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Krieger Y, Ofri M, Sagi G, Moshe-Noach H, Raiden P, Shoham Y, Sagi A, Reiner Benaim A, Silberstein E. Long-Term Functional Outcomes and Quality of Life Following Carpal Tunnel Release Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1203. [PMID: 39338086 PMCID: PMC11431222 DOI: 10.3390/ijerph21091203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/17/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024]
Abstract
This study investigates the long-term efficacy of carpal tunnel release surgery (CTR) on patient outcomes. We aimed to assess symptom severity, functional limitations, and quality of life in a large cohort (n = 186) at least five years post-surgery via a retrospective cross-sectional design that evaluated participants using the validated Boston Carpal Tunnel Questionnaire (BCTQ) over a phone interview. The BCTQ measures symptom severity, functional limitations, and quality of life specific to carpal tunnel syndrome. Seventy-three percent (73.1%) of patients reported complete resolution of symptoms and functional limitations (BCTQ = 1) with an average follow-up of 11 years. No statistically significant decline in BCTQ scores was observed over time. Univariate analysis revealed a significant association between poorer outcomes and older age at surgery and current unemployment. Carpal tunnel release surgery demonstrates long-term effectiveness in relieving symptoms and improving function in most patients. These findings contribute to the understanding of CTR's impact on patient well-being beyond short-term outcomes.
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Affiliation(s)
- Yuval Krieger
- Hand Unit, Plastic and Reconstructive Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (Y.S.); (A.S.); (E.S.)
| | - Mai Ofri
- Soroka Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel;
| | - Gali Sagi
- Department of Public Health Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (G.S.); (H.M.-N.); (P.R.); (A.R.B.)
| | - Hila Moshe-Noach
- Department of Public Health Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (G.S.); (H.M.-N.); (P.R.); (A.R.B.)
| | - Pnina Raiden
- Department of Public Health Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (G.S.); (H.M.-N.); (P.R.); (A.R.B.)
| | - Yaron Shoham
- Hand Unit, Plastic and Reconstructive Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (Y.S.); (A.S.); (E.S.)
| | - Amiram Sagi
- Hand Unit, Plastic and Reconstructive Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (Y.S.); (A.S.); (E.S.)
| | - Anat Reiner Benaim
- Department of Public Health Epidemiology, Biostatistics and Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (G.S.); (H.M.-N.); (P.R.); (A.R.B.)
| | - Eldad Silberstein
- Hand Unit, Plastic and Reconstructive Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva P.O. Box 151, Israel; (Y.S.); (A.S.); (E.S.)
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Khired Z, Shawish AM, Mojiri ME, Albarrati AM, Hobani AH, Madkhali HA, Hakami AJ, Adawi KA, Hakami SM, Hakami LB, Muqri KY, Awaji AY, Ageeli FE, Sayegh AA. Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Jazan: A Cross-Sectional Study. Cureus 2024; 16:e68458. [PMID: 39360059 PMCID: PMC11446227 DOI: 10.7759/cureus.68458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 10/04/2024] Open
Abstract
Background Carpal tunnel syndrome (CTS) is a common musculoskeletal condition of the hand and wrist frequently associated with repetitive hand motion and environmental considerations. Teachers are more likely to acquire CTS because of their lengthy writing and computer use. This study aimed to determine the prevalence of CTS symptoms and related variables among schoolteachers in Jazan, Saudi Arabia. Methods This study was conducted as a cross-sectional survey of teachers in Jazan, utilizing an online platform for data collection. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was the primary tool used to determine symptom intensity and functional status. The data were rigorously analyzed using a range of statistical methods, including descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman's correlation, the chi-square test, Fisher's exact test, and binary logistic regression, ensuring the robustness of the findings. Results The study comprised 336 schoolteachers with a mean age of 43.3 ± 6.5 years, of whom 58.0% were female and 42.0% were male. About 8.0% of instructors reported CTS symptoms. Female gender (median Symptom Severity Scale (SSS): 15.0 vs. 12.0, p < 0.001; median Functional Status Scale (FSS): 8.0 vs. 8.0, p < 0.001), increased time spent writing (r = 0.237, p < 0.001 for SSS; r = 0.217, p < 0.001 for FSS), and presence of comorbidities such as diabetes (median SSS: 16.0, p = 0.002; median FSS: 8.0, p = 0.001) had a negative correlation with symptom severity (r = -0.174, p = 0.002) and functional impairment (r = -0.141, p = 0.011). Surgical therapy (median SSS: 32.0; median FSS: 24.0; p<0.001) and post-treatment symptom recurrence (median SSS: 28.0; median FSS: 22.0; p<0.001) were associated with increased severity and disability. According to binary logistic regression, increased writing time significantly predicted CTS diagnosis (OR = 1.151, 95% CI: 1.024-1.295, p = 0.018). Conclusion CTS symptoms are common among Jazan teachers, and various sociodemographic, vocational, and clinical variables influence their intensity and functional status. Ergonomic treatment, early identification, and suitable management measures are critical for preventing and mitigating the effects of CTS among teachers. Additional research is required to develop focused therapies and enhance the results of this occupational group.
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Affiliation(s)
- Zenat Khired
- Department of Surgery, Jazan University, Jazan, SAU
| | | | | | | | | | | | - Ali J Hakami
- College of Medicine, Jazan University, Jazan, SAU
| | | | | | - Layla B Hakami
- College of Applied Medical Sciences, Jazan University, Jazan, SAU
| | - Khalid Y Muqri
- Department of Orthopedic Surgery, King Fahad Central Hospital, Jazan, SAU
| | - Alyazid Y Awaji
- Department of Plastic and Reconstructive Surgery, King Fahad Central Hospital, Jazan, SAU
| | - Fatimah E Ageeli
- Department of General Surgery, King Fahad Central Hospital, Jazan, SAU
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Cano LC, Leiby BM, Shum LC, Ward MG, Joseph AE. Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance in Over 100 Patients at Two to Six Years. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:349-354. [PMID: 38817770 PMCID: PMC11133916 DOI: 10.1016/j.jhsg.2024.02.004] [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: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose The purpose of this study was to determine the clinical results of carpal tunnel release using ultrasound guidance (CTR-US) at a minimum of 2 years postprocedure. Methods The study consisted of 102 patients (162 hands) treated with CTR-US by the same physician between June 2017 and October 2020 for whom minimum 2-year follow-up data were available. Questionnaires were sent to gather long-term information, with additional phone calls for clarification if needed. Outcomes included Boston Carpal Tunnel Questionnaire symptom severity (BCTQ-SSS) and functional status (BCTQ-FSS) scores; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores; global satisfaction scores; and subsequent surgeries. Results The 102 patients included 68 females and 34 males with a mean age of 56.9 years at the time of surgery. Fifty-five (53.9%) patients had simultaneous bilateral procedures, 42 (41.2%) had unilateral procedures, and 5 (4.9%) had staged bilateral procedures. Significant improvements in BCTQ-SSS, BCTQ-FSS, and QuickDASH scores persisted at a mean final follow-up of 46 months (range 2-6 years). At final follow-up, 91.2% of patients reported satisfaction with the procedure. No outcomes were significantly different between those treated with simultaneous bilateral versus unilateral procedures. No revision surgeries were reported. Conclusions CTR-US is a safe and effective procedure that results in significant improvements that persist up to 6 years postprocedure. Long-term results of simultaneous bilateral and unilateral procedures are similar. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
| | | | | | | | - Anthony E. Joseph
- OrthoIdaho, LLC, Pocatello, ID
- Department of Family Medicine, Idaho State University, Pocatello, ID
- Department of Family Medicine, University of Washington, Seattle, WA
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Doh CH, Kim YJ, Kim JK, Lee J, Shin YH. Association of carpal tunnel syndrome risk factors with treatment modality selection focusing on corticosteroid injection and surgery: A nationwide population-based study. Medicine (Baltimore) 2024; 103:e37781. [PMID: 38640326 PMCID: PMC11029960 DOI: 10.1097/md.0000000000037781] [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: 12/09/2023] [Revised: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
Several studies have revealed the risk factors for carpal tunnel syndrome (CTS). However, no studies have evaluated the influence of these risk factors on the selection of treatment modalities for CTS. This study aimed to determine the influence of CTS risk factors on the selection of CTS treatment modalities with a focus on corticosteroid injection (CI) and surgery. We conducted a retrospective cohort study of patients aged ≥20 years with newly diagnosed CTS in the Korean health insurance review and assessment service between 2010 and 2019. We evaluated the demographic information, the existence of CTS risk factors, and the applied treatment modalities for CTS, including CI and operation. The CTS risk factors include age, sex, diabetes mellitus, osteoarthritis of the hand or wrist, rheumatoid arthritis, hypothyroidism, gout, chronic kidney disease (CKD) on dialysis, antiestrogen or aromatase inhibitor medication, and a history of distal radius fracture (DRF). Multivariable logistic regression analyses were conducted. Age over 80 years was the most significantly associated factor for the selection of CI in CTS (odd ratio [OR], 2.149; 95% confidence interval [CI], 2.092 to 2.209; P < .001). Among underlying diseases or medications, CKD on dialysis (OR, 4.001; 95% CI, 3.819-4.193; P < .001) was the most significant associated factor for the selection of operation for CTS, followed by a history of DRF (OR, 1.803; 95% CI, 1.749-1.860; P < .001). Old age was the most significantly related factor for selecting CI. Among underlying diseases or medications, CKD on dialysis and the history of DRF were the most significantly related factors for selecting operative treatment. For these patients, clinicians should proactively consider an operation to reduce the long-term discomfort and economic burdens.
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Affiliation(s)
- Chang Hyun Doh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongjin Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Ho Shin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ghosh Moulic A, Deshmukh P, Gaurkar SS. A Comprehensive Review on Biofilms in Otorhinolaryngology: Understanding the Pathogenesis, Diagnosis, and Treatment Strategies. Cureus 2024; 16:e57634. [PMID: 38707023 PMCID: PMC11070220 DOI: 10.7759/cureus.57634] [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: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Biofilms, structured communities of microorganisms encased in a self-produced matrix, pose significant challenges in otorhinolaryngology due to their role in chronic and recurrent infections affecting the ear, nose, and throat (ENT) region. This review provides an overview of biofilms, emphasizing their formation, pathogenesis, diagnosis, and treatment strategies in otorhinolaryngological disorders. Biofilms are pivotal in chronic rhinosinusitis (CRS), otitis media, laryngopharyngeal reflux (LPR), and tonsillitis, contributing to treatment resistance and disease recurrence. Current diagnostic techniques, including imaging modalities, microbiological cultures, and molecular techniques, are discussed, alongside emerging technologies. Treatment strategies, ranging from conventional antibiotics to alternative therapies, such as biofilm disruptors, phage therapy, and immunomodulation, are evaluated in terms of their efficacy and potential clinical applications. The review underscores the significance of understanding biofilms in otorhinolaryngology and highlights the need for tailored approaches to diagnosis and management to improve patient outcomes.
