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Introduction: Widespread pain may be related to psychosocial aspects in several musculoskeletal conditions, but the literature on carpal tunnel syndrome (CTS) is scarce. Objective: To determine the relationship between pain extent and psychological factors (catastrophizing, kinesiophobia, anxiety symptoms, and depression) in people with CTS. Methods: A cross-sectional study was conducted. The independent variables were: pain intensity, disability (QuickDASH), duration of symptoms, anxiety and depressive symptoms, catastrophizing, and kinesiophobia. The main outcome was: pain extent (% of total area and categories "pain within the median nerve-innervated territory" versus "extra-median nerve pain"). Correlation analysis was performed using Spearman's correlation coefficient. A linear regression model and binary logistic regression (both with forward selection) were performed to determine the main predictors of pain extent. Results: Forty-eight participants were included. A moderate positive correlation was found between catastrophizing (r = 0.455; p = 0.024) and disability (r = 0.448; p = 0.024) with total pain extent area. Regression models indicated that catastrophizing explained 22% of the variance in the pain extent (β = 0.003; 95% CI: 0.002–0.005), while kinesiophobia was the variable that best explained the distribution of pain in the extra-median territory (R2 Nagelkerke = 0.182). Null or weak correlations were found for the rest of the associations. Conclusion: Catastrophizing and kinesiophobia were the main indicators of pain extent in people with CTS. Clinicians are advised to use specific questionnaires to check for the presence of catastrophizing or kinesiophobia in people with CTS and wider pain extension. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether nerve mobilization related to nerve mobility or the removal of edema using lymphatic drainage affects the cross-sectional area of the nerve, hand function, and symptom severity in carpal tunnel syndrome. Design: The study is a prospective randomized controlled trial. Data were analyzed between groups using ANOVA, Chi-squared test, and Kruskal–Wallis test. Setting: Treatment lasted 4 weeks. Splint group wore the splint daily. Splint+manual lymphatic drainage received lymphatic drainage 5 days a week. Splint+nerve mobilization performed neuromobilization exercises as home exercises 5 days a week. Evaluations were conducted before and after 4 weeks of treatment. Participants: The study included 80 patients with mild-to-moderate carpal tunnel syndrome. Interventions: The patients were randomly divided into three groups: splint (n = 27), splint+manual lymphatic drainage (n = 27), or the splint+nerve mobilization (n = 26). Main Outcome Measures: The main outcome measures were ultrasound assessments and the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Boston Functional Status Scale). Results: Compared to the other groups, the nerve cross-sectional area decreased at both the carpal tunnel (p = 0.003) and mid-forearm (p = 0.014) levels in the drainage group. Nerve mobilization did not result in a significant change in the nerve cross-sectional area. All groups showed significant improvements in both symptom severity and functional status scores (p < 0.001). Conclusion: The reduction of edema through lymphatic drainage contributes to a decrease in the cross-sectional area of the median nerve. Additionally, all three methods appear to positively impact the functional capacity of the hand and alleviate symptoms. [ABSTRACT FROM AUTHOR]

Aim: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy resulting from compression of the median nerve at the wrist level. Increased intercarpal canal pressure plays an important role in the etiology of CTS. Although most cases are idiopathic, there may also be some systemic or local causes. The aim of this study was to evaluate the demographic and etiological characteristics of patients with CTS who applied to our electroneuromyography (ENMG) laboratory within 3 months. Material and Methods: One hundred forty-nine patients (=298 hands) who were sent to our ENMG laboratory for ENMG evaluation and diagnosed with CTS were included in our study. Cases with cervical vertebral root lesions, thoracic outlet syndrome, polyneuropathy, trauma such as nerve injury, and cases with tumors and secondary CTS to pregnancy were excluded from the study. Results: One hundred six (71.1%) of the cases in our study were women and 43 (28.9%) were men. The average age of the patients was 54.27±13.10, and the body mass index (BMI) was 27.92±3.98. BMI ≥30 was found in 47 (31.5%) of the patients. In our study, we found that housewives were the occupational group with the highest risk in terms of CTS (n=94, 63.1%). In this study, we found bilateral hand involvement in 93 (62.4%) patients. The most common condition was idiopathic CTS (n=81, 54.6%). Conclusion: CTS is more common in postmenopausal women who work as housewives and is usually seen in the dominant hand. It was concluded that this study would be useful for the diagnosis of CTS. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome (CTS) is a common neuromuscular disorder with an incidence rate of 4.9%. Research on the impact of Kinesio taping (KT) on electroneurography in individuals with CTS is limited, highlighting a significant gap in the literature. This study aimed to evaluate the effects of KT on palm numbness, pain intensity, hand grip strength, and median nerve electroneuromyography in individuals with mild to moderate CTS. Method: This was a randomized, controlled, parallel design study. Twenty-seven participants diagnosed with CTS through hospital outpatient clinics were randomly assigned to either the control or KT group. The outcome measurements included hand grip strength, the Boston Carpal Tunnel Questionnaire (BCTQ), and electroneurography, assessed at baseline and after 6 weeks of intervention. The statistical method used was non-parametric analysis, comparing differences with the median and interquartile range (IQR). Results: Both the KT and control groups significantly improved the numbness grades, hand grip strength, and the BCTQ. The kinesio-taping group demonstrated an improvement in grip strength with a median increase of 2.21 kg (IQR: 0.65–3.79 kg), compared to the control group, which showed a median increase of only 0.70 kg (IQR: 0.22–1.45 kg). Statistical analysis revealed a significant difference between the two groups (p = 0.039), with an effect size of r = 0.33. Conclusion: This study suggested that KT can be a supplementary treatment to relieve pain intensity, enhance hand grip strength, and improve sensory conduction velocity, motor latency, and motor amplitude. Clinical Trial Registration: https://doi.org/10.1186/ISRCTN82192319 , ISRCTNregistry (No. ISRCTN82192319). [ABSTRACT FROM AUTHOR]

