scholarly journals Function of Microscopic Carpal Tunnel Release in Cases Resistant to Conservative Therapy

2021 ◽  
Vol 6 (4) ◽  
pp. 89-96
Author(s):  
Jehan Zeb ◽  
Muhammad Ullah ◽  
Muhammad Shoaib ◽  
Syed Shah ◽  
Walayat Shah ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Carpal Tunnel Release ◽  
P Value ◽  
Symptom Severity Score ◽  
Tunnel Syndrome ◽  
The Mean ◽  
And Function

Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment. Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up. Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.

Effect of Conservative Treatment on Alleviation of Symptoms in 36 cases of Carpal Tunnel Syndrome in Pregnancy: A Prospective Study

2018 ◽  
Vol 4 (2) ◽  
pp. 101-107
Author(s):  
Badrunnesa Ahmed ◽  
Md Shafiqul Alam ◽  
Md Abdul Halim ◽  
AKM Salek ◽  
Md Jahidul Islam ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Conservative Management ◽  
P Value ◽  
Physical Medicine ◽  
Functional Capability ◽  
Tunnel Syndrome ◽  
The Mean ◽  
In Pregnancy

Background: Carpal Tunnel Syndrome (CTS) is the most common upper extremity compression neuropathy which is a common entrapment neuropathy seen in pregnant women.Objective: The purpose of the present study was to assess presentation and severity of various symptoms among women with CTS in pregnancy and to see the effect of conservative management protocols in alleviation of symptoms of the disease and restoration of functional capability of the affected hands.Methodology: This interventional study was included 36 pregnant women attended in the Outpatient Department of Physical Medicine and Rehabilitation Specialist in the Hi-Tech Multicare Hospital, Dhaka during the period from January 2015 to January 2016 for a period of one year and one month. Detail history was taken and examined physically by a specialist in physical medicine to ascertain the clinical diagnosis. Out of 48 referred cases, 42 pregnant women were identified clinically as CTS cases based on symptoms and signs. However, 2 cases were not enrolled because of severe form of pain and referred to other hospital for admission and 6 patient dropped out. Therefore, 36 cases with CTS symptoms included in this study. All the patients were given conservative treatment (Wrist splint, Exercise and activity modification) for 8 weeks. All patients were followed up at 4 weeks interval. Treatment outcome were measured by Boston carpal tunnel questionnaire (BCTQ).Result: The mean age of the patients is 30±3.5 years. 26 (78%) patients mild to moderate type of CTS symptoms showed improvement in conservative management. Before treatment the mean symptoms severity scale (SSS) of BCTQ) was 2.32±0.4 and for functional status scale (FSS) was it was 1.99±0.43. After treatment for SSS 1.86±0.47 and for FSS 1.53±0.42. And in SSS the p value<.05 and in FSS p value is <.05 which was statistically significant.Conclusion: In conclusion conservative management protocols are sufficient enough in alleviation of symptoms of the disease and is effective for the restoration of functional capability of the affected hand or hands.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 101-107

scholarly journals Surgical Outcome of Open Carpal Tunnel Release Using Global Symptom Severity Score

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
MUHAMMAD NAWAZ KHAN ◽  
RIAZ-UR- REHMAN ◽  
RIZWAN ULLAH KHATTAK ◽  
ATTIYA NASIR SIDDIQUE ◽  
M. ALI NOMAN
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Severity Score ◽  
Surgical Outcome ◽  
Carpal Tunnel Release ◽  
Dominant Hand ◽  
Symptom Severity Score ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release

Objective:  Purpose of conducting this study was to evaluate the surgical outcome of open carpal tunnel release using Global Symptom Severity score (GSS) in our local setting. Material and Methods:  This prospective analytical study was conducted in the Neurosurgery Department Hayatabad Medical Complex, Peshawar. We operated consecutive 105 Carpal tunnel syndrome cases over a period of 2 years via open carpal tunnel release (OCTR) method. All of these cases were surgically indicated. All patients were evaluated preoperatively with clinical assessment and NCS. Cases were operated under local anesthesia as a day case surgery. Patients were evaluated at 3 months follow-up visit using global symptom severity score (GSS) and compared with pre operative GSS. The paired sample test was applied to obtain p value. Results:  Total 105 patients were operated during study period. 72 (69%) patients were women and 33 (31%) were men. The mean age of patients was 41 years. 70 (66.66%) procedures were done for the right hand and 35 (33.33%) were performed for left hand. Pre-op Mean GSS score was 27 ± 2.5 which decreased to 2.1 ± 0.43 postoperatively (P < 0.005). Conclusion:  Carpal tunnel syndrome is more commonly affecting the dominant hand of middle aged females. Open carpal tunnel release procedure is the safe and effective treatment for this compressive neuropathy.

scholarly journals Improvement of Sleep Quality after Surgical Decompression in Carpal Tunnel Syndrome

2021 ◽  
Author(s):  
Nguyen Le Trung Hieu ◽  
Nguyen Anh Sang ◽  
Nguyen Lam Vuong
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Surgical Decompression ◽  
Poor Sleep ◽  
Tunnel Syndrome ◽  
And Function ◽  
Hand Symptoms ◽  
The Impact

