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The carpal tunnel syndrome instrument (CTSI) is the most widely used patient-reported outcome measure (PROM) in carpal tunnel syndrome (CTS). However, CTSI is an ordinal-type questionnaire and might have caused misinterpretations of the PROM between surgical outcomes of CTS (Camitz and extra/open carpal tunnel release). This study aims to convert the CTSI to an interval scale using Rasch analysis (RA) and evaluate the outcome differences between the original and transformed scales. Prospective control study. Four hundred twenty-four patients with 567 CTSs had been interviewed for CTSI perioperatively and treated with either endoscopic/open carpal tunnel release or Camitz tendon transfer. Each CTSI was analyzed for dimensionality, fit statistics, and a transformation of the ordinal-to-interval scale by RA. We compared the two groups perioperative scores of three CTSI versions (original 11-item, modified 8-item, and transformed 8-item). Based on the RA, the original CTSI was not unidimensional. We identified two dimensions. After removing misfit items, the perioperative course of each score by three versions of each dimension was compared (Repeated 2-factor analysis of variance). The transformed interval scales of CTSI provided different assessments of score changes from the ordinal scale of CTSI analyses. Original CTSI consisted of ordinal scale items that yielded different conclusions than scores converted to interval scale by Rasch analysis. CTSI should convert into an interval scale after reclassifying dimensionality by Latent Factor Analysis and removing misfit items • The original CTSI was not unidimensional. • Carpal tunnel syndrome instrument was transformed from an ordinal scale to interval scale. • The transformed interval scales of CTSI provided different assessments of score changes from the ordinal scale of CTSI analyses. • CTSI should convert into an interval scale after re-classifying dimensionality by Latent Factor Analysis and removing misfit items. [ABSTRACT FROM AUTHOR]

• Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. • In MWM technique, neurophysiological and biomechanical effects are achieved by placing the joint in a painless position. • MWM technique provides faster and momentary painless joint movement in CTS compared to other physical therapy modalities. Single-blinded, randomized controlled study. Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program. [ABSTRACT FROM AUTHOR]

• Carpal tunnel syndrome (CTS) is the most common mononeuropathy of the hand. • Kinesio Taping (KT) lymphatic correction technique has been considered for CTS. • The study protocol consisted of 2 sessions per week for 5 weeks, including 6 exercises. • Significant differences between KT and sham taping were found at 5 weeks and 6 months. • KT might reduce symptoms and improve function in our sample of patients with mild CTS. Double-blind randomized controlled trial. Carpal tunnel syndrome (CTS) is a common mononeuropathy that causes pain and disability in the affected hand. Kinesio taping (KT) has been recently proposed as a promising conservative approach in CTS patients. To investigate the effectiveness of KT compared to a sham taping on symptoms and hand function in patients affected by mild CTS. Patients affected by mild CTS with symptoms for at least 8 weeks were enrolled and randomly allocated into two groups: KT group, according to the technique proposed by Kase plus specific exercises; control group, undergoing a sham taping plus specific exercise. All patients performed 2 sessions/week for 5 weeks of exercises of mobilization of fingers and carpal joint. At the baseline, after 5 weeks (T1), and after 6 months (T2), a physician unaware of patients' allocation assessed the Boston Carpal Tunnel Questionnaire (BCTQ) symptom (BCTQ-S) and functional (BCTQ-F) subscales. Forty-two patients (mean age:54.3 ± 15.0 y) were randomly allocated into KT (n = 21) and control group (n = 21). At T1, in both groups we found a significant improvement in hand function and symptoms, as showed by BCTQ-F (KT:4.2 ± 0.7 vs 3.0 ± 0.6, P <.001; sham: 2.2 ± 0.3 vs 1.7 ± 0.3, P =.012) and by BCTQ-S (KT: 2.2 ± 0.3 vs 1.7 ± 0.3, P <.001; sham: 2.3 ± 0.4 vs 1.9 ± 0.5, P =.007). At T2, only in the KT group there was a significant difference in both sub-items of primary outcome. There were significantly better results in the KT group at T1 and T2. The present study showed that KT compared to a sham taping might be more effective in reducing perceived symptoms in mild CTS patients, reporting a clinically significant difference. KT might be considered as an effective technique combined to rehabilitative treatment in terms of hand function and symptoms in patients affected by mild CTS. [ABSTRACT FROM AUTHOR]

