Moderate Carpal Tunnel Syndrome Research Articles

Neuroelectrophysiological Evaluation of Carpal Tunnel Syndrome before and after Surgical Intervention

Background: Carpal tunnel release operation (CTR) is required to alleviate the symptoms of carpal tunnel syndrome (CTS), the most common entrapment neuropathy. Methods: Thirty-two patients (39 hands) of CTS were subdivided into Group I is moderate CTS (n = 9 hands), Group II is severe CTS (n = 14 hands), and Group III is extreme CTS (n = 16 hands) and underwent conventional electrophysiological evaluation and short segment transcarpal nerve conduction studies preoperatively and 1 and 3 months after open CTR operation. Results: In the case of motor conduction parameter, distal motor latency showed statistically significant improvement after 1 month of CTR (P < 0.05) in all three groups of patients, and improvement consistently increased during 3rd month follow-up (P < 0.001). In Group III patients, preoperatively forearm motor conduction velocity (FMCV) and transcarpal motor conduction velocity (TMCV) were nonrecordable, FMCV became recordable in 6 hands, while TMCV in all 16 hands post CTR. In case sensory parameters, both distal sensory latency (DSL) and sensory nerve conduction velocity (SNCV) showed significant improvement in Group I, and no improvement was noted in Group III patients. Group II (6 of 14 hands) patients showed a reappearance of DSL and SNCV at 1-month follow-up and continued a steady improvement in 3rd month after CTR. Conclusion: We found that TMCV is a more sensitive parameter in assessing improvement of median nerve function after CTR. It is possible to identify patients with a poor outcome by performing electrophysiological studies.

Effectiveness of high intensity laser therapy on pain, grip strength and median nerve conductivity in pregnant women with carpal tunnel syndrome: A randomized controlled trial

Study designSingle-blind randomized controlled trial. IntroductionHigh-intensity laser therapy (HILT) was recently introduced to the physiotherapy field as a treatment option for patients with carpal tunnel syndrome (CTS). However, evidence about its effectiveness on pregnant women with CTS is sparse. Purpose of studyTo test the effectiveness of HILT combined with a conventional physical therapy program to reduce pain intensity, sensory and motor nerve distal latency, and increase grip strength in pregnant women with CTS compared with the physical therapy alone. MethodsFifty-four pregnant women with mild to moderate CTS were randomized and further allocated into two groups. The HILT group (n = 27) received both HILT and conventional physical therapy, and the control group (n = 27) received only physical therapy, including nerve and tendon gliding exercises and the use of an orthotic device. Participants received the interventions at the University Hospital (omitted for review) three times per week for 5 weeks. An 11-points numerical pain rating scale, electromyography, and a handheld dynamometer were used for data collection before and after the treatment. ResultsParticipants from both groups presented significant improvement in the median nerve motor nerve distal latency (MNDL), sensory nerve distal latency, numerical pain rating scale, and handgrip strength after the intervention. The between-group difference showed more improvements in participants of the HILT group on reducing pain intensity, mean difference (MD) = -3.11 (-4.1 to 2.1), and sensory nerve distal latency, MD = -0.3 (-0.5 to -0.1) compared with the control group. DiscussionHILT produced greater improvement in outcomes of pregnant women with mild to moderate CTS whichsuggests that adding HILT to traditional CTS physical therapy protocol is beneficial and safe. ConclusionsHigh-intensity laser therapy combined with a standard physical therapy program for CTS in pregnant women is better than the physical therapy program alone to improve pain intensity and median nerve sensory distal latency.

Comparative Efficacy of Routine Physical Therapy with and without Neuromobilization in the Treatment of Patients with Mild to Moderate Carpal Tunnel Syndrome.

