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Objectives: The mobility (transverse movement) of the median nerve (MN) is decreased in patients with carpal tunnel syndrome and can be measured noninvasively by ultrasound. To date, there are few prognostic features to help predict the outcome of 2 commonly performed treatments: surgical carpal tunnel release and corticosteroid injection. This study aimed to assess the changes in nerve mobility after the intervention and to correlate this with treatment and the disease severity. Methods: A total of 181 patients with carpal tunnel syndrome with different electrophysiologic severities were recruited and assessed by dynamic ultrasound scanning of the MN before and after treatment. The dynamic ultrasound images were collected while the patients performed finger and wrist flexion. Results: For both injection and carpal tunnel release, the nerve displacement increased with wrist flexion, from a mean ± SD of 7.0 ± 2.4 to 7.9 ± 2.7 mm (P <.005). Patients who underwent surgery showed greater improvement (P <.005) in nerve mobility compared to those who underwent injection. We also observed that the increase in nerve mobility was predominantly in patients with more nerve damage at baseline. Conclusions: This study shows that the dynamic behavior of the MN changes in response to treatment and lays a foundation for future studies to assess the prognostic potential of nerve mobility measurement. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although carpal tunnel syndrome (CTS) is a common neuromuscular disorder, studies on its conservative treatment are inadequate and contradictory. OBJECTIVES: This study aimed to investigate and compare the effectiveness of low power laser therapy (LPLT) and Kinesio taping (KT) for the treatment of CTS. METHODS: Sixty patients with CTS were included in this study. One group received 15 sessions of KT, and the second group underwent 15 sessions of LPLT within three weeks. All patients were assessed with hand grip strength (HGS), Visual Analogue Scale (VAS)-pain, Douleur Neuropathique-4 (DN4) score, Boston Questionnaire (BQ), and electroneuromyography before and after treatment. RESULTS: Before treatment, all clinical and neurophysiological parameters were similar between the groups. After treatment, both groups significantly improved in terms of HGS, VAS-pain, DN4, and BQ. However, the LPLT group had significantly better HGS, VAS-pain, DN4, and BQ than the KT group. In addition, while median nerve motor distal latency and median nerve sensory conduction velocity improved significantly with treatment in both groups, the LPLT group's improvement was significantly better than that of the KT group. CONCLUSIONS: In patients with CTS, both LPLT and KT were effective treatments. However, the LPLT group had significantly better improvements than the KT group. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome is the most common median nerve neuropathy, accounting for 90% of all neuropathies, with prevalence in the general UK adult population ranging from 7–16% and bilateral symptoms reported in more than 50% of all cases. The pathophysiological mechanisms involved in the median nerve compression and traction are thought to be complex. This study compared the effectiveness of muscle energy technique and active release technique in patients with carpal tunnel syndrome. Methods: This study involved a total of 30 male and female patients with carpal tunnel syndrome, aged between 30 and 50 years. The patients were randomly assigned to two equal groups, group A and group B. Group A received muscle energy technique, and group B received active release technique. Results: Independent one-tailed t-tests revealed that the intragroup comparisons showed statistically significant increases in pinch grip strength and motor nerve conduction velocity of the median nerve post-treatment in group A (P=0.001 and 0.0001 respectively), while in group B, there were statistically significant increases in pinch grip strength and motor nerve conduction velocity post-treatment (P=0.037 and 0.043 respectively). The intergroup comparisons showed statistically significant differences in favour of group A. Conclusions: Because there was little significant difference between the two groups, this study concluded that both treatment techniques were effective in increasing median motor nerve conduction and hand grip strength. However, muscle energy technique increased motor nerve conduction velocity and pinch grip muscle strength more than active release technique. [ABSTRACT FROM AUTHOR]

To perform an updated systematic review with meta-analysis on trials focusing on patient-reported outcome measures (PROMs), nerve conduction studies (NCS) result and cross sectional area (CSA) measurements of those who underwent PRP injection for mild to moderate CTS, versus a control. This study indicates that there may be a potential role for the use of PRP in the non-operative management of mild to moderate CTS results in improvements in pain scores, functional outcomes as well as CSA measurements of the MN at short-term follow-up. However, PRP does not result in improvements in NCS. II; Systematic Review & Meta-Analysis of Prospective Trials; [ABSTRACT FROM AUTHOR]

