Search Our Scientific Publications & Authors

J Hand Surg Am 2020 Apr 25. Epub 2020 Apr 25.

Purpose: To evaluate, from the surgeon's perspective, the importance, feasibility, and appropriateness of sharing decisions during an episode of care of carpal tunnel syndrome (CTS) or distal radius fracture in patients aged greater than 65 years.

Methods: A consortium of 9 fellowship-trained hand/upper-limb surgeons used the RAND Corporation/University of California Los Angeles Delphi Appropriateness method to evaluate the importance, feasibility, and appropriateness of sharing 27 decisions for CTS and 28 decisions for distal radius fractures in patients aged greater than 65 years. Panelists rated each measure on a scale of 1 (definitely not important/feasible/appropriate) to 9 (definitely important/feasible/appropriate) in 2 voting rounds with an intervening face-to-face discussion. Read More

Ann Plast Surg 2020 Apr 22. Epub 2020 Apr 22.

From the Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea.

Purpose: The main cause of carpal tunnel syndrome (CTS) is pathological changes in the flexor synovium, which is a known cause of pressure elevation in the carpal tunnel. The importance of the transverse carpal ligament (TCL) in the pathogenesis of CTS has hitherto been overlooked. However, the TCL significantly affects carpal biomechanics; the TCL is known to affect the carpal bone to a greater extent when intra carpal tunnel pressure is high. Read More

J Pharmacopuncture 2020 Mar;23(1):37-41

Department of Acupuncture & Moxibustion medicine, College of Korean medicine, Daegu Haany University, Republic of Korea.

Objectives: Round Acupuncture having blunt end has developed from acupotomy. This case report is to find out that Round Acupuncture is effective in treating patients with recurrent carpal tunnel syndrome (CTS), which has not improved by steroid injection or acupotomy.

Methods: Round Acupuncture was inserted into the distal fibers of transverse carpal ligament and released toward the proximal fibers. Read More

Pharmaceuticals (Basel) 2020 Mar 18;13(3). Epub 2020 Mar 18.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey.

This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Read More

Ann Dermatol Venereol 2020 Apr 11;147(4):316-317. Epub 2020 Mar 11.

Service de dermatologie et allergologie, faculté de médecine, Sorbonne université, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.

Obstet Gynecol Surv 2020 Feb;75(2):121-126

Associate Professor, Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.

Importance: Carpal tunnel syndrome and meralgia paresthetica are 2 common neuropathies complicating pregnancy. Each of these causes significant discomfort but can be diagnosed and treated safely during pregnancy.

Objective: This article outlines the existing literature diagnosis, treatment, and prognosis of carpal tunnel syndrome and meralgia paresthetica, specifically looking at the implications during pregnancy. Read More

Pain Ther 2020 Jun 25;9(1):129-142. Epub 2020 Feb 25.

Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.

Introduction: This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. Read More

Case Reports Plast Surg Hand Surg 2020 20;7(1):13-15. Epub 2020 Jan 20.

Department of Plastic, Reconstructive and Hand Surgery, Isala Hospital, Zwolle, The Netherlands.

We present a case in which a depot triamcinolone acetonide (Kenacort) was unintentionally injected intra-arterially into the ulnar artery, resulting in microembolic capillary occlusion in the digits supplied by the artery. Ischemic changes and subungual petechial hemorrhages were seen in the ulnar three digits. Angiography confirmed microembolic occlusion. Read More

Eur Radiol 2020 Mar 11;30(3):1498-1506. Epub 2019 Nov 11.

Department of Radiology, Private Institution of Ultrasonography, Athens, Greece.

Background: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence.

Methods: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. Read More

Altern Ther Health Med 2020 Mar;26(2):10-16

Background: Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy in humans. Nonsurgical management is still a matter of debate, and conservative treatments include splinting, local steroid injections, ultrasound, and oral steroids. Acupuncture and electroacupuncture therapy for symptomatic CTS may improve symptoms and aid nerve repair as well as improve sensory and motor functions. Read More

Anesth Essays Res 2019 Jul-Sep;13(3):417-422

Department of Anesthesia and Pain Management, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Background: Carpal tunnel syndrome (CTS) is one of the most common focal entrapment neuropathies. Although the exact etiology remains unclear, high-pressure-related intracarpal tunnel compression of the median nerve (MN), progressing ischemia, and mechanical strangulation are common mechanisms. The therapeutic managements for CTS depend on the disease severity, varying from a conservative treatment to surgical interventions. Read More

Arq Neuropsiquiatr 2019 23;77(9):638-645. Epub 2019 Sep 23.

