Treatment Of Carpal Tunnel Syndrome Research Articles

Photobiomodulation in carpal tunnel syndrome with pain, strength, and functionality analysis: a systematic review and meta-analysis.

Carpal tunnel syndrome (CTS) is characterized as a compressive neuropathy of the median nerve and has several treatments, including photobiomodulation, which can be performed with low-intensity laser therapy (LLLT) and light-emitting diodes (LEDs). To carry out a literature review on the effectiveness of low-intensity laser therapy (LLLT) in CTS. This study is characterized by being a systematic review with metaanalysis. The databases included were PubMed, Embase, Cochrane, the Physiotherapy Evidence Database (PEDro), Scopus and LILACS. Also, gray literature: Google Scholar, OpenGrey and CAPES Theses and DissertationsCatalog. The search was carried out in all databases on October 11, 2023 and updated on June 06, 2024. The risk of bias was assessed using the Cochrane tool, RoB 2, by two blinded reviewers and conflicts were resolved by consensus. The outcomes of interest were pain intensity (Visual analogue scale), strength (handgrip and pinch) and hand functionality (Boston questionnaire, Levine questionnaire, Purdue Pergboard Test). Statistical analysis was carried out using RevMan 5.4.1. Continuous results were expressed as standard mean differences (95% CI), with p-value of < 0.05 considered statistically significant. The value of the I2 statistical test was calculated to test for heterogeneity between studies. A random effects model was adopted. 13 randomized controlled trials were selected from 1.613 records. In the general bias analysis, two studies (15,4%) were considered to have some relevant problems that could interfere with the quality of the study, and three (23,1%) were identified as having a high risk of bias, eight studies (61,5%) were classified as having a low risk of bias. In the meta-analysis, it was possible to observe that there were no advantages of the laser for pain (p = 0.08), nor for handgrip strength (p = 0.11), but it did produce improvements in functionality. It is concluded that LLLT is an effective therapeutic modality in the treatment of CTS, improving functionality; however, despite the studies pointing to advantages for the modality in reducing pain and improving grip strength, the meta-analysis did not show this result. Even so, there is a need for more clinical trials are needed to standardize dosimetry, mainly because the primary studies showed clinical advantages of PBM. Open Science Framework (OSF)- https://doi.org/10.17605/OSF.IO/HQCRP .

Open vs. Endoscopic Carpal Tunnel Release Surgery: A 10-year Analysis of United States Utilization

Objectives Surgical treatment of carpal tunnel syndrome (CTS) can be performed through an open or endoscopic approach. Carpal tunnel release (CTR) performed endoscopically has been offered as a less invasive alternative to an open release. This study assesses the past 10-year trends in utilization and geographic differences of both approaches across the United States (U.S.). The study hypothesis is that the utilization of endoscopic CTR has been increasing. Methods A retrospective database analysis was conducted using the TriNetX U.S. Collaborative Network for patients with CTS who underwent open or endoscopic CTR surgery between 2014 and 2023. Information on patient characteristics, rates of CTR, and geographic location were collected and reported. Results A total of 215,115 patients who had undergone CTR surgery were identified. Age, sex, demographics, and BMI did not differ between the open and endoscopic groups. Overall, open and endoscopic CTR rates have increased in the past decade, with open being the most common approach. The region with the greatest usage of endoscopic surgery in the U.S. was the South (32%), followed by the Northeast, West, and Midwest. Conclusions Over the last decade, the rates of CTR have been increasing for both open and endoscopic techniques. Although open remains the most common approach, endoscopic CTR has gained popularity over the last decade. Regionally, the South utilized the endoscopic approach at greater rates than other regions in the U.S.

Timing of Carpal Tunnel Syndrome Treatment Based on Social Deprivation.

