Does idiopathic carpal tunnel syndrome deteriorate proprioception of the hand? A case-control study

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms & Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

The Effect of Proprioceptive Training on Hand Function and Activity Limitation After Open Carpal Tunnel Release Surgery: A Randomized Controlled Study

OBJECTIVE

To investigate the effect of proprioceptive training on hand function and activity limitation in patients undergoing open carpal tunnel release surgery.

DESIGN

Randomized controlled study.

SETTING

A university hospital.

PARTICIPANTS

Thirty patients were included in the study and randomized to proprioceptive training (PT) and conventional rehabilitation (CR) groups.

INTERVENTION

One week after surgery, both groups received CR for 6 weeks. All participants were asked to perform home-based exercises daily in 3 sets with 10 repetitions. For the PT group, a 6-step PT program was conducted starting from Week 6. Both groups received face-to-face interventions twice a week for 12 weeks.

MAIN OUTCOME MEASURES

The outcome measures included the Purdue Pegboard Test (PPT), the joint position sense test (JPST), the Boston Carpal Tunnel Questionnaire, and the Patient-Specific Functional Scale. In total, 3 assessments were performed (at 1, 6 and 12 weeks postoperatively).

RESULTS

In the PT group, the results for PPT were statistically significant (P<.05). Although there was a greater decrease in the absolute angular error value (JPST) of the PT group compared to the CR group, the difference was nonsignificant (P>.05). Similar reductions in activity limitation were seen in both groups (PT: 176%, CR: 175%). Symptom severity decreased by 40% in the PT group vs 32% in the CR group. The effect sizes were larger for the changes between the second and third assessments in the PT group compared to the CR group in all parameters tested.

CONCLUSION

When applied after carpal tunnel release surgery, PT may potentially to improve hand functions, reduce activity limitation, increase participation in activities of daily living, and thus improve quality of life.

Neurostimulation in severe carpal tunnel release: A more precise technique for opponensplasty decision-making

OBJECTIVES

In this study, we aimed to investigate the relationship between intraoperative thenar muscle neurostimulation responses and postoperative thumb function recovery in patients with severe carpal tunnel syndrome (CTS).

PATIENTS AND METHODS

Between January 2019 and December 2021, a total of 21 severe CTS cases in 20 patients (7 males, 13 females; mean age: 56.3±19.3 years; range, 52 to 76 years) based on clinical and electrophysiological findings were retrospectively analyzed. The median nerve motor branch (MNMB) was stimulated intraoperatively with a nerve stimulator. The patients were divided into two groups according to contraction response on abductor pollicis brevis (APB) muscle: Group C (contractile, n=13) and Group NR (non-responsive, n=7) with and without muscular contraction. The Levine Functional Severity Scale (LFSS) was used to measure the functional status of CTS patients. The Manual Muscle Testing (MMT) was used to assess muscle strength. Clinical outcomes were compared between the groups at one year of follow-up.

RESULTS

The mean total preoperative LFSS score was significantly higher in Group NR than in Group C (p=0.010). The mean postoperative MMT score was significantly higher in Group C than in Group NR (p<0.001). There was no positive result in pick-up, button fastening, and needle pinch tests in Group NR (p<0.001). However, there were significant improvements in postoperative LFSS scores in Group C (p<0.05), while the scores remained unchanged in Group NR (p>0.05).

CONCLUSION

Direct stimulation of the median nerve motor branch and observation of contraction response on APB muscle can be used to predict clinical recovery and facilitates making the decision for opponensplasty in severe CTS.