Moderate Carpal Tunnel Syndrome Research Articles

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements.

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms & Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

Is Dorso-Volar Kinesiotape Added to the Home Exercise Program Effective in the Treatment of Carpal Tunnel Syndrome? Randomized Controlled Electrodiagnostic Study

Abstract Objective We aimed to compare the short- and medium-term efficacy of dorso-volar kinesiotape (KT) added to home exercises (HE) with sham-KT and HE alone in the treatment of mild or moderate carpal tunnel syndrome (CTS) in terms of pain, symptom severity, function, gripping strength, and electrophysiological parameters. Materials and Methods A total of 120 patients (99 females, 21 males) were divided into three groups dorso-volar KT and HE (n=40), sham-KT and HE (n=40), and HE (n=40). Pain (The visual analog scale [VAS]), symptom severity (Boston symptom severity scale [SSS]), functional status (Boston functional status scale [FSS]), nerve conduction study (NCS), hand, finger muscle strength were evaluated pretreatment, at the end of treatment (4th week), and in the third month posttreatment. Results There were statistically significant improvements in VAS (p<0.001), Boston SSS (except HE group) (p<0.001), and Boston FSS (p<0.001) in all groups posttreatment compared to pretreatment, and more in the dorso-volar KT group than pretreatment and the posivite improvement continued at a decreasing rate in the third month posttreatment. At the end of treatment the dorso-volar KT group showed statistically significant improvement in Boston SSS (p<0.001, p<0.001) and Boston FSS (p<0.001, p<0.001) compared to the sham-KT and HE groups. Conclusions The combination of dorso-volar KT and HE program makes a more effective and durable contribution to the improvement of CTS symptom severity, pain and functional status, as well as handgrip strength and NCS parameters compared with sham-KT and HE program.

Is essential tremor a risk factor for carpal tunnel syndrome? A prospective study excluding the most common comorbid conditions

Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity, resulting from compression of the median nerve. Tremor, a rhythmic and involuntary movement of any part of the body, is the most common movement disorder, affecting millions of people worldwide. There is limited research on the coexistence of CTS and ET (essential tremor). Methods: This prospective study included patients aged 18-65 who presented to the neurology outpatient clinic and were diagnosed with ET. Participants supplied informed consent, a sociodemographic form, and the Fahn-Tolosa-Marin Clinical Tremor Rating Scale (FTM TRS). Patients were evaluated for the presence and severity of CTS with electromyography (EMG). The EMG data were categorized as normal, mild, moderate, and severe CTS. Results: In the study, the average age of the 50 ET patients was 56.0 (35.0-64.0) years. The gender distribution comprised 22 (44.0%) males and 28 (56.0%) females. The following tremor locations were reported: 41 (82.0%) in both upper extremities, 3 (6.0%) in the right upper extremity, 2 (4.0%) in the left upper extremity, 1 (2.0%) in both upper extremities, head tremor, and voice, and 3 (6.0%) in both upper extremities and head tremor. A high prevalence of CTS was detected in ET patients (46%). Additionally, a positive correlation was found between CTS in ET patients, long disease duration, and female gender. No significant relationship was found between FTM TRS Part A, Part B, Part C, total scores, and median sensory and motor nerve amplitude and velocity values in ETS patients. Conclusion: CTS is more common in patients with ET. This suggests that ET may be a risk factor for CTS, independent of other factors. Early diagnosis and treatment of CTS in patients with ET is important to improve their quality of life.

Ultrasound-Based Grading of Carpal Tunnel Syndrome: A Comparative Study of Cross-Sectional Area and Shear Wave Elastography at Different Wrist Joint Angles.

