Management Of Carpal Tunnel Syndrome Research Articles

Enhancing Awareness and Management of Carpal Tunnel Syndrome Among Medical Professionals and Athletes

Introduction and objective: The objective of this research is to enhance the awareness of carpal tunnel among medical professionals and individuals engaged in sports. The acquired knowledge will enable medical professionals to more effectively identify, treat, and prevent issues related to carpal tunnel. Additionally, individuals engaged in sports will be able to prevent the occurrence of carpal tunnel syndrome in themselves or their pupils, thereby allowing them to engage in long-term and safe physical activity. Review methods: Review and summary of research studies available in open-source format on Google Scholar, PubMed. Abbreviated description of the state of knowledge: Carpal tunnel syndrome is a disease belonging to the group of compression neuropathies. The symptoms of carpal tunnel syndrome typically manifest as an uncomfortable sensation in the thumb, index finger, and half of the ring finger. Such symptoms may include numbness and tingling. In some cases, weakness of the hand muscles may occur, and in rarer instances, atrophy of the hand muscles. The condition of carpal tunnel syndrome is primarily the result of repetitive movements of the fingers and wrist. Such activities include typing, using a mouse, riding a bicycle, or playing a musical instrument. Summary: Carpal tunnel syndrome is a prevalent condition among the general population. This condition may affect individuals who engage in regular physical activity, resulting in diminished efficiency and a notable reduction in the quality of life. The objective of this study is to examine the risk factors, symptoms, and diagnostic methods associated with carpal tunnel syndrome. In the context of sports, we will examine the mechanisms of disease development in athletes and focus on prevention. This encompasses the rehabilitation of individuals at risk of developing the disease and patient education, which will facilitate the minimisation of the appearance or recurrence of disease symptoms.

Is Ultrasonography a Reliable Approach for the Evaluation of Carpal Tunnel Syndrome in Patients With Mucopolysaccharidosis?

BackgroundOne of the most common causes of carpal tunnel syndrome (CTS) in childhood is mucopolysaccharidosis (MPS). While ultrasonography (US) can aid in the diagnosis of CTS in adult patients, there is limited experience of this in the pediatric group. We aimed to investigate the results of wrist ultrasonography, which may be a candidate alternative to electrophysiological examination. MethodsThe participants were evaluated for symptoms, physical examination findings, electrophysiological tests and grayscale US. CTS was diagnosed in accordance with the American Academy of Orthopedic Surgeons Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. ResultsIncluded in the study were 27 MPS patients aged 4.5–32 years and 30 healthy control subjects aged 4.3–26 years. Of the 54 wrists in the MPS group, 30 were diagnosed with CTS. The median cross-sectional area (CSA) at the proximal carpal tunnel, the CSA at the forearm, and the wrist-forearm ratio (WFR) were higher in the wrists of the MPS with CTS group than in those without CTS and the healthy control subjects. The WFR cutoff of ≥1.35, 56.6% (95% CI: 437.4–74.5) sensitivity, and 89.8% (95% CI: 81.0–95.5) specificity were consistent with a diagnosis of CTS (receiver operating characteristics analysis, area under the curve = 0.775, 95% CI: 0.673–0.877). ConclusionAlthough the US provides results with unsatisfactory specificity and sensitivity, it is a candidate for further investigation for the diagnosis of CTS because it is an innovative, noninvasive, and more accessible method. WFR value may produce more meaningful results than wrist or forearm nerve area measurements.

Study on therapeutic management of carpal tunnel syndrome

Carpal tunnel syndrome has long been considered a pathology requiring surgical intervention. Over the years, therapeutic management has become increasingly complex, with improvements observed in patients benefiting from orthopedic, surgical, ergotherapeutic and physiotherapeutic treatments, tailored to individual possibilities. The objective of this case study is to observe whether individualized and adapted kinetic treatment based on specific, non-specific and comprehensive means, succeeds in optimizing the results within the QuickDASH-Score for a 64-year-old patient following surgical intervention for carpal tunnel syndrome. The QuickDASH analyses physical function, pain and other symptoms associated with various types of upper limb musculoskeletal pathologies and disorders. The initial evaluation score was 47 points, with the physiotherapy program carried out over a six-months period. The main objectives included pain, edema, and inflammation control; enhancing joint range of motion within physiological limits in affected areas; preventing muscle-tendon retractions; and fostering independence in daily activities. The final evaluation had 32 points, signifying a 15-point improvement and achievement of the objective, resulting in enhanced quality of life. Physiotherapy in carpal tunnel syndrome is a meticulously applied treatment that alleviates specific symptoms. It's crucial to educate patients on how physiotherapy contributes to full functional recovery, as premature ending can have significant adverse effects on quality of life.

