A Comparative Study of Local Ultrasound Therapy and Local Steroid Injection in Patients of Carpal Tunnel Syndrome

2016 ◽  
Vol 27 (4) ◽  
pp. 98-103
Author(s):  
Neeraj Gupta ◽  
Sunil Goenka ◽  
Manoj Verma
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Ultrasound Therapy ◽  
Group A ◽  
Study Population ◽  
Tunnel Syndrome ◽  
Group B

Abstract Introduction Carpal tunnel syndrome is the most common compressive neuropathy of upper extremity affecting predominantly females of middle age group. Symptoms include pain, paracsthesia, numbness in median nerve distribution of hand. Study design Comparative type of interventional study. Study area Department of Physical Medicine and Rehabilitation, SMS Medical College and attached group of hospitals, Jaipur. Duration of study One and a half years April 2014-October 2015. Aims and objective To compare the efficacy of local ultrasound therapy and local corticosteroid injection for carpal tunnel syndrome management. Study population A total of sixty patients with CTS (agep>18 years) were randomly assigned to the steroid treatment plus splinting(group A) or ultrasound treatment plus splinting(group B). Results The mean age of study population was 45.47±12.24 years with males comprising 13.3% and females 86.6% of whole study. At baseline all outcome variables were comparable statistically in both the groups (p>0.05). In follow-up assessment at 8th week, statistically significant improvement was obtained in all clinical and electrophysiological parameters in group A: Grip strength, symptom severity score, functional status score, median DML, sensory nerve conduction velocity (p<0.001 for each). Also the group B showed improvement in all parameters except grip strength. At the end of 24th week all outcome variables showed decline in improvement as comparative to 8th week, but still they were better than baseline in both groups. There was no significant difference between the groups in outcome variables except for the grip strength. Conclusion Ultrasound treatment provided improvement comparable to steroid injection in all clinical and electrophysiological parameters in patients with CTS except grip strength. Overall steroid therapy is more effective than ultrasound therapy. Effectiveness of treatment persist for at least 6 months then it lessens, so long follow-up is required.

Evaluation of the Efficacy of Ultrasound Therapy in the Treatment of Patients with Carpal Tunnel Syndrome

2019 ◽  
Vol 11 (1) ◽  
pp. 24-27
Author(s):  
Nadia Siddiquee ◽  
Farzana Akonjee Mishu ◽  
Monzur Ahmed ◽  
Shaila Sharmin Shahnewaz ◽  
Hashina Bilkish Banu ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Controlled Trial ◽  
Ultrasound Therapy ◽  
Symptom Severity Scale ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B ◽  
Wrist Splint

This randomized controlled trial was conducted in Department of Physical Medicine and Rehabilitation of Bangabandhu Sheikh Mujib Medical University, Dhaka during the period from March 2014 to August 2014 to evaluate the effect of ultrasound therapy (UST) on patients of carpal tunnel syndrome. Total 110 subjects were participated in this study and they were selected randomly divided in two groups by lottery. Group-A was treated with UST, Exercise, Wrist splint, non steroidal anti inflammatory drugs (NSAIDs) and group-B received Exercise, Wrist splint and NSAIDs. Treatment continued for a period of 6 weeks. Group-A were compared to group B by both Visual Analog Scale (VAS) and Levine Symptom severity scale(LSSS) after 3 weeks and 6weeks of treatment. The result showed mean VAS at pretreatment (W0) in group-A was 6.42 ±1.23 and in group-B was 6.17±0.74. Group-A was 1.82±0.43 and in group-B was 3.1±0.23 in their follow up after 3 weeks (W 3) In Group-A was 1.71(±0.52) and in group-B was 2.52(±0.49) at 2nd follow up (W6) after 6 weeks. Mean LSSSat pretreatment (W0),1st follow up after 3 weeks (W 3), 2nd follow up (W 6) after 6 weeksin group-A was 31.64±1.55, 14.32 ± 2.29 and 14.31 ±1.12 respectively,and in group-B was 31.3±0.74,18.51±0.92and 18.31 ± 0.42 respectively.This study revealed that continuous mode of US therapy with exercise, wrist splint, NSAIDs have better outcome in case of Carpal tunnel syndrome patients. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 24-27

scholarly journals Evaluation of Ultrasound Therapeutic Effect on Patients with Carpal Tunnel Syndrome Attending in a Tertiary Care Hospital of Bangladesh

2019 ◽  
Vol 9 (1) ◽  
pp. 70-73
Author(s):  
Nadia Siddiquee ◽  
Farzana Akonjee Mishu ◽  
Sohely Rahman ◽  
Abul Khan Ahmed Zaman
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Visual Analogue Scale ◽  
Carpal Tunnel ◽  
Analogue Scale ◽  
Ultrasound Therapy ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B ◽  
Wrist Splint

