Search

Background: Carpal Tunnel Syndrome (CTS) is associated with a significant personal and societal burden. Evaluating access to care can identify barriers, limitations, and disparities in the delivery of healthcare services in this population. The purpose of this study was to evaluate access to overall healthcare and healthcare utilization among patients with CTS. Methods: This is a retrospective cohort study conducted with the All of Us database. Patients diagnosed with CTS that completed the access to care survey were included and matched to a control group. The primary outcomes were access to care across 4 domains: (1) delayed care, (2) could not afford care, (3) skipped medications, and (4) over 1 year since seeing provider. Secondary analysis was then performed to identify patient-specific factors associated with reduced access to care. Results: In total, 7649 patients with CTS were included and control matched to 7649 patients without CTS. In the CTS group, 33.7% (n = 2577) had delayed care, 30.4% (n = 2323) could not afford care, 15.4% (n = 1180) skipped medications, and 1.6% (n = 123) had not seen a provider in more than 1 year. Within the CTS cohort, low-income, worse physical health, and worse mental health were associated with poor access to care. Conclusion: Patients experience notable challenges with delayed care, affordability of care, and medication adherence regardless of having a diagnosis of CTS. Targeted interventions on modifiable risk factors such as low income, poor mental health, and poor physical health are important opportunities to improve access to care in this population. [ABSTRACT FROM AUTHOR]

Introduction: This study explores a novel smartphone application for postoperative care following carpal tunnel release (CTR). We hypothesized that a software-based 'virtual visit' for CTR could be safe, effective and convenient for the patient.Methods: Our group developed the software application utilized in this study. Interactive steps with video instructions enabled patients to complete dressing and suture removal, capture a wound photo, answer a question about median nerve symptoms and capture a video of finger range of motion. Adult patients undergoing endoscopic or open CTR were enrolled. Prior to their scheduled postoperative visit, patients received and completed the module using their smartphone. Agreement between findings of the virtual visit and the corresponding in-person clinical visit was assessed using kappa values.Results: Twenty-two patients were contacted regarding study enrolment and 17 patients were enrolled (ages 23-63, mean 48.2, 6M, 11F). Of 16 patients who participated, all completed dressing removal. Ten of 16 patients removed their sutures successfully. Fourteen patients captured a clinically adequate wound photo and 15 patients answered a question about median nerve symptoms. Fourteen patients captured a range of motion video. Software assessments of surgical wounds, nerve symptoms and physical exams agreed strongly with clinical assessments.Discussion: Most patients were able to respond to a question about their symptoms, provide clinical assessment of their wound via a photo and record a video of their range of motion. Suture removal was the most difficult task. More investigation is needed to determine which patients can reliably remove their sutures. [ABSTRACT FROM AUTHOR]

Objective: To synthesize evidence on the effectiveness of acupuncture and related therapies for primary carpal tunnel syndrome (CTS) by conducting a systematic review of randomized controlled trials (RCTs). Data Sources: Nine databases were searched for potential RCTs from their inception till July 2019. Review Methods: RCTs which reported at least one of the three outcomes were included: symptom severity, functional status and pain. Included RCTs were appraised using the Cochrane Risk of Bias Tool. Results: A total of 10 RCTs (728 participants) were included. Majority were at high risk of bias for blinding of participants, personnel and outcome assessors. When compared to conventional medications, manual acupuncture showed significant superior effect in reducing symptom than ibuprofen (mean difference (MD) on Symptom Severity Scale (SSS)) = –5.80, 95% confidence interval (CI): −7.95 to −3.65) and prednisolone (MD = −6.50, 95% CI: −10.1, −2.86). Electroacupuncture plus splinting was more effective in reducing symptom severity than splinting alone (SSS score: MD = −0.20, 95% CI: −0.36 to −0.03). Manual acupuncture showed significantly superior effect than ibuprofen in improving functional status (Functional Status Scale (FSS): MD = −1.84, 95% CI: −2.66 to −1.02). The combination of electroacupuncture and splinting showed more improvement in functional status compared to splinting alone (FSS: MD = −6.22, 95%CI: −10.7 to −1.71). Triple treatment of acupuncture, magnetic spectrum heat lamp and splinting showed stronger pain relief than splinting alone. Conclusion: For both symptom relief and function improvement, manual acupuncture is superior to ibuprofen while electroacupuncture plus splinting outperforms splinting alone. Limited evidence showed electroacupuncture's potential role in pain reduction. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques in conservative treatment of carpal tunnel syndrome. Design: Randomized controlled trial. Setting: Several medical outpatient clinics in the south of Poland. Participants: The study included 103 patients with mild and moderate carpal tunnel syndrome (mean age = 53.95, SD = 9.5) years, who were randomly assigned to a neurodynamic techniques group (experimental group, n = 58) or a group without treatment (control group, n = 45). Intervention: Neurodynamic techniques were used in the experimental group. Treatment was conducted twice weekly (20 sessions). Control group did not receive treatment. Main measures: Nerve conduction study, pain, symptom severity and functional status of Boston Carpal Tunnel Questionnaire, and strength of cylindrical and pincer grips were assessed at baseline and immediately after treatment (nerve conduction study one month after treatment). Results: Baseline assessment revealed no group differences in any assessed parameters (P > 0.05). There were significant differences between groups after treatment, including nerve conduction (e.g. sensory conduction velocity: experimental group: 38.3 m/s, SD = 11.1 vs control group: 25.9 m/s, SD = 7.72, P < 0.01). Significant changes also occurred in pain (experimental group: 1.38, SD = 1.01 vs control group: 5.46, SD = 1.05, P < 0.01), symptom severity (experimental group: 1.08, SD = 0.46 vs control group: 2.87, SD = 0.68, P < 0.01), and functional status (experimental group: 1.96, SD = 0.64 vs control group: 2.87, SD = 1.12, P < 0.01). There were no group differences in strength (P > 0.05). Conclusion: The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome. Design: Double-blind (patient and evaluator) randomized controlled trial. Setting: Miguel Servet University Hospital, Zaragoza, Spain. Subjects: A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group. Interventions: Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand. Main measures: Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment. Results: Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: –0.26, 95% confidence interval (CI): –0.49/–0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: –2.24, 95% CI: –4.08/–2.04) and upper limb functional capacity (mean difference: –19, 95% CI: –26.1/–11.9) compared to the sham group (n = 30 wrists) (P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group (P < 0.01). Conclusion: Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