Surgical Interventions for the Management of Carpal Tunnel Syndrome: A Narrative Review.

Carpal tunnel syndrome (CTS) is a severe condition that affects the hand, causing pain, numbness, paresthesia, and autonomic dysfunction caused by increased pressure, damage, and demyelination of the median nerve in the carpal tunnel. The most effective treatment for CTS is carpal tunnel release (CTR) via transverse carpal ligament (TCL) transect. We can apply decompression through endoscopic procedures; standard open techniques and minimally invasive wrist incisions can all be used to accomplish decompression. Superior outcomes have been reported in many studies, including patient satisfaction, symptom relief, improvements in multiple assessment modality results, and fewer complications. Soreness at the incision site, tenderness around the site of ligament release, transitory loss of motor or sensory function, and the need for a repeat operation are all postoperative consequences. There is minimal and low-quality evidence to support the effectiveness of postoperative rehabilitation, such as wrist orthoses, dressings, exercise, and ice therapy, which have benefited patients anecdotally.

Prevalence, Awareness, and Management of Carpal Tunnel Syndrome Among Diabetic Patients.

Carpal tunnel syndrome (CTS) is a common condition that can significantly affect the quality of life for individuals, particularly those with diabetes. This study aims to examine the severity of CTS symptoms among diabetic patients and explore the associations between demographic factors, diabetic characteristics, knowledge, and management approaches. A cross-sectional study was conducted among diabetic patients, and data were collected using standardized questionnaires. The incidence and severity of CTS were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Demographic information, diabetic characteristics, knowledge of CTS, and management approaches were also recorded. Descriptive statistics and inferential analysis were performed to analyze the data. The study included 303 participants. The majority of the participants were aged 50 or older (44.9%) (N=136), followed by those aged 39-49 (24.4%) (N=74). In terms of gender, there were more female participants (61.4%) (N=186) than male participants (38.6%) (N=117). Older age groups exhibited higher mean BCTQ scores, suggesting increased severity. Females had significantly higher severity scores compared to males (mean BCTQ score of 17.52 vs 15.56). Regarding diabetic characteristics, complications in the eye and pain/numbness in the legs or feet were significantly associated with higher severity scores of CTS (P=0.0001). The study revealed a knowledge gap among diabetic patients about CTS, with inadequate knowledge about its causes, symptoms, consequences, and treatment options among 68.6% of the patients. The use of medical interventions such as splints, injections, and surgery was associated with higher severity scores. This study highlights the incidence and severity of CTS symptoms among diabetic patients and its associations with demographic factors, diabetic characteristics, knowledge, and management approaches. Older age, female gender, widowed, diabetic complications in the eye, and pain/numbness in the legs or feet were found to be related to increased severity of CTS. Additionally, inadequate knowledge about CTS was observed among diabetic patients.

Use of nerve conduction studies in carpal tunnel syndrome.

This review article examines the use of nerve conduction studies in the management of carpal tunnel syndrome. These studies should be understood not as a test that determines the diagnosis but as a measure of impaired nerve function. They are sensitive indicators of local demyelination and axonal loss that can detect and quantify these changes before the appearance of clinical signs, providing information that cannot be obtained with the unaided senses of the physician, nor by any other investigation. They are the best available indicator of overall disease severity, correlating with symptoms and anatomical change in the median nerve. They have some prognostic value for surgical outcome and are sufficiently sensitive to change for the evaluation of treatment response. When surgery does not yield the expected improvement in symptoms, they can help to establish whether decompression has been achieved provided preoperative results are available for comparison.

Nonsurgical management of carpal tunnel syndrome

University of Colorado (University Hospital) Program, Denver, CO The corresponding author is Corey Lyon, MD; [email protected]. The authors declare no conflicts of interest.

66 Central Palmar Necrosis Following Steroid Injections for the Treatment of Carpal Tunnel Syndrome - a Case Report

Abstract Aim Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature. Method We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken. Results On examination she had a 0.5cmx1cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest. She was admitted for intravenous antibiotics and underwent a debridement, washout and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one-month following her operation. Conclusions This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.

