scholarly journals Bipolar pulsed radiofrequency neuromodulation of median nerve for treatment of carpal tunnel syndrome – a preliminary study

2021 ◽  
Vol 75 ◽  
pp. 107-110
Author(s):  
Adam Krzywda ◽  
Agata Wypych-Ślusarska ◽  
Karolina Krupa-Kotara ◽  
Klaudia Oleksiuk ◽  
Joanna Głogowska-Ligus ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Sensory Nerve ◽  
Pulsed Radiofrequency ◽  
Numerical Rating ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire

WstępWyniki chirurgicznego odbarczenia nerwu pośrodkowego u części chorych z zespołem cieśni nadgarstka są niezadowalające. Celem pracy jest ocena wczesnych wyników leczenia zespołu cieśni nadgarstka (<i>carpal tunnel syndrome</i> – CTS) za pomocą bipolarnej neuromodulacji nerwu pośrodkowego (<i>median nerve</i> – MN) z użyciem prądu o częstotliwości radiowej w trybie pulsacyjnym (<i>pulsed radiofrequency</i> – PRF).Materiał i metodyLeczeniu poddano 15 dorosłych pacjentów z CTS (10 kobiet i 5 mężczyzn, średni wiek 58,5 roku). Zastosowano technikę bipolarnej neuromodulacji z użyciem prądu PRF. Prawidłowość położenia elektrod potwierdzano neurofizjologicznie. Protokół badania składał się z kwestionariusza objawów zespołu cieśni nadgarstka (Boston Carpal Tunnel Questionnaire – BCTQ), skali numerycznej NRS (Numerical Rating Scale) dla oceny bólu oraz oceny siły mięśniowej przed neuromodulacją oraz 4 i 12 tygodni po leczeniu. Ponadto oceniano szybkość przewodnictwa czuciowego w nerwie pośrodkowym (<i>sensory nerve conduction velocity</i> – SNCV) przed i 12 tygodni po interwencji.WynikiStwierdzono znamienną poprawę w zakresie podskal BCTQ dotyczących ciężkości objawów (33,53 ± 8,25 przed zabiegiem vs. 18,33 ± 11,06 i 25,67 ± 12,39 po upływie 4 i 12 tygodni od zabiegu) oraz stanu czynnościowego (21,0 ± 5,79 vs. 12,07 ± 7,20 i 17,73 ± 9,09), a także poprawę siły mięśniowej (3,39 ± 1,68 vs. 5,86 ± 1,98 i 4,93 ± 2,22). Ponadto stwierdzono redukcję bólu i poprawę SNCV, jednak parametry te nie osiągnęły znamienności statystycznej.WnioskiNeuromodulacja nerwu pośrodkowego za pomocą prądu PRF przeprowadzona techniką bipolarną jest obiecującą metodą leczenia pacjentów z CTS i może być alternatywą dla chirurgicznego uwolnienia nerwu pośrodkowego. Dla oceny trwałości poprawy klinicznej po zastosowanym leczeniu konieczny będzie dłuższy okres obserwacji.

Ultrasound of the Median Nerve in the Surgical Treatment of Severe Carpal Tunnel Syndrome

Hand ◽  
2021 ◽  
pp. 155894472098807
Author(s):  
William Melton ◽  
Maximillian Soong ◽  
Gabrielle Paci ◽  
Brian Clair ◽  
Dayana Blanchet ◽  
...  
Keyword(s):  
High Resolution ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Statistical Significance ◽  
Objective Assessment ◽  
Boston Carpal Tunnel Questionnaire ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Questionnaire

Background High-resolution ultrasound (HRU) has demonstrated utility in the diagnosis and treatment of carpal tunnel syndrome (CTS) by measuring the cross-sectional area (CSA) of the median nerve. We investigated whether HRU could be helpful in evaluating outcomes of carpal tunnel release in patients with severe CTS. Methods Patients greater than 18 years of age with severe CTS on electrodiagnostic (EDX) studies and scheduled to have carpal tunnel release were enrolled. At baseline visit within 6 weeks preoperatively, HRU was used to measure median nerve CSA at the carpal tunnel inlet and forearm, and the wrist/forearm ratio (WFR) was calculated. Patients also completed the Boston Carpal Tunnel Questionnaire (BCTQ). Ultrasound and BCTQ were repeated at 6 weeks and 6 months postoperatively. Results Twelve patients completed the study (average age, 69 years; range, 52-80 years). The WFR improved significantly at 6 weeks and reached normal levels at 6 months. The CSA at the wrist also improved at 6 months, although this did not reach statistical significance ( P = .059). Boston Carpal Tunnel Questionnaire symptoms and function scores improved significantly at 6 weeks and 6 months. Conclusions High-resolution ultrasound provides an objective assessment of surgical outcomes in cases of severe CTS, demonstrating normalization of WFR in our series of successful cases. Future study of poor outcomes may help determine whether improvement in WFR and CSA can provide reassurance and support for observation rather than reoperation. Ultrasound also provides anatomical evaluation and may be helpful in cases with medicolegal or psychosocial issues while potentially being less costly and better tolerated than EDX or magnetic resonance imaging.