Background Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Long-Term Outcome of Electrodiagnostic Values and Symptom Improvement After Carpal Tunnel Release: A Retrospective Cohort Study

The aim of this study was to evaluate electrodiagnostic studies and clinical outcomes after carpal tunnel release surgery in moderate and severe cases of carpal tunnel syndrome (CTS). Seventy-two patients with moderate or severe CTS who underwent carpal tunnel release surgery (46 unilateral; 26 bilateral; total, 98 surgeries) between 2009 and 2014 were included in the study. The cases were divided into 2 groups according to electrodiagnostic results: those with moderate CTS and those with severe CTS. Michigan Hand Outcomes Questionnaire scores and electrodiagnostic data (sensory nerve action potentials and compound muscle action potentials) were recorded before surgery and in postoperative follow-up studies obtained at 3 months, 1 year, and 5 years. There were 56 surgeries in the moderate CTS group and 42 surgeries in the severe CTS group. Sensory nerve action potentials and compound muscle action potentials were significantly lower in the severe CTS group when compared to the moderate CTS group at all follow-up times. There was a significant difference in Michigan Hand Outcomes Questionnaire scores between the groups before surgery, but no significant differences at the final follow-up. It was found that the values of all parameters (sensory nerve action potentials, compound muscle action potentials, and Michigan Hand Outcomes Questionnaire score) demonstrated significant improvements with time in both the severe and the moderate CTS groups. Carpal tunnel release surgery improves symptoms, regardless of the preoperative severity. Postoperative electrodiagnostic study results of patients with moderate CTS improve to a greater degree than those of patients with severe CTS, but all remain abnormal. Prognosis IIb.

Efficacy of local injection therapy versus wrist splinting in moderate idiopathic carpal tunnel syndrome: the results of a randomized clinical trial

Background. Carpal tunnel syndrome is the most common compression mononeuropathy. The choice of the preferred conservative treatment method is still relevant, especially for the patients with the moderate severity of the disease. Objective: to perform a comparative study of the effectiveness of local injection therapy and wrist splinting in idiopathic moderate carpal tunnel syndrome; to assess the duration of the clinical effect in the follow‑up period to 6 months. Materials and methods. The study included 105 cases of moderate idiopathic carpal tunnel syndrome. Patients were randomized to 2 groups depending on the treatment method: the main group (n = 54) received 1 or 2 ultrasound‑guided injections with glucocorticosteroid (betamethasone 5 mg + 2 mg/1.0 ml) and lidocaine 2 % 1.0 ml into the carpal canal; the control group (n = 51) was assigned wrist splinting at night for 1 month. The primary criterion for therapy effectiveness was evaluation by clinical scales (SSS, FSS, LANSS, Visual Analogue Scale) after 1 month from the treatment initiation. A secondary criterion for the therapy effectiveness was the assessment of changes in electrophysiological and neurosonographic parameters.Results. The scores for SSS, FSS, LANSS and Visual Analogue Scale were significantly lower at 1 month in the injection therapy group than in the splinting group (p <0.0001). A significant change in the electrophysiological parameters of the median nerve (a decrease the distal motor and sensory latency, an increase in the Mand S‑response amplitude, an increase in sensory conduction velocity on the hand) and a significant decrease in the cross‑sectional area of the median nerve at the level of the pisiform bone was noted only in the local injection therapy group. The average duration of the local injection therapy clinical effect surpassed the splinting one and reached 4 months.Conclusion. After 1 month from the start of the treatment, the local injection therapy demonstrated a higher clinical efficacy compared to the wrist splinting, the average duration of the effect reached 4 months. This conservative treatment method is preferred for the patients with moderate idiopathic carpal tunnel syndrome.

Case-Control Study on Individual Risk Factors of Carpal Tunnel Syndrome in Bangladeshi Population

Introduction: Carpal tunnel syndrome (CTS) is a symptomatic compression neuropathy of the median nerve at the level of the wrist, physiologically characterized by increased pressure within the carpal tunnel and a decreased function of the nerve at that level. With the prevalence estimated between 7% and 18% of the adult population, CTS is the most common entrapment neuropathy of the upper extremities. It is the most common neuro-compressive disease. Objective: To assess the individual risk factors of carpal tunnel syndrome In Bangladeshi Population. Materials and Methods: The present case-control study was conduct at the Dept. of Neurology, Uttara Adhunik Medical College Hospital (UAMCH), Uttara, Dhaka, Bangladesh from January 2019 to December 2021. 3019 patients included in our study and who were diagnosed in the 84% of patients were aged 41-70 years both case and control groups. Both groups filled out a standardized questionnaire, and a standardized patient record was filled out by Neurology Department. In addition, participants with jobs involving lifting and carrying of loads were interviewed. The incidence of CTS in middle aged women was significantly higher than that in men. Results: In our study 3019 patients who were diagnosed in the 84% of patients were aged 41-70 years. Among these patients, there were 756 CTS patients aged 41-70 years without any other diseases which could cause numbness as the case group. Then there were 2263 non-CTS outpatients involved as the control group. The average BMI in case group was 22.79±2.60 and 21.49±5.03 in control group with significant difference (P<0.01). 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. ......................