Carpal Tunnel Syndrome (CTS) is a prevalent neuropathy where accurate diagnosis is crucial for effective treatment planning. This study introduces a novel approach for CTS grading using ultrasound, specifically through the analysis of the cross-sectional area (CSA) and shear wave elastography (SWE) of the median nerve in various wrist positions. Our research involved subjects from outpatient clinics, diagnosed with CTS through Nerve Conduction Studies (NCS), and a control group of healthy individuals. High-frequency ultrasound and SWE measurements were conducted in three wrist positions: straight, 45° extension, and 45° flexion. The key findings revealed significant differences in median nerve CSA and SWE values between the CTS and control groups across all wrist positions, with notable variances in SWE values correlating with wrist positioning. SWE demonstrated enhanced sensitivity and specificity in distinguishing between mild, moderate, and severe CTS, especially at 45° wrist flexion. In contrast, CSA measurements were limited in differentiating between the varying severity stages of CTS. The study concludes that SWE, particularly at 45° wrist flexion, provides a more precise diagnostic benchmark for CTS severity grading than CSA. This advancement in non-invasive diagnostic methodology not only aids in accurate CTS grading but also has significant implications in formulating tailored treatment strategies, potentially reducing the reliance on more invasive diagnostic methods like NCS. This study marks a significant advancement in the ultrasound diagnosis of CTS. It particularly highlights the importance of applying SWE technology across various wrist joint angles, offering a new diagnostic benchmark. This discovery provides data support and additional insights for achieving an early consensus on ultrasound-based grading diagnosis of CTS.

A revised electrodiagnosis-based severity classification for carpal tunnel syndrome

BACKGROUND: An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity. OBJECTIVE: This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS. METHODS: This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens’ classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation were performed to detect anatomical abnormalities. RESULTS: Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group. CONCLUSION: The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups.

How Does Nerve Mechanical Interface Treatment Impact Pre-Surgical Carpal Tunnel Syndrome Patients? A Randomized Controlled Trial.

Carpal tunnel syndrome (CTS) presents a high burden on the healthcare system. However, no alternative treatments are provided during the waiting period. In addition, the incidence of severe patients with comorbidities is underestimated. The aim of this study was to determine whether nerve mechanical interface treatment improves the symptoms, function, and quality of life in pre-surgical CTS patients. A randomized controlled trial and intention-to-treat analysis were carried out. Forty-two patients with an electrodiagnosis of carpal tunnel syndrome, included on the surgery waiting list of a public healthcare system, were analyzed. The intervention group (n = 20) received a 45 min session/per week of instrument-assisted manual therapy (diacutaneous fibrolysis) for 3 weeks. The Boston Carpal Tunnel Questionnaire (BCTQ) was the primary outcome. The symptoms, mechanical threshold, grip strength, mechanosensitivity of the median nerve, quality of life, and patient satisfaction were included as secondary outcomes. The control group (n = 22) remained on the waiting list. The intervention seems to be beneficial for the BCTQ score (function and symptoms scale), pain, and mechanosensitivity after treatment, at the 3 and 6 months follow-up (p < 0.05). Kinesiophobia was improved at 6 months (p = 0.043; η2 = 0.10) and the mechanical threshold at the 3-month follow-up (p = 0.048; η2 = 0.10). No differences were identified for grip strength. At 6 months, the intervention group patients were satisfied (100%), as opposed to the controls, who felt that they had experienced a worsening of their condition (50.1%). Nerve mechanical interface treatment improved the symptoms, function, and quality of life in pre-surgical CTS patients. One hundred percent of the treated patients, characterized as moderate and severe CTS with associated comorbidities, were satisfied.

Mechanisms of neurodynamic treatments (MONET): a protocol for a mechanistic, randomised, single-blind controlled trial in patients with carpal tunnel syndrome