scholarly journals The Effectiveness of Ultrasound-Guided Steroid Injection Combined with Miniscalpel-Needle Release in the Treatment of Carpal Tunnel Syndrome vs. Steroid Injection Alone: A Randomized Controlled Study

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Subo Zhang ◽  
Fei Wang ◽  
Songjian Ke ◽  
Caina Lin ◽  
Cuicui Liu ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Action Potential ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Sensory Nerve ◽  
Controlled Study ◽  
Injection Group ◽  
Tunnel Syndrome ◽  
Release Group

Objectives. Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients’ work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. Methods. Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. Results. Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). Conclusions. The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.

scholarly journals Ultrasonographic and electrophysiological outcomes of carpal tunnel syndrome treated with low-level laser therapy: A double-blind, prospective, randomized, sham-controlled study

2021 ◽  
Author(s):  
Merve Nalbant ◽  
Oya Ümit Yemişci ◽  
Selin Özen ◽  
Şehnaz Tezcan
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Therapy Group ◽  
Sensory Nerve ◽  
Nerve Conduction Studies ◽  
Low Level Laser Therapy ◽  
Level Laser ◽  
Tunnel Syndrome

Objectives: The aim of this study was to investigate the therapeutic effects of low-level laser therapy (LLLT) on clinical, ultrasonographic (US), and electrophysiological findings in carpal tunnel syndrome (CTS). Patients and methods: Between January 2015 and August 2015, 42 patients (7 males, 35 females; mean age: 50.4±8.7 years; range, 32 to 65 years) with mild-to-moderate CTS were randomly assigned to one of two groups: active LLLT (therapy group, n=22) 0.8 J/painful point and sham LLLT groups (n=20). Both groups wore neutral wrist orthoses. The patients were evaluated before and after 15 sessions of therapy (670 nm, 4 J/session over the carpal tunnel). Follow-up parameters included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), nerve conduction studies and US evaluation of the median nerve cross-sectional area (CSA), vascularization (via power Doppler), flattening ratio (FR), and palmar bowing of the flexor retinaculum. Results: Nocturnal paresthesia improved in both groups; however, pain and patients with a positive Phalen’s test reduced only in the therapy group (p=0.031). The FSS and SSS scores also improved only in the therapy group (p<0.001). Electrophysiologically, median sensory nerve conduction velocities showed a significant improvement only in the therapy group (p=0.002). The CSA, FR, and vascularization of the median nerve showed a significant improvement in the therapy group alone (p<0.001, p=0.048, and p=0.021, respectively). Conclusion: Improvements in the signs and symptoms of CTS and hand function, the improvements in sensory nerve conduction studies, and reduction in median nerve CSA, FR and vascularity in the LLLT group can be attributed to the anti-inflammatory and analgesic effects of LLLT. This study provides new US data demonstrating efficacy of LLLT along with a clinical and electrophysiological improvement. The LLLT seems to be an easily applied, non-invasive treatment option.

scholarly journals Etiology of Carpal Tunnel Syndrome in a Large Cohort of Children

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 624
Author(s):  
Christina T. Rüsch ◽  
Ursula Knirsch ◽  
Daniel M. Weber ◽  
Marianne Rohrbach ◽  
André Eichenberger ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Vascular Malformations ◽  
Sensory Nerve ◽  
Imaging Data ◽  
Sensory Nerve Action ◽  
Tunnel Syndrome ◽  
Underlying Disorder ◽  
Mixed Nerve

(1) Background: Carpal tunnel syndrome (CTS), a compressive mononeuropathy of the median nerve at the wrist, is rare in childhood and occurs most frequently due to secondary causes. (2) Methods: Medical history, electrodiagnostic findings, and imaging data of patients with CTS from two pediatric neuromuscular centers were analyzed retrospectively. The etiology of CTS was investigated and compared with the literature. (3) Results: We report on a cohort of 38 CTS patients (n = 22 females, n = 29 bilateral, mean age at diagnosis 9.8 years). Electrodiagnostic studies of all patients revealed slowing of the antidromic sensory or orthodromic mixed nerve conduction velocities across the carpal tunnel or lack of the sensory nerve action potential and/or prolonged distal motor latencies. Median nerve ultrasound was diagnostic for CTS and confirmed tumorous and vascular malformations. Etiology was secondary in most patients (n = 29; 76%), and mucopolysaccharidosis was the most frequent underlying condition (n = 14; 37%). Idiopathic CTS was rare in this pediatric cohort (n = 9; 24%). (4) Conclusion: Since CTS in childhood is predominantly caused by an underlying disorder, a thorough evaluation and search for a causative condition is recommended in this age group.

