Moderate Carpal Tunnel Syndrome Research Articles

Superb Microvascular Imaging of the Median Nerve in Carpal Tunnel Syndrome: An Electrodiagnostic and Ultrasonographic Study.

To evaluate intraneural blood flow of the median nerve using superb microvascular imaging (SMI) and power Doppler ultrasonography (PDUS), and to examine their correlation with electroneuromyography in patients with carpal tunnel syndrome (CTS). A cross-sectional survey was used, and the study was conducted in the research unit of a training and research hospital. Patients diagnosed with CTS according to electroneuromyography studies were included in the study. Ultrasound measurements were taken using an Aplio-500 (Toshiba Medical System Corporation, Tokyo, Japan) device and a linear multifrequency 14-MHz probe. The cross-sectional area of the median nerve at the carpal tunnel level was measured by the direct tracing method using electronic calipers. The power Doppler ultrasonography and superb microvascular imaging scores were recorded by grading the vascularity between 0 and 3. Evaluation was made of a total of 113 hands of 80 patients (18 men, 62 women) with a mean age of 34.67 ± 12.82 years. The mean duration of symptoms was 12.34 ± 6.66 months. When the patients were grouped as mild, moderate, and severe CTS, there was a statistically significant difference between the SMI and PDUS grades (P < .05). As the severity of CTS increased, an increase in SMI and PDUS scores was observed. There was a strong correlation between SMI scores and motor distal latency (r = .71/P = .026), amplitude of sensory action potential (r = -.77/P = .029), and sensory neurotransmission rate (r = .77/P = .029). SMI seems to be more sensitive than PDUS for evaluating the vascularity of the median nerve in patients with CTS, and SMI grading is correlated with the ENMG results.

A randomized, controlled trial of magnetic therapy for carpal tunnel syndrome.

Magnet therapy has been proposed as a treatment for neurologic conditions. In this this trial we assessed the feasibility and efficacy of a magnet inserted into a wristband for carpal tunnel syndrome (CTS). Twenty-two patients with mild to moderate CTS were randomized to wear a high-dose or low-dose "sham" magnetic wristband for 6 weeks. The primary outcome was the Symptom Severity Scale (SSS) of the Boston Carpal Tunnel Questionnaire. Secondary measures were nerve conduction studies (NCS), median nerve ultrasound, and compliance. Compliance for both groups was >90%. Improvements in the mean SSS, NCS, and median nerve ultrasound did not reach statistical significance. Magnet therapy via wristband is well-tolerated. Further investigations in larger populations are needed to determine efficacy. Muscle Nerve 58: 310-313, 2018.

Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study

PurposeThe aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). Study DesignA single-blind randomized controlled study. MethodsPatients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. ResultsThere were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05). ConclusionAdding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS.

Comparison of the Efficacy of Carpal Tunnel Release vs. Local Steroid Injection in the Management of Mild to Moderate Carpal Tunnel Syndrome: A Clinical Trial

Comparison of the Efficacy of Carpal Tunnel Release vs. Local Steroid Injection in the Management of Mild to Moderate Carpal Tunnel Syndrome: A Clinical Trial

Case-control study on individual risk factors of carpal tunnel syndrome.

This study was conducted to observe the characteristics of the risk factors of carpal tunnel syndrome (CTS) in Chinese population. CTS of 1,512 outpatients aged 41–70 years were without any other diseases which could cause numbness as a case group, and 4,536 non-CTS outpatients as a control group were involved in the study in 2013–2014. Both groups received a questionnaire and the case group received another electrical physiological examination. The results showed the odds ratio (OR) of age is 0.990 (95% CI, 0.984–0.996). The OR of BMI is 1.096 (95% CI, 1.077–1.115). The OR of smoking is 4.862 (95% CI, 3.991–5.925). The OR of wrist injury is 1.313 (95% CI, 1.019–1.691). The OR of diabetes mellitus is 1.837 (95% CI, 1.557–2.168). The OR of hypertension is 0.805 (95% CI, 0.688–0.942). The OR of hypothyroidism is 1.385 (95% CI, 1.119–1.715). The OR of rheumatic disease is 4.450 (95% CI, 3.712–5.215). The results showed that sex, age, smoking, wrist injury, diabetes mellitus, hypothyroidism and wrist working are all risk factors of CTS. Hypertension could be a protection factor of CTS in early phase but will increase the risk in a long-term high blood pressure. Smoking, alcohol and diabetes mellitus can be predictors of moderate and severe CTS.

Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial

BackgroundRecent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks.MethodsThe prospective randomized controlled trial compared efficacy in relieving pain and improving clinical function between single-dose rESWT and local corticosteroid injection (LCsI) over the mid-term (24 weeks). Twenty-five patients with mild to moderately severe CTS were randomized to receive either single-dose rESWT (n = 13) or LCsI (n = 12). Primary outcomes were evaluated using the Boston self-assessment questionnaire (BQ), while secondary outcomes used the Visual analogue scale (VAS) and electrodiagnostic parameters. Evaluations at baseline and at 1, 4, 12 and 24 weeks after treatment were performed.ResultsThere was significantly greater improvement in symptom severity scores, functional scores and Boston questionnaire scores at weeks 12 to 24 in the rESWT group compared to the LCsI group. When compared to the baseline, there was significant reduction of VAS and functional score in the rESWT group at weeks 12 and 24. The LCsI group had no statistically significant differences in VAS reduction and functional score of the same period.ConclusionsTreatment of CTS using single-dose rESWT has a carry-over effect lasting up to 24 weeks suggesting that single-dose rESWT is appropriate for treatment of mild to moderate CTS and provides longer-lasting benefits than LCsI.Trial registration(TCTR20150709001). Registered 9 July 2015

Effectiveness of Pelotherapy in carpal tunnel síndrome

Carpal tunnel syndrome (CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-tomoderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1) (n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2) (n = 28), patients received splint treatment (every night for 6 weeks) alone. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), hand grip strength (HGS), finger grip strength (FGS), and Short Form-12 (SF-12). The data were obtained before treatment (W0), immediately after treatment (W2), and one month after treatment (W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0 (p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2 (p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 (p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment (W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

Ultrasonography Predictive Factors of Response to Local Steroid Injection in Patients with Carpal Tunnel Syndrome.

Background:The aim of this study is to determine the predictive value of ultrasonography for results of local steroid injection in patients with carpal tunnel syndrome (CTS).Materials and Methods:This prospective cohort study was conducted during a 1-year period in outpatient clinics of rehabilitation and physical medicine including 35 patients with moderate and severe CTS who receive ultrasonography-guided local steroid injection. The Boston self-assessment questionnaire and electrodiagnosis parameters were recorded at baseline, 1 month, and 3 months after therapy. We also recorded the baseline ultrasonography parameters to determine the predictors of outcome.Results:The sensory severity score and functional status scale along with electrodiagnosis parameters decreased significantly at 1 month (P < 0.001) and remained unchanged after 3 months. Volar bulging was negatively associated with sensory nerve action potential latency (r = −0.392; P = 0.020). Cross-sectional area (CSA) of maximal swelling (MS; r = 0.409; P = 0.015), CSA at 2-cm of MS (r = 0.563; P < 0.001), and CSA at 12-cm of MS (r = 0.521; P = 0.001) correlated positively with compound muscle action potential (CMAP) amplitude while maximal swelling/12-cm MS ratio (r = −0.439; P = 0.008) and maximal swelling/2-cm MS ratio (r = −0.342; P = 0.045) correlated negatively. CSA at 12-cm of MS also correlated positively with CMAP amplitude nerve conduction velocity (r = 0.436; P = 0.010).Conclusion:Volar bulging, CSA of maximal swelling, CSA of MS at 2-cm, and CSA of MS at 12-cm are among the ultrasonographic predictors of response to local steroid injection in patients with CTS.

Platelet-rich plasma ultrasound-guided injection in the treatment of carpal tunnel syndrome: A placebo-controlled clinical study.

The purpose of this study is to demonstrate whether and to what extent a single injection of platelet-rich plasma (PRP), under ultrasound guidance, can improve the clinical symptoms of patients with a mild to moderate carpal tunnel syndrome (CTS). We conducted a prospective, randomized, clinical study including 50 patients suffering from mild to moderate CTS for a minimum duration of 3months. Patients were randomly divided into 2 groups: Group A (26 patients) received an ultrasound-guided PRP injection into the carpal tunnel, whereas Group B (24 patients) was injected with placebo (0.9% normal saline). The short- and mid-term outcomes were determined with the use of the Q-DASH questionnaire and the pain scale VAS administered at 0, 4, and 12weeks follow-up. The success ratio was determined by the difference in the Q-DASH obtained pre-injection minus the final Q-DASH obtained after 12weeks follow-up. Success was defined as a difference more than 25%. Group A patients demonstrated a 76.9% success as determined by the difference Q-DASH, whereas Group B patients demonstrated 33.3% success, which was significantly less than Group A (Χ2 , p=.011). The findings of this study suggest that a single PRP ultrasound-guided injection has positive effects in patients with CTS.

