Comparison Efficacy of Ultrasound-Guided Needle Release Plus Corticosteroid Injection and Mini-Open Surgery in Patients with Carpal Tunnel Syndrome

This retrospective study was to compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection versus mini-open surgery in patients with carpal tunnel syndrome (CTS). From January 2020 to December 2020, 40 patients (40 wrists) with CTS were analyzed in this study. Diagnosis was based on clinical symptoms, electro-physiological and ultrasound imaging. 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A) and other 20 wrists went mini-open surgery (Group B). We evaluated Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity and sensory nerve action potential of median nerve) and ultrasound parameters (cross-sectional area, flattening ratio and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time and complications were also recorded for two groups. Boston carpal tunnel questionnaire, electrophysiologic and ultrasound outcomes at preoperatively and 3 months postoperatively had significant difference for each group (each P༜0.05). There were no complications such as infection, haemorrhage, vascular, nerve or tendon injuries in both groups. Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.

Usefulness of infrared thermography in diagnosing and evaluating severity of carpal tunnel syndrome

Background: Pain and autonomic dysfunction are prominent symptoms in some patients with carpal tunnel syndrome (CTS). Infrared thermography (IRT) has been used to evaluate CTS by measuring the cutaneous temperature and sympathetic vasomotor function.Methods: This study enrolled the 66 hands of 33 subjects, some of which had clinical CTS and the others were healthy. The enrolled patients completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Historical-Objective scale, and underwent nerve conduction studies (NCSs) and IRT. Skin temperature was measured at the fingertips and the thenar and hypothenar regions in each hand. We analyzed (1) the correlations between self-reported severity, physician-assessed severity, and test results, and (2) the sensitivity and specificity of IRT in diagnosing CTS.Results: No significant correlation was observed between the results of the BCTQ, NCS, and IRT. IRT had a low sensitivity and high specificity in diagnosing CTS.Conclusions: IRT cannot replace NCS in diagnosing CTS, nor did it provide an advantage in combination with NCS. However, lower temperatures at the median nerve in some hands with moderate-to-severe CTS suggested the involvement of sympathetic nerve fiber function. Follow-up studies with a larger-scale and complementary design are required to elucidate the relationships.

Bipolar pulsed radiofrequency neuromodulation of median nerve for treatment of carpal tunnel syndrome – a preliminary study

WstępWyniki chirurgicznego odbarczenia nerwu pośrodkowego u części chorych z zespołem cieśni nadgarstka są niezadowalające. Celem pracy jest ocena wczesnych wyników leczenia zespołu cieśni nadgarstka (<i>carpal tunnel syndrome</i> – CTS) za pomocą bipolarnej neuromodulacji nerwu pośrodkowego (<i>median nerve</i> – MN) z użyciem prądu o częstotliwości radiowej w trybie pulsacyjnym (<i>pulsed radiofrequency</i> – PRF).Materiał i metodyLeczeniu poddano 15 dorosłych pacjentów z CTS (10 kobiet i 5 mężczyzn, średni wiek 58,5 roku). Zastosowano technikę bipolarnej neuromodulacji z użyciem prądu PRF. Prawidłowość położenia elektrod potwierdzano neurofizjologicznie. Protokół badania składał się z kwestionariusza objawów zespołu cieśni nadgarstka (Boston Carpal Tunnel Questionnaire – BCTQ), skali numerycznej NRS (Numerical Rating Scale) dla oceny bólu oraz oceny siły mięśniowej przed neuromodulacją oraz 4 i 12 tygodni po leczeniu. Ponadto oceniano szybkość przewodnictwa czuciowego w nerwie pośrodkowym (<i>sensory nerve conduction velocity</i> – SNCV) przed i 12 tygodni po interwencji.WynikiStwierdzono znamienną poprawę w zakresie podskal BCTQ dotyczących ciężkości objawów (33,53 ± 8,25 przed zabiegiem vs. 18,33 ± 11,06 i 25,67 ± 12,39 po upływie 4 i 12 tygodni od zabiegu) oraz stanu czynnościowego (21,0 ± 5,79 vs. 12,07 ± 7,20 i 17,73 ± 9,09), a także poprawę siły mięśniowej (3,39 ± 1,68 vs. 5,86 ± 1,98 i 4,93 ± 2,22). Ponadto stwierdzono redukcję bólu i poprawę SNCV, jednak parametry te nie osiągnęły znamienności statystycznej.WnioskiNeuromodulacja nerwu pośrodkowego za pomocą prądu PRF przeprowadzona techniką bipolarną jest obiecującą metodą leczenia pacjentów z CTS i może być alternatywą dla chirurgicznego uwolnienia nerwu pośrodkowego. Dla oceny trwałości poprawy klinicznej po zastosowanym leczeniu konieczny będzie dłuższy okres obserwacji.

