Two Novel Nonsurgical Treatments of Carpal Tunnel Syndrome (original) (raw)
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Physiatric Management of Carpal Tunnel Syndrome
KYAMC Journal
Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Diagnosis of CTS was rare before middle of the nineteenth century but in recent years it continues to be made with increasing frequency by the virtue of wide spread public awareness and highly specific diagnostic tests. Individuals engaged in repetitive works which involves flexion and extension of the wrist, strong grip or exposure to vibration are particularly at risk of developing the disease. It is now accounted amongst the common work related claimed disabilities in our country. KYAMC Journal Vol. 10, No.-4, January 2020, Page 206-210
Turkish Journal of Rheumatology, 2012
Bu çalışmada, hafif karpal tünel sendromu (KTS) tedavisinde bazı konservatif yöntemlerle birlikte uygulanan deksametazon iyontoforezi veya ultrason veya plasebo iyontoforezin (deksametazonsuz) etkinliği karşılaştırıldı. Hastalar ve yöntemler: Elektromiyografi ile doğrulanmış hafif KTS tanılı 58 hasta çalışmaya dahil edildi. Hastalar rastgele üç gruba ayrıldı: (i) deksametazon iyontoforezi ile tedavi edilen iyontoforez grubu (n=20); (ii) ultrason ile tedavi edilen grup (n=20) ve (iii) plasebo iyontoforezi uygulananlar (n=18). Bu tedavilerden biri, tüm hastalara üç aylık tendon ve sinir kaydırma egzersizleri, gece splinti ve aktivite modifikasyonları gibi fizyoterapi prosedürleri ile beraber 15 seans uygulandı. Tedavinin başında, tedavi sonunda ve tedavi bitiminden sonra takip sırasında 3. ayda el bileği eklem hareket açıklığı ve kas testleri, Görsel Analog Skalası (VAS), el sıkma testi, pinçmetre ölçümleri, monofilaman ile duyu testleri, iki nokta diskriminasyon testi, Phalen, ters Phalen, Tinel ve karpal kompresyon testleri, Sağlık Değerlendirme Anketi (HAQ), Boston Sorgulama Anketi (BQ) ve elektrofizyolojik ölçümler değerlendirildi. İstatistiksel analiz SPSS (versiyon 10.0, Windows) yazılımı kullanılarak yapıldı. Bulgular: Çalışma sonunda tüm grupların klinik değerlendirmelerinde istatistiksel olarak anlamlı iyileşmeler görüldü (p≤0.05). Ultrason ve plasebo grubu ile karşılaştırıldığında, iyontoforez grubunda daha başarılı sonuçlar alındı; KTS'li hastaların üç ay sonraki takiplerinde pinçmetre, monofilaman, iki nokta diskriminasyon testleri ve BQ skorlarında istatistiksel anlamlı iyileşme gözlemlendi (p≤0.05). İyontoforez ve ultrason grubunda yapılan elektrofizyolojik ölçümlerde de, istatistiksel olarak anlamlı iyileşmeler kaydedildi (p≤0.05). Sonuç: Bu çalışmanın sonuçları, hafif KTS'li hastaların deksametazon iyontoforezi, tendon kaydırma egzersizleri, splint ve aktivite modifikasyonu ile beraber tedavisinin güvenilir ve etkili olduğunu önermektedir. Ancak, bulgularımızı destekleyen daha geniş ölçekli başka çalışmalara da ihtiyaç vardır. Anahtar sözcükler: Karpal tünel sendromu; deksametazon iyontoforezi; egzersiz; splintleme; ultrason. Objectives: In this study, we aimed to compare the efficacy of some conservative methods in combination with dexamethasone iontophoresis, ultrasound therapy or placebo iontophoresis (without dexamethasone) in the treatment of mild carpal tunnel syndrome (CTS). Patients and methods: Fifty-eight patients diagnosed with mild CTS confirmed by electromyography were included in the study. The subjects were divided randomly into three groups: (i) iontophoresis group-treated with dexamethasone iontophoresis (n=20); (ii) ultrasound group-treated with ultrasound (n=20), and (iii) placebo group-treated with placebo iontophoresis (n=18). All patients received one of these treatments in 15 sessions for three months in combination with physiotherapeutic procedures, such as tendon/nerve gliding exercises, night splinting and activity modifications. Wrist range of motion, muscle test, the Visual Analog Scale (VAS), handgrip test, pinch meter measurement, sensory testing with monofilaments, two-point discrimination test, Phalen's, reverse Phalen's, Tinnel's and carpal compression test, the Health Assessment Questionnaire (HAQ), the Boston Questionnaire (BQ) and electrophysiological assessment were performed at baseline, at the end of therapies and at threemonths during follow-up. Statistical analysis was performed using SPSS software (version 10.0 for Windows). Results: Statistically significant improvements in the clinical status of all groups were observed at the end of the study (p≤0.05). Compared to ultrasound group and placebo group, more successful outcomes were seen in the iontophoresis group, resulting in statistically significant improvements in the pinch meter measurements, monofilament and two-point discrimination tests, and in BQ scores at three months during follow-up (p≤0.05). A statistically significant improvement was also recorded in the electrophysiological measurements in the iontophoresis group and ultrasound group (p≤0.05). Conclusion: Our study results suggest that dexamethasone iontophoresis administration combined with tendon gliding exercises, splint and activity modification is reliable and effective in the treatment of patients with mild CTS. However, further large-scale studies are required to confirm these findings.