L-Acetyl-carnitine in Patients with Carpal Tunnel Syndrome: Effects on Nerve Protection, Hand Function and Pain.

Background and Aim l-Acetyl-carnitine (LAC) exerts an energetic effect on nerves and muscles. Recently, preclinical experiments have demonstrated a central anti-nociceptive action.ObjectiveOur objective was to assess the effects of LAC on neuroprotection, pain, and function in carpal tunnel syndrome (CTS), a very frequent chronic compressive neuropathy.MethodsIn a multicentre, examiner-blinded, clinical and neurophysiological 4-month study, we enrolled 82 patients and examined 120 hands with CTS of mild to moderate severity. Patients were assessed at baseline and 10, 60 and 120 days after treatment with LAC 500 mg twice daily (BID). All patients underwent a conduction study of the median nerve, the Boston Carpal Tunnel Questionnaire (BCTQ) and the Neuropathic Pain Symptom Inventory (NPSI). The primary endpoint was the sensory conduction velocity (SCV) of the median nerve.ResultsThe primary endpoint was met, with significant improvement of the SCV (P < 0.0001). All sensory neurophysiological measures also significantly improved. BCTQ score changed significantly (P < 0.0001), with a greater improvement in the symptom component. Nine of the NPSI types of pain, particularly squeezing and pressure pain and pain evoked by pressure, showed a significant reduction (P < 0.0001).ConclusionsOur clinical and neurophysiological study indicated that 4 months of treatment with LAC exerted a neuroprotective effect. LAC reduced pain in patients with mild and moderate CTS, a result that is possibly due to both its neuroprotective action and its central anti-nociceptive properties.Clinical Trials Registration code: EudraCT 2014-002289-62.Electronic supplementary materialThe online version of this article (10.1007/s40263-017-0476-2) contains supplementary material, which is available to authorized users.

The Effect of Scaphoid and Hamate Mobilization on Treatment of Patients with Carpal Tunnel Syndrome.

BackgroundThis study was to evaluate the effect of hamate and scaphoid bone mobilization alongside splinting in women with carpal tunnel syndrome.MethodsIn this randomized clinical trial, 40 participants were randomly assigned into 2 groups. The intervention group received splinting with scaphoid and hamate mobilization, while the control group received splinting only. Outcome variables were pain (based on visual analogue scale), symptom severity and functional status (based on Boston questionnaire), and nerve conduction study measured before and 10 weeks after the treatments.ResultsAt the end of study, both groups showed an improvement in pain and symptom severity, functional status as well as median nerve conduction study. Although there was no statistically significant difference between groups regarding changes in median nerve sensory and motor distal latencies; the improvement was significantly higher in pain and symptom severity as well as functional status in mobilization group (P-Value < 0.05).ConclusionsHamate and scaphoid mobilization can be used as an effective option in women with mild to moderate carpal tunnel syndrome. Further investigation is required for determining long-term effects and cost-effectiveness of mobilization in carpal tunnel syndrome.

Effects of Low-Level Laser Therapy and Transcutaneous Electrical Nerve Stimulation on Pain and Hand Function Following Carpal Tunnel Syndrome

Introduction: This study aimed to compare the short-term effects of Low-Level Laser Therapy (LLLT) and Transcutaneous Electrical Nerve Stimulation (TENS) on hand pain and function in patients with low or moderate levels of Carpal Tunnel Syndrome (CTS). Materials and Methods : Twenty-four patients with confirmed mild to moderate CTS were recruited for this study. The eligible patients were randomly divided into two groups: LLLT and TENS. Patients in the LLLT group were exposed to GaAlAs diode laser, 808 nm with 6.5 J/cm 2 for two points perpendicularly over the carpal area. Patients in the TENS group were treated daily by conventional TENS with 80 µs duration for a period of 30 minutes per day. All patients were treated daily, five days per week for a period of two weeks. The researchers performed clinical assessment using visual analogue scale and McGill Pain questionnaire for pain rating and Disabilities of the Arm, Shoulder and Hand questionnaire for functional scales. For statistical analysis, paired t-test was used in each group, and analysis of variance was used for comparison between groups. Results: All outcome measures in the LLLT group were substantially improved while the TENS group provided better pain sensation. Conclusion: This study documented that LLLT might be effective in reducing pain and improving function in patients with mild to moderate CTS. Electrical stimulation might have been effective (short term) in controlling pain in these patients. Keywords: Carpal Tunnel Syndrome; Function; Low-level Lasers; Pain; TENS

