Treatment Of Carpal Tunnel Syndrome Research Articles

Retrospective Analysis of 48 Patients Reoperated for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed between the transverse ligament and the carpal bones. There are various techniques used in the surgical treatment of CTS. The present study aimed to investigate the reasons for reoperation by examining the reoperated cases diagnosed with CTS. Patients who underwent surgery for CTS at Kahramanmaraş Sütçü İmam University Department of Neurosurgery between January 1, 2015 and September 1, 2022 were evaluated retrospectively. All patients were operated by the same surgical team. Patients who underwent two or more operations with the same diagnosis were included in the study, while those operated for the first time due to CTS and with missing data were excluded. The included patients were analyzed in terms of gender, age, occupation, side of the surgery, presence of systemic diseases causing CTS such as diabetes mellitus (DM), number of the operations they underwent, time until the next operation, surgical technique, and medical branch that performed the surgery (orthopedics, neurosurgery, or plastic surgery). Forty-eight patients who met the study criteria were evaluated. Out of the 48 reoperated patients, 14 were male and 34 were female. Eighteen patients had been operated using the mini-incision open method, while 22 had undergone laparoscopic surgery, including 14 patients with biportal endoscopic surgery, and eight with uniportal endoscopic surgery. Out of the 48 patients, 31 (64.6%), 11 (22.9%), and six patients were first operated by orthopedic and traumatology physicians, plastic and reconstructive surgeons, and neurosurgeons, respectively. The use of open surgical technique is the gold standard in CTS and complete incision of the transverse ligament provides complete decompression of the median nerve. We believe that decompression with closed or small incisions due to aesthetic concerns may not be sufficient and may increase the risk of complications.

Predictors and Variation in Steroid Injection Use for Carpal Tunnel Syndrome from a Multicenter Quality Collaborative.

Steroid injections are commonly used as first-line treatment for carpal tunnel syndrome (CTS); however, research has shown that their benefit is generally short term, and many patients go on to receive carpal tunnel release (CTR). The purpose of this study was to determine the variation in steroid injection use by hand surgeons. The authors analyzed data from a nine-center hand surgery quality collaborative. Data from 1586 patients (2381 hands) were included if they underwent elective CTR at one of the sites. Mixed effects logistic regression models were used to examine the association of receipt of steroid injection and association of receipt of more than one steroid injection among patient-level covariates. Steroid injection use significantly varied by practice, ranging from 12% to 53% of patients. The odds of receiving a steroid injection were 1.4 times higher for women ( P < 0.01), 1.6 times higher for patients with chronic pain syndrome ( P < 0.01), 0.5 times lower for patients with moderate electromyography (EMG) classification, and 0.4 times lower for patients with severe EMG classification (both P < 0.01). Patients with high scores on the Six-Item CTS Scale ( P = 0.02) and patients with moderate ( P = 0.04) or severe EMG ( P = 0.05) classification had lower odds of receiving multiple steroid injections. Complete symptomatic improvement after steroid injection was significantly reported by patients with a high Six-Item CTS Scale score ( P = 0.03) and patients with severe EMG classification ( P = 0.02). The authors found wide patient-level and practice-level variation in the use of steroid injections before CTR. These findings underscore the need for improved data and standard practice guidelines regarding which patients benefit from steroid injection. Risk, III.

Idiopathic carpal tunnel syndrome in male patients

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction. &amp;lt;/strong&amp;gt;The carpal tunnel syndrome (CTS) in male patients, due to anatomical characteristics and the perception of CTS-related symptoms, remains undetected for a long time. Men respond less well to CTS treatment, and early detection enables conservative treatment of mild and moderate CTS. The aim of this paper was to examine the average age, the frequency of bilateral CTS and its correlation with the age, and to determine the grade of electrophysiological damage of the median nerve in male patients with idiopathic CTS diagnosed by electromyoneurography. &amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The retrospective study included 83 male patients, aged from 32 to 81 years, with complaints of unilateral CTS on the right, dominant hand. All patients underwent EMNG for confirmation of CTS and the degree of median nerve damage. Statistical analysis was performed by methods of descriptive statistics, t-test, Wilcoxon signed rank test, and Pearson&amp;amp;rsquo;s correlation coefficient. The value of p &amp;amp;lt; 0.05 was considered statistically significant.&amp;lt;strong&amp;gt; Results.&amp;lt;/strong&amp;gt; The average age of patients was 55.84 years. The bilateral CTS was confirmed in 88.4%, most often of a moderate degree and more pronounced on the right, dominant hand (p=0.001). In cases of bilateral CTS, age did not correlate with the grade of CTS changes in both hands. The changes in the dominant hand were more pronounced in patients older than 51 years.&amp;lt;strong&amp;gt; Conclusion.&amp;lt;/strong&amp;gt; Male patients with idiopathic CTS usually have bilateral CTS, with more pronounced changes on dominant hand. Bilaterality of CTS and the degree of median nerve damage are not connected with age.&amp;lt;/p&amp;gt;

Short-term effectiveness of kinesio taping as therapeutic tool in conservative treatment of carpal tunnel syndrome: Asystematic review and meta-analysis.

