ArticlePDF Available

Treatment of carpal tunnel syndrome: A trial of Vitamin B6

Authors:

Abstract

Objective: Carpal tunnel syndrome (CTS) is a common disorder that can be treated with surgery or conservative options. There have been several studies of Vitamin B6 as a conservative treatment for CTS, but its effectiveness remains controversial. Our objective was to compare the efficacy of splinting and placebo with splinting and VitaminB6 in patients with CTS. Methodology: We conducted a randomized case-control trial in the neurology clinic of Alzahra hospital, Isfahan, Iran, between March 2009 and March 2010. Ninety outpatients who were at least 18 years old and who had clinically and electrophysiologically confirmed idiopathic CTS were included in the study. The patients were randomly allocated to two groups: placebo plus wrist splinting (control) or VitaminB6 supplementation (for six months) plus wrist splinting (case) for at least three months. Eighty-six patients (95%) completed the study. The primary endpoint was improved sensory nerve conduction by the median nerve. Result: Evaluations performed at three months follow up revealed a significant difference in the mean peak sensory latency between the case and control groups (p=0.002). A total of 65% of patients in the case group reported subjective symptom relief compared with 58% of patients in the control group. These data suggest that splinting combined with VitaminB6 supplementation is more effective than splinting alone in improving electrophysiological parameters and subjective symptoms of CTS. Conclusion: Vitamin B6 is an effective treatment in mild and moderate CTS and could be considered as a conservative treatment.
Pak J Med Sci 2012 Vol. 28 No. 2 www.pjms.com.pk 283
INTRODUCTION
The most frequent entrapment neuropathy of
the upper limbs is carpal tunnel syndrome (CTS).
1
There are several conservative or surgical op-
tions available for the treatment of CTS. The most
common conservative treatments include wrist
splinting, non-steroidal anti-inammatory drugs
(NSAIDs), corticosteroid injection into the carpal
tunnel, systemic steroids, pyridoxine (Vitamin B6),
and diuretics.
2,3
Some researchers have suggested that Vitamin
B6 deciency can lead to CTS, and that pyridoxine
is a suitable conservative option for the treatment
of CTS.
4,5
However, other researchers have not
found any obvious benet with pyridoxine in CTS.
6
1. Fariborz Khorvash, MD,
Assistant Professor, Department of Neurology,
Isfahan Neuroscience Research Center, School of Medicine,
2. Bahador Asadi, MD,
Assistant Professor, Department of Neurology,
University of AJA, Tehran, Iran.
3. Rasul Norouzi,
Neurology Assistant, Isfahan Neurosciences Research Center,
Department of Neurology,
4. Mohammad Mehdi Shahpoori, MD,
5. Adibnejad Mohammad,
Department of Biochemistry, Falavarjan Branch,
Islamic Azad University, Isfahan, Iran.
1,3,5: Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
Correspondence:
Mohammad Mehdi Shahpoori,
E-mail: mahdijan2010@yahoo.com
* Received for Publication: February 2, 2012
* Revision Received: February 28, 2012
* Revision Accepted: March 1, 2012
Original Article
Treatment of carpal tunnel syndrome:
A trial of Vitamin B6
Fariborz Khorvash
1
, Bahador Asadi
2
, Rasul Norouzi
3
,
Mohammad Mehdi Shahpoori
4
, Sonbolestan Ali
5
, Adibnejad Mohammad
6
ABSTRACT
Objective: Carpal tunnel syndrome (CTS) is a common disorder that can be treated with surgery
or conservative options. There have been several studies of Vitamin B6 as a conservative
treatment for CTS, but its effectiveness remains controversial. Our objective was to compare
the efcacy of splinting and placebo with splinting and VitaminB6 in patients with CTS.
Methodology: We conducted a randomized case-control trial in the neurology clinic of Alzahra
hospital, Isfahan, Iran, between March 2009 and March 2010. Ninety outpatients who were at
least 18 years old and who had clinically and electrophysiologically conrmed idiopathic CTS
were included in the study. The patients were randomly allocated to two groups: placebo plus
wrist splinting (control) or VitaminB6 supplementation (for six months) plus wrist splinting
(case) for at least three months. Eighty-six patients (95%) completed the study. The primary
endpoint was improved sensory nerve conduction by the median nerve.