BackgroundPhysiotherapeutic management is the first-line intervention for patients with entrapment neuropathies such as carpal tunnel syndrome (CTS). As part of physiotherapy, neurodynamic interventions are often used to treat people with peripheral nerve involvement, but their mechanisms of action are yet to be fully understood. The MONET (mechanisms of neurodynamic treatment) study aims to investigate the mechanisms of action of neurodynamic exercise intervention on nerve structure, and function.MethodsThis mechanistic, randomised, single-blind, controlled trial will include 78 people with electrodiagnostically confirmed mild or moderate CTS and 30 healthy participants (N = 108). Patients will be randomly assigned into (1) a 6-week progressive home-based neurodynamic exercise intervention (n = 26), (2) a steroid injection (= 26), or (3) advice (n = 26) group. The primary outcome measure is fractional anisotropy of the median nerve at the wrist using advanced magnetic resonance neuroimaging. Secondary outcome measures include neuroimaging markers at the wrist, quantitative sensory testing, electrodiagnostics, and patient reported outcome measures. Exploratory outcomes include neuroimaging markers at the cervical spine, inflammatory and axonal integrity markers in serial blood samples and biopsies of median nerve innervated skin. We will evaluate outcome measures at baseline and at the end of the 6-week intervention period. We will repeat questionnaires at 6-months. Two-way repeated measures ANCOVAs, followed by posthoc testing will be performed to identify differences in outcome measures among groups and over time.DiscussionThis study will advance our understanding of the mechanisms of action underpinning neurodynamic exercises, which will ultimately help clinicians to better target these treatments to those patients who may benefit from them. The inclusion of a positive control group (steroid injection) and a negative control group (advice) will strengthen the interpretation of our results.Trial registrationNCT05859412, 20/4/2023.

CARPAL TUNNEL SYNDROME AND MIGRAINE LATERALIZATION

Abstract Background/Aims: Within the scope of this research, we aimed to elucidate the relationship between carpal tunnel syndrome and migraine to explore both the pain intensity and the localization of carpal tunnel syndrome (CTS) in concomitant migraine. The primary outcome variable was elaborated as the pain lateralization, and the secondary outcome variable was the pain intensity. Methods: This was a cross-sectional, observational prospective study of 500 patients with a preliminary carpal tunnel syndrome diagnosis in our institution. After patients with missing data were excluded from the study, 413 remained, 365 (88.4%) women and 48 (11.6%) men. After recording the demographic characteristics, the patient's migraine pain year of onset of pain, pain characteristics, localization, frequency, duration, severity, triggering factors, symptoms, and findings accompanying the pain were recorded. Results: The lateralization of migraine was on the right side (only on the right or mostly on the right) in 25.9% and on the left side (only on the left or mostly on the left) in 26.4% of the patients. Almost half of the patients (47.7%) experienced bilateral migraine headaches. Carpal tunnel syndrome was in the right hand in 13.3%, in the left hand in 11.6%, and bilateral in 75.1%. Of 197 patients with bilateral pain, 68 (34.5%) had mild, 116 (58.9%) had moderate, and 13 (6.6%) had severe CTS. The VAS level of migraine pain was higher only in patients with CTS in the left hand and in those with moderate CTS. Conclusion: It has been determined that those with carpal tunnel syndrome on the right side have migraines mostly on the right, those with carpal tunnel syndrome on the left have migraines on the left, and those with carpal tunnel syndrome in both directions have migraines predominantly in both directions.

Comparative Study between Platelet-Rich Plasma, Corticosteroids and Perineural Dextrose local Injections for Treatment of Carpal Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS), one of the most common entrapment neuropathies, is considered as a socio- economic issue that reduces work productivity and increases disability. Aim of the Work to compare the effect of Platelet- Rich Plasma (PRP), corticosteroids (CS) and perineural Dextrose 5 % in water (D5W) local injections for the treatment of idiopathic mild and moderate CTS. Patients and Methods A prospective study was performed on 60 median nerves of 60 patients. They were diagnosed as idiopathic CTS and classified randomly into 3 groups (each contains 20 patients) according to the treatment program received: group I (ultrasound guided CS injection), group II (ultrasound guided perineural Dextrose 5% injection) and group III (ultrasound guided PRP injection). Results Ultrasound guided local injection using single doses of CS, D5W, and PRP were very efficient as regards symptomatic and functional improvement, reducing distal motor latency (DML) and Peak sensory latency ( PSL) of median nerve, as well as decreased Cross Section Area (CSA) of Median nerve (MN) and improving median nerve mobility for idiopathic mild to moderate CTS. For symptom and functional improvement, single injection of CS was more effective than that of PRP and D5W within 3 months post-injection. Moreover, PRP was slightly better than D5W. For reducing DML and PSL, CS was the most effective followed by PRP and then D5W at 3 months post injection. For reducing CSA, CS was the most effective followed by PRP and then D5W at 3 months post injection. For improving mobility of median nerve, D5W was the most effective at 3 months post injection followed by CS and PRP. Conclusion Injection of CS, D5W and PRP had resulted in significant Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score reduction at 3 months post-injection in comparison to the BCTQ score at the baseline evaluation. All of the three studied groups (Corticosteroids, dextrose 5 % and PRP) have shown a great result regarding improving in clinical examination, clinical assessment scales, nerve conduction studies and improving in Neuromuscular Ultrasound results with favorable results of Corticosteroids group over Perineural dextrose 5 % group and PRP group.

