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McCarty JC, Eberlin KR. Discussion: Predictors and Variation in Steroid Injection Use for Carpal Tunnel Syndrome from a Multicenter Quality Collaborative. Plast Reconstr Surg 2024; 153:1083-1084. [PMID: 38657009 DOI: 10.1097/prs.0000000000011218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Justin C McCarty
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Kyle R Eberlin
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
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2
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Karimzadeh A, Esmaily H, Raeissadat SA, Esmaelzade M, Aghamiri SH, Bolandnazar NS. Comparison of the Effect of Intracarpal Injection of Ketorolac With Triamcinolone in Carpal Tunnel Syndrome: A Randomized Controlled Trial. Ann Pharmacother 2024; 58:205-213. [PMID: 37278013 DOI: 10.1177/10600280231175146] [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: 06/07/2023] Open
Abstract
BACKGROUND The most prevalent entrapment neuropathy is carpal tunnel syndrome (CTS). Although nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal disorders, oral NSAIDs do not provide any additional benefits for CTS. Nevertheless, the use of NSAID phonophoresis has shown significant improvement, possibly due to increased concentration in the target tissue. The effects of intracarpal injection of NSAIDs on CTS have not been studied. OBJECTIVE We conducted a controlled trial to compare the efficacy of ketorolac and triamcinolone in treating CTS. METHODS Mild to moderate CTS patients were randomly assigned to receive either a local injection of 30 mg ketorolac or 40 mg triamcinolone. Patients were evaluated using visual analog scale (VAS) for pain, severity, function, electrodiagnostic findings, patient satisfaction, and any complications at the injection site, at baseline and 12 weeks after the procedures. RESULTS Fifty patients participated, and 43 completed the study. Both groups showed significant improvement in the VAS, severity, function, and electrodiagnostic scores at 3 months compared with the baseline. A comparison of the groups showed significant differences in VAS, severity, and function, with the improvement being significantly higher in the triamcinolone group. CONCLUSION AND RELEVANCE The present study showed that injection of triamcinolone or ketorolac into the carpal tunnel relieved pain, increased function, and improved electrodiagnostic findings in patients with mild to moderate CTS. It also showed that triamcinolone was superior to ketorolac in terms of analgesic effect and resulted in greater improvement in symptom severity and function.
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Affiliation(s)
- Afshin Karimzadeh
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Esmaily
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Clinical Research Development Center, Shahid Modarres Hospital, Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaelzade
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Aghamiri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Sadat Bolandnazar
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Liu Y, Yang J, Dong W, Liu W, Chen L, Li J, Chen J, Zhou X, Yin H, Li J. Comparison of acupotomy release combined with glucocorticoid intrathecal injection versus isolated glucocorticoid intrathecal injection for carpal tunnel syndrome: A protocol for a meta-analysis of comparative studies. Medicine (Baltimore) 2023; 102:e32940. [PMID: 36862892 PMCID: PMC9981390 DOI: 10.1097/md.0000000000032940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is more common in people who need to engage in repetitive wrist work. Once it has occurred, localized pain and numbness of the fingers will develop, in severe cases, muscle atrophy will even arise, and after rest and physical therapy, many patients will still be unable to relieve or recur. In this case, the patient can receive intrathecal glucocorticoid injections, but the hormone injections alone can only provide short-term relief, and because the mechanical factors of median nerve compression are not fundamentally removed. Therefore, combined acupotomy release can help to release the compression of the transverse carpal ligament on the nerve and increase the volume within the carpal tunnel to achieve more satisfactory long-term results. Hence, a meta-analysis is necessary to provide evidence whether there is a significant difference in the treatment of CTS with acupotomy release combined with glucocorticoid intrathecal injection (ARGI) compared with isolated glucocorticoid intrathecal injection (GI). METHODS We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed, Cochrane central register of controlled trials, Web of Science, Chinese national knowledge infrastructure, Wanfang data, Chinese scientific journals database, Chinese databases SinoMed, and electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for nonrandomized studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS This systematic review will evaluate the difference in efficacy of ARGI versus isolated GI in the treatment of CTS. CONCLUSION The conclusion of this study will provide evidence for judging whether ARGI is superior to GI for treatment of CTS.