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Affiliation(s)
- Ayushi Ghosh Moulic
- Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Prasad Deshmukh
- Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sagar S Gaurkar
- Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Lusa V, Karjalainen TV, Pääkkönen M, Rajamäki TJ, Jaatinen K. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2024; 1:CD001552. [PMID: 38189479 PMCID: PMC10772978 DOI: 10.1002/14651858.cd001552.pub3] [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: 01/09/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. Surgery is considered when symptoms persist despite the use of non-surgical treatments. It is unclear whether surgery produces a better outcome than non-surgical therapy. This is an update of a Cochrane review published in 2008. OBJECTIVES To assess the evidence regarding the benefits and harms of carpal tunnel release compared with non-surgical treatment in the short (< 3 months) and long (> 3 months) term. SEARCH METHODS In this update, we included studies from the previous version of this review and searched the Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, ClinicalTrials.gov and WHO ICTRP until 18 November 2022. We also checked the reference lists of included studies and relevant systematic reviews for studies. SELECTION CRITERIA We included randomised controlled trials comparing any surgical technique with any non-surgical therapies for CTS. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS The 14 included studies randomised 1231 participants (1293 wrists). Eighty-four per cent of participants were women. The mean age ranged from 32 to 53 years, and the mean duration of symptoms from 31 weeks to 3.5 years. Trial sizes varied from 22 to 176 participants. The studies compared surgery with: splinting, corticosteroid injection, splinting and corticosteroid injection, platelet-rich plasma injection, manual therapy, multimodal non-operative treatment, unspecified medical treatment and hand support, and surgery and corticosteroid injection with corticosteroid injection alone. Since surgery is generally used for its long-term effects, this abstract presents only long-term results for surgery versus splinting and surgery versus corticosteroid injection. 1) Surgery compared to splinting in the long term (> 3 months) Surgery probably results in a higher rate of clinical improvement (risk ratio (RR) 2.10, 95% confidence interval (CI) 1.04 to 4.24; 3 studies, 210 participants; moderate-certainty evidence). Surgery probably does not provide clinically important benefit in symptoms or hand function compared with splinting (moderate-certainty evidence). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (scale 1 to 5; higher is worse; minimal clinically important difference (MCID) = 1) was 1.54 with splint and 0.26 points better with surgery (95% CI 0.52 better to 0.01 worse; 2 studies, 195 participants). The mean BCTQ Functional Status Scale (scale 1 to 5; higher is worse; MCID 0.7) was 1.75 with splint and 0.36 points better with surgery (95% CI 0.62 better to 0.09 better; 2 studies, 195 participants). None of the studies reported pain. Surgery may not provide better health-related quality of life compared with splinting (low-certainty evidence). The mean EQ-5D index (scale 0 to 1; higher is better; MCID 0.074) was 0.81 with splinting and 0.04 points better with surgery (95% CI 0.0 to 0.08 better; 1 study, 167 participants). We are uncertain about the risk of adverse effects (very low-certainty evidence). Adverse effects were reported amongst 60 of 98 participants (61%) in the surgery group and 46 of 112 participants (41%) in the splinting group (RR 2.11, 95% CI 0.37 to 12.12; 2 studies, 210 participants). Surgery probably reduces the risk of further surgery; 41 of 93 participants (44%) were referred to surgery in the splinting group and 0 of 83 participants (0%) repeated surgery in the surgery group (RR 0.03, 95% CI 0.00 to 0.21; 2 studies, 176 participants). This corresponds to a number needed to treat for an additional beneficial outcome (NNTB) of 2 (95% CI 1 to 9). 2) Surgery compared to corticosteroid injection in the long term (> 3 months) We are uncertain if clinical improvement or symptom relief differs between surgery and corticosteroid injection (very low-certainty evidence). The RR for clinical improvement was 1.23 (95% CI 0.73 to 2.06; 3 studies, 187 participants). For symptoms, the standardised mean difference (SMD) was -0.60 (95% CI -1.88 to 0.69; 2 studies, 118 participants). This translates to 0.4 points better (95% CI from 1.3 better to 0.5 worse) on the BCTQ Symptom Severity Scale. Hand function or pain probably do not differ between surgery and corticosteroid injection (moderate-certainty evidence). For function, the SMD was -0.12 (95% CI -0.80 to 0.56; 2 studies, 191 participants) translating to 0.10 points better (95% CI 0.66 better to 0.46 worse) on the BCTQ Functional Status Scale with surgery. Pain (0 to 100 scale) was 8 points with corticosteroid injection and 6 points better (95% CI 10.45 better to 1.55 better; 1 study, 123 participants) with surgery. We found no data to estimate the difference in health-related quality of life (very low-certainty evidence). We are uncertain about the risk of adverse effects and further surgery (very low-certainty evidence). Adverse effects were reported amongst 3 of 45 participants (7%) in the surgery group and 2 of 45 participants (4%) in the corticosteroid injection group (RR 1.49, 95% CI 0.25 to 8.70; 2 studies, 90 participants). In one study, 12 of 83 participants (15%) needed surgery in the corticosteroid group, and 7 of 80 participants (9%) needed repeated surgery in the surgery group (RR 0.61, 95% CI 0.25 to 1.46; 1 study, 163 participants). AUTHORS' CONCLUSIONS Currently, the efficacy of surgery in people with CTS is unclear. It is also unclear if the results can be applied to people who are not satisfied after trying various non-surgical options. Future studies should preferably blind participants from treatment allocation and randomise people who are dissatisfied after being treated non-surgically. The decision for a patient to opt for surgery should balance the small benefits and potential risks of surgery. Patients with severe symptoms, a high preference for clinical improvement and reluctance to adhere to non-surgical options, and who do not consider potential surgical risks and morbidity a burden, may choose surgery. On the other hand, those who have tolerable symptoms, who have not tried non-surgical options and who want to avoid surgery-related morbidity can start with non-surgical options and have surgery only if necessary. We are uncertain if the risk of adverse effects differs between surgery and non-surgical treatments. The severity of adverse effects may also be different.
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Affiliation(s)
- Vieda Lusa
- Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Teemu V Karjalainen
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Markus Pääkkönen
- Turku University Hospital, Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Tuomas Jaakko Rajamäki
- Department of Hand Surgery, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Kati Jaatinen
- Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
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Loomis KJ, Roll SC. External wrist ratio is not a proxy for internal carpal tunnel shape: Implications for evaluating carpal tunnel syndrome risk. Clin Anat 2024:10.1002/ca.24132. [PMID: 38173294 PMCID: PMC11219555 DOI: 10.1002/ca.24132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79-0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33-0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.
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Affiliation(s)
- Katherine J Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
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Chaudhary R, Khanna J, Bansal S, Bansal N. Current Insights into Carpal Tunnel Syndrome: Clinical Strategies for Prevention and Treatment. Curr Drug Targets 2024; 25:221-240. [PMID: 38385490 DOI: 10.2174/0113894501280331240213063333] [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: 10/17/2023] [Revised: 01/01/2024] [Accepted: 01/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a condition that is caused by medial nerve compression, resulting in symptoms such as numbness, tightness, or weakness in the hand. OBJECTIVES The aim of the study was to find out the genetic modulation, mechanism, available treatment, and recommendation for carpal tunnel syndrome at its specific stage. METHODS Almost 200 papers were searched for this review article, and 145 articles were selected. The literature was collected from different sources like Google scholar, PubMed, a directory of open-access journals, and science.gov by using keywords, such as treatment, risk factors, recommendation, and clinical features of carpal tunnel syndrome. RESULTS The most efficient non-surgical treatment is methylprednisolone acetate, which reduces inflammation by acting on the glucocorticoid receptor in conjunction with immunofilling. It has also been used successfully as a second-line drug for the treatment of patients with mild or moderate conditions in order to provide relief. New non-pharmacological options include laser therapy in acupuncture, transcutaneous electric nerve stimulation (TENS), and sham therapy. Modern treatments like TENS, laser therapy, splints, and injections of methylprednisolone acetate have been demonstrated to be helpful in sporadic situations. For patients with mild and moderate problems, more research should be conducted that includes the combination of these surgical and non-surgical treatments. CONCLUSION We propose a multifunctional panel construct and define standard data items for future research into carpal tunnel syndrome. A discussion on idiopathic carpal tunnel syndrome, risk factors, combination of therapies, using guidelines-based recommendations and treatment should be initiated.
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Affiliation(s)
- Rishabh Chaudhary
- Department of Pharmacology, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana-133207, India
| | - Janvi Khanna
- Department of Pharmacology, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana-133207, India
| | - Seema Bansal
- Department of Pharmacology, M. M. College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana-133207, India
| | - Nitin Bansal
- Department of Pharmacy, Chaudhary Bansilal University, Bhiwani, India
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Ceylan İ, Büyükturan Ö, Aykanat Ö, Büyükturan B, Şaş S, Ceylan MF. The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study. J Hand Ther 2023; 36:773-785. [PMID: 37573157 DOI: 10.1016/j.jht.2023.02.004] [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: 06/05/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 08/14/2023]
Abstract
STUDY DESIGN Single-blinded, randomized controlled study. INTRODUCTION 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. PURPOSE OF THE STUDY 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. METHODS 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. RESULTS 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. DISCUSSION This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. CONCLUSIONS 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.