When is it safe to operate after the failure of therapeutic steroid injections in carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a multifactorial neuropathy caused by the compression of the median nerve due to its entrapment as it passes through the carpal tunnel in the wrist. It accounts for nearly 90% of neuropathies and usually presents as numbness, tingling, weakness, and pain. These symptoms are predominantly present in the thumb, second finger, third finger, and radial half of the hand's fourth finger. In the US, CTS has a prevalence of 50 per 1,000, which is similar to the prevalence in other developed countries.1 Overall, the prevalence of CTS in the general population in developed countries ranges from 3% to 6%, whereas the prevalence of CTS in developing countries like Pakistan has been reported to be from 10% to 15%.2 The management of mild to moderate CTS ranges from conservative management, including ultrasound therapy using the pulsed mode, wrist splinting, and tendon gliding exercises, to Neuro-mobilization.3 On the other hand, the management of moderate to severe CTS, which is unresponsive to the above-mentioned therapies comprises therapeutic steroid injections and surgical decompression of the median nerve. In many cases, surgical decompression is used as a last resort after the failure of therapeutic steroid injections. However, studies have shown that surgical decompression in these cases is associated with poor postoperative outcomes, including increased risk of pain and paresthesia.4 Furthermore, such cases are also associated with an increased risk of surgical site infections, non-infectious wound complications, and 1 year-reoperation. The risk of these complications is maximum when surgery is performed within 30 days of the last therapeutic steroid injection along with a high number of therapeutic steroid injections (infections 1.77%, non-infectious complications 1.12%, 1-year re-operation 2.09%), and is minimal when performed from 90 to 180 days of the last therapeutic steroid injection with a low number of therapeutic steroid injections (infections 1.19%, non-infectious complications 0.44%, 1-year re-operation 1.58%). Therefore, surgical decompression of the median nerve should be delayed for 90 to 180 days after the last therapeutic steroid injection, depending on the severity.5 There is a high prevalence of CTS in developing countries like Pakistan and therapeutic steroid injections are frequently prescribed as first-line treatment for moderate to severe CTS. ---Continue

Relationships between the global symptom score and electrophysiological findings after surgical release for carpal tunnel syndrome: Indications and outcomes.

Regarding surgical indications for carpal tunnel syndrome (CTS), the hypothesis that the recovery processes of subjective symptoms differ among pain, sensory, and motor symptoms and correlate with recovery in objective nerve conduction studies was examined in the present study. The global symptom score (GSS) is a method used to assess clinical outcomes and covers subjective symptoms, including pain (pain and nocturnal awakening), sensory (numbness and paresthesia), and motor (weakness/clumsiness) symptoms. The relationships between long-term changes in GSS and recovery in nerve conduction studies were investigated. Forty patients (40 hands) were included (mean age 65years; 80% female; 68% with moderate CTS: sensory nerve conduction velocity < 45m/s and motor nerve distal latency > 4.5ms). Pain and nocturnal awakening rapidly subsided within 1month after surgery and did not recur in the long term (median 5.6years). Paresthesia significantly decreased 3months after surgery and in the long term thereafter. Weakness/clumsiness significantly decreased at 1year. Sensory nerve distal latency, conduction velocity, and amplitude significantly improved 3months and 1year after surgery, and correlated with nocturnal awakening in the short term (3months) in moderate CTS cases. The patient satisfaction rate was 91%. Rapid recovery was observed in pain and nocturnal awakening, of which nocturnal awakening correlated with the recovery of sensory nerve conduction velocity. Patients with pain symptoms due to moderate CTS may benefit from surgical release.