Objective: To provide a strong foundation for the use of high-intensity laser therapy in carpel tunnel syndrome, we conducted a systematic review and meta-analysis to investigate the outcomes of short- and long-term follow-up studies. Design: This is a systematic review and meta-analysis. Results: Sample sizes of included studies ranged from 16 to 98 patients (N = 308). Overall, a significant difference between the treatment and control groups were found across majority of the measures. Studies using a 4-wk follow-up period, however, only found significantly greater benefits for high-intensity laser therapy in visual analog scale compared with placebo (P = 0.0191), transcutaneous electrical nerve stimulation (P = 0.0026), and low-intensity laser therapy 20 J/cm2 (P < 0.0002), and exercise (P < 0.0001). For improvement in visual analog scale score over a long treatment period, high-intensity laser therapy was also preferred over control group (P < 0.0071). Insufficient evidence exists to determine effect of high-intensity laser therapy on nerve conduction examinations. The only statistically significant differences observed in examinations were in relation to sensory nerve action potential (P = 0.0083) and sensory nerve conduction velocity (P = 0.0468). Conclusions: Moderate evidence exists regarding efficacy of high-intensity laser therapy compared with placebo, high-intensity laser therapy + wrist splint, and exercise in a short period of follow-up time but evidence on long-term follow-up is limited. [ABSTRACT FROM AUTHOR]

Background: Tinel's test is commonly used in the diagnosis of carpal tunnel syndrome (CTS) despite its questionable diagnostic test accuracy (DTA). This systematic review investigated the DTA of Tinel's test in CTS using electrodiagnosis as the reference standard and explored the heterogeneity between included studies. Methods: Prospective studies evaluating Tinel's test in adults with CTS were included. The principal measures were sensitivity and specificity. A literature search was conducted for studies published up to 7 June 2024. The methodological quality was assessed using the QUADAS-2 tool. Narrative synthesis of study results and heterogeneity was undertaken. Meta-analysis was not conducted due to the high variability in diagnostic thresholds. Results: Fifteen out of 4099 identified studies met the inclusion criteria. Patient selection scored 'high' in risk of bias and applicability concerns. Examiner blinding was poorly reported. Sensitivity varied from 30 to 89%. Specificity varied from 41 to 100%. Heterogeneity was found across all studies in participant selection criteria, Tinel's test performance, electrodiagnostic criteria, and diagnostic thresholds. Conclusions: Tinel's test demonstrated variable diagnostic accuracy in CTS. Due to poor methodological quality and high variability among the studies, more DTA studies are necessary. PROSPERO Protocol number: CRD42020218165 dated 27 November 2020. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of mirror therapy (MT) and therapeutic exercise (TE) with the unaffected hand, on pain, sensitivity and functionality in individuals with unilateral carpal tunnel syndrome (CTS). Material and methods: A randomized controlled trial was carried out. Thirty-nine adults with unilateral CTS were included and randomly allocated to a six-week training programme based on MT (n = 20) or TE (n = 19). Visual Analogue Scale, Semmes-Weinstein monofilament test, Two-point discrimination (2PD), Disabilities of the Arm, Shoulder and Hand (DASH) and Boston Carpal Tunnel Questionnaire (BCTQ) were assessed before (T0) and after the intervention (T1), and at one-month follow-up (T2). Results: At T1, MT and TE showed significant improvements in pain (p = 0.001 and p = 0.03, respectively), however, only MT maintained the achieved effects at T2 (p = 0.01). In addition, 2PD significantly improved in MT in the first (p = 0.04) and fourth fingers (p = 0.02) at T1. The DASH score decreased at T1 in MT (p < 0.001) and TE (p = 0.01). Additionally, the BCTQ score improved in MT (p < 0.001), and TE (p < 0.001) at T1. The effects were maintained at T2 for DASH and BCTQ scores. Conclusions: Training of the unaffected hand resulted in a significant improvement of the affected hand in both groups; nevertheless, MT achieved a longer duration of the effects. IMPLICATIONS FOR REHABILITATION: Training of the unaffected hand may improve pain, sensitivity and functionality in people with unilateral tunnel carpal syndrome. Mirror therapy achieved longer duration of the effects on pain and hand functionality. Our research may inform clinical decision-making and guide the development of therapeutic interventions for patients with carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

The effects of Kinesio taping (KT) in carpal tunnel syndrome are controversial. This study aimed to examine whether KT has any effect on the skin, subcutaneous tissue, and median nerve measurements and to compare the effects of two different KT applications. This is a prospective, double-blinded, randomized trial. This study was prospectively registered on the clinicaltrials.gov (NCT05475197). A total of 34 wrists (21 patients) who were clinically and electrophysiologically diagnosed with mild/moderate carpal tunnel syndrome were randomly divided into two KT intervention groups (group 1: neural technique and area correction technique and group 2: area correction technique). At baseline and immediately after the removal of KT (48 hours), pain was assessed with visual analog scale, hand grip strength with a hand-held dynamometer, and pinch strength using a pinch meter. Likewise, using ultrasound, skin and subcutaneous tissue thicknesses, median nerve cross-sectional area and flattening ratio, as well as median nerve depth were measured at the carpal tunnel inlet and outlet levels. While there was significant improvement in the pain scores (compared to the baseline) immediately after the KT in both groups (group 1: p = 0.03, η p 2 = 0.44; group 2: p < 0.001, η p 2 = 0.71), there was no difference in between (p = 0.07, η p 2 = 0.10). Grip strength significantly increased only in group 2 (p = 0.01, η p 2 = 0.35). None of the sonographic measurements displayed significant difference either within or between groups at baseline and after KT (all p > 0.05). While pain scores improved after KT, they were not coupled with any morphologic changes assessed by ultrasound. • Kinesio taping (KT) has physiological effects on musculoskeletal system. • The effects of KT in carpal tunnel syndrome are controversial. • Ultrasound is an easily accessible method for imaging carpal tunnel. • While pain scores improved after KT, median nerve morphology did not change. [ABSTRACT FROM AUTHOR]