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Affiliation(s)
- İsmail Ceylan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey.
| | - Öznur Büyükturan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Ömer Aykanat
- Department of Neurosurgery, Kirsehir Ahi Evran University School of Medicine, Kirsehir, Turkey
| | - Buket Büyükturan
- School of Physical Therapy and Rehabilitation, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Senem Şaş
- Erciyes University, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Kayseri, Turkey
| | - Mehmet Fethi Ceylan
- Department of Orthopaedics and Traumatology, İnönü University School of Medicine, Malatya, Turkey
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10
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Zaheer SA, Ahmed Z. Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4888. [PMID: 37568290 PMCID: PMC10419623 DOI: 10.3390/jcm12154888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a condition that affects the main nerves in the wrist area that causes numbness, tingling, and weakness in the hand and arm. CTS affects 5% of the general population and results in pain in the wrist due to repetitive use, most commonly affecting women and office workers. Conservative management of CTS includes neurodynamic modulation to promote median nerve gliding during upper limb movements to maintain normal function. However, evidence for the benefits of neurodynamic modulation found disparities, and hence, the effectiveness of neurodynamic modulation remains unclear. This study aimed to systematically review the current evidence from randomized controlled trials (RCTs) to establish the effectiveness of neurodynamic techniques as a non-surgical treatment option for CTS. Using the PRISMA guidelines, two authors searched four electronic databases, and studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included outcomes from the Boston carpal tunnel syndrome questionnaire, while secondary outcomes included nerve conduction velocity, pain, and grip strength. Quality assessment was completed using the Cochrane RoB2 form, and a meta-analysis was performed to assess heterogeneity. Twelve RCTs met our inclusion/exclusion criteria with assessments on 1003 participants in the treatment and control arms. High heterogeneity and some risks of bias were observed between studies, but the results of the meta-analysis showed a significant reduction in our primary outcome, the Boston carpal tunnel syndrome questionnaire-symptom severity scale (mean difference = -1.20, 95% CI [-1.72, -0.67], p < 0.00001) and the Boston carpal tunnel syndrome questionnaire-functional severity scale (mean difference = -1.06, 95% CI [-1.53, -0.60], p < 0.00001). Secondary outcomes such as sensory and motor conduction velocity increased significantly, while motor latency was significantly reduced, all positively favoring neurodynamic techniques. Pain was also significantly reduced, but grip strength was not significantly different. Our systematic review demonstrates significant benefits of neurodynamic modulation techniques to treat CTS and specifically that it reduces symptom severity, pain, and motor latency, while at the same time improving nerve conduction velocities. Hence, our study demonstrates a clear benefit of neurodynamic techniques to improve recovery CTS.
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Affiliation(s)
- Sheikh Azka Zaheer
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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11
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Blough CL, Kuschner SH, Berihun H, Tseng CC, Kulber DA. Carpal Tunnel Syndrome: As Seen from the Perspective of the Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5146. [PMID: 37483890 PMCID: PMC10358804 DOI: 10.1097/gox.0000000000005146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome in the upper extremity and is one of the most common problems treated by hand surgeons. Despite its ubiquity-or perhaps because of it-there is a lack of unanimity regarding how best to treat CTS and what the options for treatment are. This study aimed to explore what patients find important when deciding on treatment of CTS in an effort to improve the physician-patient shared decision-making process. Methods An online crowdsourcing platform was used to recruit participants for this study. Study participants were first led through a clinical scenario in which the symptoms of CTS were explained. They were then asked a series of questions regarding what was important to them when deciding upon treatment. A Likert scale was used for responses. Results In total, 268 participant responses were included in the study. A majority of patients responded that all surveyed factors were either very important or important when considering treatment. The risk of surgery was most important, whereas postoperative pain was least important. The risk of surgery was significantly more important to patients than postoperative pain and time out of work. The cost of surgery was significantly more important to patients than postoperative pain. Conclusions Given the lack of consensus regarding an algorithm for the treatment of CTS, the patient's preference is increasingly important when formulating a treatment plan. The results of this study may better help physicians frame the discussion of treatment options for CTS with their patients.
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Affiliation(s)
- Christian L. Blough
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Stuart H. Kuschner
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Haben Berihun
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Cassie C. Tseng
- The Department of Outpatient Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - David A. Kulber
- From the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
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12
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Omole AE, Awosika A, Khan A, Adabanya U, Anand N, Patel T, Edmondson CK, Fakoya AO, Millis RM. An Integrated Review of Carpal Tunnel Syndrome: New Insights to an Old Problem. Cureus 2023; 15:e40145. [PMID: 37304388 PMCID: PMC10250024 DOI: 10.7759/cureus.40145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/13/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy characterized by pain, numbness, and impaired function of the hand due to compression of the median nerve at the level of the wrist. Although CTS can develop from repetitive strain, injury, or medical conditions, there are also congenital and genetic risk factors that can predispose individuals to the condition. With respect to anatomical factors, some individuals are born with a smaller carpal tunnel, which increases their susceptibility to median nerve compression. Variations in specific genes, such as those encoding proteins involved in extracellular matrix remodeling, inflammation, and nerve function, have also been linked to an increased risk for CTS. CTS is associated with a high cost of health care maintenance and loss of work productivity. Therefore, it is vital that primary care physicians fully understand the anatomy, epidemiology, pathophysiology, etiology, and risk factors of CTS, so they can be proactive in prevention, diagnosing, and guiding proper treatment. This integrated review also provides insights into how biological, genetic, environmental, and occupational factors interact with structural elements to determine who is most likely to acquire and suffer from CTS. Keeping health practitioners abreast of all the factors that could impact CTS should go a long way in decreasing the health care and socioeconomic burden of CTS.
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Affiliation(s)
- Adekunle E Omole
- Anatomical Sciences, American University of Antigua, Saint John, ATG
| | - Ayoola Awosika
- College of Medicine, University of Illinois, Chicago, USA
| | - Anosh Khan
- Emergency Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | | | - Nikhilesh Anand
- Pharmacology, American University of Antigua, Saint John, ATG
| | - Tirath Patel
- Surgery, American University of Antigua, Saint John, ATG
| | | | - Adegbenro O Fakoya
- Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Richard M Millis
- Pathophysiology, American University of Antigua, Saint John, ATG
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13
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Dong Q, Li X, Yuan P, Chen G, Li J, Deng J, Wu F, Yang Y, Fu H, Jin R. Acupuncture for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Front Neurosci 2023; 17:1097455. [PMID: 36908786 PMCID: PMC9995832 DOI: 10.3389/fnins.2023.1097455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/12/2023] [Indexed: 02/25/2023] Open
Abstract
Background The evidence for the effectiveness of acupuncture for patients with carpal tunnel syndrome (CTS) is insufficient. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of acupuncture on CTS through a comprehensive literature search. Methods English and Chinese databases were searched from their inceptions until 27 October 2022 to collect randomized controlled trials (RCTs) that investigated the effect of acupuncture on CTS. Two reviewers independently selected studies that met the eligibility criteria, extracted the required data, assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB 2), and evaluated the quality of reporting for acupuncture interventions using the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcomes were symptom severity and functional status, while secondary outcomes included pain intensity, responder rate, and electrophysiological parameters. Review Manager software (version 5.4.1) was used for data analysis. The certainty of the evidence was rated with GRADEpro (version 3.6) software. Results We included 16 RCTs with a total of 1,025 subjects. The overall risk of bias was rated as low in one RCT, some concerns in 14, and high in one. Compared with night splints, acupuncture alone was more effective in relieving pain, but there were no differences in symptom severity and functional status. Acupuncture alone had no advantage over medicine in improving symptom severity and electrophysiological parameters. As an adjunctive treatment, acupuncture might benefit CTS in terms of symptom severity, functional status, pain intensity, and electrophysiological parameters, and it was superior to medicine in improving the above outcomes. Few acupuncture-related adverse events were reported. The above evidence had a low or very low degree of certainty. Conclusion Acupuncture as an adjunctive treatment may be effective for patients with CTS. Additionally, more rigorous studies with objective outcomes are needed to investigate the effect of acupuncture in contrast with sham acupuncture or other active treatments. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=329925, identifier CRD42022329925.
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Affiliation(s)
- Qinjian Dong
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Xiaoyan Li
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Ping Yuan
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Guo Chen
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Jianfeng Li
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Jun Deng
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Fan Wu
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Yongqiu Yang
- Yilong County Hospital of Traditional Chinese Medicine, Nanchong, Sichuan, China
| | - Hui Fu
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Integrated Traditional Chinese and Western Medicine Hospital of Panzhihua City, Panzhihua, China
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14
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Garcia JO, Scott D, Parikh P, Curley KL, Turkmani A. Understanding carpal tunnel syndrome. JAAPA 2022; 35:19-26. [PMID: 36346923 DOI: 10.1097/01.jaa.0000892708.87945.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT Carpal tunnel syndrome (CTS) is an entrapment neuropathy affecting the median nerve. Prevalence is estimated at 4% to 5% of the population. A solid understanding of the anatomy, presentation, and diagnostics is key to efficient diagnosis and appropriate referral. Both surgical and nonsurgical interventions have led to improved clinical outcomes. Clinicians who have an in-depth knowledge of CTS symptoms and treatment options can prepare patients and streamline referrals for improved patient outcomes.
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Affiliation(s)
- Jose Omar Garcia
- At the Mayo Clinic Arizona, Jose Omar Garcia, Derek Scott , and Parth Parikh are students in the School of Medicine; Kara L. Curley practices in neurosurgery, is an assistant professor of neurologic surgery, and is program director of the neurosurgery PA fellowship; and Ali Turkmani is an assistant professor. The authors have disclosed no potential conflicts of interest, financial or otherwise
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15
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Ghasemi A, Olyaei GR, Bagheri H, Hadian MR, Jalaei S, Otadi K, Sarafraz H. Effectiveness of ultrasound and median nerve gliding with and without shock-wave therapy in patients with moderate carpal tunnel syndrome. J Phys Ther Sci 2022; 34:772-776. [PMID: 36507081 PMCID: PMC9711970 DOI: 10.1589/jpts.34.772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The aim of this research was to see how ultrasound and nerve gliding with and without shock wave therapy effects on clinical and sonographic data of patients with carpal tunnel syndrome (CTS). [Participants and Methods] Forty four patients with moderate carpal tunnel syndrome participated in this research. One group got shock-wave therapy in addition to median nerve glide exercises and ultrasound, whereas the other group received median nerve glide exercises and ultrasound alone. Hand grip strength (HGS), pinch grip strength (PGS), Visual Analogue Scale (VAS)-pain, Boston Questionnaire (BQ), and Cross-sectional area (CSA) of median nerve were examined before and after 10 sessions of treatment. [Results] HGS, PGS, VAS, BQ and CSA of median nerve improved considerably after therapy. [Conclusion] Patients with moderate CTS who received ultrasound and median nerve glide exercises with and without shock-wave therapy improved considerably without preference of adding shock-wave therapy to other treatment.
