Moderate Idiopathic Carpal Tunnel Syndrome Research Articles

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.

Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review.

(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. (2) Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. (3) Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. (4) Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies.

A study of median nerve cross sectional area in patients with mild to moderate idiopathic carpal tunnel syndrome

Introduction: Carpal tunnel syndrome is the most common entrapment neuropathy and is caused by median nerve compression at the wrist as it passes through carpal tunnel.  Aim: To detect cross sectional area (CSA) of median nerve at the level of distal palmar crease and ratio of cross sectional area at level of proximal carpal tunnel to area 5 cm proximal to carpal tunnel using ultrasound. Materials and Methods: Consecutive patients of age between 18 and 70 years, who presented with paraesthesia of hands (aggravated by holding or keeping hand elevated or with history of nocturnal worsening) and electrophysiological confirmed as mild to moderate idiopathic cases of carpal tunnel syndrome were included in the study. Baseline nerve conduction study was done as per standard protocol for carpal tunnel syndrome. Nerve ultrasound was done with high frequency linear-array transducer (7-14 Hz). Results: 50 wrists in 30 Patients with CTS were studied. Females were more involved with a male: female ratio of 1:5. Mean age was 56.8 years (range 25–82 years). Majority of the cases were bilateral (67%). Dominant hand was involved more (80%) than non-dominant one. Most common symptoms were numbness (100%) and paraesthesia on holding (90.91%). On nerve ultrasound, all patients had CSA of median nerve at proximal carpal tunnel more than 10 square millimetre .The wrist fore-arm CSA ratio was more than 1 in all cases. Majority of the hands were having a cross sectional area 10-11.9 square millimetre and more than 16 square millimetre. We found correlation between CSA at distal palmar crease and median sensory conduction studies. Conclusion: Our study affirms previous studies in demonstrating the usefulness of ultrasonography in diagnosing CTS. Median nerve Cross-sectional area can be used for clinical screening of Carpal tunnel syndrome patients. Keyword: Carpal tunnel syndrome, Cross sectional area, Wrist-ultrasound.

Comparison of Corticosteroid Injection Dosages in Mild to Moderate Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial

ObjectivesTo evaluate whether the therapeutic effect of ultrasound-guided injections with 10 mg or 40 mg triamcinolone acetonide (TA) was dose-dependent in patients with idiopathic mild to moderate carpal tunnel syndrome (CTS). DesignProspective, double-blind, randomized controlled study with 12 weeks of follow-up. SettingRehabilitation outpatient clinic of a single medical center. ParticipantsPatients with CTS (N=56). InterventionParticipants were randomly assigned to 2 treatment groups for injection: (A) 40 mg TA+2% lidocaine hydrochloride or (B) 10 mg TA+2% lidocaine hydrochloride. Main Outcome MeasuresParticipants were evaluated using visual analog scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ, including Symptom Severity Scale [SSS] and Functional Status Scale [FSS]) at baseline and 6 and 12 weeks after injection). Nerve conduction studies, including parameters of distal motor latency, amplitude of compound motor action potential, amplitude of sensory nerve action potential and sensory nerve conduction velocity of median nerve, and the patient’s subjective impression of improvement, were recorded before injection and 6 and 12 weeks after injection. ResultsNo significant differences were observed in baseline demographic characteristics and clinical evaluations. The parameters in group A and B at baseline, 6 weeks, and 12 weeks were (1) SSS: 2.17±0.14, 1.19±0.04, and 1.34±0.09 and 1.87±0.11, 1.21±0.07, and 1.26±0.04; (2) FSS: 1.63±0.07, 1.27±0.06, and 1.33±0.08 and 1.50±0.10, 1.18±0.05, and 1.26±0.05; (3) VAS: 6.4±0.3, 2.2±0.3, and 3.0±0.1 and 6.7±0.3, 2.0±0.3, and 3.1±0.3, respectively, and significantly decreased after 6 and 12 weeks in both treatment groups (P<.05). All parameters of nerve conduction studies improved in both groups after 12 weeks (P<.05). VAS, BCTQ, and nerve conduction studies did not show significant intergroup differences after 6 and 12 weeks. ConclusionIn patients with idiopathic mild to moderate CTS, ultrasound-guided injection with 10 and 40 mg TA yield similar improvements in BCTQ, VAS, and nerve conduction studies at the 12-week follow-up.

Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Further studies are needed to reach concrete conclusion. To study the effect of PRP injection in treatment of mild to moderate idiopathic CTS. This is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to moderate CTS. They were randomly divided into two groups. Group 1: patients received ultrasound guided PRP injection and group 2 patients received ultrasound guided corticosteroid injection. The outcome measures were assessed via Visual Analog Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological findings in sensory and motor functions of median nerve and morphological changes of median nerve detected by ultrasound. This study included 150 patients suffered from mild to moderate idiopathic CTS 15 did not provide the written consent and 37 participants were excluded from the study based on the exclusion criteria leaving only 98 patients to participate in the study they were divided into two groups PRP Injection Group (PRP-inj-G) - this group included 49 patients (40 females and 9 males) steroid injection Group (St-inj-G) - included 49 patients (41 females and 8 males). At the beginning of study there was no significant difference between both groups in all parameters. (a) PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination (EDX) parameters of the median nerve (MN), and the median nerve cross sectional area (m-CSA) at 1month and 3months post-injection evaluation in comparison to baseline recordings; (b) local steroid injection had significantly improved the clinical manifestations, the EDX parameters of the MN, and the m-CSA at 1month and 3months post-injection evaluation in comparison to baseline recordings and (c) PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the MN motor conduction velocity along the wrist-elbow segment, the sensory latency (SL) and the MN sensory conduction, this superiority was observed in third month follow-up suggesting better outcomes in long-term follow-up. Platelet-rich plasma could be effective treatment of mild to moderate idiopathic CTS and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve. Clinical Trials.gov Identifier: NCT03863873Key Points:• PRP is effective treatment of mild to moderate CTS.• PRP is superior to corticosteroids in improving pain and function in CTS.

Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study.

The aim of this study was to investigate and compare the effectiveness of splinting and Kinesio taping (KT) as forms of treatment for patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) by evaluating the symptoms and measuring the range of function and electrophysiological findings. This single-blind, randomized, prospective study included 44 patients (58 hands) suffering mild to moderate idiopathic CTS according to nerve conduction studies (NCS). The patients were randomized into two groups and evaluated before treatment and 6weeks after treatment by means of physical examination findings, NCS, and the Boston Carpal Tunnel Questionnaire (BCTQ) functional status and symptom severity scale scores. When the differences in both groups before and after treatment were compared, a significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, BCTQ symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance.

Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial

BackgroundCarpal tunnel syndrome is the most common peripheral entrapment neuropathy, for which conservative treatments are the first measures taken. However, these measures are not usually sufficient. Recently major attention has been drawn to platelet-rich plasma for its possible effects on axon regeneration and neurological recovery. Although few studies have evaluated the effects of this treatment in carpal tunnel syndrome, further investigation is required to reach concrete conclusion.MethodsIn this randomized controlled trial, women referring to the physical medicine and rehabilitation clinic at Shahid Modarres Hospital during 2016 with a diagnosis of mild and moderate idiopathic carpal tunnel syndrome were chosen. They were randomly assigned to two groups: (i) a control group using only a wrist splint, and (ii) a platelet-rich plasma group that received wrist splints along with a single local injection of platelet-rich plasma. The outcome measures were assessed via Visual Analogue Scale, the Boston Carpal Tunnel Syndrome Questionnaire and electrophysiological findings including the peak latency of sensory nerve action potential and the onset latency of the compound muscle action potential.ResultsA total of 41 women were included (20 wrists as control group) and (21 wrists as platelet-rich plasma group). Before treatment there were no significant differences between the two groups except for the median peak latency of sensory nerve action potential which was significantly higher among the patients in the platelet-rich plasma group (p = 0.03). All the measured variables significantly decreased in both groups after 10 weeks of treatment except for the median onset latency of the compound muscle action potential (p = 0.472). Finally, the changes in neither of the evaluated outcome measures were found to significantly differ between the two groups, even when the analyses were adjusted for age of the patients.ConclusionThe findings of this study showed that in a relatively short period of time after treatment, a single injection of platelet-rich plasma in the wrist does not significantly add to the effects of conservative treatment with wrist splints, in regards to the women pain and symptom severity, functional status and electrophysiological parameters.Trial registrationThe trial has been retrospectively registered with an ID: IRCT2017041513442N13 (Date of registration: 2017–06-19).

