Treatment Of Carpal Tunnel Syndrome Research Articles

Post-traumatic carpal tunnel syndrome in children

BackgroundGiven limited information about acute carpal tunnel syndrome (CTS) in children, the purpose of this study is to describe the presentation and treatment results of CTS after traumatic wrist or forearm injury in a pediatric population. MethodsIn this retrospective single-center cohort study, all children with post-traumatic CTS were identified. Demographic and clinical presentation, treatment, and outcomes data were collected from the electronic medical record. Descriptive statistics were calculated for variables of interest, and Χ2 and independent sample t-tests were used for subgroup comparisons. Results18 patients (16 male, average age 12.8 ± 3.6 years) with post-traumatic CTS were identified. 13 presented acutely (<3 days) versus 4 subacutely (1–6 weeks) and one delayed presentation (>6 weeks) after injury. Of associated traumas, 83% (15/18) involved distal radius fractures, of which 40% (6/15) had an associated ulna fracture. The most common symptoms were numbness (78%), paresthesias (33%), and increasing pain (28%). Three patients had clinical concerns for concomitant compartment syndrome. 6 patients were initially monitored (2 acute, 3 subacute, 1 delayed). Ultimately, 16/18 underwent operative release (13/13 acute, 2/4 subacute, 1/1 delayed). At follow-up, 81% of the surgically treated patients had complete symptomatic relief. There was no statistically significant difference in treatment outcomes between acute versus subacute or delayed presentation (OR: 6.67, p = .214). Of patients with acute CTS, delayed surgery resulted in prolonged recovery (28.0 vs. 2.4 weeks, p < .001). ConclusionsPost-traumatic CTS more often presents acutely than as a delayed complication of distal radius fractures in children. The type of injury and clinical presentation can vary, but patients most often present with median neuropathy symptoms like numbness. Acute CTS should be treated urgently with carpal tunnel release. While patients with delayed presentation can trial observation, the patient will likely warrant surgery for complete symptom relief. Operative treatment for both acute and subacute cases generally results in positive outcomes. Key Concepts(1)Post-traumatic CTS may present acutely as a complication of distal radius fractures in children with symptoms of numbness, paresthesias, and increasing pain.(2)Acute CTS should be treated with urgent carpal tunnel release to avoid prolonged recovery.(3)Children with delayed presentation of CTS can be safely monitored, but the patient often needs surgery to experience complete symptom relief.(4)Operative treatment for post-traumatic CTS in children generally results in positive outcomes. Level of EvidenceIV Case Series

Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study.

Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.

Prospective evaluation of a novel device for ultrasound-guided percutaneous treatment of carpal tunnel and trigger finger disease. Efficacy and safety of sono-instruments®.

To evaluate the safety and effectiveness of percutaneous release procedures under sonography using Sono-Instruments® in the treatment of carpal tunnel syndrome (CTS) and trigger finger (TF). Prospective study involving 30 patients, divided into two groups (15 CTS, and 15 TF). The primary outcomes were surgical performance-related outcomes (visibility, ease of use, satisfaction, duration) using Sono-Instruments® and patient-related outcomes (pain, activity limitations, time to return to work, functional scores). Secondary outcomes included complications. Patients were followed for two months post-operatively. In the CTS group, the average age of the patients was 58.7years. The percutaneous release of the transverse carpal ligament was effectively completed in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 80% could perform activities of daily living, and 80% of those working had returned to their activities. At two months, all patients had resumed all activities. Pillar pain was still present in 53.3%. In the TF group, the patients had an average age of 57.9years. The percutaneous release of the A1 annular pulley was successful in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 93.3% could do all activities of daily living, and 75% of those working were back to their professional activities. At two months, all patients were back to all activities of daily living and work. The DASH score was significantly improved at two months, compared to preoperative, for both groups (p < 0.001). Percutaneous sono-guided release using Sono-Instruments® is safe and efficient, and associated with quick functional recovery. II.

Metacarpal Small Incision for Carpal Tunnel Syndrome.