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Affiliation(s)
- Amirhossein Ghasemi
- Department of Physiotherapy, Faculty of Rehabilitation,
Tehran University of Medical Sciences: Felestin St., Keshavarz Blvd., Tehran 1416634793,
Iran
| | - Gholam Reza Olyaei
- Department of Physiotherapy, Faculty of Rehabilitation,
Tehran University of Medical Sciences: Felestin St., Keshavarz Blvd., Tehran 1416634793,
Iran
| | - Hossein Bagheri
- Department of Physiotherapy, Faculty of Rehabilitation,
Tehran University of Medical Sciences: Felestin St., Keshavarz Blvd., Tehran 1416634793,
Iran
| | - Mohammad Reza Hadian
- Department of Physiotherapy, Faculty of Rehabilitation,
Tehran University of Medical Sciences: Felestin St., Keshavarz Blvd., Tehran 1416634793,
Iran
| | - Shohre Jalaei
- Department of Physiotherapy, Faculty of Rehabilitation,
Tehran University of Medical Sciences: Felestin St., Keshavarz Blvd., Tehran 1416634793,
Iran
| | - Khadijeh Otadi
- Department of Physiotherapy, Faculty of Rehabilitation,
Tehran University of Medical Sciences: Felestin St., Keshavarz Blvd., Tehran 1416634793,
Iran,Corresponding author. Khadijeh Otadi (E-mail: )
| | - Hadi Sarafraz
- Department of Occupational Medicine, School of Medicine,
Hormozgan University of Medical Sciences, Iran
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16
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Beddaa H, Kably B, Marzouk B, Mouhi I, Marfak A, Azemmour Y, Bouzekraoui Alaoui I, Birouk N. The effectiveness of the median nerve neurodynamic mobilisation techniques in women with mild or moderate bilateral carpal tunnel syndrome: A single-blind clinical randomised trial. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1823. [PMID: 36483131 PMCID: PMC9724073 DOI: 10.4102/sajp.v78i1.1823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/12/2022] [Indexed: 09/02/2023] Open
Abstract
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.
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Affiliation(s)
- Hassan Beddaa
- Clinical Research Biostatistics and Epidemiology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Bouchra Kably
- Department of Clinical Neurophysiology, Specialty Hospital, Ibn Sina University Hospital Center, Mohammed V University, Rabat, Morocco
| | - Basma Marzouk
- Department of Clinical Neurophysiology, Specialty Hospital, Ibn Sina University Hospital Center, Mohammed V University, Rabat, Morocco
| | - Ikrame Mouhi
- Department of Clinical Neurophysiology, Specialty Hospital, Ibn Sina University Hospital Center, Mohammed V University, Rabat, Morocco
| | | | - Youness Azemmour
- Clinical Research Biostatistics and Epidemiology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | | | - Nazha Birouk
- Department of Clinical Neurophysiology, Specialty Hospital, Ibn Sina University Hospital Center, Mohammed V University, Rabat, Morocco
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Choi JH, Kim HR, Song KH. Musculoskeletal complications in patients with diabetes mellitus. Korean J Intern Med 2022; 37:1099-1110. [PMID: 36300322 PMCID: PMC9666255 DOI: 10.3904/kjim.2022.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
Musculoskeletal conditions are common in patients with diabetes. Several musculoskeletal disorders are viewed as chronic complications of diabetes because epidemiological studies have revealed high correlations between such complications and diabetes, but the pathophysiological links with diabetes remains unclear. Genetic predispositions, shared risk factors, microvascular impairments, progressive accumulation of advanced glycation end-products, and diabetic neuropathy may underlie the development of musculoskeletal disorders. Musculoskeletal complications of diabetics have received less attention than life-threatening microvascular or macrovascular complications. Here, we review several diabetic musculoskeletal complications with a focus on the clinical importance of early recognition and management, which would improve quality of life and physical function.
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Affiliation(s)
- Jong Han Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul,
Korea
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18
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Park J, Kim IJ, Park HY, Heo DJ, Kim JM. A clinical study of thread carpal tunnel release with a newly developed thread: A retrospective pilot study. PLoS One 2022; 17:e0276630. [PMID: 36269730 PMCID: PMC9586357 DOI: 10.1371/journal.pone.0276630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Previous studies have shown that, thread carpal tunnel release (TCTR), an ultrasound-guided transverse carpal ligament (TCL) transection procedure through needle and thread, to be a safe and effective technique for carpal tunnel release, compared to an open and endoscopic technique. We developed a newly improved thread (Smartwire-01, 0.27mm in diameter, Korea). This pilot study was performed to propose the effectiveness of TCTR with Smartwire-01 compared to the commercial thread in clinical settings. METHODS A total of 22 TCTR procedures have been performed on 19 patients by one physiatrist during a 42-month period. The diagnosis of carpal tunnel syndrome was based on standard clinical criteria including electromyography (EMG). Patients were divided into two groups, one dissected with commercial thread and the other with Smartwire-01. The technique was standardized by keeping the entry point at the middle of the palm and the exit point at just medial to the palmaris longus tendon. The Numeric Rating Scale and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were used to assess monthly outcomes for 6 months following the procedure. The Wilcoxon signed rank test and the Mann-Whitney-U test were performed to analyze the above variables in the two groups. RESULTS There was no definite evidence that the two groups have significant differences for any of the surveyed variables. The TCTR procedure with our newly developed thread also had significant improvements for all variables, showing its effectiveness in both pain and functional ability. The NRS and BCTQ severity and functional scales showed significant decreases just after the dissection and progressive improvement during each monthly follow-up of our study until the last assessment at 6 months. CONCLUSION The study suggests that, our newly developed thread is as safe and effective as the commercial thread in TCTR, we therefore recommend a randomize controlled trial with above methodology.
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Affiliation(s)
- Jisoo Park
- Department of Rehabilitation Medicine, Incheon St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jong Kim
- Department of Rehabilitation Medicine, Howareyou Rehabilitation Clinic, Seoul, Republic of Korea
| | - Hae-yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong jin Heo
- Department of Rehabilitation Medicine, Incheon St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Min Kim
- Department of Rehabilitation Medicine, Incheon St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison. Diagnostics (Basel) 2022; 12:diagnostics12102433. [PMID: 36292122 PMCID: PMC9600501 DOI: 10.3390/diagnostics12102433] [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: 08/19/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
The diagnostic process that allows pronator syndrome to be differentiated reliably from carpal tunnel syndrome remains a challenge for clinicians, as evidenced by the most common cause of pronator syndrome misdiagnosis: carpal tunnel syndrome. Pronator syndrome can be caused by compression of the median nerve as it passes through the anatomical structures of the forearm, while carpal tunnel syndrome refers to one particular topographic area within which compression occurs, the carpal tunnel. The present narrative review is a complex clinical comparison of the two syndromes with their anatomical backgrounds involving topographical relationships, morphology, clinical picture, differential diagnosis, and therapeutic options. It discusses the most frequently used diagnostic techniques and their correct interpretations. Its main goal is to provide an up-to-date picture of the current understanding of the disease processes and their etiologies, to establish an appropriate diagnosis, and introduce relevant treatment benefiting the patient.
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20
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Raut P, Jones N, Raad M, Kieffer W. Common peripheral nerve entrapments in the upper limb. Br J Hosp Med (Lond) 2022; 83:1-11. [PMID: 36322444 DOI: 10.12968/hmed.2022.0111] [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] [Indexed: 06/16/2023]
Abstract
Entrapment of peripheral nerves can occur as they travel through restrictive spaces. This nerve compression can result in a constellation of signs and symptoms, which are often called syndromes. Patients initially report pain, paraesthesia and numbness, followed by weakness and clumsiness and, ultimately, muscle wasting. The specific region of paraesthesia and pain and the specific muscle weakness is determined by the peripheral nerve involved and the location of the entrapment. Diagnosis is mainly based on history and examination. Further investigations are available for atypical presentations. Each syndrome has its own set of risk factors, but repetitive action and muscle overuse are commonly associated with most syndromes. The treatment is activity modification followed by steroid injection and finally surgical decompression for ongoing persistent symptoms or severe initial presentation. This article outlines the history, examination, possible investigations and management for common peripheral nerve entrapments of the median, ulnar and radial nerves.
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Affiliation(s)
- Pramin Raut
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
| | - Neil Jones
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
| | - Marjan Raad
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
| | - Will Kieffer
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Redhill, UK
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Krigers A, Kriwan F, Freyschlag CF, Thomé C, Fritsch H. The distance between the distal margin of the flexor retinaculum and the radiocarpal joint as a landmark in CTS surgery: a cadaver study. Ann Anat 2022; 245:152003. [PMID: 36183941 DOI: 10.1016/j.aanat.2022.152003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The most frequent peripheral entrapment neuropathy is compression of the median nerve in the carpal tunnel, known as carpal tunnel syndrome. The most effective treatment is surgery, where the flexor retinaculum (FR1) is divided. Nevertheless, after this operation, a significant number of patients suffer from persistent symptoms due to incomplete FR distal release. It may be difficult to identify the distal boundary of the FR due to the minimal skin incision. We aimed to identify an anatomical landmark to avoid incomplete distal FR release. The radiocarpal (RC2) joint can be palpated, and lies in close proximity to the boundaries of the FR. Thus, the distance between the RC joint space and the distal FR margin - the RC-FR distance - could be a reliable and individual morphologic measurement from easily acquired regional anthropological measurements. METHODS During this study, 39 radiocarpal regions of 23 embalmed cadavers were dissected, and measurements were taken. Linear regression corresponding to the ulnar length and the RC-FR distance was established. RESULTS The mean RC-FR distance from the RC joint space to the distal FR margin was 3.8cm (95% CI 3.5-4.0), and the range was 2.3 to 5.1cm. This distance was 1.1cm (95% CI 0.8-1.4) longer in males than in females (p < 0.00001), and there were no side-specific differences. The individual projection of the distal FR margin in centimeters can be calculated by measurement of the ipsilateral ulnar length divided by 4 and reduced by 2.9, p < 0.005. CONCLUSIONS The side-equal and sex-specific position of the distal flexor retinaculum margin could be calculated from the palpable radiocarpal joint space based on the ipsilateral ulnar length.
