Therapy For Carpal Tunnel Syndrome Research Articles

A Data Mining Study for Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most prevalent upper limb compressive neuropathy. A considerable number of clinical trials and meta-analyses have provided evidence supporting the effectiveness of acupuncture in treating CTS. Nevertheless, the ideal choice of acupoints remains ambiguous. A data mining analysis was conducted with the objective of determining the most effective acupoint combinations and selection for CTS. A search was conducted across seven Chinese and English electronic bibliographic databases spanning from their inception to March 2023. Selected were clinical trials that evaluated the efficacy of acupuncture therapy for CTS, with or without randomised controlled methods. Data extraction mainly included acupoint prescriptions. Information such as first author, study design and study setting were also extracted. The principal outcomes comprised the clinical manifestations linked to CTS. Statistical descriptions were generated using Excel 2019. The analysis of association rules was conducted using SPSS Modeler 18.0. Using SPSS Statistics 26.0, exploratory factor analysis and cluster analysis were conducted. 142 trials (including 86 RCTs and 56 non RCTs) were identified, and 193 groups of effective prescriptions involving 68 acupoints were extracted. The most frequently used acupoints were Da-ling (PC7), Nei-guan (PC6), He-gu (LI4), Wai-guan (TE5), and Yang-xi (LI5). The most frequently used meridians were the pericardial meridian and the large intestine meridian. The majority of special acupoints used were Five-shu points and Yuan-source points, with acupoints on the upper limbs being the most frequently used. The core acupoint groups were analyzed and 11 groups of association rules, 8 factors, and 5 effective cluster groups were obtained. The evidence-based acupoint selection and combinations of acupuncture therapy for carpal tunnel syndrome were provided by the findings of this study.

Injection therapy for carpal tunnel syndrome: A systematic review and network meta-analysis of randomized controlled trials.

Various injectants are available for the treatment of carpal tunnel syndrome. This systematic review and network meta-analysis was conducted to investigate the effectiveness of different injection therapies in alleviating the symptoms of carpal tunnel syndrome. Various databases were searched for relevant studies from inception until May 10, 2023. Eligible studies were identified using the patient (P), intervention (I), comparison (C), and outcomes (O) model, which involved (P) participants with carpal tunnel syndrome, (I) an intervention based on injection therapy, (C) the use of placebo or another injectant as a control treatment, and (O) the measurement of clinical and electrodiagnostic outcomes of interest. A total of 18 studies were included in the analysis. The network meta-analysis revealed that platelet-rich plasma is effective in the treatment of carpal tunnel syndrome in terms of symptom and pain relief and functional improvement in both the short and long term, whereas steroids are effective only in the short term. Additionally, injections of dextrose solution may offer long-term pain relief as well as short- and long-term symptom alleviation and functional improvement. The study findings suggest that platelet-rich plasma should be used as the first-line treatment for carpal tunnel syndrome, with dextrose and steroids serving as alternative treatment options.

Comparative evaluation of low-level laser therapy and multi-wave locked system laser therapy for carpal tunnel syndrome: a retrospective study

Purpose: This study aimed to evaluate the effects of Low-Level Laser Therapy (LLLT) and Multi-Wave Locked System (MLS) Laser Therapy on clinical and functional parameters in Carpal Tunnel Syndrome.
 Methods: In the study, 60 patients with mild-moderate carpal tunnel syndrome were evaluated retrospectively in 3 groups. Group I; LLLT, Group II; MLS Laser therapy, Group III; It consisted of patients who did not receive any laser application and were given splints, a home exercise program and patient education. Visual Analogue Scale (VAS), Hand Grip Strength measurement and BOSTON Carpal Tunnel Questionnaire measurements were evaluated from the patients' files at baseline, 4th week and 12th week.
 Results: Statistically significant improvements were observed in all parameters in Group I and Group II at 4 weeks and 12 weeks compared to baseline. Group III showed no significant differences in grip strength measurements and the BOSTON Functional Status Scale at 4 weeks compared to baseline. The changes between baseline and 4 weeks were statistically significantly better in Group I and Group II compared to Group III for all parameters. No significant difference was found between Group I and Group II in VAS and grip strength improvements, but the improvement in Boston Symptom Severity Scale was significantly more prominent in Group II than in Group I.
 Conclusion: Both LLLT and MLS Laser Therapy can be considered as conservative treatment options along with splinting and exercise to control the symptoms of Carpal Tunnel Syndrome. MLS Laser Therapy may be superior to LLLT in reducing symptom severity.