Hydroxyapatite crystal deposition disease (HADD) is a common disorder resulting from the deposition of calcium hydroxyapatite crystals in various soft tissues, typically in periarticular distribution, including tendons, tendon sheaths, joint capsules, ligaments, bursae, periarticular soft tissues, and occasionally within the joints. The more commonly known subtypes of HADD are calcific tendinopathy and calcific periarthritis. Carpal tunnel syndrome (CTS) can be rarely caused by calcific deposits within the carpal tunnel in the setting of HADD-related calcific periarthritis. Imaging, particularly ultrasound and radiographs, is crucial in distinguishing this entity from the conventional form of CTS that tends to be idiopathic. We describe a rare presentation of CTS secondary to calcific periarthritis in a 45-year-old patient, with imaging demonstrating mass-like calcification within the carpal tunnel, with typical features of those seen with HADD. The patient was treated with ultrasound-guided barbotage, with significant clinical improvement. The case highlights a lesser-known cause of CTS as well as a presentation of HADD, and the role of ultrasound-guided barbotage, a minimally invasive procedure, as a viable first-line management option as an alternative to surgery. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper-extremity. Due to the involvement of the median nerve, long-term compression of this nerve can lead to hand dysfunction and disability that can impact work and daily life. As such, early treatment is warranted to prevent any long-term damage to the median nerve. Conservative management is utilized in those with mild to moderate CTS. Neural mobilizations can aid in the reduction of neural edema, neural mobility, and neural adhesion while improving nerve conduction. Clinical Question: Is neurodynamics effective in reducing pain and reported symptoms in those with CTS? Summary of Key Findings: Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting. All studies showed large effect size for pain, symptom severity, and physical function. Clinical Bottom Line: Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. Strength of Recommendation: Level B evidence to support the use of neurodynamics for the treatment of CTS. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the efficacy of local heat therapy (Kaiy) in alleviating symptoms of mild to moderate idiopathic carpal tunnel syndrome (CTS). Methods: A single-blind clinical trial was conducted involving patients with mild and moderate idiopathic carpal tunnel syndrome. A total of 120 patients were randomly assigned to either the intervention or control group. Both groups utilized a medical wristband during nighttime. The intervention group received pen moxa as a local heat therapy tool (Kaiy) applied to the wrist region. The Boston questionnaire was employed for assessment. Results: Heat therapy using Kaiy (pen moxa) significantly improved symptom severity (P=0.0001), functional status (P=0.0001), and pain scores (P=0.0001) in patients with mild to moderate CTS compared to those in the control group without heat therapy. Conclusion: This study demonstrates the positive impact of heat therapy (Kaiy) as a non-surgical approach for reducing pain, symptom severity, and functional impairment in CTS patients. Integrating complementary and alternative medicine with conventional treatment modalities could enhance symptom management with minimal side effects. [ABSTRACT FROM AUTHOR]

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]

Background: Carpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life. Purposes: This study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients. Method: We employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023. Results: The results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates. Conclusion: This study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS. [ABSTRACT FROM AUTHOR]

Carpal Tunnel Syndrome (CTS) has traditionally been viewed as a specialized medical condition. However, its escalating prevalence among professionals across a multitude of industries has sparked substantial interest in recent years. This review aims to delve into CTS as an occupational disease, focusing on its epidemiological patterns, risk factors, symptoms, and management options, particularly emphasizing its relevance in professional environments. The complex interaction of anatomical, biomechanical, and pathophysiological factors that contribute to the development of CTS in different work settings underlines the critical role of ergonomic measures, prompt clinical identification, and tailored treatment plans in reducing its effects. Nevertheless, the challenges presented by existing research, including diverse methodologies and definitions, highlight the need for more unified protocols to thoroughly understand and tackle this issue. There’s a pressing demand for more in-depth research into the epidemiology of CTS, its injury mechanisms, and the potential role of targeted medicine. Moreover, recognizing CTS’s wider ramifications beyond personal health is essential. The economic burden associated with CTS-related healthcare costs, productivity losses, and compensation claims can significantly impact both businesses and the broader society. Therefore, initiatives aimed at preventing CTS through workplace interventions, education, and early intervention programs not only benefit the affected individuals but also contribute to the overall well-being of the workforce and economic productivity. By fostering a collaborative approach among healthcare professionals, employers, policymakers, and other stakeholders, we can strive towards creating safer and healthier work environments while effectively managing the challenges posed by CTS in occupational settings.

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]

Introduction: Electro-acupuncture, an innovative adaptation of traditional acupuncture, combines electrical stimulation with acupuncture needles to enhance therapeutic effects. While acupuncture is widely used, its biological mechanisms remain incompletely understood. Recent research has explored the neurophysiological aspects of acupuncture, particularly through functional magnetic resonance imaging (fMRI) to investigate its effects on brain activity. Methods: In this systematic review, we conducted an extensive search for randomized clinical trials examining electro-acupuncture effects measured by fMRI. We employed strict eligibility criteria, quality assessment, and data extraction. Results: Five studies met our inclusion criteria and were analyzed. The selected studies investigated electro-acupuncture in various medical conditions, including carpal tunnel syndrome, fibromyalgia, Crohn's disease, irritable bowel syndrome, and obesity. Notably, electro-acupuncture was found to modulate brain activity and connectivity in regions associated with pain perception, emotional regulation, and cognitive processing. These findings align with the holistic approach of traditional Chinese medicine, emphasizing the interconnectedness of body and mind. Discussion: In carpal tunnel syndrome, electro-acupuncture at both local and distal sites showed neurophysiological improvements, suggesting distinct neuroplasticity mechanisms. In fibromyalgia, somatosensory electro-acupuncture correlated with reduced pain severity, enhanced brain connectivity, and increased gamma-aminobutyric acid levels. For Crohn's disease, electro-acupuncture influenced the homeostatic afferent processing network, potentially mitigating gut inflammation. Electro-acupuncture for irritable bowel syndrome led to decreased activity in the anterior cingulate cortex, offering pain relief, while electro-acupuncture for obesity impacted brain regions associated with dietary inhibition and emotional regulation. Conclusion: This systematic review provides evidence that electro-acupuncture can positively impact a range of medical conditions, possibly by modulating brain activity and connectivity. While the quality of the reviewed studies is generally good, further research with larger sample sizes and longer-term assessments is needed to better understand the mechanisms and optimize electro-acupuncture protocols for specific health conditions. The limited number of studies in this review emphasizes the need for broader investigations in this promising field. The research protocol was registered in PROSPERO (CRD42023465866). [ABSTRACT FROM AUTHOR]

