scholarly journals Acupuncture and electroacupuncture in the treatment of carpal tunnel syndrome: Systematic review

2020 ◽  
Vol 03 (01) ◽  
pp. 013-025
Author(s):  
Marc Badia ◽  
Manel M. Santafé
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Therapeutic Option ◽  
Scientific Evidence ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Medium Level ◽  
Tunnel Syndrome ◽  
High Level

Abstract Introduction Carpal tunnel syndrome (CTS) is the most diagnosed compression neuropathy of the upper limb. In mild and moderate cases, the treatment is extensive and controversial, whereas severe cases receive surgical intervention. Objective To analyze the scientific evidence on the effectiveness of treatment of CTS using acupuncture and electroacupuncture. Methods The PRISMA declaration was followed. A literature search was performed using the following databases: Clinical Evidence BMJ, NICE, Cochrane Library, PubMed, PEDro, Science Direct, SciELO, Google Scholar. The search strategy used the terms “acupuncture”, “electroacupuncture” “carpal tunnel syndrome”. The inclusion criteria limited studies to English publications. The risk of bias was assessed for each study using the Cochrane scale. The level of evidence and the level of recommendation was determined using the SIGN scale. Results The search retrieved 698 articles in total. After applying the inclusion and exclusion criteria, 21 articles were included. The level of evidence of all the articles was medium-high. The level of recommendation was medium, and the risk of bias was neutral, with a tendency towards low bias. The articles included revealed symptomatic and neurophysiological improvements, both peripheral as well as central, due to the cerebral response that occurs associated with the function of the median nerve. Conclusion Acupuncture and electroacupuncture are a therapeutic option for mild to moderate CTS with a medium level of scientific evidence, tending towards a high level, and with a medium level of recommendation.

Evaluation of PROMIS Outcomes for Surgical Treatment of Cubital Tunnel Syndrome With and Without Carpal Tunnel Syndrome

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
Amy Phan ◽  
Warren Hammert
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Postoperative Period ◽  
Cubital Tunnel Syndrome ◽  
Cubital Tunnel ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
Measurement Information System

Background: Assessment of outcomes for cubital tunnel syndrome (CuTS) surgeries has been difficult due to heterogeneity in outcome reporting. Our objective was to evaluate the outcomes for 2 cohorts treated surgically for isolated CuTS and for combined CuTS and carpal tunnel syndrome (CTS) using Patient Reported Outcomes Measurement Information System (PROMIS). Methods: There were 29 patients in the isolated CuTS cohort and 30 patients in the combined CuTS and CTS cohort. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) were completed preoperatively and 1-week, 6-weeks, and 3-months postoperatively. Responsiveness was evaluated by standardized response means (SRM). Results: Significant improvements from the 1-week to 6-week postoperative period are shown in the isolated CuTS cohort for PROMIS PF ( P = .002), PI ( P = .0002), and UE ( P = .02), but scores plateau after 6-weeks postoperatively. A similar pattern for the same time points was seen for the combined CuTS and CTS group for PROMIS PF ( P = .001), PI ( P = .02), and UE ( P = .04), with a plateau of scores beyond 6 weeks postoperatively. PROMIS UE was more responsive (SRM range: 0.11-1.03) than the PF (SRM range: 0.02-0.52) and PI (SRM range: 0.11-0.40), which were both mildly responsive for both cohorts. Conclusions: PROMIS lacks the sensitivity to show improvement beyond 6-weeks postoperatively for both isolated CuTS and combined CuTS and CTS. Patients with combined nerve compressions follow similar trajectories in the postoperative period as those with isolated CuTS. Level of Evidence: Level IV.

scholarly journals PROFILE OF PATIENTS WITH CARPAL TUNNEL SYNDROME TREATED AT A REFERRAL SERVICE

2020 ◽  
Vol 28 (3) ◽  
pp. 117-120
Author(s):  
HENVER RIBEIRO DE PAIVA FILHO ◽  
VALDÊNIA DAS GRAÇAS NASCIMENTO PAIVA ◽  
ELIAS FELIX DE OLIVEIRA ◽  
MURILO ANTÔNIO ROCHA
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Case Series ◽  
Hand Surgery ◽  
Elementary Level ◽  
Level Of Evidence ◽  
Women Smokers ◽  
Referral Service ◽  
Tunnel Syndrome ◽  
Epidemiological Characteristics

ABSTRACT Objective: To describe the clinical and epidemiological characteristics of people diagnosed with carpal tunnel syndrome (CTS) treated at a hand surgery outpatient clinic of a regional referral service. Methods: Interview and specific medical examination of 150 people diagnosed with CTS underwent, and statistical analysis of the results obtained. Results: Women smokers, in the fifth decade of life, married, overweight and educated until the elementary level prevailed in our study. Arterial hypertension and diabetes were the most reported comorbidities, and Durkan’s test was the most prevalent. Conclusion: CTS is prevalent in women in their fifth decade of life, with bilateral involvement and high school. The hypertension and diabetes are the most common diseases in people with CTS. Level of evidence IV, Case series.