Objective People diagnosed with carpal tunnel syndrome (CTS) have fibrosis between the soft, connective, and neural tissues that could worsen the compression of the median nerve. The diacutaneous fibrolysis (DF) technique may release tissue adhesions and increase the mobility of connective tissues. The purpose of this study was to compare the outcomes of DF in people with mild to moderate CTS on mechanosensitivity, disability, and nerve conduction studies. Methods This was a secondary analysis of a double-blinded, randomized, placebo-controlled trial. Patients were recruited between April and September 2016 from the Department of Neurophysiology at the Hospital Miguel Servet, Zaragoza, Spain. Thirty-nine people (52 wrists) diagnosed with mild to moderate CTS were included. Participants were randomly assigned to either the DF group (n = 26) or the sham group (n = 26). Both groups received 5 therapy sessions, 2 sessions per week. Mechanosensitivity with the Upper Limb Neurodynamic Test 1, symptom severity and functional status with the Boston Carpal Tunnel Questionnaire, and median nerve sensory conduction velocity with nerve conduction studies were the outcomes measured. Assessments were recorded at baseline and after the intervention. Results The DF group showed significant improvements in the following: mechanosensitivity, with 28.46 degrees of elbow extension range of motion (95% CI = 19.2–37.7); an increase of 1.0 point (95% CI = 0.7–1.4) for the Boston Carpal Tunnel Questionnaire symptom severity and functional status score; and sensory conduction velocity of median nerve, which improved to 5.8 m/s (95% CI = 2.5–9.2). Conclusion Participants with mild to moderate CTS experienced improvements in symptom severity, functional status, mechanosensitivity, and nerve conduction studies after 5 sessions of DF. Impact This study provides evidence of an approach based on soft and connective tissues around the median nerve in patients with CTS. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Surgery & Medicine (JOSAM) is the property of Journal of Surgery & Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To evaluate efficacy of platelet-rich plasma (PRP) injection in carpal tunnel syndrome (CTS), we conducted this meta-analysis, as well as proposed a protocol for its application in curative processes. Methods. All randomized controlled trials (RCTs) of PRP for the management of mild or moderate CTS were included in this study. Database search was conducted from study inception to July 2020, including PubMed, Embase, Web of Science, and Cochrane Library. We used visual analogue scores (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) as evaluation tools for primary outcomes. Second outcomes comprised cross-sectional area (ΔCSA) and electrophysiological indexes including distal motor latency (DML), sensory peak latency (SPL), motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), compound muscle action potential (CMAP), and sensory nerve action potential (SNAP). The pooled data were analyzed using RevMan 5.3. Subgroup and sensitivity analyses were conducted with the evidence of heterogeneity. Egger' test was used to investigate publication bias. Results. 9 RCTs were finally screened out with 434 patients included. Control groups comprised corticosteroid injection in 5 trials, saline injection in 1 trial, and splint in 3 trials. At the 1st month after follow-up, only ΔCSA between the PRP group and the control group showed significant difference (P < 0.05). In the 3rd month, there were statistically significant differences in VAS, BCTQ, SPL, SNCV, and ΔCSA between two groups (P < 0.05), while no statistically significant differences were found in the remaining outcomes. In the 6th month, there were statistically significant differences at BCTQ (P < 0.05) in primary outcomes and ΔCSA (P < 0.05) in secondary outcomes between two groups. As to adverse events in PRP injection, only one study reported increased pain sensation within 48 h after injections. Conclusion. This systematic review and meta-analysis demonstrates that the PRP could be effective for mild to moderate CTS and superior to traditional conservative treatments in improving pain and function and reducing the swelling of the median nerve for a mid-long-term effect. To some extent, the electrophysiological indexes also improved after PRP injection compared with others conservative treatments. [ABSTRACT FROM AUTHOR]