Local ozone injection compared to local glucocorticoid injection in carpal tunnel syndrome: A randomized controlled trial.

This study aimed to compare the effectiveness of local ozone (O3) injection versus corticosteroid injection in the treatment of mild to moderate carpal tunnel syndrome (CTS). This double-blind randomized controlled trial was performed on 42 patients (9 males, 33 females; mean age: 46.7±2.1 years; range, 18 to 70 years) with mild to moderate CTS between May 2021 and June 2021. The corticosteroid group (n=21) was injected with 40 mg triamcinolone, and in the O3 group B (n=21), 4 mL of a 10 mcg/mL oxygen (O2)-O3 mixture was injected. Symptom severity and functional impairments were assessed using a Visual Analog Scale and Boston Carpal Tunnel Questionnaire. Electrodiagnostic and ultrasonographic parameters were obtained at baseline and eight weeks after the procedure. The O2-O3 solution improved pain and Boston Carpal Tunnel Questionnaire score after eight weeks (p<0.001); however, the change was nonsignificant compared to the corticosteroid group (p>0.05). Sensory nerve and compound muscle action potential latencies were not significantly changed eight weeks after O2-O3 injection (p>0.05), while both were significantly decreased in the steroid injection group (p<0.001). Volar bulging and median nerve cross-section surface area were not improved after O2-O3 injection, while the improvement was significant in the corticosteroid arm (p=0.02). Symptoms in patients with mild to moderate CTS may be alleviated by local O2-O3 injection; however, electrodiagnostic and ultrasonographic indices may be unchanged. Corticosteroid local injection may alleviate patient symptoms along with electrodiagnostic and ultrasonographic parameters.

Carpal Tunnel Syndrome: A Randomized Comparative Study of Magnetic Field Therapy and Ultrasound Therapy

Background: Carpal tunnel syndrome is a frequently observed condition affecting the wrists and fingers, characterized by numbness, tingling, and sometimes pain. Objective: To evaluate and compare the efficiency of magnetic field therapy and ultrasound therapy in rehabilitating women with carpal tunnel syndrome (CTS). Patients and Methods: Forty women with mild to moderate CTS were included in the study, and an electromyography (EMG) and examination confirmed the diagnosis. The participants were assigned into two groups. Group A received magnetic field therapy, and Group B received ultrasound therapy. Patients for each group received a six-session clinical evaluation. The outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), handgrip strength, wrist joint movements (flexion and extension), as well as the Visual Analogue Scale (VAS). Results: The paired t-test analyses demonstrate a significant improvement in the Boston questionnaire and VAS in both intervention groups at a P-value ≤0.05. The independent sample t-test analysis for post-intervention for both groups showed superiority for magnetic field therapy; no significant differences were observed in the improvement of wrist movement (Flexion = 0.66, Extension = 0.71); the Visual Analog Scale (VAS) has been improved in both treatment groups with dominance for ultrasound therapy. Conclusion: Both magnetic field and ultrasound therapy effectively treat women with carpal tunnel syndrome. Magnetic field therapy was statistically superior to ultrasound.

Carpal Tunnel Syndrome: A Randomized Comparative Study of Magnetic Field Therapy and Ultrasound Therapy

Background: Carpal tunnel syndrome is a frequently observed condition affecting the wrists and fingers, characterized by numbness, tingling, and sometimes pain. Objective: To evaluate and compare the efficiency of magnetic field therapy and ultrasound therapy in rehabilitating women with carpal tunnel syndrome (CTS). Patients and Methods: Forty women with mild to moderate CTS were included in the study, and an electromyography (EMG) and examination confirmed the diagnosis. The participants were assigned into two groups. Group A received magnetic field therapy, and Group B received ultrasound therapy. Patients for each group received a six-session clinical evaluation. The outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), handgrip strength, wrist joint movements (flexion and extension), as well as the Visual Analogue Scale (VAS). Results: The paired t-test analyses demonstrate a significant improvement in the Boston questionnaire and VAS in both intervention groups at a P-value ≤0.05. The independent sample t-test analysis for post-intervention for both groups showed superiority for magnetic field therapy; no significant differences were observed in the improvement of wrist movement (Flexion = 0.66, Extension = 0.71); the Visual Analog Scale (VAS) has been improved in both treatment groups with dominance for ultrasound therapy. Conclusion: Both magnetic field and ultrasound therapy effectively treat women with carpal tunnel syndrome. Magnetic field therapy was statistically superior to ultrasound. Keywords: Carpal Tunnel Syndrome, Magnetic Field Therapy, Ultrasound Therapy.