A cross-sectional descriptive design was used. Carpal tunnel syndrome (CTS) is a complex combination of symptoms resulting from compression of the median nerve within the carpal tunnel. A study that compares the conservative interventions identified in the literature with the actual conservative interventions being implemented by therapists for the treatment of CTS is not presently available. The purpose of this study was to examine conservative interventions for CTS as reported by certified hand therapists (CHTs) within various clinical settings. The study also aimed to identify the decision-making process for the selection of CTS interventions. CHT members of the American Society of Hand Therapists were surveyed electronically to obtain quantitative data. Patient education, nocturnal orthosis, and ergonomic modifications ranked among the top conservative interventions utilized for CTS, whereas treatments such as magnet therapy, C-TRAC, and heating lamps ranked among the least utilized interventions. When selecting interventions, clinical expertise, research evidence, and patient preferences were all highly valued considerations for CHT. Our study offers a unique summary of CHT practice patterns for CTS interventions and the associated decision-making processes. It compares findings with existing literature on this topic, offering researchers and clinicians a glimpse of the CTS practice trends. This study may serve to prioritize future research studies based on the prevalence of intervention usage among the experts. It also serves as a guide to those seeking to understand the most common interventions utilized for conservative CTS treatment. • Cross-sectional survey of hand therapists describing intervention preferences and decision-making process for carpal tunnel syndrome. • The most common carpal tunnel syndrome intervention utilized was education, followed closely by nocturnal orthosis and ergonomic modifications. • All aspects of evidence-based practice (ie, expertise, evidence, and patient preferences) were highly valued by 90% of respondents. [ABSTRACT FROM AUTHOR]

Prospective randomized study. Carpal tunnel syndrome (CTS) has been described as the most common compression neuropathy. Many modalities exist for conservative treatment. Efficacy of each modality has been described in the literature. However, the effectiveness of combination of these modalities is not well established. The purpose of this study is to assess the short-term clinical outcome of conservative treatment for CTS comparing orthosis alone with combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy. Forty-one patients who presented to Upper Limb Reconstructive and Microsurgery Clinic, University Malaya Medical Centre with CTS and positive electrodiagnostic study were recruited. Fifteen patients had bilateral CTS. Fifty-six wrists were equally randomized to orthosis alone and a combined therapy of orthosis, nerve/tendon gliding exercise, and ultrasound therapy. All patients were required to complete the Boston Carpal Tunnel Questionnaire during the first visit and 2 months after treatment. Both the orthosis and combined therapy groups showed a significant improvement in symptoms and function after treatment. The mean difference of symptoms in the orthosis group was 0.53; 95% confidence interval [CI]: 0.23-0.83 (P =.001) and in the combined therapy group was 0.48; 95% CI: 0.24-0.72 (P <.001). Mean difference of function in the orthosis group was 0.59; 95% CI: 0.28-0.91 (P =.001) and combined group was 0.69; 95% CI: 0.49-0.89 (P <.001). However, there was no significant difference in symptom severity and functional status scores between the groups. Our findings support other findings where orthosis and exercises improved symptom severity and functional status scores, however, there was no significant difference between orthosis alone and combined treatment. Patients who underwent conservative management for CTS showed improvement in symptoms and function. However, the combination of orthosis, nerve/tendon gliding exercises, and ultrasound therapy did not offer additional benefit compared to orthosis alone. • Both orthosis and a multimodal therapy resulted in significantly improved symptom severity and functional scores. • The combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy was not superior compared to orthosis alone. • Long term clinical outcome with reliable valid measures of adherence are recommended for future research. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). A single-blind randomized controlled study. Patients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. There were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P <.01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P <.05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P <.05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P <.01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P <.05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P <.05). Adding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS. • Three-month usage of orthotic device at night provides clinical, electrophysiological, and ultrasonographical recovery in carpal tunnel syndrome patients, and this improvement can be preserved for up to 6 months. • Orthotic intervention plus kinesiotaping provides better results on reducing pain and endoneural edema compared to use of a night orthotic, especially in mild carpal tunnel syndrome patients, and this superiority can last for up to 6 months. • Six-month follow-up was a challenge in this study. [ABSTRACT FROM AUTHOR]

