Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome-A Systematic Review.
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ABSTRACT:
SUBMITTER: Osiak K
PROVIDER: S-EPMC8235020 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
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Electrodiagnostic Studies in the Surgical Treatment of Carpal Tunnel Syndrome-A Systematic Review.
Osiak Katarzyna K Mazurek Agata A Pękala Przemysław P Koziej Mateusz M Walocha Jerzy A JA Pasternak Artur A
Journal of clinical medicine 20210618 12
The aim of our paper was to provide comprehensive data on the role of electrodiagnostic (EDX) studies in the surgical treatment of carpal tunnel syndrome (CTS). An extensive search was conducted through the major electronic database to identify eligible articles. Data extracted included grade of CTS based on neurophysiological testing, preoperative data of EDX studies, time of complete or partial resolution after surgery, postoperative Boston carpal tunnel questionnaire (CTQ) scores, age, sex, i ...[more]
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Project description:This systematic review with meta-analysis compared the diagnostic accuracy of neuromuscular ultrasound (NMUS) and electrodiagnostic studies (EDX) as confirmatory tests for carpal tunnel syndrome (CTS) diagnosis. We used bivariate random-effects models to estimate pooled sensitivity and specificity and generate hierarchical summary receiver-operating characteristic curves to assess diagnostic test accuracy. Nine paired accuracy studies were included, representing 1751 hands (743 clinically diagnosed CTS; 1008 without CTS) that underwent NMUS and EDX. Compared to the clinical diagnosis reference standard, the pooled sensitivity was 86.4% for NMUS and 91.6% for EDX. Pooled specificity was 79.3% for NMUS and 81.9% for EDX. The positive likelihood ratios were 4.2 and 5.1 for NMUS and EDX, respectively, and the negative likelihood ratios were 0.17 and 0.10, respectively. The diagnostic odds ratio was 24 for NMUS and 49 for EDX. No statistically significant differences were identified between NMUS and EDX for sensitivity, specificity, or overall diagnostic accuracy. Overall, the diagnostic accuracy of NMUS is similar to that of EDX for CTS diagnosis, with high sensitivity and moderate specificity for each. The choice between these confirmatory diagnostic tests should incorporate shared decision-making between patients and providers that weighs diagnostic accuracy as well as factors such as patient preferences, test availability, cost, and tolerability.
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Project description:BackgroundCarpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare the efficacy of surgical treatment of carpal tunnel syndrome with conservative treatment.MethodsWe included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010), MEDLINE (1980 to June 2010), EMBASE (1980 to June 2010), PEDro (searched in June 2010), international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR) and 95% confidence intervals for electrophysiological studies and complication were also calculated.ResultsWe assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47) and symptom severity 0.43 (95% CI 0.29, 0.57). There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months (0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56). The RR for secondary outcomes of normal nerve conduction studies was 2.3 (95% CI 1.2, 4.4), while RR was 2.03 (95% CI 1.28 to 3.22) for complication, both favoring surgery.ConclusionBoth surgical and conservative interventions had treatment benefit in carpal tunnel syndrome. Surgical treatment has a superior benefit, in symptoms and function, at six and twelve months. Patient underwent surgical release were two times more likely to have normal nerve conduction studies but also had complication and side effects as well. Given the treatment differential and potential for adverse effects and that conservative interventions benefitted a substantial proportion of patients, current practice of a trial of conservative management with surgical release for severe or persistent symptoms is supported by evidence.
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Project description:PurposeGiven the lack of a reference standard diagnostic tool for carpal tunnel syndrome (CTS), we conducted a population-level analysis of patients undergoing carpal tunnel release to characterize the utilization of preoperative electrodiagnostic studies (EDS). Secondarily, we sought to determine the impact of EDS utilization on timeliness of surgery, number of preoperative physician visits, and costs.MethodsThe 2009-2013 Truven MarketScan databases were used to identify a national cohort of adult patients undergoing carpal tunnel release. Three multivariable regression models were designed to evaluate the relationship between preoperative EDS use and timing of surgical release, the number of preoperative physician visits, and total costs for CTS-related visits, while controlling for sociodemographic variables, insurance type, comorbid conditions, and treatment characteristics.ResultsThe final study cohort included 62,894 patients who underwent carpal tunnel release, of whom 58% had preoperative EDS. Patients undergoing EDS waited 36% longer for surgical release than patients without EDS. The mean time between diagnosis and surgery was predicted to be 183 days for patients who underwent preoperative EDS and 135 days for patients who did not. Patients having EDS experienced 1 additional visit, $996 greater total costs, and $112 additional out-of-pocket costs on average. Occupational therapy consultation and steroid injection were also associated with increased time to surgery, but with one-fourth and one-third the added cost of EDS, respectively.ConclusionsOn the basis of national practice trends, providers do not consistently agree with the practice of performing EDS before carpal tunnel release. Given the uncertain utility of routine EDS before carpal tunnel release and its association with delays to surgery and increased costs, further evaluation of EDS in relation to patient preferences and value of care is warranted.Type of study/level of evidencePrognostic II.
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Project description:BackgroundCarpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disease. Either surgical or conservative intervention for CTS patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical efficacy, safety, and cost of surgical versus nonsurgical intervention.MethodsThe eligible studies were acquired from PubMed, Medline, Embase, Web of Science, Google, and Cochrane Library. The data were extracted by 2 of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias.ResultsThirteen studies including 9 randomized controlled trials (RCTs) and 4 observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The difference of clinical efficacy was statistically significant between surgical and nonsurgical intervention, and nonsurgical treatment was more effective (OR = 2.35, 95%CI = 1.18-4.67, P = 0.01). Meanwhile, different results were discovered by subgroup analysis. The pooled results of function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care at different follow-up times showed that the differences were not statistically significant between the 2 interventions. The difference of complications and side-effects was statistically significant and conservative treatment achieved better result than surgery (OR = 2.03, 95%CI = 1.28-3.22, P = 0.003). Sensitivity analysis proved the stability of the pooled results.ConclusionBoth surgical and conservative interventions had benefits in CTS. Nonsurgical treatment was more effective and safety than surgical treatment, but there were no significant differences in function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care. Nonsurgical treatment is recommended as the optical choice for CTS. If conservative treatment fails, surgical release can be taken.
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Project description:BackgroundThis systematic review program is designed to provide an assessment of the effectiveness and safety of needle-knife therapy for the treatment of carpal tunnel syndrome (CTS).MethodsA cumulative search till October 2018 will be conducted in the following 8 databases: PubMed, EMBASE, Cochrane Controlled Trials Register, MEDLINE, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, and Wanfang Database, with no language or Publication status restrictions. All randomized controlled trials (RCT) for carpal tunnel syndrome will be considered eligible. The primary outcomes will include changes in the Boston carpal tunnel questionnaire (BCTQ) and visual analogue score (VAS), as well as safety and adverse events. Study inclusion, data extraction, and quality assessment will be done independently by 2 reviewers. If no substantial heterogeneity is detected, a meta-analysis will be performed. Continuous results will be expressed as mean differences or standard average differences, while binary data will be expressed as relative risks. The deviation risk and data synthesis will be assessed using the Review Manager software.ResultsThis study will provide a high-quality synthesis of BCTQ and VAS to assess the effectiveness and safety of acupotomy for carpal tunnel syndrome patients.ConclusionThis systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with carpal tunnel syndrome.Prospero registration numberCRD42018108787.
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