Result: Evaluations performed at three months follow up revealed a signicant difference in
the mean peak sensory latency between the case and control groups (p=0.002). A total of 65% of
patients in the case group reported subjective symptom relief compared with 58% of patients in
the control group. These data suggest that splinting combined with VitaminB6 supplementation
is more effective than splinting alone in improving electrophysiological parameters and
subjective symptoms of CTS.
Conclusion: Vitamin B6 is an effective treatment in mild and moderate CTS and could be
considered as a conservative treatment.
KEY WORDS: Vitamin B6, Carpal tunnel syndrome, Splinting, Electrodiagnosis.
Pak J Med Sci January - March 2012 (Part-II) Vol. 28 No. 2 283-286
How to cite this article:
Khorvash F, Asadi B, Norouzi R, Shahpoori MM, Ali S, Mohammad A. Treatment of carpal tunnel
syndrome: a trial of Vitamin B6. Pak J Med Sci 2012;28(2):283-286
Fariborz Khorvash et al.
284 Pak J Med Sci 2012 Vol. 28 No. 2 www.pjms.com.pk
To the best of our knowledge, there have been no
randomized clinical trials comparing splinting alone
with splinting plus Vitamin B6 for the treatment of
CTS.
The aim of this study was to compare the effect
of splinting alone with splinting plus Vitamin B6 in
CTS.
METHODOLOGY
This randomized clinical trial was performed
at the neurology clinic of Alzahra Hospital, Isfa-
han, Iran, between March 2009 and March 2010.
The study was approved by the ethics committee
of Isfahan University of Medical Sciences. Written
informed consent was obtained from all patients
who participated in the study. Out patients with
clinically and electrophysiologically conrmed CTS
who attended our health center and who met the
selection criteria for the trial were enrolled. Clini-
cal conrmation of CTS was achieved by noting
compatible symptoms such as numbness, burning,
and tingling or pain in the wrists, hands, or ngers,
which are suggestive of median nerve involve-
ment.
7
Electrodiagnostic conrmation of CTS was
based on the guidelines of the American Associa-
tion of Electrodiagnostic Medicine.
4
Inclusion and
exclusion criteria were specied with the aim of en-
suring a relatively uniform group of patients with
idiopathic CTS.
Inclusion criteria were:
* Clinically and electrophysiologically conrmed
CTS
* Patients age ≥ 18years
* Available for the three-month period of the
study
Exclusion criteria were:
* Pregnant women
* Previous treatment with a wrist splint
* History of previous carpal tunnel release
* Currently receiving other treatment for CTS
* History of wrist or median nerve injury due to
trauma (e.g. contusion, fractures) or prior wrist
surgery
* History suggestive of possible underlying causes
of CTS such as diabetes mellitus, thyroid disease,
rheumatoid arthritis, anatomic abnormalities of
the wrist or hand, and pregnancy
* Clinical signs and symptoms or electrodiagnostic
studies suggesting conditions that could mimic
CTS or interfere with its validation, such as
cervical radiculopathy, brachial plexopathy,
polyneuropathy, among others.
A group of 90 CTS cases was selected for the
trial based on the inclusion and exclusion criteria.
Afterward, a primary evaluation of baseline
electrophysiological values and possible prognostic
factors such as age, sex, dominant side, and bilateral
symptoms was made.
The patients were then randomly divided into
two groups. The rst group of patients (case group)
were treated with 80 mg/day VitaminB6 plus
splinting, and the second group (control group) re-
ceived a placebo along with splinting. The placebo
and VitaminB6 tablets were the same shape, color,
and size.
In patients with bilateral symptoms, splinting was
prescribed for the most affected hand. At present,
there are no standard guidelines for the wearing of
splints, but in this study, the patients were directed
to wear the splint continuously at night for at least
three months. The only other therapy allowed dur-
ing the study was Naproxen 250 mg/day, which
was prescribed by the neurologist for pain relief if
required. To avoid wrist and nger stiffness, pa-
tients were educated in the performance of a num-
ber of mild range-of-motion exercises throughout
the study.