Neurodynamics Is an Effective Intervention for Carpal Tunnel Syndrome.

Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS.

Effectiveness of ultrasound-guided local steroid injection to the wrist for the treatment of carpal tunnel syndrome: Is it worth it?

BackgroundCarpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist level and the most frequent entrapment neuropathy in the upper limb. It can be treated with surgical or non-surgical methods. When nonsurgical treatment is indicated, a local corticosteroid injection into the carpal tunnel can be used to reduce pain and tingling sensation. To assess the clinical outcomes and effectiveness of patient satisfaction following ultrasound-guided steroid injection for the treatment of carpal tunnel syndrome.ResultsThe study comprises 44 female (73%) and 16 (27%) male patients, with a mean age of 57 (27–84) years. Thirty-one patients were left-handed and 29 right-handed. Twenty-six (43%) injections were performed on the right side, 8 (13%) on the left, and 26 were bilateral. Fifty-six hands of thirty-seven (70%) patients reported significant improvement symptoms, five (8%) had temporary improvement with recurrence, seventeen patients (28%) failed to improve, and one patient’s symptoms have resolved before intervention. Among temporary responders and nonresponders, two were referred to the neurologist for further evaluation. Out of twenty patients, fourteen patients (23%) had surgical decompression of carpal tunnel with complete resolution of symptoms, four patients had opted for repeat injections, and two patients refused any further intervention.ConclusionsThe use of ultrasound-guided injection for the treatment of mild to moderate carpal tunnel syndrome is a practical procedure before offering surgical treatment. It is also appropriate for the patient with significant medical problems or not willing to undergo surgical intervention. Its ultrasound guide reduces injection-related complications, improves patient satisfaction, is cost-effective, and improves patient compliance.

Effectiveness of therapeutic ultrasound for the treatment of carpal tunnel syndrome (the USTINCTS trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial

IntroductionThere has no consensus on optimal management of carpal tunnel syndrome (CTS), the most common compression neuropathy. Conservative therapy is generally accepted as first-line intervention. Therapeutic ultrasound has been widely...

Intracarpal midazolam: does it offer better pain relief than dexamethasone in carpal tunnel syndrome patients? A randomized double-blind clinical trial

ABSTRACT Background Intracarpal injection of steroids has produced favorable effects in patients with carpal tunnel syndrome (CTS); however, it still carries some drawbacks. Perineural midazolam injection has some promising effects in chronic neuralgia. This study focused upon pain visual analog scale (VAS) improvement, and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) improvements when comparing intracarpal injection of midazolam versus dexamethasone. Methods One hundred and thirty-four patients with mild to moderate CTS were randomized (1:1 ratio) to receive intracarpal 3 ml bupivacaine 0.5% with either 8 mg dexamethasone in 2 ml saline (group DX) or 2 mg midazolam in 2 ml saline (group MZ). VAS and BCTQ were assessed preintervention and postintervention (1st week, 1st, 3rd, and 6th months) Results The VAS showed a significantly lower value in MZ than the DX group with median value of 2 (maximum-minimum = 1–3) in MZ and 4 (2–5) in DX by the 6th month p = 0.049. Intragroup comparison of follow-up VAS to the baseline value showed significant decreases in the MZ group during the whole study period, whereas in DX the decrease was noticed by the 1st week and 1st month only. In postinterventional BCTQ, both symptom severity (SSS) and functional severity (FSS) scores were significantly lower in MZ rather than DX group after the 1st, 3rd, and 6thmonths where SSS (p = 0.029, 0.048, 0.04) and FSS (p = 0.04, 0.019, 0.003) in consequence. Conclusions Intracarpal injection of midazolam offers a longer duration of pain relief and higher hand functional improvement scores in comparison to dexamethasone.

