Effectiveness of Tendon and Nerve Gliding Exercises in the Treatment of Patients With Mild Idiopathic Carpal Tunnel Syndrome: A Randomized Controlled Trial

Background There is limited evidence regarding the efficacy of different treatment options in patients with carpal tunnel syndrome (CTS). This study aimed at assessing the effectiveness of nerve and tendon gliding exercises in the treatment of patients with mild CTS. Methods The current prospective, randomized trial with pretest-posttest design was conducted on 80 patients with mild CTS randomly assigned to 2 groups. The treatment group was instructed to perform gliding exercises in addition to the wrist splint use. The control group only used the wrist splint. All the patients were instructed to use the splint at night and during the day if required. Patients were evaluated in terms of clinical parameters (ie, grip and pinch strength). The severity of symptoms and functional status was also determined using the Boston Carpal Tunnel Syndrome Questionnaire. The subjects were followed up for 6 weeks. Results There were no significant differences in all parameters between groups. The pretest-posttest analysis showed a statistically significant improvement in subjective and objective parameters in the treatment group. However, in the control group, only a significant improvement was observed in grip strength. Wrist splint use led to a significant change in the severity of symptoms only over the second week. Conclusions Both gliding exercise and wrist splint groups showed some improvement in the severity of symptoms and functional status scores. However, the gliding exercises did not offer additional benefit compared with wrist splint alone.

Comparative study of the Effectiveness of the use of the universal tennis elbow splint compared to elbow brace in treatment of Lateral Epicondylitis

Background: Lateral epicondylitis is a serious condition affecting 1 to 3% of adult population between the age group of 30 to 50 year old. This group represents the working force and tennis elbow causes debilitating pain and patients are unable to perform the affected limb functions of lifting or holding anything. The main cause for tennis elbow is the tendinopathy of the extensor carpi radialis brevis muscle (ECRB). There are multiple treatment measures to relieve the pain and bring back the function of the limb to normalcy as early as possible. The elbow brace is used to reduce the expansion of the ECRB and thereby reducing the symptoms of tennis elbow. It was hypothesized that wrist splints would reduce the activation of the ECRB muscle and thereby will reduce the symptoms of the tennis elbow. Streek et al performed a study using the wrist splint with 20-30 degrees extension and mentioned in limitations the changing the degree of extension may improve outcomes as compared to elbow braces. On that hypothesis we used a brace with only 5-10 degrees of extension. Aims: 1) To study the symptomatic and functional outcome of the elbow brace. 2) To study the symptomatic and functional outcome of the wrist splint. 3) To compare the symptomatic and functional outcomes between the wrist splint and the elbow brace. Material & Methods: The patients included in the study were divided into Group A receiving the wrist splint and group B elbow brace. The patient rated tennis elbow evaluation score (PRTEE), grip strength and pain visual assisted (VAS) score on the day of enrolment and 6 weeks after using either the elbow brace or wrist splint was noted. We used Mann-Whitney U test to calculate P-value intergroup and for P-value intra-group we used Wilcoxon’s signed rank test. Result: Group A distribution of median 6 weeks PRTEE score improved significantly compared to median baseline PRTEE score (P-value<0.001). The VAS score, grip strength and improvement in PRTEE score at 6 weeks is relatively better in Group A compared to Group B, however the difference did not reach statistical significance (P-value>0.05).Conclusion: The use of wrist splint significantly improved the symptoms of the tennis elbow. The outcome is comparable to use of tennis elbow brace. The outcome is not statistically significant if compared between the two groups.

Splinting in Carpal Tunnel Syndrome: The Optimal Duration

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.

Intralesional steroid and ultrasound therapy in patients with carpal tunnel syndrome

The study aimed to compare the effects of intralesional steroid injection and ultrasound therapy for the treatment of carpal tunnel syndrome. A total 130 patients divided into 2 groups: a) One group (n=65) received intralesional corticosteroid injection along with wrist splint, exercise, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=65) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with Wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks. The patients were followed-up 2 weekly for 4 weeks. The visual analogue score, symptom severity scores and functional status scores were significantly improved within each group at week 2 (p<0.05) and week 4 (p<0.05) except for the symptom severity score at (p>0.05). The improvement in symptom severity scores and functional status scores in the intralesional steroid group was more than in the ultrasound therapy group after 4 weeks.

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

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

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

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