and Rehabilitation Sciences, 1(2):58-62.

The aim of this study was to compare the efficacy of local corticosteroid injection with iontophoresis of corticosteroids in the treatment of carpal tunnel syndrome. This study was a prospective, randomized, unblinded clinical trial with follow-up at 2 and 8 wks. Thirty patients (48 median nerves) with clinical and electrophysiologic evidence of carpal tunnel syndrome were included in the study. Patients were evaluated by use of clinical variables, a functional status scale, a symptom severity scale, and visual analog scale. A total of 48 median nerves were randomly assigned to one of two groups; group 1 received 40 mg of methylprednisolone acetate injected locally in the carpal tunnel, and group 2 received iontophoresis of dexamethasone sodium phosphate. Clinical variables and scales were evaluated at regular intervals: at the beginning and at the end of therapy in the second and eighth week. Twenty-seven patients (90%) were women and three patients (10%) were men. The mean age of patients was 48.0 +/- 8.2 (range, 29-61) yrs. There was a statistically significant improvement in the clinical examination variables, visual analog scale, symptom severity scale, and functional status scale scores of the patients in both of the treatment groups posttreatment (at 2 and 8 wks) compared with baseline (P < 0.05). However, there was a statistically significant difference between the values of the two group. A significant difference in mean symptom severity scale, functional status scale, and visual analog scale scores was found in second week and eighth week in the injection group compared with iontophoresis. Our study comparing a standardized treatment protocol for incorporating local corticosteroid injection and iontophoresis of dexamethasone sodium phosphate in carpal tunnel syndrome revealed success of both iontophoresis of dexamethasone sodium phosphate and injection of corticosteroids, but symptom relief was greater at 2 and 8 wks with injection of corticosteroids.

Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome.

Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of CTS in comparison with placebo or sham acupuncture. It is uncertain whether acupuncture and related interventions are more or less effective in relieving symptoms of CTS than corticosteroid nerve blocks, oral corticosteroids, vitamin B₁₂, ibuprofen, splints, or when added to NSAIDs plus vitamins, as the certainty of any conclusions from the evidence is low or very low and most evidence is short term. The included studies covered diverse interventions, had diverse designs, limited ethnic diversity, and clinical heterogeneity. High-quality randomised controlled trials (RCTs) are necessary to rigorously assess the effects of acupuncture and related interventions upon symptoms of CTS. Based on moderate to very-low certainty evidence, acupuncture was associated with no serious adverse events, or reported discomfort, pain, local paraesthesia and temporary skin bruises, but not all studies provided adverse event data.

Efficacy of a Fabricated Customized Splint and Tendon and Nerve Gliding Exercises for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial

Outcomes of bilateral carpal tunnel syndrome treatment – A systematic review and meta-analysis

Background:Generally, conservative interventions including physiotherapy modalities and manual therapy have been recommended in the management of carpal tunnel syndrome (CTS), but this subject has not been studied in diabetic patients with CTS. Therefore the aim of this study was to investigate the effects of manual therapy on diabetic patients with CTS.Methods:Thirty diabetic patients with CTS were randomly divided into two equal groups: modality group and manual therapy group. Participants in the modality group received transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) and patients in the manual therapy group received manual techniques for the median nerve and its surrounding structures. Interventions were applied 3 times weekly for 4 weeks in both groups. Visual analogue scale (VAS), symptom severity scale (SSS), functional status scale (FSS) and median neurodynamic test (MNT) were evaluated before and after the interventions in both groups. Paired t-test and independent t-test were used for statistical analysis.Results:Paired t-test revealed that all of the outcome measures had a significant change in the manual therapy group, whereas only the VAS and SSS changed significantly in the modality group at the end of 4 weeks. Independent t-test showed that the variables of SSS, FSS and MNT in the manual therapy group improved significantly greater than the modality group.Conclusions:Manual therapy techniques applied to mechanical interface of the median nerve and nerve mobilization possess more appropriate and valuable effects on hand difficulties than modalities in diabetic patients with CTS.