Endoscopic carpal tunnel release (ECTR) techniques have been established as a successful treatment for carpal tunnel syndrome and have proven equally effective as traditional open carpal tunnel release (OCTR) techniques in relieving pain and numbness. However, patients who undergo OCTR are more likely to experience scar tenderness and pillar pain and take longer to return to work. We present here a method of metacarpal small incision for carpal tunnel release (MSICTR) as a safe, reliable, cost-effective alternative surgical decompression of the median nerve of the wrist. This technique utilizes a metacarpal small incision and direct visualization of the median nerve and carpal tunnel contents, reducing the risk of permanent injury and neurasthenia when compared to traditional OCTR. MSICTR is also suitable for the examination of the median nerve, surrounding tendon sheath, or space-occupying lesions. MSICTR is associated with shorter operation times, less postoperative pain, faster recovery, and improved cosmetic results when compared to traditional OCTR. Therefore, MSICTR is an effective surgical decompression of the median nerve for the treatment of carpal tunnel syndrome.

Response to Khan et al: Long-Term Outcomes of Non-surgical versus Surgical Treatment for Carpal Tunnel Syndrome: An Observational Cohort Study.

The letter to the editor discusses the comparative fairness between surgical and non-surgical treatments for Carpal Tunnel Syndrome (CTS), highlighted in Khan et al.'s study. The authors argue that surgical treatments, being based on a unified pathophysiology of decompression, are not comparable to the diverse non-surgical treatments like splinting and local corticosteroid injections, which only some have substantial evidence backing their effectiveness. They reference their own study showing equal effectiveness of surgery and corticosteroid injections in the short term, but a long-term advantage for surgery, despite a significant number of non-surgical cases not requiring further treatment.

EXPLORING THE POSSIBILITIES OF SOME CONTEMPORARY PHYSICAL THERAPY METHODS FOR THE CONSERVATIVE TREATMENT OF CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) is the most common compression neuropathy, affecting nearly 5% of the general population. The modern approach to its treatment is complex and includes early diagnosis, prevention and treatment of all conditions and diseases leading to its manifestation.&#x0D; Many authors have worked on the problems related to the possibilities of physical therapy in treating CTS, but the question of optimal treatment and rehabilitation remains relevant to this day. In practice, various rehabilitation programs are constantly being implemented and developed. Many have demonstrated positive outcomes, but work in this area persists. Every novel approach or integration of established physiotherapeutic and rehabilitation techniques enhances the current methods and expands the potential for more comprehensive functional recovery of the impaired limb, as well as the patient's restoration to their previous lifestyle.&#x0D; Physical therapy has advanced significantly in recent decades due to the introduction of numerous new techniques and technologies. The article offers a brief literature overview of several contemporary physical medicine approaches that can be applied in the conservative treatment of carpal tunnel syndrome based on their physiological and therapeutic effects. Modern physical therapy approaches can be a viable alternative to established physical therapy methods like ultrasound, low-level laser, iontophoresis, magnetotherapy, TENS, and others. It is crucial to conduct additional qualitative and comprehensive investigations to verify the effectiveness of physical therapy in treating CTS, identify the most efficient ways, and create improved protocols for its conservative treatment.

Surgical Interventions for the Management of Carpal Tunnel Syndrome: A Narrative Review.

Carpal tunnel syndrome (CTS) is a severe condition that affects the hand, causing pain, numbness, paresthesia, and autonomic dysfunction caused by increased pressure, damage, and demyelination of the median nerve in the carpal tunnel. The most effective treatment for CTS is carpal tunnel release (CTR) via transverse carpal ligament (TCL) transect. We can apply decompression through endoscopic procedures; standard open techniques and minimally invasive wrist incisions can all be used to accomplish decompression. Superior outcomes have been reported in many studies, including patient satisfaction, symptom relief, improvements in multiple assessment modality results, and fewer complications. Soreness at the incision site, tenderness around the site of ligament release, transitory loss of motor or sensory function, and the need for a repeat operation are all postoperative consequences. There is minimal and low-quality evidence to support the effectiveness of postoperative rehabilitation, such as wrist orthoses, dressings, exercise, and ice therapy, which have benefited patients anecdotally.

[Ultrasound-guided decompression in the treatment of carpal tunnel syndrome].