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Affiliation(s)
- Yukun Liu
- Anning Municipal Hospital of Traditional Chinese Medicine, Anning City, China
| | - Jingfan Yang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Wei Dong
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Weitong Liu
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Li Chen
- Anning Municipal Hospital of Traditional Chinese Medicine, Anning City, China
| | - Jiao Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Jiankun Chen
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
| | - Xing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang, China
| | - Hong Yin
- Kunming University of Science and Technology Hospital, Kunming City, Yunnan Province, China
| | - Jinlei Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, Yunnan Province, China
- * Correspondence: Jinlei Li, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, No.25, Dongfeng East Road, Panlong District, Kunming City, Yunnan Province, P.R. China (e-mail: )
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4
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Fakunle O, Farley KX, DeMaio EL, Gottschalk MB, Wagner ER, Daly CA. When Is It Safe to Operate After Therapeutic Carpal Tunnel Injections? Hand (N Y) 2023; 18:139S-145S. [PMID: 34105384 PMCID: PMC9896289 DOI: 10.1177/15589447211017229] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent studies suggest increased complications when surgery closely follows corticosteroid injection. The purpose of this study was to understand the occurrence of surgical site infection (SSI), wound complications, and reoperation rates after carpal tunnel release (CTR) when corticosteroid injections were given within 180 days preoperatively. METHODS Data were collected from the Truven MarketScan database from 2009 to 2018. Cohorts were created based on preoperative timing of injection (<30, 30-60, 61-90, 91-180 days) and number of injections (0, 1, 2, 3+). Logistic regression was performed to assess the contribution of preoperative injections on 90-day surgical site complications and 1-year reoperation while controlling for demographics and comorbidities. RESULTS Overall, 223 899 patients underwent CTR. Of these, 17 391 (7.76%) had a preoperative injection in the 180 days preceding surgery. Univariate analysis demonstrated a relationship between timing of injections and noninfectious wound complications (P = .006) and rate of 1-year reoperation (P = .045). Univariate analysis demonstrated a relationship between number of injections and 1-year reoperation (P < .001). On multivariate analysis, those receiving injections within 30 days preoperatively had increased rates of SSI (P = .034) and noninfectious wound complications (P = .006) compared with those with no injection or at other time points. Patients with 2 (P = .002) or 3 or more injections (P < .001) in the 180-day preoperative period had increased odds of 1-year reoperation. CONCLUSION Our study suggests increased risk of SSI, wound complications, and 1-year reoperation when corticosteroid injections are administered in the 30-day preoperative period. In addition, multiple steroid injections may increase the risk of 1-year reoperation.
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Abstract
Background Carpal tunnel syndrome (CTS), one of the most common entrapment neuropathies, can, in fact, be considered as a socio-economic issue that reduces work productivity, increases disability, and requires prolonged rehabilitation. The imaging modality of choice in CTS imaging is the ultrasound (US), as several morphological parameters can be used in CTS diagnosis and follow-up. In recent years, US-guided CTS injection therapy has become an established treatment option for mild to moderate CTS. The authors of this review performed a literature search that revealed several differences in US-guided carpal tunnel injection in an attempt to unify individual stages of CTS injections protocol for future guidance: patient preparation, injection approach, needle positioning, injected medications, and injectate volume. The three approaches to carpal tunnel injections described in the literature, that is, the ulnar, radial, and longitudinal, can be implemented with single or multiple deposits and different injection volumes. Medications used for injections are corticosteroids, local anaesthetics, dextrose, saline, platelet-rich plasma, and progesterone. Conclusions Although no consensus has yet been reached as to which protocol should be used, the ulnar approach with a single deposit injected in large volumes should be considered as the first choice, while dextrose should be the first-line medication option. Furthermore, as terminological differences make it difficult to draw a uniform comparison the presented steps for US-guided carpal tunnel injection might serve as a guideline for future studies.