Electrophysiological assessment of radial shock wave therapy for carpal tunnel syndrome.

This study presents an electrophysiological assessment of radial extracorporeal shock wave therapy on patients with carpal tunnel syndrome (CTS). Sixteen CTS subjects received radial extracorporeal shock wave therapy once a week for five consecutive weeks. Outcome performance was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ) and electrodiagnostic measurements including a nerve conduction study of the median nerve and a compound muscle action potential (CMAP) scan of the abductor pollicis brevis muscle. The BCTQ and the sensory conduction test measurements were all statistically improved after the treatment. However, the motor conduction test measurements were not significantly different before and after the treatment. The CMAP scan examination revealed MScanFit motor unit number estimation (MUNE) was significantly higher after the treatment, while no significant change was found in StairFit MUNE and step index. These results confirmed the effectiveness of shock wave therapy for treating CTS symptoms and the associated sensory property changes. The reasons for the inconsistencies from different CMAP scan processing methods are worthwhile targets for further investigation.

Effect of extracorporeal shock waves on neuromuscular junctions versus carpal tunnel syndrome

Objective:to determine effectiveness of using extracorporeal shockwave therapy (ESWT) directly on the NMJ versus using it on injuries that exert pressure on the nerve such as (CTS). Background: The nervous system can be affected by many conditions and disorders that can disrupt its normal functioning and transmission of impulses, such as the destruction of neuromuscular junctions or pressure on nerves, such as carpal tunnel syndrome. Methods: The review was carried out by searching scientifically recognized medical databases, including PubMed, Scopus, Biomed, National Library of Medicine, Science direct library, Sage Journals and Spinger Link. Date restrictions were not applied. Conclusion: Preliminary research on extracorporeal shockwave therapy for carpal tunnel syndrome has shown encouraging results, leading to recommendations for its potential use as a treatment modality. However, the current literature examining shockwave therapy for neuromuscular junction dysfunction is limited. Further studies through high-quality human trials are still needed.

COMPARISON OF HYDRODISSECTION INJECTION THERAPY USING ULTRASONOGRAPHIC AS GUIDES BETWEEN TRIAMCINOLONE ACETONIDE AND 5% DEXTROSE IN CARPAL TUNNEL SYNDROME

Background: Carpal Tunnel Syndrome (CTS) is a symptomatic compression neuropathy of the median nerve characterized by increased pressure in the carpal tunnel and decreased nerve function due to compression of the median nerve in the carpal tunnel. The purpose of the hydrodissection injection method in CTS is to separate the soft tissue adhesions that cause nerve compression and this method are known for being minimally invasive, fast healing, and easy to apply. Local injection of triamcinolone acetonide (TCA) is often used as therapy for CTS because it stabilizes the sodium channels and reduces abnormal stimulatio, thus it relieved the pain. 5% dextrose injection (D5W) is also widely used as therapy of CTS because it is harmless to nerves and may reduce neurogenic inflammation through inhibition of capsaicin-sensitive receptors. Aim: To compare the effectivity of hydrodissection injection therapy using ultrasound guidance with triamcinolone acetonide and 5% dextrose in CTS. Methods: This study recruited 30 participants who diagnosed with CTS and met the inclusion criteria. Participants were divided into two treatment groups, the first group (n=15) was given 1ml TCA injection and 1 ml lidocaine 2%, while the second group (n=15) was given 5% 5 ml Dextrose injection. The parameters measured in this study were NRS, FSS, and SSS value before injection and 4 weeks after injection of the agent. We compared these parameters at week four after injection between the TCA group and the D5W group. Results: NRS values before and 4 weeks after TCA injection (sig 0.001; p <0.05), FSS values (sig 0.020; p <0.05), and SSS values (sig 0.001; p <0.05). NRS before and 4 weeks after injection of D5W (sig 0.002; p <0.05), FSS (sig 0.001; p <0.05), and SSS (sig 0.000; p <0.05). Comparison between TCA injection and D5W injection at 4 weeks after the injection showed that the results was significantly different on NRS (sig 0.806; p> 0.05) for FSS (sig 0.512; p> 0.05) and SSS (sig 0.293; p> 0.05). Conclusion: There is a significant difference in NRS, FSS and SSS values at 4 weeks after hydrodissection injection, using either TCA or D5W. TCA hydrodissection injection compared to D5W hydrodissection injection was equally effective in improving NRS, FSS and SSS after 4 weeks of injection.

