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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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Bagcaci S, Yilmaz R, Sahin N. Efficiency of therapeutic underwater ultrasound therapy in mild-to-moderate carpal tunnel syndrome: A randomized sham-controlled study. Turk J Phys Med Rehabil 2023; 69:366-376. [PMID: 37674798 PMCID: PMC10478536 DOI: 10.5606/tftrd.2023.12467] [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: 02/02/2023] [Accepted: 06/04/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives This study aimed to evaluate the efficiency of therapeutic pulsed ultrasound (US) applied underwater in mild-to-moderate carpal tunnel syndrome (CTS). Patients and methods This randomized, placebo-controlled study included 75 patients (114 hands; 7 males, 68 females; mean age: 46.7±9.9 years; range, 24 to 64 years) diagnosed with CTS through clinical evaluation and electroneuromyography (ENMG) results between March 2012 and January 2013. Patients were randomized into three groups. Group 1 received underwater pulsed US, Group 2 received sham US, and Group 3 was the control group. All groups were given night splints. Patients were evaluated at baseline, at the end of treatment (two weeks), and 12 weeks after the treatment using clinical examination tests (Tinel, Phalen, and hand elevation test), hand grip strength, Visual Analog Scale (VAS) for pain, Pain Quality Assessment Scale (PQAS), and ENMG. Results In all groups, a significant improvement was detected in the clinical assessment parameters, including the pain VAS, PQAS scores, physical examination outcomes, and hand grip strength. The decrease in VAS score and PQAS was found to be superior in the pulsed US group at both two weeks after the treatment and at the 12th week after the treatment compared to the sham US and control groups (p<0.001). Improvement in ENMG parameters, such as median motor latency, median sensorial velocity, and median sensory latency, was observed only in the underwater pulsed US group (p<0.001). Conclusion Therapeutic underwater pulsed US is an effective, safe, and easy-to-apply treatment option in the conservative treatment of mild-to-moderate CTS.
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Affiliation(s)
- Sinan Bagcaci
- Department of Physical Medicine and Rehabilitation, Konya Medicana International Hospital, Konya, Türkiye
| | - Ramazan Yilmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Konya Beyhekim Training and Research Hospital, Konya, Türkiye
| | - Nilay Sahin
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Balıkesir University, Balıkesir, Türkiye
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ElSadek A, Fathy M, AbdElMoneim A. High-resolution neuromuscular ultrasound-based diagnosis of carpal tunnel syndrome in a sample of Egyptian population. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Carpal tunnel syndrome is the commonest entrapment neuropathy. The cut-off point of cross-sectional area to diagnose carpal tunnel syndrome may vary among populations. The objective of this study was to determine the best cut-off point of median nerve cross-sectional area to diagnose carpal tunnel syndrome among Egyptian population and to compare the difference of median nerve cross-sectional area in diabetic patients versus healthy individuals.
Results
Mean cross-sectional area was 7.78 ± 1.260 mm2 among healthy individuals and 8 ± 1.018 mm2 among diabetics. Cut-off cross-sectional area of median nerve above which compression is anticipated is 9.5 mm2.
Conclusion
Ultrasound can be used to diagnose carpal tunnel syndrome by measuring the median nerve cross-sectional area.