Carpal tunnel syndrome is the most common peripheral neuropathy of the upper extremities and kinesio taping is one of the tools used as a complementary tool within the conventional treatment of carpal tunnel syndrome. To investigate the short-term effects of kinesio taping on pain, functionality, strength, and nerve conduction in subjects suffering from carpal tunnel syndrome. Systematic review with meta-analysis. Seven electronic databases (MEDLINE-Pubmed, Web of Science, Scopus, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were searched for full-text articles published from inception to March 1st , 2023. Studies had to meet the following inclusion criteria: randomised clinical trials, including patients of legal age with mild, moderate, or severe symptoms of carpal tunnel syndrome without associated pathologies, and treating the studied body area with kinesio taping, whether or not in combination with other therapies. The DerSimonian and Laird method was employed using random effects models to calculate the pooled estimate of the effect size with confidence intervals of 95%. The risk of bias was assessed with the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation approach was used to judge the certainty of the evidence for all outcomes. Thirteen studies were included, comprising 665 participants with carpal tunnel syndrome. This meta-analysis revealed a strong effect of kinesio taping on distal sensory latency and a weak effect on functionality and pain, while no significantly superior effects were found on the symptom severity, strength, or neurophysiological outcomes (distal motor latency and sensory conduction velocity) compared to other physical therapy techniques or untreated control group in the short term, with moderate-certainty evidence. Kinesio taping is a complementary tool to the conventional treatment of carpal tunnel syndrome that improves functionality, pain, and distal sensory latency in the short term.

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

Carpal tunnel syndrome (CTS), as the most common compression neuropathy in the upper limb, can lead to upper limb dysfunction in patients. The effectiveness of acupuncture in treating CTS has been validated based on numerous clinical trials and meta-analyses, but questions remain, such as how to select the best acupoints. Our purpose is to conduct the first data mining analysis to identify the most effective acupoint selection and combinations for treating CTS. We will search 7 electronic bibliographic databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chongqing VIP Database) from inception to March 2023. Clinical trials assessing the effectiveness of acupuncture therapy on the management of CTS will be selected. Reviews, protocols, animal trials, case reports, systematic reviews, and meta-analyses will be excluded. The primary outcome measure will be clinical result associated with CTS. Descriptive statistics will be performed in Excel 2019. Association rule analysis will be performed in SPSS Modeler 18.0. Exploratory factor analysis and cluster analysis will be performed in SPSS Statistics 26.0. This study will investigate the most effective acupoint selection and combinations for patients with CTS. Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint application for patients with CTS, helping clinicians and patients make a more informed decision together.

Wide Awake Local Anesthesia No Tourniquet Surgery of Carpal Tunnel Syndrome: Patients' Experience and Recall Bias in a Day-Care Setting.

Background and Objective: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a technique of local anesthesia commonly used in the surgical treatment of a wide variety of conditions affecting the upper extremity, including Carpal Tunnel Syndrome (CTS). The recent retrospective studies investigated patient experiences in a wide variety of hand disorder-related cases. The aim of our study is to evaluate patient satisfaction regarding open surgical treatment for CTS using the WALANT technique. Material and Methods: we enrolled 82 patients with CTS without medical record of surgical treatment for CTS. For WALANT, a hand surgeon used a combination of 1:200,000 epinephrine, 1% lidocaine, and 1 mL 8.4% sodium bicarbonate solution without tourniquet application and sedating the patient. All patients were treated in a day-care setting. For assessment of patient experience, Lalonde's questionnaire was adapted. Participants completed survey twice: one month and six months after the surgical treatment was performed. Results: the median pre-operative pain score for all patients was 4 (range 0-8) after one month and 3 (range 1-8) after six months. The median intraoperative pain score for all patients was 1 (range 0-8) after one month and 1 (range 1-7) after six months. The median post-operative pain score for all patients was 3 (range 0-9) after one month and 1 (range 0-8) after six months. More than half (61% after one month and 73% after six months) of the patients responded by stating that their real experience of WALANT was better than their initial expectations. An absolute majority of patients (95% after one month and 90% after six months) would recommend WALANT treatment to their relatives. Conclusions: overall, patient satisfaction with treatment for CTS using WALANT is high. Furthermore, complications related to the performed treatment and persistent post-operative pain could be associated with more reliable patient recall of this healthcare intervention. A longer period of time between intervention and assessment of patient experience could possibly be a reason for recall bias.