The experience of using anti-adhesion gel in the surgery for carpal tunnel syndrome

The study objective is to evaluate the effectiveness of anti‑adhesion gel by using in carpal tunnel syndrome surgery.Materials and methods. A prospective study was carried out among 55 patients with carpal tunnel syndrome. All patients were underwent open decompression of the carpal tunnel. Patients of study group (n = 25) got an carboxymethylcellu‑ lose anti‑adhesion gel, which was applied to the nerve before suturing the wound. Patients from control group (n = 30) were underwent surgery without using an anti‑adhesive gel. Before surgery, all patients underwent a clinical neurological examination with an assessment of symptoms according to the Boston Carpal Tunnel Questionnaire, which includes 2 scales: the scale and the functional status scale. The Boston Carpal Tunnel Questionnaire was reevaluated 2.5 years after surgery.Results. In study group the mean symptom severity decreased by 59.5 %, functional status improved by 55.1 %, in control group these indicators were 48.3 and 47.6 %. Clinical relapse of the disease was noted in 8 % of patients of study group and in 20 % of patients of control group.Conclusion. Intraoperative using of an anti‑adhesion gel allows to reduce the frequency of recurrence of carpal tunnel syndrome after surgical decompression.

A COMPARISON OF FUNCTIONAL ASSESSMENT OF PRE- AND POSTSURGICAL CARPAL TUNNEL SYNDROME USING BOSTON CARPAL TUNNEL QUESTIONNAIRE AND NERVE CONDUCTION STUDY: A PROSPECTIVE STUDY FROM A TERTIARY CENTER OF SOUTH INDIA

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome of median nerve causing frequent disability especially among working populations. Boston Carpal Tunnel Questionnaire and Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after surgical release of carpal tunnel. OBJECTIVES: To assess functional outcome of patients with Carpal Tunnel Syndrome after surgery as assessed by Boston Carpel Tunnel Questionnaire and Electrophysiological study. METHODS: A prospective observational study conducted over a period of one year (January 2017 to January 2018). The study was conducted among consecutive 31 electrophysiological conrmed carpal tunnel syndrome attending the outpatient department of Physical Medicine and Rehabilitation, Government Medical College, Thiruvananthapuram. All patients underwent open carpal tunnel release. Functional outcome was assessed using Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at interval of 3 weeks, 6weeks and 3 months postoperatively. Electrophysiological study assessed using nerve conduction study both preoperatively and 3 weeks post operatively. Data was entered in Microsoft excel and analyzed using SPSS statistical software. RESULTS: The study involves 31 conrmed cases of Carpal tunnel syndrome patients. Mean Boston Carpal Tunnel Questionnaire (BCTQ) score preoperatively was 58.52 ± 12.73 which was markedly improved postoperatively at 3weeks with mean score of 29.77±6.68. At 6 weeks and 3 month follow up period it was reduced respectively to mean score of 23.94±4.23 and 22.94±4.62. Preoperative NCS shows decreased conduction velocity with mean nerve sensory velocity (NSV) score 21.51±8.19 and mean nerve motor velocity (NMV) score of 20.72±8.81 which statistically improved following surgery with mean NSV score of 32.04±9.01 and mean NML score of 33.78±8.1. Correlation between pre- and post-operative BCTQ and NCS parameters shows positive correlation with latency and negative correlation with amplitude and conduction velocity. Increased latency and decreased conduction velocity associated with higher BCTQ score with signicant 'p' value (p<0.05). CONCLUSION: There is statistically signicant improvement of functional outcome following carpal tunnel release surgery assessed through Boston Carpal Tunnel Questionnaire and Electrophysiological ndings