Ayurvedic management of Carpal Tunnel Syndrome with Agnikarma – A Case Report

Carpal tunnel syndrome is an entrapment neuropathy caused by compression of median nerve as it passes through the carpal tunnel i.e., the space between the carpal bones posteriorly and the flexor retinaculum anteriorly. The compression can be caused by skeletal abnormalities, swelling of other tissues within the tunnel or thickness of the retinaculum. The condition is common in middle aged women at the menopause. In younger patients the cause may be rheumatoid disease, pregnancy or tenosynovitis. It is a condition that causes pain, numbness, tingling, and weakness in the hand and wrist. Carpal tunnel syndrome has fast growing annual incidence rate of 5 to 50 per Ten thousand populations. Modern treatment for this condition includes injecting hydrocortisone into flexor sheaths at the carpal tunnel, wearing cock-up splint and longitudinal division of the flexor retinaculum. On the basis of structures involved and features of carpal tunnel syndrome this condition can be correlated with Snayugata Vata Vikara which affects tendons ligaments and nerve. Sushruta has advised Agnikarma for disorders of snayu (ligaments and tendons), asthi (bone), siddhi (joints) etc. Hence, in this study a case of carpel tunnel syndrome (snayugatavata) was treated by Agnikarma, along with administration of Navajivana Rasa orally, for a period of 04 weeks. This combination therapy provided considerable relief in pain and tingling sensation of wrist.

The effectiveness of biophysical agents in the treatment of carpal tunnel syndrome- an umbrella review

BackgroundOur objective was to summarize, synthesize, and integrate the evidence evaluating the effectiveness of biophysical agents compared to other conservative treatments, for the management of carpal tunnel syndrome (CTS).MethodsThis was an overview of systematic reviews (SRs). We searched several online databases and obtained SRs relating to managing CTS using biophysical agents. Two independent researchers screened and appraised the quality of the SRs using the A MeaSurement Tool to Assess systematic Reviews-2 appraisal tool. We extracted information related to study characteristics as well as the effectiveness of biophysical agents for CTS, the effect sizes, and between-group significances. We categorized the information based on the type of biophysical agent. We also performed a citation mapping and calculated the corrected covered area index.ResultsWe found 17 SRs addressing 12 different biophysical agents. The quality of the SRs was mainly critically low (n = 16) or low (n = 1). The evidence was inconclusive for the effectiveness of Low-level Laser therapy and favorable for the short-term efficacy of non-thermal ultrasound in improving symptom severity, function, pain, global rating of improvement, satisfaction with treatment, and other electrophysiological measures compared to manual therapy or placebo. Evidence was inconclusive for Extracorporeal Shockwave therapy, and favorable for the short-term effectiveness of Shortwave and Microwave Diathermy on pain and hand function. The corrected covered area index was lower than 35% indicating a low overlap of the SRs.ConclusionsThe findings were based on low-quality primary studies, with an unclear or high risk of bias, small sample sizes, and short follow-ups. Therefore, no recommendations can be made for the long-term effectiveness of any biophysical agents. High-quality evidence is needed to support evidence-based recommendations on the use of biophysical agents in the management of CTS.PROSPERO registration numberCRD42022319002, registered on 17/04/2022

Exploring the Role of a Large Language Model on Carpal Tunnel Syndrome Management: An Observation Study of ChatGPT

Recently, large language models, such as ChatGPT, have emerged as promising tools to facilitate scientific research and health care management. The present study aimed to explore the extent of knowledge possessed by ChatGPT concerning carpal tunnel syndrome (CTS), a compressive neuropathy that may lead to impaired hand function and that is frequently encountered in the field of hand surgery. Six questions pertaining to diagnosis and management of CTS were posed to ChatGPT. The responses were subsequently analyzed and evaluated based on their accuracy, coherence, and comprehensiveness. In addition, ChatGPT was requested to provide five high-level evidence references in support of its answers. A simulated doctor-patient consultation was also conducted to assess whether ChatGPT could offer safe medical advice. ChatGPT supplied clinically relevant information regarding CTS, although at a relatively superficial level. In the context of doctor-patient interaction, ChatGPT suggested a diagnostic pathway that deviated from the widely accepted clinical consensus on CTS diagnosis. Nevertheless, it incorporated differential diagnoses and valuable management options for CTS. Although ChatGPT demonstrated the ability to retain and recall information from previous patient conversations, it infrequently produced pertinent references, many of which were either nonexistent or incorrect. ChatGPT displayed the capability to deliver validated medical information on CTS to nonmedical individuals. However, the generation of nonexistent and inaccurate references by ChatGPT presents a challenge to academic integrity. To increase their utility in medicine and academia, large language models must go through specialized reputable data set training and validation from experts. It is essential to note that at present, large language models cannot replace the expertise of health care professionals and may act as a supportive tool.