Purpose: Carpal tunnel syndrome (CTS) is a common form of median nerve compression in the wrist caused by focal peripheral neuropathy. Platelet-rich plasma (PRP) therapy could improve the healing ability by exposing the injured tissues to high concentrations of autologous growth factors. Our study aims to compare all injective treatments for CTS and assess the efficacy and priority of PRP therapy.Methods: We searched Medline, Embase, Web of Science, Cochrane databases, and Clinicaltrial.gov until 17 October 2022. We only included data from randomized controlled trials (RCTs) that evaluated PRP injection therapy or drug injection therapy. The included RCTs measured at least one of the following three outcomes with validated instruments: in the visual analog scale (VAS), symptom severity scale (SSS), and functional status scale (FSS).Results: Overall, 19 studies with 1,066 patients were included in this study. We used the SUCRA rankings to determine the merits of various therapies. In all, 5% dextrose injections were the best treatment strategy for the VAS (MD −1.22, 95% CI −2.66 to 0.23; SUCRA = 79.2%), followed by triamcinolone (high-dose) injections (MD −0.69, 95% CI −2.11 to 0.73; SUCRA = 62.7%) and PRP injections (MD −0.39, 95% CI −1.67 to 0.89; SUCRA = 60.0%). In the SSS, the most effective intervention was hydroxyprogesterone injections (MD −0.62, 95% CI −1.09 to −0.16; SUCRA = 91.0%). The SUCRA ranking of PRP was second only to steroids and estrogen (MD −0.39, 95% CI −0.60 to −0.18; SUCRA = 60.8%). In the FSS, the best regimen strategy was hydroxyprogesterone injections (MD 0.12, 95% CI −0.30 to 0.54; SUCRA = 99.5%), followed by triamcinolone (low-dose) injections (MD −0.02, 95% CI −0.54 to 0.49; SUCRA = 87.4%) and PRP injections (MD −0.26, 95% CI −0.43 to −0.09; SUCRA = 77.1%).Conclusion: PRP is an alternative choice for CTS treatment. PRP injection is second only to steroids and estrogen in the treatment efficacy of CTS, with a wide indication and safe outcome.

Objective: To synthesize evidence on the effectiveness of acupuncture and related therapies for primary carpal tunnel syndrome (CTS) by conducting a systematic review of randomized controlled trials (RCTs). Data Sources: Nine databases were searched for potential RCTs from their inception till July 2019. Review Methods: RCTs which reported at least one of the three outcomes were included: symptom severity, functional status and pain. Included RCTs were appraised using the Cochrane Risk of Bias Tool. Results: A total of 10 RCTs (728 participants) were included. Majority were at high risk of bias for blinding of participants, personnel and outcome assessors. When compared to conventional medications, manual acupuncture showed significant superior effect in reducing symptom than ibuprofen (mean difference (MD) on Symptom Severity Scale (SSS)) = –5.80, 95% confidence interval (CI): −7.95 to −3.65) and prednisolone (MD = −6.50, 95% CI: −10.1, −2.86). Electroacupuncture plus splinting was more effective in reducing symptom severity than splinting alone (SSS score: MD = −0.20, 95% CI: −0.36 to −0.03). Manual acupuncture showed significantly superior effect than ibuprofen in improving functional status (Functional Status Scale (FSS): MD = −1.84, 95% CI: −2.66 to −1.02). The combination of electroacupuncture and splinting showed more improvement in functional status compared to splinting alone (FSS: MD = −6.22, 95%CI: −10.7 to −1.71). Triple treatment of acupuncture, magnetic spectrum heat lamp and splinting showed stronger pain relief than splinting alone. Conclusion: For both symptom relief and function improvement, manual acupuncture is superior to ibuprofen while electroacupuncture plus splinting outperforms splinting alone. Limited evidence showed electroacupuncture’s potential role in pain reduction.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. METHODS Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. RESULTS A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). CONCLUSION Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.