The efficacy of ultrasound and low-intensity laser therapy in carpal tunnel syndrome

Aim: The most frequent type of peripheral entrapment neuropathy is carpal tunnel syndrome (CTS), which is caused by compression of the median nerve at the wrist level. Ultrasound (US) and low-intensity laser therapy (LILT) are among the most commonly used physical therapy methods in the treatment of CTS. The aim of this study is to examine the efficacy of US and LILT in the treatment of CTS and their superiority to each other.
 Material and Method: Patients who were admitted to the physical therapy program with the diagnosis of CTS in our clinic were retrospectively examined. A total of eleven patients (18 wrists) diagnosed with mild and moderate CTS were included in our study with the G-Power program with a 5 % margin of error and 80 % power. Patients were divided into US and LILT groups using a simple randomization method. The patients were evaluated in terms of clinical and electrophysiological parameters before and after treatment.
 Results: A total of 18 wrists were included in our study, of which eight patients were diagnosed with mild CTS and the rest (n=10) with moderate CTS. The mean age of the patients was 49.66±10.68 years. When the post-treatment clinical (Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), hand and pinch grip strength, measurement of wrist joint range of motion) and electrophysiological parameters were evaluated between the US and LILT groups, no significant difference was found in terms of their superiority over each other (p>0.05). When the LILT group was compared before and after treatment, a statistically significant difference was found in the degree of wrist extension, handgrip strength and BCTQ parameters. (p

Physiotherapy and sports therapeutic interventions for treatment of carpal tunnel syndrome : Asystematic review

HintergrundDie Behandlung des Karpaltunnelsyndroms (KTS) besteht in der Regel in einer operativen Dekompression des Nervs oder Schienung und einer zusätzlichen medikamentösen Therapie. Physio- und Sporttherapie können eine nichtinvasive und gleichzeitig nebenwirkungsarme Alternative darstellen.ZielDie vorliegende Übersichtsarbeit fasst aktuelle Studien zur Wirksamkeit von physio- und sporttherapeutischen Interventionen für die Therapie des KTS systematisch zusammen und fokussiert auf die Reduktion der Symptome sowie als sekundäres Outcome auf die Verbesserung der Funktionalität der Hand.Material und MethodenDas systematische Review integriert randomisierte, kontrollierte Studien mit physio- oder sporttherapeutischen Interventionen, die in den elektronischen Datenbanken PubMed, CINAHL und Web of Science bis Februar 2021 publiziert wurden. Den Richtlinien von Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) und der Cochrane Collaboration folgend wurden eine systematische Suche der Literatur, eine Datenextraktion und eine Bewertung des „risk of bias“ anhand des Cochrane Risk of Bias Tool von zwei unabhängigen Reviewern durchgeführt.ErgebnisseVon 461 identifizierten Studien konnten n = 26 in die qualitative Analyse einbezogen werden. Das Biasrisiko über die einzelnen Studien ist als moderat bis gering einzustufen. Verzerrungspotenzial ergibt sich teilweise durch eine unzureichende Verblindung der Patient:innen und des Studienpersonals sowie durch eine selektive Berichterstattung der Studienergebnisse und der Durchführung. Die manuelle Therapie erwies sich im Vergleich zu einem operativen Eingriff als schneller und langfristig gleichermaßen zielführend in Bezug auf Schmerzreduktion und Funktionsverbesserung. Auch Mobilisationstechniken, Massagetechniken und das Kinesiotaping sowie Yoga als therapeutische Interventionen zeigten positive Effekte.SchlussfolgerungIn der Therapie eines leichten bis mittelschweren KTS zeichnen sich physio- und sporttherapeutische Interventionen vor allem durch Erfolge bereits nach 2‑wöchiger Behandlung aus, zudem durch vergleichbare Erfolge wie nach operativem Eingriff und 3‑monatiger postoperativer Behandlung. Zudem sind Patient:innen keinen Operationsrisiken ausgesetzt. Das Review ist im International Prospective Register of Systematic Reviews (PROSPERO) mit der Nr. 42017073839 registriert.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00482-022-00637-x) enthält die Datenextraktionstabelle.

Kinesio taping as an alternative treatment for manual laborers with carpal tunnel syndrome: A double-blind randomized clinical trial.