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Affiliation(s)
- Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria; Division of Clinical & Functional Anatomy, Medical University of Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria.
| | - Fabian Kriwan
- Division of Clinical & Functional Anatomy, Medical University of Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Helga Fritsch
- Division of Clinical & Functional Anatomy, Medical University of Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria
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Roghani RS, Kara S, Taheri MJ, Gohari F, Sadrneshin S, Thant HL, Diaz JJ, Lokk J. Intra-flexor retinaculum steroid injection in elderly patients with carpal tunnel syndrome: A randomized clinical trial. INTERVENTIONAL PAIN MEDICINE 2022; 1:100106. [PMID: 39238523 PMCID: PMC11372893 DOI: 10.1016/j.inpm.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 09/07/2024]
Abstract
Introduction The efficacy of ultrasonography-guided intra-flexor retinaculum corticosteroid injection is compared to within-carpal tunnel steroid injection, for the treatment of elderly patients with carpal tunnel syndrome (CTS). Material & methods In this prospective, double-blind, randomized trial, the elderly patients with CTS are allocated 1:1 into the two treatment groups. Subjects and assessors remained blinded to group allocation throughout the trial. All patients received 40 mg triamcinolone (1 mL) plus 1 mL of 2% lidocaine, either fenestrated in the flexor retinaculum (group 1) or injected within the carpal tunnel between the flexor retinaculum and median nerve (group 2). Patients were instructed to use a wrist splint for two weeks post-treatment. Symptom severity, grip, electrodiagnostic indices, and ultrasonographic features were measured at baseline and 6-weeks thereafter. The primary outcomes were median nerve distal motor and sensory latencies, and those secondary outcomes were Boston Carpal Tunnel Questionnaire (BCTQ) scores, visual analog scale (VAS) pain scores, and the median nerve inlet cross-sectional area (CSA). Results Of 92 individuals screened, 50 eligible participants were randomized, all of whom completed the study and were included in the analysis. Patients receiving the intra-flexor retinaculum injection demonstrated significantly greater improvements in their total BCTQ score (p = 0.023), VAS score (p = 0.026), and inlet CSA (p = 0.004), while the electrodiagnostic indices and the grip scale did not differ between groups. Conclusion The intra-flexor retinaculum corticosteroid injection can provide better functional recovery and symptom reduction for elderly patients with CTS, compared to the within-carpal tunnel corticosteroid injection.
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Affiliation(s)
- Reza S Roghani
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Physical Medicine and Rehabilitation, Larkin University & Health System, Miami, FL, USA
| | - Sam Kara
- Department of Neurology, Larkin University & Health System, Miami, FL, USA
| | - Mohammad J Taheri
- Department of PM&R, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeze Gohari
- Department of PM&R, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sadrneshin
- Department of PM&R, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hein Linn Thant
- Department of Physical Medicine and Rehabilitation, Larkin University & Health System, Miami, FL, USA
| | - Jose J Diaz
- Department of Physical Medicine and Rehabilitation, Larkin University & Health System, Miami, FL, USA
| | - Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Snow EL, White AC, Tyce AM, McCumber TL. Coexistence of five extrinsic accessory flexor muscles collectively able to flex all five digits of the hand. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Salman LA, Omari RY, Moghamis IS, Hantouly AT, Ahmed G. Appropriateness of carpal tunnel syndrome management compared with the AAOS appropriate use criteria: A retrospective review across various specialties. Ann Med Surg (Lond) 2022; 80:104140. [PMID: 36045855 PMCID: PMC9422078 DOI: 10.1016/j.amsu.2022.104140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Loay A. Salman
- Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- Corresponding author. Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Rand Y. Omari
- Plastic and Reconstructive Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Isam S. Moghamis
- Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ashraf T. Hantouly
- Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Patil AD, Kasabe PJ, Dandge PB. Pharmaceutical and nutraceutical potential of natural bioactive pigment: astaxanthin. NATURAL PRODUCTS AND BIOPROSPECTING 2022; 12:25. [PMID: 35794254 PMCID: PMC9259778 DOI: 10.1007/s13659-022-00347-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/09/2022] [Indexed: 05/31/2023]
Abstract
Astaxanthin (3,3'-dihydroxy-β,β-carotene-4,4'-dione) is an orange-red, lipophilic keto-carotenoid pigment. It is majorly found in marine ecosystems particularly in aquatic animals such as salmon, shrimp, trout, krill, crayfish, and so on. It is also synthesized in microalgae Heamatococcus pluvialis, Chlorococcum, Chlorella zofingiensis, red yeast Phaffia rhodozyma and bacterium Paracoccus carotinifaciens. Some aquatic and terrestrial creatures regarded as a primary and secondary sources of the astaxanthin producing and accumulating it through their metabolic pathways. Astaxanthin is the powerful antioxidant, nutritional supplement as well as promising therapeutic compound, observed to have activities against different ravaging diseases and disorders. Researchers have reported remarkable bioactivities of astaxanthin against major non-communicable chronic diseases such as cardiovascular diseases, cancer, diabetes, neurodegenerative, and immune disorders. The current review discusses some structural aspects of astaxanthin. It further elaborates its multiple potencies such as antioxidant, anti-inflammatory, anti-proliferative, anti-cancer, anti-obese, anti-diabetic, anti-ageing, anti-TB, anti-viral, anti-COVID 19, neuro-protective, nephro-protective, and fertility-enhancing properties. These potencies make it a more precious entity in the preventions as well as treatments of prevalent systematic diseases and/or disorders. Also, the review is acknowledging and documenting its powerful bioactivities in relation with the pharmaceutical as well as nutraceutical applicability.
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Affiliation(s)
- Apurva D. Patil
- Department of Biochemistry, Shivaji University, Kolhapur, 416004 Maharashtra India
| | - Pramod J. Kasabe
- School of Nanoscience and Biotechnology, Shivaji University, Kolhapur, Maharashtra India
| | - Padma B. Dandge
- Department of Biochemistry, Shivaji University, Kolhapur, 416004 Maharashtra India
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Nikbakht S, Vafaei MA, Ashraf A, Nasiri A, Nikpay-Hosseinabad N. Assessment of L-carnitine effectiveness on carpal tunnel syndrome. CURRENT JOURNAL OF NEUROLOGY 2022; 21:162-169. [PMID: 38011355 PMCID: PMC10082954 DOI: 10.18502/cjn.v21i3.11109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2023]
Abstract
Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy. Due to the results of recent studies about the protective effects of L-carnitine on nerves, this study was conducted to evaluate the effects L-carnitine on CTS improvement in terms of patient's function, electrodiagnostic study (EDX), and median nerve sonography. Methods: In this double-blind, randomized, controlled trial, patients with CTS were selected based on the inclusion and exclusion criteria, and then, divided into two groups of placebo and L-carnitine at a dose of 500 mg twice daily for 6 weeks. They were assessed at baseline, and 4 and 6 weeks later using Boston Carpal Tunnel Questionnaire (BCTQ), median nerve conduction study (EDX), and sonography. Results: There was no statistically significant difference between the intervention and control groups in terms of BCTQ scores, electrodiagnostic findings, and sonographic indexes. Although based on the results of the repeated measures test of the intervention and control groups separately, there was a statistically significant difference in some electrodiagnostic criteria and BCTQ scores. These indexes improved after the intervention. Conclusion: The effectiveness of L-carnitine on mild to moderate CTS improvement cannot be approve based on the findings of this study and more studies and systematic reviews are required in this regard.
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Affiliation(s)
- Saeid Nikbakht
- Department of Orthopedics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Amin Vafaei
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Ashraf
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Geriatrics Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aref Nasiri
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Nikpay-Hosseinabad
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
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Symanski JS, Ross AB, Davis KW, Brunner MC, Lee KS. US for Traumatic Nerve Injury, Entrapment Neuropathy, and Imaging-guided Perineural Injection. Radiographics 2022; 42:1546-1561. [PMID: 35776677 DOI: 10.1148/rg.210152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
US is commonly performed to help diagnose traumatic peripheral nerve injury and entrapment neuropathy, particularly with superficial nerves, where higher spatial resolution provides an advantage over MRI. Other advantages of US include dynamic evaluation, easy contralateral comparison, fewer implant contraindications, less artifact from ferromagnetic debris, and facile needle guidance for perineural injections. The authors review peripheral nerve US for traumatic peripheral nerve injury with an emphasis on injury grading and entrapment neuropathy and describe best-practice techniques for US-guided perineural injections while highlighting specific techniques and indications. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- John S Symanski
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Andrew B Ross
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Kirkland W Davis
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Michael C Brunner
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Kenneth S Lee
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
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Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome. Pain Res Manag 2022; 2022:1975803. [PMID: 35719196 PMCID: PMC9200595 DOI: 10.1155/2022/1975803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/06/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Background Carpal tunnel syndrome (CTS) is the symptomatic compression neuropathy of the median nerve at the wrist level that may become a reason for upper limb disability, in the women and men population. Objective This study aimed to compare the efficacy of the neurodynamic technique (NT) and carpal bone mobilization technique (CBMT) incorporated with tendon gliding exercises (TGE) as an effect-enhancing adjunct while managing the participants with chronic CTS. Methods The study followed a two-arm parallel-group randomized comparative design. Thirty participants (aged 30–59 years) with chronic CTS were recruited randomly to both the NT and CBMT groups. In addition to the TGE (a common adjunct), NT and CBMT were performed in the NT and CBMT groups, respectively, for three weeks. The primary outcome measures including pain intensity, functional status, grip strength, and motor nerve conduction study were assessed using a visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand-held dynamometer, and electromyograph, respectively, at baseline, 3 weeks postintervention, and follow-up at one week post end of the intervention. Paired and unpaired t-test were used to calculate the differences in intervention effects within and between the groups with keeping the level of significance α at 0.05. Results The data analysis revealed a significant (95% CI, p < 0.05) difference for all outcomes within each group compared across different time intervals. Similarly, a significant difference was found for all outcomes except pain and grip strength compared between groups at 3 weeks postintervention and follow-up at one week post end of the intervention. Conclusions The NT revealed more effectiveness than the CBMT when incorporated with TGE to improve nerve conduction velocity and functional status of the hand. However, both NT and CBMT were equally effective in improving pain and grip strength while managing the participants with chronic CTS. In addition, the TGE contributed as a beneficial, effect-enhancing adjunct to the NT and CBMT differently. Significance. The study will guide the physiotherapist in applying either of the combination techniques suitable for achieving treatment objectives while managing the participants with chronic CTS.