The purpose of this review was to understand the research on carpal tunnel syndrome in athletes who compete in wheelchair sport. Eight articles were identified using the search strategy. The most common sport evaluated was wheelchair basketball (N = 4). Most athletes were male and were diagnosed with a spinal cord injury. Different clinical and electrodiagnostic criteria have been used to diagnose carpal tunnel syndrome. Two studies incorporated ultrasound into the clinical evaluation of median nerve pathology. The duration of disability and wheelchair use were associated with increased risk of carpal tunnel syndrome in four studies. There was no association between training load and the prevalence of carpal tunnel syndrome. No study has explored the functional implications of carpal tunnel syndrome on sports participation and performance. No study has assessed the prevention and treatment of carpal tunnel syndrome in individuals who compete in wheelchair sport. This review provides an understanding of the important diagnostic tools, and demographic and training risk factors to consider when evaluating para-athletes for carpal tunnel syndrome and highlights areas for future research. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to compare the effects of Kinesio taping and night splinting along with physical therapy intervention on symptoms in patients with moderate carpal tunnel syndrome undergoing rehabilitation. Design: In this double-blind, randomized controlled trial, 45 patients with moderate carpal tunnel syndrome were included and randomly assigned to three groups: Kinesio taping group (n = 15), night splinting group (n = 15), and control group (n = 15). All patients received 20 physical therapy intervention sessions. The primary outcome was self-reported disability status measured by the Boston Carpal Tunnel Questionnaire, and secondary outcomes were pain and paresthesia (rest, activity, and night) measured by the Numeric Rating Scale. Outcomes were recorded at baseline and 4 wks. Results: All patients showed clinically meaningful improvements for all outcome measures over time ( P < 0.05). The intergroup analysis revealed that the Kinesio taping group demonstrated better results in all measures than the night splinting ( P < 0.05) except for pain during activity ( P = 0.054), at night ( P = 0.191), and paresthesia at rest ( P = 0.575). In addition, the Kinesio taping group showed better outcomes than the control group ( P < 0.05) except for the activity pain ( P = 0.022). However, there were negligible differences between night splinting and control group ( P > 0.05). Conclusion: Kinesio taping in combination with physical therapy intervention is more effective than night splinting in combination with physical therapy intervention or physical therapy intervention alone and may be recommended. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = −2.36, 95% CI −4.31 to −0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = −1.27 95% CI −1.60 to −0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS. [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]

Objective: The traditional volar approach requires the release of the pronator quadratus (PQ) muscle in the treatment of distal radius fractures. However, intraoperative repair of the PQ muscle often fails due to tissue injury and unstable muscle repair. This study compared the outcomes of different methods of sparing the PQ muscle combined with the volar plate in treating distal radius fractures. Methods: A total of 95 patients with distal radius fractures sparing the PQ muscle were enrolled with the brachioradialis (BR) splitting approach (group A, 33 people), the volar plating insertion PQ muscle approach (group B, 35 people) and traditional Henry approach without sparing PQ muscle (group C, 27 people). Postoperative internal fixation, fracture healing and postoperative complications were observed in the three groups. The visual analog scale (VAS) of postoperative wrist pain was compared between three groups. The Dienst joint scale was used to evaluate the wrist function of patients, and imaging indexes were used to evaluate the surgical efficacy. Results: A total of 95 patients with distal radius fractures were followed up for more than one year after surgery. All fractures obtained good union, with no vascular injury, nerve injury or wound infection. Outcomes at three days, one month and three months all showed no significant differences in postoperative imaging indexes among three groups and no significant differences in various indexes among three groups during the same period. The mean operative time in group C was significantly lower than that in groups A and B. There was significant difference in the mean operation time between group A and group B. The amount of mean operative blood loss or mean bone union time in groups A and B was significantly lower than those in group C. No significant difference was shown in mean operative blood loss or mean bone union time between group A and group B. No significant differences in limb function scores, VAS scores and the mean range of motion existed among three groups at the 12-month postoperative follow-up. However, outcomes assessed one week, one month and three months after surgery demonstrated significant differences in the VAS scores and the mean range of motion among three groups, and the group B had lower VAS score and greater the mean range of motion. According to Dienst score, the excellent rate in groups A, B and C was 91.0% (30/33), 94.2% (33/35) and 85.2% (23/27), respectively, at 12 months after surgery. Tendon irritation occurred in 2 cases and joint stiffness in 1 case in group A. In group B, there were 2 cases traumatic arthritis and 2 cases delayed carpal tunnel syndrome and 1 case tendon irritation. In group C, tendon irritation and delayed carpal tunnel syndrome occurred, respectively, in 3 cases. Conclusion: Our results demonstrated that these two different surgical approaches were effective ways to reserve PQ and had good clinical outcomes. The volar plating insertion PQ muscle approach could reduce early postoperative pain, promote early activity and return to normal life, while the BR splitting approach was more advantageous in intraoperative fracture exposure and could shorten the operative time. However, some defects also existed. At 12 months of follow-up, no significant advantage was seen in sparing the PQ muscle. Therefore, surgeons should be aware of their individual characteristics and choose patients carefully. [ABSTRACT FROM AUTHOR]