An Analysis of Treatment Choices among White and African American Medicaid Patients with Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and has severe long-term effects on hand function if surgery is delayed significantly following diagnosis. The authors investigated the timespan between diagnosis and surgical intervention for carpal tunnel syndrome among African American and White patients on Medicaid. Using the MarketScan Truven Database Medicaid Supplement 2009 to 2020, the authors identified patients with CTS. Demographic data and time intervals between diagnosis and treatment were collected and analyzed using chi-square test and regression models. A total of 361,942 African American and White Medicaid patients with a diagnosis of CTS were included in the study. Overall, 21.4% of White patients compared with 13.6% of African American patients chose surgery as their first and only option ( P < 0.001). A greater proportion of White patients underwent surgery less than 6 months after diagnosis compared with African Americans (75.5% and 67.7%, respectively; P < 0.001). African American women underwent surgery at a significantly lower rate compared with White women (13.8% and 21.8%, respectively); P < 0.001). Despite the increase in rates of surgery among both groups, the gap in use of surgery widened from a 6.6% difference in 2009 to a difference of 9.5% in 2020 between racial groups. African American race and female sex are significantly correlated with choice of treatment and time to surgery among Medicaid patients with CTS. Identification of the relationship between health care disparities and the decision to undergo surgery is the first step in the development of strategies to mitigate underuse of this quality-of-life-improving procedure.

Effects of Power Ball Exercises in Addition to Routine Physical Therapy on Pain, Grip Strength and Functional Disability in Patients with Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy that often presents with pain, numbness, tingling, and weakness in the hand and arm. Delayed treatment in CTS may worsen the symptoms and progresses to permanent sensory loss and thenar paralysis in some cases.&#x0D; Objective: To determine the comparative effects of power ball exercises &amp; strength training on pain, grip strength and functional disability in patients with carpal tunnel syndrome.&#x0D; Methodology: This randomized clinical trial was conducted from December 2021 to May 2022 at Badar Medical Complex on 86 patients that were recruited through purposive sampling technique. Group A received routine physical therapy only while Group B received Power Ball Exercise and routine physical therapy. Participants of both gender with aged 45-60 years, clinically diagnosed CTS with duration of more than two months, tingling sensation and numbness over the dorsum surface of thumb, index, middle, and lateral 1/3rd of ring fingers and positive Tinel’s sign with Phalen’s Maneuver were included in the study. Pain, grip strength and functional status were the outcome measures, observed through Numeric Pain Rating Scale, Hand Held Dynamometer and Boston Carpel Tunnel Syndrome Questionnaire at baseline, 2nd and 4th week. Independent t-test and mixed design ANOVA were used for between and within-group differences respectively.&#x0D; Results: The results showed significant between-group difference in pain, and functional disability (p&lt;0.05). However, no significant difference was observed for grip strength. Within-group difference was found significant in both group A and group B for all variables (p&lt;0.05).&#x0D; Conclusion: The addition of Power Ball Exercises with routine physical therapy is more effective in reducing pain, and functional disability in patients with carpal tunnel syndrome than physical therapy alone.

Re-evaluation of the Indications for the Camitz Procedure in Severe Carpal Tunnel Syndrome

The modified Camitz procedure has been used to improve thumb opposition in patients with severe carpal tunnel syndrome (CTS), although its indications remain controversial. This study compared the functional recovery of thumb opposition following carpal tunnel release with and without a concomitant Camitz procedure. We used the Carpal Tunnel Syndrome Instrument questionnaire (CTSI) and the compound muscle action potential of the abductor pollicis brevis (APB-CMAP) to assess the recovery. Five hundred sixty-seven hands underwent surgical treatment for CTS following electrophysiologic studies and the CTSI. The procedures included carpal tunnel release (either endoscopic carpal tunnel release [ECTR] or open carpal tunnel release [OCTR]) and OCTR with a Camitz procedure. One hundred thirty-six patients with absent preoperative APB-CMAP constituted the material of our study. The CTSI and APB-CMAP recoveries between the "ECTR/OCTR group" and the "Camitz group" were compared before surgery and at three, six, and 12 months after surgery. There were no statistically significant differences in recovery between the "ECTR/OCTR group" and the "Camitz group" according to the three scales of CTSI (symptom severity scale, functional state scale, and FS-2 item, buttoning clothes: an alternative test of thumb opposition) and the APB-CMAP. Carpal tunnel release procedures resulted in the useful recovery of thumb opposition without the need for Camitz, even if APB-CMAP did not fully recover. The action of the other synergistic muscles acting on the thumb and the sensory recovery may have contributed to the recovery of thumb opposition. The Camitz procedure also may be only rarely indicated for hands affected by severe CTS. Therapeutic IV.