Assessment of carpal tunnel syndrome via ultrasonography among hospital workers: a screening study

Background Carpal tunnel syndrome is a reasonably common disorder among working individuals. It may also be a cause of functional impairment. The aim of the study was to screen for the presence of carpal tunnel syndrome among hospital workers by non-invasive ultrasound. Results The prevalence of carpal tunnel syndrome diagnosed by ultrasound among hospital workers was 21.5%. Age and Boston carpal tunnel questionnaire scale were positively correlated to median nerve cross sectional area. Conclusions Ultrasound can be used as a non-invasive and convenient method for screening for carpal tunnel syndrome.

Comparison Efficacy of Ultrasound-Guided Needle Release Plus Corticosteroid Injection and Mini-Open Surgery in Patients with Carpal Tunnel Syndrome

Purpose To compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection versus mini-open surgery in patients with carpal tunnel syndrome (CTS).Methods From January 2020 to December 2020, 40 patients (40 wrists) with CTS were retrospectively analyzed in this study. Diagnosis was based on clinical symptoms, electro-physiological and ultrasound imaging. 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A) and other 20 wrists went mini-open surgery (Group B). We evaluated Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity and sensory nerve action potential of median nerve) and ultrasound parameters (cross-sectional area, flattening ratio and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time and complications were also recorded for two groups.Results Boston carpal tunnel questionnaire, electrophysiologic and ultrasound outcomes at preoperatively and 3 months postoperatively had significant difference for each group (each P༜0.05). There were no complications such as infection, haemorrhage, vascular, nerve or tendon injuries in both groups.Conclusion Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application

Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome—A Systematic Review

The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, intraoperative and postoperative data of EDX studies, time to complete or partial resolution of symptoms, and number of patients without postsurgical improvement. Our main findings revealed that that electrodiagnostic testing is still a powerful tool for diagnosis of CTS. Moreover, it can also detect other pathologies. EDX testing provides a quantitative measure of the physiological function of the median nerve, which may be used to guide surgical treatment. Thirdly, when the outcome of surgery is unsatisfactory, NCS can assist in determining the reason for failure.

Effect of Perineural Injection with Different Dextrose Volumes on Median Nerve Size, Elasticity and Mobility in Hands with Carpal Tunnel Syndrome

This study aimed to investigate the effect of different injectate volumes on ultrasonographic parameters and the correlation to clinical outcomes under perineural dextrose injection (PDI). In this post hoc analysis of the randomized, double-blinded, three-arm trial, ultrasound-guided PDI with either 1 mL, 2 mL, and 4 mL 5% dextrose water was administered, respectively, in 14, 14, and 17 patients. Ultrasound outcomes included mobility, shear-wave elastography (SWE), and cross-sectional area (CSA) of the median nerve; clinical outcomes were Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) score. Outcomes were measured before injection, and after injection at the 1st, 4th, 12th, and 24th week. For ultrasound outcomes, CSA decreased significantly from baseline data at all follow-up time-points in the 2 mL group (p = 0.005) and the 4 mL group (p = 0.015). The mean change of mobility from baseline showed a greater improvement on the 4 mL group than the other groups at the 1st week post-injection. For clinical outcomes, negative correlation between the VAS and mobility at the 1st (p = 0.046) and 4th week (p = 0.031) post-injection in the 4 mL group were observed. In conclusion, PDI with higher volume yielded better nerve mobility and decreased CSA of median nerve, but no changes of nerve elasticity.