The patients were permitted to continue their nor-
mal activities without any limitations. They were
followed up by telephone throughout the study
to see if they had continued with their prescribed
therapy or not, and to ask about possible side ef-
fects. After three months, 86 patients completed the
study. The electrophysiological assessments were
repeated at the end of the trial. Based on the nerve
conduction study (NCS) ndings, patients were di-
vided into three categories: Mild (3.5<distal sensory
latency <4.5); Moderate (4.5< distal sensory laten-
cy<5.5); and Severe (distal sensory Latency 5.5). In
addition, the patients were asked about subjective
symptom relief.
Outcome Assessment: Although there is currently
no agreement on the best means of assessing treat-
ment effects, in this study, the results of the elec-
trodiagnostic study were considered the primary
endpoint. Subjective assessments of symptom im-
provement were based on the patients reporting of
their symptoms as ‘improved’ (complete recovery or
signicant recovery) or ‘not improved’ (mild recov-
ery, no change, mildly worse, or much worse),and
were considered the secondary end point.
Statistical Analyses: The results are presented as
mean ± standard deviation (SD). The mean NCS
values were calculated before and after the inter-
vention. Independent sample t tests were used to
Pak J Med Sci 2012 Vol. 28 No. 2 www.pjms.com.pk 285
identify differences between the analyzed case and
control groups. A Pvalue ≤ 0.05 was considered
statistically signicant. Statistical analyses were
performed using SPSS 14 for Windows (SPSS, Inc.,
Chicago, IL, 1996).
RESULTS
Eighty-six patients completed the study. They
ranged in age from 38 to 67 years. The mean age
of the patients in the case and control groups was
48.18±2.93 years and 45.89±3.56 years, respectively;
there was no signicant difference between the
groups in terms of age (p=0.25). Thirty patients in
the case group (69.87%) and 33 patients in the con-
trol group (76.7%) were women; there was no sig-
nicant difference between the groups in terms of
sex (p = 0.47) as summarized in Table-I.
The mean sensory peak latency of the median
nerve before and after the intervention was 5.2±1.1
and 4.8±1.2, respectively, in the case group (p
=0.002), and 5.1±1.1 and 4.9±1.3, respectively, in the
control group (p = 0.98). Improvement in median
distal sensory latency was observed in both groups;
however, the improvement was not statistically
signicant in the control group. Furthermore, a
signicant difference in mean peak sensory latency
was found between the case and control groups
(p=0.002).
A total of 65% of subjects reported subjective
symptom relief (improved)after the use of a splint
plus Vitamin B6 whereas only 58% of patients
reported symptom improvement from the splint
alone. No serious side effects were reported by the
patients.
DISCUSSION
CTS is the most common entrapment neuropathy
1,8
with a total lifetime risk of 10%.
1
It usually occurs
after the third decade of life, and tends to affect more
women than men (3: 1 ratio).
8
The majority of CTS
cases are idiopathic; however, many predisposing
factors for CTS have been suggested, including
diabetes mellitus, thyroid dysfunction, pregnancy,
and some rheumatologic diseases.
9
Slow but
progressive ischemia and mechanical deformation
of the median nerve as a consequence of elevated
pressure within the carpal tunnel is believed to
be the underlying pathophysiology of CTS.
10
Symptoms consist of sensory complaints such as
tingling, a burning sensation, and numbness in
the territory of the median nerve, pain in the hand,
and motor decits such as weakness and atrophy
of the thenargroup of muscles, and reduction in the
dexterity of hand movements.
10,11
Electrodiagnostic studies
12
and clinical ndings
13,14
are both essential for diagnosing CTS. The most
sensitive electrodiagnostic test for CTS is the me-
dian nerve sensory conduction study, which pro-
vides evidence of a distal delayed sensory latency
in 70–90% of cases.
15
Several conservative and sur-
gical alternatives have been used for the treatment
of CTS.
11
There is currently no agreement on the
selection criteria for each treatment methodology,
16
but in severe cases the recommended treatment is
often surgery.
16,17
Patients with mild symptoms are
usually managed with nonoperative and alterna-
tive options.
18-20
Initially, conservative treatments
are effective in approximately 80% of cases of CTS;
however, the rate of recurrence of symptoms is re-
ported to be close to 80% after one year.
21
Conservative options should be tried for those
who are not able to undergo surgery or for those
who do not wish to undergo surgery. The most
frequently used conservative treatments are
splinting, corticosteroid injection into the carpal
tunnel, NSAIDs, systemic steroids, pyridoxine
(Vitamin B6), and diuretics.