Comparison of local versus intramuscular steroid injection in patients with carpal tunnel syndrome: A prospective open label randomized clinical trial

AimThis study compared the efficacy and safety of local corticosteroid injection (LCI) vs intramuscular (IM) corticosteroid injection in mild to moderate carpal tunnel syndrome (CTS). MethodsThis is an open labeled, randomized controlled trial conducted during December 2021 to August 2023. Eighty-six patients with CTS were randomized in 1:1 ratio to receive either single 40 mg methylprednisolone (MP) injection at the wrist (LCI arm), or single 40 mg MP intramuscular injection (IM arm) in the deltoid. Primary outcome was absolute Symptom Severity Scale (SSS) at 3 months. Secondary outcomes were SSS score at 1-month, Functional Status Scale (FSS) score at 1 and 3 months, and recurrence at 3 months and injection site pain assessed on visual analog (VAS) scale. ResultsMedian age was 45 (range 22 – 80) years, and 86 % were females. Baseline characteristics were comparable between groups. Mean SSS score at 3 months was similar in two arms (1.72 ± 0.71 vs 2.0 ± 0.93) with mean difference (MD) −0.03 (-0.31 to 0.25, p = 0.83) after adjusting for baseline SSS scores. LCI, however, resulted in significantly better SSS (1.48 ± 0.51 vs 1.88 ± 0.69, adjusted p = 0.04), and FSS scores (1.57 ± 0.44 vs 1.80 ± 0.66, adjusted p = 0.03) at 1 month compared to IM arm. Response rate (67.4 % vs 55.8 %; p = 0.30) and recurrence rate (17.1 % vs 22.6 %, p = 0.74) at 3 months were similar. Injection site pain was severe in LCI arm[median 5 (range 3 – 8) vs median 3 (range 2 – 6)]. ConclusionsIn patients with mild to moderate CTS, LCI resulted in better improvement in the BCTQ scores at 1 month compared to IM steroid. However, 3-month’s outcome was similar. Intramuscular steroid injection was better tolerated.

Association between electrodiagnosis and neuromuscular ultrasound in the diagnosis and assessment of severity of carpal tunnel syndrome.

Neuromuscular ultrasound plays an increasing role in diagnosing carpal tunnel syndrome (CTS). There are limited data supporting the correlation between the electrodiagnostic studies and ultrasound measurements in CTS. To assess the association between different electrodiagnostic severities and ultrasound measurements of the median nerve in CTS. A retrospective cohort study. An academic tertiary care center. Patients 18 years or older evaluated with upper limb electrodiagnostic studies and neuromuscular ultrasound. Ultrasound measurements of the median nerve cross-sectional area (CSA) at the wrist and the calculated wrist-to-forearm ratio (WFR) were compared with the electrodiagnostic severity (normal, mild, moderate, and severe). Mean analysis and analysis of variance test (α = 0.05) were performed to assess the association. A total of 1359 limbs were identified. There was a statistically significant association between electrodiagnostic severity of CTS and median nerve CSA at the wrist (p < .001), as well as the WFR (p < .001). The mean median nerve CSA at the wrist and WFR were 7.01 ± 2.06 mm2 (95% CI: 6.80-7.20) and 1.24 ± 0.36 (95% CI: 1.16-1.24) in electrodiagnostically normal median nerves, 10.47 ± 2.82 mm2 (95% CI: 10.25-10.75) and 2.06 ± 0.67 (95% CI: 2.04-2.16) in electrodiagnostically mild CTS, 12.95 ± 4.74 mm2 (95% CI: 12.41-13.59) and 2.49 ± 1.04 (95% CI: 2.37, 2.63) in electrodiagnostically moderate CTS, and 14.69 ± 5.38 mm2 (95% CI: 13.95-15.44) and 2.71 ± 1.02 (95% CI: 2.56-2.84) in electrodiagnostically severe CTS, respectively. This study suggests a direct association between electrodiagnostic severity and ultrasound measurements of the median nerve in patients with suspected CTS.