Background: Splinting is frequently used in the treatment of CTS (carpal tunnel syndrome) and is mostly preferred at night. On the other hand, there are some studies suggesting the use of splint throughout the day. However, there is still no consensus. The aim of this randomized controlled study was to evaluate the effects of day and night splinting in terms of pain, symptom severity, functional status, and quality of life in patients with CTS. Results: Seventy wrists of 46 patients with CTS were evaluated. In the day-night splint group, according to without splint group and night-only splint group, a statistically significant improvement was found in terms of pain level assessed by Visual Analogue Scale (p = 0.001, p = 0.015, respectively), Boston Carpal Tunnel Questionnaire-Functional Severity Scale (p = 0.004, p = 0.020, respectively), The Nottingham Health Profile-pain (p = 0.001, p = 0.003, respectively), The Nottingham Health Profile-social isolation (p = 0.001, p = 0.001, respectively), and The Nottingham Health Profile-total score (p = 0.001, p = 0.012, respectively). In addition, it was found that even the use of splint only at night resulted in a significant reduction in pain compared to the control group (p = 0.018). Conclusions: Continuation of splinting as much as possible during the daytime in addition to night splinting is beneficial in terms of pain, nocturnal symptoms, functionality, and quality of life. [ABSTRACT FROM AUTHOR]

Introduction: A pilot CTS Triage and Treat clinic led by an Advanced Practice Occupational Therapist was established to address the CTS wait list at a large urban hospital. The aims of this pilot were to develop a clinical triage and screening protocol to inform the stratification of patients for suitable treatment options and to reduce waiting time. Methods: A cross sectional study with follow up was conducted, patients on the wait list at time of commencement of the pilot and subsequent referrals over a 1‐year period were recruited. Triage consisted of tests of sensibility, self‐rating measures, provocative tests and detailed patient to inform the subsequent treatment stratification, conservative, injection, surgery, or further investigation. Nonparametric analyses were used to test relationships between the test scores and to complete subgroup comparisons. Results: Eighty‐nine patients were triaged over the pilot period, 62 (70%) had a positive Phalen's at triage. Following triage 48 (54%) patients were stratified for conservative management, injection (n = 23, 26%) and surgery/differential diagnosis (n = 18, 20%). Statistically significant differences in BCTQ (SSS and FSS) and Q‐DASH scores were noted across the three outcome groups, with lower scores among those commenced on conservative management. BCTQ (SSS) scores were aligned with the Semmes Weinstein Monofilaments sensibility thresholds. Wait times showed a marked decrease from 10 to 2 months over the period of the pilot. Discussion: Findings highlight the positive impact of occupational therapy led triage and treat approach in the reduction of wait time for assessment and treatment for patients with CTS. [ABSTRACT FROM AUTHOR]

Objectives: Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy with squeezing of the median nerve and the patient is unable to function properly. There are different physiotherapy interventions for the management of these patients and recently, shock wave therapy and low-power laser (LPL) have been widely used, but there is no strong evidence comparing the effect of shock wave therapy and LLLT. Therefore, this trial was designed to compare the effect of extracorporeal shock wave therapy (ESWT), LPL, and routine interventions on clinical outcomes and electrophysiological parameters in patients with moderate CTS. Methods: Fifty-four patients were randomly assigned to the control (routine interventions), ESWT, and LPL therapy groups. All participants received transcutaneous electrical nerve stimulation (TENS) therapeutic ultrasound, hot pack, mobilization, and stretching for ten sessions over two weeks. Additionally, the ESWT group received radial ESWT in four sessions, and the LPL therapy group received laser in ten sessions. The primary outcomes were pain (assessed by the visual analog scale), function (assessed using the Boston questionnaire (BQ)), hand grip, and finger pinch strength. Secondary outcomes were electrophysiological parameters (distal motor and sensory latency and nerve conduction velocity (NCV) of the median nerve. Results: Time group interactions were significant for pain, the symptom severity subscale of BQ, finger pinch, and hand grip strength (P<0.001). Significant improvements were seen in clinical and sensory latency and motor NCV of the median nerve (P<0.05). The ESWT group experienced significant improvements with a large effect size in pain, function, and finger pinch strength compared to the control group (P<0.01). Additionally, the LPL therapy group showed significant changes in the function and finger pinch and hand grip strength compared to the control group. There were no significant differences between the LPL therapy and ESWT groups except for pain in favor of the ESWT group. No significant differences were found among the three groups in electrophysiological parameters (P>0.05). Discussion: Although laser therapy increased the efficacy of routine interventions, it seems adding ESWT to the routine treatment may be superior for the management of moderate CTS patients. [ABSTRACT FROM AUTHOR]

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

Carpal tunnel syndrome (CTS) is a neuropathic pain condition characterised by pain, paresthesia, loss of strength and disability. To explore the experiences of women with CTS regarding the management of symptoms and limitations. A qualitative phenomenological study was conducted. Women with a clinical and electromyographic diagnosis of CTS recruited from the Neurology Department of a Public Hospital were included. Purposeful sampling was performed. Data were collected using in-depth interviews and researchers' field notes. Analysis proposed by Giorgi was used. A total of 18 women with CTS were included. Two themes emerged: a) Living with CTS symptoms and limitations: describing the symptoms experienced, triggers of their symptoms and how they define CTS. Also, describing the difficulties that they experience on a daily basis, at home when handling tools, communicating, driving, and at work; and b) developing daily strategies for managing limitations: developing potential daily strategies to overcome daily limitations and/or compensate for them, and seeking professional help. Current results provide insight on how symptoms and daily limitations are experienced by a group of women with CTS. These findings could help occupational therapists to understand the day-to-day difficulties and the reasons for developing certain strategies. [ABSTRACT FROM AUTHOR]