University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurosurgery, Istanbul, Turkey.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. Read More

Eplasty 2019 29;19:e19. Epub 2019 Jul 29.

Division of Plastic Surgery, University of Louisville, Louisville.

Carpal tunnel syndrome is the most common entrapment neuropathy involving the upper extremity. As such, various nonoperative techniques have been developed to aid in management of mild to moderate disease, including local steroid injection. However, definitive guidelines for needle/injection location have not been defined, especially in relation to diminishment of iatrogenic injury to the median nerve. Read More

Clin Rheumatol 2019 Dec 16;38(12):3643-3654. Epub 2019 Aug 16.

Faculty of Medicine, Department of Rheumatology and Rehabilitation, Mansoura University, Elgomhoria St., Mansoura, Egypt.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Read More

Hand (N Y) 2019 Jul 9:1558944719861715. Epub 2019 Jul 9.

4 Department of Pain & Rehab Medicine, BayCare Clinic, Green Bay, WI, USA.

The aim of this report is to describe a new ultrasound guided technique for carpal tunnel injection and median nerve hydrodissection using distal to proximal approach. From 2015 to 2019, 827 consecutive injections by distal-to-proximal approach were included using coding information to check for post-procedural skin hypopigmentation, hematoma, seroma, nerve injury, or vascular injury. There were no occurrences of post-procedural skin-hypopigmentation, hematoma or seroma formation, or neurovascular injury. Read More

Clin Rheumatol 2019 Oct 17;38(10):2933-2940. Epub 2019 Jun 17.

Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt.

Objective: To compare effectiveness of ultrasound-guided local insulin injection, local steroid injection, and local steroid followed by insulin injections in treating mild to moderate carpal tunnel syndrome (CTS) in type 2 diabetes mellitus (DM).

Method: Study included 60 patients with electrophysiologic evidence of mild to moderate CTS. They were randomly divided into three groups: group I received insulin injection locally into the affected carpal tunnel at first visit and a similar dose after 2 weeks; group II received single injection of 40 mg methylprednisolone acetate injection; and group III received steroid injection then followed by insulin injection twice after 2 and 4 weeks. Read More

Arch Phys Med Rehabil 2019 09 17;100(9):1592-1598. Epub 2019 Apr 17.

Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA.

Objective: Carpal tunnel syndrome (CTS) is frequently seen as a work-related disorder. Few studies have examined the treatment of CTS by insurance coverage, and none have used a large, population-based dataset. This study examined the extent to which the use of CTS tests and treatments varied for those on workers' compensation insurance (WCI) vs private insurance and Medicaid, controlling for patient and provider characteristics. Read More

J Hand Surg Am 2019 Apr;44(4):304-310

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.

Purpose: Although a local corticosteroid injection for carpal tunnel syndrome (CTS) is frequently performed by palpation using anatomical landmarks, ultrasound (US) allows physicians to visualize and confirm placement of the injectate close to the median nerve, possibly improving the efficacy of the injection. The aim of this study was to compare the effectiveness and complications of US-guided steroid injections with landmark-based injections for CTS.

Methods: A total of 102 patients with CTS were randomized into 2 groups: landmark-based injection and US-guided injection. Read More

Hong Kong Physiother J 2018 Dec 2;38(2):91-114. Epub 2018 Jul 2.

Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Greece.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Treatment options include physiotherapy, splinting, steroid injections or surgery.

Objective: To compare the effectiveness of surgical versus conservative treatment for CTS for symptom and functional improvement and improvement of neurophysiological parameters. Read More

Biomed Res Int 2019 24;2019:9498656. Epub 2019 Feb 24.

Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.

Objectives: Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. Read More

Muscle Nerve 2019 07 24;60(1):32-40. Epub 2019 Mar 24.

Department of Neurophysiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.

Introduction: Studies of prognosis for surgery and corticosteroid injection for carpal tunnel syndrome (CTS) have considered only a limited range of explanatory variables for outcome.

Methods: Data were prospectively collected on patient-reported symptoms, physical and psychological functioning, comorbidity, and quality of life at baseline and every 6 months for up to 2 years. Outcomes were patient-rated change over a 6-month period and symptom-severity score at 18 months. Read More

J Pain Res 2019 5;12:579-584. Epub 2019 Feb 5.

Department of Medical Genetics, Tarbiat Modares University, Tehran, Iran.