The therapeutic potential of carpal tunnel syndrome by laser acupuncture: a before-after interventional study

Carpal Tunnel Syndrome (CTS) is a common pathology that affects the quality of human life. It is essential to promote clinical intervention studies. Our initial step in this study focused on the cure for CTS and the safety of Laser Acupuncture (LA), which is a type of acupuncture uses low-level laser instead of metal acupuncture needles. This is a before-after interventional study based on a group of 38 CTS patients, ranging from mild to moderate. Intervention using LA 5 times per week for 4 weeks, using low-level laser with a continuous wavelength of 655 nm, wattage of 5 mW/point, dose of 6 J/point, and direction perpendicular to the skin surface, in 10 pressure points on the affected hand, including PC4, PC6, PC7, PC8, LI4, LI10, LI1, HT3, HT7, LU10. The change in the Symptom Severity Scale (SSS), Functional Status Scale (FSS) through the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and adverse events were monitored to assess the effectiveness and safety of LA. At the second and fourth weeks, respectively, the SSS score decreased from 28 (27-33) to 14 (14-21) and 12 (11-13); this difference was statistically significant (p&lt;0001). Similarly, the FSS score decreased from 13 (13-15) to 8 (8-10), 8 (8-8), and the difference was statistically significant (p&lt;0001). Following the intervention, 37% (CI 95%, 23-53%) of patients experienced complete symptom recovery and 100% experienced complete functional recovery. No side effects were noted during the treatment. LA was initially shown to be safe and effective in the treatment of CTS by improving symptoms and rehabilitation.

Manipulative treatment of carpal tunnel syndrome: Biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament.

To quantify the amount of transverse carpal ligament (TCL) elongation in response to osteopathic manipulation or sustained load bearing (or both), a study involving seven cadaver limbs was conducted. Distances from the trapezium to the hamate (distance A) and from the scaphoid to the pisiform (distance B) were measured in five mounted cadaver limbs during and after the limbs bore the weight (2 newtons [N] to 4 N) for 2 several-hour periods. A several-hour period occurred between the weight bearing to assess recoil. Distances A and B were measured before and after the limbs were manipulated, according to previously described techniques, as well as with a new maneuver, termed the "guy-wire" technique. Two dissected limbs also were subjected to further weight bearing, this time increased to 8 N. Greater weight loads produced greater lengthening of the TCL, and recoil after removal of weight loads was slower than recoil after manipulation. Manipulation was more effective than weight loading for increasing distance A (distal canal), but weight loading generally was more effective than manipulation for increasing distance B (proximal canal). The guy-wire manipulation combined with direct transverse extension appeared to have the greatest impact on lengthening the TCL distally. These results show promise for the effective use of manipulation and load bearing for TCL elongation and nonsurgical relief of pressure on the median nerve in patients with carpal tunnel syndrome.

Research advances and trends in the surgical treatment of carpal tunnel syndrome from 2003 to 2022: A CiteSpace-based bibliometric analysis.

Carpal Tunnel Syndrome (CTS) is one of the most common peripheral neuropathies. The typical symptoms are tingling and numbness in the median nerve distribution of the hand. Current treatment for CTS includes general conservative treatment and surgical treatment. Surgical treatment plays a crucial role in the management of CTS, but little bibliometric analysis has been conducted on it. Therefore, this study aimed to map the literature co-citation network using CiteSpace (6.1 R4) software. Research frontiers and trends were identified by retrieving subject headings with significant changing word frequency trends, which can be used to predict future research advances in the surgical treatment of CTS. Publications on the surgical treatment of CTS in the Web of Science database were collected between 2003 and 2022. CiteSpace software was applied to visualize and analyze publications, countries, institutions, journals, authors, references, and keywords. A total of 336 articles were collected, with the USA being the major publishing power in all countries/regions. JOURNAL OF HAND SURGERY AMERICAN VOLUME was the journal with the most published and co-cited articles. Based on keyword and reference co-citation analysis, keywords such as CTS, surgery, release, median nerve, and diagnosis were the focus of the study. The results of this bibliometric study provide clinical research advances and trends in the surgical treatment of patients with CTS over the past 20 years, which may help researchers to identify hot topics and explore new directions for future research in the field.