This study sought to investigate the impact of the area deprivation index (ADI) on the treatment timeline from carpal tunnel syndrome (CTS) to carpal tunnel release (CTR). We hypothesize that increased social deprivation will correlate with increased time between care milestones from presentation to surgery. This is a retrospective review of patients diagnosed with CTS who underwent CTRat a single academic institution. Variables including gender, race, ethnicity, smoking status, medical comorbidities, ADI, timing of visits and surgery, and electrodiagnostic (EDX) studies were collected. The analysis included univariate chi-square tests, ANOVA, and multivariate linear and logistic regressions. In total, 501 patients were divided by ADI national percentiles from least to most deprived tertiles. Univariate analysis demonstrated increased time from EDX to CTR comparing the least and most deprived tertiles (52 days vs. 95 days). On multivariate analysis, this correlation was no longer significant. Multivariate analysis also revealed a non-significant trend towards least deprived ADI correlating with a trial of corticosteroid injections. Injections prior to surgery correlated with an increased time from EDX to CTR and time from initial presentation to CTR. A diagnosis of severe CTS on EDX correlated with a decreased likelihood of corticosteroid injections. Although previous studies have demonstrated mixed outcome results in CTS, we found that social deprivation does not correlate with delays in the treatment timeline. Factors other than delays in the treatment timeline may be contributing to the potentially worse outcomes in CTS patients with greater social deprivation.

American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome.

Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies with regard to the diagnosis and treatment of carpal tunnel syndrome in adult patients (≥18 years of age). The scope of this guideline addresses the diagnosis and treatment of carpal tunnel syndrome and contains nine recommendations to assist orthopaedic surgeons and all qualified clinicians managing patients presenting with signs and symptoms which may be attributable to carpal tunnel syndrome based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners, health services researchers, and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.

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

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

A Data Mining Study for Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome [Response to Letter

A Data Mining Study for Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome [Response to Letter

Revision Carpal Tunnel Release with Endoscopic Technique: Clinical Outcomes and Intraoperative Findings.

The standard treatment for recurrent carpal tunnel syndrome (CTS) has been open revision. We hypothesize that endoscopic carpal tunnel release can be used successfully in the revision setting. We identified patients between 2018-2023 who underwent revision carpal tunnel release (CTR). All patients underwent prior open or mini-open CTR (OCTR). All had electrodiagnostically proven CTS and CTS-6 scores >12. Those with suspected or documented nerve injury after primary CTR were excluded. Patient-reported outcomes, including visual analog scale pain scores and 5-point Likert-style rating of symptom improvement, were collected. Thirty patients were identified: 22 with recurrent and 8 with persistent CTS. Average time from index surgery was 110 months in recurrent and 18 months in persistent CTS cases. Twenty-five patients had prior mini-open CTR, and five underwent traditional-open CTR. Intraoperative findings included incomplete release (n= 4), median nerve (MN) adhesions to skin (n= 1) or flexor retinaculum (n= 4), inadequate visualization of the MN (n= 5) and no documented findings (n= 17). Five of 30 patients (16%) were converted from endoscopic to open release procedures intraoperatively. All conversions occurred in patients with prior traditional-open CTR and incisions crossing the wrist flexion crease. At 6-month follow-up, average visual analog pain scores improved from 7 to 2 after revision endoscopic release and from 7 to 3 in cases in which conversion from endoscopic to open release was required. Of the patients, 92% in the revision endoscopic group and 60% in the conversion group had symptom improvement (5-point Likert score ≥3 at final follow-up). Revision endoscopic carpal tunnel release can be performed successfully after primary mini-open CTR. A prior traditional OCTR with an incision crossing the wrist crease is more likely to require conversion to open release. A lower proportion of patients converted to OCTR have postoperative symptom improvement than those treated with revision endoscopic release. Therapeutic IV.

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements.

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms &amp; Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

The Correlation Between Electrodiagnostic Severity and Patient-Reported Disability Among Carpal Tunnel Syndrome Patients.