Background: Applying radial extracorporeal shock wave therapy (R-ESWT) with LCI(local corticosteroid injection) in carpal tunnel syndrome (CTS) management is gaining momentum. The objective is to actualize the topic of this study. Methods: In this prospective randomized controlled trial, forty patients with mild to moderate CTS are divided into two sham- R-ESWT and R-ESWT groups subject to LCI(local corticosteroid injection). The first group received four sessions of sham-ESWT weekly, which involved sound but no energy; the second group received R-ESWT at equal intervals and were assessed for pain score (VAS score) and symptoms (GSS) baseline, 1st month, 3rd month, and 6th month. Results: A considerable improvement is observed in both groups for pain at (P < 0.05) and symptoms at (P < 0.05) in the 3rd month. The second group revealed more significant symptom improvement at (P < 0.05) in the 6th month. Conclusion: The R-ESWT + LCI combined therapy course is the first line of treatment in patients with mild to moderate symptoms and leads to control and reduction of symptoms and the need for surgery, thus a primary concern in CTS treatment with an orthopedist. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is the most typical peripheral entrapment neuropathy. To date, various non-invasive methods have been used tomanageCTS. This study investigates the effectiveness of Transfer Energy Capacitive and Resistive (TECAR), a new physical agent modality, on symptoms and neurophysiological parameters in patients with CTS. Methods: In this single-blind randomized clinical trial, 29 patients with mild or moderate CTS were randomly assigned to two groups. Group 1 received TECAR therapy with a frequency of 500 Hz and an intensity of 30 to 50%, 2 sessions/week, in addition to wrist splints and vitamin B supplements for 4 weeks. Group 2 also received a wrist splint and vitamin B for 4 weeks without TECAR therapy. The Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ-SSS and FSS), as well as clinical and neurophysiological findings, were assessed before and 8 weeks after treatment. Within and between-group comparisons were made after the intervention period. Results: VAS and the Boston Carpal Tunnel Questionnaire (FSS and SSS) showed significant changes. Clinical CTS tests and electrophysiological parameters did not show significant differences before and after the study. From a clinical perspective (pain relief and functional improvement), the TECAR therapy group showed more definite changes. Conclusions: TECAR can be considered an effective non-invasive treatment for patients with mild to moderate CTS. [ABSTRACT FROM AUTHOR]

Pilot, randomized, single‐blinded controlled clinical trial Trigger point (s) (TrPs) in thenar muscles could be a cause of narrowing of carpal tunnel in manual laborers with carpal tunnel syndrome (CTS). Effects of dry needling (DN) on the treatment of muscle tension have been reported, but no research has been done on the effect of DN on thenar tight muscles on reducing CTS symptoms. The aim of this study was to assess the effect of DN of thenar muscles TrPs in the treatment of mild-to-moderate carpal tunnel syndrome Thirty manual laborers with mild-to-moderate CTS and the presence of TrP(s) in thenar muscles were randomized to DN group (n = 15) and control group (waiting list) (n = 15). The DN group received 2 sessions of DN of thenar muscles TrP(s), with a 48-h interval. The control group received no treatment. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores were the primary outcome, while secondary outcomes included electrophysiological domains, pinch and grip strength. Outcome measures were obtained at baseline, 48 hours, and 2 weeks after treatment (follow-up). Two-way analysis of variance (2 groups × 3 times) was used to compare within- and between-group differences. Bonferroni post hoc test was used to find any significant differences in the main effect for group, time, or interaction (group time) A baseline assessment revealed no intergroup differences in all evaluated parameters (P >.05). Compared to the control group, the DN group had a statistically significant improvement in pinch and grip strength, median SDL, and BCTQ score after 2 weeks (P <.05). There were no between-group differences in the assessment of motor electrophysiologic and SNCV findings (P >.05) Dry needling of thenar TrP(s) is effective in short-term improvement of function in manual laborers with mild-to-moderate CTS. [ABSTRACT FROM AUTHOR]

Background: Carpal Tunnel Syndrome occurs when median nerve is compressed as it travels through the wrist. The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve and leads to reduction in grip strength and hand function. Stage II Carpal Tunnel Syndrome occurs when patient is involved in activities of repetitive movement of wrist during day. The study aimed to compare functional improvement in results after treating with Extinguishing manual therapy techniques and Upcoming manual therapy techniques. Materials and Methods: In this experimental study 30 dentists having Stage II Carpal Tunnel Syndrome were treated first with extinguishing manual therapy techniques (Phase I) for 10 days and then there was a gap of 1 week to decondition the effects of Phase I. After deconditioning same group of patients were treated with Upcoming manual therapy techniques for 10 days. In both the Phases Conservative therapy was also included. Patient specific activity scoring scheme and Boston scale were used to compare the results. Conclusion: The study concluded that Upcoming manual therapy are more effective than extinguishing manual therapy techniques in treating dentists having Stage II Carpal Tunnel Syndrome. [ABSTRACT FROM AUTHOR]

Background: To study the difference between the effects of wrist splint and nerve tendon gliding exercises for carpal tunnel syndrome in women with computer desk job and the difference between the effects of wrist splint and nerve tendon gliding exercises in non computer desk job women with carpal tunnel syndrome. Methods: 34 Females objects with symptomatic carpal tunnel syndrome were selected randomly with age group between 25-30 years with due consideration to inclusion and exclusion criteria. In this study 34 subjects are selected. They were randomly divided into two groups using lottery method. In group A (Non Computer desk job women) wrist splint& Exercises was given. In group B (Computer desk job women) Nerve tendon gliding technique & exercises was done for 6 weeks. The beneficial effect of gliding exercises may be the mobilization of the nerve directly or facilitation of venous return or oedema dispersal. The pressure in the carpal tunnel is lowest in neutral wrist flexion extension range, with the pressure rising significantly as the wrist is moved into flexion or extension. Splint with the wrist in a neutral position, at night and during the day is used for starting 3 weeks and any at night during rest of period. Analyzing scores after 6 weeks the mean and SD values for pre and post FSS Sores of group A were 27 &21. 64 and 1.36 & 1.80 respectively. Conclusion: The study showed that there was decrease in the pain and improvement in the functional ability statistically in carpal tunnel syndrome women with computer desk job by performing nerve and tendon gliding exercises and wrist splinting for both the groups for a period of 6weeks. This concluded that there was equal improvement in pain in both the groups but the functional ability is more improved after the nerve and tendon gliding exercises in group B. Therefore this study is rejecting the null hypothesis and accepts the alternate hypothesis. [ABSTRACT FROM AUTHOR]

