Treatment Of Carpal Tunnel Syndrome Research Articles

Decision for Carpal Tunnel Surgery: High-deductible Health Plans versus Traditional Health Plans.

Delay in surgical treatment for carpal tunnel syndrome (CTS) may result in long-term decreased functional outcomes. Few investigators have examined the relationship between type of health insurance plan and time to definitive treatment of CTS following diagnosis. We investigated the relationship between insurance type, treatment decision, and the time between diagnosis and surgery across groups. This was a retrospective cohort study using the MarketScan Commercial Claims and Encounters Database 2011-2020. We used χ2 tests, linear regression, and logistic regression models to analyze demographic data and the time lag interval between CTS diagnosis and treatment. Overall, 28% of high-deductible health plan (HDHP) patients underwent carpal tunnel release, compared with 20% of traditional insurance patients (P < 0.001). HDHPs are defined by the internal revenue service as a deductible of $1400 for an individual or $2800 for a family per year. The odds of undergoing surgery versus no treatment for HDHP patients were 47% higher than traditional patients (P < 0.001). Among the patients who underwent surgery, HDHP patients underwent surgery 65 days earlier on average following diagnosis compared with traditional patients (P < 0.001). Patients with HDHPs who receive a diagnosis of CTS are more likely to undergo surgery, with a shorter time lag between diagnosis and surgery. The results from this study call attention to differences in surgical decision-making between patients enrolled in different insurance plans.

Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment.

Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand. The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage. Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome. The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments. We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.

Prevalence and Awareness of Carpal Tunnel Syndrome Among Adults in Tabuk City of Saudi Arabia: A Cross-Sectional Study.

Background Carpal Tunnel Syndrome (CTS) is a condition when the median nerve is entrapped and compressed within the wrist. It significantly affects the quality of life and work productivity of the affected individuals. Aim This study aimedto assess the prevalence of CTS and the risk factors associated withthis condition amongthegeneral population in Tabuk City, Saudi Arabia, andto explore their knowledge of the causes, manifestations, and treatment options. Methods This cross-sectional studyincluded male and female adult residents of Tabuk City aged 18 years and above who agreed to participate in the study. Datawerecollected using an online, self-administered questionnaire thatwas distributed to the publicusingdifferentsocial mediaplatforms. Results In this study, the prevalence of CTS was 3.4%.The presence of chronic diseases was a significant risk factor for the CTS (p = 0.003). Participants having chronic diseases were 6.370 times more likely to develop CTS (AOR: 6.370, 95%CI: 2.048 to 19.817). The participants had good levels of awareness about the causes (89.3%), clinical manifestations, and treatment of CTS (92.2%). There was a significant association between the level of knowledge about the causes of CTS and gender (p=0.014). Females (74.3%)showed a higher level of knowledge than males (25.7%). As well, the young (18-25) age group (67.9%)was more significantly aware of the causes of CTS in comparison to the other age groups (p=0.023). Conclusion The prevalence of carpal tunnel syndrome amongtheadult population in Tabuk City, Saudi Arabia, was 3.4%, andthe significant underlying risk factorswere chronic diseases such as diabetes mellitus, hypothyroidism, and rheumatoid arthritis. The level of awareness of CTS was satisfactory.

History of Glucopuncture

Glucopuncture is a treatment option originating from Europe (Austria) and Asia (South Korea). It is a medical technique which uses regional injections with 5% sugar water such as D5W (or G5W) into dermis, fascia, joints, muscles and ligaments. Pain modulation is mainly achieved by intradermal, fascial and US-guided perineural injections. Biotensegrity regulation is mainly achieved by injecting into the superficial layer of regional fascia. Functional improvement is achieved by giving injections into muscles. Such intramuscular injections can support and accelerate tissue repair, which is an interesting tool when treating sports injuries in professional athletes. Especially injections into superficial fascia are becoming more popular recently because of easy application and interesting clinical outcome. Over the last decades, clinicians worldwide came to see that regional D5W injections are safe, inexpensive and efficient tools to manage musculoskeletal pain and sports injuries. Both patient-guided as well as screen-guided glucopuncture gain popularity worldwide. Clinical research so far was mainly focused on treatment of carpal tunnel syndrome with D5W.

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review.

Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic neuropathic pain (20 ± 4 weeks with VAS < 5 or VAS diminished by 2 points after the procedure). Carpal tunnel syndrome (CTS) is a common entrapment mononeuropathy, and its distribution is typically innervated by the median nerve. Patients with mild or moderate CTS may benefit from nonsurgical treatments or conservative therapies. This review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Four investigators assessed each title, abstract, and full-text article for eligibility, with disagreements being resolved by consensus with two experienced investigators. The qualitative assessment of the studies was carried out using the modified Oxford quality scoring system, also known as the modified Jadad score. Furthermore, risk of possible biases was assessed using the Cochrane collaboration tool. The results of this review suggest that US-guided HD is an innovative, effective, well-tolerated, and safe technique (11 out of 923 patients had collateral or side effects after the procedure). However, further studies comparing all drugs and with a larger sample population are required to determine the most effective substance.

Long-term Efficacy of Corticosteroid Injection for Carpal Tunnel Syndrome: A Systematic Review.

Carpal tunnel syndrome (CTS) is a debilitating condition that can cause significant morbidity. Corticosteroid injection (CI) is a popular treatment for CTS. Short-term benefits of CI for CTS have been reported, but there is little evidence on long-term outcomes. We performed a systematic review in the PubMed/MEDLINE and Cochrane Library databases to identify studies which reported outcomes of CI for CTS with at least 1-year follow-up. We identified 20 total studies and extracted data on outcomes such as number of patients needing eventual surgery or reinjection, complications, and functional scores. In included studies, 41.6% of patients underwent eventual carpal tunnel release surgery (CTRS), 29% underwent reinjection, there were no major and approximately 34/1133 (3.0%) minor complications, and median/mean time from CI to eventual CTRS ranged from 128 to 446 days. There was disparity on the long-term efficacy of CI for functional outcomes. The evidence indicates that CI is a very low risk procedure that has potential to improve symptoms enough to either prevent or, in most cases, delay the need for further reintervention. However, our conclusions are limited by the heterogeneity of available studies. There is a need for further, high-quality research on this topic.

Predictive Factors for Converting Endoscopic to Open Carpal Tunnel Release

Introduction: Both open and endoscopic methods of carpal tunnel release are accepted treatments for carpal tunnel syndrome. The objective was to determine the endoscopic to open conversion rate of all carpal tunnel surgeries. We evaluated potential predictive factors for an increased rate of conversion. Methods: The IRB/IRBnet approved (#20210613/1639264) a retrospective chart review of all attempted endoscopic carpal tunnel surgeries performed from July 1, 2012 through June 30, 2021. Charts were reviewed for procedure, age, sex, body mass index (BMI), electromyograph (EMG) reading, wrist arthritis on x-ray, preoperative steroid injections, trainee as surgeon, diabetes, hand dominance, and operated side. Conversion rate was noted. A chi-square test using a P-value of &lt;0.05 was used to determine the statistical significance of the patients’ age, sex, BMI, EMG severity, the presence of wrist arthritis, preoperative steroid injections, resident as surgeon, diabetic status, and operated hand dominance as predictive factors for conversion. Results: The plastic surgery service attempted 1053 endoscopic carpal tunnel releases using the Chow dual port technique over a 9-year period. Forty-five cases converted to an open release. Median age ( P = 0.54), sex ( P = 0.43), median BMI ( P = 0.76), EMG severity ( P = 0.20), wrist arthritis ( P = 1.0), preoperative steroid injections ( P = 0.65), resident surgeon ( P = 0.53), diabetes ( P = 0.50), and operated hand dominance ( P = 0.36) were not statistically significant predictive risk factors. Nineteen of 45 converted cases had a future successful contralateral endoscopic release. Conclusion: Our study found a 4.27% endoscopic to open conversion rate. No identifiable risk factors could predict conversion. Prior conversion does not determine a future contralateral conversion.

Surgical versus non-surgical treatment for carpal tunnel syndrome.

Surgical versus non-surgical treatment for carpal tunnel syndrome.

