Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome—A Systematic Review

Huisstede, Bionka M. A.; Brink, Janneke van den; Randsdorp, Manon S.; Geelen, Sven J G; Koes, Bart W.

doi:10.1016/j.apmr.2017.04.024

Cited by 28 publications

(15 citation statements)

References 97 publications

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“…As expected, and in agreement with the effects reported elsewhere 6,85,86 , surgical release of the carpal ligament nearly normalized the pain (WBFS) and symptomology (e.g. numbness or tingling sensations; BCTSQs) and low or medium hand-strength motor function of activities (e.g.…”

Section: Discussionsupporting

confidence: 91%

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

Trull-Ahuir

Sala

Chismol-Abad

et al. 2020

Sci Rep

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The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, tripleblinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP (n = 25) or the platelet-poor plasma (PPP, n = 25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was irrigated with 3 mL of PRP or PPP according to each participant's group allocation. The primary outcome was hand grip strength (HGS). Secondary outcomes were the time taken off work after surgery (in days) and scores on the Wong-Baker Faces Scale, Boston Carpal Tunnel Questionnaire, and Southampton Wound Assessment Scale. We evaluated patients before treatment and at 6-weeks. As expected, the pain levels, symptom severity, and functional status improved in all the patients after surgery. However, intragroup analysis revealed that only the participants in the PRP group had regained their pre-operative HGS levels at 6-weeks follow-up. These findings indicate that PRP is an effective adjuvant treatment in patients with mild to severe CTS who require surgery. Carpal tunnel syndrome (CTS), which affects approximately 3% of the general adult population 1 , is the most commonly diagnosed upper limb peripheral entrapment neuropathy 2. CTS is characterized by compression of the median nerve (MN) at the wrist as it passes through the carpal tunnel 3 and typical symptoms include numbness, paresthesias, and pain in areas innervated by the MN. In more severe cases, weakness and atrophy of the thenar muscles (innervated by the MN) can occur which in turn, usually affects the work productivity and quality of life of the affected patient 4-6. Depending on the severity of the symptoms, treatments for CTS may be conservative (including the use of medications, a night splint, steroid injections, or physical therapy) or require surgical intervention. Surgical decompression of the carpal tunnel by transection of the transverse carpal ligament is the standard treatment for patients with muscle atrophy, or whose symptoms do not respond to conservative therapies 2,7. Carpal tunnel decompression is a well-established surgical treatment for CTS whose reported success rate and levels of patient satisfaction are high 8. Nonetheless, this technique is not exempt from potential complications including: sensitive scar areas, persistent symptoms, neurovascular injury, wound complications, bleeding, pillar pain (pain adjacent to the ligament release site), and reduced grip strength 9,10. Therefore, adjuvant surgical treatments are worth exploring. Platelet-rich plasma (PRP) is an autologous blood product comprising concentrated platelets and several growth factors (including transforming growth factor-β, platelet-derived growth factor, epidermal growth factor, vascular endothelial growth factor, insulin-like growth factor-1, fibroblast growth factor, hepatoc...

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Section: Discussionsupporting

confidence: 91%

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

Trull-Ahuir

Sala

Chismol-Abad

et al. 2020

Sci Rep

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“…[8] Pillar pain, which is known as the pain between the thenar and hypothenar areas of the hand, is reported as the most common complication after surgical treatment of CTS, whereas regardless of the surgical technique, the occurrence was estimated between 6% and 36%. [6] Although rest, bracing, and physiotherapy are usual treatment methods of pillar pain, painful symptoms are reported insignificant number of patients after surgery. [9]…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Shockwave Therapy in Pillar Pain after Carpal Tunnel Release: A Prospective Randomized Controlled Trial

et al. 2019

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Background: The aim of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pillar pain after carpal tunnel release. Materials and Methods: In this prospective randomized controlled trial, forty patients with pillar pain for at least 1 month after carpal tunnel release surgery were randomly assigned in two groups. ESWT group received four sessions of ESWT at weekly intervals, and patients in the control group received sham ESWT treatment at the same intervals, involved sound but no energy. At baseline, 1 st month, and 3 rd month, hand function (using Brief-Michigan Hand Outcome Questionnaire) and pain score were assessed and compared between groups. Results: At baseline, pain score and hand function score were similar in both groups. After 1 st month, pain score in ESWT and control groups was 3.7 versus 4.7, respectively ( P = 0.066), and hand function score was 60.7 versus 52.2, respectively ( P = 0.032). After 3 months, pain score in ESWT group was significantly lower than the control group (1.6 versus 3.6, respectively, P < 0.0001), hand function score in ESWT group was significantly better than the control group (75.4 vs. 63.7, respectively, P < 0.0001). Trend of decrease in pain score between groups was significantly different, but trend of increase in hand function score was not significantly different. Conclusion: After ESWT, hand function and pain score in patients with pillar pain improved faster compared to control patients. Hence, ESWT can be used as a safe and effective noninvasive technique in patients with pillar pain after carpal tunnel release.

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“…1 There are systematic reviews and meta-analyses that prove the effectiveness of several treatments for carpal tunnel syndrome, 2,3 including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, physiotherapy, and surgery. 4,5 Therefore, any experimental intervention in patients with carpal tunnel syndrome associated with electrophysiological changes must be compared with other interventions that have demonstrated effectiveness, making the use of placebo a very questionable strategy.…”

Section: To the Editormentioning

confidence: 99%

Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial

et al. 2019

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Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome—A Systematic Review

Cited by 28 publications

References 97 publications

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial

Extracorporeal Shockwave Therapy in Pillar Pain after Carpal Tunnel Release: A Prospective Randomized Controlled Trial

Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial

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