Objectives This follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate CTS on symptoms, resource use and carpal tunnel surgery, over 24 months. Methods Adults with mild-to-moderate CTS were randomized 1:1 to a local corticosteroid injection or a night splint worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery, and healthcare utilization. A cost–utility analysis was conducted. Results One hundred and sixteen participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly [mean difference £68.59 (95% CI: −120.84, 291.24)] with fewer quality-adjusted life-years than NS over 24 months [mean difference −0.022 (95% CI: −0.093, 0.045)]. Conclusion Over 24 months, surgical intervention rates were low in both groups, but less frequent in the NS group. While there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to compare the efficacy of ultrasonography (US) and steroid phonophoresis (PH) treatments in patients with idiopathic carpal tunnel syndrome (CTS). Patients and methods: Between January 2013 and May 2015, a total of 46 hands of 27 patients (5 males, 22 females; mean age: 47.3+13.7 years; range, 23 to 67 years) with idiopathic mild/moderate CTS without tenor atrophy or spontaneous activity in abductor pollicis brevis were included. The patients were randomly divided into three groups. The first group was ultrasound (US) group, the second group was PH group, and the third group was placebo US group. Continuous US with a frequency of 1 MHz, an intensity of 1.0 W/cm2 was used in the US and the PH groups. The PH group received 0.1% dexamethasone. Placebo group received a frequency of 0 MHz, an intensity of 0 W/cm2 US. Treatments were administered for five days a week, a total of 10 sessions. All patients also wore night splints during treatment. The Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire consisting of two parts, namely the Symptom Severity Scale and Functional Status Scale), grip strength, and electroneurophysiological evaluations were compared before the treatment, after the treatment, and three months later. Results: All clinical parameters improved in all groups after treatment and at three months, except for the grip strength. Recovery in the sensory nerve conduction velocity between palm and wrist was seen in US group at three months after the treatment; however, recovery in the sensory nerve distal latency between the second finger and palm was seen in PH and placebo groups after treatment and at three months after the treatment. Conclusion: The results of this study suggest that splinting therapy combined with steroid PH, placebo or continuous US is effective for both clinical and electroneurophysiological improvement; however, electroneurophysiological improvement is limited. [ABSTRACT FROM AUTHOR]

The article presents a case study of carpal tunnel syndrome (CTS) in a 31-year-old man and highlights the role of diagnostic ultrasound in identifying an accessory flexor digitorum superficialis (FDS) muscle belly as a contributing factor. It underscores the importance of considering anatomical variations in diagnosing and managing CTS and discusses the advantages of ultrasound in detecting morphological changes early in the disease process.

The article presents a case study of a 57-year-old-male with a long-standing history of type 2 diabetes, who complained of night-time discomfort affecting his hands and forearms, characterised as numbness. It notes that the diagnosis was carpel tunnel syndrome (CTS) with secondary thenar muscle atrophy, with primary management involving conservative therapy and wrist splinting to reduced wrist flexion/extension, typically worn at night and local steroid injections to reduce swelling.

The article focuses on carpal tunnel syndrome, a condition caused by compression of the median nerve in the wrist. Topics include the gradual development and symptoms of the syndrome, the potential treatments such as corticosteroid injections and surgery, and post-surgery recovery measures to manage swelling and stiffness.

• 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]

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Objective: The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. Design: A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale–pain, a Visual Analog Scale–numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. Results: Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale–pain, Visual Analog Scale–numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale–pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. Conclusions: Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection. [ABSTRACT FROM AUTHOR]

Workers' compensation guidelines, such as the widely used Official Disability Guidelines, are evidence- and data-based. These guidelines can be potentially improved by taking into account the evidence regarding mental and social aspects of health for illnesses such as carpal tunnel syndrome. Objective: Workers' compensation guidelines may reinforce unhelpful thoughts regarding symptoms that are known to increase symptom intensity and magnitude of incapability. Methods: One guideline commonly used (the Official Disability Guidelines) was reviewed regarding carpal tunnel syndrome. For 15 statements, we created an alternative statement based on a set of consensus principles for health, value, and quality in care. One hundred eight upper extremity surgeons of the Science of Variation Group reviewed both versions of the statements to indicate their preference. Results: Surgeons preferred seven revised statements and five guideline statements and were neutral on three statements. Favored revisions related to more accurate discernment of symptoms that are clearly related to idiopathic median neuropathy and representative of severity of pathology. Conclusions: There may be important mental health considerations for care under a work claim, such as unhelpful thoughts or distress regarding symptoms, which are not adequately considered by the Official Disability Guidelines. [ABSTRACT FROM AUTHOR]