Study Design Systematic review. Introduction Median nerve mobilization is one of the interventions used in the treatment of carpal tunnel syndrome (CTS). However, it is uncertain how many types of mobilization techniques are described in the current literature or the relative effectiveness of these techniques in treating CTS. Purpose of the Study The aim of this review was to describe the types and effectiveness of median nerve mobilization techniques studied in the CTS literature. Methods Electronic searches of 5 databases and manual searches of references lists located randomized controlled trials studies published between 2000 and April 2015. Quality appraisal for each study was conducted using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields by 2 independent reviewers. Results Nine randomized controlled trial studies describing various median nerve mobilization techniques used in the treatment of CTS were included. All studies were rated as of “adequate”, “good”, or “strong” quality for the Standard Quality Assessment Criteria. Three techniques of median nerve mobilization were described. Treatment outcomes included measures of electrodiagnostic testing, functional performance, pain, physical examination, sensation, and strength. Standardized mean differences for the treatment outcomes ranged from very small to large (0.05-1.71). Conclusion The findings are inconclusive regarding the effectiveness of each mobilization technique due to methodological limitations in the current body of research. Therefore, there is a clear need for high-quality controlled studies to examine various approaches to median nerve mobilization techniques in the treatment of CTS. Level of Evidence 2a. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case series. Introduction: Open carpal tunnel release (OCTR) is a common treatment for carpal tunnel syndrome, but there is no consensus on the number of hand therapy visits needed to achieve optimal patient outcomes. Purpose of the Study: The purpose is to examine changes in patient-reported symptoms and function over a 12-week period after OCTR with 1 postoperative hand therapy visit. Methods: Eligible subjects were consecutive patients treated with a standard OCTR protocol by a fellowship trained hand surgeon that included 1 hand therapy visit at 10-14 days postoperatively. Patients were excluded from participation if they had additional surgery at the time of OCTR, had another upper extremity diagnosis that required therapeutic intervention, or received more or less than 1 visit of hand therapy. Responses on the Boston Carpal Tunnel Questionnaire (BCTQ) were collected at preoperative and 3 postoperative time points: at the hand therapy visit, 6 weeks, and 12 weeks. Change over time in the BCTQ Symptom Severity Scale and Functional Status Scale was assessed. Results: A total of 134 patients who were treated with the standard protocol had a complete BCTQ data set. Both BCTQ scales showed significant improvement over time. The Symptom Severity Scale showed significant improvement by the hand therapy visit at 10-14 days postoperatively, whereas significant improvement on the Functional Status Scale did not occur until 6 weeks postoperatively. The magnitude of change from preoperative to 12 weeks postoperative was 1.51 points on the Symptom Severity Scale and 0.91 points on the Functional Status Scale. Complication rates were low with an incidence of 13% for pillar pain and palm pain combined. Conclusions: Patient-reported symptoms and function improved significantly up to 12 weeks after OCTR. Moreover, there was a low incidence of pillar and palm pain. In a retrospective review of patients with a favorable prognosis based on having no need for extra surgical procedures or additional therapy visits, one therapy visit associated with improvements in symptoms and function, a low incidence of pillar/ palm pain and favorable 12-weeks outcomes. There appears to be a subset of less complicated patients for whom one visit can allow for favorable outcomes. Level of Evidence: 2B. [ABSTRACT FROM AUTHOR]

