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Dabbagh A, Ziebart C, MacDermid JC, Packham T, Grewal R. The effectiveness of biophysical agents in the treatment of carpal tunnel syndrome- an umbrella review. BMC Musculoskelet Disord 2023; 24:645. [PMID: 37563725 PMCID: PMC10416372 DOI: 10.1186/s12891-023-06778-z] [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] [Received: 03/30/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Our objective was to summarize, synthesize, and integrate the evidence evaluating the effectiveness of biophysical agents compared to other conservative treatments, for the management of carpal tunnel syndrome (CTS). METHODS This was an overview of systematic reviews (SRs). We searched several online databases and obtained SRs relating to managing CTS using biophysical agents. Two independent researchers screened and appraised the quality of the SRs using the A MeaSurement Tool to Assess systematic Reviews-2 appraisal tool. We extracted information related to study characteristics as well as the effectiveness of biophysical agents for CTS, the effect sizes, and between-group significances. We categorized the information based on the type of biophysical agent. We also performed a citation mapping and calculated the corrected covered area index. RESULTS We found 17 SRs addressing 12 different biophysical agents. The quality of the SRs was mainly critically low (n = 16) or low (n = 1). The evidence was inconclusive for the effectiveness of Low-level Laser therapy and favorable for the short-term efficacy of non-thermal ultrasound in improving symptom severity, function, pain, global rating of improvement, satisfaction with treatment, and other electrophysiological measures compared to manual therapy or placebo. Evidence was inconclusive for Extracorporeal Shockwave therapy, and favorable for the short-term effectiveness of Shortwave and Microwave Diathermy on pain and hand function. The corrected covered area index was lower than 35% indicating a low overlap of the SRs. CONCLUSIONS The findings were based on low-quality primary studies, with an unclear or high risk of bias, small sample sizes, and short follow-ups. Therefore, no recommendations can be made for the long-term effectiveness of any biophysical agents. High-quality evidence is needed to support evidence-based recommendations on the use of biophysical agents in the management of CTS. PROSPERO REGISTRATION NUMBER CRD42022319002, registered on 17/04/2022.
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Affiliation(s)
- Armaghan Dabbagh
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada.
| | - Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
- KITE-UHN, University of Toronto, Toronto, ON, Canada
| | - Joy C MacDermid
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ruby Grewal
- Department of Surgery, Western University, London, ON, Canada
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Cage ES, Beyer JJ, Ebraheim NA. Injections for treatment of carpal tunnel syndrome: A narrative review of the literature. J Orthop 2023; 37:81-85. [PMID: 36974095 PMCID: PMC10039115 DOI: 10.1016/j.jor.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Background Carpal tunnel syndrome is an extremely common condition in the general population. Nonoperative treatment is a mainstay of management prior to surgical carpal tunnel release. Injections are frequently used as treatment, especially corticosteroid injections, but there is little consensus in the literature regarding injection number, volume, corticosteroid dose, and technique. Methods A comprehensive literature search was performed of PubMed to identify papers relating to corticosteroid injections as well as other injections performed in patients with carpal tunnel syndrome. Results A total of 45 articles were selected for inclusion in this review. Corticosteroid injections for carpal tunnel syndrome are discussed in detail, including injection number, volume, and technique as well as corticosteroid dose. Alternative injections for management of carpal tunnel syndrome are also discussed. Conclusions Corticosteroid injections have been identified as a safe, effective short term management option for carpal tunnel syndrome. However, there is no standardized recommendation for specifics of their use in relation to corticosteroid dose, number of injections, injectate volume, and use of ultrasound guidance. Further research is required to better establish the optimal role for corticosteroid injections in the treatment of carpal tunnel syndrome. Platelet rich plasma, lidocaine, and hyaluronic acid, among others, are additional injections that warrant further exploration for use in management of carpal tunnel syndrome.
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Affiliation(s)
- Emily S. Cage
- Department of Orthopaedic Surgery, University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, United States
| | - Julia J. Beyer
- Department of Orthopaedic Surgery, University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, United States
| | - Nabil A. Ebraheim
- Department of Orthopaedic Surgery, University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, United States
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Padua L, Cuccagna C, Giovannini S, Coraci D, Pelosi L, Loreti C, Bernabei R, Hobson-Webb LD. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol 2023; 22:255-267. [PMID: 36525982 DOI: 10.1016/s1474-4422(22)00432-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting quality of life for many people. Although it is a well recognised condition, new insights into epidemiology, diagnosis, and treatment have emerged in the past 6 years. The availability of disease-modifying treatments for rare systemic disorders associated with carpal tunnel syndrome (eg, amyloidosis) should alert clinicians to these diagnostic possibilities. Besides clinical evaluation and electrophysiology, the role of ultrasonography as a diagnostic tool has been confirmed and new ultrasound techniques have been applied, the clinical use and feasibility of which require further investigation. Surgical and non-surgical interventions are beneficial for the treatment of carpal tunnel syndrome and several treatment options are now available, giving clinicians the possibility to choose the best approach for every patient. New diagnostic and therapeutic techniques require further validation.
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Affiliation(s)
- Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Cristina Cuccagna
- UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua, Italy
| | - Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Durham, NC, USA
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Lam KHS, Lai WW, Ngai HY, Wu WKR, Wu YT. Commentary: Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial. Front Med (Lausanne) 2022; 8:833862. [PMID: 35096917 PMCID: PMC8793904 DOI: 10.3389/fmed.2021.833862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.,Taiwan Association of Prolotherapy and Regenerative Medicine, Taichung, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wai Wah Lai
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ho Yin Ngai
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Wing Keung Ricky Wu
- The Hong Kong Institute of Musculoskeletal Medicine, Kwoloon, Hong Kong SAR, China.,Department of Family Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Family Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Research and Development, School of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
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