Carpal tunnel syndrome – Part II (treatment)

Abstract

The treatments for non-deficit forms of carpal tunnel syndrome (CTS) are corticoid infiltration and/or a nighttime immobilization brace. Surgical treatment, which includes sectioning the retinaculum of the flexors (retinaculotomy), is indicated in cases of resistance to conservative treatment in deficit forms or, more frequently, in acute forms. In minimally invasive techniques (endoscopy and mini-open), and even though the learning curve is longer, it seems that functional recovery occurs earlier than in the classical surgery, but with identical long-term results. The choice depends on the surgeon, patient, severity, etiology and availability of material. The results are satisfactory in close to 90% of the cases. Recovery of strength requires four to six months after regression of the pain of pillar pain type. This surgery has the reputation of being benign and has a complication rate of 0.2–0.5%.

The Influence of the Type of Surgical Thread and Suture in the Open Carpal Tunnel Syndrome Surgery

“…7 O tratamento da STC pode ser realizado por meio de duas abordagens distintas: tratamento conservador e tratamento cirúrgico. 12 Evidências sugerem que o tratamento conservador pode auxiliar na recuperação do paciente com STC, sendo a injeção intra-articular de corticoide associada à lidocaina, assim como a corticoterapia via oral e imobilização noturna, terapias efetivas no tratamento da STC. Outros meios terapêuticos, como perda ponderal, ultrassom, laser, diuréticos e vitaminoterapia B 6 , ainda permanecem controversos, não sendo recomendados.…”

“…Outros meios terapêuticos, como perda ponderal, ultrassom, laser, diuréticos e vitaminoterapia B 6 , ainda permanecem controversos, não sendo recomendados. [12][13][14] No tratamento cirúrgico, faz-se a secção do retináculo dos flexores com o objetivo de aumentar o volume do túnel do carpo e, consequentemente, reduzir a pressão intratúnel. 12 A descompressão do nervo mediano por secção do ligamento transverso do carpo é o tratamento de escolha, proporcionando resultados excelentes em 75% dos pacientes.…”

Low-level laser therapy in carpal tunnel syndrome – systematic review

“…In addition, in the studies, there was a difference of two months in the mean time of CTS development between the laser group and placebo, and this is a factor that may influence recovery. 8,15 In spite of being a small difference, the evolution time of the disease may have influenced the results, since in the study by Alves & Araújo, 13 who presented better results, the group submitted to LLLT presented the CTS at a shorter time than the placebo, while in the work of Ekim et al 14 this time was lower. And among these studies the mean evolution time was similar.…”

“…Among these conservative treatment modalities, LLLT is a device that produces a beam of radiation, and can be used alone or as a coadjuvant of other treatments. [6][7][8][9][10] There is evidence in clinical and experimental research that one of the effects of LLLT is the improvement of nerve function, increase metabolism and repair capacity of the myelin sheath. Because laser therapy is not invasive, the ability to radiate injured nerve is helpful.…”

Can decrease in hand grip strength in carpal tunnel syndrome be explained by interosseous muscle and intermetacarpal space dimensions?

“…Visible muscle atrophies are mostly located in the thenar part of the hand and are observed in advanced and severe pathology [5,6]. Predicting muscle strength decrease with sonographically detectable parameters such as intermetacarpal space (IMS) and IOM is an important step for treatment planning in the early phase [7,8].…”