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6
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Celenlioglu AE, Unal-Artık HA, Guler G. Comparison of ultrasound-guided pulsed radiofrequency versus steroid injection in the treatment of carpal tunnel syndrome. Ir J Med Sci 2022; 191:2751-2757. [PMID: 35129753 DOI: 10.1007/s11845-022-02923-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most widespread form of nerve entrapment neuropathy results from increase compression pressure of the median nerve at the wrist under the transverse carpal ligament. AIMS To compare ultrasound (US)-guided median nerve steroid injection and pulsed radiofrequency (PRF) on pain intensity, functional status, and patient satisfaction in the treatment of CTS. METHODS A total of 90 hands of 59 patients who underwent steroid injection at the level of proximal carpal tunnel or PRF for CTS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. The pain severity was assessed using the Numerical Rating Scale (NRS), and the functional status and clinical outcomes were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ) before the procedure and at Week 1, Month 1, and Month 3 after the procedure. Time to pain relief was evaluated at week 1. Patient satisfaction was evaluated at Month 3. RESULTS There was no significant difference in the NRS and BCTQ scores between the two treatment methods (p > 0.05 for both). In addition, a significant decrease in the NRS and BCTQ scores were detected at all follow-ups compared to baseline in treatment groups (p < 0.001). The mean time to pain relief was significantly shorter in the PRF group (p < 0.001). Patient satisfaction was similar at Month 3 between the treatment methods (p > 0.05). CONCLUSIONS Our study results suggest that both US-guided steroid injection to the median nerve and PRF are effective and safe methods in the short-term in the treatment of CTS.
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Affiliation(s)
- Alp Eren Celenlioglu
- Department of Pain Medicine, Health Sciences University Gulhane Training and Research Hospital, General Dr. Tevfik Sağlam Cd. No. 1, 06010, Etlik, Ankara, Turkey.
| | - Hanzade Aybuke Unal-Artık
- Department of Pain Medicine, Usak University Training and Research Hospital, Fevzi Çakmak, Gazi Blv. Yanyolu No. 50, 64300, Usak, Merkez, Turkey
| | - Gulen Guler
- Department of Anesthesiology and Reanimation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, Köşk Mah. Prof. Dr. Turhan Feyzioğlu Cad. No. 42, 38039, Melikgazi, Kayseri, Turkey
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7
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Badıl Güloğlu S, Bilgilisoy Filiz M, Kılıç KK, Koldaş Doğan Ş, Toslak İE, Toraman NF. Treatment of carpal tunnel syndrome by low-level laser therapy versus corticosteroid injection: a randomized, prospective clinical study. Lasers Med Sci 2022; 37:2227-2237. [PMID: 35022874 DOI: 10.1007/s10103-021-03489-6] [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: 09/16/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022]
Abstract
To compare the effects of low level laser therapy (LLLT) and corticosteroid injection in patients with moderate carpal tunnel syndrome (CTS). Eighty-seven patients (143 wrists) with moderate CTS were randomized to the corticosteroid or LLLT groups. 40 mg of triamcinolone acetate solution was applied to carpal tunnel of 44 patients (74 wrist). LLLT was applied to 43 patients (70 wrist) five times a week, for a total of 15 sessions (fluence of 6 j/cm2 for 1 min per point at a wavelength of 830 nm). Outcome measures were numbness and pain, QuickDASH questionnaire, grasping tests, Tinel and Phalen tests, electrophysiological tests and MRI evaluations, which were tested at the baseline and 1st and 6th months after the treatment. Eighty patients (133 wrists) completed the study at the end of 6 months. VAS and Quick DASH scores were better in the corticosteroid group in the 1st month, but there were no significant differences between groups in the 6th month. Phalen and Tinel tests, strength tests, and motor distal latency improved significantly and similarly in both groups at the 1st and 6th months. Sensory distal latency and sensory nerve conduction velocity showed significant improvements in the 1st and 6th months only in the corticosteroid group. In both groups, median nerve intensity rate and palmary spring rate improved significantly after the treatment. Based on this study, corticosteroid injection and LLLT groups showed statistically significant difference at the 1st month (short-term), whereas there was no significant difference at the 6th month (intermediate-term).