The use, easy applicability, and costs of accurate diagnostic tools and their utility for early diagnosis, efficient treatment, and follow-up are important. In this study, we aimed to evaluate how electrophysiologic data were reflected in the clinical data of the patients with carpal tunnel syndrome (CTS). This study included 102 patients with definitive CTS based on electroneuromyography. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the 36-item Short Form (SF-36) questionnaire of the general quality of life, the Visual Analog Scale (VAS), and the painDETECT (PD-Q) neuropathic pain questionnaire were administered by a clinical practitioner. We found a moderate correlation between electrophysiologic measurements and VAS and a weak correlation between PD-Q scores. When we tested the mean scores of the SF-36 quality of life scale subscales for differences across the CTS groups, we found significant differences in the mean scores of the physical functioning, bodily pain, and social functioning subdomains by disease severity ( P < 0.05 for each). While the BCTQ Symptom Severity Scale (BCTQ-SSS) was predictive of the early stages of CTS, we found that both BCTQ-SSS and BCTQ-Functional Status Scale scores increased in correlation with advanced stage CTS. In addition to the electrophysiological data, self-report measures may help to pursue a multidirectional approach in patient management by acting as a reference for the diagnosis, treatment, and monitoring of CTS. The correlation between objective data and time-saving, practical, subjective measurements can serve as markers to facilitate a diagnosis.

Role and Impact of Prophylactic Interventions in the Conservative Treatment of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) refers to the compression or tension over the median nerve at the level of the wrist and represents the most commonly encountered compression mononeuropathy. It is diagnosed significantly more often in individuals, whose work involves similar, repetitive movements. The condition affects approximately 4–6% of the active population. Its social aspect stems from the significant deterioration of patients' professional and private life, which, in a high percentage of cases, leads to a change in profession. Multiple surgical and conservative treatment approaches have been described. The literature proposes a general recommendation for compliance with prophylactic interventions and a specific mobilization regimen but a consensus on the subject has not yet been achieved. In our study, we followed 45 patients diagnosed with CTS who reported pain and altered sensation, over a period of 6 months. The patients were divided into three groups which were randomly assigned to different treatment modalities. All patients received the same prophylactic interventions with regard to the physical load and exercises, which were to be followed individually over the course of the study. At the end of the study, the obtained data were analyzed statistically and we reported a correlation between patient improvement and the frequency of the exercises.

Is Dorso-Volar Kinesiotape Added to the Home Exercise Program Effective in the Treatment of Carpal Tunnel Syndrome? Randomized Controlled Electrodiagnostic Study

Abstract Objective We aimed to compare the short- and medium-term efficacy of dorso-volar kinesiotape (KT) added to home exercises (HE) with sham-KT and HE alone in the treatment of mild or moderate carpal tunnel syndrome (CTS) in terms of pain, symptom severity, function, gripping strength, and electrophysiological parameters. Materials and Methods A total of 120 patients (99 females, 21 males) were divided into three groups dorso-volar KT and HE (n=40), sham-KT and HE (n=40), and HE (n=40). Pain (The visual analog scale [VAS]), symptom severity (Boston symptom severity scale [SSS]), functional status (Boston functional status scale [FSS]), nerve conduction study (NCS), hand, finger muscle strength were evaluated pretreatment, at the end of treatment (4th week), and in the third month posttreatment. Results There were statistically significant improvements in VAS (p&lt;0.001), Boston SSS (except HE group) (p&lt;0.001), and Boston FSS (p&lt;0.001) in all groups posttreatment compared to pretreatment, and more in the dorso-volar KT group than pretreatment and the posivite improvement continued at a decreasing rate in the third month posttreatment. At the end of treatment the dorso-volar KT group showed statistically significant improvement in Boston SSS (p&lt;0.001, p&lt;0.001) and Boston FSS (p&lt;0.001, p&lt;0.001) compared to the sham-KT and HE groups. Conclusions The combination of dorso-volar KT and HE program makes a more effective and durable contribution to the improvement of CTS symptom severity, pain and functional status, as well as handgrip strength and NCS parameters compared with sham-KT and HE program.

