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Rajapandian R, Moti Wala S, Aledani EM, Samuel EA, Ahmad K, Manongi NJ, Rauf Butt S. Endoscopic Versus Open Carpal Tunnel Release: A Systematic Review of Outcomes and Complications. Cureus 2024; 16:e64991. [PMID: 39165434 PMCID: PMC11335062 DOI: 10.7759/cureus.64991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/20/2024] [Indexed: 08/22/2024] Open
Abstract
Carpal tunnel syndrome (CTS) is a condition that causes discomfort due to the compression of the median nerve in the wrist. Carpal tunnel release (CTR) is a surgical procedure that can help alleviate the symptoms of CTS. Two methods are commonly used for CTR: endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). The choice of method can impact surgical outcomes and potential complications. This review aims to compare the outcomes of both methods for individuals diagnosed with CTS. This systematic review analyzes the outcomes and potential complications of ECTR and OCTR for CTS. The study encompassed a comprehensive analysis of randomized controlled trials (RCTs) and meta-analyses comparing both methods. We searched for studies released between January 2012 and October 2023 on PubMed, Science Direct, and Google Scholar. The researchers assessed the quality of studies using the Cochrane risk of bias tool and the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool. The study's scope included a range of outcomes and complications, such as symptom relief, functional recovery, grip strength, return to work, patient satisfaction, scar sensitivity, pillar pain, wound complications, nerve-related issues, morphological changes, and recurrence. The review analyzed 11 studies, including seven RCTs and four meta-analyses. These studies evaluated 4367 ECTR and 4107 cases of OCTR. The patients' ages ranged from 46 to 58, and the follow-up periods ranged from three to 24 months. The findings reveal that ECTR has comparable or better outcomes than OCTR, particularly in postoperative discomfort, functional recovery, grip strength, resumption of work, and patient satisfaction. Additionally, ECTR has lower levels of scar sensitivity, pillar pain, and wound-related complications than OCTR. However, ECTR carries a higher risk of reversible nerve injury. There were no substantial differences between the two techniques regarding other potential complications. Both ECTR and OCTR are safe and effective interventions for CTS. ECTR has benefits like faster recovery and improved cosmetic outcomes but requires higher technical proficiency and carries the risk of nerve injury. The choice of technique should consider patient preference, cost-effectiveness, and surgeon expertise.
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Affiliation(s)
- Ramkumar Rajapandian
- Trauma and Orthopedics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sajida Moti Wala
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Esraa M Aledani
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Essa A Samuel
- Physical Medicine and Rehabilitation, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Khoula Ahmad
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Naelijwa J Manongi
- Health Sciences and Public Health, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Samia Rauf Butt
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Vongvachvasin P, Phakdepiboon T, Chira-Adisai W, Siriratna P. Efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome: a preliminary study. J Rehabil Med 2024; 56:jrm13411. [PMID: 38332536 PMCID: PMC10865893 DOI: 10.2340/jrm.v56.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of focused extracorporeal shockwave therapy for symptoms and function in patients with moderate-to-severe carpal tunnel syndrome. DESIGN A single-blind randomized controlled trial. SUBJECTS Twenty-four outpatients with moderate-to-severe carpal tunnel syndrome. METHODS Patients were randomly allocated into 2 groups: a focused extracorporeal shockwave therapy group and a control group. The focused extracorporeal shockwave therapy group received conservative treatment in addition to focused extracorporeal shockwave therapy with an energy flux density ranging from 0.01 to 0.15 mJ/mm2, a frequency of 4-5 Hz, and 1500 pulses per session once a week for a total of 3 sessions. The control group received only conservative treatment, which comprised gliding exercises for carpal tunnel syndrome, a night wrist splint, and lifestyle modification. The Thai version of the Boston Carpal Tunnel Questionnaire (T-BCTQ), a nerve conduction study, and ultrasonography of the median nerve cross-sectional area were performed before treatment and at 3 and 6 weeks after baseline. RESULTS The T-BCTQ symptom and function scores had significantly decreased in both groups, favouring focused extracorporeal shockwave therapy at all time-points. In addition, distal sensory and motor latency were significantly different between the groups at 3 weeks from baseline. CONCLUSION Focused extracorporeal shockwave therapy plus conservative treatment effectively provided short-term improvement in symptoms, hand function, and nerve conduction in patients with moderate-to-severe carpal tunnel syndrome compared with conservative treatment alone.
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Affiliation(s)
- Pimpisa Vongvachvasin
- Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Thitiporn Phakdepiboon
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Waree Chira-Adisai
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punpetch Siriratna
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Jung DH, Lee SE, Park D, Lee JW. A revised electrodiagnosis-based severity classification for carpal tunnel syndrome. J Back Musculoskelet Rehabil 2024; 37:1205-1212. [PMID: 38578879 DOI: 10.3233/bmr-230275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity. OBJECTIVE This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS. METHODS This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens' classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation were performed to detect anatomical abnormalities. RESULTS Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group. CONCLUSION The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups.