New role for insulin injection in the treatment of idiopathic carpal tunnel syndrome

Local insulin injection for the median nerve was administered in patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) to evaluate its effectiveness on the median nerve regeneration as it has been suggested that insulin has an effect on nerve regeneration, similar to that of nerve growth factor. This study included 82 patients (130 hands) with clinical and electrophysiologic evidence of mild to moderate idiopathic CTS (grade 3 or less according to Bland’s classification). The 130 hands were randomly assigned to two groups: group I received insulin injection of 10 IU Neutral Protamine Hagedorn known as humulin N (NPH) insulin locally into the affected carpal tunnel at the first visit and a similar dose of insulin after 2 weeks; and group II received a single injection of 40mg triamcinolone acetonide injection into the carpal tunnel. Clinical and electrophysiologic evaluations were carried out at the start of the study and at 1 month after treatment. Patients were evaluated on the basis of the mean score on the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire. All patients showed a symptomatic and functional improvement. Distal motor latency and distal sensory latency were decreased for both groups (4.84±0.74 vs. 4.61±0.72 and 2.88±0.27 vs. 2.55±0.19, respectively), with a significant decrease in the mean of Functional Status Scale score and Symptom Severity Scale score for patients treated with the insulin injection (2.5±0.6 vs. 2.07±0.55 and 3.13±0.47 vs. 2.23±0.5, respectively). Local insulin injection effectively reduced the symptoms of CTS and improved electrophysiological findings in the present study. Our findings suggest that local insulin injection may be of great benefit in improving nerve functions in patients with mild to moderate idiopathic CTS. Further controlled studies are needed to confirm our preliminary findings and to compare local insulin injection with conventional approaches for the treatment of CTS.

Short-term effectiveness of short-wave diathermy treatment on pain, clinical symptoms, and hand function in patients with mild or moderate idiopathic carpal tunnel syndrome.

We determined the effects of short-wave diathermy (SWD) treatment on mild and moderate idiopathic carpal tunnel syndrome (CTS). This was a prospective, randomized, controlled, double-blind clinical trial. The study involved 58 wrists in 31 patients diagnosed clinically and electrophysiologically with mild and moderate CTS. They were assigned randomly to one of two groups. Group 1 received a hot pack, SWD, and nerve and tendon gliding exercises and Group 2 received a hot pack, placebo SWD, and nerve and tendon gliding exercises. The treatment was applied five times weekly for a total of 15 sessions. Patients were evaluated using the Tinel test, Phalen test, carpal compression test, reverse Phalen test, carpal tunnel compression test, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), and a visual analog scale (VAS). Clinical tests and scales were evaluated at the beginning and end of therapy. In the SWD group, in the Tinel test, Phalen test, reverse Phalen test, carpal compression test, VAS, BCTQ-FSS, and BCTQ-SSS, statistically significant improvements were detected (p < 0.001). In the placebo group, although improvements were seen in all parameters, the results were not statistically significantly different (p > 0.05) from baseline. All parameters improved significantly in the SWD group versus the controls (p < 0.05). SWD provided short-term improvements in pain, clinical symptoms, and hand function in patients with mild and moderate CTS.

Pilot randomised controlled trial comparing C-Trac splints with Beta Wrist Braces for the management of carpal tunnel syndrome

Introduction The C-Trac splint has been designed to mechanically stretch the transverse carpal ligament and is advertised as an alternative to surgical Carpal Tunnel Decompression. The purpose of the study is to compare the effectiveness of the C-Trac splint with standard splinting in mild to moderate idiopathic carpal tunnel syndrome. Methods This is a pilot parallel randomised controlled trial. Forty-nine patients with clinically and neurophysiologically proven carpal tunnel syndrome were randomised into the two treatment groups, C-Trac and Beta Wrist Brace, and reassessed clinically for one year. Results Patients were generally satisfied with both splints, but two out of the 24 C-Trac patients developed problematic side effects possibly due to using the splint: De Quervains tenosynovitis and basal joint arthritic pain. There was no clinically relevant or statistically significant difference in the success and failure rates of the two splints by eight weeks, six months or at one year. Three of the 25 C-Trac splints (costing £130 each) used during the one-year study required replacement, compared with eight of the Beta Wrist Braces (costing approximately £10 each). Conclusions These results suggest that C-Trac splint is not dissimilar in efficacy to a resting Beta Wrist Brace. The reported side effects raise questions as to the wisdom of its unregulated use.