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Local Corticosteroid Injections versus Surgical Carpal Tunnel Release for Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:life12040533. [PMID: 35455023 PMCID: PMC9026554 DOI: 10.3390/life12040533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. This meta-analysis compared local steroid injections (LSIs) versus carpal tunnel release (CTR) for the management of CTS. Neurophysiological parameters, patient-reported outcome measures (PROMs), and the complication rate were investigated. We hypothesized that LSIs may represent an effective and safe alternative to surgical management. Methods: This systematic review was conducted according to the 2020 PRISMA statement. All the clinical investigations comparing LSIs versus CTR for carpal tunnel syndrome were accessed. In March 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, and Embase. No time constrains were used for the search. The risk of bias and statistical analyses were conducted using the Review Manager Software 5.3 (The Nordic Cochrane Collaboration, Copenhagen). Results: Data from 1096 procedures were retrieved. The mean follow-up was 12.3 (1 to 58) months. The mean age of the patients was 51.1 ± 4.6. Nocturnal paraesthesia (p < 0.0001) and visual analogue scale (p < 0.0001) were greater in the LSIs cohort. No difference was found in the functional (p = 0.2) and symptom (p = 0.4) subscales of the Boston Carpal Tunnel Questionnaire (BCTQ), median nerve distal motor latency (p = 0.9), median nerve motor amplitude (p = 0.7), median nerve sensory conduction velocity (p = 0.4), or median nerve sensory amplitude (p = 0.3). No difference was found in terms of minor complications (p = 0.9). No major complications were observed within the duration of follow-up. Conclusion: Both CTR and LSIs were effective and feasible in reducing symptoms of carpal tunnel syndrome. Though LSIs led to greater pain relief, this superiority was not permanent. Irrespective of the severity of the symptoms, current evidence suggests that a cycle of LSIs may be considered in patients with CTS. However, patients must be aware that LSIs may not be the definitive therapy, and CTR should be recommended.
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Abstract
BACKGROUND North American surgeons continue to routinely order narcotic medication for postoperative pain relief after carpal tunnel surgery. For some patients, this instigates persistent use. This double-blind, multicenter trial investigated whether over-the-counter medications were inferior to opioid pain control after carpal tunnel release. METHODS Patients undergoing carpal tunnel release in five centers in Canada and the United States (n = 347) were randomly assigned to postoperative pain control with (opioid) hydrocodone/acetaminophen 5/325 mg versus over-the-counter ibuprofen/acetaminophen 600/325 mg. The two primary outcome measures were the Numeric Pain Rating Scale (0 to 10) and the six-item Patient-Reported Outcome Measurement Information System Pain Interference T-score. Secondary outcome measures were total medication used and overall satisfaction with pain medication management. RESULTS The authors found no significant differences between opioid and over-the-counter patients in the Numeric Pain Rating Scale scores, Pain Interference T-scores, number of doses of medication, or patient satisfaction. The highest Numeric Pain Rating Scale group difference was the night of surgery, when opiate patients had 0.9/10 more pain than over-the-counter patients. The highest group difference in Pain Interference T-scores (2.1) was on the day of surgery, when the opiate patients had more pain interference than the over-the-counter group. Patient nationality or sex did not generate significant pain score differences. CONCLUSIONS Pain management is not inferior for patients managed with over-the-counter acetaminophen/ibuprofen versus opioids. This study provides high-quality evidence that U.S. and Canadian surgeons should stop the routine prescription of narcotics after carpal tunnel surgery for patients who are not taking pain medicines daily before surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Cavalcante MC, Moraes VYD, Osés GL, Nakachima LR, Belloti JC. Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature. SAO PAULO MED J 2022; 141:e20211020. [PMID: 36541951 PMCID: PMC10065117 DOI: 10.1590/1516-3180.2021.1020.r2.10102022] [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: 12/28/2021] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common condition greatly affects patients' quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil. METHODS We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were "low" or "very low". PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman's correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328).
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Affiliation(s)
- Marcelo Cortês Cavalcante
- MD. Physician, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Vinicius Ynoe de Moraes
- MD, PhD. Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Guilherme Ladeira Osés
- MD. Physician, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Luis Renato Nakachima
- MD, PhD. Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - João Carlos Belloti
- MD, MSc, PhD. Adjunct Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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Hoogendam L, Bakx JAC, Souer JS, Slijper HP, Andrinopoulou ER, Selles RW. Predicting Clinically Relevant Patient-Reported Symptom Improvement After Carpal Tunnel Release: A Machine Learning Approach. Neurosurgery 2022; 90:106-113. [PMID: 34982877 DOI: 10.1227/neu.0000000000001749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Symptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering a carpal tunnel release (CTR). OBJECTIVE To predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR. METHODS We split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire-symptom severity scale were classified as "improved." Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397). RESULTS A gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81. CONCLUSION We developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR.
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Affiliation(s)
- Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands
| | - Jeanne A C Bakx
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands
| | | | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands
| | | | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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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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Kennedy DL, Vollert J, Ridout D, Alexander CM, Rice ASC. Responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study. Pain 2021; 162:2881-2893. [PMID: 33769367 DOI: 10.1097/j.pain.0000000000002277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism-associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy. With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated before and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change. Quantitative sensory testing results (n = 76) were compared with healthy controls (n = 54). At 6 months postsurgery, 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (P < 0.001). Change in QST parameters occurred for thermal detection, thermal pain, and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures was not statistically significant. Change occurred in sensory phenotype postsurgery (P < 0.001); sensory phenotype was associated with symptom subgroup (P = 0.03) and patient-rated surgical outcome (P = 0.02). Quantitative sensory testing-derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease-modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
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Affiliation(s)
- Donna L Kennedy
- Pain Research Group, Imperial College London, London, United Kingdom
| | - Jan Vollert
- Pain Research Group, Imperial College London, London, United Kingdom
- MSK Labs, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Deborah Ridout
- Population, Policy and Practice Programme, University College London Great Ormond St Institute of Child Health, London, United Kingdom
| | - Caroline M Alexander
- Therapies Department, Imperial College Healthcare NHS Trust, London, United Kingdom
- MSK Labs, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Andrew S C Rice
- Pain Research Group, Imperial College London, London, United Kingdom
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Kennedy DL, Ridout D, Lysakova L, Vollert J, Alexander CM, Rice ASC. The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery. BMC Musculoskelet Disord 2021; 22:962. [PMID: 34789204 PMCID: PMC8600705 DOI: 10.1186/s12891-021-04832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome. METHODS With ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; "worse" or "no change" and good outcome; "slightly better", "much better" or "completely cured". RESULTS Seventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability (p < 0.001). Symptom severity diminished (p < 0.001), as did pain-related worry (p < 0.001), anxiety (p = 0.02) and insomnia (p < 0.001). Patient-rated surgical outcome was good in 92% of the cohort, poor in 8%. Baseline sensory phenotype category was not associated with surgical outcome however pain-related worry, anxiety and functional interference were significantly associated with outcome (p ≤ 0.05). CONCLUSION In patients undergoing carpal tunnel surgery, pain-related worry, anxiety and pain functional interference are candidate prognostic outcome factors and require further elucidation.
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Affiliation(s)
- Donna L Kennedy
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Chelsea & Westminster Hospital Campus, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK. .,Therapies Department, Imperial College Healthcare NHS Trust, London, UK.
| | - Deborah Ridout
- Population, Policy and Practice Programme, University College London Great Ormond St Institute of Child Health, London, UK
| | - Ladislava Lysakova
- Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Chelsea & Westminster Hospital Campus, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK.,Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.,Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.,Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Caroline M Alexander
- Therapies Department, Imperial College Healthcare NHS Trust, London, UK.,MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Chelsea & Westminster Hospital Campus, Imperial College London, 369 Fulham Rd, London, SW10 9NH, UK
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Degrugillier L, Prautsch KM, Schaefer DJ, Guzman R, Kalbermatten DF, Schären S, Madduri S. Systematic investigation and comparison of US FDA-approved immunosuppressive drugs FK506, cyclosporine and rapamycin for neuromuscular regeneration following chronic nerve compression injury. Regen Med 2021; 16:989-1003. [PMID: 34633207 DOI: 10.2217/rme-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare therapeutic benefits of different immunophilin ligands for treating nerve injuries. Materials & methods: Cyclosporine, FK506 and rapamycin, were evaluated first in vitro on a serum-free culture of embryonic dorsal root ganglia followed by a new in vivo model of chronic nerve compression. Results: Outcomes of the in vitro study have shown a potent effect of cyclosporine and FK506, on dorsal root ganglia axonal outgrowth, comparable to the effect of nerve growth factor. Rapamycin exhibited only a moderate effect. The in vivo study revealed the beneficial effects of cyclosporine, FK506 and rapamycin for neuromuscular regeneration. Cyclosporine showed the better maintenance of the tissues and function. Conclusion: Cyclosporine, FK506 and rapamycin drugs showed potential for treating peripheral nerve chronic compression injuries.
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Affiliation(s)
- Lucas Degrugillier
- Department of Pathology, University Hospital Basel, Hebelstrasse 20, Basel, 4021, Switzerland.,Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Katharina M Prautsch
- Department of Pathology, University Hospital Basel, Hebelstrasse 20, Basel, 4021, Switzerland.,Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, Basel, 4021, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, University of Basel, Spitalstrasse 21, Basel, 4021, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, Basel, 4021, Switzerland.,Bioengineering & Neuroregeneration, Department of Surgery, Geneva University Hospitals & University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland.,Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Geneva University Hospitals and University of Geneva, 1211 Geneva, 14, Switzerland
| | - Stefan Schären
- Department of Spinal Surgery, University Hospital Basel, 4021, Basel, Switzerland
| | - Srinivas Madduri
- Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, Allschwil, 4123, Switzerland.,Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Spitalstrasse 21, Basel, 4021, Switzerland.,Bioengineering & Neuroregeneration, Department of Surgery, Geneva University Hospitals & University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland.,Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, Geneva University Hospitals and University of Geneva, 1211 Geneva, 14, Switzerland
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Degrugillier L, Prautsch KM, Schaefer DJ, Guzman R, Schären S, Kalbermatten DF, Madduri S. A new model of chronic peripheral nerve compression for basic research and pharmaceutical drug testing. Regen Med 2021; 16:931-947. [PMID: 34553612 DOI: 10.2217/rme-2020-0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To develop a consistent model to standardize research in the field of chronic peripheral nerve neuropathy. Methods: The left sciatic nerve of 8-week-old Sprague-Dawley rats was compressed using a customized instrument leaving a defined post injury nerve lumen (400 μm, 250 μm, 100 μm, 0 μm) for 6 weeks. Sensory and motor outcomes were measured weekly, and histomorphology and electrophysiology after 6 weeks. Results: The findings demonstrated compression depth-dependent sensory and motor pathologies. Quantitative measurements revealed a significant myelin degeneration, axon irregularities and muscle atrophy. At the functional level, we highlighted the dynamics of the different injury profiles. Conclusion: Our novel model of chronic peripheral nerve compression is a useful tool for research on pathophysiology and new therapeutic approaches.
