Lingua/Sprache/Language          -   letztes update 17 May 2013

Multiparametrische Beurteilung der konservativen Therapie des Karpaltunnel-Syndroms mit einem neuen Splint-Modell

Authoren: N.Paciello, L.Padua, I.Aprile, R.Padua, P.Tonali

Eine der konservativen Therapien des KarpaltunnelSyndroms besteht in der Benutzung eines „Splint" (Handgelenkorthese). Die Splints wirken durch die Verringerung der Flexions- und Extensionsbewegungen und dadurch, dass das Handgelenk in einer solchen Position gehalten wird, dass der Druck im Karpaltunnel so weit wie möglich verringert wird. Das Ziel unserer Studie war es, die tatsächliche therapeutische Wirksamkeit eines neuen Splint-Modells zu prüfen (POLICARPAL), das aus halbstarrem Material besteht und so ausgelegt ist, dass die Funktionstüchtigkeit der Hand nur geringfügig eingeschränkt wird, um die Daumenbewegung und die Fingerbeugung noch zu ermöglichen. Die Studie wurde unter Benutzung eines multiparametrischen Protokolls ausgeführt, das von der „Italienischen Studiengruppe des KarpaltunnelSyndroms" angewendet worden ist. Die Beurteilung vor und nach der Anwendung des Spints wurde wie folgt beurteilt: Boston Questionnaire; klinische Beurteilung mit klinisch-anamnestischer Skala; neurophysiologische Beurteilung (aufgrund der Richtlinien von AAEM) und eine neue, von uns entwickelte neurophysiologische Klassifizierung. Die Studie betraf nacheinander 30 Patienten, die unter einem Karpaltunnel-Syndron „minimalen“, „leichten“ und „mittelschweren” neurophysiologischen Grades litten. In diesen Fällen hat die multidimensionale und multiparametrische Beurteilung, die für unsere Arbeit benutzt wurde, eine Verbesserung sowohl der objektiven Parameter (Nervenleitung) als auch der subjektiven Parameter (Parästhesie und Schmerz) erwiesen. Institut für Neurologie, Institut für Orthopädie, Università Cattolica Sacro Cuore- Rom. Neurological Sciences, Supplement to Number 6, Vol. 19, 1998.
14°Fortbildungskurs der Italienische Gesellschaft für Neurologie.

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Syndrome du Canal Carpien: the cause dictates the treatment.

Authoren: Carneiro RS.

Department of Plastic Surgery, Cleveland Clinic, Florida, USA.
Mild carpal tunnel syndrome should be conservatively treated and severe carpal tunnel syndrome usually requires surgery; however, management of moderate carpal tunnel syndrome is more complex. Usually, the treatment is dictated by the cause, which may be occupational injury, acute trauma, systemic disease such as diabetes, hypothyroidism, or rheumatoid arthritis, or other causes.
Cleve Clin J Med 1999 Mar;66(3):159-64. PMID: 10079585 [PubMed- indexed for Medline].

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Neutral wrist splinting in syndrome du canal carpien: a comparison of night-only versus full-time wear instructions.

Authoren: Walker WC, Metzler M, Cifu DX, Swartz Z.

Department of Physical Medicine and Rehabilitation, Medical College of Virginia at Virginia Commonwealth University, Richmond, USA.
Obiective: to compare the effects of night-only to full-time splint wear instructions on symptoms, function and impairment in carpal tunnel syndrome (CTS).
Subjects: outpatients with untreated CTS were consecutively recruited from our electrodiagnostics lab. Twenty-one patients (30 hands) were enrolled, and 17 patients (24 hands) completed the study. Interventions: thermoplastic, custom-molded, neutral wrist splints with subjects receiving either full-time or night-only wear instructions. Outcome measures: symptoms and functional deficits were measured by Levine's self-administered questionnaire, and physiologic impairment was measured by median nerve sensory and motor distal latency. Compliance and crossover: almost all (92) of the combined sample reported frequent splint use, but their adherence to specific wearing instructions was limited. A majority (73%) of the full-time group reported splint wear less than one half of waking hours, and some (23%) of the night-only group reported occasional daytime wear. Despite this tendency for treatment crossover, the two treatment groups differed in daytime wear as intended (chi2 analysis, p=.004). Results: subjects receiving full-time wear instructions showed superior distal latency improvement, both motor (.35 vs -.07 msec, p=.04) and sensory (.46 vs .13 msec, p=0.5) when compared with subiects receiving night-only wear instructions. Conclusions: this study provides added scientific evidence to support the efficacy of neutral wrist splint in CTS and suggests that physiologic improvement is bet with full-time splint wear instructions.
Arch Phy Med Rehabil. 2000 Apr:81(4);424-9.
PMID: 10768530 [PubMed -indexed for Medline].

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Splinting for symptoms of carpal tunnel syndrome during pregnancy.