Is essential tremor a risk factor for carpal tunnel syndrome? A prospective study excluding the most common comorbid conditions

Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity, resulting from compression of the median nerve. Tremor, a rhythmic and involuntary movement of any part of the body, is the most common movement disorder, affecting millions of people worldwide. There is limited research on the coexistence of CTS and ET (essential tremor). Methods: This prospective study included patients aged 18-65 who presented to the neurology outpatient clinic and were diagnosed with ET. Participants supplied informed consent, a sociodemographic form, and the Fahn-Tolosa-Marin Clinical Tremor Rating Scale (FTM TRS). Patients were evaluated for the presence and severity of CTS with electromyography (EMG). The EMG data were categorized as normal, mild, moderate, and severe CTS. Results: In the study, the average age of the 50 ET patients was 56.0 (35.0-64.0) years. The gender distribution comprised 22 (44.0%) males and 28 (56.0%) females. The following tremor locations were reported: 41 (82.0%) in both upper extremities, 3 (6.0%) in the right upper extremity, 2 (4.0%) in the left upper extremity, 1 (2.0%) in both upper extremities, head tremor, and voice, and 3 (6.0%) in both upper extremities and head tremor. A high prevalence of CTS was detected in ET patients (46%). Additionally, a positive correlation was found between CTS in ET patients, long disease duration, and female gender. No significant relationship was found between FTM TRS Part A, Part B, Part C, total scores, and median sensory and motor nerve amplitude and velocity values in ETS patients. Conclusion: CTS is more common in patients with ET. This suggests that ET may be a risk factor for CTS, independent of other factors. Early diagnosis and treatment of CTS in patients with ET is important to improve their quality of life.

Comparison of Treatment Methods for Carpal Tunnel Syndrome: Surgical vs. Non-Surgical

Introduction Carpal tunnel syndrome (CTS) is a common condition that results from the compression of the median nerve within the carpal tunnel in the wrist. Both surgical and non-surgical treatments are used to manage CTS. While surgery is necessary in some cases, many patients can be treated effectively with conservative methods. This review compares the efficacy of surgical treatment for CTS against various conservative approaches. Aim The study aims to evaluate and compare the outcomes of surgical versus conservative treatments for CTS, focusing on symptom relief, patient outcomes, and long-term prognosis. State of Knowledge The carpal tunnel is a narrow passage in the wrist formed by carpal bones and the flexor retinaculum. Compression of the median nerve within this tunnel leads to CTS, which can be caused by anatomical variations or systemic conditions like diabetes. Symptoms include pain, numbness, and tingling in the hand, which may worsen at night or with repetitive movements. Summary (Conclusions) Surgical treatment, especially decompression, offers superior symptom relief and functional improvement but carries risks of complications. Conservative treatments like wrist immobilization and anti-inflammatory medications are effective for many patients, supporting their use as initial treatment. Further research is needed to optimize CTS management.

Which kinesiotaping technique is effective? Comparision of two different techniques in patients with carpal tunnel syndrome

Background &amp; Objective: Although different kinesiotaping (KT) techniques can be applied in the treatment of carpal tunnel syndrome (CTS), to our knowledge, there is no study in the literature showing the superiority of these techniques over each other. The aim of this study is to compare the effectiveness of KT techniques applied to the dorsal surface and palmar surface of the forearm in patients with CTS. Methods: Forty six patients (70 wrists) diagnosed with CTS were randomized into 3 groups. Fabricated night splint was applied to the first group, KT was applied to the palmar surface of the wrist to the second group, and KT was applied to the dorsal surface of the wrist to the third group. Clinical, electrophysiological and ultrasonographic evaluations before treatment and at the end of 3-week treatment were compared. Results: In the comparison pre- and post-treatment, the changes in pain evaluated with Visual Analog Scale, and median motor nerve distal latency were significant in all groups, the change in median nerve sensory conduction velocity was significant in Groups 1 and 2, the change in median motor nerve conduction velocity was significant in only Group 2, the change in The Boston Carpal Tunnel Questionnaire (BCTQ)-Symptom Severity Status was significant in Group 1 and Group 3, the change in BCTQ-Functional Severity Scale and median nerve cross-sectional area was significant in only group 1. When the changes in treatment between the groups were compared, no statistically significant difference was found in any of the parameters. Conclusion: While splinting and different KT methods provided various benefits in CTS patients, they were not statistically superior to each other.

