scholarly journals Acupuncture and related interventions for carpal tunnel syndrome: systematic review

2019 ◽  
Vol 34 (1) ◽  
pp. 34-44
Author(s):  
Irene XY Wu ◽  
Victor CK Lam ◽  
Robin ST Ho ◽  
William KW Cheung ◽  
Regina WS Sit ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Symptom Relief ◽  
Risk Of Bias ◽  
Manual Acupuncture ◽  
Superior Effect ◽  
Tunnel Syndrome

Objective: To synthesize evidence on the effectiveness of acupuncture and related therapies for primary carpal tunnel syndrome (CTS) by conducting a systematic review of randomized controlled trials (RCTs). Data Sources: Nine databases were searched for potential RCTs from their inception till July 2019. Review Methods: RCTs which reported at least one of the three outcomes were included: symptom severity, functional status and pain. Included RCTs were appraised using the Cochrane Risk of Bias Tool. Results: A total of 10 RCTs (728 participants) were included. Majority were at high risk of bias for blinding of participants, personnel and outcome assessors. When compared to conventional medications, manual acupuncture showed significant superior effect in reducing symptom than ibuprofen (mean difference (MD) on Symptom Severity Scale (SSS)) = –5.80, 95% confidence interval (CI): −7.95 to −3.65) and prednisolone (MD = −6.50, 95% CI: −10.1, −2.86). Electroacupuncture plus splinting was more effective in reducing symptom severity than splinting alone (SSS score: MD = −0.20, 95% CI: −0.36 to −0.03). Manual acupuncture showed significantly superior effect than ibuprofen in improving functional status (Functional Status Scale (FSS): MD = −1.84, 95% CI: −2.66 to −1.02). The combination of electroacupuncture and splinting showed more improvement in functional status compared to splinting alone (FSS: MD = −6.22, 95%CI: −10.7 to −1.71). Triple treatment of acupuncture, magnetic spectrum heat lamp and splinting showed stronger pain relief than splinting alone. Conclusion: For both symptom relief and function improvement, manual acupuncture is superior to ibuprofen while electroacupuncture plus splinting outperforms splinting alone. Limited evidence showed electroacupuncture’s potential role in pain reduction.

scholarly journals Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

2020 ◽  
Vol 13 (3) ◽  
pp. 49 ◽  
Author(s):  
Chih-Peng Lin ◽  
Ke-Vin Chang ◽  
Yi-Kai Huang ◽  
Wei-Ting Wu ◽  
Levent Özçakar
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Symptom Relief ◽  
Indirect Evidence ◽  
Therapeutic Effects ◽  
Tunnel Syndrome

This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections—including 5% dextrose (D5W) and platelet-rich plasma (PRP)—for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.

scholarly journals Reliability and Validity of The Finnish Version of The Boston Carpal Tunnel Questionnaire among Surgically Treated Carpal Tunnel Syndrome Patients

2019 ◽  
Vol 109 (4) ◽  
pp. 343-350
Author(s):  
J. Multanen ◽  
J. Ylinen ◽  
T. Karjalainen ◽  
H. Kautiainen ◽  
J. P. Repo ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Severity Scale ◽  
Floor Effect ◽  
Symptom Severity Scale ◽  
Boston Carpal Tunnel Questionnaire ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire

Background and Aims: The Boston Carpal Tunnel Questionnaire is the most commonly used outcome measure in the assessment of carpal tunnel syndrome. The purpose of this study was to translate the original Boston Carpal Tunnel Questionnaire into Finnish and validate its psychometric properties. Materials and Methods: We translated and culturally adapted the Boston Carpal Tunnel Questionnaire into Finnish. Subsequently, 193 patients completed the Finnish version of the Boston Carpal Tunnel Questionnaire, 6-Item CTS Symptoms Scale, and EuroQol 5 Dimensions 12 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire was re-administered after a 2-week interval. We calculated construct validity, internal consistency, test–retest reliability, and coefficient of repeatability. We also examined floor and ceiling effects. Results: The cross-cultural adaptation required only minor modifications to the questions. Both subscales of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Functional Status Scale) correlated significantly with the CTS-6 and EuroQol 5 Dimensions, indicating good construct validity. The Cronbach’s alpha was 0.93 for both the Symptom Severity Scale and Functional Status Scale, indicating high internal consistency. Test–retest reliability was excellent, with an intraclass correlation coefficient greater than 0.8 for both scales. The coefficient of repeatability was 0.80 for the Symptom Severity Scale and 0.68 for the Functional Status Scale. We observed a floor effect in the Functional Status Scale in 28% of participants. Conclusion: Our study shows that the present Finnish version of the Boston Carpal Tunnel Questionnaire is reliable and valid for the evaluation of symptom severity and functional status among surgically treated carpal tunnel syndrome patients. However, owing to the floor effect, the Functional Status Score may have limited ability to detect differences in patients with good post-operative outcomes.

