Boston Carpal Tunnel Questionnaire Research Articles

SUTURE CHOICE IN CARPAL TUNNEL SURGERY: A RANDOMIZED CONTROLLED TRIAL

ObjectiveCarpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design.MethodsEighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695.ResultsStatistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice.ConclusionInsights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed.

Relationship between median nerve vascularization before tourniquet release and the Boston Carpal Tunnel Questionnaire: a cohort study.

The results of this study suggest that a decreased vascularization of the median nerve after releasing the carpal tunnel predicts an inferior clinical improvement assessed by the Boston Carpal Tunnel Questionnaire.

Skin closUre in carPal tunnEl Release (SUPER): protocol for a blinded randomised controlled trial comparing absorbable and non-absorbable sutures in carpal tunnel release

IntroductionCarpal tunnel syndrome is a common disorder affecting a substantial portion of the general population. Surgical intervention is often deemed necessary, with the median nerve release being one of the...

Effectiveness of manual therapy to the Cervical Spine on clinical outcomes and electrodiagnostic tests in people with carpal tunnel syndrome: A randomized controlled trial

ObjectiveTo determine if cervical spine manual therapy (CMT) plus conventional physical therapy (PT) optimizes clinical objective and self-reported outcomes, compared to PT alone, in people with carpal tunnel syndrome (CTS). MethodForty-eight patients with the diagnosis of CTS were randomly divided into conventional PT (control group) and conventional PT plus cervical spine manual therapy (intervention group). All patients received 10 sessions of supervised conventional physical therapy (wrist splint, electrotherapy and wrist joint mobilization). Patients in the cervical spine manual therapy group also had manual therapies techniques given to their neck. Visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, median nerve motor distal latency (mMDL), and median sensory nerve conduction velocity (mSNCV) were assessed at three points: baseline, post-intervention, and six months later. ResultsThe cervical spine manual therapy group showed significantly greater improvement in VAS, DASH score, mMDL, and mSNCV in post-intervention and follow-up compared to the conventional group. There was no significant difference in two subscales of BCTQ at post-intervention for two groups, whereas these two subscales showed a significant difference in favor of the cervical manual therapy group at follow-up. ConclusionThe analysis of results showed that conventional CMT combined with PT could be more effective in improving the clinical outcomes and electrodiagnostic findings of patients with CTS compared to conventional PT only in the long term. Therefore, it can be suggested as a proper therapeutic method in CTS.

Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance in Over 100 Patients at Two to Six Years

PurposeThe purpose of this study was to determine the clinical results of carpal tunnel release using ultrasound guidance (CTR-US) at a minimum of 2 years post-procedure. MethodsThe study consisted of 102 patients (162 hands) treated with CTR-US by the same physician between June 2017 and October 2020 for whom minimum 2-year follow-up data were available. Questionnaires were sent to gather long-term information, with additional phone calls for clarification if needed. Outcomes included Boston Carpal Tunnel Questionnaire symptom severity (BCTQ-SSS) and functional status (BCTQ-FSS) scores, Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, global satisfaction scores, and subsequent surgeries. ResultsThe 102 patients included 68 females and 34 males with a mean age of 56.9 years at the time of surgery. Fifty-five (53.9%) patients had simultaneous bilateral procedures, 42 (41.2%) had unilateral procedures, and 5 (4.9%) had staged bilateral procedures. Significant improvements in BCTQ-SSS, BCTQ-FSS, and QDASH scores persisted at a mean final follow-up of 46 months (range 2-6 years). At final follow-up, 91.2% of patients reported satisfaction with the procedure. No outcomes were significantly different between those treated with simultaneous bilateral versus unilateral procedures. No revision surgeries were reported. ConclusionsCTR-US is a safe and effective procedure that results in significant improvements that persist up to 6 years post-procedure. Long-term results of simultaneous bilateral and unilateral procedures are similar. Level of EvidenceIV therapeutic

Comparison between Work Related Musculoskeletal Wrist Pain and Carpal Tunnel Syndrome among Students of Figurative Painting and Calligraphy