Adherence to Complication Reporting for Randomized Controlled Trials Contained in Clinical Practice Guidelines for the Management of Carpal Tunnel Syndrome

Randomized controlled trials (RCTs) are frequently used in creating recommendations contained within clinical practice guidelines (CPGs). However, investigations outside of hand surgery have reported that RCTs within CPGs infrequently report complications and harms-related data. Our purpose was to assess adherence to complication reporting and harms-related outcomes contained in the Consolidated Standards for Reporting (CONSORT) Extension of Harms and Standards for Reporting of Diagnostic Accuracy Studies (STARD) reporting checklists for RCTs within the American Academy of Orthopaedic Surgery (AAOS) CPGs for carpal tunnel syndrome (CTS). We identified all RCTs within the AAOS CTS CPGs. All therapeutic RCTs and diagnostic studies were included. We used the CONSORT Harms Checklist criteria to assess adherence to the reporting of adverse events for therapeutic RCTs and the STARD criteria to assess the diagnostic accuracy of the articles. We defined adequate compliance as adherence to ≥50% of the checklist items. We identified 82 therapeutic RCTs and 90 diagnostic accuracy articles within the AAOS CTS CPG. For therapeutic RCTs, we found that the average compliance with the published checklists was 19%. For diagnostic studies, the average compliance with checklists was found to be 55%. Eleven therapeutic RCTs (13%) and 60 diagnostic studies (67%) were determined to have adequate compliance for the CONSORT and STARD checklists, respectively. Randomized controlled trials in the AAOS CPGs for CTS have low compliance with the CONSORT Extension for Harms Checklist. Although the overall adherence to the items published in the STARD statement for diagnostic accuracy evaluation remains higher, future efforts should be made to improve the adherence rates to both checklists. Improved standardization of complication reporting may aid in comparing outcomes across multiple clinical investigations of upper-extremity procedures.

34. Racial and Ethnic Disparities in Operative Management of Carpal Tunnel Syndrome in a National Single-payer System

34. Racial and Ethnic Disparities in Operative Management of Carpal Tunnel Syndrome in a National Single-payer System

Prevalence of Carpal Tunnel Syndrome and its Associated Risk Factors among Workers of Marble Industries of Abbottabad

Background: Carpal tunnel syndrome occurs when the median nerve that passes through the carpal tunnel is compressed due narrowing of the tunnel at the wrist. Pain, tingling and numbness, at median nerve distribution on fingers and hands are the symptoms of carpal tunnel syndrome.
 Objective: The objective of this study is to find out the prevalence of Carpal Tunnel Syndrome and its associated risk factors in workers of Marble industries of Abbottabad
 Methodology: This descriptive cross sectional study was completed within 6 months. A total of 150 workers were recruited to collect the data. Convenience sampling technique was used. inclusion criteria of this study was only industrial workers of age between ages 20-60 years, Work related carpal tunnel syndrome, Only males were included in this study, so convenient sampling approach was applied for data collection within research time period. The exclusion criteria of this study were those who were unable to complete the questionnaire and particularly those who were diabetic along with carpal tunnel syndrome, Women’s are excluded, Neoplasm, Any systemic disease, Peripheral nerve injury. Boston carpal tunnel syndrome questionnaire were used as tool. Data was collected with the help of questionnaire in Abbottabad. Data was collected from Jadoon marble industry, Taj marble industry, Hazara marble industry and Janzib marble industry Data is entered and analyzed using SPSS 20.0.
 Results: The results of total participant showed age range from 21 to 56, whereas the mean age was 36.52. Prevalence of CTS via Phalen's and Tinnel's test for all the samples was positive for with 11 participant. Statistically, age, work experience and types of work showed significant (P vale>0.05), whereas type of activities had shown highly significant (P value > 0.01) association with CTS. Further, study showed that prevalence of CTS increased with increase in age, experience and increase in force activities.
 Conclusion: The study concluded that marble factory works who work more for 6 hours or having greater year of work experience, increased age, those using repetitive movements or vibratory tools were at high risk of developing carpal tunnel syndrome. Hence awareness campaign needs to be arranged for marble industries worker about awareness of hands posture and management of carpal tunnel syndrome.

The Agreement of Clinical Evaluation and Electrodiagnostic Studies in a Modified Surgical Technique in Carpal Tunnel Syndrome Management

The Agreement of Clinical Evaluation and Electrodiagnostic Studies in a Modified Surgical Technique in Carpal Tunnel Syndrome Management

The agreement of clinical evaluation and electrodiagnostic studies in a modified surgical technique in carpal tunnel syndrome management.

The agreement of clinical evaluation and electrodiagnostic studies in a modified surgical technique in carpal tunnel syndrome management.

Improved Agreement With American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on Carpal Tunnel Syndrome.

