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Surgery versus corticosteroid injection for carpal tunnel syndrome (DISTRICTS): an open-label, multicentre, randomised controlled trial
Surgery and corticosteroid injections are established treatments for carpal tunnel syndrome, but the optimal treatment strategy remains unclear. This study aimed to compare starting treatment with surgery versus starting with a corticosteroid injection.
We conducted an open-label, randomised controlled trial across 31 hospitals in the Netherlands. Eligible patients, diagnosed with carpal tunnel syndrome for at least 6 weeks and confirmed by electrophysiological or sonographic testing, were randomly assigned (1:1) to start treatment with either surgery or an injection via a web-based system. Randomisation was stratified by unilateral or bilateral symptoms, carpal tunnel syndrome with or without concomitant disease as risk factor, and previous ipsilateral injections. If needed, additional treatments were allowed, such as additional injections or surgery. The primary outcome, assessed in the intention-to-treat population, was the proportion of patients who were recovered (defined as a score of less than eight points on the six-item carpal tunnel syndrome scale) at 18 months. The trial was preregistered with the ISRCTN Registry (ISRCTN13164336) and is now completed.
From Nov 7, 2017, to Nov 4, 2021, 934 participants (545 female and 389 male participants) were included. 468 were randomised to the surgery group and 466 to the injection group. At 18 months, 805 (86%) of 934 participants had primary outcome data. In the surgery group, 243 (61%) of 401 participants had recovered, significantly higher than the 180 (45%) of 404 participants recovered in the injection group (relative risk 1·36; 95% CI 1·19–1·56; p<0·0001). One or more adverse event occurred in 376 (86%) of 436 participants in the surgery group and in 384 (85%) of 453 participants in the injection group. One participant in the surgery group was hospitalised due to complications. No treatment-related deaths were reported.
In patients with carpal tunnel syndrome, initiating treatment with surgery offers a higher chance of recovery after 18 months compared with starting with a corticosteroid injection, even with the possibility of additional interventions.
The Netherlands Organization for Health Research and Development and Zorgverzekeraars Nederland.
Journal Article
Carpal tunnel syndrome: clinical features, diagnosis, and management
Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.
Journal Article
Contested ground : The tunnel and the struggle over television news in Cold War America
\"In 1962, an innovative documentary on a Berlin Wall tunnel escape brought condemnation from both sides of the Iron Curtain during one of the most volatile periods of the Cold War. The Tunnel, produced by NBC's Reuven Frank, clocked in at ninety minutes and prompted a range of strong reactions. While the television industry ultimately awarded the program three Emmys, the U.S. Department of State pressured NBC to cancel the program, and print journalists criticized the network for what they considered to be a blatant disregard of journalistic ethics. It was not just The Tunnel's subject matter that sparked controversy, but the medium itself. The surprisingly fast ascendance of television news as the country's top choice for information threatened the self-defined supremacy of print journalism and the de facto cooperation of government officials and reporters on Cold War issues. In Contested Ground, Mike Conway argues that the production and reception of television news and documentaries during this period reveals a major upheaval in American news communications\"-- Provided by publisher.
Book
Effect of splinting and kinesiotaping treatments on functional status, sleep quality and median nerve cross-sectional area in carpal tunnel syndrome: A single blind prospective randomized controlled study
The effect of conservative treatments on sleep quality in carpal tunnel syndrome is unclear.
Comparing the effect of splinting and kinesiotaping in carpal tunnel syndrome on functional status, pain, grip strength, nerve cross-sectional area and sleep quality.
Randomized controlled study.
The participants were divided into three groups. One group was given night splint and nerve tendon gliding exercises, one group was given kinesiotaping and nerve tendon gliding exercises and one group was given only nerve tendon gliding exercises. The participants was evaluated with Visual Analog Scale (VAS), Boston Carpal Tunnel Syndrome Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Jamar hand dynamometer, ultrasonography by a blind investigator in the treatment group at baseline and at 3 months.
A total of 90 participants, 53 women and 37 men, with a mean age of 47.6±10.5, participated in the study. The decrease in Boston symptom severity and functional status scores was higher in the kinesiotaping group than in the splint group (Cohen's d=−0.78). A statistically significant decrease was found in PSQI scores in all groups (p<0.05). A statistically significant decrease was found in the PSQI total and sleep duration component score in the kinesiotaping group compared to the splint group and the exercise group (Cohen's d=0.69).
Both splinting and kinesiotaping are effective on pain, functional status, hand grip strength and median nerve cross-sectional area. This effect is greater in kinesiotaping. Splinting, kinesiotaping and nerve tendon gliding exercises treatments are effective in improving sleep quality, but this effect is greater in kinesiotaping. ClinicalTrials.gov ID: NCT06514625.
•Splinting and kinesiotaping are effective in carpal tunnel syndrome.•Kinesiotaping is more effective on pain, hand grip strength and sleep quality.•Kinesiotaping may be the first choice for those with sleep disorders.
Journal Article
Can manual lymphatic drainage be a new treatment option in mild-moderate carpal tunnel syndrome? A randomized controlled study
Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity, making it essential to assess the effectiveness of various physiotherapy treatments.
This study aimed to determine the clinical and electrodiagnostic improvement in mild-to-moderate carpal tunnel syndrome patients through manual lymphatic drainage (MLD) versus an orthosis alone.
This is a prospective randomized controlled study.
The sample consisted of a total of 36 patients who met the inclusion criteria. Experimental group received MLD and orthosis, and the control group received only orthosis. The patients were evaluated with electrodiagnostic tests, Visual Analog Scale, algometer measurements (pressure pain threshold), Boston Carpal Tunnel Syndrome Questionnaire before and after treatment. Evaluations were made before and after treatment (4 weeks later).
Boston Carpal Tunnel Syndrome Questionnaire scores improved significantly with both treatment methods in both the experimental (p < 0.001, d = 2.0) and control groups (p < 0.001, d = 1.5). The pressure pain threshold significantly increased in the experimental group at the level of the transverse carpal ligament (p = 0.02, d = 0.86, 95% Confidence Interval (CI) = −0.08 to 1.2). At the distal radioulnar joint and extensor digitorum communis muscle levels, the pressure pain threshold similarly increased for two groups after treatment (p = 0.65, d = 0.31, 95% CI = −0.44 to 1.2), but the post-treatment increase in the experimental group was significant (p = 0.007, d = 0.31). In the experimental group, motor velocity (p = 0.001, d = 0.98), amplitude (p = 0.002, d = 1.5), and latency (p = 0.002, d = 0.60) and sensory velocity (p = 0.03, d = 0.91) and latency (p = 0.001, d = 1.2) significantly improved, while in the control group, there was a significant change only in motor velocity and amplitude (p = 0.047, d = 0.59). The post-treatment sensory improvement was significantly higher in the experimental group (p = 0.01, d = 0.81, 95% CI = −0.78 to −0.49).
MLD significantly improved sensory conduction velocity, amplitude, and latency of the median nerve. Additionally, MLD and orthosis increased the pain pressure threshold and led to functional improvement.
This is listed with study ID: NCT05394870
•Manual lymphatic drainage (MLD) significantly improved sensory conduction the median nerve.•MLD and orthosis increased the pain pressure threshold and functionality.•MLD can be a new option for conservative treatment in carpal tunnel syndrome.
Journal Article