Objective No study to our knowledge has investigated the effects longer than 1 year of manual therapy in carpal tunnel syndrome (CTS). The purpose of this study was to investigate the effects of manual therapy versus surgery at 4-year follow-up and to compare the post-study surgery rate in CTS. Methods This randomized controlled trial was conducted in a tertiary public hospital and included 120 women with CTS who were randomly allocated to manual therapy or surgery. The participants received 3 sessions of physical therapy, including desensitization maneuvers of the central nervous system or carpal tunnel release combined with a tendon/nerve gliding exercise program at home. Primary outcome was pain intensity (mean and the worst pain). Secondary outcomes included functional status, symptom severity, and self-perceived improvement measured using a global rating of change scale. Outcomes for this analysis were assessed at baseline, 1 year, and 4 years. The rate of surgical intervention received by each group was assessed throughout the study. Results At 4 years, 97 (81%) women completed the study. Between-group changes for all outcomes were not significantly different at 1 year (mean pain: mean difference [MD] = −0.3, 95% CI = −0.9 to 0.3; worst pain: MD = −1.2, 95% CI = −3.6 to 1.2; function: MD = −0.1, 95% CI = −0.4 to 0.2; symptom severity: MD = −0.1, 95% CI = −0.3 to 0.1) and 4 years (mean pain: MD = 0.1, 95% CI = −0.2 to 0.4; worst pain: MD = 0.2, 95% CI = −0.8 to 1.2; function: MD = 0.1, 95% CI = −0.1 to 0.3; symptom severity: MD = 0.2, 95% CI = −0.2 to 0.6). Self-perceived improvement was also similar in both groups. No between-group differences (15% physical therapy vs 13% surgery) in surgery rate were observed during the 4 years. Conclusions In the long term, manual therapy, including desensitization maneuvers of the central nervous system, resulted in similar outcomes and similar surgery rates compared with surgery in women with CTS. Both interventions were combined with a tendon/nerve gliding exercise program at home. Impact This is the first study to our knowledge to report clinical outcomes and surgical rates during a 4-year follow-up and will inform decisions regarding surgical versus conservative management of CTS. Lay summary Women with CTS may receive similar benefit from a more conservative treatment—manual therapy—as they would from surgery. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate optimal neutral wrist splint duration in treatment-naive mild and mild to moderate carpal tunnel syndrome (CTS). Neutral wrist splinting is a conservative treatment for CTS; however, no clear guidelines exist for how long splinting should be prescribed for optimal outcomes.Materials and Methods: In this prospective clinical trial subjects were assigned to wear a neutral wrist splint for 6 (group A) or 12 weeks (group B). Symptom and functional outcomes were assessed by questionnaire at baseline, 6 and 12 weeks. Median nerve sensory and motor latencies were recorded at baseline and 12 weeks. Pretreatment, midtreatment, and posttreatment measures were compared within and between treatment groups where applicable. This study was approved by the United States Air Force Academy institutional review board.Results: A total of 30 subjects (37 hands) were randomized to 2 treatment groups. Mean symptom severity and median sensory peak latency significantly improved in both groups at 12 weeks, without a significant difference between groups. Mean functional severity significantly improved only in group A.Conclusion: Neutral wrist splint for 6 weeks resulted in better clinical improvements in patients with untreated mild and mild to moderate CTS. There was no additional benefit in extending splinting 6 additional weeks. This is the first study to compare duration of wrist splint use beyond 8 weeks. A larger sample size is needed to identify the reason for lack of functional improvement in group B. Long-term follow-up of this cohort will be helpful to determine the natural history of initial wrist splint use. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the combination effect of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) for moderate carpal tunnel syndrome (CTS), compared with PRP alone. Design A randomized, double-blinded, placebo-controlled trial. Setting A single medical center in Taiwan. Patients Patients diagnosed with moderate CTS. Interventions All subjects were administered one dose of ultrasound-guided PRP injection at baseline. After two weeks, one session of rESWT was completed in the intervention group, whereas the control group received one session of sham rESWT. Evaluations were performed at baseline and one, three, and six months post–PRP injection. Outcome Measures The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was measured as the primary outcome. Electrophysiological study and cross-sectional area (CSA) of the median nerve were used as secondary outcomes. Results All 40 enrolled subjects (male/female: 4/36) completed the study, resulting in an analysis of 32 wrists per group (total: N = 64 wrists). Compared with the control group, the intervention group did not show statistically significantly superior outcomes, except in BCTQs at one month (mean change ± SE = –11.47 ± 1.18 vs –7.06 ± 1.26, P  = 0.013) and distal motor latency at three months (mean change ± SE = –0.59 ± 0.09 vs –0.30 ± 0.09, P  = 0.031). Conclusions Combined PRP and one-session rESWT was not superior to PRP alone in treating moderate CTS. Further studies with multiple sessions of ESWT and longer follow-up periods are needed to verify the clinical efficacy of ESWT. [ABSTRACT FROM AUTHOR]

Neuromobilization exercises are increasingly advocated in the conservative management of individuals with carpal tunnel syndrome (CTS), as they may mitigate CTS-related signs and symptoms via potential peripheral (ie, musculoskeletal) and central (ie, neurophysiological) adaptations. However, the mechanisms underlying these adaptations have not been studied extensively. Hence, this exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program. Fourteen individuals with CTS were evaluated before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. Pain and upper limb functional abilities were assessed using standardized questionnaires. The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively. Upon completion of the program, participants reported both large and moderate improvements in pain (P ≤.03) and upper limb functional abilities (P =.02), respectively. The biological integrity and mechanical properties of the median nerve remained unchanged (P ≥.22), whereas a small significant increase in corticospinal excitability (P =.04) was observed. The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Future studies, especially with a larger sample size, longer intervention duration, and additional measurement times, are needed to strengthen current evidence. [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]

Copyright of Clinical Neuroscience / Ideggyógyászati Szemle is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

The purpose of this review is to identify the role of joint mobilization for individuals with Carpal tunnel syndrome (CTS). A systematic search of 5 electronic databases (PubMed, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and SPORTDiscus) was performed to identify eligible full-text randomized clinical trials related to the clinical question. Joint mobilization had to be included in one arm of the randomized clinical trials to be included. Two reviewers independently participated in each step of the screening process. A blinded third reviewer assisted in cases of discrepancy. The PEDro scale was used to assess quality. Ten articles were included after screening 2068 titles. In each article where joint mobilization was used, positive effects in pain, function, or additional outcomes were noted. In most cases, the intervention group integrating joint mobilization performed better than the comparison group not receiving joint techniques. In the articles reviewed, joint mobilization was associated with positive clinical effects for persons with CTS. No studies used joint mobilization in isolation; therefore, results must be interpreted cautiously. This review indicates that joint mobilization might be a useful adjunctive intervention in the management of CTS. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in humans. Nonsurgical management is still a matter of debate, and conservative treatments include splinting, local steroid injections, ultrasound, and oral steroids. Acupuncture and electroacupuncture therapy for symptomatic CTS may improve symptoms and aid nerve repair as well as improve sensory and motor functions. However, limited evidence based on comprehensive evaluation methods is available regarding the effects of those treatments.Objective: The study intended to compare the short-term effects of acupuncture and conventional medical treatment on CTS patients' clinical symptoms and on the results of their electrodiagnostic tests.Design: The research team designed a randomized controlled trial.Setting: The study took place at the electrodiagnostic clinic of the School of Persian and Complementary Medicine at Mashhad University of Medical Sciences (Mashhad, Iran).Participants: Participants were 60 patients at the clinic with the clinical diagnosis of CTS.Interventions: Participants were randomly assigned to 1 of 2 groups. Patients in the control group received 100 mg of Celebrex as tablets, 2 times daily. Patients in the intervention group received 12 sessions of acupuncture, each for 30 min, for 4 wk. The needle insertion points were fixed for all sessions. In addition, wrist braces were provided to wear at night for 1 mo in both groups.Outcome Measures: At baseline, postintervention at the end of week 4, and at a 3-mo follow-up at the end of week 16, participants' clinical symptoms-pain, numbness, tingling, weakness/clumsiness, and night awakenings-and the results of their electrodiagnostic studies were evaluated and compared.Results: In total, 49 patients completed the study-24 in the control group and 25 in the intervention group. Compared with the control group, the intervention group's clinical symptoms-pain, numbness, tingling, and muscular weakness-based on the subscales of the global symptoms score questionnaire as well as the overall score on that questionnaire improved significantly (P < .05). Regarding the electrodiagnostic studies, only the distal motor latency showed a significantly greater decrease in the acupuncture group in comparison to controls (P = .001).Conclusion: All clinical symptoms and the results of the electrodiagnostic tests improved significantly in the intervention group, and the improvements continued during the 3 mo postintervention. The therapeutic results of acupuncture were mostly similar to and in certain cases better than those of the conventional medical treatment. Therefore, acupuncture can be suggested as a safe and suitable therapeutic method in CTS. [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]