The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines on the diagnosis and management of carpal tunnel syndrome (CTS). Previous versions made controversial recommendations, which failed to yield universal endorsement. Updated guidelines were published in 2016, and we aimed to evaluate agreement with their highest-strength recommendations among members of the American Society for Surgery of the Hand. An online questionnaire was sent to American Society for Surgery of the Hand members. There were 22 questions that inquired about respondents' specialty, experience level, and practice patterns. We sought to determine their level of agreement with 6 of the highest-strength recommendations in the guidelines. We also investigated their awareness of the guidelines and perceived barriers to their use in clinical practice. The response rate was 17%. The typical respondent was a private practice orthopedic surgeon with at least 10 years of practice. The majority of respondents were aware of the AAOS guidelines. Approximately half (55%) felt that there were no significant barriers to their implementation into clinical practice. Overall, our study demonstrated that nearly half of the respondents agreed with the highest-strength recommendations. There is an improved agreement with the current AAOS guidelines on CTS, perhaps because they reflect a more accurate role in assisting physicians with their independent medical judgment, rather than as fixed protocols. We believe that all surgeons managing CTS should be familiar with the AAOS guidelines. [Orthopedics. 2023;46(2):114-120.].

National trends in the initial diagnosis and management of carpal tunnel syndrome: results from the ELECTS (ELEctrophysiology in Carpal Tunnel Syndrome) study.

The optimal role of nerve conduction studies (NCS) in management of carpal tunnel syndrome (CTS) is unclear, with no standardised guidance. This study aimed to identify variation in practice in the initial diagnosis of patients with suspected CTS, alongside evaluating how NCS findings influence clinical decision making. A national multicentre collaborative survey was conducted in 2021. All centres providing surgery for CTS were invited to participate, primarily via social media. All middle-senior grade orthopaedic/plastic surgeons and advanced care practitioners that regularly manage new referrals for suspected CTS were eligible to respond. Local representatives at each participating site submitted their responses to a central team who collated and analysed the results. A total of 137 healthcare professionals responded from 18 UK NHS Trusts. Of these 137, 124 (91%) reported not employing any validated clinical questionnaires in their routine practice, preferring to rely on clinical diagnosis and/or NCS if available, whereas 84 (61%) utilised NCS to aid diagnosis, with significant differences among professionals with differing experience (p < 0.01). The most common methods for determining the severity of CTS were history, examination and NCS. In symptomatic CTS with confirmatory NCS, over 50% of clinicians would choose surgical decompression as their first-line intervention. In cases of either negative NCS or atypical presentation, 37% and 51%, respectively, would consider conservative management (e.g. splintage) or steroid injection first line. With growing waiting lists for NCS and surgery, national consensus guidelines should be developed to support decision making, while maximising efficient utilisation of increasingly constrained resources.

Carpal tunnel mechanics and its relevance to carpal tunnel syndrome

The carpal tunnel is an elaborate biomechanical structure whose pathomechanics plays an essential role in the development of carpal tunnel syndrome. The purpose of this article is to review the movement related biomechanics of the carpal tunnel together with its anatomical and morphological features, and to describe the pathomechanics and pathophysiology associated with carpal tunnel syndrome. Topics of discussion include biomechanics of the median nerve, flexor tendons, subsynovial tissue, transverse carpal ligament, carpal tunnel pressure, and morphological properties, as well as mechanisms for biomechanical improvement and physiological restoration. It is our hope that the biomechanical knowledge of the carpal tunnel will improve the understanding and management of carpal tunnel syndrome.

Effect of Agnikarma with Tapta Guda in Carpal Tunnel Syndrome- A Case Study

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of upper extremity. It affects approximately 3% of the general adult population in the world. Women are three times more likely to have CTS than men. In conventional system, medications such as corticosteroids, Non-Steroidal anti-inflammatory drugs, etc., are used in management of carpal tunnel syndrome. Surgical decompression of carpal tunnel is the main stay of treatment for CTS. The structures involved in carpal tunnel is mainly the tendons, ligaments and nerves which can closely related with Snayu, thus Carpal tunnel syndrome can be correlated with Snayugata vata affecting Manibandhasandhi. Dahanopkarana used for Vatavyadi affecting Snayu, Sandhi, Asthi are Kshaudra, Guda, Sneha. Agnikarma with Snigdha dravyas have more penetrating capacity than Rooksha dravyas like Shalaka. So, Taptaguda is taken in the present study to assess the effect of Agnikarma in carpal tunnel syndrome. Here the patient was treated with Agnikarma using Taptaguda over the most painful and tender points. Assessments were done before treatment, after treatment, 7th day, 15th day and 30th day. The result showed Agnikarma with Taptha guda was effective in treating Carpal tunnel syndrome