scholarly journals THE BOSTON CARPAL TUNNEL QUESTIONNAIRE /BCTQ/ − A RELIABLE METHOD FOR DIAGNOSIS AND ASSESSMENT OF THE TREATMENT OF CARPAL TUNNEL SYNDROME

2020 ◽  
pp. 58-63
Author(s):  
Vladeva E. P.
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Subjective Assessment ◽  
Standard Methods ◽  
Tunnel Syndrome ◽  
Subjective Complaints ◽  
Boston Questionnaire ◽  
Objective Study

CTS is the most common compression neuropathy with an incidence of 125-515/100 000. It is a result of compression of the median nerve by the transverse carpal ligament. It is observed in 2 to 5% of the general population, more frequently in women.In the last few years the scientific society has acknowledged the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and more and more frequently it is being used as a standard in CTS patients. The literature also contains numerous studies on the diagnostics and treatment of CTS using BCTQ.Aim of study. To investigate the effect of a complex of physical factors on the reverse development of symptoms of moderate carpal tunnel syndrome using BCTQ and to compare the results of the BCTQ subjective rating (SSS) (symptom severity scale) and function − FSS (functional status scale) with objective assessment measured by the ENG parameters of n. medianus Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were examined. 38.60% of the patients were with right hand affected, 9 patients (15.80%) with left hand affected and 26 patients (45.60%) with bilateral involvement (n=26), In the last group, we examined both hands, i.e. 57 patients and 82 hands were investigated.Based on the analysis of our own studies, we applied the following complex physiotherapeutic program to the patients involved in the study: ultrasound, electrophoresis with Nivalin (Galantamine), and traditional kinesitherapy program.Results and discussion. By analyzing the results of the symptom severity assessment of the first part of the questionnaire we find that subjective complaints of patients decreased statistically significantly at the end of physiotherapy course from an average of 2.67 before treatment to 2.21 at the end of FTP (p <0.01). This trend continues within 1 − 4 months after the end of physiotherapy − average 1.79 and maintains up to 4 − 8 months when the mean of the results is 1.69 (p <0.001). We found that with regard to the recovery of the function of the affected hand and the way it affects some of the activities of daily living, the results of the second part of the BCTQ - functional status scale - show a statistically significant improvement at the end of the physiotherapy course 1.91 to an average of 1.63 (p <0.001), with a tendency for long-term retention and a slight decrease in the average of the results obtained to 1.37 within the first control examination at 1-4 months (p <0.001) and resistance to this trend in the following months (4-8) − 1.31 (p <0.001).Based on the ANOVA analysis and the calculation of the η coefficient, we proved that there is no significant difference in the results obtained from the Boston questionnaire and those from the ENG examination. There is a high percentage of overlap - from 53.10% to 95.60%.Although the results of the questionnaire are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of CТ C studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severityConclusions. In the presented facts of the discussion impression makes the patient's influence both on the subjective complaints and the clinical symptoms as well as on the degree of restoration of the affected hand functions at the end of the physiotherapy course, the continuation of this trend up to 4 months after the end of the treatment and maintaining it for 4 to 8 months.Although the results of BCTQ are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of carpal tunnel studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severity

scholarly journals Surgical treatment results of carpal tunnel syndrome in patients with and without type 2 diabetes mellitus

2014 ◽  
Vol 142 (11-12) ◽  
pp. 675-679 ◽  
Author(s):  
Melih Malkoc ◽  
Özgür Korkmaz ◽  
Ismail Oltulu ◽  
Ali Seker ◽  
Ferhat Say ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Severity Score ◽  
Type 2 Dm ◽  
Status Score ◽  
Symptom Severity Score ◽  
Tunnel Syndrome

