Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, caused by compression of the median nerve. Symptoms usually are present for months and aggravate over time. Acute onset of complaints and symptoms, like coldness of the hand, should raise awareness of a possible vascular cause of CTS.Persistent median artery (PMA) is a very rare anatomical variant of the blood supply of the upper limb. The presence of a thrombosed PMA is an extremely rare cause of CTS. In this article a case is presented in which the patient has carpal tunnel syndrome of his left hand, caused by a thrombosed persistent median artery. Conservative treatment, consisting of rest, ice applica- tion and non-steroidal anti-inflammatory drugs, failed. Surgical excision of the thrombosis and open exploration of the carpal tunnel was performed, with complete relief of symptoms. In literature different treatment options, like conservative treatment with antiplatelet therapy or surgical excision of the throm- bosis and decompression of the nerve, are described with good results. However up until now, no consensus exists about the golden standard in treatment of a thrombosed persistent median artery.

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Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2017.08.482 ◽

2018 ◽

Vol 99 (8) ◽

pp. 1623-1634.e23 ◽

Cited By ~ 15

Author(s):

Bionka M. Huisstede ◽

Peter Hoogvliet ◽

Thierry P. Franke ◽

Manon S. Randsdorp ◽

Bart W. Koes

Keyword(s):

Systematic Review ◽

Physical Therapy ◽

Carpal Tunnel Syndrome ◽

Randomized Controlled Trials ◽

Carpal Tunnel ◽

Controlled Trials ◽

Randomized Controlled ◽

Tunnel Syndrome

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Ultrasound-guided corticosteroid injection for patients with carpal tunnel syndrome: a systematic review and meta-analysis of randomized controlled trials

10.21203/rs.3.rs-125732/v1 ◽

2020 ◽

Author(s):

Fu-An Yang ◽

Ya-Chu Shih ◽

Jia-Pei Hong ◽

Chin-Wen Wu ◽

Chun-De Liao ◽

...

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Randomized Controlled Trials ◽

Carpal Tunnel ◽

Corticosteroid Injection ◽

Meta Analysis ◽

Controlled Trials ◽

Ultrasound Guided ◽

Randomized Controlled ◽

Tunnel Syndrome

Abstract Carpal tunnel syndrome (CTS) refers to the symptoms and signs caused by the compression of the median nerve in the carpal tunnel. It can be treated by corticosteroid injection into the carpal tunnel. Two methods for injection have been employed, namely ultrasound-guided and landmark-guided injection. This systematic review and meta-analysis was conducted to compare these methods in terms of several outcomes. Randomized controlled trials (RCTs) were identified, and data collection was completed on 7 October 7, 2020. Results for continuous variables are expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Analyses were performed using RevMan 5.3 software. The analysis included eight RCTs published between 2013 and 2019 with a total of 448 patients. Ultrasound-guided injection yielded more favorable results for the Boston Carpal Tunnel Syndrome Questionnaire, Symptom Severity Scale [SMD = −0.49, 95% CI (−0.74, −0.25), P < 0.0001], Boston Carpal Tunnel Syndrome Questionnaire, Functional Status Scale [SMD = −0.24, 95% CI (−0.42, −0.06), P = 0.01], distal motor latency [SMD = −0.36, 95% CI (−0.70, −0.02), P = 0.04], and compound muscle action potential [SMD = 0.38, 95% CI (0.16, 0.61), P = 0.0008] . Ultrasound-guided corticosteroid injection is recommended for patients with CTS.

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Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.10.193 ◽

2020 ◽

Vol 101 (5) ◽

pp. 897-906 ◽

Cited By ~ 3

Author(s):

Michael Catapano ◽

Joseph Catapano ◽

Gregory Borschel ◽

Seyed Mohammad Alavinia ◽

Lawrence R. Robinson ◽

...

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Randomized Controlled Trials ◽

Carpal Tunnel ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Nonsurgical Management ◽

Tunnel Syndrome

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Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-320165 ◽

2019 ◽

Vol 90 (9) ◽

pp. 1051-1058 ◽

Cited By ~ 10

Author(s):

Robert Simpson ◽

Sharon Simpson ◽

Nitish Ramparsad ◽

Margaret Lawrence ◽

Jo Booth ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Treatment Options ◽

Well Being ◽

Controlled Trials ◽

Medical Subject Headings ◽

Randomised Controlled ◽

Mental Well Being

ObjectiveImpairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS.MethodsSystematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD).ResultsTwelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28–0.53), p<0.01, I2=28%; against active comparators only (three studies) SMD was 0.17 (0.01–0.32), p<0.05, I2 =0%. Only three adverse events were reported.ConclusionsMBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness.PROSPERO registration numberCRD42018093171.

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