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Conservative or surgical treatment of carpal tunnel syndrome based on the severity and patient risk factors

MUSCULOSKELETAL SURGERY volume 105, pages 315–319 (2021)Cite this article

Abstract

Background

The carpal tunnel syndrome (CTS) is the most common median nerve compression disease which may result in impaired nerve function. This study was carried out to determine which treatment is more appropriate for moderate or severe CTS patients with or without risk factors.

Materials and methods

In a cohort prospective study, the patients with moderate CTS received a conservative treatment including night splint for 3 months, one methyl prednisolone injection whereas patients with severe CTS underwent surgical release. They were followed for 1 year using the bland scale based on the electromyography and nerve conduction velocity studies and five-point global assessment outcome scale.

Results

Totally, 68 moderate CTS cases (32 patients with risk factors and 36 without any risk factors) and 32 cases with severe CTS (16 patients with risk factors and 16 without any risk factors) were assess at 6 months and 1 year following the treatment. Although about 22% of moderate CTS patients with risk factors changed to mild CTS after 6 months of conservative treatment, about 75% showed mild CTS or complete remedy following 1 year (P value < 0.001). This result was about 30% at 6 months and about 95% at 1 year following conservative treatment in patients with moderate CTS without risk factors. None of moderate CTS patients with or without risk factors underwent surgery after 1 year of follow-up. Although almost all patients with severe CTS, with and without risk factors, showed complete recovery or changed to mild CTS at 1 year postoperatively, the result was statistically significant for cases without risk factors (P value = 0.002).

Conclusion

Conservative treatment for moderate CTS would be a good option, and the final result may be seen 1 year later; however, its positive effect is quicker and better for moderate CTS cases without risk factors. Surgical release of the carpal tunnel may be the best choice not only for severe CTS cases with risk factors but also for cases without risk factors. For obtaining consistent rapid result, it is recommended to do surgical release for all cases of moderate or severe CTS without considering risk factors, but more clinical researches are needed.

Level of evidence

II.

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References

  1. Zamborsky R, Kokavec M, Simko L, Bohac M (2017) Carpal tunnel syndrome: symptoms, causes and treatment options. Literature reviev. Ortop Traumatol Rehabil 19:1–8. https://doi.org/10.5604/15093492.1232629

    Article  PubMed  Google Scholar 

  2. English JH, Gwynne-Jones DP (2015) Incidence of carpal tunnel syndrome requiring surgical decompression: a 10.5-year review of 2,309 patients. J Hand Surg 40:2427–2434. https://doi.org/10.1016/j.jhsa.2015.07.029

    Article  Google Scholar 

  3. Iskra T, Mizia E, Musial A, Matuszyk A, Tomaszewski KA (2013) Carpal tunnel syndrome - anatomical and clinical correlations. Folia Med Cracov 53:5–13

    PubMed  Google Scholar 

  4. Goodman CM, Steadman AK, Meade RA, Bodenheimer C, Thornby J, Netscher DT (2001) Comparison of carpal canal pressure in paraplegic and nonparaplegic subjects: clinical implications. Plast Reconstr Surg 107:1464–1471

    Article  CAS  Google Scholar 

  5. Franklin GM, Friedman AS (2015) Work-related carpal tunnel syndrome: diagnosis and treatment guideline. Phys Med Rehabil Clin N Am 26:523–537. https://doi.org/10.1016/j.pmr.2015.04.003

    Article  PubMed  Google Scholar 

  6. Newington L, Harris EC, Walker-Bone K (2015) Carpal tunnel syndrome and work. Best Pract Res Clin Rheumatol 29:440–453. https://doi.org/10.1016/j.berh.2015.04.026

    Article  PubMed  PubMed Central  Google Scholar 

  7. Maghsoudipour M, Moghimi S, Dehghaan F, Rahimpanah A (2008) Association of occupational and non-occupational risk factors with the prevalence of work related carpal tunnel syndrome. J Occup Rehabil 18:152–156. https://doi.org/10.1007/s10926-008-9125-4

    Article  PubMed  Google Scholar 

  8. Manes HR (2012) Prevalence of carpal tunnel syndrome in motorcyclists. Orthopedics 35:399–400. https://doi.org/10.3928/01477447-20120426-06

    Article  PubMed  Google Scholar 

  9. D'Arcy CA, McGee S (2000) The rational clinical examination. Does this patient have carpal tunnel syndrome? JAMA 283:3110–3117

    Article  CAS  Google Scholar 

  10. Vanhees M, Van Glabeek F, Amandio PC (2014) Carpal tunnel syndrome etiology update: where do we stand? Acta Orthop Belgica 80:331–335

    CAS  Google Scholar 

  11. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R (2004) Risk factors in carpal tunnel syndrome. J Hand Surg (Edinb, Scotl) 29:315–320. https://doi.org/10.1016/j.jhsb.2004.02.009

    Article  CAS  Google Scholar 

  12. Pope D, Tang P (2018) Carpal tunnel syndrome and distal radius fractures. Hand Clin 34:27–32. https://doi.org/10.1016/j.hcl.2017.09.003

    Article  PubMed  Google Scholar 

  13. Ricco M, Cattani S, Signorelli C (2016) Personal risk factors for carpal tunnel syndrome in female visual display unit workers. Int J Occup Med Environ Health 29:927–936. https://doi.org/10.13075/ijomeh.1896.00781

    Article  PubMed  Google Scholar 

  14. Wolny T, Linek P (2018) Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial. Clin Rehabil. https://doi.org/10.1177/0269215518805213

