Efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome: a preliminary study.

OBJECTIVE: To evaluate the efficacy of focused extracorporeal shockwave therapy for symptoms and function in patients with moderate-to-severe carpal tunnel syndrome. DESIGN: A single-blind randomized controlled trial. SUBJECTS: Twenty-four outpatients with moderate-to-severe carpal tunnel syndrome. METHODS: Patients were randomly allocated into 2 groups: a focused extracorporeal shockwave therapy group and a control group. The focused extracorporeal shockwave therapy group received conservative treatment in addition to focused extracorporeal shockwave therapy with an energy flux density ranging from 0.01 to 0.15 mJ/mm2, a frequency of 4-5 Hz, and 1500 pulses per session once a week for a total of 3 sessions. The control group received only conservative treatment, which comprised gliding exercises for carpal tunnel syndrome, a night wrist splint, and lifestyle modification. The Thai version of the Boston Carpal Tunnel Questionnaire (T-BCTQ), a nerve conduction study, and ultrasonography of the median nerve cross-sectional area were performed before treatment and at 3 and 6 weeks after baseline. RESULTS: The T-BCTQ symptom and function scores had significantly decreased in both groups, favouring focused extracorporeal shockwave therapy at all time-points. In addition, distal sensory and motor latency were significantly different between the groups at 3 weeks from baseline. CONCLUSION: Focused extracorporeal shockwave therapy plus conservative treatment effectively provided short-term improvement in symptoms, hand function, and nerve conduction in patients with moderate-to-severe carpal tunnel syndrome compared with conservative treatment alone.

Effects of shelf bar assistance on kinetic control during sit-to-stand in healthy young and elderly subjects.

This study aimed to determine the kinetic effects of using unilateral shelf bar, vertical grab bar (GB), and horizontal GB during sit-to-stand (STS) in young and elderly subjects. Twenty young adults aged 20-40 years and eighteen healthy elderly people aged ≥ 65 years old were recruited. The subjects performed STS with and without using the three types of bars. Bar reaction force (BRF) and maximum power (MP) defined as the maximal product calculated by multiplying the GRF and the velocity of the center of mass in each direction were measured using three-dimensional motion analysis, two load sensors of GB, and four force plates. The use of the shelf bar generated a significantly larger BRF in the vertical direction than the other bars (p < 0.05) and lower MP in the vertical direction than the horizontal bar (p < 0.05) and no bar (p < 0.05). In the younger subjects, only the use of the vertical bar generated a significantly larger BRF (p < 0.05) and negative MP (p < 0.05) in the forward direction than those in elderly subjects. The use of the shelf bar may assist the decreased MP in the vertical direction during STS in elderly people, resulting in decrease of failed STS in daily living. In contrast, the use of the vertical bar in the elderly may not generate sufficient BRF in the forward direction because of lack of eccentric control in the whole body in the forward direction during STS.

Hypothenar fat pad flap vs conventional open release in primary carpal tunnel syndrome: A randomized controlled trial.

AIM: To compared outcomes between the hypothenar fat pad flap (HTFPF) and conventional open carpal tunnel release (COR) in primary carpal tunnel syndrome (CTS). METHODS: Forty-five patients (49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients (41 hands) by computer generated (Block of four randomization) into COR and HTFPF group. Nerve conduction study (NCS) included distal sensory latency (DSL), distal motor latency (DML), sensory amplitude (S-amp), motor amplitude (M-amp) and sensory nerve conduction velocity (SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale (VAS)], 2-point discrimination (2-PD), Semmes-Weinstein monofilament test (SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes. RESULTS: The COR group, 19 patients (20 hands) mean age 50.4 years. The HTFPF group, 20 patients (21 hands) mean age 53.3 years. Finally 33 patients (36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk (P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups (P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain (VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups. CONCLUSION: There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.