Study Design: Randomized controlled trial. Introduction: Two-point discrimination (2PD) test can be used to assess both clinical condition and the effects of therapy in carpal tunnel syndrome (CTS) patients. Purpose of the Study: To determine whether there are specific differences in 2PD between symptomatic and asymptomatic hands in CTS patients and to evaluate the impact of 2 therapy regimes on 2PD in patients with CTS. Methods: Therapy for the neurodynamic mobilization group was based on manual therapy and neurodynamic techniques. Therapy for the electrophysical modalities group was based on red and infrared laser and ultrasound therapy using a contact method applied in the transverse ligament area. Therapeutic cycle consisted of 20 therapy sessions delivered at twice-weekly intervals. Results: After therapy, 2PD in the symptomatic limbs in the neurodynamic mobilization and electro-physical modalities groups significantly improved (p < .001). However, there was no statistically significant difference between the treatment groups. Conclusions: Both therapy programs used in this study were beneficial for improving 2PD. Level of evidence: 2. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effects of using night orthosis for 6 weeks in patients with mild to moderate carpal tunnel syndrome (CTS), including a follow up after 3 months using electrophysiological and functional outcome measurements. Study design: 12 week follow-up prospective study. Methods: Twenty-two patients with a total of 36 hands diagnosed as CTS were included. Subjects were informed about using a night orthosis for 6 weeks and were evaluated at the baseline, 6th and 12th week. Results: Median motor distal latency was significantly decreased and median motor compound muscle action potential was significantly increased at the 6th week. Median sensory velocity was significantly increased at the 12th week. No significant difference was found in terms of functional outcome measurements. Conclusion: Electrophysiological follow-up findings support the positive effects of using a wrist orthosis on median nerve conduction for CTS patients. [ABSTRACT FROM AUTHOR]

Study design: Retrospective cohort study. Purpose: To measure the impact of initial treatment by a hand therapist of people referred to a hand surgeon for common hand conditions. Methods: This retrospective cohort study included 224 patients with Carpal Tunnel Syndrome, Trigger Finger/Thumb, de Quervain's tenosynovitis, and trapeziometacarpal osteoarthrosis. All were invited to attend for assessment and non-operative treatment and were followed up for at least one year. Between groups comparisons for who attended (N = 164) and those who did not (N = 60) were conducted. Results: 40.8% of the non-operative treatment group and 65% of the no treatment group underwent surgery, which was statistically significant (p = 0.02). Univariate analysis found that the variable "attending non-operative treatment" was able to predict those who did not have surgery (p = 0.02). Multivariate analysis using logistic regression also showed that this was the only significant predictor of not progressing to surgery (p = 0.001). Conclusions: Assessment and treatment by a non-operative provider were associated with a decrease in the rate of operative treatment. Prospective, randomized studies could help determine if this observed difference is related to the treatment approach. [ABSTRACT FROM AUTHOR]

Demonstrating the efficacy of our practice requires a paradigm shift. Becoming an effective leader and clinician can facilitate opportunities for program development and clinical research. The use of strategic planning strategies, such as needs assessment and SWOT analysis, can help lead the way to such change. The following illustrates the use of strategic planning to develop The Carpal and Cubital Tunnel Syndrome Program (CCTSP) within a growing orthopedic practice. [ABSTRACT FROM AUTHOR]

Study design: Mixed methods, cross-sectional. Introduction: Nearly 30% of Certified Hand Therapists rarely or never use research findings when treating carpal tunnel syndrome. Purpose of the study: To identify groups of CHTs with common research utilization patterns. Methods: National randomized mail survey of 600 CHTs (n = 308, RR = 55%). Latent class and thematic analysis of eight questions assessing research use and beliefs. Results: Four groups of CHT research users were identified: Analytic (n = 135, 45%); Skeptic (n = 65, 22%); Pragmatic (n = 53, 18%); and Traditional (n = 46, 15%). Highest research use was reported among Analytics and Pragmatics although Skeptics willingly relied on research evidence when it contradicted other sources of knowledge. Age, not experience or population density, was a significant covariate of group membership. Conclusions: Empowering CHTs to use research findings by increased understanding of their group membership, and understanding others' groups, may increase progress toward evidence-based practice. [ABSTRACT FROM AUTHOR]

he article presents comment on study of effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome. Topics include studies on the effectiveness of carpal ligament stretching on symptomatic and electrophysiologic outcomes; and evaluate the effect of self-myofascial stretching of the carpal ligament on symptom outcomes and nerve conduction findings in persons.

The article discusses a study that examines changes in symptoms, function, and electrophysiology of patients with carpal tunnel syndrome (CTS), using a clinically reasoned manual physical therapy (MPT) approach.

A letter to the editor is presented in response to the article "The impact of a hand therapy screening and management clinic for patients referred for surgical opinion in an Australian public hospital," by Lisa O'Brien, Alison Hardman and Sharon Goldby in the 2013 issue.

A response from the authors of the article "The impact of a hand therapy screening and management clinic for patients referred for surgical opinion in an Australian public hospital" is presented.