Abstract Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy which can cause severe sleep disturbance. Carpal tunnel release (CTR) is a choice for severe cases, which has shown to improve sleep quality, but the available evidence is limited. This study aimed to investigate the impact of CTR on sleep quality and hand symptoms and functions in patients with CTS. Methods This was a prospective study in 2019–2020 on patients with CTS and poor sleep quality undergoing CTR. Patients were evaluated before and at 1, 3, and 12 months after CTR by the Pittsburgh sleep quality index (PSQI) and Boston carpal tunnel syndrome questionnaires. Results There were 33 patients with 27 females (82%) and a median age of 51 years. The median time of CTS diagnosis and having sleep disorder before CTR were 12 and 6 months, respectively. The outcomes significantly improved after CTR, with the median PSQI and Boston symptom and function scores reduced from 12, 33, and 23 before CTR to 9, 14, and 11 at 1 month; 7, 13, and 9 at 3 months; and 1, 11, and 8 at 12 months postoperatively, respectively. The correlations between the PSQI and Boston symptom and function scores were > 0.6 at all time-points. Conclusions Surgical decompression significantly improves sleep quality and the hand symptoms and functions in patients with CTS. Long-term evaluations are lacking and thus are required in future studies.

scholarly journals Mathematical Modeling for Neuropathic Pain: Bayesian Linear Regression and Self-Organizing Maps Applied to Carpal Tunnel Syndrome

Symmetry ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 1581
Author(s):  
Oscar J. Pellicer-Valero ◽  
José D. Martín-Guerrero ◽  
Margarita I. Cigarán-Méndez ◽  
Carmen Écija-Gallardo ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Mathematical Modeling ◽  
Neuropathic Pain ◽  
Carpal Tunnel Syndrome ◽  
Pain Intensity ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Grip Force ◽  
Self Organizing Maps ◽  
Tunnel Syndrome ◽  
And Function

A better understanding of the connection between risk factors associated with pain and function may assist therapists in optimizing therapeutic programs. This study applied mathematical modeling to analyze the relationship of psychological, psychophysical, and motor variables with pain, function, and symptom severity using Bayesian linear regressions (BLR) and self-organizing maps (SOMs) in carpal tunnel syndrome (CTS). The novelty of this work was a transfer of the symmetry mathematical background to a neuropathic pain condition, whose symptoms can be either unilateral or bilateral. Duration of symptoms, pain intensity, function, symptom severity, depressive levels, pinch tip grip force, and pressure pain thresholds (PPTs) over the ulnar, radial, and median nerve trunks, the cervical spine, the carpal tunnel, and the tibialis anterior were collected in 208 women suffering from CTS. The first BLR model revealed that symptom severity, PPTs over the radial nerve, and function had significant correlations with pain intensity. The second BLR showed that symptom severity, depressive levels, pain intensity, and years with pain were associated with function. The third model demonstrated that pain intensity and function were associated with symptom severity. The SOMs visualized these correlations among variables, i.e., clinical, psychophysical, and physical, and identified a subgroup of women with CTS exhibiting worse clinical features, higher pressure sensitivity, and lower pinch tip grip force. Therefore, the application of mathematical modeling identified some interactions among the intensity of pain, function, and symptom severity in women with CTS.

NEW TECHNIQUE FOR REDUCING FIBROSIS IN RECURRENT CASES OF CARPAL TUNNEL SYNDROME

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 381-387 ◽  
Author(s):  
Wael A. M. Nassar ◽  
Ahmed Naeem Atiyya
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Rating Scale ◽  
Functional Results ◽  
Verbal Rating Scale ◽  
Functional Score ◽  
Symptom Severity Score ◽  
Tunnel Syndrome ◽  
The Mean

Purpose: Synthetic bio-degradable materials have been used as an artificial barrier in prophylaxis of adhesions. We report on the use of lactid caprolacton film (Mesofol®) in recurrent carpal tunnel syndrome. We hypothesise that its use will give favourable results regarding the functional outcome and the recurrence rate. Patients and methods: Fourteen patients were prospectively reviewed following neurolysis and application of Mesofol® film. Average age was 48 years. Outcome assessment measures included; two-point discrimination, verbal rating scale, and Boston Questionnaire. Results: Follow-up period averaged 25.5 months. Post-operative two-point discrimination improved to an average of 4.57 mm. The post-operative average verbal rating scale was 1.5. The mean symptom severity score improved to 1.88 and the mean functional score improved to 1.69 post-operatively. Conclusion: In cases of recurrent carpal tunnel syndrome, the use of mesofol barrier yields good functional results at the short term follow-up. The technique is simple. No patients needed further surgeries.