Authoren: Courts RB

Occupational Therapy Clinic, darnall Army Community Hospital, Fort Hood Texas, USA.
Objective: to determine whether splints are effective in decreasing symptoms of carpal tunnel syndrome during pregnancy.
Methods: case series at a military hospital of 82 pregnant women who had symptoms of carpal tunnel syndrome (135 hands). The author compared the ratings of eight subjective symptoms and grip and pinch strengths at the time of referral and 1 week after splinting (polyform volar splint with the wrist in 10 to 15 degrees of extension). Forty-eight women (82 hands) returned 1 month postpartum for reassessment. Grip and pinch strengths of an additional 26 women who had not had problems with their hands during pregnancy were measured 1 month postpartum.
Results: one week after splinting, there was an average increase of 5.4 pounds in grip strength and over 1 pound in each type of pinch strength (p<0.0001). there was a decrease in each of the eight symptoms (range, -0.9 to -1.6; scale of 5).
At 1 month postpartum, symptoms had resolved completely for 76% of the subjects. Strength was improved, but was not normal. However, the women who had not had hand problems during pregnancy did have normal stregths.
Conclusions: splinting is a noninvasive method for helping to decrease the uncomfortable symptoms of carpal tunnel syndrome during pregnancy.
J. Hand Ther 1995 Jan-Mar;8(1):31-4.
PMID: 7742893 [PubMed - indexed for Medline].

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Prevalence of carpal tunnel syndrome and upper extremity tendonitis among dental hygienists.

Authoren: Werner RA, Hamann C, Franzblau A, Rodgers PA.

Ann Arbor VA Medical Center, University of Michigan, USA.
Purpose: this study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper extrmity (UE) tendonitis among dental hygienists.
Methods: in a cross-sectional study dental hygienists (n=305) were screened using sensory nerve conduction, a focused physical examination of the UE, and a symptom questionnaire. CTS was diagnosed if the subject had slowing of the median nerve at the wrist and symptoms of numbness, tingling of pain in the median distribution. Localized tendonitis of the UE was diagnosed if the subject had focal symptoms and associated findings on physical examination. Results: three percent of the participating dental hygienists were diagnosed with CTS. Thirteen were diagnosed with shoulder tendonitis, while 6% had a tendonitis of the elbow and 7% had tendonitis of the hand or wrist. Twenty-eight percent had a giagnosis of some UE tendonitis or CTS. Conclusions: the prevalence of handand finger sympotms in the dominant hand among dental hygienists in this study was high, but the prevalence CTS was nearly the same as the general population. There was a high rate of US tendonitis noted within this population.
PMID: 12078576 [PubMed - indexed for Medline].

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Prevalence and risk factors of tendinitis and related disorders of the distal upper extremity among U.S. workers: comparison to carpal tunnel syndrome.

Authoren: Tanaka S, Petersen M, Cameron L.

Division of Surveillance, Hazard Evaluations. and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Public Health Service, Cincinnati, Ohio 45226, USA.
Background: national estimates of tendinitis and related disorders of the distal upper extremity among U.S. workers have not been available with the exception of carpal tunnel syndrome. Methods: the Occupational Health Supplement Data of the 1988 National Health Interview Survey were analyzed for tendinitis and related disorders of the hand/wrist and elbow (distal upper extremity) using the Survey Data Analysis (SUDAAN) software. Results: among the 30,074 respondents (statistically weighted population of 127 milion) who had worked anytime during the previous 12 months, 0.46% (95% CI: 0.36, 0.56) reported that they experienced a "prolonged" hand discomfort which was called tendinitis, synovitis, tenosynovitis, deQuervain's disease, epicondylitis, ganglion cyst, or trigger finger, by a medical person. This corresponds to 588,000 persons (95% CI: 457,000; 712,000) reporting one of these disorders, 28% (or 164,000) of which were thought to be work-related by the medical person. Among various risk factors examined by multiple logistic regression analysis, bending/twisting of the hand/wrists at work and female gender were significantly associated with reporting of these disorders.
Conclusions: by combining these cases with the previously reported cases of work-related carpal tunnel syndrome, we estimate that there were approximately 520,000 cases of work-related musculoskeletal disorders of the distal upper extremity among US workers in 1988.
PMID:11241566 [PubMed- indexed for Medline].

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Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review.

Authoren: Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC.

Scool of Rehabilitation Science, McMaster University, Hamilton Ontario, Ontario, Canada.
The purpose of this study was to determine the effectiveness of hand therapy interventions for carpal tunnel syndrome (CTS) based on the best available evidence. A qualitative systematic review was conducted. A literature search using 40 key terms was condected from the earliest available date to january 2003 using seven databases. Articles were randomly assignes to two of five reviewers and evaluated according to predetermined criteria for inclusion at each of the title, abstract, and article levels. included studies were independently scored by two reviewers using a structured effectiveness quality evaluation scale and also graded according to Sackett's Levels of Evidence. There were 2027 articles identified from the literature search, of which 345 met the inclusion criteria. Twenty-four studies were used to formulate 30 recommendations. Current evidence demonstrates a significant benefit (grade B recommendations) from splinting, ultrasound, nerve gliding exercises, carpal bone mobilization, magnetic therapy, and yoga for people with carpal tunnel syndrome.
J Hand Ther. 2004 Apr-Jun; 17(2):210-28.
[PubMed-indexed for MEDLINE]

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Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome.

Authoren: Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, Milcan A.

Department of Neurology, Faculty of Medicine, Mersin University, Noroloji Anabilim Dali, 33070 Mersin, Turkey. serhansevim@mail.koc.net
To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiological evidence were included in a prospective, randomizes blinded trial: 60 patients were instructed to wear splints every night, 30 received injection of betametasone 4 cm proximal to the carpal tunnel , and 30 received injiction distal to the carpal tunnel. After approximately 1 year (mean, 11 months;range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptoms an performed detailde electrophusiological examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the lomg-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroid were ineffective on the basis of both clinical symptoms and electrophysiological findings.
Neurol Sci. 2004 Jun;25(2):48-52.
PMID: 15221621 [PubMed-indexed for MEDLINE]

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