Effectiveness of surgical versus conservative treatment for carpal tunnel syndrome: A systematic review, meta-analysis and qualitative analysis

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters.Methods: Systematic searches of PubMed and EBSCO host were conducted to identify the studies published between 1990 and 2016, comparing any surgical treatment to any conservative treatment. Participants were adults with a diagnosis of CTS, with symptom duration ranging from 8 months to 3 years. A meta-analysis and a qualitative analysis were conducted to summarize the results of the included studies and establish any agreement between the two.Results: A total of 15 studies were included in the study and 10 were included in the meta-analysis, involving 1787 wrists. The qualitative and quantitative analyses were consistent with the results of both indicating that surgical treatment leads to a greater improvement of symptoms at six months (mean difference: 0.52, 95%CI 0.27 to 0.78) and a greater improvement of neurophysiological parameters [distal motor latency (mean difference: 0.31, 95%CI 0.06 to 0.56), sensory nerve conduction velocity (mean difference: 3.71 m/s, 95%CI 1.94 to 5.49)]. At 3 months and 12 months, the results were not significant in favor of surgery or conservative treatment.Conclusion: Conservative treatment for CTS should be preferred for mild and short-term CTS. Surgery is more effective than conservative in CTS, and should be considered in persisting symptoms, taking into account the complications, which are more severe after surgery. Further research should focus on the field of manual therapy and compare it to surgical treatment for CTS.

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When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.8555 ◽

2021 ◽

Vol 67 (4) ◽

pp. 518-525

Author(s):

Zuhal Özişler ◽

Müfit Akyüz

Keyword(s):

Carpal Tunnel Syndrome ◽

Spontaneous Activity ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Sensory Nerve ◽

Symptom Duration ◽

Thenar Muscle ◽

Distal Motor Latency ◽

Motor Latency ◽

Tunnel Syndrome

Objectives: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). Patients and methods: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. Results: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). Conclusion: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

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Effect of Platelet-Rich Plasma Injection on Mild or Moderate Carpal Tunnel Syndrome: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

BioMed Research International ◽

10.1155/2020/5089378 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Chunke Dong ◽

Yan Sun ◽

Yingna Qi ◽

Yuting Zhu ◽

Hongyu Wei ◽

...

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Nerve Conduction Velocity ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Sensory Nerve ◽

Controlled Trials ◽

Randomized Controlled ◽

Tunnel Syndrome

Objective. To evaluate efficacy of platelet-rich plasma (PRP) injection in carpal tunnel syndrome (CTS), we conducted this meta-analysis, as well as proposed a protocol for its application in curative processes. Methods. All randomized controlled trials (RCTs) of PRP for the management of mild or moderate CTS were included in this study. Database search was conducted from study inception to July 2020, including PubMed, Embase, Web of Science, and Cochrane Library. We used visual analogue scores (VAS) and the Boston Carpal Tunnel Questionnaire (BCTQ) as evaluation tools for primary outcomes. Second outcomes comprised cross-sectional area (ΔCSA) and electrophysiological indexes including distal motor latency (DML), sensory peak latency (SPL), motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), compound muscle action potential (CMAP), and sensory nerve action potential (SNAP). The pooled data were analyzed using RevMan 5.3. Subgroup and sensitivity analyses were conducted with the evidence of heterogeneity. Egger’ test was used to investigate publication bias. Results. 9 RCTs were finally screened out with 434 patients included. Control groups comprised corticosteroid injection in 5 trials, saline injection in 1 trial, and splint in 3 trials. At the 1st month after follow-up, only ΔCSA between the PRP group and the control group showed significant difference ( P < 0.05 ). In the 3rd month, there were statistically significant differences in VAS, BCTQ, SPL, SNCV, and ΔCSA between two groups ( P < 0.05 ), while no statistically significant differences were found in the remaining outcomes. In the 6th month, there were statistically significant differences at BCTQ ( P < 0.05 ) in primary outcomes and ΔCSA ( P < 0.05 ) in secondary outcomes between two groups. As to adverse events in PRP injection, only one study reported increased pain sensation within 48 h after injections. Conclusion. This systematic review and meta-analysis demonstrates that the PRP could be effective for mild to moderate CTS and superior to traditional conservative treatments in improving pain and function and reducing the swelling of the median nerve for a mid-long-term effect. To some extent, the electrophysiological indexes also improved after PRP injection compared with others conservative treatments.