Extracorporeal Shock Wave Therapy Provides Limited Therapeutic Effects on Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

Night wrist splinting has been a conservative treatment for carpal tunnel syndrome. The addition of extracorporeal shock wave therapy provides an alternative treatment. However, strong evidence on the clinical effectiveness of extracorporeal shock wave therapy for carpal tunnel syndrome is still lacking. This study aimed to investigate the effectiveness and safety of extracorporeal shock wave therapy compared with treatments of night wrist splints alone for patients with carpal tunnel syndrome. In this systematic review and meta-analysis, no limitation criteria were used for study selection. All available articles that compare the effectiveness between extracorporeal shock wave therapy combined with night wrist splint and night wrist splint alone for treating carpal tunnel syndrome published up to 20 January 2022 were identified from the databases of PubMed, Embase, and Cochrane Central Register of Controlled Trials Central. The primary outcomes were a standard mean difference with a 95% confidence interval on the improvement of symptom severity and functional impairment between the two groups. In an attempt to analyze trends over time in studies that report repeated measurements, an all time-points meta-analysis (ATM) was undertaken. Seven randomized controlled trials with a total of 376 participants were included in this study. Significant improvements in functional impairment and symptom remission were only observed in the extracorporeal shock wave group at four weeks post-treatment. Extracorporeal shock wave therapy did not demonstrate superior efficacy compared to treatment with night wrist splint alone at 8–10 and 12–14 weeks post-treatment, or through the ATM approach. In conclusion, the therapeutic effect of extracorporeal shock wave therapy is transient and mostly nonsignificant compared with using night wrist splint alone. No serious side effects were reported in all included studies. Other conservative treatments to ameliorate carpal tunnel syndrome symptoms are warranted.

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.
 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.
 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 & 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.
 Result: Male-Female distribution was 9% & 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 < 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 < 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.
 Conclusion: Low intensity laser therapy has superior clinical effectiveness at 6 weeks compared with night-resting splints in mild or moderate CTS.
 Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 103-107

Application of low-level laser therapy for carpal tunnel syndrome in Cyprus

Aim: The aim of the study was to create a questionnaire that could be used by physiotherapists in Cyprus to define the parameters of low-level laser therapy (LLLT) in patients suffering from carpal tunnel syndrome (CTS) who had exhibitedsuch symptoms for more than 3 months. Material-Methods:Ninety-four questionnaires were distributed to physiotherapists working in Cyprus. The distribution was random and of the total 94 questionnaires 8 were sent via email and 86 were handed out in person. However, only 30 were answered, 29 in person and 1 via email (31.91% of the total) Results: The following parameters relating to use of the LLLT device in patients with CTS were recorded during the study. The treatment usesan aluminum gallium arsenide laser, set to continuous pulse width and emitting radiation in the form of red visible light.In addition, the non-contact technique is used,the average output power is 1.1W, the spot size is 20cm2 and the duration of treatment is 5 minutes. The energy density is 5J/cm2 and a laser of 30J energy is applied. The LLLT is used 5 times per week and the treatment lasts for 12 sessions. Conclusion: There is a consensus as to the choice of parameters in the LLLT: i.e. the type of laser, the radiation and the frequency of application per week. However, the emission wavelength, the question of contact, the average output power, the energy, the energy density, the duration of treatment, the spot size and the total number of sessions are still controversial issues

The experience of using fermenkol phonophoresis in complex therapy of carpal tunnel syndrome

The issue of compression ischemic syndromes, in particular, carpal tunnel syndrome, is currently extremely relevant. Prolonged compression of the nerve leads to irreversible consequences and degeneration of its fibers, followed by neurogenic muscle atrophy and permanent loss of function. Standard medical and physical therapy methods of treatment do not always achieve a positive effect. The paper considers the results of the use of phonophoresis of hydrocortisone and fermenkol in 35 patients with carpal tunnel syndrome. Positive dynamics was noted in both groups, which increases the possibility of treatment tactics selection for patients of this profile.

Effect of vacuum-compression therapy for carpal tunnel syndrome as a part of physiotherapy - pilot study

Aims: The aim of this pilot study was to assess effect of combined kinesiotherapy and vacuum-compression therapy in patients with carpal tunnel syndrome. Methods: Ten patients (six women and four men, average age 55 ± 12.7 years) with a total of 18 hands, indicated for the surgical treatment of carpal tunnel syndrome underwent six individual kinesiotherapy sessions and ten applications of vacuum-compression therapy. The effect of the intervention was evaluated by electromyography and a visual analogue scale. Results: After the therapy, electromyography did not show a statistically significant difference in distal motor latency, sensory nerve action potential, and sensory conduction velocity of the nervus medianus. However, the visual analogue scale decreased significantly (P = 0.001). A statistically significant relationship was found after the therapy between the visual analogue scale score and the distal motor latency (r = 0.646, P = 0.005). Conclusions: After the therapy consisting of kinesiotherapy and vacuum-compression therapy, the typical symptoms of carpal tunnel syndrome decreased. We found great inter-individual differences in measurable parameters of the manifestations of carpal tunnel syndrome. Additionally, none of the patients opted for surgical treatment even one year after finishing the therapy.