Study Design. Prospective randomized clinical trial. The trial is registered in the Chinese registry of clinical trials with a trial number of ChiCTR1800019908. Background. Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective. To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero-Pérez et al., 2017), muscle strength, and functional status. Methods. A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm2 and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3rd and 6th weeks. Results. Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions. The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is disease that gives burdens for many countries, with a few choices for the management such as drugs or surgery, each has side effects that decrease the quality of life. Acupuncture is proven to be an effective treatment for pain and can restore nerve functions, and laser acupuncture is one of the modalities. This study aims to assess the effectiveness of laser acupuncture with total sample of 3 patients (6 wrists) mostly with tingling sensations and the outcomes are Boston questionnaire (BCTQ), visual analogue scale (VAS), Tinel sign, Phalen sign, and parameters of nerve conduction study (NCS). Acupuncture points used here are PC6, PC7, EXUE9, and LI4. The results show a decrease in NCS grades for 3 wrists, all wrists have BCTQ score improvements, a decrease in VAS, but no significant improvement in Tinel and Phalen signs. It is concluded that laser acupuncture can be used as a treatment option for the management of carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS). Methods. Data from a randomized clinical trial (n=104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term,mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity. Results. Manual physical therapy improved function in women with CTS (between-groups difference: 0.09; 95% CI=0.07 to 0.11). The Bayesian network showed that early improvements (at 1 month) in function and symptom severity led to longterm (at 12 months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI=0.11 to 0.17 point) poorer function at 12 months than those with mild CTS and 0.12-point (95% CI=0.09 to 0.15 point) poorer function at 12 months than those with severe CTS. Conclusion. Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that betweengroup differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects. Impact. Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome affects one out of ten people throughout their lives, and repetitive work related conditions affecting wrist and hand are the most common cause of prolonged absenteeism from work and limited functional ability. Multiple physical therapy interventions have been used by physical therapists for reducing pain severity, increasing range of motion and decreasing functional limitations in carpal tunnel syndrome. Methods: A cross-sectional survey was conducted among 196 physical therapists in Karachi, Pakistan. Demographic data of physical therapists was obtained, as well as information regarding carpal tunnel syndrome and its intervention techniques used. Conclusion: There existed variability among the treatment preferences of physical therapists regarding the management of carpal tunnel syndrome. A majority of respondents (72.4%) used nerve mobilization techniques, and therapeutic ultrasound was given by 66.3%. The least common intervention used was myofascial release (28.1%). Different approaches had been given in combination as well, which showed that physical therapists are also aware about the recent approaches and their effects for the management of CTS. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the therapeutic effects of low-level laser therapy (LLLT) on clinical, ultrasonographic (US), and electrophysiological findings in carpal tunnel syndrome (CTS). Patients and methods: Between January 2015 and August 2015, 42 patients (7 males, 35 females; mean age: 50.4±8.7 years; range, 32 to 65 years) with mild-to-moderate CTS were randomly assigned to one of two groups: active LLLT (therapy group, n=22) 0.8 J/painful point and sham LLLT groups (n=20). Both groups wore neutral wrist orthoses. The patients were evaluated before and after 15 sessions of therapy (670 nm, 4 J/session over the carpal tunnel). Follow-up parameters included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), nerve conduction studies and US evaluation of the median nerve cross-sectional area (CSA), vascularization (via power Doppler), flattening ratio (FR), and palmar bowing of the flexor retinaculum. Results: Nocturnal paresthesia improved in both groups; however, pain and patients with a positive Phalen's test reduced only in the therapy group (p=0.031). The FSS and SSS scores also improved only in the therapy group (p<0.001). Electrophysiologically, median sensory nerve conduction velocities showed a significant improvement only in the therapy group (p=0.002). The CSA, FR, and vascularization of the median nerve showed a significant improvement in the therapy group alone (p<0.001, p=0.048, and p=0.021, respectively). Conclusion: Improvements in the signs and symptoms of CTS and hand function, the improvements in sensory nerve conduction studies, and reduction in median nerve CSA, FR and vascularity in the LLLT group can be attributed to the anti-inflammatory and analgesic effects of LLLT. This study provides new US data demonstrating efficacy of LLLT along with a clinical and electrophysiological improvement. The LLLT seems to be an easily applied, non-invasive treatment option. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS), one of the most common entrapment neuropathies, can, in fact, be considered as a socio-economic issue that reduces work productivity, increases disability, and requires prolonged rehabilitation. The imaging modality of choice in CTS imaging is the ultrasound (US), as several morphological parameters can be used in CTS diagnosis and follow-up. In recent years, US-guided CTS injection therapy has become an established treatment option for mild to moderate CTS. The authors of this review performed a literature search that revealed several differences in US-guided carpal tunnel injection in an attempt to unify individual stages of CTS injections protocol for future guidance: patient preparation, injection approach, needle positioning, injected medications, and injectate volume. The three approaches to carpal tunnel injections described in the literature, that is, the ulnar, radial, and longitudinal, can be implemented with single or multiple deposits and different injection volumes. Medications used for injections are corticosteroids, local anaesthetics, dextrose, saline, platelet-rich plasma, and progesterone. Although no consensus has yet been reached as to which protocol should be used, the ulnar approach with a single deposit injected in large volumes should be considered as the first choice, while dextrose should be the first-line medication option. Furthermore, as terminological differences make it difficult to draw a uniform comparison the presented steps for US-guided carpal tunnel injection might serve as a guideline for future studies. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is the most prevalent upper limb compression neuropathy. Surgical or nonsurgical treatment is recommended. Both mild and moderate CTS can be managed conservatively. Neurodynamic mobilisation techniques (NMTs) of the median nerve have not been widely studied, and conflicting findings exist. Methods/design: Sixty-two female patients with mild or moderate bilateral CTS were assigned one wrist to the treatment group (TG) and the other to the control group (CG). Both groups underwent carpal bone mobilisation. The TG underwent NMTs while the CG received a placebo elbow mobilisation not targeting the median nerve. The Numerical Rating Pain Scale, JAMAR Plus Digital Hand dynamometer and Functional Status Scale (FSS) were used to assess pain, grip strength and functional status. Discussion: Comparison of groups showed that NMTs at 5 weeks decreased pain intensity by 1.15 (p = 0.001) and by 2 (p ˂ 0.001) at 10 weeks. Difference in functional status was 0.45 at 5 weeks (p = 0.003) and 0.84 at 10 weeks (p = 0.003). The CG's grip strength improved by 0.59 (p = 0.05) after 5 weeks and 0.61 (p = 0.028) at 10 weeks. Both groups improved in all parameters over time. Conclusion: When combined with carpal bone mobilisation, both NMTs and placebo elbow mobilisation seem to reduce pain intensity and improve grip strength and functional status. However, NMTs had better results in pain intensity and FSS. Clinical implications: Women with mild or moderate bilateral CTS may benefit from NMTs as a conservative treatment option. Trial registration: Pan African Clinical Trials Registry, PACTR202201807752672, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=19340. [ABSTRACT FROM AUTHOR]

*OBJECTIVES: We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions. *DESIGN: Intervention systematic review with meta-analysis. *LITERATURE SEARCH: We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020. *STUDY SELECTION CRITERIA: We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS. *DATA SYNTHESIS: Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison. *RESULTS: There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI: -0.95, -0.13) and function (SMD, -0.35; 95% CI: -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty). *CONCLUSION: Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence. [ABSTRACT FROM AUTHOR]