O b j e c t i v e : To compare painting related variables for carpal tunnel syndrome (CTS) and musculoskeletal wrist pain among students of calligraphy and figurative painting. M e t h o d o l o g y : A comparative cross-sectional study was conducted on 212 participants from 21 January to 25 May 2023. The data was collected from the fine arts departments of public and private universities in Sialkot, Pakistan. Phalen’s clinical test was used to screen the CTS and Boston carpal tunnel questionnaire was used as an outcome measuring tool. SPSS version 22 was used to analyze the data. Mean, Standard deviation and Independent-t-test was used to compare the groups at significance level (p=0.05). R e s u l t s : Out of 212, (N=148, 69.81%) were participants in figurative painting (group A) and (N=64, 30.18%) were in calligraphy (group B) with positive Phalen test. The total mean score of symptom severity scale for CTS was (26.49 ± 6.25) and functional status (21.26±7.58) which determines moderate difficulty with routine tasks. The symptom severity scale for CTS among groups A and B had mean scores (27.83 ± 6.20) and (23.40, ± 5.20) whereas the functional status scale among group A; had mean scores (23.20 ± 7.67) and B (16.79, ± 5.13) respectively. Factors that showed significant difference between painters and calligraphers BCTQ were working hours, medium of paints, size of paint brushes and types of paint brushes (p-value= 0.00). C o n c l u s i o n : The results of this study showed an overall 'moderate' symptom severity and functional difficulty level among participants with CTS but figurative painters were more affected in some factors than calligraphers

Steroid versus placebo injections and wrist splints in patients with carpal tunnel syndrome: a systematic review and network meta-analysis.

A network meta-analysis of randomized controlled trials compared the effectiveness of corticosteroid injections with placebo injections and wrist splints for carpal tunnel syndrome, focusing on symptom relief and median nerve conduction velocity. Within 3 months of the corticosteroid injection, there was a modest statistically significant difference in symptom relief compared to placebo injections and wrist splints, as measured by the Symptom Severity Subscore of the Boston Carpal Tunnel Questionnaire; however, this did not meet the minimum clinically important difference. Pain reduction with corticosteroids was slightly better than with wrist splints, but it also failed to reach clinical significance. Electrodiagnostic assessments showed transient changes in distal motor and sensory latencies in favour of corticosteroids at 3 months, but these changes were not evident at 6 months. The best current evidence suggests that corticosteroid injections provide minimal transient improvement in nerve conduction and symptomatology compared with placebo or wrist splints.

Perineural Injection of Mecobalamin Versus Dextrose 5% Against Clinical Changes and Electrophysiological Features of Carpal Tunnel Syndrome Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Carpal tunnel syndrome (CTS) is a common compression neuropathy with symptoms of pain, tingling, and numbness in the hands. Perineural injections of steroids and mecobalamin have been shown to be effective in relieving CTS symptoms. This study aims to compare the effectiveness of the perineural injection of mecobalamin and 5% dextrose on clinical changes and electrophysiological features in CTS sufferers.
 Methods: This research is a pilot study open-label randomized controlled trial conducted at Dr. Mohammad Hoesin General Hospital Palembang. A total of 24 CTS patients were randomly divided into two groups: the mecobalamin group (n=12) and the 5% dextrose group (n=12). Patients in both groups received a single perineural injection.
 Results: In the mecobalamin group, there were significant improvements in pain scores (NPRS), Boston carpal tunnel questionnaire (BCTQ) - symptom severity scale (SSS) and functional status scale (FSS), as well as median nerve motor and sensory conduction after 2 weeks. In the 5% dextrose group, there were significant improvements in pain scores and BCTQ-SSS but not in BCTQ-FSS and nerve conduction. Comparison between groups showed significant differences in BCTQ-SSS and sensory conduction amplitude.
 Conclusion: Perineural injection of mecobalamin and 5% dextrose is effective in improving clinical symptoms of CTS. Mecobalamin showed better effects on BCTQ-SSS and sensory conduction amplitude than 5% dextrose.

Determinant Analysis of Carpal Tunnel Syndrome and Phalen’s Test Examination of Tobacco Sorting Workers at Jember District

