Current concepts in carpal tunnel syndrome: a review of the literature

Lewis, C. W. D.; Mauffrey, Cyril; Newman, Sp; Lambert, A.; Hull, Peter

doi:10.1007/s00590-010-0585-9

Cited by 30 publications

(28 citation statements)

References 46 publications

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“…28 We also excluded patients with secondary carpal tunnel syndrome owing to coexisting polyneuropathy, inflammatory arthropathy, pregnancy, diabetes mellitus, hypothyroidism, malignancy, rheumatoid arthritis, alcoholism, infections, spaceoccupying lesions (tumours, hypertrophic synovial tissue, fracture callus and osteophytes) and familial neuropathy. 29 Patients who had previous carpal tunnel release surgery, who were taking oral steroids or warfarin, who had received treatment with local steroid injections or acupuncture for carpal tunnel syndrome, or patients with other serious diseases requiring inpatient care were also considered ineligible. Patients with cervical radiculopathy were also excluded (see details in Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.151003/-/DC1.…”

Section: Exclusion Criteriamentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

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Background:The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods:We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results:Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] -0.20, 95% confidence interval [CI] -0.36 to -0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD -6.72, 95% CI -10.9 to -2.57), function (Functional Status Scale score MD -0.22, 95% CI -0.38 to -0.05), dexterity (time to complete blinded pick-up test MD -6.13 seconds, 95% CI -10.6 to -1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale -0.70, 95% CI -1.34 to -0.06), and not significant for sensation (first finger monofilament test -0.08 mm, 95% CI -0.22 to 0.06).Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting.

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Section: Exclusion Criteriamentioning

confidence: 99%

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Chung

Liu

et al. 2016

CMAJ

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“…93 Chronic CTS has insidious onset and is related to several prognostic factors including pregnancy, diabetes mellitus, hypothyroidism, osteoarthritis, gout, overweight and occupation. 94 The annual incidence of CTS in UK primary care is approximately 88 per 100,000 males and 193 per 100,000 females. 95 Incidence peaks in the late fifties for women and the late seventies for both men and women.…”

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

“…97 Specific diagnostic signs and symptoms such as Phalen's manoeuvre, Tinel's sign, and the Durkan test and the patient-completed Katz hand diagram may contribute to the diagnosis. 94 Electrophysiological tests stimulate the median nerve and measure the muscle or sensory response at a point further along the nerve pathway 94 with the aim of quantifying the severity of the damage and define the pathophysiology. Prognosis varies with the duration and severity of symptoms.…”

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

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BackgroundNHS expenditure has stagnated since the economic crisis of 2007, resulting in financial pressures. One response is for policy-makers to regulate use of existing health-care technologies and disinvest from inefficiently used health technologies. A key challenge to disinvestment is to identify existing health technologies with uncertain cost-effectiveness.ObjectivesWe aimed to explore if geographical variation in procedure rates is a marker of clinical uncertainty and might be used by local commissioners to identify procedures that are potential candidates for disinvestment. We also explore obstacles and solutions to local commissioners achieving disinvestment, and patient and clinician perspectives on regulating access to procedures.MethodsWe used Hospital Episode Statistics to measure geographical variation in procedure rates from 2007/8 to 2011/12. Expected procedure numbers for each primary care trust (PCT) were calculated adjusting for proxies of need. Random effects Poisson regression quantified the residual inter-PCT procedure rate variability. We benchmarked local procedure rates in two PCTs against national rates. We conducted rapid systematic reviews of two high-use procedures selected by the PCTs [carpal tunnel release (CTR) and laser capsulotomy], searching bibliographical databases to identify systematic reviews and randomised controlled trials (RCTs). We conducted non-participant overt observations of commissioning meetings and semistructured interviews with stakeholders about disinvestment in general and with clinicians and patients about one disinvestment case study. Transcripts were analysed thematically using constant comparison methods derived from grounded theory.ResultsThere was large inter-PCT variability in procedure rates for many common NHS procedures. Variation in procedure rates was highest where the diffusion or discontinuance was rapidly evolving and where substitute procedures were available, suggesting that variation is a proxy for clinical uncertainty about appropriate use. In both PCTs we identified procedures where high local use might represent an opportunity for disinvestment. However, there were barriers to achieving disinvestment in both procedure case studies. RCTs comparing CTR with conservative care indicated that surgery was clinically effective and cost-effective on average but provided limited evidence on patient subgroups to inform commissioning criteria and achieve savings. We found no RCTs of laser capsulotomy. The apparently high rate of capsulotomy was probably due to the coding inaccuracy; some savings might be achieved by greater use of outpatient procedures. Commissioning meetings were dominated by new funding requests. Benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective. Most patients were unaware of rationing.ConclusionsPolicy-makers could use geographical variation as a starting point to identify procedures where health technology reassessment or RCTs might be needed to inform policy. Commissioners can use benchmarking to identify procedures with high local use, possibly indicating overtreatment. However, coding inconsistency and limited evidence are major barriers to achieving disinvestment through benchmarking. Increased central support for commissioners to tackle disinvestment is needed, including tools, accurate data and relevant evidence. Early engagement with patients and clinicians is essential for successful local disinvestment.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Carpal tunnel syndrome is shown to have a higher incidence rate in employed patients than in unemployed persons. [2,3,7,[16][17][18][19] It has been shown that occupational exposure to excess vibration, increased hand force and repetition increases the risk of developing CTS in a meta-analysis investigating the relationship between CTS and occupation. [20] Lengthy exposure to high repetitive hand and wrist movements, high range wrist action, constant extreme wrist position, using handheld vibrating tools, work involving frozen food and availability of protection have been shown to be the key occupational points to consider in determining work liability for CTS.…”