Bevezetés: A kéztőalagút-szindróma hazánkban is gyakran előforduló megbetegedés, akár minden 10. embert érintheti. Korai tüneteinek felismerése elengedhetetlen az időben történő diagnózishoz és a beavatkozáshoz. Súlyos vagy konzervatív kezelésekre nem reagáló esetekben sebészeti beavatkozás válhat szükségessé. Célkitűzés: A jelen közlemény célja egy hazánkban újonnan meghonosított, ultrahangvezérelt dekompressziós műtét bemutatása és eredményeinek taglalása. Módszer: A műtét egynapos sebészeti ellátás keretében történik, lokális érzéstelenítésben. Ultrahang segítségével azonosítjuk a medianus ideg lefutását, a fontosabb érképleteket, biztonsági határokat. 2 mm-es bőrmetszésen keresztül folyamatos ultrahangkontroll alatt vezetjük be a műtéti eszközöket. A sarlós szikével alulról metsszük át a ligamentum carpi transversumot, így dekomprimálva a medianus ideget. A teljes dekompressziót igazoljuk ultrahanggal és segédeszközökkel is. A sebet a legtöbb esetben ragasztjuk. Eredmények: A módszert 44 beteg esetében végeztük 2022. október és 2023. november között. A műtétet megelőzően minden esetben ultrahangvizsgálat is történt a szekunder okok és a kontraindikáló tényezők (például egyedi éranatómia) kizárására. Műtéti indikációnak az elektrofiziológiailag igazolt, közepes vagy súlyos fokú idegi károsodást, továbbá a betegek által jelzett, az életminőséget jelentősen rontó, tűrhetetlen panaszokat tekintettük. Intraoperatív vagy major komplikációt egyetlen esetben sem tapasztaltunk. 2 esetben jelentkezett kisebb komplikáció (bőrpír, hosszabb gyógyulás a kéz túl korai erőltetése miatt). A betegek már a műtétet követő 2. naptól a tünetek jelentős csökkenését tapasztalták, és az operált kezüket a mindennapokban használhatták. A zsibbadásos panaszok megszűnése átlagosan 2,5 hét alatt következett be. Következtetés: Az ultrahangvezérelt dekompresszió kiváló és biztonságos lehetőséget nyújt a kéztőalagút-szindróma minimálisan invazív kezelésére. A technika fő előnyei közül kiemelhető az apró vágásból származó kisebb fokú hegesedés, valamint a rövid ideig tartó rehabilitáció és munkába való gyors visszatérés lehetősége. Orv Hetil. 2024; 165(9): 346–350.

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.

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.

Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. Surgery is considered when symptoms persist despite the use of non-surgical treatments. It is unclear whether surgery produces a better outcome than non-surgical therapy. This is an update of a Cochrane review published in 2008. To assess the evidence regarding the benefits and harms of carpal tunnel release compared with non-surgical treatment in the short (< 3 months) and long (> 3 months) term. In this update, we included studies from the previous version of this review and searched the Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, ClinicalTrials.gov and WHO ICTRP until 18 November 2022. We also checked the reference lists of included studies and relevant systematic reviews for studies. We included randomised controlled trials comparing any surgical technique with any non-surgical therapies for CTS. We used the standard methodological procedures expected by Cochrane. The 14 included studies randomised 1231 participants (1293 wrists). Eighty-four per cent of participants were women. The mean age ranged from 32 to 53 years, and the mean duration of symptoms from 31 weeks to 3.5 years. Trial sizes varied from 22 to 176 participants. The studies compared surgery with: splinting, corticosteroid injection, splinting and corticosteroid injection, platelet-rich plasma injection, manual therapy, multimodal non-operative treatment, unspecified medical treatment and hand support, and surgery and corticosteroid injection with corticosteroid injection alone. Since surgery is generally used for its long-term effects, this abstract presents only long-term results for surgery versus splinting and surgery versus corticosteroid injection. 1) Surgery compared to splinting in the long term (> 3 months) Surgery probably results in a higher rate of clinical improvement (risk ratio (RR) 2.10, 95% confidence interval (CI) 1.04 to 4.24; 3 studies, 210 participants; moderate-certainty evidence). Surgery probably does not provide clinically important benefit in symptoms or hand function compared with splinting (moderate-certainty evidence). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (scale 1 to 5; higher is worse; minimal clinically important difference (MCID) = 1) was 1.54 with splint and 0.26 points better with surgery (95% CI 0.52 better to 0.01 worse; 2 studies, 195 participants). The mean BCTQ Functional Status Scale (scale 1 to 5; higher is worse; MCID 0.7) was 1.75 with splint and 0.36 points better with surgery (95% CI 0.62 better to 0.09 better; 2 studies, 195 participants). None of the studies reported pain. Surgery may not provide better health-related quality of life compared with splinting (low-certainty evidence). The mean EQ-5D index (scale 0 to 1; higher is better; MCID 0.074) was 0.81 with splinting and 0.04 points better with surgery (95% CI 0.0 to 0.08 better; 1 study, 167 participants). We are uncertain about the risk of adverse effects (very low-certainty evidence). Adverse effects were reported amongst 60 of 98 participants (61%) in the surgery group and 46 of 112 participants (41%) in the splinting group (RR 2.11, 95% CI 0.37 to 12.12; 2 studies, 210 participants). Surgery probably reduces the risk of further surgery; 41 of 93 participants (44%) were referred to surgery in the splinting group and 0 of 83 participants (0%) repeated surgery in the surgery group (RR 0.03, 95% CI 0.00 to 0.21; 2 studies, 176 participants). This corresponds to a number needed to treat for an additional beneficial outcome (NNTB) of 2 (95% CI 1 to 9). 2) Surgery compared to corticosteroid injection in the long term (> 3 months) We are uncertain if clinical improvement or symptom relief differs between surgery and corticosteroid injection (very low-certainty evidence). The RR for clinical improvement was 1.23 (95% CI 0.73 to 2.06; 3 studies, 187 participants). For symptoms, the standardised mean difference (SMD) was -0.60 (95% CI -1.88 to 0.69; 2 studies, 118 participants). This translates to 0.4 points better (95% CI from 1.3 better to 0.5 worse) on the BCTQ Symptom Severity Scale. Hand function or pain probably do not differ between surgery and corticosteroid injection (moderate-certainty evidence). For function, the SMD was -0.12 (95% CI -0.80 to 0.56; 2 studies, 191 participants) translating to 0.10 points better (95% CI 0.66 better to 0.46 worse) on the BCTQ Functional Status Scale with surgery. Pain (0 to 100 scale) was 8 points with corticosteroid injection and 6 points better (95% CI 10.45 better to 1.55 better; 1 study, 123 participants) with surgery. We found no data to estimate the difference in health-related quality of life (very low-certainty evidence). We are uncertain about the risk of adverse effects and further surgery (very low-certainty evidence). Adverse effects were reported amongst 3 of 45 participants (7%) in the surgery group and 2 of 45 participants (4%) in the corticosteroid injection group (RR 1.49, 95% CI 0.25 to 8.70; 2 studies, 90 participants). In one study, 12 of 83 participants (15%) needed surgery in the corticosteroid group, and 7 of 80 participants (9%) needed repeated surgery in the surgery group (RR 0.61, 95% CI 0.25 to 1.46; 1 study, 163 participants). Currently, the efficacy of surgery in people with CTS is unclear. It is also unclear if the results can be applied to people who are not satisfied after trying various non-surgical options. Future studies should preferably blind participants from treatment allocation and randomise people who are dissatisfied after being treated non-surgically. The decision for a patient to opt for surgery should balance the small benefits and potential risks of surgery. Patients with severe symptoms, a high preference for clinical improvement and reluctance to adhere to non-surgical options, and who do not consider potential surgical risks and morbidity a burden, may choose surgery. On the other hand, those who have tolerable symptoms, who have not tried non-surgical options and who want to avoid surgery-related morbidity can start with non-surgical options and have surgery only if necessary. We are uncertain if the risk of adverse effects differs between surgery and non-surgical treatments. The severity of adverse effects may also be different.

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.