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Vol. 53, No. 7, July 2007, pp.1186 - 1190
Copyright © 2007 by The College of Family Physicians of Canada
Research |
Treatments for carpal tunnel syndrome
Who does what, when ... and why?
Regina M. Taylor-Gjevre, MD MSc FRCPC, John A. Gjevre, MD FRCPC, Lannae Strueby, Carol A.J. Boyle, MD FRCPC, Bindu Nair, MD FRCPC and John T. Sibley, MD FRCPCDrs Taylor-Gjevre, Gjevre, Boyle, Nair, and Sibley are on staff in the Department of Medicine in the Royal University Hospital at the University of Saskatchewan in Saskatoon. Ms Strueby is a medical student at the University of Saskatchewan
Correspondence to: Dr R.M. Taylor-Gjevre, Division of Rheumatology, Department of Medicine, Royal University Hospital, 103 Hospital Dr, Saskatoon, SK S7N 0W8; telephone 306 966-8271; fax 306 966-8371; e-mailr.gjevre{at}usask.ca
OBJECTIVE To determine how frequently treatments had been offered to patients with suspected diagnoses of carpal tunnel syndrome (CTS) who had been referred for confirmatory nerve conduction studies (NCSs) and to identify potential predictors of such treatment. A follow-up survey was conducted to determine the effect of NCS results on subsequent treatment.
DESIGN Self-administered survey questionnaire and follow-up telephone survey.
SETTING Royal University Hospital at the University of Saskatchewan in Saskatoon.
PARTICIPANTS Two hundred eleven patients with clinically suspected CTS who had been referred for confirmatory NCS.
MAIN OUTCOME MEASURES Results of NCSs, number of patients prescribed wrist splints or nonsteroidal anti-inflammatory drugs (NSAIDs) before and after NCSs, patient characteristics associated with being prescribed therapy, and reporting benefit of therapy.
RESULTS Nerve conduction studies confirmed CTS in 121 (57.3%) of the 211 study patients. Before NCSs, wrist splints and NSAIDs had been prescribed to 33.2% and 38.8% of patients, respectively. Splints and NSAIDs were reported to alleviate symptoms by 78.3% and 74% of patients, respectively, who received such treatments. No significant differences in age, sex, body mass index, symptom duration, symptom or function scores, or subsequent NCS results were noted between patients who were and were not prescribed these therapies or between those who did or did not report improvement in symptoms. Results of the follow-up survey indicated that the number of recommendations for splints and NSAIDs had doubled after NCSs were completed and that surgical intervention had been at least discussed in most cases. Treatment recommendations, including surgery, however, were not associated with identifiable patient factors, including patients’ NCS results.
CONCLUSION Some patients were prescribed conservative treatments before NCSs. Following NCSs, prescriptions for wrist splints or NSAIDs approximately doubled. Interestingly, NCS results did not appear to influence subsequent therapeutic decision-making for either conservative treatment or surgical options. We think these findings suggest a lack of confidence in electrodiagnostic study results. It would be interesting to evaluate a larger population of primary care patients prospectively to examine further the use of NCSs in current clinical decision-making.
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  I. Sestak, F. Sapunar, and J. Cuzick Aromatase Inhibitor-Induced Carpal Tunnel Syndrome: Results From the ATAC Trial J. Clin. Oncol., October 20, 2009; 27(30): 4961 - 4965. [Abstract] [Full Text] [PDF]
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 H. S. Gong, G. H. Baek, J. H. Oh, Y. H. Lee, S. H. Jeon, and M. S. Chung Factors Affecting Willingness to Undergo Carpal Tunnel Release J. Bone Joint Surg. Am., September 1, 2009; 91(9): 2130 - 2136. [Abstract] [Full Text] [PDF]
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