Section: Discussionmentioning

confidence: 99%

Carpal tunnel syndrome in manual tea harvesters

Çiftdemir

Çopuroğlu

Özcan

et al. 2013

Eklem Hastalik Cerrahisi

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Amaç: Bu çalışmada elle yapılan çay tarımına bağlı karpal tünel sendromunun (KTS) fizyopatolojik ve cerrahi boyutu, sinir ileti çalışmaları ve klinik skorlama sistemleri kullanarak değerlendirildi. Hastalar ve yöntemler: Şiddetli KTS nedeniyle cerrahi tedavi uygulanan 56 tarım işçisinin klinik ve nörofizyo-lojik skorları ile klinik ve mesleki değişkenleri; Boston anketi, İtalyan KTS çalışma grubunun modifiye kriterleri ve İtalyan KTS çalışma grubunun modifiye nörofizyolojik evreleme sistemi kullanılarak istatistiksel olarak değerlen-dirildi. Bulgular: Hastaların klinik evreleri, yaşları, toplam çalışma süreleri ile semptomların süresi arasında anlamlı istatistiksel ilişki bulundu. Hastalardaki KTS'nin nörofizyolojik evreleri ve semptomların süresi ile cerrahi tedavi öncesi ve sonrasında fonksiyonel sonuçlar arasında da anlamlı bir istatistiksel ilişki saptandı. Sonuç: Elle yapılan çay tarımının mesleğe bağlı KTS gelişimi için mesleki bir risk faktörü olabileceği düşünüldü. Bu alanda çalışan isçilerde KTS'nin cerrahi tedavisi ile tatminkar sonuçlar elde edildi.Anahtar sözcükler: Tarım isçileri hastalıkları; karpal tünel sendromu; sinir basısı sendromları; cerrahi uygulamalar, küçük; çay.Objectives: This study aims to present the physiopathological and surgical aspects of carpal tunnel syndrome (CTS) related to manual tea harvesting based on nerve conduction studies and clinical scoring systems. Patients and methods: Clinical and neurophysiological scores as well as clinical and occupational variables were statistically analyzed using Boston questionnaire, modified criteria of Italian CTS study group, and modified neurophysiologic grading system of Italian CTS study group in 56 agricultural laborers who underwent surgery due to severe CTS. Results: A statistically significant correlation was found among the clinical stages of the patients and age, working duration and duration of symptoms. There was a statistically significant relationship among neurophysiologic grades of the CTS in patients and the duration of symptoms and functional outcomes before and after surgery. Conclusion: We concluded that manual tea harvesting might be an occupational risk factor for work-related CTS development. Surgical treatment of CTS among manual tea harvesters revealed satisfactory results.

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Current concepts in carpal tunnel syndrome: a review of the literature

Cited by 30 publications

References 46 publications

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Carpal tunnel syndrome in manual tea harvesters

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