2,3
To the best of our
knowledge, few well-designed trials have evaluated
and compared these treatments
16
, and high quality
Treatment of carpal tunnel syndrome
Table-I: Mean sensory peak latency of the median nerve in the case and control groups before and after intervention.
Groups Before treatment After treatment Pvalue of within group comparison Pvalue of between group comparison
Case 5.2±1.1 4.8±1.2 0.002 0.002
Control 5.1±1.1 4.9±1.3 0.98
Table-II: Frequency distribution of
disease severity in the two groups.
Severity Case Control All patients
n % N % n %
Mild
(3.5< latency <4.5) 13 30.2 17 39.5 30 34.9
Moderate
(4.5< latency<5.5) 18 41.9 16 37.2 34 39.5
severe
Latency >5.5 12 27.9 10 23.3 22 25.6
All of the patients 43 100 43 100 86 100
Table-III: Comparison of NCS
changes between the two groups
Severity Case Control P value
Mean + SD Mean + SD
Mild 0.25 0.19 0.025
Moderate 0.52 0.15 0.005
Severe 0.35 0.14 0.87
286 Pak J Med Sci 2012 Vol. 28 No. 2 www.pjms.com.pk
supporting evidence is only available for splinting
22
and steroids.
23
There is conicting evidence as to
the benets of oral pyridoxinein the treatment of
CTS. It has been assumed that idiopathic CTS may
be a manifestation of VitaminB6 deciency, and
some investigators have declared that Vitamin B6
supplementation can reduce symptoms and others
have claimed that pain alleviation is a consequence
of Vitamin B6’s anti-nociceptive nature.
24
In 1973, Ellis and Presley
25
suggested a relationship
between Vitamin B6 deciency and CTS. Thereafter,
several additional studies emerged
26
that were
suggestive of a causal association in many CTS
patients. However, numerous reports have failed
to prove an exact causal relation between Vitamin
B6 deciency and CTS.
27,28
Indeed, the connection
between pyridoxine deciency and CTS is
multifaceted and remains poorly understood.
4,5,29-31
The cause of this complexity may be the fact that
pyridoxine has numerous biological functions
31
and
separating the contributions of these to CTS is not
easy.
Our data suggest that combined treatment
with splinting and Vitamin B6 is more effective
than splinting alone in terms of the effects on
electrophysiological parameters and subjective
improvement in clinical status, especially among
patients with mild and moderate forms of CTS.
The main concern regarding the therapeutic
use of Vitamin B6 in CTS is its safety as it can be
toxic.
29
Vitamin B6-related sensory neuropathy has
been reported several times and was most often
associated with dosages >1000 mg/day.
Overall, most studies recommend a dose of
between 40 and 500 mg/day for safety, and to avoid
the development of neuropathy. In our study, the
assessment of side effects was not well designed,
but oral questioning of patients during follow-up
revealed no signicant side effects related to the
use of Vitamin B6, suggesting that doses < 200 mg/
day can be safe. Finally, the ndings of this trial are
supported by the results of several studies that have
used Vitamin B6 for CTS. A large, well-designed
study should allay concerns as to the effectiveness
and safety of Vitamin B6 in CTS.
CONCLUSION
Although the effectiveness of VitaminB6 in CTS
is controversial, our clinical trial results indicate
thatVitaminB6 is a suitable conservative treatment
for CTS, especially among patients with mild and
moderate symptoms.
ACKNOWLEDGMENTS
The authors wish to acknowledge the contribution
of Dr. Hemaseh Tavahen, who helped to prepare
this article.
REFERENCES
1. Stevens J, Beard C, O’Fallon W, Kurland L. Conditions associated with
carpal tunnel syndrome. Mayo Clinic 1992;67(6):541-548.
2. Pal B, Morris J, Keenan J, Mangion P. Management of idiopathic carpal
tunnel syndrome (ICTS): A survey of rheumatologists’ practice and
proposed guidelines. Rheumatology 1997;36(12):1328-1330.
3. Scholten RJPM, de Krom MC, Bertelsmann FW, Bouter LM. Variation in the
treatment of carpal tunnel syndrome. Muscle Nerve 1997;20(10):1334-1335.