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Affiliation(s)
- Lucas Degrugillier
- Department of Pathology, University Hospital Basel, Basel, 4021, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.,Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Basel, 4021, Switzerland
| | - Katharina M Prautsch
- Department of Pathology, University Hospital Basel, Basel, 4021, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.,Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Basel, 4021, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Basel, 4021, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, 4021, Switzerland
| | - Stefan Schären
- Department of Spinal Surgery, University Hospital Basel, Basel, 4021, Switzerland
| | - Daniel F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Basel, 4021, Switzerland.,Bioengineering & Neuroregeneration, Department of Surgery, Geneva University Hospitals & University of Geneva, 1211, Geneva, Switzerland.,Plastic, Reconstructive & Aesthetic Srugery, Department of Surgery, Geneva University Hospitals & University of Geneva, 1211, Geneva, Switzerland
| | - Srinivas Madduri
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.,Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, University of Basel, Basel, 4021, Switzerland.,Bioengineering & Neuroregeneration, Department of Surgery, Geneva University Hospitals & University of Geneva, 1211, Geneva, Switzerland.,Plastic, Reconstructive & Aesthetic Srugery, Department of Surgery, Geneva University Hospitals & University of Geneva, 1211, Geneva, Switzerland
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Fang Y, Baker NA, Dole J, Roll SC. Quality of Carpal Tunnel Syndrome Patient Education Handouts Available on the Internet: A Systematic Analysis of Content and Design. Arch Phys Med Rehabil 2021; 103:297-304. [PMID: 34547274 DOI: 10.1016/j.apmr.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the quality of carpal tunnel syndrome (CTS) patient education handouts and identify the best resources for patients and clinicians. DESIGN A document content analysis of handouts identified through a systematic internet search using 8 search terms on Google and Bing and a hand search of professional association websites. SETTING Not applicable. PARTICIPANTS Documents (N=56) were identified from the top 50 search results across 16 individual searches. Included documents provided general patient education for CTS; descriptive websites, videos, and research studies were excluded. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Content analysis was conducted using the Information Score (IS) tool to evaluate completeness of information (0%-100%) and misleading treatment recommendations were identified. Design analysis was conducted using the Patient Material Assessment Tool for Printable Materials (PEMAT-P) (0%-100%) and 2 widely used readability formulas, Flesch Reading Ease and Flesch Kincaid Grade Level. Using these results, all handouts were rated with a summative 12-point scale. RESULTS Of 805 unique search results, we included 56 CTS handouts. The average IS was 74.6%±17.9%, and 78.6% of the handouts mentioned non-evidence-based treatment recommendations. The average PEMAT-P score was 70.2%±10.9%, and the average readability grade level was 7.7±1.7. Only 3 handouts were identified as high quality based on the 12-point summative scores, 22 handouts had mixed quality, and 17 handouts had low quality on both content and design. CONCLUSIONS Findings of this study suggest a lack of high-quality and easily understandable CTS patient education handouts. Most handouts contained unreliable treatment information. Improvements are needed to ensure patients' ability to understand and manage this condition.
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Affiliation(s)
- Yiyang Fang
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA
| | - Nancy A Baker
- Tufts University, Schools of Arts & Sciences, Department of Occupational Therapy, Medford, MA
| | - Julianna Dole
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA
| | - Shawn C Roll
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Los Angeles, CA.
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Abstract
Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.
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The Influence of Transverse Carpal Ligament Thickness on Treatment Decisions for Idiopathic Mild to Moderate Carpal Tunnel Syndrome. Ann Plast Surg 2021; 85:127-134. [PMID: 32332386 DOI: 10.1097/sap.0000000000002386] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. In addition, the effect of TCL properties on the progression course of idiopathic CTS is unknown.Therefore, we hypothesized that TCL thickness, measured using ultrasonography, would influence the results of conservative treatment for CTS patients with mild to moderate symptoms. We aimed to investigate the relationship between the ultrasound-measured TCL thickness and idiopathic carpal tunnel conservative treatment surgery rate. MATERIALS AND METHODS We analyzed the wrists of 127 patients with mild to moderate symptoms of CTS. The patients were diagnosed on the basis of electrophysiological assessment outcomes, median nerve cross-sectional area in the carpal tunnel, and clinical symptoms. The Boston carpal tunnel questionnaire score was also measured. Patients with a TCL thinner than 1.5 mm were classified into group A (n = 62), and those with a TCL thicker than 1.5 mm were classified into group B (n = 65). Patients with severe symptoms or other diseases were excluded. The patients were initially treated with night splinting after diagnosis. If symptoms were not ameliorated, steroid injection and surgical treatment were performed consecutively. The procedures were determined by a single surgeon. RESULTS The mean TCL thickness was 1.51 mm: 0.98 mm in group A and 2.28 mm in group B. The percentages of patients who underwent surgery were 43.0% in group A and 67.7% in group B. Group B was 1.77 times more likely to have surgery, and the interval between diagnosis and surgery and/or steroid injection was shorter. The TCL thickness in group B was also related to cross-sectional area and symptom duration. CONCLUSIONS Transverse carpal ligament thickness affects disease progression and may affect treatment efficacy, depending on the treatment method. Transverse carpal ligament thickness may be a criterion for deciding between surgical and conservative treatments based on a thickness threshold of 1.5 mm.
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Meta-synthesis of Carpal Tunnel Syndrome Treatment Options: Developing Consolidated Clinical Treatment Recommendations to Improve Practice. Arch Phys Med Rehabil 2021; 102:2261-2268.e2. [PMID: 33932358 DOI: 10.1016/j.apmr.2021.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/26/2021] [Accepted: 03/27/2021] [Indexed: 11/21/2022]
Abstract
Carpal tunnel syndrome (CTS) treatment contains ambiguities across and within disciplines. This meta-synthesis of professional guidelines consolidates clinical treatment recommendations for CTS treatment and classifies them by strength of evidence. We conducted a search of Google, Google Scholar, and PubMed for published clinical treatment recommendations for CTS. A systematic hand search was completed to identify additional professional organizations with published recommendations. We extracted any mentioned treatment from all sources but developed our final consolidated clinical treatment recommendations only from select rigorous guidelines based on the Institute of Medicine (IOM) criteria for trustworthy guidelines. We translated rating systems of the primary guidelines into a universal rating system to classify recommendations for consolidated clinical treatment recommendations. Our search yielded 30 sources that mentioned a total of 55 CTS treatments. Six of the sources met the IOM inclusion criteria. These primary guidelines provided recommendations for 46 of the 55 treatments, which were consolidated into 12 broad treatment categories. Surgery, positioning, and steroids were strongly supported. Conservative treatments provided by rehabilitation professionals were conditionally supported. Pharmaceuticals, supplements, and alternative treatments were not generally supported. CTS is a complex condition with a wide variety of treatments provided by a multitude of disciplines. Our consolidated clinical treatment recommendations offer a comprehensive outline of available treatments for CTS and contributes to the process of developing best practices for its treatment.
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Yamanaka Y, Gingery A, Oki G, Yang TH, Zhao C, Amadio PC. Effect of a monocyte chemoattractant protein-1 synthesis inhibitor on fibroblasts from patients with carpal tunnel syndrome. J Orthop Sci 2021; 26:295-299. [PMID: 32317146 PMCID: PMC7572818 DOI: 10.1016/j.jos.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/03/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Carpal Tunnel Syndrome (CTS) is an idiopathic fibrotic disorder. Fibrosis in the subsynovial connective tissues (SSCT) of CTS and many other fibrotic diseases is mediated by Transforming growth factor β (TGF-β). Recently monocyte chemoattractant protein-1 (MCP-1) a cytokine involved in cellular recruitment has been suggested to regulate TGF-β activity. It is related to the onset of diseases which are caused by fibrosis, such as idiopathic pulmonary fibrosis, renal fibrosis, and systemic scleroderma. In this study, we evaluated the effect of the MCP-1 synthesis inhibitor, Bindarit, on primary cultures of fibroblasts from the SSCT of five CTS patients. METHODS Fibroblasts were treated with Bindarit (10 μM, 50 μM, 100 μM, or 300 μM). Responses to inhibitors were evaluated by regulation of CTS fibrosis-associated genes, fibrosis gene array and Smad luciferase reporter assay. We also assessed the combination effect of Bindarit and SD208, a TGF-β receptor type 1 inhibitor on TGF-β signaling. RESULTS Collagen type III A1 (Col3), connective tissue growth factor (CTGF), and SERPINE1 expression were significantly down-regulated by Bindarit (300 μM) compared to vehicle control. In the fibrosis array, expression of inhibin beta E chain precursor (INHBE), beta actin (ACTB), endothelin 1 (EDN1) and hypoxanthine phosphoribosyltransferase 1 (HPRT1) were significantly down-regulated, and integrin beta-3 (ITGB3) was significantly up-regulated by Bindarit (300 μM). Smad signal transduction activation was significantly down-regulated by Bindarit (300 μM) and/or SD208 (1 μM) with TGF-β1 compared to vehicle control with TGF-β1. CONCLUSIONS These results suggest that Bindarit in combination with SD208 may be beneficial as medical therapy for the SSCT fibrosis associated with CTS.