    Article  PubMed  Google Scholar 

  15. Ucan H, Yagci I, Yilmaz L, Yagmurlu F, Keskin D, Bodur H (2006) Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome. Rheumatol Int 27:45–51. https://doi.org/10.1007/s00296-006-0163-y

    Article  CAS  PubMed  Google Scholar 

  16. Page MJ, O'Connor D, Pitt V, Massy-Westropp N (2013) Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev 3:Cd009601. https://doi.org/10.1002/14651858.CD009601.pub2

    Article  Google Scholar 

  17. Page MJ, Massy-Westropp N, O'Connor D, Pitt V (2012) Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 7:Cd010003. https://doi.org/10.1002/14651858.cd010003

    Article  Google Scholar 

  18. Meys V, Thissen S, Rozeman S, Beekman R (2011) Prognostic factors in carpal tunnel syndrome treated with a corticosteroid injection. Muscle Nerve 44:763–768. https://doi.org/10.1002/mus.22183

    Article  CAS  PubMed  Google Scholar 

  19. Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW (2010) Carpal tunnel syndrome. Part II: Effectiveness of surgical treatments: a systematic review. Arch Phys Med Rehabil 91:1005–1024. https://doi.org/10.1016/j.apmr.2010.03.023

    Article  PubMed  Google Scholar 

  20. Wang L (2018) Guiding treatment for carpal tunnel syndrome. Phys Med Rehabil Clin N Am 29:751–760. https://doi.org/10.1016/j.pmr.2018.06.009

    Article  PubMed  Google Scholar 

  21. Shi Q, MacDermid JC (2011) Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 6:17. https://doi.org/10.1186/1749-799x-6-17

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bland JD (2000) A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve 23:1280–1283

    Article  CAS  Google Scholar 

  23. Guan W, Lao J, Gu Y, Zhao X, Rui J, Gao K (2018) Case-control study on individual risk factors of carpal tunnel syndrome. Exp Therapeutic Med 15:2761–2766. https://doi.org/10.3892/etm.2018.5817

    Article  Google Scholar 

  24. Hlebs S, Majhenic K, Vidmar G (2014) Body mass index and anthropometric characteristics of the hand as risk factors for carpal tunnel syndrome. Coll Antropol 38:219–226

    PubMed  Google Scholar 

  25. Goodson JT, DeBerard MS, Wheeler AJ, Colledge AL (2014) Occupational and biopsychosocial risk factors for carpal tunnel syndrome. J Occup Environ Med 56:965–972. https://doi.org/10.1097/jom.0000000000000202

    Article  PubMed  Google Scholar 

  26. Jerosch-Herold C, Shepstone L, Wilson EC, Dyer T, Blake J (2014) Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: the PALMS study protocol. BMC Musculoskelet Disord 15:35. https://doi.org/10.1186/1471-2474-15-35

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mooar PA, Doherty WJ, Murray JN, Pezold R, Sevarino KS (2018) Management of carpal tunnel syndrome. J Am Acad Orthop Surg 26:e128–e130. https://doi.org/10.5435/jaaos-d-17-00451

    Article  PubMed  Google Scholar 

  28. Atroshi I (2018) Steroid injection or wrist splint for first-time carpal tunnel syndrome? Lancet (Lond, Engl) 392(10156):1383–1384. https://doi.org/10.1016/s0140-6736(18)31929-9

    Article  Google Scholar 

  29. Calandruccio JH, Thompson NB (2018) Carpal tunnel syndrome: making evidence-based treatment decisions. Orthop Clin N Am 49:223–229. https://doi.org/10.1016/j.ocl.2017.11.009

    Article  Google Scholar 

  30. Hubbard ZS, Law TY, Rosas S, Jernigan SC, Chim H (2018) Economic benefit of carpal tunnel release in the Medicare patient population. Neurosurg Focus 44:E16. https://doi.org/10.3171/2018.1.focus17802

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lee YH, Kim J, Cho J, Lee MH, Oh S, Bae KJ (2018) Which factors affect the rate of surgery performed in patients with carpal tunnel syndrome? J Hand Surg Asian Pac Vol 23:562–565. https://doi.org/10.1142/s2424835518500583

    Article  PubMed  Google Scholar 

  32. Miranda BH, Asaad K, Cerovac S (2013) Carpal tunnel syndrome study: local corticosteroids, conversion to surgery and NHS implications. J Plast Reconstr Aesthet Surg JPRAS 66:1432–1433. https://doi.org/10.1016/j.bjps.2013.04.005

    Article  CAS  PubMed  Google Scholar 

  33. Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Pareja JA, Alonso-Blanco C (2017) The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: a randomized clinical trial. J Orthop Sports Phys Ther 47(3):151–161. https://doi.org/10.2519/jospt.2017.7090

    Article  PubMed  Google Scholar 

  34. Fowler JR, Munsch M, Huang Y, Hagberg WC, Imbriglia JE (2016) Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release. J Hand Surg Eur Vol 41:137–142. https://doi.org/10.1177/1753193415576248

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Jahrom University of Medical Sciences, Jahrom, Iran

    M. Pourmokhtari

  2. Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran

    M. Mazrooyi

  3. Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

    A. R. Vosoughi

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  1. M. Pourmokhtari
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  2. M. Mazrooyi
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Correspondence to A. R. Vosoughi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of Jahrom University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Pourmokhtari, M., Mazrooyi, M. & Vosoughi, A.R. Conservative or surgical treatment of carpal tunnel syndrome based on the severity and patient risk factors. Musculoskelet Surg 105, 315–319 (2021). https://doi.org/10.1007/s12306-020-00663-x

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  • DOI: https://doi.org/10.1007/s12306-020-00663-x

Keywords

  • Carpal tunnel syndrome
  • Treatment
  • Wrist
  • Risk factors