Aim: This study aimed to evaluate the feasibility of median ulnar nerve selective blockage vs. brachial plexus blockage in day procedures such as carpal tunnel release surgery. We hypothesized that selective median and ulnar blockage is a feasible classic axillary approach. Material and Methods: This randomized, controlled, double-blind, single-center study included 60 patients. Patients were randomly allocated to two groups; namely, the plexus blockage group (control) and selective group. Patients in the plexus blockage group were administered with 15 ml of local anesthetic for axillary plexus, and in the selective group, 2.5 ml of local anesthetic was applied under USG guidance. We evaluated of full sensory and motor block. Results: The onset of motor block time was observed to be longer and recovery time was shorter in the selective group than in the plexus blockage group (P<0.05). Conclusion: Selective nerve block has been shown to be more advantageous than the classic axillary approach of brachial plexus block for day procedures such as carpal tunnel release surgery. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome is a common complaint in orthopedic practice and usually treated with surgical intervention. The aim of the study was to compare wide awake local anesthesia no tourniquet (WALANT) technique with general anesthesia and arm tourniquet in Carpal tunnel cases. Methods: Fifty-two patients who underwent surgery for Carpal tunnel syndrome were retrospectively divided into two groups as WALANT technique (Group W) and general anesthesia with arm tourniquet (Group G). In addition to the demographic data, visual analog scale (VAS), opioid consumption, early complications, duration of stay in operating room (DSOR) and first analgesic need time were evaluated. Results: When both groups were evaluated, early postoperative VAS scores, opioid consumption and DSOR were significantly lower in Group W than in Group G. Conclusion: In conclusion, WALANT technique was associated with reduced early postoperative pain, lower DSOR and opioid consumption compared to general anesthesia with tourniquet method for carpal tunnel release. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic ultrasound has been suggested as a treatment for carpal tunnel syndrome (CTS), but existing trial evidence is of poor quality and inconclusive.Methods: We conducted a randomized, controlled trial of therapeutic ultrasound in mild to moderate CTS. Forty patients were treated with wrist splints plus either real or sham therapeutic ultrasound and followed for 1 year posttreatment. The primary outcome was change in symptom severity scale score. Secondary outcomes were functional status scale score, nerve conduction studies, and ultrasound imaging of the median nerve.Results: Both groups showed significant clinical and neurophysiological improvement at 6 and 12 months compared with baseline. There were no significant differences between groups at any time. In a multivariate analysis, the only independently significant predictors of the primary outcome were pretreatment symptom severity and additional treatments during follow-up.Discussion: We found no clinically significant benefit from ultrasound treatment for CTS. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the efficacy of laser acupuncture (LA) treatment with that of placebo LA treatment in patients with idiopathic, mild-to-moderate carpal tunnel syndrome (CTS), as measured by subjective symptom assessments and objective changes in nerve conduction studies (NCSs). Design: A randomized, single-blinded, controlled study. Settings: A Teaching Hospital in the Taichung, Taiwan between March 2013 and November 2013. Subjects: 84 consecutive treatment-naive patients with CTS. Interventions: Participants were randomly divided into two treatment arms: (1) LA, administered at traditional Chinese acu-points on the affected side, once a day, 5 times a week, for 4 weeks (N = 43); and (2) placebo LA, administered using the same device and protocol, with the LA device switched off (N = 41). Outcome measures: Patients completed the Global symptom score (GSS) at baseline and two and four weeks later. The primary outcome was changes in GSS. NCSs were performed at baseline and repeated at the end of the study as a secondary outcome. Results: There was a significantly greater reduction in GSS in the LA group than in the placebo group at week 2 (−9.30 ± 4.94 vs. −2.29 ± 4.27, respectively, P < 0.01) and at week 4 (−10.67 ± 5.98 vs. −2.90 ± 5.61, respectively, P < 0.01). However, NCSs did not show significant difference between the two groups. Conclusions: LA may be more effective than placebo LA in the treatment of mild-to-moderate idiopathic CTS in terms of subjective measurement. For patients who fear needle-based treatment, such as acupuncture or local injections, or those who do not opt for early surgical decompression, LA treatment can be considered as an effective and alternative form of acu-points stimulation therapy. [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]