Clinical results of carpal tunnel Re-release revision surgery and synovial wrap for recurrent carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision surgery with a synovial wrap for cases of recurrent carpal tunnel syndrome in patients who had adhered median nerve, with a minimum 1-year follow-up. Patients and methodsA retrospective analysis was conducted on 10 patients (mean age: 73.7 years, nine females and one male) who underwent treatment for recurrent carpal tunnel syndrome. The approach involved carpal tunnel revision surgery coupled with a median nerve synovial wrap. Patients were followed up for a minimum of 1 year. The procedure involved harvesting a 3.5 cm × 4 cm section of the flexor synovial membrane with a distal ulnar pedicle, which was then wrapped around the adherent site of the median nerve. Physical assessments included the pain visual analogue scale (VAS), Tinel sign in the carpal tunnel, thenar muscle atrophy, the Semmes-Weinstein monofilament test (SW test), manual muscle test (MMT) as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent), and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. The physical variables were compared before surgery and at final follow-up. ResultsAll patients showed some improvement in SW test. The MMT for the abductor pollicis brevis showed significant improvement at final follow-up (3 for four patients, 4 for four patients, and 5 for two patients) compared to pre-surgery assessments (2 for six patients, 3 for two patients, and 4 for two patients). The mean VAS score and DASH score at final follow-up (13.0 ± 10.3, 19.3 ± 12.7, respectively) were significantly lower than those recorded before surgery (76.5 ± 11.1, 52.4 ± 17.1, respectively). The Tinel sign and the thenar muscle atrophy significantly improved from before surgery to final follow-up. ConclusionCarpal tunnel release with a synovial wrap demonstrated significant improvements in muscle strength, pain relief and function. The synovial wrap method is an effective procedure for treating recurrent carpal tunnel syndrome.

Local corticosteroid injection versus surgery for carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a very common clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the carpal tunnel in the wrist. Direct and indirect costs of CTS are substantial, with estimated costs of two billion US dollars for CTS surgery in the USA alone. Local corticosteroid injection has been used as a non-surgical treatment for CTS for many years, but its effectiveness is still debated. To evaluate the benefits and harms of corticosteroids injected in or around the carpal tunnel for the treatment of carpal tunnel syndrome (CTS) compared to surgery. We used standard, extensive Cochrane search methods. We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and WHO ICTRP. The latest search was 26 May 2022. We included randomised controlled trials (RCTs) or quasi-randomised trials of adults with CTS that included at least one comparison group of local corticosteroid injection (LCI) into the wrist and one group of any surgical intervention. We used standard Cochrane methods. Our primary outcome was 1. improvement in symptoms at up to three months of follow-up. Our secondary outcomes were 2. functional improvement, 3. improvement in symptoms at greater than three months of follow-up, 4. improvement in neurophysiological parameters, 5. improvement in imaging parameters, 6. improvement in quality of life and 7. We used GRADE to assess the certainty of evidence for each outcome. We included seven studies involving 569 'hands' (although two studies had unusable data for quantitative analyses). All studies used a one-time LCI as a comparator, using several different types and doses of corticosteroids. In every study, for both surgery and LCI groups, all our primary and secondary outcomes showed improvement from pre- to post-treatment. However, evidence from the combined analysis was too uncertain for us to draw reliable conclusions for the comparison of surgical treatment versus LCI with respect to our primary outcome of symptom relief at up to three months' follow-up (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) -0.61 to 1.88; I2 = 95%; 5 trials, 305 participants; very low-certainty evidence). Findings with respect to secondary outcome measures of symptom relief at greater than three months' follow-up (SMD 0.94, 95% CI -0.31 to 2.19; I2 = 93%; 4 trials, 235 participants), functional improvement at up to three months' follow-up (SMD -0.11, 95% CI -0.94 to 0.72; I2 = 84%; 3 trials, 215 participants) and functional improvement at greater than three months' follow-up (SMD 0.19, 95% CI -1.22 to 1.59; I2 = 93%; 3 trials, 185 participants) were also uncertain (very low-certainty evidence) and showed no clear advantage for surgery or LCI. Surgery may improve neurophysiology (median nerve distal motor latency) more than LCI (mean difference (MD) 0.87 ms, 95% CI 0.32 to 1.42; I2 = 72%; 3 trials, 162 participants; low-certainty evidence). Evidence for quality of life and adverse events was also uncertain; quality of life (EuroQol-5D-3L) may be slightly improved after LCI than after surgery (the difference may not be clinically important) (MD 0.07, 95% CI 0.02 to 0.12; 1 trial, 38 participants; very low-certainty evidence) and there may be fewer adverse events with LCI than with surgery (risk ratio (RR) 0.34, 95% CI 0.04 to 3.26; 3 trials, 112 participants; very low-certainty evidence). The evidence comparing LCI to surgery for CTS, either in the short term or up to 12 months' follow-up, is too uncertain for any reliable conclusions to be drawn.