This study compared the therapeutic effect of flax seed oil topical gel and hand splint in the treatment of carpal tunnel syndrome. This study was a randomized clinical trial. Forty-nine patients, 96 hands, with mild to moderate idiopathic carpal tunnel syndrome were divided into 2 groups randomly. One group was treated by topical gel and the other group by hand splint. Intensity of symptoms and function before and after intervention was measured via Boston Carpal Tunnel Questionnaire. After intervention, the ANCOVA showed a significant difference between the symptom and function scores of the 2 groups. In both cases, recovery was higher in the gel group (P < .001). The topical use of flax seed oil gel is more effective in the improvement of symptoms and function of patients with mild to moderate carpal tunnel syndrome as compared with hand splint, and it can be introduced as an effective treatment. [ABSTRACT FROM AUTHOR]

We studied the effect of the Manu® soft hand brace, which has been designed to relieve median nerve entrapment in carpal tunnel syndrome. An observational, controlled study was conducted in 10 participants, five with bilateral carpal tunnel syndrome and five controls, using sonography to study changes in the dimensions of the carpal tunnel before and while wearing the brace. An increase in transverse diameter, thinning of the flexor retinaculum, and displacement of the proximal insertion of the lumbrical muscle to the middle finger from the edge of the carpal tunnel were observed in patients while wearing the brace. The changes in the morphology of the carpal tunnel while wearing the Manu® support its use as an alternative to a night wrist splint. [ABSTRACT FROM PUBLISHER]

Minimal clinically important difference is the smallest difference in the score of an outcome instrument that patients perceive as important. A prospective observational study was conducted involving 66 consecutive patients undergoing limited open carpal tunnel release. Patients completed the Carpal Tunnel Questionnaire (CTQ) before surgery and 3 months post-surgery. A transition item for patient satisfaction after 3 months of surgery was used as an anchor. Receiver operator characteristic curves were used to determine the minimal clinically important differences for the CTQ and its two subscales that best separated satisfied and unsatisfied patients. A 0.92 point change in the CTQ, a 1.14 point change in the symptom subscale, and a 0.74 point change in the function subscale indicated a clinically relevant threshold of satisfaction, and those values were greater than what could be accounted for by measurement errors. [ABSTRACT FROM PUBLISHER]

The article presents several papers on acupuncture research. One paper focuses on research conducted on patients with new onset low back pain (LBP) from four primary care health centres in Spain, who underwent acupuncture. One paper focuses on acupuncture treatment for patients with severe dry eye. Other research papers focus on acupuncture for the treatment of carpal tunnel syndrome, migraine, and cancer pain.