Background: Carpal tunnel syndrome is a common condition in medical practice. Ultrasound therapy is a common non-surgical treatment of carpal tunnel syndrome including other modalities like the use of antiinflammatory agents and exercise. This study was designed to evaluate the effect of ultrasound therapy for the relief of symptoms of patients with carpal tunnel syndrome. Methods: This was a randomized controlled trial. This study as conducted in Department of Physical Medicine and Rehabilitation of Bangabandhu Sheikh Mujib Medical University, Dhakaduring the period from March 2014 to August 2014to evaluate the effect of ultrasound therapy on patients of carpal tunnel syndrome. Total 110 subjects were participated in this study and they were selected randomly. The patients were divided in two groups by lottery. For group A patients treatment schedule (Ultrasound therapy+ Exercise+ Wrist splint +NSAIDs) and group B (Exercise+ Wrist splint+ NSAIDs) were applied for a period of 6 weeks. Group A were compared to group B byVisual Analog Scale after 3weeks and 6weeks of treatment.Statistical analysis of the finding was done with the help of statistical package for social science version (SPSS) 19. The student t test used to analyze the level of significance, p< 0.05. Results: This study showed mean visual analogue scale (VAS) at pretreatment (W0) in group-A was 6.42 ±1.23 and in group-B was 6.17±0.74. Group-A was 1.82±0.43 and in group-B was 3.1±0.23 in their follow up after 3 weeks (W 3). Mean Visual Analogue scale in groupA- was 1.71(±0.52) and in group-B was 2.52(±0.49) at 2nd follow up (W 6) after 6 weeks . So these result reveled that group-A is significantly better than group-B. Conclusion: This study revealed that continuous mode of US therapy with exercise, wrist splint, NSAIDs have better outcome in case of Carpal tunnel syndrome patients. Birdem Med J 2019; 9(1): 70-73

scholarly journals Comparison of surgical out come between virgin carpal tunnel syndrome and previous local steroid injected tunnel

2020 ◽  
Vol 7 (2) ◽  
pp. 33-40
Author(s):  
Ali Shahad Safi ◽  
Hussein A. Alseady ◽  
Mohammed H. Younise
Keyword(s):  
Carpal Tunnel ◽  
Steroid Injection ◽  
Night Pain ◽  
Group A ◽  
Tunnel Syndrome ◽  
Local Steroid Injection ◽  
Group B ◽  
Grip Power ◽  
Surgical Release

Carpal tunnel syndrome(CTS) is the most commonly occurring peripheral nerve compression neuropathy and its condition characterized by an abnormality of the median nerve function due to compression of the nerve within the carpal tunnel. Surgical release of the transverse carpal ligament is an effective treatment for patients with CTS. Non-steroidal anti-inflammatory drugs, diuretics, vitamin B6 injection, ultrasound therapy, laser therapy, acupuncture, magnetic therapy, bracing and local steroid injections have been used for closed treatment of CTS and effective results in the short-term treatment have been demonstrated clearly only for bracing and local steroid injections. Aim: was to identify the effect of local steroid injection on the outcome of surgical release of CTS. A prospective study that was conducted in the Orthopedic Department of at Basra General Hospital during the period from 1st of July 2005 till end of September 2006 on 40 patients, 20 of them with received local steroid injection (group A) and 20 without local steroid injection (group B virgin carpal tunnel) operations done to release the tunnel with monthly follow up by telephone call because of social and security problems at time of study. Pearson’s Chi–square test was used to assess statistical association between injection of local steroid and outcome of CTS surgery. A level of P – value less than 0.05 was considered significant. Postoperatively, in Group A, night pain and grip power were found to be improved in 17 (85%) and 11 (55%) of women, respectively, while 16 (80%) relieved from night pain, paresthesia and numbness. On the other hand, the postoperative follow up of women in group B showed that the improvement of night pain was occurred in 20 cases (90%), relieving of night pain, paresthesia and numbness in 17 (85%), and improvement of grip power was reported in 12 (60%). The analysis of association didn’t show statistical significant difference (P > 0.05) in surgical outcome between study groups. In conclusion; local steroid injection for CTS prior to surgery didn’t affect outcome of surgical release.

scholarly journals Comparison of surgical out come between virgin carpal tunnel syndrome and previous local steroid injected tunnel

2020 ◽  
Vol 7 (2) ◽  
pp. 18-40
Author(s):  
Ali Shahad Safi
Keyword(s):  
Carpal Tunnel ◽  
Steroid Injection ◽  
Night Pain ◽  
Group A ◽  
Tunnel Syndrome ◽  
Local Steroid Injection ◽  
Group B ◽  
Grip Power ◽  
Surgical Release