Effect of low level laser therapy versus pulsed ultrasound on postpartum carpal tunnel syndrome

Background. Carpal tunnel syndrome (CTS) is a major health issue that can impede postpartum women's activities and skills in both their personal and professional lives. Purpose. To compare the effectiveness of low-level laser therapy (LLLT) and pulsed ultrasound (US) in relieving postpartum CTS. Methods. Forty-eight women with mild to moderate CTS were divided into three groups. In addition to wrist exercises, Group (A) (n = 16) received LLLT, Group (B) (n = 16) received pulsed US, and Group (C) (n = 16) performed wrist exercises alone. For all groups, the treatment sessions were applied to the affected hand, 3 sessions weekly for four weeks. All postpartum women were evaluated pre- and post-treatment via a visual analogue scale (VAS) for pain intensity, the Boston Questionnaire of CTS (BCTS) for diagnosing CTS symptoms, electromyography for measuring motor conduction velocity (MCV), sensory conduction velocity (SCV), motor distal latency (MDL), and sensory peak latency (SPL), and a hand grip dynamometer for assessing hand grip strength. Results. All measured variables were significantly improved in the three groups post-treatment compared to pre-treatment. Between-groups comparison showed a highly significant decrease in the VAS, BCTS, and SPL and a significant increase of SCV and hand grip strength between groups A and C in favor of group A and between groups B and C in favor of group B, while the significant change in MDL and MCV was found between groups A and C only in favor of group A (p &lt; 0.05), with no significant change in all outcome measures between groups A and B (P &gt; 0.05). Conclusion. Either LLLT or pulsed US are useful modalities that can be used as an effective conservative therapy for alleviating postpartum CTS.

Application of radiomics model based on ultrasound image features in the prediction of carpal tunnel syndrome severity.

The aim of our study is to develop and validate a radiomics model based on ultrasound image features for predicting carpal tunnel syndrome (CTS) severity. This retrospective study included 237 CTS hands (106 for mild symptom, 68 for moderate symptom and 63 for severe symptom). There were no statistically significant differences among the three groups in terms of age, gender, race, etc. The data set was randomly divided into a training set and a test set in a ratio of 7:3. Firstly, a senior musculoskeletal ultrasound expert measures the cross-sectional area of median nerve (MN) at the scaphoid-pisiform level. Subsequently, a recursive feature elimination (RFE) method was used to identify the most discriminative radiomic features of each MN at the entrance of the carpal tunnel. Eventually, a random forest model was employed to classify the selected features for prediction. To evaluate the performance of the model, the confusion matrix, receiver operating characteristic (ROC) curves, and F1 values were calculated and plotted correspondingly. The prediction capability of the radiomics model was significantly better than that of ultrasound measurements when 10 robust features were selected. The training set performed perfect classification with 100% accuracy for all participants, while the testing set performed accurate classification of severity for 76.39% of participants with F1 values of 80.00, 63.40, and 84.80 for predicting mild, moderate, and severe CTS, respectively. Comparably, the F1 values for mild, moderate, and severe CTS predicted based on the MN cross-sectional area were 76.46, 57.78, and 64.00, respectively.. This radiomics model based on ultrasound images has certain value in distinguishing the severity of CTS, and was slightly superior to using only MN cross-sectional area for judgment. Although its diagnostic efficacy was still inferior to that of neuroelectrophysiology. However, this method was non-invasive and did not require additional costs, and could provide additional information for clinical physicians to develop diagnosis and treatment plans.

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.

Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluation.

Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.