scholarly journals Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial

2020 ◽  
Vol 66 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Karina J Lewis ◽  
Michel W Coppieters ◽  
Leo Ross ◽  
Ian Hughes ◽  
Bill Vicenzino ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Randomised Trial ◽  
Group Education ◽  
Tunnel Syndrome ◽  
Night Splinting

Night Splinting for Carpal Tunnel Syndrome

2007 ◽  
Vol 40 (18) ◽  
pp. 21
Author(s):  
JON O. EBBERT ◽  
ERIC G. TANGALOS
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Night Splinting

scholarly journals P143 The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of an open-label, parallel group, randomised controlled trial

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Claire L Burton ◽  
Trishna Rathod-Mistry ◽  
Milica Blagojevic-Bucknall ◽  
Linda S Chesterton ◽  
Graham Davenport ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Corticosteroid Injection ◽  
Cost Effective ◽  
Mean Difference ◽  
Injection Group ◽  
Tunnel Syndrome ◽  
Night Splinting ◽  
Night Splints

Abstract Background Patients with mild-to-moderate carpal tunnel syndrome (CTS) are commonly treated with night splints and/or local corticosteroid injection. In the INSTINCTS (INjection versus SplinTing in Carpal Tunnel Syndrome) trial, we previously reported that a single corticosteroid injection is more effective than night splinting at 6 weeks but not at 6 months. The aims of follow-up at 12 and 24 months were to examine whether corticosteroid injection is clinically and cost-effective in reducing symptoms in the longer-term compared to night splinting and to compare rates of CTS surgery. Methods INSTINCTS was a pragmatic clinical trial in adults ≥18 years with mild-to-moderate CTS diagnosed using standardised clinical criteria. Participants were recruited from primary care or musculoskeletal interface services and randomised 1:1 to receive either a single carpal tunnel injection of 20mg methylprednisolone acetate or a night splint. Follow-up questionnaires were mailed at 6 weeks and 6, 12 and 24 months. Key clinical outcomes at 12 and 24 months were the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity (0-10 numeric rating scale (NRS)) and the number of patients referred for and receiving CTS surgery. Longitudinal mixed effect models were fitted to estimate overall treatment effect at each time point by including interaction terms between treatment and time, adjusted for age, gender, symptom duration and baseline score. The cumulative number (%) of participants i) referred or ii) undergoing CTS surgery were examined by treatment group. Cost-utility analysis was conducted from an NHS perspective to determine the cost-effectiveness of injection versus night splinting. Results 118 participants were randomised to night splinting and 116 to corticosteroid injection. In the splint group, 88 (78%) and 81 (74%) completed follow-up at 12 and 24 months respectively compared to 87 (77%) and 78 (72%) in the injection group. There were no statistically significant differences between splint and injection groups in BCTQ score at 12 (adjusted mean difference -0.09; 95%CI -0.30, 0.12) or 24 months (0.06; -0.16, 0.28) or hand pain NRS (12 months 0.03; -0.79, 0.85. 24 months 0.41; -0.45, 1.26). By 24-month follow-up, a greater proportion of the injection group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery than the splint group. Injection was more costly (mean difference £68.59 (-120.84, 291.24)) with lower quality-adjusted life-years (QALYs) than splinting over 24 months (mean difference -0.022 (-0.074, 0.024)). Conclusion To our knowledge, this is the longest-reported follow-up of a randomised trial investigating the conservative management of CTS, with the largest sample size. Over 24-months, there were no differences in symptoms between groups and injection was not cost-effective compared with splinting. Surgical referral and intervention rates were low overall, but slightly more frequent in the injection group. Disclosures C.L. Burton None. T. Rathod-Mistry None. M. Blagojevic-Bucknall None. L.S. Chesterton None. G. Davenport None. K.S. Dziedzic None. S.M. Jowett Consultancies; Sue Jowett received payment as an independent advisor for a Pfizer chronic pain advisory board meeting in November 2018. H.L. Myers None. R.A. Oppong Consultancies; Raymond Oppong received payment as an independent advisor for a Pfizer Tanezumab HEOR Advisory Board Meeting in October 2018. D.A. Van der Windt None. E.M. Hay None. E. Roddy None.

The effectiveness of splinting and surgery on sleep disturbance in carpal tunnel syndrome

2017 ◽  
Vol 43 (3) ◽  
pp. 286-289 ◽  
Author(s):  
Guy Rubin ◽  
Hagay Orbach ◽  
Micha Rinott ◽  
Nimrod Rozen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Severity Index ◽  
Level Of Evidence ◽  
Insomnia Severity Index ◽  
Sleep Log ◽  
Tunnel Syndrome ◽  
Night Splinting ◽  
Insomnia Symptoms ◽  
Insomnia Severity

This controlled prospective study assessed the effectiveness of night splinting compared with non-splinting and surgery for severity of insomnia in patients with carpal tunnel syndrome. Sleep characteristics were observed for several days without a brace, with a brace and after surgery. The sleep measurements included the use of an actigraph worn on the wrist during night, a ‘sleep log’ that conveyed subjective impressions as to how the patient had slept and a short insomnia instrument, the Insomnia Severity Index. The Insomnia Severity Index scores showed that a night splint significantly improved insomnia symptoms compared with no splinting, and surgery significantly improved insomnia symptoms compared with splinting. The sleep log scores showed that the sleep quality and the number of awakenings when a splint was not worn were significantly different from the scores with the splint and the scores after surgery but showed no differences between splint and surgery. The actigraph did not show any significant differences between the treatment methods. Level of evidence: III

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

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