Introduction: Studies of prognosis for surgery and corticosteroid injection for carpal tunnel syndrome (CTS) have considered only a limited range of explanatory variables for outcome.Methods: Data were prospectively collected on patient-reported symptoms, physical and psychological functioning, comorbidity, and quality of life at baseline and every 6 months for up to 2 years. Outcomes were patient-rated change over a 6-month period and symptom-severity score at 18 months.Results: In total, 754 patients with CTS completed baseline questionnaires, and 626 (83%) completed follow-up to 18 months. Multivariable modeling identified, independent of symptom severity at outset, higher health utility, fewer comorbidities, and lower anxiety as significant predictors of better outcome from surgery. In patients treated by steroid injection, independent of symptom severity at outset, shorter duration of symptoms and having no prior injection were significant predictors of better outcome.Discussion: These multivariable models of outcome may inform shared decision making about treatment for CTS. Muscle Nerve, 2019. [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]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To find effect of Customized Splint and Soft tissue mobilization Exercises in Carpal Tunnel Syndrome. Methods: 30 Subjects Diagnosed with CTS were screened and were divided into 2 group. i.e, Group A Subjects were given Customized Splint, Ultrasound and Exercises and Group B Subjects were given Soft tissue Mobilization, Ultrasound, Exercises. The interpretation of the study was done on the basis of Comparing pre-test and post-test assessment of VAS and FSS. Result: Within group comparison result, FSS and VAS were found to be statistically extremely significant in both the groups (p < 0.0001). Whereas between the group comparison result showed that group A was statistically significant in reducing FSS score (p = 0.01), VAS (on rest) score (p = 0.0008) and VAS (on activity) score (p = 0.016) than Group B. Conclusion: It was concluded that group A and Group B showed significant reduction in FSS and VAS scores in Subjects with CTS. But from this Study Group A was found to be more effective than Group B. [ABSTRACT FROM AUTHOR]

The article explores Clinical Practice Guidelines for management of carpal tunnel syndrome (CTS) from the international classification of functioning, disability and health from the academy of hand and upper extremity physical therapy. Topics include use of Purdue Pegboard or the Del-Ion-modified Moberg pick-up test to quantify dexterity for the treatment, use of orthosis recommended for pregnant women with CTS, and instructions to perform phonophoresis in nonsurgical management of patients.

Copyright of Timisoara Physical Education & Rehabilitation Journal is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Carpal Tunnel Syndrome (CTS) is one of the most common peripheral upper limb's neuropathy. It can affect up to 4% of the human population. There is not one specific CTS's reason. Predisposing factors include: injuries and overloading of the wrists, frequently repetitions of the same activities, pregnancy and acromegaly. The ENG and USG are gold standards in the diagnosis of CTS. CTS treatment includes surgical and physiotherapeutic conservative treatment. Physiotherapists uses manual therapy techniques, neuromobilization, fascial manipulation, osteopathy and other kinds of physical therapy. Material and methods: A systematic review of the literature was based on publications from the last 5 years. Articles concerned the physiotherapy of people with carpal tunnel syndrome (CTS). Publications from the PubMed and ScienceDirect scientific databases have been analyzed. The inclusion and exclusion criteria were introduced and based on an analysis of the titles and abstracts related to carpal tunnel syndrome (CTS). Results: Out of over 28,000 CTS articles, 8 were selected to meet all inclusion and exclusion criteria. The publications concerned physiotherapeutic treatment in the conservative treatment of CTS. The analyzed publications examined the effectiveness of wrist manual therapy, median nerve mobilization, kinesiotaping, soft tissue therapy and fascial manipulations as well as other physiotherapy treatments. Conclusions: The reviewed publications show that physiotherapeutic procedures bring significant benefits and improve CTS symptoms within the hand. The development of physiotherapy and research on rehabilitation in the carpal tunnel syndrome (CTS) allow for more effective conservative treatment. This increases the chance of avoiding or delaying surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is a common medical condition that doctors and physiotherapists come across in clinical practice. There are no explicit recommendations concerning which physical therapy methods should be applied in its treatment; however, there have also been no studies on the effects of combining low-level laser therapy (LLLT) or ultrasound with nerve and tendon gliding exercises. The purpose of this study was to evaluate the therapeutic efficacy of ultrasound and LLLT combined with gliding exercises. Materials and Methods: A total of seventy patients with mild to moderate CTS, divided into two groups, were included in this study. Group 1 received ultrasound treatment, whereas Group 2 underwent LLLT. The treatment lasted 2 weeks (5 sessions/week). In addition, both groups were treated with nerve and tendon gliding exercises three times daily. The clinical evaluation involved an interview on subjective and objective sensory abnormalities, the intensity of pain, the measurement of grip strength, Phalen's test, Tinel's sign, and the Boston Carpal Tunnel Questionnaire. The assessment was performed before and after the treatment. Results: A decrease in sensory impairments, improvement in visual analog scale, hand grip strength and the Boston Questionnaire results were significant in all patients after therapy. No meaningful differences between groups were noted in any of the examined variables after treatment. No adverse effects were observed. Conclusions: The results of this study may suggest the clinical efficacy of LLLT or ultrasound combined with gliding exercises in patients with mild to moderate CTS. [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]