Carpal tunnel decompression in patients with normal nerve conduction studies

2019 ◽  
Vol 45 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Samuel P. Mackenzie ◽  
Oliver D. Stone ◽  
Paul J. Jenkins ◽  
Nicholas D. Clement ◽  
Iain R. Murray ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Clinical Features ◽  
Carpal Tunnel ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Study Groups ◽  
Nerve Conduction Studies ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
Normal Nerve Conduction

Some patients present with typical clinical features of carpal tunnel syndrome despite normal nerve conduction studies. This study compared the preoperative and 1-year postoperative QuickDASH scores in patients with normal and abnormal nerve conduction studies, who underwent carpal tunnel decompression. Of the 637 patients included in the study, 19 had clinical features of carpal tunnel syndrome but normal nerve conduction studies, and underwent decompression after failure of conservative management. Preoperative QuickDASH scores were comparable in both groups (58 vs 54.8). However, there were significant differences between the normal and abnormal nerve conduction study groups in the QuickDASH at 1 year (34.9 vs 21.5) and change in QuickDASH postoperatively (23.1 vs 33.4). Patients with normal nerve conduction studies had comparable preoperative disability scores compared with those with abnormal studies. Although they had a significant improvement in QuickDASH at 1 year, this was significantly less than those with abnormal nerve conduction studies. Level of evidence: III

Cochrane corner: ergonomic positioning or equipment for treating carpal tunnel syndrome

2013 ◽  
Vol 38 (5) ◽  
pp. 580-581 ◽  
Author(s):  
S. Buchan ◽  
R. Amirfeyz
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Surgical Intervention ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Tunnel Syndrome ◽  
Mean Differences ◽  
The Cochrane Library

Background: Non-surgical treatments, including ergonomic positioning or equipment, are sometimes offered to people experiencing mild to moderate symptoms from carpal tunnel syndrome. The effectiveness and duration from ergonomic positioning or equipment interventions for treating carpal tunnel syndrome are unknown. Objectives: To assess the effects of ergonomic positioning compared with no treatment, a placebo or another non-surgical intervention in people with carpal tunnel syndrome. Search methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 2, in The Cochrane Library), MEDLINE (1966 to June 2011), EMBASE (1980 to June 2011), CINAHL Plus (1937 to June 2011), and AMED (1985 to June 2011). We also reviewed the reference lists of randomized or quasi-randomized trials identified from the electronic search. Selection criteria: Randomized or quasi-randomized controlled trials comparing ergonomic positioning or equipment with no treatment, placebo or another non-surgical intervention in people with carpal tunnel syndrome. Data collection and analysis: Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of included studies. They calculated risk ratios and mean differences with 95% confidence intervals for the primary and secondary outcomes. Results of clinically and statistically homogeneous trials were pooled, where possible, to provide estimates of the effect of ergonomic positioning or equipment.

Patient-reported outcomes of carpal tunnel release surgery in patients with bilateral severe carpal tunnel syndrome

2017 ◽  
Vol 42 (9) ◽  
pp. 932-936 ◽  
Author(s):  
C. Q. Y. Tang ◽  
S. W. H. Lai ◽  
S. C. Tay
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Complete Resolution ◽  
Patient Reported Outcomes ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery

This retrospective study examined whether the presenting complaint of numbness is relieved post-operatively in severe carpal tunnel syndrome and also assessed any correlation between outcomes of the first and second procedures in staged bilateral carpal tunnel releases. Carpal tunnel release (60 open and 38 endoscopic) was done in 49 patients with bilateral severe carpal tunnel syndrome. There was complete resolution of numbness post-operatively in 77% ( n = 75) of hands. The median post-operative time before complete resolution of numbness was 21 days (IQR 8 to 21; range 3 to 482). The likelihood of complete resolution of symptoms after the second carpal tunnel release in patients with complete resolution of symptoms after the first carpal tunnel release was 22 (95% CI: 4 to 131) times that of the likelihood of improvement in patients with incomplete resolution of symptoms after the first carpal tunnel release. Level of evidence: IV

Prevalence of decompression surgery in patients with carpal tunnel syndrome 8 years after initial treatment with a local corticosteroid injection

2016 ◽  
Vol 42 (3) ◽  
pp. 275-280 ◽  
Author(s):  
A. Hameso ◽  
J. D. P. Bland
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Decompression Surgery ◽  
Level Of Evidence ◽  
Clinically Important Difference ◽  
Group A ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire

Repeated local corticosteroid injections have become a common mode of treatment for carpal tunnel syndrome, despite an existing recommendation that no more than three injections should be given. We studied the clinical outcomes in 254 patients who initially opted for a corticosteroid injection into their carpal canal during 2007. Follow-up records of treatment were obtained for 157 patients of whom 41% had proceeded to surgery by 2015. A mean of 1.9 injections had been given before surgery. In the unoperated group, a mean of two (range 0–12) further injections had been given. The final subjective severity and functional status scores measured using the Boston carpal tunnel questionnaire were significantly lower in the operated than in the unoperated group, but both groups improved significantly from baseline. The differences between the final scores are less than the estimated minimal clinically important difference for these measures. We conclude that repeated steroid injection may be a valid treatment option for some patients with carpal tunnel syndrome. Level of evidence: III

Prospective evaluation of preoperative and postoperative sleep quality in carpal tunnel release

2018 ◽  
Vol 44 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Cüneyt Emre Okkesim ◽  
Sancar Serbest ◽  
Uğur Tiftikçi ◽  
Meriç Çirpar
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Level Of Evidence ◽  
Nerve Decompression ◽  
Tunnel Syndrome ◽  
Median Nerve Decompression

Sleep disturbance is a frequent symptom of carpal tunnel syndrome. The aim of this study was to investigate the effect of median nerve decompression on sleep quality of patients with this condition. The study sample consisted of 41 patients with severe carpal tunnel syndrome who were admitted to our clinic and treated with open median nerve decompression. Sensation and functional recovery of the patients were followed using the Boston Function Questionnaire, the Semmes–Weinstein monofilament test and the two-point discrimination test. Symptomatic recovery of the patients was followed by the Boston Symptom Questionnaire. The tests were used before surgery and at three and six months afterwards. Sensory, functional and symptomatic recovery from the third month to the sixth month following surgery also affected sleep parameters and improved the sleep quality of patients with carpal tunnel syndrome. Level of evidence: IV

scholarly journals Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study

2019 ◽  
Vol 45 (3) ◽  
pp. 226-230 ◽  
Author(s):  
Sina Hulkkonen ◽  
Kaisa Lampainen ◽  
Juha Auvinen ◽  
Jouko Miettunen ◽  
Jaro Karppinen ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Middle Age ◽  
Incidence Rates ◽  
Specialist Care ◽  
Level Of Evidence ◽  
Crude Incidence ◽  
Entrapment Neuropathies ◽  
Tunnel Syndrome ◽  
Nationwide Register Study

The aim of this study was to investigate the incidence rates and operations for carpal tunnel syndrome and ulnar and radial neuropathies in specialist care in Finland. Patients diagnosed with entrapment neuropathies of the upper extremity were identified from the Care Register for Health Care, 2007–2016. There were 81,911 cases in 54,095,070 person-years. The total crude incidence rates per 100,000 person-years among women and men were 197 and 105 for carpal tunnel syndrome, 26 and 36 for ulnar neuropathies, and 5.7 and 8.5 for radial neuropathies, respectively. Of these, carpal tunnel syndrome was operated on in 63% of women and 61% of men, ulnar neuropathy in 43% of women and 47% of men, and radial neuropathy in 11% of women and 8% of men. Incidence of carpal tunnel syndrome and ulnar neuropathies increased up to late middle age, while radial neuropathies were less common. Level of evidence: III

AN UNCOMMON CAUSE FOR A COMMON COMPLAINT

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 131-134 ◽  
Author(s):  
P. A. Rust ◽  
T. Bennett
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Extensive Review ◽  
Common Condition ◽  
Mycobacterium Kansasii ◽  
Review Of The Literature ◽  
Common Complaint ◽  
Carpal Tunnel Surgery ◽  
Tunnel Syndrome ◽  
High Level

Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.

scholarly journals PHALEN TEST POSITIVATION TIME AND ITS CORRELATION WITH ELECTRONEUROMYOGRAPHY

2020 ◽  
Vol 28 (3) ◽  
pp. 114-116
Author(s):  
THÚLIO ADLEY LIMA CUNHA ◽  
OSVALDO MENDES DE OLIVEIRA FILHO ◽  
MARCELO BARBOSA RIBEIRO
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Observational Study ◽  
Carpal Tunnel ◽  
Outpatient Clinic ◽  
Treatment Level ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Tunnel Syndrome

ABSTRACT Objective: To compare the classification of CTS by the Phalen test with electromyography. Methods: Cross-sectional observational study. Patients at orthopedic outpatient clinic with carpal tunnel syndrome were evaluated by the Phalen test and compared with the result of the electroneuromyography. Results: Sample of 33 patients, mostly women (87.9%). Most patients were already diagnosed with severe CTS by ENMG. The results of the Phalen test and the electromyography were equal in 26 of the 33 patients (78.8%). Conclusion: The Phalen test showed its applicability, since it had results similar to those of ENMG in most cases, especially in the most severe ones. The exam studied is a possible tool for the classification and recommendation of surgical treatment. Level of evidence IV, Retrospective observational study.

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