Carpal tunnel syndrome (CTS) is one of the most common forms of peripheral neuropathies due to median nerve compression. Occupational factors, such as repetitive hand motions are believed to be associated with this condition. This clinical trial assessed the effect of Kinesio taping (KT) of hand flexor muscles on the management of mild to moderate CTS in Iranian manual laborers. Thirty manual laborers with mild to moderate CTS participated in this clinical trial. They were assigned to an intervention or a control group. The treatment consisted of a 2-week KT followed by a 4-week follow-up. The control group received sham KT without tension applied. Boston Carpal Tunnel Questionnaire scores, pinch and grip force tests, and electrophysiological examination of the median nerve were performed for each participant at baseline, 24 to 48 hours, and two to four weeks of follow-up. The statistical analysis of variance was performed (2 groups × 5 times) for all participants, comparing differences in the data within and between the two groups. The baseline assessment revealed no inter-group differences in the clinical outcomes (P> 0.05). Comparisons of the changes in the electro-physiological and functional variables indicated significantly greater improvement in the KT group than in the sham counterpart (P< 0.05). No statically significant improvement was evident by the electrodiagnostic criteria in the sham-KT group (P> 0.05). KT is an effective, safe, reliable, and conservative therapeutic choice for the management of patients with CTS. The treatment does not restrict the daily activities of patients nor has it any side effects.

Assessment Of Carpal Tunnel Syndrome With Ultrasonography.

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy caused by compression of median nerve at wrist as it passes through Osseo fibrous canal known as carpal tunnel. Epidemiological statistics shows one in every ten people develops the disease at any stage of life. CTS mostly affect females than males with mean age of 50. Clinical features are considered to be enough for establishing the diagnosis of carpal tunnel syndrome. However, nerve conduction studies give quantitative information regarding median nerve function therefore good at predicting outcome of intervention. Ultrasound being easily available, cost effective and real time is a promising modality for diagnosis and grading carpal tunnel syndrome. This correlational study was conducted in collaboration of Neurology and Radiology Department of Pakistan Institute of Medical Sciences, Islamabad from January 2018 to January 2019. Total 50 patients with 85 wrists involved were included in the study. All patients with positive nerve conduction study were included. Patient with history of wrist trauma were not included. Detailed history and clinical features were recorded. All patients with positive result on nerve conduction studies underwent ultrasound examinations. Fifty control wrists were also included to establish the normal median nerve cross sectional area value in our study population. Results were recorded. Data was analyzed and appropriate statistical tests were applied by using SPSS v20. Mean cross sectional area of median nerve for controls was 6.34±1.23. Mean cross sectional area of median nerve for mild CTS was 8.05±1.72, moderate CTS was 11.15±2.32, severe was 17.49±4.93. Strong correlation was found between (r=0.76, p-value <0.0001) between increased cross-sectional area on Ultrasonography and severity of CTS on NCS. Other finding on Ultrasonography included flattening in 4 and fluid in 10 affected wrists. Increased cross-sectional area on Ultrasonography and severity of carpal tunnel syndrome on nerve conduction studies are very strongly correlated.

Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial.

The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS). Data from a randomized clinical trial (n = 104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity. Manual physical therapy improved function in women with CTS (between-groups difference:0.09; 95% CI = 0.07 to 0.11). The Bayesian network showed that early improvements (at 1month) in function and symptom severity led to long-term (at 12months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI = 0.11 to 0.17 point) poorer function at 12months than those with mild CTS and 0.12-point (95% CI = 0.09 to 0.15 point) poorer function at 12months than those with severe CTS. Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects. Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS.

Efficacy of Low Intensity Laser Therapy for Carpal Tunnel Syndrome: Experience of 54 Cases in Bangladesh