Low-Level Laser Therapy for Carpal Tunnel Syndrome: Systematic Review and Network Meta-analysis

The 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.Fifty patients (25–55 years) 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.Patients in group (A) received a program of IR Gallium Arsenide LLLT (wavelength 904 nm, average power 20 mW, laser probe 7 mm diameter), with a total application of 4.8 J, while patients in group (B) received a program of US (frequency 1 MHz, power 1.0 W/cm2, pulsed mode 1:5).The 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 (20 mW power, 904 nm Wavelength) and ultrasound (1.0 w/cm2 power, 1 MHz frequency) are effective in the treatment of mild and moderate CTS patients.

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.

Low-level laser therapy for carpal tunnel syndrome.

Low-level laser therapy for carpal tunnel syndrome.

Evidence Supporting the Benefits of Manual Therapy for Carpal Tunnel Syndrome

Evidence Supporting the Benefits of Manual Therapy for Carpal Tunnel Syndrome

The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial.

Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

Low-power laser therapy for carpal tunnel syndrome: effective optical power.

Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efficacy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efficacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside reflection and scattering laser power from human skin at the wrist, the effective laser power can be inferred. Using clinical measurements from 30 cases, we found that the effective laser power differed significantly among cases, with the measured laser reflection coefficient ranging from 1.8% to 54%. The reflection coefficient for 36.7% of these 30 cases was in the range of 10-20%, but for 16.7% of cases, it was higher than 40%. Consequently, monitoring the effective optical power during laser irradiation is necessary for the laser therapy of carpal tunnel syndrome.

Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial.

Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo-controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double-blinded study to assess the effect of rESWT for treating CTS. Thirty-four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo-controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:977-984, 2016.

What is the best nonsurgical therapy for carpal tunnel syndrome (CTS)?

Evidence-Based Answer Local corticosteroids injections, splinting, and therapeutic ultrasound all appear to be effective in the short-term treatment of CTS compared with placebo or no treatment. Ergonomic keyboards do not appear to be effective. Among effective treatments, none were clearly superior and no head-to-head trials were evaluated (SOR: B, systematic reviews).

Static Magnetic Field Therapy for Carpal Tunnel Syndrome: A Feasibility Study

Colbert AP, Markov MS, Carlson N, Gregory WL, Carlson H, Elmer PJ. Static magnetic field therapy for carpal tunnel syndrome: a feasibility study. Objectives To assess the feasibility of conducting trials of static magnetic field (SMF) therapy for carpal tunnel syndrome (CTS), to collect preliminary data on the effectiveness of 2 SMF dosages, and to explore the influence of an SMF on median nerve conduction. Design Randomized, double-blind, sham-controlled trial with a 6-week intervention and a 12-week follow-up. Setting University hospital outpatient clinics. Participants Women and men (N=60), ages 21 to 65 years, with an electrophysiologically confirmed CTS diagnosis recruited from the general population. Interventions Participants wore nightly either neodymium magnets that delivered either 15 or 45mTesla (mT) to the contents of the carpal canal or a nonmagnetic disk. Main Outcome Measures Symptom Severity Scale (SSS) and Function Severity Scale (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ) and 4 median nerve parameters: sensory distal latency, sensory nerve action potential amplitude, motor distal latency and compound motor action potential amplitude. Results Fifty-eight of 60 randomized participants completed the study. There were no significant between-group differences for change in the primary endpoint SSS or for FSS or median nerve conduction parameters. For the SSS and the FSS, each group showed a reduction at 6 weeks indicating improvement in symptoms. Conclusions This study showed the feasibility and safety of testing SMF therapy for CTS. There were no between-group differences observed for the BCTQ or median nerve parameters after 6 weeks of SMF therapy. Significant within-group, symptomatic improvements of the same magnitude were experienced by participants in both active and sham magnet groups. Future studies are needed to optimize SMF dosimetry and resolve issues related to the use of sham controls in SMF trials.