Evaluation of Vitamin D Levels in Women with Carpal Tunnel Syndrome

Background:For decades, the role of vitamin D was limited to the formation and maintenance of bone as well as homeostasis of calcium and phosphate. Vitamin D is a steroid molecule, mainly synthesized in the skin from 7 dehydro cholesterol by ultraviolet irradiation or obtained through the diet. The major circulating metabolite of vitamin D is 25(OH) Vitamin D (25(OH)D), with a half-life of 21–30 days. Serum concentration of 25(OH) D is the most reliable biochemical index of vitamin status. Aim: The goal of the present study was to investigate the relationship between vitamin D levels and carpal tunnel syndrome (CTS)Patients and Methods:This study included 50 female patients with mild to moderate CTS and assessed their serum 25-hydroxyvitamin D levels. We included patients with a diagnosis of CTS based on both the clinical symptoms and positive neurophysiology. Controls (electrophysiological negative symptomatic patients) were evaluated 50 patients matched with sex and age clinically by rheumatologist. Results: the mean age of patients with CTS symptoms and control group were 49.2 ± 10.6 (range 21–54) and 49.7 ± 10.6 (range 20–55), respectively, with no significant difference between the two groups (p = 0.534). Patients with CTS symptoms had significantly lower 25(OH) D levels compared to controls. There’s significance difference among the CTS patient regarding Boston Carpal Tunnel Questionnaire (BQ). Conclusion: a potential link between vitamin D status and the occurrence of CTS is suggested.

Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome.

Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS) as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms) and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms). Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047), intensity (p = 0.044) and area (p = 0.012) of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006). Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.

P227 Carpal tunnel syndrome grading using high-resolution ultrasonography

Introduction Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the wrist. The diagnosis of CTS has been a concern for physicians for a long time. The aim of this study is to evaluate the use of the median nerve (MN) cross-sectional area (CSA) in the wrist compared with the CSA in the forearm to grade the severity of carpal tunnel syndrome in Egyptian patients. Methods The cross sectional areas of the median nerve in the wrist and forearm were measured in 72 wrists that were diagnosed with carpal tunnel syndrome via nerve conduction studies (NCS) and 80 healthy wrists. The CTS group was subdivided into 3 subgroups (mild, moderate and severe CTS). The ratio of the cross sectional area of the median nerve in the wrist to that in the forearm (WFR) was used to calculate cutoff values for carpal tunnel syndrome grading. Results There were positive correlations between the CSAs of the MN in the wrist and MN conduction latency. At a WFR of 1.7, the high resolution ultrasonography (HRUS) showed 96.1% accuracy in the detection of carpal tunnel syndrome. Conclusion As the disease severity increased, the CSA in the wrist showed significant increase among all groups so HRUS could be used for carpal tunnel grading.

P349 Assessment of prevalence and risk factors for carpal tunnel syndrome in polio survivors

Objective Carpal tunnel syndrome (CTS) is a commonly reported nerve entrapment syndrome in patients with chronic physical disabilities. It causes disability independent of underlying disease. In this study, we aimed to identify prevalence and risk factors for CTS in polio survivors. Methods Based on clinical and electrophysiological findings, 46 patients with prior paralytic poliomyelitis were selected from patients referred to clinical neurophysiology laboratory. The CTS was classified according to the severity of nerve conduction (NC) changes. Demographic factors, medical history, crutch or cane use, post-polio syndrome,body mass index (BMI), wrist index and Barthel index were compared between the polio survivors with CTS (CTS group) and without CTS (non-CTS group). A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. Results Prevalence of CTS confirmed by NC studies in polio survivors was 43.4% (20 patient). Eighteen (45%), 12 (30%) and 2 (%5) hands had mild, moderate and severe CTS, respectively. The age, BMI and wrist index were higher in the CTS group than in the non-CTS group (p Discussion Our study confirms a high occurrence of CTS in polio survivors. Conclusions Body mass index may be associated with prevalent CTS in polio survivors. Significance Prevention of weight gain in polio survivors may reduce the risk of CTS.

Effectiveness of Lavendula stoechas essential oil in treatment of mild to moderate carpal tunnel syndrome: A randomized controlled trial