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Affiliation(s)
- Sevtap Badıl Güloğlu
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey.
| | - Meral Bilgilisoy Filiz
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Koray Kaya Kılıç
- Radiology, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Şebnem Koldaş Doğan
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - İclal Erdem Toslak
- Radiology, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
| | - Naciye Füsun Toraman
- Physical Medicine and Rehabilitation, Health Science University Antalya Training and Research Hospital, Antalya, Turkey
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8
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Guo K, McCool L, Wang H, Guo D, Guo D. The Modified Ultrasound-Guided Distal-to-Proximal Carpal Tunnel Injection With Median Nerve Hydrodissection: A Retrospective Safety Review of 827 Procedures. Hand (N Y) 2021; 16:407-409. [PMID: 31288592 PMCID: PMC8120585 DOI: 10.1177/1558944719861715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: The aim of this report is to describe a new ultrasound guided technique for carpal tunnel injection and median nerve hydrodissection using distal to proximal approach. Methods: From 2015 to 2019, 827 consecutive injections by distal-to-proximal approach were included using coding information to check for post-procedural skin hypopigmentation, hematoma, seroma, nerve injury, or vascular injury. Results: There were no occurrences of post-procedural skin-hypopigmentation, hematoma or seroma formation, or neurovascular injury. Conclusions: The distal approach carpal tunnel injection is a safe and effective method. It may directly inject the medication into carpal tunnel to avoid skin hypopigmentation from steroid side effect with previous report method, also it may release adhesion of median nerve with surrounding soft tissue by hydrodissection. It helps median nerve compression at outlet of carpal tunnel.
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Affiliation(s)
- Kathy Guo
- St. George’s University, Grenada, West Indies
| | | | - Hao Wang
- Guilford Orthopaedic and Sports Medicine Center, Greensboro, NC, USA
| | - Danzhu Guo
- Department of Pain & Rehab Medicine, BayCare Clinic, Green Bay, WI, USA
| | - Danqing Guo
- Department of Pain & Rehab Medicine, BayCare Clinic, Green Bay, WI, USA,Danqing Guo, Department of Pain & Rehab Medicine, BayCare Clinic 2401 Holmgren Way, Green Bay, WI 54304, USA.
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9
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Hernández-Secorún M, Montaña-Cortés R, Hidalgo-García C, Rodríguez-Sanz J, Corral-de-Toro J, Monti-Ballano S, Hamam-Alcober S, Tricás-Moreno JM, Lucha-López MO. Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2365. [PMID: 33671060 PMCID: PMC7957741 DOI: 10.3390/ijerph18052365] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. (2) Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. (3) Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. (4) Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies.
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Affiliation(s)
- Mar Hernández-Secorún
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Raquel Montaña-Cortés
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
| | - César Hidalgo-García
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jacobo Rodríguez-Sanz
- Department of Basic Sciences, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain;
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Jaime Corral-de-Toro
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sofia Monti-Ballano
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sami Hamam-Alcober
- Unit of Reconstructive Surgery of the Locomotor System, Hand-Microsurgery, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - José Miguel Tricás-Moreno
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
| | - María Orosia Lucha-López
- Physiotherapy Department, Faculty of Health Sciences, Universidad de Zaragoza, 50009 Zaragoza, Spain; (M.H.-S.); (R.M.-C.); (J.C.-d.-T.); (S.M.-B.); (J.M.T.-M.); (M.O.L.-L.)
