Boston Carpal Tunnel Syndrome Case Study

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Effectiveness of splinting and splinting plus local steroid injection in moderate to severe carpal tunnel syndrome;
A Randomized control clinical Trial
Introduction
Carpal tunnel syndrome (CTS) which defined as “a symptomatic compression neuropathy of the median nerve at the level of the wrist” is considered as the most common disabling neuromascular condition of the upper extremities(1,2). With an incidence rate of 276:100000 per year, it known as the most prevalent entrapment neuropathy, accounting for 90% of all neuropathies (3,4).
The overall prevalence rate of CTS have been reported to be 3.8% in general population and 1% for its moderate and severe forms (5,6).
The pathophysiology of the syndrome and the mechanisms involved in the
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The validity and reliability and internal consistency of the questionnaire have been evaluated previously (17).BCTQ symptom severity scale (SSS) and functional status scale (FSS) has 11 and 8 questions .Each of the questions uses a 5 point scale. Higher scores represented more severe symptoms and functional impairment. The BCTQ SSS and FSS calculated as mean of the scores for each participant.
The patients satisfaction was evaluated using the Likert scale with five options of 1 to 5(Completely satisfied, Almost satisfied, Moderately satisfied, Somewhat satisfied and Dissatisfied).Lower scores represented more satisfaction.
A nerve conduction study was done for each patient at baseline and 12 weeks after intervention. Nerve conduction studiy was performed using Medelec Synergy(UK) elecromyograph by an expert electro-myographer who was blinded to random assignment. Studied elecrophysiological parameters were as follows; Median nerve distal motor latency(MNDML),median nerve distal sensory latency(MNDSL),median nerve sensory and motor nerve conduction velocity(MSNV and MMNV), compound muscle action potential (CMAP) and sensory nerve action potential amplitude (SNAP).The details of the method has been described previously(13).
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in Turkey (28). They compared the outcomes of splinting vs. splinting plus local steroid injection in patients with CTS. Our findings were similar to their results. In our study both methods have improving effect on clinical and elecrophysiological characteristics of patients with CTS.
In our study ,SSS and FSS improved in both interventional groups during follow up ,but the scores were not significantly different in two groups.Our results were similar to the reported results of Ucan et al.(28).
In this study, nerve conduction variables including MNDML,CMAP, MNDSL, SNAP and MSNV had significant improvement after interventions in two studied groups. The differences were not significant between groups. Our findings were similar to the results of Ucan and colleagues (28).
Considering some of our findings regarding FFS and patients satisfaction, it is suggested that the combination therapy would have more proper results. However for obtaining more conclusive results studies with larger sample size is recommended. In addition evaluation of different dose of injected corticosteroids or longer duration of using splint would be more helpful in this

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