"Carpal tunnel syndrome(CTS) is the most commonly occurring peripheral nerve compression neuropathy and its condition characterized by an abnormality of the median nerve function due to compression of the nerve within the carpal tunnel. Surgical release of the transverse carpal ligament is an effective treatment for patients with CTS. Non-steroidal anti-inflammatory drugs, diuretics, vitamin B6 injection, ultrasound therapy, laser therapy, acupuncture, magnetic therapy, bracing and local steroid injections have been used for closed treatment of CTS and effective results in the short-term treatment have been demonstrated clearly only for bracing and local steroid injections. Aim: was to identify the effect of local steroid injection on the outcome of surgical release of CTS. A prospective study that was conducted in the Orthopedic Department of at Basra General Hospital during the period from 1st of July 2005 till end of September 2006 on 40 patients, 20 of them with received local steroid injection (group A) and 20 without local steroid injection (group B virgin carpal tunnel) operations done to release the tunnel with monthly follow up by telephone call because of social and security problems at time of study. Pearson’s Chi–square test was used to assess statistical association between injection of local steroid and outcome of CTS surgery. A level of P – value less than 0.05 was considered significant. Postoperatively, in Group A, night pain and grip power were found to be improved in 17 (85%) and 11 (55%) of women, respectively, while 16 (80%) relieved from night pain, paresthesia and numbness. On the other hand, the postoperative follow up of women in group B showed that the improvement of night pain was occurred in 20 cases (90%), relieving of night pain, paresthesia and numbness in 17 (85%), and improvement of grip power was reported in 12 (60%). The analysis of association didn’t show statistical significant difference (P > 0.05) in surgical outcome between study groups. In conclusion; local steroid injection for CTS prior to surgery didn’t affect outcome of surgical release."

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

Carpal tunnel syndrome: matching minimally invasive surgical techniques

2008 ◽  
Vol 108 (5) ◽  
pp. 1033-1036 ◽  
Author(s):  
Vittoria Nazzi ◽  
Angelo Franzini ◽  
Giuseppe Messina ◽  
Giovanni Broggi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Surgical Techniques ◽  
The Past ◽  
Minimally Invasive Surgical ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B

✓In the past few years, several different minimally invasive surgical techniques have been proposed to decompress the median nerve at the wrist. Use of these techniques has become widespread due to fewer local complications, faster functional recovery, and reduced surgical time. In this paper the authors compare 3 different minimally invasive surgical techniques used at their institution in the past 13 years. Between January 1994 and January 2007, 891 patients underwent 1272 surgeries at the authors' institution for carpal tunnel syndrome (CTS), for which a minimally invasive technique was used. In 473 cases (Group A), the transillumination technique with a single wrist incision and a “carpalotome” (a modified Paine retinaculotome) was used; in 216 cases (Group B), transillumination was abandoned and a single linear wrist incision for access with the carpalotome was performed; and in 583 cases (Group C), the techniques were further modified by making a second incision in the palm using the carpalotome. All 3 groups of patients were homogeneous for age, sex, and duration of the symptomatology. In 90% of the patients in Group A, in 88% of those in Group B, and 99.8% of patients in Group C, complete remission of symptoms was obtained. Due to persistence of symptoms, 44 patients in Group A, 24 in Group B, and only 1 in Group C underwent a repeated operation with the open technique. The only surgical complication requiring repeated operation of the 1272 operations was a lesion of the primitive median artery (1 patient in Group C). The technique of median nerve decompression at the wrist that was used for patients in Group C represents a valid alternative for treatment of CTS.

scholarly journals Comparison in Wrist Splints and Wrist-­Metacarpophalangeal Splints Use for Patients with Carpal Tunnel Syndrome Evi

1970 ◽  
Vol 1 (1) ◽  
pp. 63-69
Author(s):  
Evi Yuliani ◽  
Widjajalaksmi Kusumaningsih ◽  
Vitriana ◽  
Hadyana Sukandar
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Functional Improvement ◽  
P Value ◽  
Symptom Severity Scale ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B ◽  
Improvement Score ◽  
Wrist Splint