Objective: To determine the short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate idiopathic carpal tunnel syndrome.Design: Double-blind randomized sham-controlled trial.Setting: Outpatient clinic of the Department of Physical Medicine and Rehabilitation, University Hospital.Participants: Twenty-two patients with idiopathic carpal tunnel syndrome, 12 of whom had bilateral involvement, for a total of 34 wrists, divided into two groups: a hyperthermia active treatment group (number of wrists = 17) and a sham-controlled group (number of wrists = 17).Intervention: Six sessions, two per week, of either hyperthermia or sham treatment were provided over a period of three weeks.Main measures: Visual analogue scale, Levine–Boston Self-Assessment Questionnaire (part I: evaluation of pain intensity; part II: evaluation of functional status) and neurophysiological assessments, were determined at baseline and at the end of the treatment.Results: The hyperthermia group experienced a significant improvement in pain (visual analogue scale: P = 0.002; Levine–Boston part I: P < 0.0001) and functional status (Levine–Boston part II: P = 0.002) relative to baseline. No improvements in pain intensity or functionality were observed in the sham-treated group. Changes in pain severity between baseline and the end of treatment were larger in the hyperthermia group than in the sham-controlled group (Δ visual analogue scale P = 0.004; Δ Levine–Boston part I: P = 0.009). No differences either intra or between groups were observed for median nerve conduction velocity.Conclusion: Hyperthermia provides short-term improvements in pain and function in patients with mild to moderate carpal tunnel syndrome. [ABSTRACT FROM PUBLISHER]

One hundred and fifty-two patients with suspected carpal tunnel syndrome (CTS) completed a questionnaire, including questions about the location of paraesthesia, nocturnal pain, the effect of shaking the hand, relief by use of a wrist splint and impairment of manual dexterity. A score was derived from the symptom questionnaire and clinical signs including Tinel’s test, Phalen’s test, and altered sensation. Nerve conduction studies (NCS) were done in 91 cases in which the diagnosis of CTS was in doubt. A threshold questionnaire score was selected as indicating a diagnosis of CTS. Sixty-six patients were predicted to have CTS. When compared with the results of NCS this score had a specificity of 67% and sensitivity of 82%. Ninety-five patients underwent carpal tunnel release. A management model has been developed based on the questionnaire score for symptoms and signs. [ABSTRACT FROM PUBLISHER]

A prospective study was performed to assess the outcome of conservative treatment of carpal tunnel syndrome and to establish the predictive value of preoperative Boston carpal tunnel questionnaire scores. Sixty-seven patients with 101 symptomatic hands underwent an evidence-based education and conservative therapy regime prior to surgery. All patients were scored using the Boston carpal tunnel questionnaire at presentation and at 3 months. Fifty-eight of 67 patients completed both assessments providing a complete assessment of 89 symptomatic hands. The mean Boston carpal tunnel questionnaire scores improved significantly from 2.45 to 2.12 and throughout the duration of the study 73% of patients improved with conservative treatment and 14% did not require surgery. Severity scoring at presentation was predictive of outcome with conservative therapy. This work suggests that the Boston carpal tunnel questionnaire can be used to identify patients who are likely to respond to conservative treatment. [ABSTRACT FROM AUTHOR]

The author provides an overview of the current indications for obstetric acupuncture, shares his personal experience in the area, and offers some practical suggestions for treatment. Topics discussed include an overview of acupuncture, its potential role in obstetric and non-obstetric pathologies, and the various evidence-based indications of obstetric acupuncture including pregnancy-associated nausea and vomiting, carpal tunnel syndrome, and headaches.

A letter to the editor is presented which discusses the medication of a 35-year-old right-handed manual worker with carpal tunnel syndrome.

The article discusses a study on the effects of ergonomic positioning compared with no treatment, a placebo, or another non-surgical intervention in patients diagnosed with carpal tunnel syndrome. It describes two trials that compared ergonomic versus placebo keyboards, where one trial showed a lack of significance difference in pain severity after six months when using ergonomic keyboards versus standard keyboards. Risk ratios and mean differences for primary and secondary outcomes are cited.

The article describes the case of a 37-year-old woman with rheumatoid arthritis. The patient underwent a Universal 2 total wrist implant aimed at increasing stiffness and significant pain in the right wrist. After six years, the patient complained of numbness and tingling in the median nerve distribution. She underwent an open carpal tunnel release.

A letter to the editor is presented in response to an article about local injection of corticosteroids for symptomatic relief of carpal tunnel syndrome in a 2007 issue.

Reports on the use of acupuncture to treat a 51-year-old school crossing patrol officer with severe carpal tunnel syndrome affecting her dominant hand, and co-existing cervical spondylosis. Response of patient to acupuncture which provided good symptomatic treatment rather than cure.

The author highlights the important role of the journal in disseminating knowledge, challenging current knowledge, and making readers think. He describes the evolution of knowledge of carpal tunnel release and Dupuytren's contracture. The author also calls on readers of the journal to make hypotheses and test them constructively and ethically.

A letter is presented which describes the case of a 55-year old right-hand dominant woman presented with carpal tunnel syndrome in the right hand with an associated palmar wrist ganglion. The patient had a successful adipofascial flaps based on perforators from both the radial artery and the ulnar artery. Patient outcome is stated in the article.