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Moradi A, Sadr A, Ebrahimzadeh MH, Hassankhani GG, Mehrad-Majd H. Does diabetes mellitus change the carpal tunnel release outcomes? Evidence from a systematic review and meta-analysis. J Hand Ther 2021; 33:394-401. [PMID: 32156577 DOI: 10.1016/j.jht.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. INTRODUCTION Carpal tunnel syndrome (CTS) is one of the most common upper extremity conditions which mostly affect women. Management of patients suffering from both CTS and diabetes mellitus (DM) is challenging, and it was suggested that DM might affect the diagnosis as well as the outcome of surgical treatment. PURPOSE OF THE STUDY This meta-analysis was aimed to compare the response with CTS surgical treatment in diabetic and nondiabetic patients. METHODS Electronic databases were searched to identify eligible studies comparing the symptomatic, functional, and neurophysiological outcomes between diabetic and nondiabetic patients with CTS. Pooled MDs with 95% CIs were applied to assess the level of outcome improvements. RESULTS Ten articles with 2869 subjects were included. The sensory conduction velocities in the wrist-palm and wrist-middle finger segments showed a significantly better improvement in nondiabetic compared with diabetic patients (MD = -4.31, 95% CI = -5.89 to -2.74, P < .001 and MD = -2.74, 95% CI = -5.32 to -0.16, P = .037, respectively). However, no significant differences were found for the improvement of symptoms severity and functional status based on the Boston Carpal Tunnel Questionnaire and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire as well as motor conduction velocities and distal motor latencies. CONCLUSION Metaresults revealed no significant difference in improvements of all various outcomes except sensory conduction velocities after CTS surgery between diabetic and nondiabetic patients. A better diabetic neuropathy care is recommended to achieve better sensory recovery after CTS surgery in diabetic patients.
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Affiliation(s)
- Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ata Sadr
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Hassan Mehrad-Majd
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran.
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Pattankar S, Roy R, Warade A, Desai K. Analysis of the Long-Term Outcome in Open Carpal Tunnel Release Surgeries with and without External Neurolysis of Median Nerve, Using Boston Carpal Tunnel Questionnaire (BCTQ)-Hindi Version. J Neurosci Rural Pract 2021; 12:470-477. [PMID: 34295100 PMCID: PMC8289532 DOI: 10.1055/s-0041-1723100] [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] [Indexed: 11/21/2022] Open
Abstract
Background
The effectiveness of open carpal tunnel release (OCTR) in treating carpal tunnel syndrome (CTS) is well known. However, the role of ancillary external neurolysis of the median nerve is not well-documented. The Boston carpal tunnel questionnaire (BCTQ) is a commonly used disease-specific outcome instrument for CTS, which is validated across major languages of the world. No such validated Hindi version of BCTQ exists.
Objectives
To analyze and compare the long-term outcome in patients who underwent OCTR alone and OCTR with external neurolysis of the median nerve, using BCTQ–Hindi version, while checking its validity.
Materials and Methods
A retrospective, cross-sectional study was conducted at a tertiary care institute. The BCTQ was translated into Hindi language by a language expert. Eighty-four consecutive patients who underwent either unilateral/bilateral OCTR, with or without external neurolysis of the median nerve, between 2009 and 2019 were included in the study. Outcome analysis was done using BCTQ–Hindi version and patient satisfaction scoring. BCTQ–Hindi version was examined for statistical validity. Subgroup analysis of the outcome based on surgical technique (OCTR vs. OCTR with external neurolysis) used was carried out.
Results
Response rate was 80.9%. Total hands evaluated were 108. BCTQ–Hindi version showed statistical validity. Overall symptom severity score (SSS) and functional severity score (FSS) were 1.14 ± 0.4 and 1.12 ± 0.35, respectively. Subgroup analysis of outcome revealed statistically significant results in favor of OCTR with external neurolysis of the median nerve.
Conclusions
BCTQ–Hindi version is statistically validated. OCTR with external neurolysis of the median nerve is a promising avenue in surgical management of CTS. Further prospective studies are warranted.
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Affiliation(s)
- Sanjeev Pattankar
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Rohan Roy
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Anshu Warade
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
| | - Ketan Desai
- Department of Neurosurgery & Gamma Knife Radiosurgery, P D Hinduja Hospital & MRC, Mumbai, India
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Yunoki M, Imoto R, Kawai N, Matsumoto A, Hirashita K, Yoshino K. Occurrence of Trigger Finger Following Carpal Tunnel Release. Asian J Neurosurg 2020; 14:1068-1073. [PMID: 31903342 PMCID: PMC6896635 DOI: 10.4103/ajns.ajns_149_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Surgical treatment of carpal tunnel syndrome (CTS) was recently started in our department, and we noticed that the development of trigger finger (TF), with which neurosurgeons are generally unfamiliar, is not rare after such treatment. We summarized the clinical and pathogenetic aspects of TF and retrospectively analyzed the medical records of all 39 patients who underwent CTR in our department to investigate the occurrence of TF. In 39 patients with CTS, 46 surgical interventions were performed in our department. All surgical procedures were carried out by open release of the transverse carpal ligament under local anesthesia infiltration, but the distal forearm fascia was not released. The mean postoperative follow-up period was 21.1 ± 16.8 months. TF after CTR occurred in nine hands of eight patients (9 of 46 hands, 19.6%). The mean interval between CTR and TF onset was 5.3 ± 2.8 months. TF after surgical treatment of CTS is not rare; therefore, surgeons who treat CTS should understand the clinical features of TF and carefully assess affected patients, particulary at presentation and within 6 months postoperatively.