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Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome

Scientific Reports ◽

10.1038/s41598-021-00353-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Djamila Rojoa ◽

Firas Raheman ◽

Joseph Rassam ◽

Ryckie G. Wade

Keyword(s):

Diffusion Tensor Imaging ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Diffusion Tensor ◽

Meta Analysis ◽

Mean Diffusivity ◽

Mean Difference ◽

Fiber Density ◽

Tunnel Syndrome

AbstractCarpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve ‘health’ which are sensitive to myelination, axon diameter, fiber density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS. This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods. We included 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS. The normal FA was 0.58 (95% CI 0.56, 0.59) and the normal MD was 1.138 × 10–3 mm2/s (95% CI 1.101, 1.174). Patients with CTS had a significantly lower FA than controls (mean difference 0.12 [95% CI 0.09, 0.16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0.16 × 10–3 mm2/s [95% CI 0.05, 0.27]). The differences were independent of experimental factors. We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.

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Diffusion Tensor Imaging of the Median Nerve: A Systematic Review and Meta-Analysis of Normal Values in Asymptomatic Adults and How They Change in Carpal Tunnel Syndrome

10.21203/rs.3.rs-697643/v1 ◽

2021 ◽

Author(s):

Djamila Rojoa ◽

Firas Raheman ◽

Joseph Rassam ◽

Ryckie George Wade

Keyword(s):

Systematic Review ◽

Diffusion Tensor Imaging ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Diffusion Tensor ◽

Meta Analysis ◽

Mean Diffusivity ◽

Mean Difference ◽

Tunnel Syndrome

Abstract Background: Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve ‘health’ which are sensitive to myelination, axon diameter, fibre density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS.Methods: This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods.Results: 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS were included. The normal FA was 0·58 (95% CI 0·56, 0·59) and the normal MD was 1·138 x10-3 mm2/s (95% CI 1·101, 1·174). Patients with CTS had a significantly lower FA than controls (mean difference 0·12 [95% CI 0·09, 0·16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0·16 mm2/s x10-3 [95% CI 0·05, 0·27]). The differences were independent of experimental factors.Conclusion: We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.

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Electrophysiological and Clinical Improvement in Non-Invasive Treatment of Carpal Tunnel Syndrome

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530320666200728152953 ◽

2020 ◽

Vol 20 ◽

Author(s):

Riccardo Marvulli ◽

Giancarlo Ianieri ◽

Grazia Devenuto ◽

Marta Falcicchio ◽

Giulia A. Gallo ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Sleep Quality ◽

Conduction Velocity ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Nerve Conduction Velocity ◽

Pantothenic Acid ◽

Sensory Nerve ◽

Sensory Nerve Conduction Velocity ◽

Tunnel Syndrome

Background and Objective: Carpal tunnel syndrome (CTS) is the most common form of nerve entrapment. Clinically, various signs and symptoms compare due to overexposure to mechanical vibrations transmitted to the wrist bones and cartilage, resulting in compression of the sensory and motor nerve fibers of median nerve. Early symptoms include nocturnal paresthesia and electromyography reveals reduced sensory nerve conduction velocity. Aim of this study was to evaluate the efficacy of a dietary integrator composed of acetyl-L-carnitine, α-lipoic acid,quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins in patients with early (minimal) carpal tunnel syndrome. Methods: 36 patients (28 female and 8 male) with early CTS characterized by sensory nerve demyelination and inflammation of the transverse carpal ligament. Patients were divided into two groups, group A (18 patients received physical therapy) and group B (18 patients, received physical therapy and an oral integrator). Clinical (sleep quality questionnaire to measure severity of paresthesia) and neurophysiological assessment (Sensory Nerve Conduction Velocity) performed at baseline, and then at 30 and 60 days after treatment. Results: Sleep quality and Sensory Nerve Conduction Velocity data analysis show improvement in both groups at 30 and 60 days, with statistically difference between them in both time of analysis. Conclusions: In the early CTS, with sensory fibers damage, use of dietary integrator, such as Micronil Dol®, composed composed of acetyl-L-carnitine, α-lipoic acid,quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins can be effective in quick recovery of median nerve sensory.

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Platelet-rich plasma in non-operative management of mild to moderate carpal tunnel syndrome – A systematic review & meta-analysis of short-term outcomes

Journal of Orthopaedics ◽

10.1016/j.jor.2021.05.004 ◽

2021 ◽

Author(s):

Martin S. Davey ◽

Matthew G. Davey ◽

Eoghan T. Hurley ◽

J. Tristan Cassidy ◽

Hannan Mullett ◽

...

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Operative Management ◽

Short Term ◽

Tunnel Syndrome ◽

Non Operative Management

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Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211001715 ◽

2021 ◽

pp. 175319342110017

Author(s):

Saskia F. de Roo ◽

Philippe N. Sprangers ◽

Erik T. Walbeehm ◽

Brigitte van der Heijden

Keyword(s):

Systematic Review ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Meta Analysis ◽

Surgical Techniques ◽

Open Release ◽

Flap Coverage ◽

Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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