- Unidad de Investigación en Fisioterapia, University of Zaragoza, 50009 Zaragoza, Spain
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Hojjati F, Afjei MH, Ebrahimi Takamjani I, Rayegani SM, Sarrafzadeh J, Raeissadat SA, Payami S. The Effect of High-Power and Low-Power Lasers on Symptoms and the Nerve Conduction Study in Patients With Carpal Tunnel Syndrome. A Prospective Randomized Single-Blind Clinical Trial. J Lasers Med Sci 2020; 11:S73-S79. [PMID: 33995973 DOI: 10.34172/jlms.2020.s12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. Various treatments have been suggested for CTS and there is no consensus on their superiority and the order of their use. Laser therapy is a non-invasive treatment method for many musculoskeletal diseases, including CTS. This study aimed to determine and compare the effect of high-power lasers (HPLs) and low-power lasers (LPLs) on pain severity, function, pinch strength, and nerve conduction study findings in patients aged 30-50 years with mild or moderate CTS. Methods: This is a prospective, randomized, single-blind clinical trial. The study population included 45 patients aged 30-50 years who came to the physical medicine and rehabilitation clinic of Shohada-e-Tajrish hospital and mild or moderate CTS was confirmed for them. Patients were randomly assigned to control, LPL therapy, and HPL therapy groups. Pain, function, pinch strength, and nerve conduction study findings were recorded in all groups before, immediately and 12 weeks after the treatment. All data were compared using SPSS version 21. Results: All groups showed improvement regarding pain, function, and pinch strength. Laser therapy showed significantly better results compared to a wrist splint, but no significant difference was seen between high-power and LPL therapy groups. Nerve conduction evaluation findings did not reveal any significant difference. Conclusion: Both the wrist splint and laser therapy can improve the symptoms of carpal tunnel syndrome. HPL therapy showed better results, although not significantly different from LPL therapy.
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Affiliation(s)
- Fateme Hojjati
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Physical medicine & rehabilitation research center, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Afjei
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services (IUMS), Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services (IUMS), Tehran, Iran
| | - Seyed Mansour Rayegani
- Physical medicine & rehabilitation research center, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Javad Sarrafzadeh
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services (IUMS), Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Physical medicine & rehabilitation research center, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.,Clinical Development Research Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Payami
- Department of Emergency Medicine, Amir al momenin Hospital, Tehran Azad University of Medical Sciences, Tehran, Iran
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11
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Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.102631] [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] [Indexed: 12/17/2022] Open
Abstract
: One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-op protocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation.
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12
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Abstract
Carpal tunnel syndrome is the most common compression neuropathy. Despite the prevalence of carpal tunnel syndrome, many other conditions present with similar symptoms (numbness, tingling, thenar atrophy, and weakness). Carpal tunnel syndrome is differentiated from other etiologies through a detailed history and physical examination, aided by electrodiagnostic and adjunctive imaging studies. Misdiagnosis can lead to unnecessary operative procedures and persistent symptoms.