How Useful Is TikTok for Patients Searching for Carpal Tunnel Syndrome-Related Treatment Exercises?

Since orthopedic surgery has been slower to acknowledge the rise of social media for distributing medical information, this study aims to evaluate TikTok videos' quality and educational value in relation to carpal tunnel syndrome treatment exercises. TikTok was searched using the hashtags "#carpaltunnelexercises", "#carpaltunnelremedies", "#carpaltunnelrehab", and "#physicaltherapyforcarpaltunnel". The engagement indicators were documented and the video content quality was assessed using the DISCERN, CTEES, JAMA, and GQS grading scales. There were 101 videos included, which accumulated 20,985,730 views. The videos received 1,460,953 likes, 15,723 comments, 243,245 favorites, and 159,923 shares. Healthcare professionals were responsible for 72% of the video uploads, whereas general users contributed 28%. More healthcare professionals' videos were graded as "poor" (79%) compared to general users (21%). General users received slightly more video grades of "very poor" (52%) than healthcare professionals (48%). For the DISCERN grading, the videos by healthcare professionals were significantly better than those by general users in terms of reliability, achieving aims, and relevancy. They were also superior in the overall composition of the health information derived from the total DISCERN score. However, no significant differences were found between the two groups when using the CTEES, JAMA, and GQS grading scales. Overall, despite the emergence of TikTok as a medical information tool, the quality and educational value of the carpal tunnel syndrome exercise videos were poor.

Impact of Exposure to Hand-Held Vibrating Tools on Patient-Reported Outcome Measures after Open Carpal Tunnel Release: A Retrospective Cohort Study with Matched Controls.

Objectives: Vibration exposure is a known risk factor for developing carpal tunnel syndrome (CTS), and insufficient outcomes for surgery for CTS have been reported after such exposure. We aim to investigate whether vibration exposure affects patient-reported outcomes following open carpal tunnel release. Methods: From a population surgically treated for CTS (n = 962), we identified patients who reported previous or present vibration exposure, had undergone preoperative electrophysiology testing and answered the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire before and at 12 months post-surgery (n = 23). We then matched the patients with controls based on age, sex, diabetes status, type of diabetes and smoking (n = 23). Results: Most of the patients included were men (17/23; 74% in each group) and had a mean age of 61 years. The preoperative electrophysiology results were slightly worse among vibration-exposed individuals, although the differences were not statistically significant. The QuickDASH scores did not differ between the two groups (preoperative QuickDASH scores in vibration-exposed individuals: median 45 [interquartile range; IQR 30-61]; non-exposed individuals: 43 [25-64], p = 0.68; postoperative 12 months QuickDASH score in vibration-exposed individuals: 20 [2-45]; non-exposed individuals: 14 [5-34], p = 0.87). Conclusions: When controlling for known confounders, vibration-exposed individuals can expect the same symptom relief following open carpal tunnel release as non-exposed individuals. Individual assessments and treatment of CTS are warranted if there is a history of vibration exposure.

Exploring the Non-Invasive Approaches to Carpal Tunnel Syndrome in Routine Clinical Practice: A Focus on the Role of Acetylcholinesterase Inhibitors.

The prevalence of N. medianus compression neuropathies remains high in clinical practice. The objective was to evaluate modalities of conservative treatments for carpal tunnel syndrome (CTS) focusing on the role of acetylcholinesterase inhibitors. This observational study involved 51 adult outpatients diagnosed with CTS. Patients were observed during routine clinical protocols and we compared two groups of 25 and 26 individuals, with the first group receiving basic therapy for CTS and 20 mg of ipidacrine (Neiromidin®) two or three times a day per os, while the second group received only basic therapy. The condition of all patients was assessed twice, with at least a one-month interval. The parameters evaluated included the Boston Carpal Tunnel Questionnaire (BCTQ); the Disabilities of the Arm, Shoulder, and Hand scale (DASH); and pain intensity on the Numeric Rating Scale (NRS). The mean reduction in DASH score was 12.3 (SD 7.7) in Group 1 and 7.1 (SD 6.3) in Group 2 (p < 0.01). Also, other scores showed statistically significant differences between the two groups: -2.3 vs. -1.0 for NRS, -0.89 vs. -0.44 for SSS, and -0.68 vs. -0.31 for FSS, respectively (p < 0.01). Moreover, these findings correlated positively with the global improvement (CGI-I) between the groups. The addition of ipidacrine to basic therapy led to improved recovery in patients with CTSs of varying severity.

Comparative Study between Platelet-Rich Plasma, Corticosteroids and Perineural Dextrose local Injections for Treatment of Carpal Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS), one of the most common entrapment neuropathies, is considered as a socio- economic issue that reduces work productivity and increases disability. Aim of the Work to compare the effect of Platelet- Rich Plasma (PRP), corticosteroids (CS) and perineural Dextrose 5 % in water (D5W) local injections for the treatment of idiopathic mild and moderate CTS. Patients and Methods A prospective study was performed on 60 median nerves of 60 patients. They were diagnosed as idiopathic CTS and classified randomly into 3 groups (each contains 20 patients) according to the treatment program received: group I (ultrasound guided CS injection), group II (ultrasound guided perineural Dextrose 5% injection) and group III (ultrasound guided PRP injection). Results Ultrasound guided local injection using single doses of CS, D5W, and PRP were very efficient as regards symptomatic and functional improvement, reducing distal motor latency (DML) and Peak sensory latency ( PSL) of median nerve, as well as decreased Cross Section Area (CSA) of Median nerve (MN) and improving median nerve mobility for idiopathic mild to moderate CTS. For symptom and functional improvement, single injection of CS was more effective than that of PRP and D5W within 3 months post-injection. Moreover, PRP was slightly better than D5W. For reducing DML and PSL, CS was the most effective followed by PRP and then D5W at 3 months post injection. For reducing CSA, CS was the most effective followed by PRP and then D5W at 3 months post injection. For improving mobility of median nerve, D5W was the most effective at 3 months post injection followed by CS and PRP. Conclusion Injection of CS, D5W and PRP had resulted in significant Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score reduction at 3 months post-injection in comparison to the BCTQ score at the baseline evaluation. All of the three studied groups (Corticosteroids, dextrose 5 % and PRP) have shown a great result regarding improving in clinical examination, clinical assessment scales, nerve conduction studies and improving in Neuromuscular Ultrasound results with favorable results of Corticosteroids group over Perineural dextrose 5 % group and PRP group.