ABSTRACT
PURPOSE: To study the relationship between the severity of carpal tunnel syndrome (CTS) symptoms and surgery for CTS and the relationship between conservative treatments and surgery for CTS. METHODS: A secondary analysis of baseline to 6-month data from a randomized controlled trial, which examined the effectiveness of orthosis/stretch combinations on the symptoms of CTS, was conducted for a total of 96 participants with CTS. Participants completed the Carpal Tunnel Questionnaire and posttreatment surveys. Statistical analyses included exploration of correlates of progression to surgery for CTS and logistical regression to examine the association between conservative treatments and CTS symptoms and progression to surgery for CTS. RESULTS: Twenty-one participants received surgery for their CTS, and 31 participants received 1 or more conservative treatments. Severity of baseline CTS symptoms and additional treatments were indicators of progression to surgery. The randomized controlled trial intervention was inversely associated with progression to surgery. CONCLUSIONS: CTS that does not respond to an initial course of conservative treatment may not improve with additional treatments. More than half of the participants who received additional conservative treatment still progressed to surgery. Current intervention guidelines for CTS provide limited guidance as to the best methods to efficiently treat CTS. CLINICAL RELEVANCE: CTS is a costly and high-burden disorder, resulting in reduced quality of life. Research should examine when and for whom conservative care is an effective choice and the association between conservative care and the eventual need for CTS surgery.
Subject(s)
Carpal Tunnel Syndrome/therapy , Carpal Tunnel Syndrome/surgery , Disease Progression , Female , Humans , Male , Middle Aged , Muscle Stretching Exercises , Orthotic Devices , Patient Selection , Severity of Illness Index , Surveys and Questionnaires , Treatment OutcomeABSTRACT
The purpose of this paper is to describe the transverse metacarpal arch (TMA) during a dynamic typing task. Static/relaxed and dynamic typing TMA were collected from 36 right-handed females with musculoskeletal discomfort using a motion capture system. While the angle of right TMA static/relaxed posture (10.1° ± 5.5°) was significantly larger than the left (8.5° ± 5.6°) (P < .05), the right dynamic posture (10.6° ± 4.3°) was not significantly different from the left (10.3° ± 5.5°) (P = .66). Within both these mean scores, there was considerable individual variation, with some subjects demonstrating very flat TMA, and some very curved. The results indicate that TMA angular postures both for static/relaxed and dynamic typing are highly variable both between individuals and between individual hands.