Factors determining the effectiveness of conservative treatment in patients with carpal tunnel syndrome

Abstract

Objectives: The study aims to assess selected factors contributing to the long-term effects of the conservative treatment of carpal tunnel syndrome (CTS). Material and Methods: Forty-nine individuals diagnosed with CTS were enrolled in the study. The symptoms resulted from occupational hand overuse in 37 patients. The assessment involved 78 hands before the therapy (study 1) and 1 year after the end of the therapy (study 2). The clinical symptoms assessed included: pain, numbness, tingling, morning stiffness, vegetative disorders and difficulties in activities of daily living (ADL). The range of motion (ROM) in the hand joints and the pressure generated during the cylindrical grip were measured. Phalen's tests, an electrodiagnostic test and a 2-point discrimination study were performed. Results: A significant reduction of symptoms and improvement in tested parameters were found in study 2. The largest ROM in the hand, the lowest level of pain and the largest reduction in the frequency of daytime tingling were found in the oldest patients in study 2. In subjects with better initial electrodiagnostic test results, a significant reduction in daytime numbness and daytime tingling was obtained. In individuals previously subjected to conservative therapy, a significant improvement in the ROM of the hand and a better quality of sensation were noted in study 2. A higher level of pain, a lower reduction in the frequency of daytime tingling, and a smaller improvement in ADL capacity were noted in individuals who overused their hands at work after the therapy. Conclusions: The effects of conservative CTS treatment after 1 year, expressed as the reduction of subjective symptoms, were independent of the patient's age. A worse initial electrodiagnostic test result is a predictor of less favorable therapy results. Hand overuse during occupational activity may negatively affect the effects of conservative treatment in individuals with CTS. A change in the nature of occupational activity positively influenced the long-term maintenance of the effects of conservative treatment.

Prognostic factors in carpal tunnel syndrome treated with 5% dextrose perineural injection: A retrospective study

“…Our results demonstrated that SNCV is an independent prognostic factor of outcome, where a worse SNCV score predicts poor outcomes for patients after the D5W injection. This finding was in line with previous research [20][21][22][23] and this information can be valuable for clinical practice of decision making and informs patient expectations.…”

“…Visser et al [20] stated that only severity of electrodiagnostic results was a predictor of outcome after corticosteroid injections and a mild grade has a better outcome. Zwolińska et al [21] reported that worse primary SNCV and DML are prognostic factors of a less favorable outcome after conservative treatment such as whirlpool massage, sonotherapy, and glide exercise. Moreover, CTS patients with better DML and sensory latencies were good candidates for wrist splinting [22], and failure of wrist splinting and corticosteroid injections could be predicted by long motor and sensory distal latency [23].…”

Carpal tunnel surgery: predictors of clinical outcomes and patients’ satisfaction

“…We measured patients' satisfaction only at 6 months after CTS surgery. However, studies with longer follow-up periods showed that the persistence of positive effects had no further improvement beyond 6 months [4,17,18]. Furthermore, there was a substantial drop-out rate among patients between the intake and the follow-up at 6 months.…”

Outcome predictors of platelet‐rich plasma injection for moderate carpal tunnel syndrome

“…Electrophysiological studies are the most objective way of assessing a CTS diagnosis or grading, 19,20 and it may be widely used as a prognostic tool. Poor initial electrodiagnostic results were considered predictors of poor outcomes in conservative treatment, 27 and electrodiagnostically mild CTS was related to good outcomes in steroid injection. 28 However, few studies found no association between electrophysiological studies and outcomes after steroid injection.…”

“…Although younger age was shown to be an independent predictor of higher postoperative satisfaction, 49,50 one study revealed that old age was a good outcome predictor after conservative treatment. 27 Bowman et al 51 reported that sex and the dominant hand were outcome predictors when treating CTS, in which males and the dominant hand had poor outcomes. Although older age, shorter symptom duration, and higher VAS score were noted in good outcome group in our study, none of them were associated with outcome significantly.…”