4. Folkers K, Ellis J. Successful Therapy with Vitamin B6 and Vitamin B2 of
the Carpal Tunnel Syndrome and Need for Determination of the RDAs for
Vitamins B6 & B2 for Disease Statesa. Ann NyAcad Sci 1990;585(1):295-301.
5. Bernstein A, Dinesen J. Brief communication: effect of pharmacologic doses
of vitamin B6 on carpal tunnel syndrome, electroencephalographic results,
and pain. J Am Coll Nutr 1993;12(1):73-76.
6. Guzmán FJL, Gonzalez-Buitrago J, de Arriba F, Mateos F, Moyano J, López-
Alburquerque T. Carpal tunnel syndrome and vitamin B6. J Mol Med
1989;67(1):38-41.
7. Franzblau A, Werner R, Valle J, Johnston E. Workplace surveillance for
carpal tunnel syndrome: a comparison of methods. J Occup Rehabil
1993;3(1):1-14.
8. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I.
Prevalence of carpal tunnel syndrome in a general population. JAMA
1999;282(2):153-158.
9. Dawson DM. Entrapment neuropathies of the upper extremities. New Engl
J Med 1993;329(27):2013-2018.
10. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and
clinical neurophysiology. Clin Neurophysiol 2002;113(9):1373-1381.
11. Gerritsen AAM, de Vet HCW, Scholten RJPM, Bertelsmann FW, de Krom
MC, Bouter LM. Splinting vs surgery in the treatment of carpal tunnel
syndrome. JAMA 2002;288(10):1245-1251.
12. Gerritsen A, Scholten R, Assendelft W, Kuiper H, de Vet H, Bouter L.
Splinting or surgery for carpal tunnel syndrome? Design of a randomized
controlled trial [ISRCTN18853827]. BMC Neurol 2001;1(1):8.
13. De Krom M, Knipschild P, Spaans F, Kester A. Efcacy of provocative tests
for diagnosis of carpal tunnel syndrome. Lancet 1990;335(8686):393-395.
14. Katz J, Simmons B. Clinical practice. Carpal tunnel syndrome. New Engl J
Med 2002;346(23):1807-1812.
15. Bradley WG, Daroff RB, Fenichel G, Jankovic J. Neurology in Clinical
Practice. 5th ed. Butterworth Heinemann; 2008.
16. Splints W. Management of carpal tunnel syndrome. Am Fam Physician
2003;68(2):265-272.
17. Edward A, Weiss A. Carpal tunnel syndrome: aetiology and endoscopic
treatment. Orthop Clin North Am 1995;26(4):769-778.
18. Goodyear-Smith F, Arroll B. What can family physicians offer patients
with carpal tunnel syndrome other than surgery? A systematic review of
nonsurgical management. Ann Fam Med 2004;2(3):267-273.
19. Katz RT. Carpal tunnel syndrome: a practical review. Am Fam Physician
1994;49(6):1371-1379.
20. Weiss A, Akelman E. Carpal tunnel syndrome: a review. R I Med
1992;75(6):303-306.
21. Kanaan N, Sawaya R. Carpal tunnel syndrome: modern diagnostic and
management techniques. Br J Gen Pract 2001;51(465):311-314.
22. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical
treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2008;4.
23. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal
tunnel syndrome. Cochrane Database Syst Rev 2007;2.
24. Auero E, Stitik TP, Foye PM, Chen B. Pyridoxine hydrochloride treatment
of carpal tunnel syndrome: a review. Nutr Rev 2004;62(3):96-104.
25. Ellis JM, Presley J. Vitamin B6: the doctor’s report: Harper & Row; 1973.
26. Ellis J. Treatment of carpal tunnel syndrome with vitamin B6. SMJ
1987;80(7):882-884.
27. Spooner G, Desai H, Angel J, Reeder B, Donat J. Using pyridoxine to treat
carpal tunnel syndrome. Randomized control trial. Can Fam Physician
1993;39:2122-2127.
28. Wu S, Chan R, Hsu T. Electrodiagnostic evaluation of conservative
treatment in carpal tunnel syndrome. Zhonghua Yi XueZaZhi (Taipei)
1991;48(2):125-130.
29. Franzblau A, Rock CL, Werner RA, Albers JW, Kelly MP, Johnston EC.
The relationship of vitamin B6 status to median nerve function and carpal
tunnel syndrome among active industrial workers. Occup Environ Med
1996;38(5):485-491.