Effects of kinesio taping with and without active release technique in carpal tunnel syndrome

BackgroundKinesio taping is used as a conservative treatment for carpal tunnel syndrome and the active release technique is also effective. ObjectiveThe purpose of the present study was to compare the effects of kinesio taping with and without the active release technique on pain, grip strength, functional disability and range of motion in patients with carpal tunnel syndrome. MethodsIt was a randomized controlled trial. Thirty-two patients with carpal tunnel syndrome were randomly allocated to two groups: Group A received kinesio taping with the active release technique for 4 weeks (3 days/week); Group B received kinesio taping alone for 4 weeks (5 days/week). Outcome measures were the Boston Carpal Tunnel Syndrome Questionnaire, a numeric pain rating scale, goniometry and hand-held dynamometry. SPSS software, version 25, was used for data analysis. ResultsNormal distribution was assessed on the Shapiro-Wilk test and parametric tests were applied. Independent t-test results showed that patients who received kinesio taping with the active release technique showed significantly greater improvement (p < 0.05) in pain, functional status and range of motion than the group that received kinesio taping alone. Within-group analysis (paired t-test) showed that both groups significantly improved (p < 0.05) in all outcome measures. ConclusionKinesio taping with the active release technique procured significantly greater improvement in pain, range of motion and functional disability than kinesio taping alone.Clinicaltrials.gov registration number: 789.

Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study.

Ultrasound-guided thread carpal tunnel release (TCTR) was proposed as an effective and safe surgical technique with faster recovery and fewer complications. This study was conducted to confirm the long-term outcomes after TCTR and verify its clinical effectiveness in severe carpal tunnel syndrome (CTS) for more insights into TCTR procedure. A total of 168 TCTR procedures were performed in 152 individual patients by two physiatrists during 36-month period. In an assessment of 82 hands, surgical outcomes of 2 years after TCTR could be obtained, and the grade 6 CTS group of 21 hands, classified as extremely severe grade by Bland's classification, was compared with other severity groups (grade 1-5). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to assess surgical outcomes. No adverse events occurred in all cases including the case of severe CTS and anatomical variants. TCTR showed significant improvement in BCTQ scale within 1-2 weeks, which continued up to 2 years with no recurrence (p < 0.01). Although slower and more progressive than the other severity group, there was also significant improvement relative to the BCTQ scale around 4 weeks after procedure in the grade 6 CTS group (p < 0.05). With the familiarity of ultrasound, ultrasound-guided TCTR is an effective and reliable surgical treatment for CTS in long-term outcomes and in severe CTS.

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

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

Карпальды туннель синдромы мен стенозды лигаментиттің дамуы арасындағы байланыс: Әдеби шолу

Carpal tunnel syndrome and trigger finger disorder are both hand pathologies and the most common reasons for visiting a hand surgeon. Carpal tunnel syndrome is a compression of the median nerve by the flexor retinaculum ligament at the level of the wrist joint. Trigger finger disorder is a condition caused by compression of the digital flexor tendon by the A-1 annular ligament. During the development of hand surgery and new clinical studies, it was noticed that trigger finger often occurs after an operative treatment of carpal tunnel syndrome, less often - vice versa. There were also cases of simultaneous development of both pathologies. The authors of this review tried to find out the reason for this relationship between two different hand disorders by examining the currently available information, containing the results of genetic, histological, biochemical, and clinical studies on this topic. A search was made in the Web of Science, PubMed, Cochrane Library, and Google Scholar databases. The authors concluded that there is an unambiguous relationship between carpal tunnel syndrome and trigger finger disorder, manifested in similar risk factors, changes in the mechanism of movement of the flexor tendons after carpal tunnel release, similar biochemical and histological changes in the tissues of the hand in both pathologies, as well as the presence of the same genetic markers in such patients.

Endoscopy Assisted Carpal Tunnel Syndrome Release Surgery: Case Series

Objective: Endoscopy-assisted surgical procedures for CTS has become increasingly prevalent since 1990s. In endoscopy-assisted carpal tunnel release surgery (EACTRS), it has been proposed that nerve damage likelihood is similar to other procedures. It has also been proposed that EACTRS is especially associated with smaller scar size, painless and faster recovery period. We aimed to determine our clinical and functional results in patients with EACTRS and compare them with the literature Method: We evaluated 25 (39 hands ) patients who underwent endoscopy-assisted carpal tunnel release surgery between 2012 and 2017. In all patients, demographic characteristics, preoperative- postoperative functional scores, patient satisfaction levels and time required to return-to-work were recorded; Results: The endoscopy-assisted carpal tunnel release surgery had positive significant effect on patient satisfaction scores(p&lt;0.05). A statistically significant difference was found between those with and without Double Crush syndrome (DCS) in favor of those without DCS in terms of pre- and postoperative BTCQ symptom severity score (p&lt;0.05). We found only two scar tenderness and two revision Carpal Tunnel release . Conclusion: The EACTRS is an effective method in the treatment of carpal tunnel syndrome. Clinical outcomes are comparable to other methods. Those with DCS, those with comorbidities, and female gender were evaluated as negative prognostic factors in patients who underwent EACTRS.