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Affiliation(s)
- Masatoshi Yunoki
- Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Ryoji Imoto
- Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Nobuhiko Kawai
- Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan
| | | | - Koji Hirashita
- Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Kimihiro Yoshino
- Department of Neurosurgery, Kagawa Rosai Hospital, Kagawa, Japan
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Ezzati K, Laakso EL, Saberi A, Yousefzadeh Chabok S, Nasiri E, Bakhshayesh Eghbali B. A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med 2019; 56:733-740. [PMID: 31742366 DOI: 10.23736/s1973-9087.19.05835-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common peripheral nerve disorder of the wrist. Nonsurgical treatments e.g. laser therapy may cause potential beneficial effects. AIM To compare the dose dependent effects of low level laser therapy (LLLT) and high intensity laser therapy (HILT) on pain and electrophysiology studies in patients with CTS. DESIGN Double-blind randomized controlled trial. SETTING Outpatient physiotherapy clinic. POPULATION Ninety-eight participants with CTS, aged between 20 to 60 years, were randomly assigned to five groups. METHODS All participants undertook four standard exercises, with one group serving as exercise-only controls. Patients were randomly allocated to either high or low fluence LLLT or high or low fluence HILT received over 5 sessions. All patients were assessed by visual analogue scale, median compound muscle action potential (CMAP) and sensory nerve conduction studies before and 3 weeks after the interventions. RESULTS VAS was significantly lower in all groups after 3 weeks (P<0.05). CMAP latency decreased in all groups. The interaction of group and time (5×2) was significant for pain (P<0.001), the latency of CMAP (P=0.001) and CMAP amplitude (P=0.02). The interaction of group and time was not significant for the CMAP conduction velocity, sensory nerve latency and amplitude (P>0.05). CONCLUSIONS HILT with a power of 1.6 W and low fluence of 8 J/cm2 was superior in reduction of pain and improvement of the median motor nerve electrophysiological studies compared to LLLT and exercise-only control groups. CLINICAL REHABILITATION IMPACT LLLT and HILT in conjunction with exercise program are effective in reducing pain and improving median motor nerve conduction studies of the patients with CTS. It seems that high power and low fluence laser therapy is better than LLLT and exercise interventions to treat these patients.
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Affiliation(s)
- Kamran Ezzati
- Neuroscience Research Center, Faculty of Medicine, Poorsina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - E-Liisa Laakso
- School of Allied Health Science, Griffith University, Gold Coast, Australia
| | - Alia Saberi
- Neuroscience Research Center, Department of Neurology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran -
| | - Shahrokh Yousefzadeh Chabok
- Department of Neurosurgery, Faculty of Medicine, Neuroscience Research Center, Poorsina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ebrahim Nasiri
- Faculty of Medicine, Neuroscience Research Center, Poorsina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Babak Bakhshayesh Eghbali
- Neuroscience Research Center, Department of Neurology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Schuh A, Handschu R, Eibl T, Janka M, Hönle W. [Carpal tunnel syndrome]. MMW Fortschr Med 2017; 159:59-62. [PMID: 28718115 DOI: 10.1007/s15006-017-9903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Alexander Schuh
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - René Handschu
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Thomas Eibl
- Neurologische Klinik, Kliniken des Landkreises Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Michael Janka
- Muskuloskelettales Zentrum, Klinikum Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
| | - Wolfgang Hönle
- Muskuloskelettales Zentrum, Klinikum Neumarkt i. d. OPf., Neumarkt i. d. OPf., Deutschland
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