Background: Management of the carpal tunnel syndrome (CTS) is very crucial for the clinical outcomes of the patients.&#x0D; Objective: The purpose of the present study was to assess the effectiveness of low intensity laser therapy (LILT) for the management of carpal tunnel syndrome patients.&#x0D; Methodology: This single centered, parallel, single blinded randomized control trial was conducted in the Department of Physical Medicine and Rehabilitation at National Institute of Neurosciences &amp; Hospital, Dhaka, Bangladesh from January 2019 to June 2019 for a period of six months. All the Nerve Conduction Study (NCS) test confirmed cases of CTS patients with the age group of more than 18 years in both male and female were selected as study population. Patients who received regular nonsteroidal anti-inflammatory drugs or corticosteroids, patients treated with therapeutic modalities before, acute wrist trauma and surgery, cervical radiculopathy, thoracic outlet syndrome, tumor or infectious diseases, pregnancy, and any serious heart, liver or kidney diseases were excluded from this study. Patients were randomly assigned into two groups designed as group A and group B. The assignment was done with single blind method. Group A underwent laser therapy (3 Joules/cm2, 50 Hz, 2 min) over the carpal tunnel area. Group B were treated with conventional method. All patients received therapy for a total of 14 sessions, first 7 sessions on consecutive 7 days, and last 7 sessions on alternate days. Patients also used a wrist splint each night, practiced therapeutic exercises for CTS, and followed ADL advices. Patients were assessed according to BCTQ, Boston Carpal Tunnel Questionnaire.&#x0D; Result: Male-Female distribution was 9% &amp; 91% respectively. Total score of SSS was 26.35±5.94 and 13.70±1.78 in baseline and after 6 weeks follow up respectively (p &lt; 0.001) in group A. In group B, total score of SSS was 28.19 ±7.35 and 18.22 ± 5.63 in baseline and after 6 weeks follow up respectively (p &lt; 0.001). In group A, FSS was initially 18.1, which was improved to 9.15 in 6 weeks; whereas in group B, FSS was improved from 18.86 to 11.25. The pain, numbness and paresthesia also significantly changed after 6 weeks follow up in laser therapy group.&#x0D; Conclusion: Low intensity laser therapy has superior clinical effectiveness at 6 weeks compared with night-resting splints in mild or moderate CTS.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 103-107

Assessment of Carpal Tunnel Syndrome Severity by Ultrasound and Electrodiagnosis Study

Carpal tunnel syndrome (CTS) is the upper limb neuropathic entrapment. Electrodiagnostic study (EDX) is the gold standard for diagnosis. However, EDX is not always abnormal in CTS beside its relatively high cost which requires the search for alternative modalities. Objectives: To investigate ultrasound (US) has a function in the evalution of CTS as well as determination disease severity. Subjects and Methods: A case-control experiment which involve 50 CTS patients (65 wrists) and 30 healthy subjects (30 wrists). Electrodiagnostic study involve nerve coduction test (NCS) were performed for all included wrists, with ultrasound measure the cross-sectional area (CSA) of the median nerve. Results: The result of 65 affected wrists with CTS is classified for 40 (61.15%) wrist mild disease, 19 wrists (29.23%) demonstrated a moderate disease and 6 wrists (9.23%) had severe disease. The mean in mild, moderate, and severe cases, median nerve CSA was determined 11.21±1.22 mm2, 15.09±0.1.14 mm2 and 17.88±0.2.1 mm2, respectively with highly significant differences between the three categories. Furthermore, all three categories had higher CSA than control (8.73±0.45 mm2) with highly significant differences. In patients, CSA demonstrated a significant linked with median distal sensory latency (r = 0.71 8, p &lt;0.001), median motor distal latency (r = 0.818, p &lt; 0.001) and age (r = 0.316, p = 0.0 1) and a negative significant with median nerve conduction velocity (r= -0.837, p &lt; 0.001). US demonstrated excellent diagnostic values. The sensitivity and specificity of US in the context of discriminate patients and controls at cut off value of CSA = 10 mm2 were 92% and 100%, respectively. Furthermore, US can effectively discriminate between mild, moderate and severe cases CTS with sensitivity levels ranging from 83%- 100% and 94%-100% specificity. The optimal cut off values ranges between 13.2-16.2 mm2. Conclusions: The CSA of the median nerve is increased and the degree of enlargement significantly correlates with the parameters of disease severity. However, the CSA of the nerve does not associate with the gender of patients or the side of the affected wrist. Ultrasound of CST of median nerve has an excellent diagnostic value in the disinguish between patients and controls, with 92 percent sensitivity and 99 percent specificity, respectively. The optimum cut off value is 10 mm2. Also, US can effectively distinguish mild, moderate and severe cases CTS with Sensitivity levels ranging from 83%- 100% and 94%-100% Specificity. The optimal values cut off ranges between 13.2-16.2 mm2.