Short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate carpal tunnel syndrome: a double blind randomized sham-controlled trial

Objective: To determine the short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate idiopathic carpal tunnel syndrome. Design: Double-blind randomized sham-controlled trial. Setting: Outpatient clinic of the Department of Physical Medicine and Rehabilitation, University Hospital. Participants: Twenty-two patients with idiopathic carpal tunnel syndrome, 12 of whom had bilateral involvement, for a total of 34 wrists, divided into two groups: a hyperthermia active treatment group (number of wrists = 17) and a sham-controlled group (number of wrists = 17). Intervention: Six sessions, two per week, of either hyperthermia or sham treatment were provided over a period of three weeks. Main measures: Visual analogue scale, Levine–Boston Self-Assessment Questionnaire (part I: evaluation of pain intensity; part II: evaluation of functional status) and neurophysiological assessments, were determined at baseline and at the end of the treatment. Results: The hyperthermia group experienced a significant improvement in pain (visual analogue scale: P = 0.002; Levine–Boston part I: P < 0.0001) and functional status (Levine–Boston part II: P = 0.002) relative to baseline. No improvements in pain intensity or functionality were observed in the sham-treated group. Changes in pain severity between baseline and the end of treatment were larger in the hyperthermia group than in the sham-controlled group (Δ visual analogue scale P = 0.004; Δ Levine–Boston part I: P = 0.009). No differences either intra or between groups were observed for median nerve conduction velocity. Conclusion: Hyperthermia provides short-term improvements in pain and function in patients with mild to moderate carpal tunnel syndrome.

Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome

This study aimed to compare the short-term efficacy of splinting (S) and splinting plus low-level laser therapy (SLLLT) in mild or moderate idiopathic carpal tunnel syndrome (CTS) with a prospective, randomized controlled study. The patients with unilateral, mild, or moderate idiopathic CTS who experienced symptoms over 3 months were included in the study. The SLLLT group received ten sessions of laser therapy and splinting while S group was given only splints. The patients were evaluated at the baseline and after 3 months of the treatment. Follow-up parameters were nerve conduction study (NCS), Boston Questionnaire (BQ), grip strength, and clinical response criteria. Forty-five patients with CTS completed the study. Twenty-four patients were in S and 21 patients were in SLLLT group. In the third-month control, SLLLT group had significant improvements on both clinical and NCS parameters (median motor nerve distal latency, median sensory nerve conduction velocities, BQ symptom severity scale, and BQ functional capacity scale) while S group had only symptomatic healing (BQ symptom severity scale). The grip strength of splinting group was decreased significantly. According to clinical response criteria, in SLLLT group, five (23.8%) patients had full and 12 (57.1%) had partial recovery; four (19%) patients had no change or worsened. In S group, one patient (4.2%) had full and 17 (70.8%) partial recovery; six (25%) patients had no change or worsened. Additionally, applied laser therapy provided better outcomes on NCS but not in clinical parameters in patients with CTS.

Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome

The objective of this study was to compare the short- and long-term efficacies of splinting (S), splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild or moderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathic CTS who experienced symptoms for over 6 months were included in the study. The patients were evaluated for the baseline and the third and sixth month scores after treatment. Follow-up criteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-seven hands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-three hands were given a single steroid injection and splinted for 3 months, and 11 hands were operated. In the first 3 months, all treatment methods provided significant improvements in both clinical and EMG parameters in which OCTR had better outcomes on median sensorial nerve velocity at palm wrist segment. In the second 3 months, while the clinical and EMG parameters began to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functional capacity score of OCTR group was statistically better than that in conservative methods (P = 0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR in short term. However, these beneficial effects were transient in the sixth month follow-up and OCTR was superior to conservative treatments.

