Treatment of carpal tunnel syndrome.

The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.4). 07/2009; 17(6):397-405.
Source: PubMed

ABSTRACT In September 2008, the Board of Directors of the American Academy of Orthopaedic Surgeons approved a clinical practice guideline on the treatment of carpal tunnel syndrome. This guideline was subsequently endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The guideline makes nine specific recommendations: A course of nonsurgical treatment is an option in patients diagnosed with carpal tunnel syndrome. Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects. Another nonsurgical treatment or surgery is suggested when the current treatment fails to resolve symptoms within 2 to 7 weeks. Sufficient evidence is not available to provide specific treatment recommendations for carpal tunnel syndrome associated with such conditions as diabetes mellitus and coexistent cervical radiculopathy. Local steroid injection or splinting is suggested before considering surgery. Oral steroids or ultrasound are options. Carpal tunnel release is recommended as treatment. Heat therapy is not among the options to be used. Surgical treatment of carpal tunnel syndrome by complete division of the flexor retinaculum is recommended. Routine use of skin nerve preservation and epineurotomy is not suggested when carpal tunnel release is performed. Prescribing preoperative antibiotics for carpal tunnel surgery is an option. It is suggested that the wrist not be immobilized postoperatively after routine carpal tunnel surgery. It is suggested that instruments such as the Boston Carpal Tunnel Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire be used to assess patient responses to carpal tunnel syndrome treatment for research.

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    ABSTRACT: This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release (CTR). From 2008 to 2009, patients with isolated carpal tunnel syndrome were randomized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center. Pre-operatively, participants completed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ), as well as grip and pinch strength and Semmes-Weinstein monofilament sensation testing. At 2 weeks, 6 weeks and at least 6 months post-operatively, these measurements were repeated along with assessment of scar tenderness and pillar pain. Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson's correlations. Significance was set at p = 0.05. There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores, BWCTQ scores, grip strength, pinch strength, scar tenderness, or pillar pain. The only statistically significant difference was improved sensation by Semmes-Weinstein in the single-incision group in the second finger at 6 weeks post-operatively and in the third finger at 6 months post-operatively. The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period. However, there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6+ months post-operatively.
    Hand 03/2014; 9(1):36-42. DOI:10.1007/s11552-013-9572-z
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    ABSTRACT: Carpal tunnel syndrome (CTS) compromises fine sensorimotor function during activities of daily living. Reach-to-pinch for a small object requires not only dexterity of the grasping digits, but also coordinated transport of the hand to the target. This study examined the effects of CTS on the kinematic performance of reach-to-pinch maneuver. Eleven CTS subjects and 11 able-bodied (ABL) controls donned markers for motion capture of the hand, thumb and index finger during reach-to-pinch. Subjects were presented with a virtual target they could see without seeing their reaching upper-extremity. Subjects were instructed to reach to and grasp a virtual object as accurately and precisely as possible. Performance was assessed by variability of the movement trajectories of the digits and hand, the accuracy relative to the target, and precision of pinch contact over repetitive trials. The CTS group demonstrated significantly increased movement variability in inter-pad distance, joint angles, and transport of the hand compared to ABL controls (p<0.01). CTS subjects also exhibited reductions in accuracy (41%) and precision (33%) of their pinch contact location (p<0.05). CTS adversely affects the ability to execute the reach-to-pinch maneuver. Reduced performance was shown in terms of increased variability for both grasp and transport and the ability to locate the grasping digits relative to a target-object. These performance indices could be used for diagnostic and evaluative purposes of CTS.
    PLoS ONE 03/2014; 9(3):e92063. DOI:10.1371/journal.pone.0092063 · 3.53 Impact Factor
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    ABSTRACT: Background Authors have reported better outcomes, by reducing surgical dissection for carpal tunnel syndromes requiring surgery. Recently, a new sonographically guided technique for ultra minimally invasive (Ultra-MIS) carpal tunnel release (CTR) through 1 mm incision has been described. Hypothesis We hypothesized that a clinical trial for comparing Ultra-MIS versus Mini-open Carpal Tunnel Release (Mini-OCTR) was feasible. Materials and methods To test our hypothesis, we conducted a pilot study for studying Ultra-MIS versus Mini-OCTR respectively performed through a 1 mm or a 2 cm incision. We defined success if primary feasibility objectives (safety and efficacy) as well as secondary feasibility objectives (recruitment rates, compliance, completion, treatment blinding, personnel resources and sample size calculation for the clinical trial) could be matched. Score for Quick-DASH questionnaire at final follow-up was studied as the primary variable for the clinical trial. Turnover times were studied for assessing learning curve stability. Results Forty patients were allotted. Primary and secondary feasibility objectives were matched with the following occurrences: 70.2% of eligible patients finally recruited; 4.2% of randomization refusals; 26.6 patients/month recruited; 100% patients receiving a blinded treatment; 97.5% compliance and 100% completion. A sample size of 91 patients was calculated for clinical trial validation. At final follow-up, preliminary results for Quick-Dash substantially favored Ultra-MIS over Mini-OCTR (average 14.54 versus 7.39) and complication rates were lower for Ultra-MIS (5% versus 20%). A stable learning curve was observed for both groups. Conclusions The clinical trial is feasible. There is currently no evidence to contraindicate nor withhold the use of Ultra-MIS for CTR. Level of evidence III.
    Orthopaedics & Traumatology Surgery & Research 05/2014; 100(3). DOI:10.1016/j.otsr.2013.11.015 · 1.17 Impact Factor