Prevalence of rheumatic disorders in Iranian chemical injured patients: a WHO–ILAR COPCORD Study

Background: Rheumatic disorders are one of the most prevalent human diseases which commonly become chronic and cause different types of disabilities. Chemical veterans may suffer from chronic difficulties caused by rheumatic disorders that can lead to decrease of their quality of life. The main purpose of this study was to evaluate the prevalence of rheumatic disorders among Iranian chemical warfare patient’s long-years after sulfur mustard (SM) exposure. Methods: This cross-sectional study was conducted from 2013 to 2014 on 245 Iranian chemical veterans. In order to evaluate rheumatic disorders, a special questionnaire for COPCORD studies were filled by veterans and then general and special rheumatology examinations were applied under the supervision of internists and rheumatologists. Data from all questionnaires were analyzed by SPSS software and the results were reported as percentage or mean ±SD. Results: Osteoarthritis (69.9%) was the most common complications diagnosed in these patients. After that back pain (30.5%) and pre-arthritis (27.2) were the other popular complications among veterans. The percentage of frozen shoulder and moderate carpal tunnel syndrome was 13.2% and 11.5%, respectively. Tennis elbow and fibromyalgia (3.7%), rheumatoid arthritis (0.8%) and gouty arthritis with 0.4% were the lowest complications among these patients. Conclusion: Rheumatic associated complications in Iranian chemical injured veterans are higher than the mean of whole community. This data provided the possibility of calculating the disease’s burden and making efficient decisions in the sanitary and treatment systems.

Efficacy of Ultrasound-Guided Particulate Versus Nonparticulate Steroid Injection in Carpal Tunnel Syndrome: An Open-Label Randomized Control Trial.

IntroductionPerineural corticosteroid injection is an extensively used and accepted treatment for carpal tunnel syndrome (CTS). However, to this date, there is no guideline as to which corticosteroid has to be used as the standard treatment for CTS. Triamcinolone acetonide is a commonly used particulate steroid that can cause permanent nerve injury if it is accidentally injected into the nerve. Conversely, dexamethasone sodium phosphate is a nonparticulate steroid that would not cause permanent nerve damage following accidental injection.MethodsMild to moderate cases of CTS, confirmed by nerve conduction studies (NCS), with symptoms greater than three months were recruited. The participants received one session of ultrasound-guided perineural injection by the in-plane axial ulnar-sided approach with 4 mL of either dexamethasone (dexamethasone sodium phosphate 8 mg (2 mL) + 2 mL 0.5% bupivacaine) or triamcinolone (triamcinolone acetonide 40 mg/mL (1 mL) + 2 mL 0.5% bupivacaine + 1 mL normal saline) solution. The parameters assessed were Phalen’s test time (in seconds), visual analog scale (VAS), and Boston carpal tunnel questionnaire (BCTQ) scores at baseline and two and four months, and NCS changes in sensory nerve conduction velocity (SNCV) and distal motor latency (DML) of the median nerve at baseline and four months. Statistical analysis was conducted using the software SPSS version 26.0 (IBM Corporation, Armonk, NY, USA). Independent samples t-test was used for comparison between groups and the paired t-test for improvement within each group. P values < 0.05 were considered statistically significant.ResultsThe mean age was 42.64 ± 10.99 in the dexamethasone and 45.22 ± 10.602 in the triamcinolone group cases (P = 0.324).There were 58 females (84.06%) and 11 males (15.94%). Each of Phalen’s test time, VAS, and BCTQ scores significantly improved within both dexamethasone and triamcinolone groups at the second and fourth months after injection (P < 0.05). The NCS parameters (SNCV and DML) also significantly improved in both groups at the fourth month after the injection (P < 0.05). However, there were no significant differences in the improvement of Phalen’s test time between the two groups (P = 0.745), VAS score (P = 0.319), BCTQ score (P = 0.137), SNCV (P = 0.511), or DML (P = 0.753). Postprocedural pain lasted significantly longer in the triamcinolone group (P < 0.05). No major complications were noted in either of the two groups.ConclusionDexamethasone is as effective as triamcinolone in improving the symptoms of CTS and can be used as a safer and more effective alternative in the treatment of mild to moderate CTS cases.

Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study.

To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1min per point at a wavelength of 830nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).