Objectives : To compare the effect of both wrist splint and wrist-­metacarpophalangeal splint at night using Symptom Severity Scale (SSS) and Functional Status Scale (FSS) and to know the validity andreliability of Indonesian version of SSS dan FSS.Methods : This study enrolled 19 subjects in each of the two groups that were given neutral wrist splint and exercise in one group (group A) and neutral wrist-­metacarpophalangeal splint and exercise in theother group (group B).Results : Indonesian version of SSS and FSS have been proven valid with rs lowest = 0.360 and highest 0.810(>0.3) and relable with α SSS=0.762 dan FSS=0.781 (>0.7). There were significant improvement score of SSS and FSS in each group with p value <0.001. There were greater functional improvement in group treated with wrist-­metacarpophalangeal splint (group B) with p value = 0.036 (p<0.05) Conclusions: There was improvement of SSS and FSS in both groups of study with greater improvement of in wrist-­hand splint group.Keywords: Carpal Tunnel Syndrome, wrist splint, wrist-­hand splint,,nerve and tendon gliding, SSS, FSS.

scholarly journals Splinting in Carpal Tunnel Syndrome: The Optimal Duration

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2049-e2054
Author(s):  
Michele A Gatheridge ◽  
Elsa A Sholty ◽  
Alexander Inman ◽  
Meghan Pattillo ◽  
Frank Mindrup ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
The United States ◽  
Functional Improvement ◽  
Treatment Groups ◽  
Significant Difference ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B ◽  
Wrist Splint

Abstract Introduction The purpose of this study was to evaluate optimal neutral wrist splint duration in treatment-naive mild and mild to moderate carpal tunnel syndrome (CTS). Neutral wrist splinting is a conservative treatment for CTS; however, no clear guidelines exist for how long splinting should be prescribed for optimal outcomes. Materials and Methods In this prospective clinical trial subjects were assigned to wear a neutral wrist splint for 6 (group A) or 12 weeks (group B). Symptom and functional outcomes were assessed by questionnaire at baseline, 6 and 12 weeks. Median nerve sensory and motor latencies were recorded at baseline and 12 weeks. Pretreatment, midtreatment, and posttreatment measures were compared within and between treatment groups where applicable. This study was approved by the United States Air Force Academy institutional review board. Results A total of 30 subjects (37 hands) were randomized to 2 treatment groups. Mean symptom severity and median sensory peak latency significantly improved in both groups at 12 weeks, without a significant difference between groups. Mean functional severity significantly improved only in group A. Conclusion Neutral wrist splint for 6 weeks resulted in better clinical improvements in patients with untreated mild and mild to moderate CTS. There was no additional benefit in extending splinting 6 additional weeks. This is the first study to compare duration of wrist splint use beyond 8 weeks. A larger sample size is needed to identify the reason for lack of functional improvement in group B. Long-term follow-up of this cohort will be helpful to determine the natural history of initial wrist splint use.

Cystic Radio-Lucency of Carpal Bones in Haemodialysis Patients

1994 ◽  
Vol 19 (5) ◽  
pp. 636-637 ◽  
Author(s):  
T. KONISHIIKE ◽  
H. HASHIZUME ◽  
K. NISHIDA ◽  
H. INOUE ◽  
T. NANBA
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Bone Cyst ◽  
Carpal Bones ◽  
Syndrome X ◽  
Cystic Lesions ◽  
X Rays ◽  
Group A ◽  
Tunnel Syndrome ◽  
Group B

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radio-lucency of carpal hones in 35% of the hands. Radiographs were classified into three groups: Group A—cyst growing, Group B—cyst not growing, and Group C—cyst absent. The prevalence of carpal tunnel syndrome was 100% (27/27) in Group A, 5.6% (1/18) in Group B, and 6.5% (6/93) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.

The effect of the involvement of the dominant or non-dominant hand on grip/pinch strengths and the Levine score in patients with carpal tunnel syndrome

2011 ◽  
Vol 37 (5) ◽  
pp. 427-431 ◽  
Author(s):  
A. Żyluk ◽  
I. Walaszek
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Outcome Measurement ◽  
Carpal Tunnel Release ◽  
Pinch Strength ◽  
Dominant Hand ◽  
Before And After ◽  
Tunnel Syndrome

The Levine questionnaire is a disease-oriented instrument developed for outcome measurement of carpal tunnel syndrome (CTS) management. The objective of this study was to compare Levine scores in patients with unilateral CTS, involving the dominant or non-dominant hand, before and after carpal tunnel release. Records of 144 patients, 126 women (87%) and 18 men (13%) aged a mean of 58 years with unilateral CTS, treated operatively, were analysed. The dominant hand was involved in 100 patients (69%), the non-dominant in 44 (31%). The parameters were analysed pre-operatively, and at 1 and 6 months post-operatively. A comparison of Levine scores in patients with the involvement of the dominant or non-dominant hand showed no statistically significant differences at baseline and any of the follow-up measurements. Statistically significant differences were noted in total grip strength at baseline and at 6 month assessments and in key-pinch strength at 1 and 6 months.

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