Objectives: The study aims to assess selected factors contributing to the long-term effects of the conservative treatment of carpal tunnel syndrome (CTS).Material and Methods: Forty-nine individuals diagnosed with CTS were enrolled in the study. The symptoms resulted from occupational hand overuse in 37 patients. The assessment involved 78 hands before the therapy (study 1) and 1 year after the end of the therapy (study 2). The clinical symptoms assessed included: pain, numbness, tingling, morning stiffness, vegetative disorders and difficulties in activities of daily living (ADL). The range of motion (ROM) in the hand joints and the pressure generated during the cylindrical grip were measured. Phalen's tests, an electrodiagnostic test and a 2-point discrimination study were performed.Results: A significant reduction of symptoms and improvement in tested parameters were found in study 2. The largest ROM in the hand, the lowest level of pain and the largest reduction in the frequency of daytime tingling were found in the oldest patients in study 2. In subjects with better initial electrodiagnostic test results, a significant reduction in daytime numbness and daytime tingling was obtained. In individuals previously subjected to conservative therapy, a significant improvement in the ROM of the hand and a better quality of sensation were noted in study 2. A higher level of pain, a lower reduction in the frequency of daytime tingling, and a smaller improvement in ADL capacity were noted in individuals who overused their hands at work after the therapy.Conclusions: The effects of conservative CTS treatment after 1 year, expressed as the reduction of subjective symptoms, were independent of the patient's age. A worse initial electrodiagnostic test result is a predictor of less favorable therapy results. Hand overuse during occupational activity may negatively affect the effects of conservative treatment in individuals with CTS. A change in the nature of occupational activity positively influenced the long-term maintenance of the effects of conservative treatment. Int J Occup Med Environ Health. 2019;32(2):197-215. [ABSTRACT FROM AUTHOR]

Objectives. Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods. Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results. Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions. The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530. [ABSTRACT FROM AUTHOR]

In this regular feature, aesthetic nurse Claudia McGloin presents a brief synopsis of a range of recently published articles on medical aesthetics. Research roundup aims to provide an overview, rather than a detailed summary and critique, of the papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided at the end of each study summary [ABSTRACT FROM AUTHOR]

The authors comment on a study published in within the issue which compared the safety and effectiveness of corticosteroid injection versus night splints for the management of carpal tunnel syndrome. Topics covered include the strengths and limitations of the study, the reason that nocturnal splinting is more cost effective than corticosteroid injection therapy, and the clinical implications of the study.

Objectives. Occupational carpal tunnel syndrome (CTS) due to upper extremity overuse has in recent years been the most commonly recognized occupational disease in the Czech Republic and its prevalence has steadily increased. This pilot observation aimed to assess the effects of exercise techniques and oral enzyme therapy in automotive plant workers with early CTS. Patients and Methods. The observation comprised automotive plant assembly line workers in whom nerve conduction study revealed incipient CTS. The subjects were divided into three groups: a group practicing exercise techniques (exercising; N=15), a group receiving oral enzyme therapy (N=16), and a group of controls (N=14). Subjects in the control group were only observed without any specific intervention, which is a common procedure in incipient CTS. Throughout 9-week observation, the workers did their jobs. Prior to and after that period, the workers' CTS-related symptoms were ascertained through structured interviews with a physician and the following median nerve parameters were measured: sensory conduction velocity (SCV) and distal motor latency (DML). Results. In both the exercise and enzyme therapy groups, statistically significant decreases in the total score for symptoms were achieved (p<0.0001), unlike controls. On final examination, both treated groups demonstrated significantly increased SCV as compared with the initial values (p=0.00013 and p<0.0001, respectively); in controls, the mean SCV did not significantly change. Similarly, a statistically significant shortening of DML was noted in the enzyme therapy group (p=0.008). Conclusion. The results showed the efficiency of both exercise and oral enzyme therapy in incipient CTS. These methods may be recommended for preventing more severe forms of CTS. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: The aim of study was researching the relationship of pain in patients with carpal tunnel syndrome on Quality of Life (QoL) and upper limb functionality. METHODS: Demographical and physical measurements were performed by a physiotherapist. Pain levels were measured by Visuel Analog Scale at rest, on motion and in fatique, and the patients' results were recorded. Functionality levels were evaluated by 'Boston Carpal Tunnel Syndrome Questionnaire' and QoL by 'Short Form 12' (SF-12). Patients had 10 sessions of the physiotherapy and rehabilitation program. Assessments were repeated 1 month later. RESULTS: The mean age 49.97 ± 11.15 years of 28 patients were included. While pre- and post-treatment between pain and functionality evaluation found a significant relationship (p < 0.05); there was no significant relationship in QoL (SF-12 p > 0.05). CONCLUSIONS: As a result while we found statistical differences between pain and symptomatic status; there were no statistical differences between functionality, daily living activities and QoL. Appropriate rehabilitation programs should be taken into consideration to help patients obtain functionality, daily living activities and QoL. [ABSTRACT FROM AUTHOR]

