The effectiveness of the median nerve neurodynamic mobilisation techniques in women with mild or moderate bilateral carpal tunnel syndrome: A single-blind clinical randomised trial

Conservative Treatments of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-analysis

OBJECTIVE

To evaluate the comparative efficacy of various conservative treatments for carpal tunnel syndrome (CTS), including manual therapy (MT), local steroid injections, platelet-rich plasma (PRP) injections, extracorporeal shock wave therapy, and low-level laser therapy, through a comprehensive network meta-analysis.

DATA SOURCES

PubMed, Web of Science, Cochrane Library, Embase, SPORTDiscus, and China National Knowledge Infrastructure databases were searched to identify published studies until April 2024.

STUDY SELECTION

Randomized controlled trials comparing the efficacy of conservative CTS treatments in individuals with CTS were included.

DATA EXTRACTION

Data from the included articles were extracted independently by 2 researchers, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, participants' age, disease severity, symptom duration, intervention parameters, follow-up period, and reported outcomes.

DATA SYNTHESIS

A total of 49 randomized controlled trials involving 11 conservative treatments and 3323 participants were included. The network meta-analysis showed that MT demonstrated the highest efficacy in both short-term and medium-term pain relief with surface under the cumulative ranking curve values of 87.6% and 99.3%, respectively. Dextrose 5% in water and PRP were closely followed in terms of efficacy. Compared to control groups, low-level laser therapy (standardized mean difference=-1.45; 95% CI, -2.16 to -0.74) and extracorporeal shock wave therapy (standardized mean difference=-1.03; 95% CI, -1.86 to -0.20) also showed significant benefits.

CONCLUSIONS

This study provides robust evidence that MT and dextrose 5% in water injections are the most effective conservative treatments for CTS which offer valuable insights for clinical decision-making. Further research is needed to assess the long-term efficacy and cost-effectiveness of these interventions.

Effect of three traditional conservative treatment techniques on patients with mild-to-moderate carpal tunnel syndrome: A systematic review and meta-analysis

BACKGROUND

Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment syndrome that can be treated in a variety of ways, including manual therapy, massage, and acupuncture.

PURPOSE

Traditional conservative treatment techniques have been widespread used for treatment of patients with mild-to-moderate carpal tunnel syndrome (CTS), such as manual therapy, massage, and acupuncture. However, there appears to be no consensus about the benefits of traditional conservative treatment techniques for patients with CTS. This systematic review and meta-analysis were aimed to analyze the effectiveness of three traditional conservative treatment techniques (manual therapy, massage, and acupuncture) on the patients with mild-to-moderate CTS.

STUDY DESIGN

Intervention systematic review with meta-analysis.

METHODS

Randomized controlled clinical trails were searched from the inception of PubMed, Web of Science and CNKI up to May 22, 2024. Mean differences (MD) or standardized mean differences (SMD) were used as effect sizes by us and 95% confidence intervals (CI) were used to analyze these studies. Analyses were performed using RevMan 5.3 software. Funnel plots and Egger's test were used to assess publication bias.

RESULTS

A total of 14 articles with 1110 patients with mild-to-moderate CTS satisfied the inclusion criteria in this systematic review and meta-analysis. The meta-analysis found that the three traditional conservative treatment techniques can significantly reduce the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) [MD = -1.55, 95% CI (-2.15, -0.95), p < 0.00001], Symptom Severity Scale (SSS) [MD = -0.90, 95% CI (-1.28, -0.51), p < 0.00001], Functional Status Scale (FSS) [MD = -0.85, 95% CI (-1.17, -0.54), p < 0.00001] and pain [SMD = -2.03, 95% CI (-2.75, -1.30), p < 0.00001] scores, and improve sensory nerve conduction velocity (SNCV) [MD = 5.37, 95% CI (2.43, 8.32), P = 0.0004] compared with the control group.

CONCLUSIONS

This study demonstrated that three traditional conservative treatment techniques can effectively improve the severity of symptoms, functional status, pain levels, and sensory nerve conduction velocity on patients with mild-to-moderate CTS.

Mechanism, application and effect evaluation of nerve mobilization in the treatment of low back pain: A narrative review

Lower back pain is a prevalent condition affecting people across all age groups and causing significant personal and societal burdens. While numerous treatments exist, nerve mobilization has emerged as a promising approach for managing lower back pain. Nerve mobilization involves applying gentle and rhythmic movements to the affected nerves, promoting normal nerve function and releasing tension. It has been well documented that nerve mobilization can be effective in reducing pain and improving function in patients with lower back pain, but the underlying mechanisms have not been clarified. This study aims to review the mechanisms of nerve mobilization in the management of lower back pain, its application, and effectiveness evaluation, and provide a potential solution for managing lower back pain.

Quantifying Hand Strength and Isometric Pinch Individuation Using a Flexible Pressure Sensor Grid

Modulating force between the thumb and another digit, or isometric pinch individuation, is critical for daily tasks and can be impaired due to central or peripheral nervous system injury. Because surgical and rehabilitative efforts often focus on regaining this dexterous ability, we need to be able to consistently quantify pinch individuation across time and facilities. Currently, a standardized metric for such an assessment does not exist. Therefore, we tested whether we could use a commercially available flexible pressure sensor grid (Tekscan F-Socket [Tekscan Inc., Norwood, MA, USA]) to repeatedly measure isometric pinch individuation and maximum voluntary contraction (MVC) in twenty right-handed healthy volunteers at two visits. We developed a novel equation informed by the prior literature to calculate isometric individuation scores that quantified percentage of force on the grid generated by the indicated digit. MVC intra-class correlation coefficients (ICCs) for the left and right hands were 0.86 (p < 0.0001) and 0.88 (p < 0.0001), respectively, suggesting MVC measurements were consistent over time. However, individuation score ICCs, were poorer (left index ICC 0.41, p = 0.28; right index ICC -0.02, p = 0.51), indicating that this protocol did not provide a sufficiently repeatable individuation assessment. These data support the need to develop novel platforms specifically for repeatable and objective isometric hand dexterity assessments.