Effects of Dry Needling in Carpal Tunnel Syndrome: A Mini-review

Carpal Tunnel Syndrome (CTS) is a complicated ailment in which there is compression of the median nerve in the carpal tunnel and which can lead to pain, disrupt the range of motion, hand function, and finger grip force. Dry needling treatment is used for CTS by inserting the needle to reduce pain and lowering the tension over the nerve to improve symptoms. This review aimed to determine whether dry needling is useful in treating carpal tunnel syndrome symptoms. Studies published between 2000 and 2021 were identified by searching PubMed, Google Scholar, and Springer. Studies identified by the electronic search were screened against a set of predetermined inclusion criteria. Five studies were included in this review. The main variables measured were pain, range of motion, hand function, and grip strength. Results show that dry needling is effective in the short term for pain relief and increased range of motion and improved finger grip in patients with mild to moderate carpal tunnel syndrome. There is less literature on the treatment of carpal tunnel syndrome associated with dry needling. As there is some evidence of a positive effect in the short term and in mild to moderate CTS, further randomised clinical trials of good methodological quality using standardised and well-described procedures for the application of dry needling are needed.

Early Postoperative Recovery after Modified Ultra-Minimally Invasive Sonography-Guided Thread Carpal Tunnel Release.

Thread carpal tunnel release (TCTR) has been reported to be safe and effective for the treatment of carpal tunnel syndrome. The aim of this study is to evaluate the modified TCTR for safety, efficacy, and postoperative recovery. Seventy-six extremities in 67 patients undergoing TCTR were analyzed pre- and postoperatively using clinical parameters and patient-reported outcome measures. Twenty-nine men and 38 women with a mean age of 59.9 ± 18.9 years underwent TCTR. The mean postoperative time to resume activities of daily living was 5.5 ± 5.5 days, analgesia was completed after 3.7 ± 4.6 days, and return to work was achieved after a mean of 32.6 ± 15.6 days for blue-collar workers and 4.6 ± 4.3 days for white-collar workers. The Boston Carpal Tunnel Questionnaire (BCTQ) and Disability of Arm, Shoulder, and Hand (DASH) scores were comparable with previous studies. Overall, two persistent compressions and one recurrence required open reoperation (3.9%). All three had been operated in the initial phase, and none required reoperation after an additional safety step was introduced. No other complications occurred. TCTR surgery appears to be a safe and reliable technique with almost no wound and scarring and a potentially faster recovery time than open techniques. Although our technical modifications may reduce the risk of incomplete release, TCTR requires both ultrasound and surgical skills and has a considerable learning curve.

Effect of electromyography biofeedback treatment on reaction time, pain, hand grip strength, and upper extremity functional status in patients with carpal tunnel syndrome.

Purpose: The aim of the study was to investigate the effect of electromyography biofeedback (EMG-BF), which in addition to conventional electrophysical therapy (EPT) commonly used in the symptomatic treatment of carpal tunnel syndrome (CTS), on motor parameters such as strength and reaction time and symptomatic functional parameters such as pain and function of the upper extremity.&#x0D; Materials and Methods: Patients diagnosed with CTS were divided into two groups. The first group was the conventional EPT group only (control group, n=46 hands), and the second group was the group that received EMG-BF in addition to the conventional EPT treatment (research group, n=42 hands). The pain (VAS), hand grip strength (HGS), audio-visual reaction time (ART-VRT), and upper extremity disability (Quick DASH) of patients in both groups were assessed before and after the treatment program.&#x0D; Results: After treatment, VRT, ART, HGS, and Quick DASH were significantly better in favor of the EPT +EMG- BF group. Before treatment, resting state (VASr), mobile state (VASm), and night state (VASn) VAS values were similar between the two groups. After training, the VAS -values were better in favor of the EPT +EMG- BF –group.&#x0D; Conclusion: Although EPT applications provide effective results in the rehabilitation of CTS, EMG-BF applications together with EPT applications provide more meaningful results in the rehabilitation process.