Introduction. To explore the effect of myofascial release on electrophysiological and clinical measures of pregnant women with carpal tunnel syndrome (CTS). Methods. Randomized controlled trial. Overall, 30 pregnant women with CTS, aged 25--35 years, were randomized into 2 equal groups. The control group only wore a neutral wrist splint during sleeping for 4 weeks, while the study group received a myofascial release in addition to wearing a neutral wrist splint during sleeping for 4 weeks. All pregnant women in both groups were evaluated pre- and post-treatment with median nerve distal motor latency and Boston Carpal Tunnel Questionnaire to assess pain, numbness, and tingling sensation severity, as well as hand function. Results. Comparing both groups post-treatment revealed that there was a statistically highly significant decrease in median nerve distal motor latency, pain intensity, numbness, and tingling sensation severity, as well as in weakness and difficulty in grasping severity (p < 0.001) in favour of the study group. Conclusions. Myofascial release is an effective method for improving electrophysiological and clinical measures of pregnant women with CTS. [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]

Copyright of Clinical Neuroscience / Ideggyógyászati Szemle is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ultrasound‐guided carpal tunnel release was performed on 14 patients (18 wrists) using dynamic expansion of the transverse safe zone. Our patient population included able‐bodied patients and those with impairments. The first 8 cases (12 wrists) underwent the procedure in an operating room, the remainder in an outpatient setting. No complications occurred, and all patients were able to immediately resume use of their hands without therapy. Improvements in the Quick Form of the Disabilities of the Arm, Shoulder, and Hand Index and Boston Carpal Tunnel Questionnaire at 3 months were comparable to results reported with mini‐open and endoscopic release. Our results show that ultrasound‐guided carpal tunnel release can be safely and effectively performed in an outpatient setting. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiac amyloidosis often have carpal tunnel syndrome that precedes cardiac manifestations by several years. However, the prevalence of cardiac involvement at the time of carpal tunnel surgery has not been established.Objectives: The authors sought to identify the prevalence and type of amyloid deposits in patients undergoing carpal tunnel surgery and evaluate for cardiac involvement. The authors also sought to determine if patients with soft tissue transthyretin (TTR) amyloid had abnormal TTR tetramer kinetic stability.Methods: This was a prospective, cross-sectional, multidisciplinary study of consecutive men age ≥50 years and women ≥60 years undergoing carpal tunnel release surgery. Biopsy specimens of tenosynovial tissue were obtained and stained with Congo red; those with confirmed amyloid deposits were typed with mass spectrometry and further evaluated for cardiac involvement with biomarkers, electrocardiography, echocardiography with longitudinal strain, and technetium pyrophosphate scintigraphy. Additionally, serum TTR concentration and tetramer kinetic stability were examined.Results: Of 98 patients enrolled (median age 68 years, 51% male), 10 (10.2%) had a positive biopsy for amyloid (7 ATTR, 2 light chain [AL], 1 untyped). Two patients were diagnosed with hereditary ATTR (Leu58His and Ala81Thr), 2 were found to have cardiac involvement (1 AL, 1 ATTR wild-type), and 3 were initiated on therapy. In those patients who had biopsy-diagnosed ATTR, there was no difference in plasma TTR concentration or tetramer kinetic stability.Conclusions: In a cohort of patients undergoing carpal tunnel release surgery, Congo red staining of tenosynovial tissue detected amyloid deposits in 10.2% of patients. Concomitant cardiac evaluation identified patients with involvement of the myocardium, allowing for implementation of disease-modifying therapy. (Carpal Tunnel Syndrome and Amyloid Cardiomyopathy; NCT02792790). [ABSTRACT FROM AUTHOR]

Background: To our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.Methods: We did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452.Findings: Between April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference -0·32; 95% CI -0·48 to -0·16; p=0·0001). No adverse events were reported.Interpretation: A single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.Funding: Arthritis Research UK. [ABSTRACT FROM AUTHOR]