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Affiliation(s)
- Jana Dengler
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J D Stephens
- Kettering Health Network Orthopaedic Surgery Residency, Dayton, Ohio
| | - H Brent Bamberger
- Kettering Health Network Orthopaedic Surgery Residency, Dayton, Ohio
| | - Amy M Moore
- Washington University in St. Louis, St. Louis, Missouri
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13
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Rayegani SM, Raeissadat SA, Ahmadi-Dastgerdi M, Bavaghar N, Rahimi-Dehgolan S. Comparing The Efficacy Of Local Triamcinolone Injection In Carpal Tunnel Syndrome Using Three Different Approaches with or without Ultrasound Guidance. J Pain Res 2019; 12:2951-2958. [PMID: 31749629 PMCID: PMC6817831 DOI: 10.2147/jpr.s212948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The present article has investigated the added value of ultrasound (US) guidance on improving the efficacy of local triamcinolone injection via comparing two US-guided methods versus a conventional landmark-guided approach. Methods Eighty-one subjects with mild or moderate CTS were included and randomly assigned into three categories including landmark-guided, conventional US-guided midline approach and US-guided ulnar in-plane method. Primarily, participants in the three groups were relatively similar in terms of demographics and their clinical variables comprising visual analog scale (VAS) for pain, pain-free grip strength (PFGS), Boston CTS questionnaire (BCTQ), EDX parameters, and cross-sectional area (CSA) of median nerve measured by ultrasonography. Ten weeks after injection, the changes of clinical and para-clinical outcomes were reassessed for 76 patients who finished the study. Results Our findings showed that all three injection methods were associated with a significant and relatively similar improvement in clinical and electrodiagnostic parameters. The post-injection evaluation showed a statistically significant change in all variables except for symptom severity score (SSS) of BCTQ. The best effect-size values were observed for VAS [56%] and functional severity scale (FSS) of BCTQ [42%], both reported in the US-guided midline group. However, no significant difference was found between the groups regarding their improvement in any of the outcome variables (P value >0.05). Conclusion Based on the current data, all three injection methods were effective in improving electrodiagnostic findings and clinical symptoms of CTS. Although all approaches were relatively similar, US-guided midline approach was associated with slightly better outcomes.
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Affiliation(s)
- Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Mohammad Ahmadi-Dastgerdi
- Physical Medicine and Rehabilitation Research Center, Shohada-E-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafise Bavaghar
- Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular, Medical and Research, Iran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- Physical Medicine and Rehabilitation Department, IKHC Center, Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, Iran
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Ertem DH, Sirin TC, Yilmaz I. Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:638-645. [PMID: 31553394 DOI: 10.1590/0004-282x20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. METHODS Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. RESULTS A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). CONCLUSION Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.
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Affiliation(s)
- Devrimsel Harika Ertem
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Tuba Cerrahoglu Sirin
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurology, Istanbul, Turkey
| | - Ilhan Yilmaz
- University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurosurgery, Istanbul, Turkey
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15
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Bahrami MH, Raeissadat SA, Nezamabadi M, Hojjati F, Rahimi-Dehgolan S. Interesting effectiveness of ozone injection for carpal tunnel syndrome treatment: a randomized controlled trial. Orthop Res Rev 2019; 11:61-67. [PMID: 31123423 PMCID: PMC6510386 DOI: 10.2147/orr.s202780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/10/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper limb. Local injection of different substances has been increasingly used as an acceptable conservative treatment in non-severe cases. This study aimed to evaluate the efficacy and safety of local ozone injection in the management of non-severe CTS. Methods: In the current randomized controlled trial (RCT), 40 patients with mild or moderate CTS were included in two parallel groups. Both of them used the resting volar wrist splint for 8 weeks; while the intervention group received a single dose of local ozone injection, except for the same splinting protocol. The main outcome measures including visual analog scale (VAS) for pain; symptom severity or functional status, based on Boston questionnaire (BQ); and median nerve conduction study, were reassessed 10 weeks after the treatment. Results: All of the measures including VAS, symptom severity, functional status and EDX improved significantly in both groups with the maximal changes in VAS. The VAS reduction was more remarkable in the ozone group than the control group [64% versus 45.3%, respectively]. Moreover, both of the BQ subscales showed significantly higher improvement in the ozone group compared to the control group (P=0.01 and 0.02, respectively). Although the improvement of EDX parameters was slightly better in the ozone group, the difference was not significant. Neither minor nor major side effects were reported. Conclusion: Ozone therapy as a safe and low-cost method, could provide promising results among women with mild to moderate CTS, at least for short-term treatment. Clinical trial registration: IRCT2016040913442N9.
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Affiliation(s)
- Mohammad Hasan Bahrami
- Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Department and Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Mohammadrasoul Nezamabadi
- Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Fateme Hojjati
- Physical Medicine and Rehabilitation Department and Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- Physical Medicine and Rehabilitation Department, Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, Iran
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