Validation of the Polish version of the Boston Carpal Tunnel Questionnaire, and the influence of treatment for disordered sleep and daytime sleepiness in carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with paresthesias and pain in the hand and wrist. CTS is also associated with insomnia and excessive daytime sleepiness (EDS) resulting from the nocturnal exacerbation of symptoms. The Boston Carpal Tunnel Questionnaire (BCTQ) was developed for the assessment of therapeutic outcomes. It consists of two subscales: the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). The aim of this study was to perform an adaptation and validation of the Polish language version of BCTQ (pBCTQ). A second aim was to investigate the influence of treatment of CTS on insomnia and EDS. The validation of the pBCTQ followed the widely accepted recommendations. In our consecutive sampling survey 130 patients with CTS filled out the pBCTQ, EQ-5D-5L quality of life questionnaire, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS). 26 of them filled out pBCTQ once again, two weeks later, and 35 filled out the pBCTQ and other items after therapy. The pBCTQ showed good internal consistency: 0.91 for SSS and 0.93 for FSS (Cronbach's α). The test-retest reliability showed an intraclass coefficient of 0.69 for SSS and 0.55 for FSS. Both subscales correlated also with nerve conduction studies (NCS) as well as with the EQ-5D-5L, AIS, and ESS. After therapy, both subscales and AIS significantly decreased. Improvement was also seen in the NCS and EQ-5D-5L, but not in the ESS. The pBCTQ is a reliable, valid, and responsive tool for measuring the outcome of CTS. Therapy for CTS leads to the improvement of concurrent insomnia but may not change daytime sleepiness.

Comparison of clinical efficacy of open and single channel carpal tunnel release in the treatment of carpal tunnel syndrome

Background. Open or wrist arthroscopic release of carpal tunnel is a relatively safe and reliable method. However, there is still some debate as to which of these various surgical methods is superior. Therefore, this study provides more clinical evidence by comparing the clinical efficacy of open and endoscopic single-channel bowl release in the treatment of carpal tunnel syndrome. Methods. The study conducted a retrospective analysis from January 2010 to January 2021. A total of 105 patients met the inclusion criteria, including 56 patients in the open carpal tunnel Release (OCTR) group and 49 patients in the single channel carpal tunnel release (SCCTR) group. The preoperative, intraoperative, and postoperative symptom improvement and functional recovery of the patients were compared. Results. The results of this study showed that the surgical incision healed well in all patients and complete remission of entrapment symptoms. Compared with the OCTR group, the SCCTR group had reduced surgical and hospital duration, intraoperative blood loss, postoperative scar pain score, and time required to return to normal lifestyle, and the SCCTR group had a lower incidence of sympathetic dystrophy and significantly improved clinical symptoms. Conclusion. Single Channel Carpal Tunnel Release under Carpal Arthroscopy in the treatment of carpal tunnel syndrome can achieve reliable clinical efficacy. It can relieve symptoms such as hand numbness and improve hand function. Postoperative pain and other complications are low, and worthy of clinical promotion.