Tobacco sorting officers in Jember Regency are still sorting tobacco leaves manually using hand muscles which can cause Musculo Skeletal Disorders (MSDs) complaints.One of the MSDs registered at the International Labor Organization (ILO) is Carpal Tunnel Syndrome (CTS) which is a disorder resulting from compression of the median nerve in the carpal tunnel at the wrist with the main symptom being tingling, pain radiating to the fingers which can be accompanied by numbness, weakness. muscles, stiffness, and possible muscle atrophy. This study aims to determine the factors associated with CTS supported by Phalen's test. This research is expected to provide information to workers and the public regarding health problems that can be experienced by tobacco sorting workers as well as being a consideration for increasing health insurance for these workers. This research was conducted using a cross-sectional survey design at PTPN A and PT B, Jember Regency with a sample calculation using the Slovin formula and obtained 246 respondents.The data analysis technique used was univariate SPSS analysis of frequency distribution, bivariate Chi Square analysis and SEM PLS multivariate analysis. research results show that education had an effect on the symptom severity scale, age had an influence on the symptom severity scale, age had an effect on the functional status scale and age had an influence on the Phalen's test. Conclusion:Age is the dominant factor affecting the symptom severity scale, functional status scale and Phalen's test. Keywords: CTS (Carpal Tunnel Syndrome), BCTQ (Boston Carpal Tunnel Questionnaire), SSS (Symptom Severity Scale), FSS (Functional Status Scale), Phalen's Test

Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique.

Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques. In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0-10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year. Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (-1.8 versus -1.8; P = 0.96), BCTQ-FSS (-1.0 versus -1.0; P = 0.75), numeric pain scale (-3.9 versus -3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group. CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.

Corticosteroid injection for carpal tunnel syndrome: A meta-analysis comparing ultrasound guided approach with landmark approach.

To assess and compare the clinical and functional outcomes of corticosteroid injections in patients with carpal tunnel syndrome, focusing on two different approaches: ultrasound-guided and landmark-guided. A systematic search was conducted in PubMed, Scopus and Embase databases for relevant studies published prior to 30th April 2023. Studies that were either randomized controlled trials or had a cohort design were included. The review assessed symptom severity, functional status, electrodiagnostic parameters, complications, need for surgical intervention, visual analogue score, and grip strength. Pooled effect sizes were reported as relative risk (RR) or weighted mean difference (WMD). A total of 8 articles were included. Compared to those that received steroid injection using landmark approach, those with ultrasound guided approach had lower symptom severity scale (SSS) score on Boston Carpal Tunnel Questionnaire (BCTQ) [WMD -0.50, 95% CI: -0.94, -0.07; I2=78.0%, N=7], lower risk of "any complications" [RR 0.58, 95% CI: 0.36, 0.93; I2= 22.9%, N=3] and lower risk of need for surgical intervention [RR 0.55, 95% CI: 0.34, 0.89; I2= 3.0%, N=2]. All other parameters were similar in the two groups i.e., functional status scale (FSS) score, visual analogue score (VAS) and grip strength. The electrophysiological findings were similar in the two groups. Findings suggest that ultrasound guided approach may be better than landmark guided approach especially in terms of alleviation of symptoms, reducing the risk of complications and need for surgical intervention. However, larger trials with long term follow up may provide conclusive evidence.

Usefulness of the Phalen Test and the Tinel Sign in the Prognosis and the Impact on Quality of Life of Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release.

Objective:  To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach. Methods:  The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment. Results:  The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95%CI]: 1.16%-8.17%), 0.88% (95%CI: 0.08%-4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%-19.18% ), 4.42% (95%CI : 1.65%-9.36%) and 2.65% (95%CI : 0.70%-6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity ( p  < 0.001) and of 1.6 points for functional status ( p  < 0.001). Conclusion:  Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life.

Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study

BackgroundCarpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life.PurposesThis study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients.MethodWe employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023.ResultsThe results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates.ConclusionThis study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS.

The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial.

Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. The effect of tissue adhesives as a material for wound closure following CTS decompression has been insufficiently investigated. This study aimed to evaluate outcomes by comparing two modalities of wound closure following carpal surgery in patients randomly assigned to either tissue adhesives or sutures. Methodology This randomized, prospective study was conducted in April 2022 at the University Hospital of Split in Croatia. Patients aged 61.56 ± 12.03 years were randomized to either tissue adhesive Glubran Tiss 2®-based (n = 50) or suture-based (n = 50) wound-closure techniques. The following outcomes were assessed before surgery and six months postoperatively: hand strength, electroneurographic characteristics of the median nerve, and the Boston Carpal Tunnel Questionnaire. Results Significant differences between glue-based and suture-based wound-closure techniques were found in the six-month postoperative hand grip strength (25.06 ± 6.69 vs. 21.41 ± 5.62 kg; p = 0.002), postoperative sensory amplitude (10.08 ± 5.50 vs. 7.54 ± 5.41 mV; p = 0.012), and postoperative sensory velocity (42.22 ± 11.04 vs. 35.23 ± 16.40 m/s; p = 0.008). In the glue-based group, significantly more patients achieved a postoperative sensory velocity greater than 45 m/s (47.9% vs. 22.0%; p= 0.006), postoperative distal sensory latency less than 3.5 ms (89.6% vs. 84.0%; p = 0.304), and postoperative motor latency of less than 4.2 ms (60.42% vs. 38.00%; p = 0.022). Conclusions This trial demonstrated that cyanoacrylate-based adhesion material for wound closure after open CTS decompression compared with sutures showed a significant six-month postoperative increment in hand grip strength and median nerve sensory conduction.

Efficacy of topical curcumin on mild to moderate carpal tunnel syndrome: a randomized double-blind, placebo-controlled clinical trial.

Recently, there has been a renewed interest in traditional medicine for carpal tunnel syndrome (CTS). Curcumin has been reported as an agent with antioxidant, anti-inflammatory, analgesic, and neuroprotective attributes. This study is one of the first investigations to assess the effect of curcumin gel on CTS. This study is a prospective, 8-week, randomized, placebo-controlled, parallel-group clinical trial. A total of 70 patients with CTS were analyzed. The intervention group (n = 35) received a topical curcumin gel and a night wrist splint and the control group (n = 35) received a placebo gel and a night wrist splint for 8 weeks. The primary outcome was the assessment of the symptom severity scale (SSS) and functional status scale (FSS) of the participants using the Boston Carpal Tunnel Questionnaire (BCTQ) after 8 weeks. In addition, all participants were evaluated by electrodiagnostic (EDX) test at baseline and after 8 weeks. The mean scores of SSS demonstrated a significant decrease in the curcumin group compared to the placebo group; P-value= 0.021. The mean change score of SSS after the intervention was 12.45 ± 8.18 in curcumin and 3.28 ± 7.06 in the placebo group; P-value = 0.0001 and the mean change score of FSS were 6.24 ± 4.91 and 2.31 ± 4.95 in curcumin and placebo groups, respectively; P-value = 0.002. However, the EDX study showed no significant changes in both groups. It seems that curcumin gel could be effective in the improvement of the symptom severity and daily activity of patients with CTS.

Correlation between electrodiagnostic severity and Boston carpal tunnel questionnaire in surgically treated carpal tunnel syndrome patients.

The objectives of this study were to (1) investigate whether electrodiagnostic (EDX) findings reflect the preoperative symptom severity and functional impairment in patients with carpal tunnel syndrome (CTS) and (2) evaluate the relationship between EDX findings and the clinical outcomes reported according to the self-administered patient questionnaires. Patients diagnosed with idiopathic CTS who underwent carpal tunnel release between May 2016 and July 2018 were included. Carpal tunnel syndrome was clinically diagnosed and confirmed based on the EDX findings. The association between EDX findings, such as motor latency, motor amplitude, sensory latency, sensory amplitude, and severity (mild, moderate, and severe), and the Boston symptom and function scores were analyzed. The change in the Boston symptom and function scores from the preoperative baseline values (visit 1) to those recorded 1 year postoperatively (visit 5) was assessed. The effect of disease severity based on the EDX findings on the change in Boston symptom and function scores by visit was also investigated. The EDX severity, motor latency, motor amplitude, sensory latency, and sensory amplitude were not correlated with the Boston symptom and function scores preoperatively and postoperatively. Electrodiagnostic severity did not affect the improvement in the Boston symptom and function scores recorded at each visit. We found no association between the EDX severity and perioperative Boston questionnaire scores, and the degree of improvement in patient symptoms and function did not differ according to the CTS severity based on the EDX findings. Level IV, Prognostic study.

Surgical versus non-surgical treatment for carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. Surgery is considered when symptoms persist despite the use of non-surgical treatments. It is unclear whether surgery produces a better outcome than non-surgical therapy. This is an update of a Cochrane review published in 2008. To assess the evidence regarding the benefits and harms of carpal tunnel release compared with non-surgical treatment in the short (< 3 months) and long (> 3 months) term. In this update, we included studies from the previous version of this review and searched the Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, ClinicalTrials.gov and WHO ICTRP until 18 November 2022. We also checked the reference lists of included studies and relevant systematic reviews for studies. We included randomised controlled trials comparing any surgical technique with any non-surgical therapies for CTS. We used the standard methodological procedures expected by Cochrane. The 14 included studies randomised 1231 participants (1293 wrists). Eighty-four per cent of participants were women. The mean age ranged from 32 to 53 years, and the mean duration of symptoms from 31 weeks to 3.5 years. Trial sizes varied from 22 to 176 participants. The studies compared surgery with: splinting, corticosteroid injection, splinting and corticosteroid injection, platelet-rich plasma injection, manual therapy, multimodal non-operative treatment, unspecified medical treatment and hand support, and surgery and corticosteroid injection with corticosteroid injection alone. Since surgery is generally used for its long-term effects, this abstract presents only long-term results for surgery versus splinting and surgery versus corticosteroid injection. 1) Surgery compared to splinting in the long term (> 3 months) Surgery probably results in a higher rate of clinical improvement (risk ratio (RR) 2.10, 95% confidence interval (CI) 1.04 to 4.24; 3 studies, 210 participants; moderate-certainty evidence). Surgery probably does not provide clinically important benefit in symptoms or hand function compared with splinting (moderate-certainty evidence). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (scale 1 to 5; higher is worse; minimal clinically important difference (MCID) = 1) was 1.54 with splint and 0.26 points better with surgery (95% CI 0.52 better to 0.01 worse; 2 studies, 195 participants). The mean BCTQ Functional Status Scale (scale 1 to 5; higher is worse; MCID 0.7) was 1.75 with splint and 0.36 points better with surgery (95% CI 0.62 better to 0.09 better; 2 studies, 195 participants). None of the studies reported pain. Surgery may not provide better health-related quality of life compared with splinting (low-certainty evidence). The mean EQ-5D index (scale 0 to 1; higher is better; MCID 0.074) was 0.81 with splinting and 0.04 points better with surgery (95% CI 0.0 to 0.08 better; 1 study, 167 participants). We are uncertain about the risk of adverse effects (very low-certainty evidence). Adverse effects were reported amongst 60 of 98 participants (61%) in the surgery group and 46 of 112 participants (41%) in the splinting group (RR 2.11, 95% CI 0.37 to 12.12; 2 studies, 210 participants). Surgery probably reduces the risk of further surgery; 41 of 93 participants (44%) were referred to surgery in the splinting group and 0 of 83 participants (0%) repeated surgery in the surgery group (RR 0.03, 95% CI 0.00 to 0.21; 2 studies, 176 participants). This corresponds to a number needed to treat for an additional beneficial outcome (NNTB) of 2 (95% CI 1 to 9). 2) Surgery compared to corticosteroid injection in the long term (> 3 months) We are uncertain if clinical improvement or symptom relief differs between surgery and corticosteroid injection (very low-certainty evidence). The RR for clinical improvement was 1.23 (95% CI 0.73 to 2.06; 3 studies, 187 participants). For symptoms, the standardised mean difference (SMD) was -0.60 (95% CI -1.88 to 0.69; 2 studies, 118 participants). This translates to 0.4 points better (95% CI from 1.3 better to 0.5 worse) on the BCTQ Symptom Severity Scale. Hand function or pain probably do not differ between surgery and corticosteroid injection (moderate-certainty evidence). For function, the SMD was -0.12 (95% CI -0.80 to 0.56; 2 studies, 191 participants) translating to 0.10 points better (95% CI 0.66 better to 0.46 worse) on the BCTQ Functional Status Scale with surgery. Pain (0 to 100 scale) was 8 points with corticosteroid injection and 6 points better (95% CI 10.45 better to 1.55 better; 1 study, 123 participants) with surgery. We found no data to estimate the difference in health-related quality of life (very low-certainty evidence). We are uncertain about the risk of adverse effects and further surgery (very low-certainty evidence). Adverse effects were reported amongst 3 of 45 participants (7%) in the surgery group and 2 of 45 participants (4%) in the corticosteroid injection group (RR 1.49, 95% CI 0.25 to 8.70; 2 studies, 90 participants). In one study, 12 of 83 participants (15%) needed surgery in the corticosteroid group, and 7 of 80 participants (9%) needed repeated surgery in the surgery group (RR 0.61, 95% CI 0.25 to 1.46; 1 study, 163 participants). Currently, the efficacy of surgery in people with CTS is unclear. It is also unclear if the results can be applied to people who are not satisfied after trying various non-surgical options. Future studies should preferably blind participants from treatment allocation and randomise people who are dissatisfied after being treated non-surgically. The decision for a patient to opt for surgery should balance the small benefits and potential risks of surgery. Patients with severe symptoms, a high preference for clinical improvement and reluctance to adhere to non-surgical options, and who do not consider potential surgical risks and morbidity a burden, may choose surgery. On the other hand, those who have tolerable symptoms, who have not tried non-surgical options and who want to avoid surgery-related morbidity can start with non-surgical options and have surgery only if necessary. We are uncertain if the risk of adverse effects differs between surgery and non-surgical treatments. The severity of adverse effects may also be different.