Algorithm of surgical tactics for the treatment of carpal tunnel syndrome

Carpal tunnel syndrome is the most common of compression neuropathies and in the structure of upper limb tunnel syndromes. Surgical treatments are diverse and clarifications of the indications for the implementation of each of them will allow to individualize the behavior of the intervention. Purpose of work – clarify the determining factors for classical and advanced minimally invasive intervention in carpal tunnel syndrome; evaluate the effectiveness of such an approach. We observed 52 patients with carpal tunnel syndrome with unsuccessful conservative treatment; electroneuromyographic and ultrasound signs of gross changes in the structures of the carpal canal. There were 19 men and 33 women (36.5% and 63.5%, respectively). In 28 patients (group 1), surgical intervention was performed according to the classical technique from an incision of 5.0-5.5 cm. Surgical treatment in 24 patients was carried out from an access of up to 2.5 cm (minimally invasive intervention). They made up the 2nd group. The dynamics of the indicators of the Boston BCTQ questionnaire and the visual analogue scale indicated a greater severity of symptoms, functional and pain disorders of the hand after 4 weeks in the extended access group compared with the minimally invasive access group with similar indicators before the intervention. However, by 3 and 6 months, the results converge and practically do not differ. Similar good results indicate the correctness of the chosen tactics and the validity of an individual approach in determining the nature and scope of the intervention.

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.

Comparison of acupotomy release combined with glucocorticoid intrathecal injection versus isolated glucocorticoid intrathecal injection for carpal tunnel syndrome: A protocol for a meta-analysis of comparative studies.

Carpal tunnel syndrome (CTS) is more common in people who need to engage in repetitive wrist work. Once it has occurred, localized pain and numbness of the fingers will develop, in severe cases, muscle atrophy will even arise, and after rest and physical therapy, many patients will still be unable to relieve or recur. In this case, the patient can receive intrathecal glucocorticoid injections, but the hormone injections alone can only provide short-term relief, and because the mechanical factors of median nerve compression are not fundamentally removed. Therefore, combined acupotomy release can help to release the compression of the transverse carpal ligament on the nerve and increase the volume within the carpal tunnel to achieve more satisfactory long-term results. Hence, a meta-analysis is necessary to provide evidence whether there is a significant difference in the treatment of CTS with acupotomy release combined with glucocorticoid intrathecal injection (ARGI) compared with isolated glucocorticoid intrathecal injection (GI). We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed, Cochrane central register of controlled trials, Web of Science, Chinese national knowledge infrastructure, Wanfang data, Chinese scientific journals database, Chinese databases SinoMed, and electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for nonrandomized studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review will evaluate the difference in efficacy of ARGI versus isolated GI in the treatment of CTS. The conclusion of this study will provide evidence for judging whether ARGI is superior to GI for treatment of CTS.

Efficacy of platelet-rich plasma injection versus other conservative treatments of carpal tunnel syndrome: A meta-analysis

Objective: Injection of platelet-rich plasma (PRP) as a proposed treatment for carpal tunnel syndrome (CTS) is a recent innovation. The aim of this analysis is to evaluate the functional and objective outcomes after PRP injection versus other conservative treatments of CTS. Methods: We systematically searched the electronic databases for trials that met our inclusion criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality, and performed data analysis. Subgroup analysis was stratified by the follow-up periods. Results: Five randomized controlled trials (RCTs) and one prospective cohort trial met the inclusion criteria. A total of 318 subjects were reported including 160 with PRP injection and 158 with other conservative treatments. The quality of the included studies was high. The meta-analysis showed that no significant differences were detected in the visual analog scale (VAS), the Boston Carpal Tunnel Syndrome Questionnaire-the syndrome (BCTQ-S) and the Boston Carpal Tunnel Syndrome Questionnaire-the functional status (BCTQ-F) at 6 months, changes of VAS, BCTQ-S and BCTQ-F, distal motor latency (DML) and sensory conduction velocity (SCV) between the PRP injection and other conservative treatments. However, the BCTQ-S and BCTQ-F score at 3 months of PRP injection were significantly lower than other conservative treatments. Conclusion: Current evidence revealed that there were no significant differences between PRP injection and other conservative treatment in relief pain, improving clinical symptom and functional status and electrophysiological findings at the final follow up period. However, PRP injection could improve the clinical symptom and functional status at the early period (3 months) of treatment.

Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS)

Background and objectiveThe gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. ObjectiveTo analyse the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Material and methodProspective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anaesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. ResultsThe sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4–54.5). Percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p>0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. ConclusionsIn view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarisation with the ultrasound visualisation of the anatomical structures to be treated.