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Affiliation(s)
- Yoshiaki Yamanaka
- Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Anne Gingery
- Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Gosuke Oki
- Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Tai-Hua Yang
- Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA,Corresponding Author: Peter C. Amadio, MD, Department of Orthopedic Surgery, Biomechanics and Tendon & Soft Tissue Biology Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA, Phone: 507-538-1717; Fax: 507-284-5392,
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Association of routine hematological and inflammation parameters with surgical treatment results in patients with carpal tunnel syndrome. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.827520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Civi Karaaslan T, Berkoz O, Tarakci E. The effect of mirror therapy after carpal tunnel syndrome surgery: A randomised controlled study. HAND SURGERY & REHABILITATION 2020; 39:406-412. [DOI: 10.1016/j.hansur.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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Campos-Serna I, Garcia-Espinoza JA, Cahuana-Quispe AI, Marquez-Espriella C, Cuervo-Vergara MA, Martinez-Lopez JC, Dávila-Diaz R. Diagnosis and Treatment of Carpal Tunnel Syndrome in A Tertiary Care Center in Mexico City. World J Plast Surg 2020; 9:213-218. [PMID: 32934935 PMCID: PMC7482530 DOI: 10.29252/wjps.9.2.219] [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] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome is the most common peripheral neuropathy affecting patients at productive age and has an important economical impact on those who suffer it. This study assessed the diagnostic performance of carpal tunnel syndrome´s signs and described the epidemiology at a tertiary care center in Mexico City. METHODS All patients diagnosed with carpal tunnel syndrome during a five-year period were included. Demographic data, electromyography results, positive clinical signs and the severity score according to the Italian scale were recorded. Diagnostic accuracy of Tinel and Phalen´s signs were calculated via odds ratio. RESULTS Totally, 650 patients were diagnosed and treated during a five-year period, 84% were female and 16% male, and the mean age was 55.8 years. The associated comorbidities were trigger finger (36.1%), thyroid disease (25.6%) and diabetes (20%). Diagnosis yielded for Phalen and Tinel signs were variable in each of the study groups (males and females) and showed to be beneficial in diagnosis of the disease. CONCLUSION Carpal tunnel syndrome is a complex disease in which clinical signs remain the cornerstone of diagnosis. Extension studies are useful to assess the severity of the disease.
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Affiliation(s)
- I Campos-Serna
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
| | - Jaime Aron Garcia-Espinoza
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
| | - Alberto Ignacio Cahuana-Quispe
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
| | - Cuahutemoc Marquez-Espriella
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
| | - Marco Antonio Cuervo-Vergara
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
| | - Jose Carlos Martinez-Lopez
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
| | - Rodrigo Dávila-Diaz
- Division of Plastic and Reconstructive Surgery, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
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Pourmokhtari M, Mazrooyi M, Vosoughi AR. Conservative or surgical treatment of carpal tunnel syndrome based on the severity and patient risk factors. Musculoskelet Surg 2020; 105:315-319. [PMID: 32394276 DOI: 10.1007/s12306-020-00663-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The carpal tunnel syndrome (CTS) is the most common median nerve compression disease which may result in impaired nerve function. This study was carried out to determine which treatment is more appropriate for moderate or severe CTS patients with or without risk factors. MATERIALS AND METHODS In a cohort prospective study, the patients with moderate CTS received a conservative treatment including night splint for 3 months, one methyl prednisolone injection whereas patients with severe CTS underwent surgical release. They were followed for 1 year using the bland scale based on the electromyography and nerve conduction velocity studies and five-point global assessment outcome scale. RESULTS Totally, 68 moderate CTS cases (32 patients with risk factors and 36 without any risk factors) and 32 cases with severe CTS (16 patients with risk factors and 16 without any risk factors) were assess at 6 months and 1 year following the treatment. Although about 22% of moderate CTS patients with risk factors changed to mild CTS after 6 months of conservative treatment, about 75% showed mild CTS or complete remedy following 1 year (P value < 0.001). This result was about 30% at 6 months and about 95% at 1 year following conservative treatment in patients with moderate CTS without risk factors. None of moderate CTS patients with or without risk factors underwent surgery after 1 year of follow-up. Although almost all patients with severe CTS, with and without risk factors, showed complete recovery or changed to mild CTS at 1 year postoperatively, the result was statistically significant for cases without risk factors (P value = 0.002). CONCLUSION Conservative treatment for moderate CTS would be a good option, and the final result may be seen 1 year later; however, its positive effect is quicker and better for moderate CTS cases without risk factors. Surgical release of the carpal tunnel may be the best choice not only for severe CTS cases with risk factors but also for cases without risk factors. For obtaining consistent rapid result, it is recommended to do surgical release for all cases of moderate or severe CTS without considering risk factors, but more clinical researches are needed. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Pourmokhtari
- Department of Orthopedic Surgery, Jahrom University of Medical Sciences, Jahrom, Iran
| | - M Mazrooyi
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - A R Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Alanazy MH, Alaboudi M, Almaari A, Alhumayyd Z, Albulaihe H, Muayqil T. Translation and validation of the Arabic version of the Boston carpal tunnel syndrome questionnaire. ACTA ACUST UNITED AC 2020; 24:296-301. [PMID: 31872809 PMCID: PMC8015544 DOI: 10.17712/nsj.2019.4.20190014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives: To translate and validate the Arabic version of the Boston carpal tunnel questionnaire (BCTQ-A). Methods: We recruited consecutive patients with carpal tunnel syndrome (CTS). Reliability was assessed with Cronbach α, reproducibility with intraclass correlation coefficients, construct validity with factor analysis, and responsiveness post carpal tunnel release (CTR) with the Wilcoxon signed-rank test. Results: In 134 patients, the mean total scores for the symptom severity scale (SSS) and functional status scale (FSS) were 32.0±8.4 (α=0.88, ICC=0.88) and 18.5±7.6 (α=0.87, ICC=0.89), respectively. As in the original Boston carpal tunnel questionnaire (BCTQ), a 3-factor model of the BCTQ-A best fitted the data. The BCTQ-A, SSS, and FSS scores were significantly lower post-CTR. Conclusion: The BCTQ-A is reliable, valid, reproducible, and responsive to interventions. The Arabic version can be now used with Arabic-speaking patients with CTS.
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Affiliation(s)
- Mohammed H Alanazy
- Division of Neurology, Department of Internal Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Buentello-Volante B, Molina-Medinilla M, Aguayo-Flores E, Magaña-Guerrero FS, Garfias Y. Comparison of amniotic membrane transplantation and carpal tunnel syndrome release surgery (CTRS) and CTRS alone: Clinical outcomes at 1-year follow-up. J Tissue Eng Regen Med 2020; 14:714-722. [PMID: 32174033 DOI: 10.1002/term.3033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/31/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022]
Abstract
Carpal tunnel syndrome (CTS) is the most common focal entrapment mononeuropathy, comprising medium nerve chronic inflammation and fibrosis. Although carpal tunnel release surgery (CTRS) has demonstrated to be effective, around 3% to 25% of CTRS show recurrence. Amniotic membrane transplantation (AMT) has been used in different pathologies inhibiting inflammation and fibrosis and promoting nerve repair. The aim of this study was to determine the efficacy of AMT in CTRS. The present study comprised a randomized, single-blind controlled trial to compare the 1-year follow-up outcomes of AMT in CTRS (AMT group) or CTRS alone (control group) in patients with CTS. Thirty-five patients with unilateral or bilateral CTS were enrolled, and 47 wrists were randomized into two groups: the AMT group and the control group. To compare the outcomes, three different questionnaires scores (Boston Carpal Tunnel Syndrome Questionnaire, Disabilities of the Arm, Shoulder, and Hand, and Historical-Objective scale) were used. Evaluations were assessed at baseline and at 15 days, 1, 3, 6, and 12 months after surgery. Compared with the control group, the AMT group showed significant (p < 0.05) reductions in all scores from 6 months after surgery until the end of the study. Both AMT and control groups showed significant intragroup differences in all scores, since the first month after surgery until the end of the study in comparison with the baseline scores. Taken together, these results indicate that CTRS in conjunction with AMT is more effective than CTRS alone in patients with CTS at 1-year follow-up. Clinical Trial: NCT04075357; Amniotic Membrane in Carpal Tunnel Syndrome.
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Affiliation(s)
- Beatriz Buentello-Volante
- Amniotic Membrane Tissue Bank, Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana Foundation, Mexico City, Mexico
| | | | - Eduardo Aguayo-Flores
- Amniotic Membrane Tissue Bank, Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana Foundation, Mexico City, Mexico
| | - Fátima Sofía Magaña-Guerrero
- Amniotic Membrane Tissue Bank, Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana Foundation, Mexico City, Mexico
| | - Yonathan Garfias
- Amniotic Membrane Tissue Bank, Cell and Tissue Biology, Research Unit, Institute of Ophthalmology, Conde de Valenciana Foundation, Mexico City, Mexico.,Department of Biochemistry, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Lores-Peniche J, Huchim-Lara O, Méndez-Domínguez N. Síndrome del túnel carpiano: análisis epidemiológico de los casos atendidos en los servicios hospitalarios de México. FISIOTERAPIA 2020; 42:69-74. [DOI: 10.1016/j.ft.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
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Joseph AE, Leiby BM, Beckman JP. Clinical Results of Ultrasound-Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:441-452. [PMID: 31449326 DOI: 10.1002/jum.15120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/26/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the safety and efficacy of ultrasound-guided carpal tunnel release (USCTR) in a consecutive group of patients treated by a single primary care sports medicine physician. METHODS The study group consisted of 35 USCTRs performed on 22 consecutive patients for whom clinical outcomes were available before USCTR and at 1 to 2 weeks, 1 month, and 3 months after USCTR. All procedures were performed by the same operator using a single USCTR technique. Outcomes included complications, Quick Disabilities of the Arm, Shoulder, and Hand scores, Boston Carpal Tunnel Questionnaire symptom severity and functional status scores, and a 5-point global satisfaction score. RESULTS The 22 patients included 13 female and 9 male patients (ages 31-82 years). Eleven patients (22 wrists) had bilateral simultaneous USCTRs; 2 patients (4 wrists) had staged bilateral USCTRs; and 9 patients had unilateral USCTRs. No complications occurred in any patient. Statistically and clinically significant reductions in Quick Disabilities of the Arm, Shoulder, and Hand scores and Boston Carpal Tunnel Questionnaire symptom severity and functional status scores occurred by 1 to 2 weeks after USCTR (mean 1- to 2-week changes, -29.23, -1.74, and -1.18, respectively), and further improvements occurred during the 3-month follow-up period (mean 3-month changes, -51.11, -2.29, and -1.91; P < .0001 for all values versus before USCTR). Mean global satisfaction scores at 1 to 2 weeks and 3 months were 4.63 and 4.66. CONCLUSIONS Ultrasound-guided CTR is a safe and effective procedure that can be performed by an experienced primary care sports medicine physician and typically results in significant improvements within the first 2 weeks after the procedure. Furthermore, bilateral simultaneous USCTRs are feasible and may provide significant advantages for patients who are candidates for bilateral CTRs.
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Affiliation(s)
- Anthony E Joseph
- OrthoIdaho, Pocatello, Idaho, USA
- Department of Family Medicine, Idaho State University, Pocatello, Idaho, USA
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