Validation of the Polish version of the Boston Carpal Tunnel Questionnaire, and the influence of treatment for disordered sleep and daytime sleepiness in carpal tunnel syndrome

Validation of the Polish version of the Boston Carpal Tunnel Questionnaire, and the influence of treatment for disordered sleep and daytime sleepiness in carpal tunnel syndrome

Comparative evaluation of low-level laser therapy and multi-wave locked system laser therapy for carpal tunnel syndrome: a retrospective study

Purpose: This study aimed to evaluate the effects of Low-Level Laser Therapy (LLLT) and Multi-Wave Locked System (MLS) Laser Therapy on clinical and functional parameters in Carpal Tunnel Syndrome.&#x0D; Methods: In the study, 60 patients with mild-moderate carpal tunnel syndrome were evaluated retrospectively in 3 groups. Group I; LLLT, Group II; MLS Laser therapy, Group III; It consisted of patients who did not receive any laser application and were given splints, a home exercise program and patient education. Visual Analogue Scale (VAS), Hand Grip Strength measurement and BOSTON Carpal Tunnel Questionnaire measurements were evaluated from the patients' files at baseline, 4th week and 12th week.&#x0D; Results: Statistically significant improvements were observed in all parameters in Group I and Group II at 4 weeks and 12 weeks compared to baseline. Group III showed no significant differences in grip strength measurements and the BOSTON Functional Status Scale at 4 weeks compared to baseline. The changes between baseline and 4 weeks were statistically significantly better in Group I and Group II compared to Group III for all parameters. No significant difference was found between Group I and Group II in VAS and grip strength improvements, but the improvement in Boston Symptom Severity Scale was significantly more prominent in Group II than in Group I.&#x0D; Conclusion: Both LLLT and MLS Laser Therapy can be considered as conservative treatment options along with splinting and exercise to control the symptoms of Carpal Tunnel Syndrome. MLS Laser Therapy may be superior to LLLT in reducing symptom severity.

Hand and wrist complaints in dialysis nurses in Germany: a survey of prevalence, severity, and occupational associations.

Occupations involving repetitive movements of the wrists, activities that require a lot of force, and hand-arm swinging are particularly likely to contribute to the development of hand and wrist complaints. The daily setup and dismantling of dialysis machines as part of the dialysis treatment process can strain the wrists and fingers of nurses. However, evidence regarding the relationship between the work activities of dialysis nurses and the incidence of hand and wrist complaints is limited. This study aimed to investigate the prevalence and severity of hand and wrist complaints among dialysis nurses in Germany and to relate these to their work activities. An online survey was created and sent to 836 dialysis centres in Germany. The Nordic Musculoskeletal Questionnaire was used in an online survey to assess the prevalence of musculoskeletal complaints in the hands and wrists. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess symptom severity. Dialysis nurses rated the effort required to set up dialysis machines using the BORG-CR10 scale. The analysis was descriptive. A total of 122 dialysis nurses (18 male, 104 female; mean age 45 ± 12 years) participated in the survey, and 59% of them reported developing hands or wrist complaints in the last 12 months. According to BCTQ, the average severity of these complaints is 2.0 ± 0.8 (N = 72). The severity of symptoms increased significantly with the number of setups performed by a dialysis nurse per day (rs = 0.35, P = 0.003, N = 72). The nurses rated the effort required to set up the dialysis machines as 2.8 ± 1.8 on the BORG-CR10 scale (N = 101). The results of the online survey showed that dialysis nurses were more likely than the general population to experience hand and wrist complaints. The repetitive activities of the hands and wrists while setting up a dialysis machine are thought to be the cause. Preventive measures are needed to reduce hand and wrist strain in dialysis nurses.