Purpose: Local corticosteroid injection is one of the most prevalent methods in treating carpal tunnel syndrome (CTS). However, the most efficient substance and its appropriate dosage remain controversial. In the present double-blind randomized controlled trial, the efficacy and safety of local injection of two corticosteroids (triamcinolone and methylprednisolone) were compared at two different dosages, 20 and 40 mg. Read More

J Hand Surg Am 2019 Feb 20;44(2):85-92.e1. Epub 2018 Dec 20.

Veterans Affairs Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA; Department of Surgery, Stanford University, Palo Alto, CA.

Purpose: To evaluate facility-level variation in the use of services for patients with carpal tunnel syndrome (CTS) receiving care in the Veterans Health Administration (VHA).

Methods: A national cohort of VHA patients diagnosed with CTS during fiscal year 2013 was divided into nonsurgical and operative treatment groups for comparison. We assessed the use of 5 types of CTS-related services (electrodiagnostic studies [EDS], imaging, steroid injection, oral steroids, and therapeutic modalities) in the prediagnosis and postdiagnosis periods before any operative intervention at the patient and facility levels. Read More

Eur J Radiol 2018 Nov 24;108:172-176. Epub 2018 Sep 24.

Marmara University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey. Electronic address:

Purpose: To evaluate if there is a place for ultrasonography (US) and ultrasonographic elastography (UE) in the diagnosis and follow up of carpal tunnel syndrome treatment.

Materials And Methods: The study was performed on 25 patients (study group) and 17 healthy volunteers (control group). Measured US and UE criteria were median nerve area (MNA), proximal median nerve area (pMNA), difference between MNA and pMNA (dMNA) and strain values of carpal tunnel content (CTC) and median nerve (MN). Read More

Lancet 2018 10;392(10156):1423-1433

Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Stoke-on-Trent, UK. Electronic address:

Background: To our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.

Methods: We did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Read More

Lancet 2018 10;392(10156):1383-1384

Department of Clinical Sciences and Department of Orthopaedics, Lund University, Lund, Sweden; Department of Orthopaedics, Hässleholm-Kristianstad, Hässleholm SE 28125, Sweden. Electronic address:

Ann Neurol 2018 10 4;84(4):601-610. Epub 2018 Oct 4.

Department of Physical Medicine and Rehabilitation.

Objective: Perineural injection with 5% dextrose (D5W) is a novel strategy in the treatment of carpal tunnel syndrome (CTS). In contrast, perineural injection with corticosteroid has been used for decades for treating CTS, but possible neurotoxicity has been a major concern. No studies investigating the comparative effects have been published so far. Read More

Hand (N Y) 2020 Jan 17;15(1):13-22. Epub 2018 Jul 17.

Western University, London, ON, Canada.

The objective of the study is to examine the short-term and long-term efficacy of surgical treatment of carpal tunnel syndrome (CTS) compared with conservative treatment (ie, splint, steroid injection, or physical therapy). Two reviewers searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and PEDro up to September 2017. Quality appraisal and data extraction were performed in duplicate. Read More

Acta Radiol 2019 Mar 6;60(3):347-355. Epub 2018 Jul 6.

1 Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Background: Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief.

Purpose: To use magnetic resonance diffusion tensor imaging (MR-DTI) to determine the association between diffusion values of the median nerve (MN) at several anatomic locations and symptom relief in patients with CTS following corticosteroid injection.

Material And Methods: MR-DTI was performed on 15 wrists of 12 patients with CTS before and two weeks after ultrasound-guided corticosteroid injections. Read More

Muscle Nerve 2018 09;58(3):402-406

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei City, 11217, Taiwan.

Introduction: The sonographic changes of the median nerve after steroid injection for carpal tunnel syndrome (CTS) still require investigation.

Methods: Sixty-two patients with CTS were included. The Boston Carpal Tunnel Questionnaire was administered, and ultrasonographic examinations were performed before and at 2, 6, and 12 weeks after steroid injection. Read More

J Hand Surg Am 2018 06 14;43(6):537-544. Epub 2018 Apr 14.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. Electronic address:

Purpose: The optimal volume and dose of corticosteroid injections for treatment of carpal tunnel syndrome (CTS) have not yet been established. It is unknown whether the volume of injectate influences the outcome of carpal tunnel injection. The purpose of this study was to assess whether there is an association between the volume of injectate and subsequent intervention in the treatment of CTS. Read More

Arch Phys Med Rehabil 2018 08 5;99(8):1609-1622.e10. Epub 2018 Apr 5.

Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.

Objective: To present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS).

Data Sources: The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs).

Study Selection: Two reviewers independently applied the inclusion criteria to select potential studies. Read More

Adv Biomed Res 2018 16;7:22. Epub 2018 Feb 16.

Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The aim of this study is to determine the predictive value of ultrasonography for results of local steroid injection in patients with carpal tunnel syndrome (CTS).

Materials And Methods: This prospective cohort study was conducted during a 1-year period in outpatient clinics of rehabilitation and physical medicine including 35 patients with moderate and severe CTS who receive ultrasonography-guided local steroid injection. The Boston self-assessment questionnaire and electrodiagnosis parameters were recorded at baseline, 1 month, and 3 months after therapy. Read More

PM R 2018 08 13;10(8):826-835. Epub 2018 Feb 13.

Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15218.

Background: Treatment of carpal tunnel syndrome (CTS) in commercially insured patients across the spectrum of provider types rarely has been described.

Objective: To describe patterns of types of treatment for patients with CTS using a large commercial insurance database.

Design: Retrospective cohort descriptive study. Read More

J Hand Surg Asian Pac Vol 2018 Mar;23(1):71-75

† Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.

Background: Intramedullary fixation for distal radius fractures is reported to be free of hardware irritation and less invasive than other fixation methods. Some specific complications associated with intramedullary fixation, such as radial nerve sensory neuritis, have been reported, but no study has focused on the complication rates of intramedullary fixation for distal radius fractures in the elderly population. Furthermore, no studies have analyzed common complications, such as carpal tunnel syndrome and flexor tenosynovitis including trigger finger, among patients with distal radius fractures treated by intramedullary fixation based on a comprehensive complication checklist. Read More

Clin Interv Aging 2018 18;13:117-124. Epub 2018 Jan 18.

Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.

Background: Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS.

Methods: We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Read More

BMC Musculoskelet Disord 2018 01 25;19(1):32. Epub 2018 Jan 25.

Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: Recent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks.

Methods: The prospective randomized controlled trial compared efficacy in relieving pain and improving clinical function between single-dose rESWT and local corticosteroid injection (LCsI) over the mid-term (24 weeks). Read More

Acta Chir Orthop Traumatol Cech 2017 ;84(5):391-395

Kafkas Univercity, Department of Orthopedics and Traumatology, Faculty of Medicine, Kars, Turkey.

PURPOSE OF THE STUDY The purpose of the current study is to assess the efficacy of anti-adhesion gel on the symptom severity and functional outcomes after mini incision open surgery for carpal tunnel syndrom (CTS). MATERIAL AND METHODS A total of 200 CTS patients (154 women, 46 men) were included in this study. Group I (n = 100; 78 women, 22 men) did not receive local administration of anti-adhesion gel, while anti-adhesion gel consisting of hyaluronic acid-carboxymethylcellulose (Seprafilm®, SanofiBiosurgery, Bridgewater, NJ, USA) was locally applied to patients in Group II (n = 100; 76 women, 24 men). Read More

Turk J Med Sci 2017 Dec 19;47(6):1785-1790. Epub 2017 Dec 19.

Background/aim: This study aimed to compare the effectiveness of ultrasound (US)-guided injection versus blind injection of corticosteroids in the treatment of carpal tunnel syndrome (CTS). Materials and methods: This prospective, randomized clinical trial included patients with severe CTS based on clinical and electrophysiological criteria. The patients were evaluated for clinical and electrophysiological parameters at baseline and 4 weeks after treatment. Read More

Am J Phys Med Rehabil 2018 06;97(6):407-413

From the Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran (AB-G, NN, BF, GRR, TA, SE, PR); Physical Medicine and Rehabilitation Specialist With Subspecialty in Interventional Pain Management, Mission Pain and Spine, Mission Viejo, California (HRF); Clinical Development Research Center of Shahid Modarres Hospital, Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (SAR); and Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran (BE).

Objective: In this study, the clinical effectiveness of ultrasound-guided corticosteroid injection "above" versus "below" the median nerve for treatment of patients with mild to moderate carpal tunnel syndrome was compared.

Design: This prospective randomized double-blind clinical trial included 44 patients with mild to moderate carpal tunnel syndrome. The subjects were randomly assigned to two groups to receive ultrasound-guided injection of 40 mg of triamcinolone either "above" or "below" the involved median nerve. Read More

Bone Joint J 2017 Dec;99-B(12):1637-1642

Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.

Aims: The aim of this study was to compare the efficacy of a corticosteroid injection for the treatment of carpal tunnel syndrome (CTS) in patients with and without Raynaud's phenomenon.