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 Long-term patient observation after conservative treatment of carpal tunnel syndrome: a summary of two randomised controlled trials

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e8012 ◽  
Author(s):  
Tomasz Wolny ◽  
Pawel Linek
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Muscle Strength ◽  
Conservative Treatment ◽  
Conduction Velocity ◽  
Manual Therapy ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Controlled Trials ◽  
Tunnel Syndrome

Background Physiotherapy of carpal tunnel syndrome (CTS) involves manual therapy based on neurodynamic techniques. Until now, two randomized controlled trials have shown that immediately after therapy, CTS patients who received neurodynamic techniques had significant improvement in nerve conduction, pain, symptom severity (SSS), functional state (FSS), muscle strength (MS) and two-point discrimination (2PD). However, long-term effects seem to be more important, as they are the only ones that can significantly improve the patient’s health and influence economic and social costs. Thus, the objective of this study was to evaluate the long-term (six months) effects of neurodynamic techniques in the conservative treatment of CTS patients. Methods Carpal tunnel syndrome patients (107) from two previously published randomised clinical trials were observed for six months after the treatment based on neurodynamic techniques. Results The sensory conduction velocity, motor conduction velocity, and motor latency were not subject to statistically significant changes within six months after therapy (p > 0.05). In both groups, there was further pain reduction (p < 0.05). In Group B, the symptom severity improved significantly (p < 0.05), while the functional status in both groups remained unchanged (p > 0.05). In both groups, there was muscle strength improvement (p < 0.05). Two-point discrimination remained unchanged six months after the therapy. Conclusion The use of manual therapy based on neurodynamic techniques maintains the beneficial effects 6 months after therapy in CTS patients.

scholarly journals Functional Outcome Of Mini-Open Carpal Tunnel Release In Carpal Tunnel Syndrome

2019 ◽  
Vol 2 (1) ◽  
pp. 8-14
Author(s):  
Sagun Pradhan ◽  
Rishi Bista ◽  
Laxman Sharma ◽  
Nabin Poudel ◽  
Bhawana Amatya
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Functional Outcome ◽  
Carpal Tunnel ◽  
Symptom Severity ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Tunnel Syndrome ◽  
Open Carpal Tunnel Release ◽  
Mini Open ◽  
Boston Questionnaire

Introduction: Carpal tunnel syndrome is the most common compression neuropathy in clinical practice and is also the most extensively studied. In Mini-open carpal tunnel release, the transverse carpal ligament is transected using a small open cut at the volar aspect of the proximal palm. The objectives of this study were to determine the functional outcome of mini-open carpal tunnel release procedure, to use the Boston Questionnaire to determine the functional outcome following mini open carpal tunnel release which includes pain, numbness, weakness and fine hand activities. Methods: This descriptive cross-sectional was conducted in National After informed consent, the cases who meet the informed criteria were examined and relevant details were filled up in the proforma preoperatively and two weeks post-operatively. Assessment of the patient’s symptom severity and functional status was done with the Boston questionnaire. Results: CTS was most common in the age group of 25-29 years (36.36%) and was predominant in housewives (18.20%). Mean symptom severity scores per person improved from 3.11 pre-operatively to 1.12 post-operatively. Mean functional status scores per person improved from 2.65 pre-operatively to 1.03 post-operatively. There was a statistically significant improvement in postoperative outcomes in our population. Conclusions: The findings in this study indicate that mini-open carpal tunnel release has a good functional outcome. Keywords: carpal tunnel syndrome; compression neuropathy; transverse carpal ligament.

The Use of Neurodynamic Techniques in the Conservative Treatment of Carpal Tunnel Syndrome – a Critical Appraisal of the Literature

2017 ◽  
Vol 19 (5) ◽  
pp. 0-0
Author(s):  
Tomasz Wolny
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Control Group ◽  
Therapeutic Effects ◽  
Beneficial Effects ◽  
Tunnel Syndrome ◽  
Passive Mobilization ◽  
Motor Abnormalities ◽  
And Function

Background. Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy, characterized by the presence of many sensory and motor abnormalities. In the physiotherapy of patients with CTS, neurodynamic tech­niques are very common, while the scientific literature does not show clear evidence of beneficial effects obtained by using these techniques. Therefore, the aim of this work was to critically evaluate the use of neurodynamic techniques in the conservative treatment of CTS. Material and methods. Three electronic databases (MEDLINE, SCOPUS and POL-index) and Google Scholar were queried to find articles. The search terms were combinations of words (in Polish, English and German) contain­ing abbreviated and full versions of the following expressions: carpal tunnel syndrome, CTS, neuromobilization, neurodynamic techniques and manual therapy. Results. Sixteen research papers met the conditions for inclusion in this review. Most of them used different methodologies of therapeutic intervention, making it difficult to interpret the results of individual works. Fourteen studies were randomized trials, one a case-control retrospective study and one was a clinical study without a control group. The most common evaluation variables were pain, nerve conduction, subjective symptoms and function, grip strength, sensation and range of motion. The therapy used neurodynamic techniques carried out by the patient or passive mobilization by the physiotherapist. Conclusions. 1. A review of existing studies evaluating the effec­tiveness of neurodynamic techniques in the treat­ment of CTS shows that most of them produced beneficial therapeutic effects. 2. Due to a considerable heteroge­n­ei­­ty of the parti­cipants, study design and metho­do­logy of thera­peutic interventions, it is difficult to for­mulate a general conclusion. 3. Hence the need arises for further research to assess the effectiveness of neu­ro­dynamic techniques in conservative therapy of CTS based on a similar therapeutic methodology.

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