Study DesignRandomized controlled trial. IntroductionCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. To date, no previous study has evaluated the efficacy of topical Lavendula stoechas (Lavender) oil in CTS patients. Purpose of the StudyTo investigate the effectiveness of topical Lavender essential oil in pain intensity, isometric pinch strength, electrophysiological features, and functional status of patients with mild to moderate CTS. MethodsForty eight patients with mild to moderate CTS were enrolled in this randomized placebo-controlled trial. Group A was treated with night wrist orthotic and topical lavender oil ointment. Group B was treated with night wrist orthotic and a placebo ointment. Patients were evaluated at baseline, and after 40 days of intervention with Boston CTS questionnaire (BCTQ), visual analog scale (VAS) for pain, pinch grip strength, power grip, median compound motor action potential latency, and median sensory nerve action potential latency. ResultsAt the end of the study period, both groups improved significantly in terms of BCTQ, VAS, isometric pinch powers, and electrodiagnosis study parameters. However, group A showed significantly greater improvements in BCTQ (mean difference, 0.39 ± 0.31 vs 0.6 ± 0.35; P = .03), VAS (3.37 ± 1.86 vs 1.33 ± 2.07; P = .001), and pinch grip strength (0.73 ± 0.63 vs 0.27 ± 0.54; P = .01) than group B. No significant differences in power grip, median compound motor action potential latency, and median sensory nerve action potential latency were seen between the 2 groups. ConclusionThis study was the first trial of topical lavender oil used in patients with CTS. Wrist orthotic combined with topical lavender oil was more effective than orthotic and placebo in treatment of mild to moderate CTS. Level of Evidence1b.

Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3weeks) alone and splint (during the night and day time as much as possible for 3weeks)+paraffin treatment (five consecutive days a week for 3weeks). Clinical and electrophysiological assessments were performed before and 3weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values (p<0.05). There was no significant improvement in functional capacity score (p>0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group (p<0.05). Significant improvements were demonstrated in both scorers in the combined treatment group. Similarly, significant improvements were found in the combined treatment group in terms of motor and sensory distal latency, sensory amplitude, and median sensory nerve velocity (p<0.05). There was no significant change in electrophysiologic parameters in the splint group (p>0.05), and the difference in these parameters between the groups was statistically significant (p<0.05). In conclusion, using splinting alone in patients with CTS is an effective treatment for reducing symptoms in the early stages. Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

The Effect of Hand Dominance on Patient-Reported Outcomes of Carpal Tunnel Release in Patients with Bilateral Carpal Tunnel Syndrome.

There is a paucity of studies in published literature that examines the effect of hand dominance on the resolution of symptoms following a carpal tunnel release. The objective of this study is to examine the effect of hand dominance on the resolution of symptoms following surgical decompression in patients with severe and moderate carpal tunnel syndrome. Bilateral carpal tunnel release (total 90 open and 84 endoscopic) was performed on 87 patients (11 males, 76 females) presenting with bilateral severe or moderate carpal tunnel syndrome of equal severity. Patient-reported outcome of resolution of symptoms were recorded, with patients followed up until complete resolution of symptoms or last recorded consultation (mean follow-up duration 11.4 months, range 3.1 to 32.4 months). In patients with bilateral severe carpal tunnel syndrome, a larger proportion of non-dominant hand (75.4%) achieved complete resolution compared to dominant hand (72.1%), and did so at a statistically shorter time (mean: 52.3 days) than the dominant hand (mean: 81.0 days). However, there was no statistically significant difference between proportion of patients and time taken before complete resolution of symptoms between dominant and non-dominant hand in patients with bilateral moderate carpal tunnel syndrome. Symptoms in the non-dominant hand resolved faster after carpal tunnel release in patients with severe carpal tunnel syndrome. We postulate that greater daily activity by the dominant hand compared to the non-dominant hand may be a contributing factor to its slower rate of symptoms resolution post-surgically in patients with bilateral severe carpal tunnel syndrome. This effect of hand dominance is not evident in post-surgical patients with moderate carpal tunnel syndrome.

Treatment of mild to moderate carpal tunnel syndrome in patients with diabetic neuropathy using low level laser therapy versus ultrasound controlled comparative study

AimThe aim of the present study was to investigate and compare between Low Level Laser Therapy (LLLT) and Ultrasound (US) in treatment of Carpal Tunnel Syndrome (CTS) using the advantage of application of treatment directly over the transverse carpal ligament, as well as over the course of the median nerve in the forearm simultaneously. DesignFifty patients (25–55years) with diabetic neuropathy, diagnosed as unilateral carpal tunnel syndrome participated in the study. They were equally divided and randomly assigned into two groups; each group consisted of 25 patients. Materials and methodsPatients in group (A) received a program of IR Gallium Arsenide LLLT (wavelength 904nm, average power 20mW, laser probe 7mm diameter), with a total application of 4.8J, while patients in group (B) received a program of US (frequency 1MHz, power 1.0W/cm2, pulsed mode 1:5). Results & discussionThe results of our study showed that there were no statistical significance differences (P>0.05) were observed between the two groups. It was concluded that both low level laser (20mW power, 904nm Wavelength) and ultrasound (1.0w/cm2 power, 1MHz frequency) are effective in the treatment of mild and moderate CTS patients.