Patients And Methods: In a prospective study, 139 patients with CTS were treated with a corticosteroid injection (10 mg triamcinolone acetonide); 34 had Raynaud's phenomenon and 105 did not (control group). Grip strength, perception of touch with a Semmes-Weinstein monofilament and the Boston Carpal Tunnel Questionnaires (BCTQ) were assessed at baseline and at six, 12 and 24 weeks after the injection. Read More

Hand (N Y) 2019 05 22;14(3):317-323. Epub 2017 Nov 22.

1 NYU Langone Orthopedic Hospital, New York, USA.

Background: Over 500 000 carpal tunnel releases costing over $2 billion are performed each year in the United States. The study's purpose is to perform a cost-minimizing analysis to identify the least costly strategy for carpal tunnel syndrome treatment utilizing existing success rates based on previously reported literature.

Methods: We evaluate the expected cost of various treatment strategies based on the likelihood of further treatments: (1) a single steroid injection followed by surgical release; (2) up to 2 steroid injections before surgical release; (3) 3 steroid injections before surgery, and (4) immediate surgical release. Read More

Arthritis Care Res (Hoboken) 2018 11;70(11):1717-1718

University of South Carolina School of Medicine, Columbia, SC.

J Hand Surg Eur Vol 2018 Mar 11;43(3):296-302. Epub 2017 Oct 11.

Department of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.

The risks of corticosteroid injection for carpal tunnel syndrome, principally intraneural injection and tendon rupture, are known only from anecdotal reports. The literature does not allow an accurate estimate of their incidence or that of lesser side effects such as local pain. We have encountered only four serious complications in 9515 injections. Read More

Int J Rheum Dis 2018 Jan 13;21(1):102-107. Epub 2017 Sep 13.

Integrated Diagnostic and Medical Centre, Tung Wah Group of Hospitals, Hong Kong, China.

Aim: We conducted a prospective randomized parallel clinical trial comparing the efficacy of local steroid injection and nocturnal wrist splinting in patients with carpal tunnel syndrome (CTS).

Methods: The well-validated and disease-specific Boston Carpal Tunnel Questionnaire (BCTQ) was employed and its score at 4 weeks after treatment was used as the primary outcome measure. Important secondary outcomes included patient satisfaction, the change of an objective finger dexterity test and the side effects. Read More

Skeletal Radiol 2017 Nov 2;46(11):1521-1530. Epub 2017 Aug 2.

Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon, 34943, South Korea.

Objective: To determine the ultrasonographic changes after steroid injection in carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of ultrasound in post-treatment examination with clinical correlation.

Materials And Methods: Twenty-seven wrists with idiopathic CTS after a single injection of 40 mg of prednisolone hydrochloride were prospectively studied using a high-resolution ultrasound. Axial images of the wrists were obtained at the level of the distal radius, pisiform and hamate prior to and 1, 4 and 8 weeks after steroid injection. Read More

PLoS One 2017 20;12(7):e0181631. Epub 2017 Jul 20.

Institute of Bone and Joint Research, Kolling Institute, and University of Sydney, Sydney, New South Wales.

Objective: Evaluate general practitioner (GP) management of tennis elbow (TE) in Australia.

Methods: Data about the management of TE by GPs from 2000 to 2015 were extracted from the Bettering the Evaluation of Care of Health program database. Patient and GP characteristics and encounter management data were classified by the International Classification of Primary Care, version 2, and reported using descriptive statistics with point estimates and 95% confidence intervals. Read More

J Hand Surg Asian Pac Vol 2017 Jun;22(2):194-199

* Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: The purpose of this study was to identify predictive factors of poor response to intra-flexoral sheath corticosteroid injection, as well as to identify factors associated with patients' decisions to undergo surgical treatment.

Methods: Data from 112 patients who received steroid injection treatment for trigger finger were reviewed retrospectively. Logistic regression was used to assess the prognostic value of factors assumed to affect prognosis (age, sex, underlying disease, history of illness, presence of carpal tunnel syndrome, multiple digit involvement, and pre- and post-operative disability scores). Read More

Pilot Feasibility Stud 2017 24;3:20. Epub 2017 Apr 24.

Royal College of Surgeons Surgical Intervention Trials Unit, NDORMS, University of Oxford, Oxford, UK.

Background: Carpal tunnel syndrome (CTS) is the commonest peripheral nerve disorder in the UK, with over 52,996 carpal tunnel decompressions performed in 2011. By 2030, this figure is estimated to double. Whilst evidence supports conservative measures for mild symptoms, and early surgery for severe symptoms, controversy remains over the most appropriate management for patients that present with moderate disease, with regard to early surgery or late surgery following steroid injection. Read More