Clinical Care Redesign to Improve Value in Carpal Tunnel Syndrome: A Before-and-After Implementation Study

2019 ◽  
Vol 44 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Robin N. Kamal ◽  
Raj Behal
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Care ◽  
Implementation Study ◽  
Before And After ◽  
Tunnel Syndrome

Use of a Wheel Aesthesiometer for Testing Sensibility in the Hand Results in patients with carpal tunnel syndrome

1986 ◽  
Vol 11 (2) ◽  
pp. 182-186
Author(s):  
D. R. MARSH
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Surgical Decompression ◽  
Spatial Discrimination ◽  
Sensory Impairment ◽  
Discrimination Test ◽  
New Instrument ◽  
Before And After ◽  
Tunnel Syndrome

Tests of spatial discrimination were performed on the hands of patients with carpal tunnel syndrome, before and after surgical decompression. Impairment of sensibility and its recovery after treatment were better demonstrated by a new instrument, the wheel aesthesiometer, than by the moving two-point discrimination test. The psychophysics of the new test and the nature of the sensory impairment in carpal tunnel syndrome are discussed.

Use of Nerve Conduction Studies and the Pressure-Specified Sensory Device in the Diagnosis of Carpal Tunnel Syndrome

2009 ◽  
Vol 34 (1) ◽  
pp. 60-65 ◽  
Author(s):  
D. J. SLUTSKY
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Diagnostic Yield ◽  
Carpal Tunnel Release ◽  
Nerve Conduction Studies ◽  
Control Group ◽  
Asymptomatic Volunteers ◽  
Before And After ◽  
Tunnel Syndrome

Sixty-nine patients with signs of carpal tunnel syndrome (CTS) underwent nerve conduction studies (NCS) and testing with the Pressure-Specified Sensory Device (PSSD). A total of 102 tests were performed (28 bilateral). Twenty patients underwent a carpal tunnel release and were retested after 4 to 6 months. The Symptom Severity Score (SSS) was calculated before and after surgery. A control group of 20 hands in 10 asymptomatic volunteers underwent identical testing. The NCS sensitivity was 87% with a specificity of 90% whereas the PSSD sensitivity was 81% with a specificity of 65%. The combined sensitivity of the two tests was 93%. In the operative group the SSS improved from a mean of 3.34 pre-operatively to 1.95 postoperatively. The NCS improved in 19/21 hands whereas the PSSD improved in 16/19 hands. The non-invasive SSS and PSSD can increase the diagnostic yield in CTS, especially when the NCS are normal.

scholarly journals Comparison of the efficacy of a neutral wrist splint and a wrist splint incorporating a lumbrical unit for the treatment of patients with carpal tunnel syndrome

2016 ◽  
Vol 40 (5) ◽  
pp. 617-623 ◽  
Author(s):  
Batol Golriz ◽  
Monireh Ahmadi Bani ◽  
Mokhtar Arazpour ◽  
Mahmood Bahramizadeh ◽  
Sarah Curran ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
T Test ◽  
Pinch Strength ◽  
Before And After ◽  
Quasi Experimental ◽  
Tunnel Syndrome ◽  
Wrist Splint

Background: Different types of splints have been used as a conservative intervention to improve symptoms in patients with Carpal tunnel syndrome (CTS). Although a number of studies have been undertaken to compare different splints, information and understanding of the influence of these interventions are lacking. Objectives: The purpose of this study was to compare the effect of a classic thermoplastic wrist splint or a wrist splint with an additional metacarpophalangeal unit on pain, function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome. Study design: Quasi experimental design. Methods: A total of 24 patients received conservative treatment using either the classic wrist splint or the wrist splint with the metacarpophalangeal unit for a period of 6 weeks. Primary outcome measures were pain, function, grip strength, and pinch strength. Data were collected immediately before and after using the two types of splints at baseline (0 weeks) and 6 weeks. Statistical analysis was performed using the paired t-test and an independent t-test. Results: Compared to baseline, both the classic thermoplastic wrist splint and the wrist splint with a metacarpophalangeal unit significantly decreased pain and increased function, pinch strength, and grip strength. Comparisons of the two types of splints for grip strength ( P = 0.675) and pinch strength ( P = 0.650) revealed that there were no significant differences between the two after 6 weeks of wear. However, there were significant differences in pain levels ( P = 0.022) and the Disability of the Arm, Shoulder, and Hand score ( P = 0.027) between the two types of splints from baseline to 6 weeks. Conclusion: The wrist splint with a metacarpophalangeal unit was more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function. Clinical relevance A wrist splint with a metacarpophalangeal unit may be an appropriate conservative treatment in the rehabilitation of patients with mild-to-moderate carpal tunnel syndrome.

scholarly journals Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

2014 ◽  
Vol 41 (6) ◽  
pp. 426-433 ◽  
Author(s):  
Adham do Amaral e Castro ◽  
Thelma Larocca Skare ◽  
Paulo Afonso Nunes Nassif ◽  
Alexandre Kaue Sakuma ◽  
Bruno Luiz Ariede ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Control Group ◽  
Clinical Tests ◽  
Ultrasound Evaluation ◽  
Significant Difference ◽  
Before And After ◽  
Tunnel Syndrome

Objective:To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods:We studiedthree groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results:We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p<0.00001). There were lowe levels of paresthesias (p=0.0002) and median nerve area (p=0.04) in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work.Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

scholarly journals Ozone Therapy in Idiopathic Carpal Tunnel Syndrome. Biochemical, Neurophysiological and Clinical Aspects [abstract]

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Marco Rascaroli ◽  
Barbara Borghi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Reperfusion Injury ◽  
Carpal Tunnel ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Ozone Therapy ◽  
Before And After ◽  
Idiopathic Carpal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Physiological Tests

PURPOSE: Idiopathic Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. The aim of the paper was to design a prospective study to evaluate clinical and neurophysiological outcome following Ozone Therapy . We also focusing the attention on the evidences concerning the role of Subsynovial Connective Tissue (SSCT )in the pathogenesis of CTS and the ozone pre-conditioning effects linked to pain pathways and to fibrosis induced by Ischemia-Reperfusion Injury. MATERIALS and METHODS: Thirty-one patients, aged between 36 and 86 23 women and 8 men), were stratified clinically by Boston Carpal Tunnel Questionnaire (B.C.T.Q.) and Neurophysiologically by Padua’s Gravity Scale classifying patients into five Electro-myographic categories (Minimal, Slight, Moderate, Severe and Extreme) . The mean symptom duration was also recorded. The patients included in the B.C.T.Q. underwent diagnostic neurophysiological tests, strictly standardized in stimulation parameters, electrodes distances and skin temperature, before and after treatment. The Ozone Therapy was performed by injecting 4 ml of O3-O2 mixture at 10 mcrg/mL concentration under the transverse carpal ligament twice a week for eight sessions. RESULTS: We compared the B.C.T.Q. scores and the neurophysiological parameters obtained before and after O2-O3 treatment: the improvement of symptoms was significantly greater than the improvement of motor and sensory nerve conduction. The highest clinical improvement degree was found in patients classified in Slight and Moderate Groups. DISCUSSION: Chemical mediators, neo-angiogenesis and Ischemia-Reperfusion Injury lead to oxidative stress and non-inflammatory fibrosis that play a central role at various stages in CTS pathogenesis that can be recognized by clinical and neuro-physiological tests. Further studies have to be carried out to better understand these relationships and optimize timing of Ozone Therapy.

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