30. Jacobson MD, Plancher KD, Kleinman WB. Vitamin B6 (pyridoxine)
therapy for carpal tunnel syndrome. Hand Clin 1996;12(2):253-257.
31. Nathan PA, Keniston RC, Lockwood RS, Meadows KD. Tobacco, caffeine,
alcohol, and carpal tunnel syndrome in American industry: a cross-
sectional study of 1464 workers. Occup Environ Med 1996;38(3):290-298.
Fariborz Khorvash et al.
Article
Objective: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. Methods: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We included studies with a low risk of bias in our best evidence synthesis. Results: We screened 6618 articles; 21 were eligible for critical appraisal and nine (reporting on eight RCTs) had a low risk of bias. All RCTs with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low level laser therapy for persistent lateral epicondylitis. Discussion: Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.
Article
Full-text available
A variety of screening procedures for carpal tunnel syndrome (CTS) were applied among workers in a manufacturing plant, and results were compared. The test procedures included a symptom survey, physical examination, limited electrodiagnostic testing at the wrists, quantitative vibratory threshold testing, 2-point discrimination, palmar pinch grip, and hand grip strength testing. When electrodiagnostic testing alone was used as “gold standard,” the sensitivity and positive predictive value (PPV) of physical examination findings and quantitative test procedures were no better than, and usually worse than, the results on the symptom survey alone. Variation of the constellation of symptoms (i.e., numbness, tingling, pain or burning) and the anatomic distribution of reported symptoms (i.e., fingers, hand, wrist, or forearm) for inclusion in the screening symptom definition of CTS yielded modest changes in the sensitivity and PPV of the symptom survey. However, addition of the requirement for nocturnal symptoms as part of the screening symptom definition for CTS resulted in substantially higher PPV with only slight reduction in sensitivity. These results suggest that, in the absence of electrodiagnostic testing, the simplest test, and the procedure with the highest sensitivity and PPV for CTS is a symptom survey alone. Quantitative test procedures (vibrometry, pinch grip strength, hand grip strength) and physical examination for findings consistent with CTS (e.g., Phalen's test, Tinel's test, thenar muscle wasting, 2-point discrimination) appear to contribute little, if any, additional information when screening subjects in the work setting. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/45020/1/10926_2005_Article_BF01076738.pdf
Article
Full-text available
Abstract Background Carpal tunnel syndrome is a common disorder, which can be treated with surgery or conservative options. However, there is insufficient evidence and no consensus among physicians with regard to the preferred treatment for carpal tunnel syndrome. Therefore, a randomized controlled trial is conducted to compare the short- and long-term efficacy of surgery and splinting in patients with carpal tunnel syndrome. An attempt is also made to avoid the (methodological) limitations encountered in earlier trials on the efficacy of various treatment options for carpal tunnel syndrome. Methods Patients of 18 years and older, with clinically and electrophysiologically confirmed idiopathic carpal tunnel syndrome, are recruited by neurologists in 13 hospitals. Patients included in the study are randomly allocated to either open carpal tunnel release or wrist splinting during the night for at least 6 weeks. The primary outcomes are general improvement, waking up at night and severity of symptoms (main complaint, night and daytime pain, paraesthesia and hypoesthesia). Outcomes are assessed up to 18 months after randomization.
Article
Carpal tunnel syndrome (CTS), or compression neuropathy of the median nerve at the wrist, is the one of the most common conditions encountered by the hand surgeon. The condition is diagnosed with increasing frequency in the general population and in certain occupational groups. There are a wide variety of factors and conditions that are associated with the development of CTS, giving rise to the typical symptoms of pain, numbness and paraesthesia in the hand which may wake the patient at night. CTS is a frequent cause of morbidity and can have a profound impact on an individual's ability to perform their daily activities. In this review we look at the history, anatomy, epidemiology, diagnosis and the key issues in the management of CTS.