Design: Randomized clinical trial. Objective: To investigate the association of the Val158Met polymorphism with pain and function outcomes in women with carpal tunnel syndrome (CTS) who received surgery or manual therapy including desensitization manoeuvres of the central nervous system. Methods: A pre-planned secondary analysis of a randomized controlled trial investigating the efficacy of manual therapy including desensitization manoeuvres of the central nervous system vs. surgery in 120 women with CTS was conducted. Women were randomized to receive 3 sessions of manual therapy (n = 60) or decompression of the carpal tunnel (n = 60). The primary outcome was intensity of pain (mean pain and the worst pain), and secondary outcomes included function and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire. Outcomes were assessed at baseline, and 1, 3, 6, and 12 months after the intervention. Rs4680 genotypes were determined after amplifying the Val158Met polymorphism by polymerase chain reactions. We classified subjects according to their Val158Met polymorphism: Val/Val, Val/Met, or Met/Met. The primary aim (treatment group*Val158Met*time) was examined with repeated measures ANCOVA with intention-to-treat analysis. Results: At 12 months, 111 (92%) women completed the follow-up. No interaction was observed between the Val158Met genotype and any outcome: mean pain intensity (F = 0.60; P = 0.69), worst pain intensity (F = 0.49; P = 0.61), function (F = 0.12; P = 0.88) or symptom severity (F = 0.01; P = 0.98). Conclusion: The current clinical trial did not show an association between the Val158Met polymorphism and changes in pain and function outcomes after either surgery or physical therapy in women with CTS. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome is the most common nerve entrapment syndrome. The majority of cases are due to compression or irritation of the median nerve in the carpal canal. It is diagnosed clinically, often being confirmed by an electromyogram, while ultrasonography criteria have become increasingly useful for the diagnosis. Ultrasonography is better tolerated, less expensive, yet just as effective as other diagnostic methods. It provides a good indication of the severity of the condition and it allows anatomical variants to be discerned. In light of this, for a number of medical professionals it is the first-line examination. In terms of therapeutic use, ultrasound can be used to guide infiltrations. In case medical treatment is unsuccessful, release by transection of the flexor retinaculum is generally done surgically as an open procedure or by endoscopy. A new minimally invasive percutaneous treatment to release the nerve based on ultrasonography guided or ultrasound surgery appears to be a promising alternative, however, to conventional open surgery or endoscopic treatments. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is one of the commonest conditions encountered in primary care centers as mentioned earlier. CTS of mild to moderate severity can often be effectively treated in a primary care environment. However, many patients being referred immediately to hospital for consideration of surgical decompression. Objective: In this study, we aim to evaluate the available primary care options and their efficacy in dealing with CTS. Methods: PubMed database was used for articles selection, and the following keys used in the mesh (("Carpal tunnel syndrome"[Mesh]) AND ("Carpal tunnel syndrome/Management"[Mesh] OR "Carpal tunnel syndrome/Diagnosis"[Mesh] OR "Carpal tunnel syndrome/ Primary Health Care Center)). 5 studies were enrolled according to our inclusion, and exclusion criteria. Results: Patients successfully treated with wrist splinting alone reported a higher level of satisfaction with their treatment compared to patients who failed wrist splint treatment or had surgical decompressionMechanical traction is associated with fewer surgical interventions compared to care as usual in CTS patients. Reductions in patient-reported symptoms at 6 months' follow-up was similar in both groups.Steroid injection combined with splinting resulted in modestly greater reduction of symptoms, functional recovery, and improvement of nerve function at 12-week follow-up compared to steroid injection alone. Conclusion: CTS is commonly encountered in primary care. So, a trial of conservative treatment can be done before referral for surgical decompression. Conservative treatment of CTS had shown a clear reduction in hand surgery waitlists, thus reduction in expenditures and costs. Wrist splinting is recommended as first line treatment for patients with symptoms of CTS. Other methods of nonsurgical treatment include steroid injection, osteopathic manipulative therapy, mechanical wrist traction and combining wrist splinting with steroid injection or with NSAIDs use. Referral for surgical decompression may be a more appropriate option when the level of numbness and other symptoms are getting worse, or when conservative management has failed and is likely to lead to dissatisfaction. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this study was to assess the influence of manual therapy, including neurodynamic techniques, compared with no treatment on overall health status (OHS) in patients with mild to moderate carpal tunnel syndrome (CTS). Methods The study included 189 patients with CTS who were randomly assigned to the manual therapy (MT) group (including the use of neurodynamic techniques) or to the control group (CG; without therapy). The CTS diagnosis was made on the basis of nerve conduction studies and clinical examinations. Overall health status was assessed using the RAND 36-Item Short Form Health Survey. Therapy in the MT group was conducted twice weekly (20 therapy sessions). The CG had no therapy. Results A baseline assessment revealed no group differences in the physical and mental components of OHS (in all cases P > 0.05).There were also no significant differences in the Physical Component Summary or Mental Component Summary on the RAND 36-Item Short Form Health Survey (P > 0.05). Immediately after therapy, analysis of variance revealed differences in the physical and mental components in the MT group (in all cases P < 0.001) and no differences in the CG (in all cases P > 0.05). After therapy, analysis of variance also revealed differences in Physical Component Summary and Mental Component Summary in the MT group (in both cases P < 0.001) and no differences in the CG (in both cases P > 0.05). Conclusion Manual therapy, including neurodynamic techniques, had a positive effect on OHS in this group of individuals with CTS. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate and compare the effectiveness of splinting and Kinesio taping (KT) as forms of treatment for patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) by evaluating the symptoms and measuring the range of function and electrophysiological findings. This single-blind, randomized, prospective study included 44 patients (58 hands) suffering mild to moderate idiopathic CTS according to nerve conduction studies (NCS). The patients were randomized into two groups and evaluated before treatment and 6 weeks after treatment by means of physical examination findings, NCS, and the Boston Carpal Tunnel Questionnaire (BCTQ) functional status and symptom severity scale scores. When the differences in both groups before and after treatment were compared, a significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, BCTQ symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance. [ABSTRACT FROM AUTHOR]