Ultrasonographic assessment of mild and moderate idiopathic carpal tunnel syndrome

AIM: To investigate the diagnostic value of ultrasonography in mild and moderate idiopathic carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Cross-sectional areas (CSA), flattening ratios at three different levels, swelling ratio, and palmar displacement were analysed in 26 patients (14 with bilateral and 12 with unilateral disease, 40 wrists in total) for the presence and the severity of CTS. Twenty had normal nerve conduction studies (NCS) defined as “mild”, and 20 of them had abnormal NCS defined as “moderate”. The control group consisted of 20 healthy participants. RESULTS: All parameters were significantly different between patient and control groups. Palmar displacement, swelling ratio, CSA at all levels and distal flattening ratio had the highest significance ( p<0.0001). The criterion with the highest sensitivity was the swelling ratio≥1.3 (72.5%), followed by the middle CSA >9 mm 2 and the palmar displacement >2.5 mm. All of these criteria had a higher sensitivity in diagnosing moderate cases (85–100%) than diagnosing mild cases (30–55%). There was a significant difference between normal and mild CTS groups regarding palmar displacement, distal flattening ratio, middle CSA and swelling ratio ( p<0.0001 for all) and between normal and moderate groups regarding all parameters ( p<0.01−0.0001). When combined middle CSA, palmar displacement and swelling ratio had an overall discriminatory accuracy of 83.8%. CONCLUSION: Additional diagnostic confirmation can be provided by ultrasonography and may be preferred as the initial step instead of electrophysiological studies. Detection of at least two of the three criteria (median nerve CSA >9 mm 2 at pisiform level, swelling ratio≥1.3, and palmar displacement >2.5 mm) may be helpful for the verification of the diagnosis.

Ultrasound and laser therapy in the treatment of carpal tunnel syndrome

This study was designed to compare the efficacy of ultrasound and laser treatment for mild to moderate idiopathic carpal tunnel syndrome. Ninety hands in 50 consecutive patients with carpal tunnel syndrome confirmed by electromyography were allocated randomly in two experimental groups. One group received ultrasound therapy and the other group received low level laser therapy. Ultrasound treatment (1 MHz, 1.0 W/cm(2), pulse 1:4, 15 min/session) and low level laser therapy (9 joules, 830 nm infrared laser at five points) were applied to the carpal tunnel for 15 daily treatment sessions (5 sessions/week). Measurements were performed before and after treatment and at follow up four weeks later, and included pain assessment by visual analogue scale; electroneurographic measurement (motor and sensory latency, motor and sensory action potential amplitude); and pinch and grip strength. Improvement was significantly more pronounced in the ultrasound group than in low level laser therapy group for motor latency (mean difference 0.8 m/s, 95% CI 0.6 to 1.0), motor action potential amplitude (2.0 mV, 95% CI 0.9 to 3.1), finger pinch strength (6.7 N, 95% CI 5.0 to 8.2), and pain relief (3.1 points on a 10-point scale, 95% CI 2.5 to 3.7). Effects were sustained in the follow-up period. Ultrasound treatment was more effective than laser therapy for treatment of carpal tunnel syndrome. Further study is needed to investigate the combination therapy effects of these treatments in carpal tunnel syndrome patients.

A critical appraisal of an article examining the efficacy of ultrasound treatment for carpal tunnel syndrome

Abstract Objective: To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome. Design: Randomised, double blind, controlled trial with assessments at baseline, after 2 weeks and 7 weeks treatment, and at a follow up assessment 6 months later (8 months after baseline evaluation). Setting: Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna. Subjects: 45 patients with mild to moderate bilateral carpal tunnel syndrome as verified by electroneurography. Intervention: 20 sessions of ultrasound (active) treatment (1 MHz, 1.0 W/cm2, pulsed mode 1:4, 15 minutes per session) applied to the area over the carpal tunnel of one wrist, and indistinguishable sham ultrasound treatment applied to the other. The first 10 treatments were performed daily (5 sessions/week); 10 further treatments were twice weekly for 5 weeks. Main outcome measures: Score of subjective symptom ratings assessed by visual analogue scale; electroneurographic measures (for example, motor distal latency and sensory antidromic nerve conduction velocity). Results: Improvement was significantly more pronounced in actively treated than in sham treated wrists for both subjective symptoms (P Conclusion: Results suggest there are satisfying short to medium term effects due to ultrasound treatment in patients with mild to moderate idiopathic carpal tunnel syndrome. Findings need to be confirmed, and ultrasound treatment will have to be compared with standard conservative and invasive treatment options.

Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial

Objective: To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome.Design: Randomised, double blind, “sham” controlled trial with assessments at baseline, after 2 weeks' and...