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Affiliation(s)
- Do Hun Jung
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Korea
| | - Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Sunjic Roguljic V, Roguljic L, Kovacic V, Bilic I, Jukic I. The Influence of the Tissue Adhesive Material as a Surgical Wound-Closure Technique Following Carpal Tunnel Decompression on Neurological and Functional Outcomes: A Single-Center Randomized Controlled Trial. Cureus 2024; 16:e53312. [PMID: 38435874 PMCID: PMC10906781 DOI: 10.7759/cureus.53312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve in the carpal tunnel. The effect of tissue adhesives as a material for wound closure following CTS decompression has been insufficiently investigated. This study aimed to evaluate outcomes by comparing two modalities of wound closure following carpal surgery in patients randomly assigned to either tissue adhesives or sutures. Methodology This randomized, prospective study was conducted in April 2022 at the University Hospital of Split in Croatia. Patients aged 61.56 ± 12.03 years were randomized to either tissue adhesive Glubran Tiss 2®-based (n = 50) or suture-based (n = 50) wound-closure techniques. The following outcomes were assessed before surgery and six months postoperatively: hand strength, electroneurographic characteristics of the median nerve, and the Boston Carpal Tunnel Questionnaire. Results Significant differences between glue-based and suture-based wound-closure techniques were found in the six-month postoperative hand grip strength (25.06 ± 6.69 vs. 21.41 ± 5.62 kg; p = 0.002), postoperative sensory amplitude (10.08 ± 5.50 vs. 7.54 ± 5.41 mV; p = 0.012), and postoperative sensory velocity (42.22 ± 11.04 vs. 35.23 ± 16.40 m/s; p = 0.008). In the glue-based group, significantly more patients achieved a postoperative sensory velocity greater than 45 m/s (47.9% vs. 22.0%; p= 0.006), postoperative distal sensory latency less than 3.5 ms (89.6% vs. 84.0%; p = 0.304), and postoperative motor latency of less than 4.2 ms (60.42% vs. 38.00%; p = 0.022). Conclusions This trial demonstrated that cyanoacrylate-based adhesion material for wound closure after open CTS decompression compared with sutures showed a significant six-month postoperative increment in hand grip strength and median nerve sensory conduction.
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Affiliation(s)
- Veridijana Sunjic Roguljic
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery With Burn Care, University Hospital of Split, Split, HRV
| | - Luka Roguljic
- Department of Surgery, Division of Orthopaedics and Traumatology, University Hospital of Split, Split, HRV
| | - Vedran Kovacic
- Department of Internal Medicine, Division of Emergency and Intensive Medicine With Clinical Pharmacology and Toxicology, University Hospital of Split, Split, HRV
| | - Ivica Bilic
- Department of Neurology, Division of Clinical Neurology, University Hospital of Split, Split, HRV
| | - Ivana Jukic
- Department of Internal Medicine, University Hospital of Split, Split, HRV
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Zhang X, Liu H. Letter to the Editor concerning "The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta‑analysis". INTERNATIONAL ORTHOPAEDICS 2022; 46:1433-1434. [PMID: 35347373 DOI: 10.1007/s00264-022-05386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China.
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Huh JH, Jeong HI, Kim KH. Effect of Manual Acupuncture for Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review. J Pharmacopuncture 2021; 24:153-164. [PMID: 35028166 PMCID: PMC8716703 DOI: 10.3831/kpi.2021.24.4.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/09/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Despite the low cost and high accessibility of manual acupuncture (MA) treatments for the carpal tunnel syndrome (CTS), this intervention has not been uniformly evaluated in systematic reviews (SR), and no SR has evaluated MA monotherapy for CTS. This review was conducted to summarize the findings and undertake a quality assessment of randomized controlled trials (RCTs) of acupuncture treatment methods for mild-to-moderate CTS to identify clinical evidence for the use of MA in CTS. Methods We searched five databases for articles on relevant RCTs that were published until June 2021 without imposing specific restrictions, such as age or sex, on CTS patients. RCTs that evaluated MA were included without any restriction on comparator interventions. Measurement tools for evaluating pain reduction and functional improvement or for evaluating efficacy using electrophysiological indicators were included as outcome measures. Results We included seven RCTs, of which three studies reported both post-treatment improvement effects and statistical significance using p-values for all outcomes. Five studies reported statistically significant intergroup differences (p-values for all outcomes) in post-treatment improvement. None of the studies reported severe adverse effects of MA. In all of the RCTs, the reporting rates of the 2c, 2a, and 6a items of STRICTA 2010 were 14%, 29%, and 29%, respectively. PC7 (Daereung) was used to treat CTS in all of the included studies. Conclusion MA can be used for CTS treatment without serious adverse effects. PC7 was the most commonly used acupoint. In order to ensure objective and reliable reporting, accurate standardization of acupuncture treatment methods acupoint terms should be undertaken in future RCTs.
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Affiliation(s)
- Jeong Ho Huh
- College of Korean Medicine, Woosuk University, Jeonju, Republic of Korea
| | - Hye In Jeong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyeong Han Kim
- Woosuk Institute of Smart Convergence Life Care (WSCLC), Woosuk University, Wanju, Republic of Korea.,Department of Preventive Medicine, College of Korean Medicine, Woosuk University, Wanju, Republic of Korea
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