scholarly journals Effect of Gabapentin on nerve conduction studies in carpal tunnel syndrome

2018 ◽  
Vol 5 (1) ◽  
pp. 1923-1930 ◽  
Author(s):  
Reza Sabet ◽  
Karamatollah Rahmanian ◽  
Abdolreza Sotoodeh Jahromi ◽  
Abdolhossein Madani
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Sensory Nerve ◽  
Nerve Conduction Studies ◽  
Quasi Experimental ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B

Background: The most common type of neuropathy in adults is carpal tunnel syndrome (CTS) which is caused by compression of the median nerve at the wrist. Methods: This quasi-experimental study was conducted to determine the efficacy of gabapentin on nerve conduction studies in patients with mild CTS. The patients with mild CTS were randomly allocated into two groups. Group A received naproxen alone (500 mg/day, orally) while group B received both gabapentin (100-300 mg) and naproxen (500 mg/day, orally) for two months. Sensory nerve conduction velocity (SNCV) and distal motor latency (DML) were performed at baseline and two months after treatment. Results: There were no significant differences between the two groups with regards to the outcome parameters before initiation of intervention. The SNCV and DML showed no significant improvements in group A (p>0.05), whereas for group B the SNCV and DML of the median nerve were significantly improved at two months after treatment (p<0.001). Conclusion: Gabapentin was found to be effective for SNCV and DML in patients with mild CTS over a two-month period.

scholarly journals Effects of Cervical Manual Therapy Versus Conventional Physical Therapy on Clinical Outcomes in People With Carpal Tunnel Syndrome: A Study Protocol for a Randomized Controlled Trial

2021 ◽  
Author(s):  
Milad Zarrin ◽  
maryam saadat ◽  
Mohammad Jafar Shaterzadeh ◽  
Davood Shalil Ahmadi
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Therapy ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Manual Therapy ◽  
Carpal Tunnel ◽  
Controlled Trial ◽  
Sensory Nerve ◽  
Randomized Controlled ◽  
Tunnel Syndrome

Abstract BackgroundCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy. A recent systematic review described limited or no evidence about the conservative interventions. Literature has expressed that more proximal area such as the cervical spine is involved in CTS. Therefore, the aim of this study is to examine the effects of combination cervical manual therapy and conventional physical therapy on pain, self-reported function, and electrophysiological findings in the management these patients.MethodsThis study will be a double-blind, parallel-group, randomized, controlled trial (RCT) in which carpal tunnel syndrome subjects randomize to either conventional or combined exercise groups. The conventional group take routine physical therapy treatments, while patients in combine exercise group receive cervical manual therapy plus routine physical therapy treatments. All patients receive 10 sessions of supervised intervention. The outcome measures included visual analogue scale (VAS), Boston Carpal Tunnel and DASH questionnaire, motor distal latencies and sensory nerve conduction velocity of median nerve. They obtain pre- and post-intervention. DiscussionThe findings of this study will provide knowledge about the comparison effectiveness of conventional physical therapy with and without cervical manual therapy on symptom severity, functional status, disability, velocity and latency median nerve in patients with CTS.Trial registrationIranian Registry of Clinical Trials, IRCT20201201049565N1. Registered on 15 December 2020.

scholarly journals The Potential Benefit of Intracarpal Pressure Measurement in Endoscopic Carpal Tunnel Syndrome Surgery – An Analysis of EMG Findings and Pressure Values

2009 ◽  
Vol 52 (2) ◽  
pp. 63-68 ◽  
Author(s):  
Martin Kanta ◽  
Edvard Ehler ◽  
Jan Kremláček ◽  
Svatopluk Řehák ◽  
David Laštovička ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Pressure Measurement ◽  
Nerve Conduction ◽  
Motor Response ◽  
Sensory Nerve ◽  
Sensory Nerve Action ◽  
Invasive Method ◽  
Tunnel Syndrome

Endoscopic carpal tunnel syndrome surgery is a modern minimally invasive method of carpal tunnel decompression. However, the method does also have its critics, who emphasize that there is an increased rate of complications in comparison to open procedures. To further improve and optimize results of endoscopic surgery we used an intracarpal pressure sensor to verify the effect of carpal tunnel decompression. The endoscopic single portal approach was used in all cases. Median nerve conduction studies were performed prior to and 3 months after surgery. Two groups, those with pressure studies and those without, were then compared according to several EMG parameters such as: median nerve distal motor latency, amplitude of motor response, sensory nerve conduction velocity to the index finger, and amplitude of sensory nerve action potential. In both groups, we observed similarly significant improvements in all conduction parameters, except the amplitude of motor response, which did not change in either group, i.e. no difference in postoperative EMG between the two groups was observed. Despite this fact, intracarpal pressure measurement is still useful in localising the point in which the median nerve is compressed and provides valuable functional information on the level decompression achieved.

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