15 research outputs found
Surgical versus non-surgical treatment for carpal tunnel syndrome
Background
Carpal tunnel syndrome results from entrapment of the median nerve in the wrist. Common symptoms are tingling, numbness, and
pain in the hand that may radiate to the forearm or shoulder. Most symptomatic cases are treated non-surgically.
Objectives
The objective is to compare the efficacy of surgical treatment of carpal tunnel syndrome with non-surgical treatment.
Search strategy
We searched the Cochrane Neuromuscular Disease Group Trials Register (January 2008), MEDLINE (January 1966 to January 2008),
EMBASE (January 1980 to January 2008) and LILACS (January 1982 to January 2008). We checked bibliographies in papers and
contacted authors for information about other published or unpublished studies.
Selection criteria
We included all randomised and quasi-randomised controlled trials comparing any surgical and any non-surgical therapies.
Data collection and analysis
Two authors independently assessed the eligibility of the trials.
Main results
In this update we found four randomised controlled trials involving 317 participants in total. Three of them including 295 participants,
148 allocated to surgery and 147 to non-surgical treatment reported information on our primary outcome (improvement at three
months of follow-up). The pooled estimate favoured surgery (RR 1.23, 95% CI 1.04 to 1.46). Two trials including 245 participants
described outcome at six month follow-up, also favouring surgery (RR 1.19, 95% CI 1.02 to 1.39).
Two trials reported clinical improvement at one year follow-up. They included 198 patients favouring surgery (RR 1.27, 95% CI 1.05
to 1.53). The only trial describing changes in neurophysiological parameters in both groups also favoured surgery (RR 1.44, 95% CI
1.05 to 1.97). Two trials described need for surgery during follow-up, including 198 patients. The pooled estimate for this outcome indicates that a significant proportion of people treated medically will require surgery while the risk of re-operation in surgically treated
people is low (RR 0.04 favouring surgery, 95% CI 0.01 to 0.17). Complications of surgery and medical treatment were described
by two trials with 226 participants. Although the incidence of complications was high in both groups, they were significantly more
common in the surgical arm (RR 1.38, 95% CI 1.08 to 1.76)
Sensory dysfunction in HTLV-I-associated myelopathy/tropical spastic paraparesis
We performed a comprehensive clinical and neurophysiological evaluation of function of the large- and small-caliber afferent pathways in 29 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Sensory symptoms, particularly cutaneous paresthesias, were present in 11 (37.9%) patients. On examination, a mild distal impairment of vibration and sense of position were found in 14 (48.2%) and 5 (17.2%) patients, respectively. Ten (34.4%) patients had distal tactile hypoesthesia and 7 (24.1%) presented pinprick hypoesthesia. Quantitative somatosensory thermotest showed cold hypoesthesia in 58.6% of patients. Nerve conduction studies and electromyography were normal. Tibial somatosensory evoked potentials were abnormal in 88.5% of patients. All of the sensory abnormalities found were restricted to sensations carried by myelinated (A-beta and A-delta) fibers. Unmyelinated C fibers mediating warm sensation and thermal pain appeared unimpaired. Our findings indicat
Retrovirus HTLV-1 en Chile: estudio en 140 enfermos neurolĂłgicos
We screened 140 patients with different neurological diseases for the presence of anti HTLV-1 virus antibodies. ELISA test confirmed with Western Blot analysis was performed in CSF and blood. Positive findings were obtained in 23 out of 52 patients with progressive spastic paraparesis (44%). All patients with multiple sclerosis, polymyositis, amyotrophic lateral sclerosis or chronic polyneuropathy were negative. Patients with progressive spastic paraparesis and positive HTLV-1 antibodies were most commonly women (78%) and middle aged (mean 46 years old), with a history of surgical interventions (70%) or blood transfusion (35%). A slowly progressive spastic paraparesis with asymmetric onset and minimal sensory complaints was observed in some cases. Mononuclear pleocytosis in the CSF was observed in 35% with an increased IgG index in 88%. A delayed latency and low amplitude of somatosensory evoked potentials was observed in 89% of patients