Introduction. Carpal tunnel syndrome (CTS) is the most commonly seen peripheral nerve compression syndrome and CTS surgery is the most common surgery done for peripheral nerve compression syndromes. Type 2 diabetes mellitus (DM) is a systemic disease with a component of peripheral neuropathy. Objective. We aimed to investigate the effects of type 2 DM on functional results in type 2 DM patients who underwent carpal tunnel surgery. Methods. The study included 39 patients with carpal tunnel syndrome which was confirmed by electromyography. Twenty-one patients did not have DM, 18 patients had type 2 DM that were treated for DM and had regulated blood glucose levels. Assessments were done with the Boston scale. All operations were done by the same surgical team using the same surgical technique. Functional and symptomatic scores between the two groups were compared with the Mann-Whitney U test which is the non-parametric version of the Student?s t test, and 95% confidence interval p<0.05, which is considered as statistically significant. Results. In patients with type 2 DM, preoperative mean Symptom Severity Score was 3.6?0.35 (2.9 to 4.2) in the last control mean Symptom Severity Score was 1.2?0.16 (1.0-1.7), and preoperative mean functional status score was 3.3?0.56 (2.3 to 4.5) and in the last control mean functional status score was 1.3?0.36 (1.0 to 2.4). The patients without DM, preoperative mean Symptom Severity Score was 3.5?0.45 (2.8 to 4.2) in the last control mean Symptom Severity Score was 1.2?0.19 (1.0 to 1.6), and preoperative functional status score was 3.2?0.47 (2.4 to 4.6) in the last control mean functional status score was 1.3?0.35 (1.0 to 2.5). There was no statistically significant difference between the two groups. Conclusion. Type 2 DM patients with regulated blood glucose levels can be operated without additional procedure during and after surgery for carpal tunnel syndrome like in carpal tunnel syndrome patients without DM.

scholarly journals Intralesional steroid and ultrasound therapy in patients with carpal tunnel syndrome

2019 ◽  
Vol 12 (4) ◽  
pp. 177-181
Author(s):  
Md. Israt Hasan ◽  
Syed Mozaffar Ahmed
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Naproxen Sodium ◽  
Ultrasound Therapy ◽  
Severity Scores ◽  
Intralesional Steroid ◽  
Tunnel Syndrome ◽  
Wrist Splint

The study aimed to compare the effects of intralesional steroid injection and ultrasound therapy for the treatment of carpal tunnel syndrome. A total 130 patients divided into 2 groups: a) One group (n=65) received intralesional corticosteroid injection along with wrist splint, exercise, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=65) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with  Wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks. The patients were followed-up 2 weekly for 4 weeks. The visual analogue score, symptom severity scores and functional status scores were significantly improved within each group at week 2 (p<0.05) and week 4 (p<0.05) except for the symptom severity score at (p>0.05). The improvement in symptom severity scores and functional status scores in the intralesional steroid group was more than in the ultrasound therapy group after 4 weeks.

scholarly journals A Prospective, Randomized Trial Comparing Open and Endoscopic Carpal Tunnel Release Within the Same Patient

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 322-326 ◽  
Author(s):  
Brett M. Michelotti ◽  
Kavita T. Vakharia ◽  
Diane Romanowsky ◽  
Randy M. Hauck
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Status ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Carpal Tunnel Release ◽  
Demographic Data ◽  
Pinch Strength ◽  
Postoperative Time ◽  
Tunnel Syndrome ◽  
A Prospective Study

Background: Surgical management of carpal tunnel syndrome includes performing an endoscopic (ECTR) or open (OCTR) carpal tunnel release. Several studies have shown less postoperative pain and improvement in grip and pinch strength with the endoscopic technique. The goal of this study was to prospectively examine outcomes, patient satisfaction, and complications after both ECTR and OCTR in the opposite hands of the same patient. Methods: This was a prospective study in which patients with bilateral carpal tunnel syndrome underwent surgical release with both techniques, with initial operative approach randomized in the more symptomatic hand. Demographic data and functional outcomes were recorded, including the pain score, 2-point discrimination, Semmes-Weinstein monofilament testing, thenar strength testing, grip strength, carpal tunnel syndrome functional status score, carpal tunnel syndrome symptom severity score, and overall satisfaction. Results: Thirty patients completed the study; there were no significant differences in any measure at any of the postoperative time points. Symptom severity and functional status scores were not significantly different between groups at any evaluation. Subjectively, 24 of 30 patients did state they preferred the ECTR, mostly citing less pain as their primary reason, although pain scores were not significantly different. Differences in overall satisfaction were also not significant. Conclusions: Both techniques are well tolerated with no differences in outcomes. With the added cost and equipment associated with ECTR, and no added benefit, the usefulness of ECTR is questionable.

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