Carpal tunnel syndrome

Bland, Jeremy D.P.

doi:10.1136/bmj.39282.623553.ad

Cited by 196 publications

(141 citation statements)

References 27 publications

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“…100 The most commonly described treatments for CTS are hand splinting, injection of steroids and oral steroids. 93 A Cochrane systematic review 100 of non-surgical treatment for CTS found limited evidence, from one small trial at high risk of bias, that nocturnal hand splinting was better than control (no treatment) at improving symptoms and function in the short term. The Cochrane review also found moderate evidence (consistent findings in more than one RCT) to support the short-term benefit of DOI: 10.3310/hsdr03130 HEALTH SERVICES AND DELIVERY RESEARCH 2015 VOL.…”

Section: Overview Of Evidence On Non-surgical Interventionsmentioning

confidence: 99%

“…Pressure is much higher in patients with CTS than in patients with asymptomatic wrists and is raised by wrist or finger flexion. 93 Chronic CTS has insidious onset and is related to several prognostic factors including pregnancy, diabetes mellitus, hypothyroidism, osteoarthritis, gout, overweight and occupation. 94 The annual incidence of CTS in UK primary care is approximately 88 per 100,000 males and 193 per 100,000 females.…”

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

“…Comparisons of endoscopic and open surgical techniques indicate that success and complication rates are broadly similar 112,113 and selection of technique is largely based on surgeon preference. 93,113 Potential complications of surgery include infection, bleeding, nerve injury, scarring, persistence or return of CTS symptoms and, rarely, complex regional pain syndrome.…”

Section: Overview Of Surgical Interventions and Guidelines For Surgerymentioning

confidence: 99%

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Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

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BackgroundNHS expenditure has stagnated since the economic crisis of 2007, resulting in financial pressures. One response is for policy-makers to regulate use of existing health-care technologies and disinvest from inefficiently used health technologies. A key challenge to disinvestment is to identify existing health technologies with uncertain cost-effectiveness.ObjectivesWe aimed to explore if geographical variation in procedure rates is a marker of clinical uncertainty and might be used by local commissioners to identify procedures that are potential candidates for disinvestment. We also explore obstacles and solutions to local commissioners achieving disinvestment, and patient and clinician perspectives on regulating access to procedures.MethodsWe used Hospital Episode Statistics to measure geographical variation in procedure rates from 2007/8 to 2011/12. Expected procedure numbers for each primary care trust (PCT) were calculated adjusting for proxies of need. Random effects Poisson regression quantified the residual inter-PCT procedure rate variability. We benchmarked local procedure rates in two PCTs against national rates. We conducted rapid systematic reviews of two high-use procedures selected by the PCTs [carpal tunnel release (CTR) and laser capsulotomy], searching bibliographical databases to identify systematic reviews and randomised controlled trials (RCTs). We conducted non-participant overt observations of commissioning meetings and semistructured interviews with stakeholders about disinvestment in general and with clinicians and patients about one disinvestment case study. Transcripts were analysed thematically using constant comparison methods derived from grounded theory.ResultsThere was large inter-PCT variability in procedure rates for many common NHS procedures. Variation in procedure rates was highest where the diffusion or discontinuance was rapidly evolving and where substitute procedures were available, suggesting that variation is a proxy for clinical uncertainty about appropriate use. In both PCTs we identified procedures where high local use might represent an opportunity for disinvestment. However, there were barriers to achieving disinvestment in both procedure case studies. RCTs comparing CTR with conservative care indicated that surgery was clinically effective and cost-effective on average but provided limited evidence on patient subgroups to inform commissioning criteria and achieve savings. We found no RCTs of laser capsulotomy. The apparently high rate of capsulotomy was probably due to the coding inaccuracy; some savings might be achieved by greater use of outpatient procedures. Commissioning meetings were dominated by new funding requests. Benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective. Most patients were unaware of rationing.ConclusionsPolicy-makers could use geographical variation as a starting point to identify procedures where health technology reassessment or RCTs might be needed to inform policy. Commissioners can use benchmarking to identify procedures with high local use, possibly indicating overtreatment. However, coding inconsistency and limited evidence are major barriers to achieving disinvestment through benchmarking. Increased central support for commissioners to tackle disinvestment is needed, including tools, accurate data and relevant evidence. Early engagement with patients and clinicians is essential for successful local disinvestment.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Overview Of Evidence On Non-surgical Interventionsmentioning

confidence: 99%

Section: Overview Of Carpal Tunnel Syndromementioning

confidence: 99%

Section: Overview Of Surgical Interventions and Guidelines For Surgerymentioning

confidence: 99%

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Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

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“…Carpal tunnel syndrome (CTS) is one of the most common compressive neuropathies in the upper extremities (Bland, 2007) and a frequent cause of pain, paresthesias and impaired hand function. A syndrome is, by definition, a collection of signs and symptoms.…”

Section: Introductionmentioning

confidence: 99%

EMG vs. Thermography in Severe Carpal Tunnel Syndrome

Papež¹,

Palfy²

2012

EMG Methods for Evaluating Muscle and Nerve Function

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“…Conservative treatment of CTS includes non-steroidal anti-inflammatory drugs, local steroid injection, wrist splinting, activity modification, stretching exercises, and physical therapy modalities [10]. In recent years, the beneficial effects of LLLT on clinical and electrophysiological parameters have been shown in several studies without any side effects [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation

et al. 2010

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The objective of this study is to investigate the efficacy of low-level laser therapy (LLLT) in patients with carpal tunnel syndrome (CTS). Sixty patients with CTS were included in this placebo-controlled and double-blind study and randomly assigned to three treatment groups: active laser with a dosage of 1.2 J/per painful point, active laser with a dosage of 0.6 J/per painful point, and placebo groups. A total of 5 points across the median nerve trace were irradiated with Gal-Al-As diode laser. All groups were treated 5 times per week for 3 weeks. Clinical assessments included pain intensity, grip strength, symptom severity score (SSS), functional status score (FSS), nerve conduction studies, and cross-sectional area (CSA) of the median nerve as measured by ultrasonography. Compared to baseline, post-treatment VAS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), grip strength (P < 0.05), SSS scores (group 1, P < 0.001; group 2, P < 0.001; group 3, P < 0.01), and FSS scores (P < 0.05) improved significantly in all groups. Only sensorial nerve velocity measurements on the palmar region showed a significant improvement in both active laser groups (P < 0.01). There was no significant difference in any of the outcome measures among the groups. With the chosen laser type and dose regimen, the results suggested that LLLT was no more effective than placebo in CTS.

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Carpal tunnel syndrome

Cited by 196 publications

References 27 publications

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

EMG vs. Thermography in Severe Carpal Tunnel Syndrome

Low-level laser in the treatment of carpal tunnel syndrome: clinical, electrophysiological, and ultrasonographical evaluation

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