Long-Term Outcomes of Non-surgical versus Surgical Treatment for Carpal Tunnel Syndrome: An Observational Cohort Study

Background: Carpal Tunnel Syndrome (CTS) is a common condition that significantly impacts patients' quality of life and work productivity. While both non-surgical and surgical treatments are employed, there is a lack of consensus regarding the most effective management strategy.&#x0D; Objective: This study aims to compare the outcomes of non-surgical and surgical treatments for CTS, focusing on symptom severity, functional status, and patient satisfaction.&#x0D; Methods: This observational cohort study included 74 participants, with 37 in each treatment group (non-surgical and surgical). Demographic data, including age, gender, occupation, and hand dominance, were recorded. Clinical parameters assessed were duration and severity of CTS symptoms, previous treatments, and comorbid conditions. The non-surgical group underwent treatments like wrist splinting, NSAIDs, and physical therapy, while the surgical group underwent decompression surgery. Outcomes measured included frequency and severity of symptoms, impact on daily activities, and satisfaction with treatment outcomes. Data were analysed using descriptive statistics to compare between groups.&#x0D; Results: The average age was 50 ± 9 years in the non-surgical group and 52 ± 8 years in the surgical group, with a predominance of females in both. The non-surgical group showed higher frequency and severity of symptoms, with daily symptoms reported by 76.1% of patients, compared to 44.4% in the surgical group. Severity of pain was higher in the non-surgical group (5.8 out of 10) than in the surgical group (2.8 out of 10). Satisfaction with surgical outcomes was high, with all patients in the surgical group reporting satisfaction despite a 100% rate of postoperative complications.&#x0D; Conclusion: The study indicates that surgical treatment for CTS may be more effective in reducing symptom severity and improving patient satisfaction compared to non-surgical methods. However, the high rate of postoperative complications in the surgical group necessitates careful consideration and patient counselling regarding treatment choices.&#x0D; Keywords: Carpal Tunnel Syndrome, Non-surgical Treatment, Surgical Treatment, Patient Outcomes, Symptom Severity, Treatment Satisfaction

Comparative study of trimming and resection of diseased finger superficial flexor tendons in gouty carpal tunnel syndrome

BackgroundHyperuricemia can lead to synovial hyperplasia in the wrist. In severe cases, it can lead to the deposition of gouty stone in the carpal tunnel, resulting in increased pressure in the carpal tunnel and compression of the median nerve to cause carpal tunnel syndrome (CTS), which is called gouty carpal tunnel syndrome (GCTS). As for the surgical treatment of gouty carpal tunnel syndrome, scholars have different opinions on whether it is necessary to remove the superficial flexor tendon. The purpose of this study was to compare the clinical efficacy of trimming and resection of the diseased superficial flexor tendon in the treatment of gouty carpal tunnel syndrome.MethodsClinical data were collected from May 2016 to July 2021 from 10 patients (13 affected wrists) diagnosed with gouty carpal tunnel syndrome and classified into two groups according to the surgical modality: the diseased portion of the gout-eroded superficial finger tendon was trimmed in 9 wrists, and the diseased superficial finger flexor tendon was excised in 4 wrists. Values related to flexion and extension functions, 2-PD, DASH, BCTQ, VAS and recurrence in the affected fingers were compared between the two groups as well as before and after surgery in each group.ResultsAll affected limbs used were cleared of gouty stones, finger numbness improved, no skin necrosis occurred, and all incisions healed at stage I. At follow-up (13.58 ± 5.53 months), there was no significant difference between groups in flexion and extension function, 2-PD, DASH, BCTQ, and VAS with respect to the affected fingers, and patients in both groups improved significantly before and after surgery. Treatment of only one wrist involved trimming to remove lesion-affected portions of tendon, which reappeared 1 year after surgery, and there was one case of poor recovery from greater piriformis muscle atrophy in both procedures.ConclusionRegarding surgical treatment of patients with gouty carpal tunnel syndrome in which the gouty stone has invaded the superficial flexor tendons of the fingers, the diseased superficial flexor tendons can be selectively excised, and the postoperative mobility of the affected fingers may not be impaired.

The Efficacy of Single Dose Local Steroid Injection versus Standard Carpal Tunnel Release in the Treatment of Carpal Tunnel Syndrome in Population of D.I. Khan Division, Pakistan

The Efficacy of Single Dose Local Steroid Injection versus Standard Carpal Tunnel Release in the Treatment of Carpal Tunnel Syndrome in Population of D.I. Khan Division, Pakistan

ACUTE CARPAL TUNNEL SYNDROME: RESULTS OF A PROTOCOL FOR EARLY NERVE DECOMPRESSION AND SURGICAL STABILIZATION FOR BONY WRIST TRAUMA

We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours.We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing.The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up.We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours.

Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: an assessor-blinded randomised controlled trial

ObjectivesTo compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial...