Treatment Of Carpal Tunnel Syndrome Research Articles

Expert consensus on the diagnosis and treatment of carpal tunnel syndrome with integrated Chinese and Western medicine

Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression disease. The early diagnosis and treatment are very necessary due to the high incidence rate, diverse hazard factors and the irreversible muscle atrophy caused by the late disease. Clinically, there are many treatments on CTS, both traditional Chinese medicine (TCM) and Western medicine treatment have their advantages and disadvantages. If we can combine them and complement each other, it will be more conducive to the diagnosis and treatment of CTS. Under the support of Professional Committee of Bone and Joint Diseases of the World Federation of Chinese Medicine Societies, in this consensus, we synthesized the opinions of experts in related fields of TCM and Western medicine and formed the recommendations for the diagnosis and treatment of TCM and western medicine of CTS. The consensus also makes a brief CTS diagnosis and treatment flow chart, hoping to provide reference for academic community.

Local corticosteroid injection versus placebo 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 in 1995 alone. Local corticosteroid injection has been used as a non-surgical treatment for CTS 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 compared to no treatment or a placebo injection. We used standard, extensive Cochrane search Methods. The searches were 7 June 2020 and 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 injection of corticosteroid (LCI) into the wrist and one group that received a placebo or no treatment. 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. requirement for carpal tunnel surgery, 7. improvement in quality of life and 8. We used GRADE to assess the certainty of evidence for each outcome. We included 14 trials with 994 participants/hands with CTS. Only nine studies (639 participants/hands) had useable data quantitatively and in general, these studies were at low risk of bias except for one quite high-risk study. The trials were conducted in hospital-based clinics across North America, Europe, Asia and the Middle East. All trials used participant-reported outcome measures for symptoms, function and quality of life. There is probably an improvement in symptoms measured at up to three months of follow-up favouring LCI (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.94 to -0.59; 8 RCTs, 579 participants; moderate-certainty evidence). Up to six months this was still evident favouring LCI (SMD -0.58, 95% CI -0.89 to -0.28; 4 RCTs, 234 participants/hands; moderate-certainty evidence). There is probably an improvement in function measured at up to three months favouring LCI (SMD -0.62, 95% CI -0.87 to -0.38; 7 RCTs, 499 participants; moderate-certainty evidence). We are uncertain if there is a difference in median nerve DML at up to three months of follow-up (mean difference (MD) -0.37 ms, 95% CI -0.75 to 0.02; 6 RCTs, 359 participants/hands; very low-certainty evidence). The requirement for surgery probably reduces slightly in the LCI group at one year (risk ratio 0.84, 95% CI 0.72 to 0.98; 1 RCT, 111 participants, moderate-certainty evidence). Quality of life, measured at up to three months of follow-up using the Short-Form 6 Dimensions questionnaire (scale from 0.29 to 1.0; higher is better) probably improved slightly in the LCI group (MD 0.07, 95% CI 0.02 to 0.12; 1 RCT, 111 participants; moderate-certainty evidence). Adverse events were uncommon (low-certainty evidence). One study reported 2/364 injections resulted in severe pain which resolved over "several weeks" and 1/364 injections caused a "sympathetic reaction" with a cool, pale hand that completely resolved in 20 minutes. One study (111 participants) reported no serious adverse events, but 65% of LCI-injected and 16% of the placebo-injected participants experienced mild-to-moderate pain lasting less than two weeks. About 9% of participants experienced localised swelling lasting less than two weeks. Four studies (229 participants) reported that they experienced no adverse events in their studies. Three studies (220 participants) did not specifically report adverse events. Local corticosteroid injection is effective for the treatment of mild and moderate CTS with benefits lasting up to six months and a reduced need for surgery up to 12 months. Where serious adverse events were reported, they were rare.

Predicting CTS Diagnosis and Prognosis Based on Machine Learning Techniques.

Carpal tunnel syndrome (CTS) is a clinical disease that occurs due to compression of the median nerve in the carpal tunnel. The determination of the severity of carpal tunnel syndrome is essential to provide appropriate therapeutic interventions. Machine learning (ML)-based modeling can be used to classify diseases, make decisions, and create new therapeutic interventions. It is also used in medical research to implement predictive models. However, despite the growth in medical research based on ML and Deep Learning (DL), CTS research is still relatively scarce. While a few studies have developed models to predict diagnosis of CTS, no ML model has been presented to classify the severity of CTS based on comprehensive clinical data. Therefore, this study developed new classification models for determining CTS severity using ML algorithms. This study included 80 patients with other diseases that have an overlap in symptoms with CTS, such as cervical radiculopathysasas, de quervian tendinopathy, and peripheral neuropathy, and 80 CTS patients who underwent ultrasonography (US)-guided median nerve hydrodissection. CTS severity was classified into mild, moderate, and severe grades. In our study, we aggregated the data from CTS patients and patients with other diseases that have an overlap in symptoms with CTS, such as cervical radiculopathysasas, de quervian tendinopathy, and peripheral neuropathy. The dataset was randomly split into training and test data, at 70% and 30%, respectively. The proposed model achieved promising results of 0.955%, 0.963%, and 0.919% in terms of classification accuracy, precision, and recall, respectively. In addition, we developed a machine learning model that predicts the probability of a patient improving after the hydro-dissection injection process based on the aggregated data after three different months (one, three, and six). The proposed model achieved accuracy after six months of 0.912%, after three months of 0.901%, and after one month 0.877%. The overall performance for predicting the prognosis after six months outperforms the prediction after one and three months. We utilized statistics tests (significance test, Spearman's correlation test, and two-way ANOVA test) to determine the effect of injection process in CTS treatment. Our data-driven decision support tools can be used to help determine which patients to operate on in order to avoid the associated risks and expenses of surgery.

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

Update on surgical procedures for carpal tunnel syndrome: What is the current evidence and practice? What are the future research directions?

Carpal tunnel syndrome (CTS) is a multifactorial compression neuropathy. It is reported to be very common and rising globally. CTS's treatment varies from conservative measures to surgical treatments. Surgery has shown to be an effective method for more severe cases. However few unclear aspects and room for further research and improvements still remains. We performed a narrative literature review on the most up to date progress and innovation in terms of surgical treatments for CTS. The simple algorithm of leaving the choice of the surgical method to surgeons' preference and experience (together with consideration of patients' related factors) seem to be the best available option, which is supported by the most recent metanalysis and systematic reviews. We suggest that surgeons (unless in presence of precise indications towards endoscopic release) should tend to perform a minimally invasive open approach release, favoring the advantage of a better neurovascular structures visualization (and a consequent higher chance to perform a complete release with long term relief of symptoms) instead of favoring an early reduction (in the first postoperative days) of immobilization and pain. Research towards a universally accepted standardization should be aimed for by the researchers, who have failed to date to sufficiently limit bias and limitations.

Nucleo CMP Forte™ for the treatment and rehabilitation of patients with carpal tunnel syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common and best well-known cause of peripheral nerve compression. To date, none of the studies have determined the optimal combination of pyrimidine nucleotides and electrical stimulation (ES) in CTS patients. The objective of the study was to evaluate the effectiveness of a novel product containing uridine and cytidine monophosphate (Nucleo CMP Forte™) in combination with ES for the treatment of CTS. Methods: This open-label, randomized, controlled study involved 60 patients with CTS at the Azerbaijan Medical University (Baku, Azerbaijan) and Research Institute of Medical Rehabilitation between 2017 and 2021 years. Patients were randomized to receive the exploratory treatment (Nucleo CMP Forte™ and ES) or single ES treatment for ten days. The combination treatment included two stages: Nucleo CMP Forte™ and ES for ten days (stage one), and Nucleo CMP Forte™ as monotherapy (stage two) for ten days. Results: In the exploratory group, the complete restoration of pain sensitivity was achieved by 17.1% of patients and the narrowing of the existing zone of hypesthesia by 74.3%. Positive Tinel test was revealed in 52.4% of patients after the first and 76.2% after the second stage in the exploratory group, versus 43.8% in the control group. Mean values in the Boston Carpal Tunnel Questionnaire significantly decreased in both groups. Conclusion: Nucleo CMP Forte™ in combination with ES contributes to a more pronounced regression of patients' complaints, clinical manifestations, severity, and neurophysiological indicators in mild-to-moderate CTS.

Efficacy of median nerve hydrodissection by hyalase versus midazolam in the treatment of carpal tunnel syndrome.

Background: The objective was to determine which of midazolam or hyalase could improve the pain score and functional disability in median nerve hydrodissection. Methods: In a double-blind study with two groups, both received bupivacaine 15 mg with either 300 IU hyalase in 2 ml of saline (group HA) or 2mg of midazolam in 2ml of sterile saline (group MZ). Results: Statistically significantly lower post-injection Visual Analog Scale scores in group MZ compared with group HA at all follow-ups. Group MZ had significantly lower functional disability scores than group HA. Conclusion: Both drugs yielded favorable results. Midazolam was more impactful in alleviating pain and reducing functional disability up to 6months.

Eficacia del tratamiento de rehabilitación para el síndrome del túnel carpiano: un ensayo clínico controlado aleatorizado

Introduction and objectiveCarpal tunnel syndrome is the most common median nerve mononeuropathy. There are multiple conservative treatments, invasive (corticoid injections [CI]) and non-invasive (splinting, therapeutic ultrasound [TUS], laser, exercise). However, the treatment choice is controversial. The aim was to determine the efficacy of conservative treatment to improve the clinical and electrophysiological evaluations. MethodsOutpatients referred whit carpal tunnel syndrome clinical diagnosis to perform nerve conduction study (NCS) were included, without chronic or metabolic diseases that affect the peripheral nerves, without carpal tunnel syndrome treatment and with mild or moderate axonotmesis or neuropraxia in NCS baseline. Patients who signed informed consent forms were randomized in three treatment groups (Group 1: TUS+splint; Group 2: CI+splint and Group 3: TUS+CI+splint) were referred for clinical evaluations. The NCS was performed in each patient at baseline, fourth and eighth weeks by the same physiatrist and the clinical evaluations were performed at baseline and the final follow-up. ResultsThirty patients were included; mean age was 50.7±7.5 years and all of them females, without differences in NCS or clinical variables in the baseline evaluations. All groups exhibited improvement in some clinical and electrophysiological variables in the final evaluation, though only group 3 showed improvement on median/ulnar nerves sensory peak latency difference (1.2±0.4 vs. 0.4±0.4; p=0.001) starting in week four. ConclusionsThe conservative treatment in patients with CTS improves NCS and clinical variables, including the most sensitive electrophysiological test (medial/ulnar difference), though if we combined three treatments (splint+TUS+CI), the improvement was found to be faster and remarkable.

Transcarpal Motor Conduction Velocity: Repeatability and Application in Carpal Tunnel Syndrome.

Conduction velocity of the short segment of the median motor nerve, across wrist (transcarpal motor conduction velocity (TCMCV)), has been used to increase diagnostic yield in carpal tunnel syndrome (CTS). However, repeatability of this parameter has not been studied till date. It has not been used as an indicator of response to treatment. Using surface stimulation techniques, it is difficult to localize the sites of stimulation of transcarpal segment of median nerve in palm. As a result, small errors in measurements of TCMCV can be magnified and variability of TCMCV may occur on successive measurements. Despite this possible variation, TCMCV can be a useful tool for assessing response to therapy, if its repeatability is assessed and a cut-off value determined for a significant change in nerve conduction velocity. In this study, it was determined whether TCMCV is repeatable. If found to be repeatable, we show a method to determine the cut-off value of the change in this parameter for it to be considered significant. Difference between values of TCMCV on successive measurements was obtained in hands of 26 controls. Repeatability of this parameter was determined in this control population following criteria of British Standards Institution. In 19 patients of CTS, treated with intracarpal steroid injection, pre-treatment and post-treatment values of TCMCV, and of symptom severity scale (SSS) and functional status scale (FSS), were obtained at 1, 2, and 3 months after treatment. Repeat measurements of TCMCV were made in each hand of all controls. After applying criteria of British Standards Institution, to such recordings, TCMCV was found to be repeatable and the cut-off value for significant change determined. According to this cut-off value, 4 patients of CTS showed improvement in TCMCV, with consistent improvement in SSS and FSS. Change in TCMCV corroborated qualitatively with changes in SSS and FSS. Repeatability of TCMCV can be assessed by criteria of British Standards Institution and a cut-off value determined to use it as an indicator of response to treatment in CTS.

Ultrasound-guided percutaneous release procedures in the transverse carpal ligament by acupotomy: A cadaveric study.

This study aimed to determine the safety and accuracy of ultrasound-guided acupotomy percutaneous loosening of the transverse carpal ligament. The 100 upper limb specimens were equally divided into the ultrasound-guided acupotomy group (U) and the nonultrasound-guided acupotomy group (N). For the U group, we simulated ultrasound-guided acupotomy loosening of the transverse carpal ligament in a human specimen, and for the N group, we performed the loosening of the transverse carpal ligament through the same approach under nonultrasound-guided conditions. The safety and accuracy of the two methods were compared through measurement. In the ultrasound-guided group, the injury rate of nerves, blood vessels and tendons caused by needle-knife release was 0%. In the non-ultrasound-guided group, the rate of nerve, blood vessel and tendon damage was 6 percent, 12 percent and 20 percent, respectively. χ 2 test (Fisher exact test) was performed for the nerve and blood vessel damage rates in the two groups (PN > 0.05, PA < 0.05), the difference in nerve damage rates was not statistically significant, but the difference in blood vessel damage rates was statistically significant. Pearson's χ 2 test was performed on the tendon injury rates of the two groups (PF < 0.05), and the difference was statistically significant. In the ultrasound-guided group, the proportion of acupotomy marks greater than or equal to half of the width of the transverse carpal ligament was 86%, and the non-ultrasound-guided group was 36%. The accuracy of the two surgical methods was tested by Pearson's χ 2 test (PL < 0.05), and the difference was statistically significant. According to the measurement, the ultrasound-guided acupotomy technology had high safety and accuracy. In this study, we designed a new method for cutting the transverse carpal ligament under ultrasound guidance, which is different from surgery. These results indicate that this is a safe and accurate method of interventional treatment of carpal tunnel syndrome.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature.

Carpal tunnel syndrome (CTS) is a common condition greatly affects patients' quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil. We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were "low" or "very low". PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman's correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328).

Comparison of Surgery and Local Steroid Injections for the Treatment of Carpal Tunnel Syndrome

Background: There is no consensus about the optimum treatment or treatment algorithm for carpal tunnel syndrome (CTS). In previous randomized studies that compared open carpal tunnel release and local steroid injections (LSIs), the two most used nonconservative treatments, conflicting results were found. Objective: The objective of the study was to compare the efficacies of surgery and LSI in the treatment of CTS. Subjects and Methods: A randomized, controlled clinical trial was conducted with 80 patients who were clinically diagnosed as having idiopathic CTS. The requirements for enrollment were awakening from sleep due to nocturnal paresthesia and a diagnosis to be confirmed through electrodiagnostic tests. Patients were randomly assigned to the surgery and the steroid groups. Assessments were performed at baseline and 1, 3, 6, and 12 months after initial treatment. The primary outcome measure was the improvement of awakening from sleep. Results: A total of 80 patients were enrolled in the study. Thirty-six patients were assigned to the surgery group and 44 to the steroid group. None of our patients were lost to follow-up. Fourteen out of the 44 patients in the steroid group and all 36 patients in the surgery group had a successful outcome at the 12-month assessment. Success rates in the steroid group at 1, 3, 6, and 12 months were 77.3%, 61.4%, 45.5%, and 31.8%, respectively. When the injection group was evaluated separately, LSI was found more successful in mild cases and unilateral cases. Conclusion: Surgery should be chosen for the treatment of moderate-to-severe idiopathic CTS, but LSI may be used for mild cases. The historical-objective scale may predict which patient will benefit from which treatment.

Microsurgical interfascicular dissection operation is a viable treatment of carpal tunnel syndrome caused by Lipofibromatous hamartoma: A case report

Lipofibromatous Hamartoma (LFH) is a rare and slow growing benign tumor affecting the peripheral nerves, which usually involves the median nerve. Median nerve involvement commonly causes pain, numbness, paresthesia and carpal tunnel syndrome (CTS). This article describes a case of lipofibromatous hamartoma in a 6-years-old girl, complained of the mass and numbness in her left distal forearm. Microsurgical interfascicular dissection operation was performed to remove the epineural proliferation tissue, numbness disappeared after the operation. At the 12-months follow-up appointment she remained asymptomatic and there was no change in mass size.

Treatment of Carpal Tunnel Syndrome with Neural Therapy: A Case Report

Treatment of Carpal Tunnel Syndrome with Neural Therapy: A Case Report

Retracted: Clinical Characteristics and Treatment of Adult Idiopathic Carpal Tunnel Syndrome Accompanied with Trigger Digit.

[This retracts the article DOI: 10.1155/2022/8104345.].

Treatment of recurrent carpal tunnel syndrome with fat grafting as an adjunct

Aim: The purpose of this study is to compare the surgical outcomes of treating recurrent carpal tunnel with recurrent carpal tunnel release only compared to recurrent carpal tunnel release with fat grafting as an adjunct. Methods: Retrospective case-control study was performed of the recurrent carpal tunnels treated, excluding explicit nerve injury such as transections, neuromas in continuity, etc. Patients with recurrent carpal tunnel received re-release of carpal tunnel only or fat grafting as an adjunct. The outcomes of both groups were compared utilizing chi-square analysis. Results: A total number of 81 patients were found to meet the inclusion criteria. Of the recurrences, a total of 16 patients did not receive fat grafting and 65 did. The rate of improvement in symptoms for performing a carpal tunnel release was only 50.0% and for performing carpal tunnel release with fat grafting was 92%, with P-value &lt; 0.00. Conclusion: Adipose-derived stem cells as an adjunct to carpal tunnel release increased the rate of improvement in symptoms of carpal tunnel compression after recurrence compared to carpal tunnel release alone. Further studies need to be performed to confirm the validity of these findings.

Mean Pain Score Before and After Wrist Splinting for Carpal Tunnel Syndrome Presenting to Orthopedic Department Hayatabad Medical Complex, Peshawar

Median nerve neuropathy, often known as carpal tunnel syndrome (CTS), is a pathological condition that develops when the median nerve becomes entrapped within the carpal tunnel, resulting in pain, numbness, and tingling sensations. The most popular non-surgical procedure right now is splinting the wrist with a rigid splint, mainly at night and occasionally in conjunction with other therapies. Objective: To determine mean change in pain score before and after wrist splinting for carpal tunnel syndrome presenting to orthopedic department Hayatabad Medical Complex, Peshawar. Methods: This Quasi Experimental Study (Uncontrolled Trial) was held in the Orthopedic Department Hayatabad Medical Complex Peshawar for six months duration from 5th September 2020 to 6th March 2021 after approval of synopsis. A total of 60 patients with CTS were included in the study in a consecutive manner and subjected to wrist splinting. Baseline and follow up pain scores were measured at 6th post splinting week. Results: The mean age of the sample was 42.3 + 12.8 years. While distributing the patients with regards to gender, we observed that in our study 65% of the sample was male and 35% were female gender. The mean BMI was 25.2 + 3.4kg/m2 and 13.3% of sample was diabetic. Mean use of splint / day was 5.3 + 2.2 hours and 43.3% used ibuprofen as analgesic. Mean baseline pain score of the sample was 8.9 + 0.9 and mean follow up pain score at 6th week of splint use was 4.2 + 1.5 (p &lt; 0.001). Conclusion: Wrist splinting is an effective conservative treatment for CTS in terms of significant pain relief after 6 weeks and is not dependent upon BMI, gender, diabetes or type of NSAIDs used. However, our study sample size was too small to draw conclusions there is no evidence of functional improvement after splinting. We recommend more studies (interventional) on large sample size and taking into account pain as well as functional assessment to develop future guidelines for the treatment of CTS using wrist splinting Keywords: Carpal tunnel syndrome, Splinting, diabetes, Body mass index, Pain, Visual analogue scale

Electrophysiological Changes in Patients with Carpal Tunnel Syndrome after Open Carpal Tunnel Release

Objective: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy affecting the upper limbs. Various treatment methods exist for this disease, but only a few reports have compared the effects of various treatments using objective indicators. This study analyzed the changes in electrophysiological parameters after carpal tunnel release.Methods: In patients planning to undergo surgical treatment for CTS, electrophysiological studies, including nerve conduction studies and electromyography (EMG), of both upper extremities were performed before and 6 to 8 weeks after mini-open transverse carpal ligament release and median nerve neurolysis.Results: After surgical intervention, the onset latency and amplitude of the sensory nerve action potential (SNAP) and the onset latency of the compound muscle action potential (CMAP) of the median nerve improved. Additionally, the grade of abnormal spontaneous activity in needle EMG of the abductor pollicis brevis (APB) and the severity of the electrodiagnostic study results significantly decreased after the intervention compared to the initial evaluation.Conclusion: This study shows that the onset latency of SNAP and CMAP, the amplitude of SNAP of the median nerve, and EMG findings in the APB can be useful electrodiagnostic parameters for postoperative monitoring in CTS patients.

The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years.

A review of the literature from the last 10 years quite clearly shows that immobilization of the wrist in the splint (orthosis) is the most effective, initial method of conservative treatment of carpal tunnel syndrome (CTS). The particular advantages of the described method of treatment are: availability, low cost, good patient tolerance, simplicity and minimal incidence of complications.The aim of this study was to try to define the criteria of proceeding with the selection of the type of orthosis and the duration of its use depending on the clinical condition and the patient's expectations. The PubMed electronic database was searched for appropriately selected studies published between 2012 and 2022. The search strategy used was based on the following keywords: carpal tunnel syndrome, immobilization, orthosis, conservative treatment. The authors also searched the cited literature on relevant research and review papers on potentially relevant topics related to conservative treatment of the CTS. Immobilization in an orthosis gives therapeutic effects in all patients, regardless of the stage of the carpal tunnel syndrome.Most often the orthosis is only used at night for several weeks. During the exacerbation of symptoms, it can also be used during the day during activities that increase symptoms.In practice, it is recommended to wear a splint that immobilizes the wrist in a neutral position or slightly extended at 0-15 degrees (most often 0-5 degrees).A splint immobilizing the wrist and the 2-5 metacarpophalangeal joints are recommended for patients with positive Berger test results.There are no statistically significant differences in the treatment results between individual and traditional orthoses.No statistically significant differences were observed in the treatment effects between rigid and soft orthoses.