Manual Therapy Interventions For Carpal Tunnel Syndrome: A Review
2019
Carpal Tunnel Syndrome (CTS) is a debilitating condition which affects majority of the middle aged people in the community. This condition is predominant in females than the males. The condition may be affecting the patient‘s single hand (unilateral) or both hands (bilateral). The functional outcomes are very poor and patient may be deteriorating psychologically as well. Signs and symptoms of the CTS can be varied from mild to moderate to severe. This includes numbness or paresthesia along the distribution of the median nerve of hand, pain, atrophy of muscles, reduced hand grip strength etc. The people who are experiencing mild or moderate symptoms usually seek for conservative therapies including elctro therapeuatic modalities and manual therapy techniques. When the condition becomes chronic, the concern is more towards the surgical approaches that involves the carpal tunnel release and thereby releasing the median nerve compression. But majority of the patients with CTS are reluct...
Treatment of carpal tunnel syndrome
Muscle & Nerve, 2007
Introduction. In the literature one can find descriptions of many methods that concern both conservative and surgical treatment of the carpal tunnel syndrome (CTS). Similarly, the effectiveness of these methods is assessed differently. The aim of the study. The main objective of the thesis was to discuss the methods of conservative and surgical treatment of CTS. Selection of material. The search was carried out in the Scopus database using the concepts of the carpal tunnel syndrome, methods of surgical treatment, conservative treatment and complications after treatment of patients with CTS in years 2000-2018. The literature found in the Google Scholar database was analysed in terms of the largest number of citations. Literature selected in this way served as the material for the thesis. Conclusions. Prophylaxis, diagnostics and, above all, therapy implemented in patients with CTS are of great importance in the disease prognosis. The validity of this statement may seem obvious, although it is not always noticed by the patients themselves or even doctors. Prognosis in the case of people with CTS may be established in relation to the progress of the undertaken treatment and the physical condition of the patient in the long-term perspective.
Carpal Tunnel Syndrome. Part II: Effectiveness of Surgical Treatments—A Systematic Review
Archives of Physical Medicine and Rehabilitation, 2010
Objective: To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS). Data Sources: The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Study Selection: Two reviewers independently applied the inclusion criteria to select potential studies. Data Extraction: Two reviewers independently extracted the data and assessed the methodologic quality. Data Synthesis: A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or antiinflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of followup. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting. Conclusions: Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.
A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome
Journal of Manipulative and Physiological Therapeutics, 2007
Objective: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft tissue mobilization (GISTM) and soft tissue mobilization administered with the clinician hands.
Management of Carpal Tunnel Syndrome
Journal of the American Academy of Orthopaedic Surgeons, 2018
This report presents three quality measures related to diagnosis and treatment of carpal tunnel syndrome. • Discouraging use of MRI for diagnosis of carpal tunnel syndrome • Discouraging the use of adjunctive surgical procedures during carpal tunnel release • Discouraging the routine use of occupational and/or physical therapy after carpal tunnel release This report presents the measure specifications and analytic results. Included are the rationale for each measure and the specific proposed technical approach to each measure.
Carpal Tunnel Syndrome: A Review of Literature
Cureus, 2020
Carpal tunnel syndrome (CTS) is a common medical condition that remains one of the most frequently reported forms of median nerve compression. CTS occurs when the median nerve is squeezed or compressed as it travels through the wrist. The syndrome is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve. Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation. The diagnosis of CTS is conducted through medical assessments and electrophysiological testing, although idiopathic CTS is the most typical method of diagnosis for patients suffering from these symptoms. The pathophysiology of CTS involves a combination of mechanical trauma, increased pressure, and ischemic damage to the median nerve within the carpal tunnel. The diagnosis of CTS patients requires the respective medical professional to develop a case history associated with the characteristic signs of CTS. In addition, the doctor may question whether the patients use vibratory objects for their tasks, the parts of the arm where the sensations are felt, or if the patient may already have predisposing factors for CTS incidence. During the diagnosis of CTS, it is essential to note that other conditions may also provide similar symptoms to CTS, thus requiring vigorous diagnosis to assert the medical condition of the patients. Doctors use both non-surgical and surgical treatments when addressing CTS. Non-surgical treatments include wrist splinting, change of working position, medications, and the use of alternative non-vibrating equipment at work. On the other hand, surgical methods include open release and endoscopic surgeries. This review of literature has provided an overview of CTS with an emphasis on anatomy, epidemiology, risk factors, pathophysiology, stages of CTS, diagnosis, and management options.