Article
The validity of twelve provocative tests for carpal tunnel syndrome (CTS) in a random sample of 504 people from the general population was assessed. 50 woke up at night due to paraesthesiae (with or without numbness or pain) in the fingers innervated by the median nerve (CTS symptoms) in 93 hands. CTS was neurophysiologically confirmed in 28 subjects (44 hands)—a prior probability for CTS of 47%. All clinical diagnostic tests had a low validity. Posterior probability of CTS ranged from 35 to 70% for positive test results and from 41 to 62% for negative test results. A combination of three tests with relatively high validity (paresis of abductor pollicis brevis muscle, hyperpathia, and flick sign) did not significantly change the probability of CTS. Patients with CTS symptoms should be referred directly for neurophysiological examination.
Article
Carpal tunnel syndrome is caused by compression of the median nerve which goes through the carpal tunnel in the wrist. It causes tingling, numbness and pain, mostly in the hand. Treatment is controversial. This review aimed to compare surgical decompression with non-surgical treatments such as splinting or corticosteroid injections. Four trials were found and included, while three are awaiting assessment. The results suggest that surgical treatment is probably better than splinting but it is unclear whether it is better than steroid injection. Further research is needed for those with mild symptoms.
Article
Carpal tunnel syndrome involves classic symptoms of numbness and paresthesias in the radial 3-1/2 digits, most frequently nocturnal, and pain associated with this distribution. Thenar weakness and autonomic dysfunction rarely are seen in this syndrome except in advanced cases. Provocative tests on physical examination such as the wrist flexion test and the local percussion sensitivity test over the median nerve can be extremely helpful in determining and confirming the diagnosis. Nerve conduction velocity and electromyographic studies of the median nerve and its compression can be helpful especially in difficult cases involving a complex differential diagnosis. It has been clearly documented that a negative NCV/EMG study by itself, does not exclude the possibility of carpal tunnel syndrome. The hallmark of the diagnosis remains the history and a careful physical examination. Treatment initially consisting of wrist splint immobilization and steroid injection into the carpal canal can provide initial relief and elimination of symptoms on a long-term basis in several patient groups. Patients without any resolution of symptoms after two to three months of conservative treatment or those with symptoms of greater than one year's duration generally can be considered candidates for surgical decompression of the carpal canal. The likelihood of operative treatment being required for resolution of symptoms is heightened if the patient is involved in daily manual repetitive activities of the hand and/or wrist. Surgical decompression can be accomplished by either a limited open technique or the new endoscopic released technique.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
With use of a comprehensive medical records-linkage system, we identified the comorbid conditions and risk factors in the residents of Rochester, Minnesota, who had a diagnosis of carpal tunnel syndrome during 1961 through 1980. In 43.2% of the 1,016 patients, no associated conditions were found on review of the medical records, whereas associated conditions were documented in 56.8%. The most frequent of these conditions were Colles' fracture, rheumatoid arthritis, hormonal agents or oophorectomy (or both), diabetes mellitus, and, among men, occupations that involved excessive use of the hands. Rheumatoid arthritis, diabetes mellitus, and pregnancy were significantly more frequent among the study patients with carpal tunnel syndrome than in the general population of Rochester, Minnesota. The standardized morbidity ratio was 3.6 for rheumatoid arthritis, 2.3 for diabetes mellitus, and 2.5 for pregnancy. The population attributable risk for pregnancy among women 15 to 44 years old was 7.0%. The standardized morbidity ratio for polymyalgia rheumatica was not significantly increased.
Article
The incidence of carpal tunnel syndrome ranks first by far among all entrapment neuropathies. Many foreign studies have been reported over the years concerning the diagnosis of carpal tunnel syndrome, but very few about its treatment effects. Moreover, data have been based on the patients' subjective reports of their symptoms. Our data, however, are wholly derived from objective electromyographic examination. Five treatment approaches were compared for patients suffering from carpal tunnel syndrome in this study. Ninety-nine hands of 61 patients were divided into five treatment groups vitamins B6 & B12, steroid injection, hand splint, splint combined with vitamins, and splint combined with injection. Each patient was evaluated with electrodiagnostic study before the treatment, and 1 and 2 months after the treatment. Treatment with hand splinting, local injection at wrist, and combined therapies were all superior in effect to vitamins B6 & B12 alone in sensory nerve conduction study. The effects of treatment appeared faster in the groups with local injection and local injection combined with hand splinting in the sensory and motor nerve conduction studies. The results of this study suggest that treatment with vitamins B6 & B12 alone does not suit carpal tunnel syndrome well and that hand splint combined with steroid injection is the better conservative treatment.